Exam 1
12. The patient states that he is 14 trillion years old and created the world. The nurse documents this statement as an example of which type of thinking displayed by the patient? A) Delusional thinking B) Ideas of reference C) Word salad D) Hallucination
Ans: A Feedback: A delusion is a fixed false belief not based in reality. Ideas of reference are client's inaccurate interpretation that general events are personally directed to him or her, such as hearing a speech on the news and believing the message had personal meaning. Word salad is flow of unconnected words that convey no meaning to the listener. Hallucinations are false sensory perceptions or perceptual experiences that do not really exist.
5. Which one of the following statements about the roles that biologic makeup plays in a client's emotional responses is most accurate? A) Biologic differences can affect a client's response to treatment with psychotropic drugs. B) Biologic differences do not affect a client's response to treatment with psychotropic drugs. C) Heredity and biologic factors are under voluntary control. D) Persons cannot change their health status and improve the ability to cope.
Ans: A Feedback: Biologic differences can affect a client's response to treatment with psychotropic drugs. Heredity and biologic factors are not under voluntary control. Persons can change their health status and improve their ability to cope.
Which of the following medications rarely causes extrapyramidal side effects (EPS)? A) Ziprasidone (Geodon) B) Chlorpromazine (Thorazine) C) Haloperidol (Haldol) D) Fluphenazine (Prolixin)
Ans: A Feedback: First-generation antipsychotic drugs cause a greater incidence of EPS than do atypical antipsychotic drugs, with ziprasidone (Geodon) rarely causing EPS. Thorazine, Haldol, and Prolixin are all first-generation antipsychotic drugs.
4. Genetics have been shown to play which of the following roles in a person's mental and emotional health? A) Several mental disorders appear to run in families. B) Specific genes have been linked to certain mental disorders. C) Biologic factors can be modified to change the influence on emotional health. D) Psychiatric treatment is effective regardless of an individual's biologic influences.
Ans: A Feedback: Heredity and biologic factors are not under voluntary control. We cannot change these factors. Research has identified genetic links to several disorders. Although specific genetic links have not been identified for several mental disorders (e.g., bipolar disorder, major depression, and alcoholism), research has shown that these disorders tend to appear more frequently in families. Genetic makeup tremendously influences a person's response to illness and perhaps even to treatment.
16. The client spoke of a current event in the national news and described it as it relates to the client. Then the client spoke of a historical event and described it as it relates to the client. Which of the following questions might the nurse ask to determine if the client is experiencing ideas of reference? A) "Where were you when this happened?" B) "Why do you think that?" C) "Are you sure?" D) "That is unbelievable!"
Ans: A Feedback: Ideas of reference are the client's inaccurate interpretation that general evens are personally directed to him or her, such as hearing a speech on the news and believing the message had personal meaning. "Where were you when this happened," would relate to the place and might give the nurse more information to validate the client's previous comments. "Why do you think that," may be interpreted as the nurse challenging the client. "Are you sure," is a closed-ended question and does not encourage the client to elaborate. "That is unbelievable," is a statement rather than a question and could be interpreted as the nurse's opinion of the information provided by the client.
15. A patient reported to the nurse that on his way to the clinic, a policeman in a patrol car turned on his lights and pulled him over. When asked what he did next, the patient stated, "I pulled over, of course." Which of the following was the nurse trying to assess? A) The client's judgment B) The client's insight C) The client's concentration D) The client's self-concept
Ans: A Feedback: Judgment refers to the ability to interpret one's environment and situation correctly and to adapt one's behavior and decisions accordingly. Insight is the ability to understand the true nature of one's situation and accept some personal responsibility. Self-concept is the way one views oneself in terms of personal worth and dignity. The nurse assesses the client's ability to concentrate by asking the client to perform certain cognitive tasks. To assess a client's self-concept, the nurse can ask the client to describe himself or herself and what characteristics he or she likes and what he or she would change.
Which of the following is a neuromodulator? A) Neuropeptides B) Glutamate C) Dopamine D) GABA
Ans: A Feedback: Neuropeptides are neuromodulators. Glutamate and dopamine are excitatory neurotransmitters. GABA is an inhibitory neurotransmitter.
A patient is being seen in the crisis unit reporting that poison letters are coming in the mail. The patient has no history of psychiatric illness. Which of the following medications would the patient most likely be started on? A) Aripiprazole (Abilify) B) Risperidone (Risperdal Consta) C) Fluphenazine (Prolixin) D) Fluoxetine (Prozac)
Ans: A Feedback: New-generation antipsychotics are preferred over conventional antipsychotics because they control symptoms without some of the side effects. Injectable antipsychotics, such as Risperdal Consta, are indicated after the client's condition is stabilized with oral doses of these medications. Prozac is an antidepressant and is not indicated to relieve of psychotic symptoms.
When teaching a client about restrictions for tranylcypromine (Parnate), the nurse will tell the client to avoid which of the following foods? A) Broad beans B) Citrus fruit C) Egg products D) Fried foods
Ans: A Feedback: Parnate is a monoamine oxidase inhibitor; clients must avoid tyramine, and broad beans contain tyramine. Answers citrus fruit, egg products, and fried foods are not tyramine- containing foods.
3. Which one of the following statements is most accurate regarding the age at onset of a mental illness such as schizophrenia? A) Persons who are diagnosed at a younger age will more likely have a poorer outcome. B) Persons who are diagnosed at a younger age will more likely have a better outcome. C) Age at diagnosis is not related to outcomes. D) Younger clients have more experiences that will help them.
Ans: A Feedback: Persons who are diagnosed with schizophrenia at a younger age at onset have poorer outcomes, such as more negative signs and less effective coping skills, than do people with a later age at onset. A possible reason for this difference is that younger clients have not had experiences of successful independent living or the opportunity to work and be self-sufficient and have a less well-developed sense of personal identity than older clients.
19. Which of the following situations would most likely provide social support to a client? A) A friend who will share his or her perspective on an issue B) The transportation service that provides access to daily rehabilitation services C) Fellow teammates participating in a community softball league D) The teacher assisting a client to obtain a GED
Ans: A Feedback: Social support is emotional sustenance that comes from friends, family members, and even health-care providers who help a person when a problem arises. It is different from social contact, which does not always provide emotional support. An example of social contact is the friendly talk that goes on at parties.
27. The client tells the nurse, "That new TV anchor is telling the world about me." This is an example of A) ideas of reference. B) persecutory delusions. C) thought broadcasting. D) thought insertion.
Ans: A Feedback: The client's inaccurate interpretation that general events are personally directed to him or her is an example of ideas of reference. Persecutory delusions involve the client's belief that "others" are planning to harm the client. Thought broadcasting is a delusional belief that others can hear or know what the client is thinking. Thought insertion is a delusional belief that others are putting ideas or thoughts into the client's head.
4. A client is being evaluated for dementia. The nurse knows that a client who is able to complete very few tasks is most likely to have A) a greater cognitive deficit. B) A less precise mental status exam. C) more potential for agitation. D) no bearing on mental status.
Ans: A Feedback: The fewer tasks the client competes accurately, the greater the cognitive deficit. The other choices are not true.
The nurse is assessing a patient suffering a head injury as a result of an altercation with two other individuals. The patient has difficulty accurately reporting the events of the altercation and appears very emotional during the assessment. The nurse suspects which part of the brain received the greatest amount of injury? A) Cerebrum B) Cerebellum C) Medulla D) Amygdala
Ans: A Feedback: The frontal lobes of the cerebrum control the organization of thought, body movement, memories, emotions, and moral behavior. The cerebellum is located below the cerebrum and is the center for coordination of movements and postural adjustments. The medulla, located at the top of the spinal cord, contains vital centers for respiration and cardiovascular functions. The hippocampus and amygdala are involved in emotional arousal and memory.
7. The nurse asks a patient to list the days of the week in reverse order. The nurse is assessing which of the following? A) Concentration B) Memory C) Orientation D) Abstract thinking
Ans: A Feedback: The nurse assesses the client's ability to concentrate by asking the client to perform certain tasks such as repeating the days of the week backward. The nurse directly assesses memory, both recent and remote, by asking questions with verifiable answers. Orientation refers to the client's recognition of person, place, and time. Abstract thinking is to making associations or interpretations about a situation or comment.
18. The nurse asks the client, "What is similar about a cow and a horse?" and "What do a bus and an airplane have in common?" These questions would best assess which of the following areas? A) Intellectual function B) Insight C) Judgment D) Memory
Ans: A Feedback: These questions would elicit information about the client's intellectual function. Insight is the ability to understand the true nature of one's situation and accept some personal responsibility for that situation. Judgment refers to the ability to interpret one's environment and situation correctly and to adapt one's behavior and decisions accordingly. Questions about memory would require that the client identify knowledge of past events.
32. Sexuality and self-harm behaviors are often difficult areas for nurses to assess. An effective way for nurses to deal with this discomfort includes A) recognizing that these areas may also be uncomfortable for the patient to discuss. B) share feelings of discomfort with the patient. C) defer assessing these areas to a more experienced nurse. D) develop a standard question to ask of all patients during this area of assessment
Ans: A Feedback: Two areas that may be uncomfortable or difficult for the nurse to assess are sexuality and self-harm behaviors. The beginning nurse may feel uncomfortable, as if prying into personal matters, when asking questions about a client's intimate relationships and behavior and any self-harm behaviors or thoughts of suicide. Asking such questions, however, is essential to obtaining a thorough and complete assessment. The nurse needs to remember that it may be uncomfortable for the client to discuss these topics as well.
28. During the admission assessment, the nurse asks the client, "How are you feeling?" The client responds, "I was able to purchase gas for 7 cents a gallon less than yesterday, which saved me a total of 84 cents. My car has a 12-gallon gas tank. Usually I am able to put in 11.7 gallons. I am very happy to have saved so much money." The nurse recognizes this response as which of the following? A) Circumstantial thinking B) Echolalia C) Flight of ideas D) Neologisms
Ans: A Feedback: With circumstantial thinking, the client eventually answers a question but only after giving excessive unnecessary detail. Echolalia is repetition or imitation of what someone else says. Flight of ideas is excessive amount and rate of speech composed of fragmented or unrelated ideas. Neologisms are invented words that have meaning only for the client.
7. The nurse is preparing to administer PRN medication to a client of a Japanese descent who is anxious. The prescription reads, ìAlprazolam (Xanax) 0.25 to 1.0 mg PO PRN.î The best dose for the nurse to give initially is A) 0.25 mg. B) 0.5 mg. C) 0.75 mg. D) 1.0 mg
Ans: A Feedback: In general, nonwhites treated with Western dosing protocols have higher serum levels per dose and suffer more side effects. Persons of Asian descent often metabolize drugs more slowly, requiring lower doses to produce therapeutic effects.
8. A client's prognosis is said to be good due to a high degree of self-efficacy. Which of the following is evidence of a high degree of self-efficacy? A) The client is self-motivated and asks for help when needed. B) The client is able to resist illness when under stress. C) The client responds well in stressful situations. D) The client uses good problem-solving abilities.
Ans: A Feedback: People with high self-efficacy set personal goals, are self-motivated, cope effectively with stress, and request support from others when needed. Hardiness is the ability to resist illness when under stress. Resilience is defined as having healthy responses to stressful circumstances or risky situations. Resourcefulness involves using problem- solving abilities and believing that one can cope with adverse or novel situations.
20. A holistic plan of recovery would be especially important to a client from which of the following cultural groups? A) American Indian B) African American C) Mexican American D) Arab American
Ans: A Feedback: The American Indians' concept of health is holistic and wellness oriented. African Americans and Mexican Americans value feelings of well-being, ability to fulfill role expectations, and being free of pain or excess stress. Arab Americans view health as a gift of God manifested by eating well, meeting social obligations, being in a good mood, and having no stressors or pain.
1. When assessing a patient's mental health status, which of the following describe the purpose of the psychosocial assessment? Select all that apply. A) To assess the client's current emotional state B) To assess the client's mental capacity C) To assess the client's behavioral function D) To assess the client's plan of care E) To assess the client's physical health status
Ans: A, B, C Feedback: The purpose of the psychosocial assessment is to construct a picture of the client's current emotional state, mental capacity, and behavioral function. This assessment serves as the basis for developing a plan of care to meet the client's needs. The client's physical health status would need to be completed as another assessment or an extended assessment.
21. Which of the following are the types of roles that are usually included when assessing roles and relationships? Select all that apply. A) Family B) Hobbies C) Occupation D) Activities E) Race F) Ethnicity
Ans: A, B, C, D Feedback: The number and type of roles may vary, but they usually include family, occupation, and hobbies or activities.
Which of the following disorders are extrapyramidal symptoms that may be caused by antipsychotic drugs? Select all that apply. A) Akathisia B) Pseudoparkinsonism C) Neuroleptic malignant syndrome D) Dystonia E) Anticholinergic effects F) Breast tenderness in men and women
Ans: A, B, D Feedback: Extrapyramidal symptoms include dystonia, pseudoparkinsonism, and akathisia. Neuroleptic malignant syndrome is also a side effect of antipsychotic drugs but is an idiosyncratic reaction to an antipsychotic drug, not an extrapyramidal symptom. Breast tenderness in men and women is also a potential side effect of antipsychotic drugs that cause elevated prolactin levels, but it is not an extrapyramidal symptom.
14. Which of the following statements about spirituality are true? Select all that apply. A) Many clients with mental disorders have disturbing religious delusions. B) Religious activities have been shown to be linked with better health and a sense of well-being. C) Spirituality only involves religion. D) Hope and faith are two critical factors in psychiatric and physical rehabilitation. E) Spirituality may include a relationship with the environment.
Ans: A, B, D, E Feedback: Many clients with mental disorders have disturbing religious delusions. Religious activities have been shown to be linked with better health and a sense of well-being. Spirituality involves the essence of a person's being and his or her beliefs about the meaning of life and the purpose for living. It may include belief in God or a higher power, the practice of religion, cultural beliefs and practices, and a relationship with the environment. Hope and faith are two critical factors in psychiatric and physical rehabilitation.
20. The nurse plans to assess a patient's self-concept in the admission assessment knowing that self-concept influences which of the following? Select all that apply. A) Body image B) Cognitive processing C) Frequently experienced emotions D) Coping strategies E) Responsiveness to medications
Ans: A, C, D Feedback: Self-concept is the way one views oneself in terms of personal worth and dignity. The client's description of self in terms of physical characteristics gives the nurse information about the client's body image. Also included in an assessment of self-concept are the emotions that the client frequently experiences and whether or not the client is comfortable with those emotions. The nurse also must assess the client's coping strategies. Cognitive processing and response to medications are biologically based.
3. Which of the following are components of the assessment of thought process and content? Select all that apply. A) What the client is thinking B) Abstract thinking abilities C) How the client is thinking D) Clarity of ideas E) Self-harm or suicide urges
Ans: A, C, D, E Feedback: The components of the assessment of thought process and content include content (what the client is thinking), process (how the client is thinking), clarity of ideas, self-harm, or suicide urges. Abstract thinking abilities are an element of the abnormal sensory experiences or misperception assessment.
13. Which of the following personal characteristics influence a client's response to stressors? Select all that apply. A) Self-efficacy B) Sense of belonging C) Spirituality D) Hardiness E) Resilience F) Resourcefulness
Ans: A, C, D, E, F Feedback: Personal characteristics that influence a client's response to stressors include self- efficacy, spirituality, hardiness, resilience, and resourcefulness. Sense of belonging is an interpersonal factor that can influence a client's response to stressors.
An abnormality of which of the following structures of the cerebrum would be associated with schizophrenia? A) Parietal lobes B) Frontal lobe C) Occipital lobe D) Temporal lobes
Ans: B Feedback: Abnormalities in the frontal lobes are associated with schizophrenia, attention deficit hyperactivity disorder (ADHD), and dementia. The parietal lobes interpret sensations of taste and touch and assist in spatial orientation. The temporal lobes are centers for the senses of smell and hearing and for memory and emotional expression. The occipital lobe assists in coordinating language generation and visual interpretation, such as depth perception.
25. The nurse has completed the psychosocial assessment. Which of the following is the best approach toward analysis of the data to identify nursing diagnoses and develop an appropriate plan of care? A) Focus on each piece of information obtained from the patient. B) Look for patterns reflected in the overall assessment. C) Consider only the abnormal findings in the assessment. D) Present all data obtained in the treatment team meeting.
Ans: B Feedback: After completing the psychosocial assessment, the nurse analyzes all the data that he or she has collected. Data analysis involves thinking about the overall assessment rather than focusing on isolated bits of information. The nurse looks for patterns or themes in the data that lead to conclusions about the client's strengths and needs and to a particular nursing diagnosis. No one statement or behavior is adequate to reach such a conclusion.
26. The nurse reviews results of the Minnesota Multiphasic Personality Inventory (MMPI) recorded in a patient record. While considering the usefulness of these data, the nurse is mindful that the MMPI has which limitation? A) The patient must be able to read to complete the MMPI. B) The results of the MMPI could be culturally biased. C) The MMPI assesses a narrow scope of functioning. D) The MMPI does not have established validity.
Ans: B Feedback: Both intelligence tests and personality tests are frequently criticized as being culturally biased. It is important to consider the client's culture and environment when evaluating the importance of scores or projections from any of these tests. Objective personality tests compare the client's answers with standard answers or criteria and obtain a score or scores. The MMPI provides scores on 10 clinical scales such as hypochondriasis, depression, hysteria, and paranoia; four special scales such as anxiety and alcoholism; three validity scales to evaluate the truth and accuracy of responses.
When the client experiences facial flushing, a throbbing headache, nausea and vomiting after consuming alcohol while taking Disulfiram (Antabuse), the nurse is aware that this is due to which of the following? A) A mild side effect of the medication. B) The intended therapeutic result. C) An idiosyncratic reaction D) A severe allergy to the medication.
Ans: B Feedback: Disulfiram is a sensitizing agent that causes an adverse reaction when mixed with alcohol in the body. Five to ten minutes after a person taking disulfiram ingests alcohol, symptoms begin to appear: facial and body flushing from vasodilation, a throbbing headache, sweating, dry mouth, nausea, vomiting, dizziness, and weakness. These symptoms are not mild side effects because these are very uncomfortable symptoms. These symptoms would not be an idiosyncratic reaction because this is the expected reaction. These symptoms are not indicative of a severe allergy to the medication.
24. Several family members arrive to visit an African American client. The nurse can best meet this client's need for socialization by providing the client and family which of the following? A) Individual visits to provide the client with a calm environment B) Group gatherings and open conversation C) Inclusion of ritualistic health practices with the family present D) A spiritual healer to remove the illness and protect the family
Ans: B Feedback: During illness, families are often a support system for the sick person. Families often feel comfortable demonstrating public affection such as hugging and touching one another. Conversation among family and friends may be animated and loud. Spiritual rituals are more prevalent in Native American cultures.
Which of the following is an inhibitory neurotransmitter? A) Dopamine B) GABA C) Norepinephrine D) Epinephrine Ans: B Feedback: GABA is the major inhibitory neurotransmitter in the brain and has been found to modulate other neurotransmitter systems rather than to provide a direct stimulus. Dopamine, norepinephrine, and epinephrine are excitatory neurotransmitters.
Ans: B Feedback: GABA is the major inhibitory neurotransmitter in the brain and has been found to modulate other neurotransmitter systems rather than to provide a direct stimulus. Dopamine, norepinephrine, and epinephrine are excitatory neurotransmitters.
33. Which of the following is the most compelling reason for the nurse to discuss matters of sexuality and suicide? A) It is required by the law by the federal government and in most states in the union. B) It is the nurse's professional responsibility to keep safety needs first and foremost. C) This is commonly required documentation for every encounter with every client. D) It allows the nurse to gain valuable experience in these kind of difficult discussions.
Ans: B Feedback: It is the nurse's professional responsibility to keep the client's safety needs first and foremost, and this includes overcoming any personal discomfort in talking about suicide. This is not required by any laws nor is it commonly required documentation for every encounter with every client. The nurse needs to gain experience in these kind of difficult discussions, but that is not a compelling reason for the nurse to discuss it if not warranted.
17. Which of the following questions is best to ask when assessing the client's judgment? A) "Can you describe your usual daily activities for me?" B) "If you found yourself downtown without money or a car, how would you get home?" C) "On a scale of 1 to 10, how stressed would you rate yourself?" D) "What problem would you like to work on while you're hospitalized?"
Ans: B Feedback: Judgment refers to the ability to interpret one's environment and situation correctly and to adapt one's own behavior and decisions accordingly. This question will elicit information about the client's problem-solving and decision-making abilities. The other choices do not assess the concept of judgment.
Which of the following is a term used to describe the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia? A) Opisthotonus B) Oculogyric crisis C) Torticollis D) Pseudoparkinsonism
Ans: B Feedback: Oculogyric crisis is the occurrence of the eye rolling back in a locked position, which occurs with acute dystonia. Opisthotonus is tightness in the entire body with the head back and an arched neck. Torticollis is twisted head and neck. Oculogyric crisis, opisthotonus, and torticollis are manifestations of acute dystonia. Pseudoparkinsonism is drug-induced parkinsonism and is often referred to by the generic label of extrapyramidal side effects.
A nurse is leading a medication education group for patients with depression. A patient states he has read that herbal treatments are just as effective as prescription medications. The best response is, A) "When studies are published they can be trusted to be accurate." B) "We need to look at the research very closely to see how reliable the studies are." C) "Your prescribed medication is the best for your condition, so you should not read those studies." D) "Switching medications will alter the course of your illness. It is not advised."
Ans: B Feedback: Often, reports in the media regarding new research and studies are confusing, contradictory, or difficult for clients and their families to understand. The nurse must ensure that clients and families are well informed about progress in these areas and must also help them to distinguish between facts and hypotheses. The nurse can explain if or how new research may affect a client's treatment or prognosis. The nurse is a good resource for providing information and answering questions.
How should the nurse respond to a family member who asks how Alzheimer's disease is diagnosed? A) It is impossible to know for certain that a person has Alzheimer's disease until the person dies and his or her brain can be examined via autopsy. B) Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living clients. C) Alzheimer's disease can be diagnosed by using chemical markers that demonstrate decreased cerebral blood flow. D) It will be necessary for the patient to undergo positron emission tomography (PET) scans regularly for a long period of time to know if the patient has Alzheimer's disease.
Ans: B Feedback: Positron emission tomography (PET) scans can identify the amyloid plaques and tangles of Alzheimer's disease in living clients. These conditions previously could be diagnosed only through autopsy. Some persons with schizophrenia also demonstrate decreased cerebral blood flow. A limitation of PET scans is that the use of radioactive substances limits the number of times a person can undergo these tests.
15. Individuals who grow up in ìat-riskî environments but are able to become productive, successful citizens are believed to possess which of the following characteristics? A) Hardiness B) Resilience C) Social skills D) Tolerance
Ans: B Feedback: Resilience is having healthy responses to stressful situations or risky environments. Hardiness is the ability to resist illness when under stress. Social skills are a type of coping strategy. Tolerance is the ability to deal with increasing levels of stress in an adaptive way.
When the client asks the nurse how long it will take before the SSRI antidepressant medication will be effective, which of the following replies is most accurate and therapeutic? A) "This is a good medication! It will be effective within 20 minutes of the first dose." B) "You will have gradual improvement in symptoms over the next few weeks, but the changes may be so subtle that you may not notice them for a while. It is important for you to keep taking the medication." C) "It will probably take months for the medication to work. In the meantime, you should work on improving your attitude." D) "If you believe it will work, then it will. You have to have faith!"
Ans: B Feedback: SSRIs may be effective in 2 to 3 weeks. Researchers believe that the actions of these drugs are an "initiating event" and that eventual therapeutic effectiveness results when neurons respond more slowly, making serotonin available at the synapses. The medication will not be effective within 20 minutes of the first dose, and it will not likely take months for the medication. Attitude and faith will improve with the medication's effectiveness.
Which of the following antidepressant drugs is a preferred drug for clients at high risk of suicide? A) Tranylcypromine (Parnate) B) Sertraline (Zoloft) C) Imipramine (Tofranil) D) Phenelzine (Nardil)
Ans: B Feedback: SSRIs, venlafaxine, nefazodone, and bupropion are often better choices for those who are potentially suicidal or highly impulsive because they carry no risk of lethal overdose, in contrast to the cyclic compounds and the MAOIs. Parnate and Nardil are MAOIs. Tofranil is a cyclic compound.
A patient with depression has been taking paroxetine (Paxil) for the last 3 months and has noticed improvement of symptoms. Which of the following side effects would the nurse expect the patient to report? A) A headache after eating wine and cheese B) A decrease in sexual pleasure during intimacy C) An intense need to move about D) Persistent runny nose
Ans: B Feedback: Sexual dysfunction can result from enhanced serotonin transmission associated with SSRI use. Headache caused by hypertension can result when combining MAOIs with foods containing tyramine, such as aged cheeses and alcoholic beverages. SSRIs cause less weight gain than other antidepressants. Dry mouth and nasal passages are common anticholinergic side effects associated with all antidepressants. An intense need to move about (akathisia) is an extrapyramidal side effect that would be expected of an antipsychotic medication. Furthermore, sedation is a common side effect of Paxil.
19. Which of the following would best assess a client's judgment? A) Counting by serial sevens B) Discussing hypothetical situations C) Interpreting proverbs D) Spelling words backward
Ans: B Feedback: The client's judgment can be elicited by asking the client to discuss hypothetical situations, which would indicate one's ability to interpret one's environment and situation correctly and to adapt one's behavior and decisions accordingly. Counting by serial sevens and spelling words backward would assess the client's ability to concentrate. Interpreting proverbs would assess the client's abstract thinking.
Which one of the following types of antipsychotic medications is most likely to produce extrapyramidal effects? A) Atypical antipsychotic drugs B) First-generation antipsychotic drugs C) Third-generation antipsychotic drugs D) Dopamine system stabilizers
Ans: B Feedback: The conventional, or first-generation, antipsychotic drugs are potent antagonists of D2, D3, and D4. This makes them effective in treating target symptoms but also produces many extrapyramidal side effects because of the blocking of the D2 receptors. Newer, atypical or second-generation antipsychotic drugs are relatively weak blockers of D2, which may account for the lower incidence of extrapyramidal side effects. The third generation of antipsychotics, called dopamine system stabilizers, is being developed. These drugs are thought to stabilize dopamine output that results in control of symptoms without some of the side effects of other antipsychotic medications.
14. A nurse can best assess a patient's ability to use abstract thinking by asking the patient which of the following questions? A) "What would you do if you found a wallet containing $100 on the sidewalk?" B) "What do I mean when I say, 'Don't sweat the small stuff?'" C) "What are you going to do next time you hear voices?" D) "Can you begin with the number 100 and subtract 7, and then subtract 7 again?"
Ans: B Feedback: The nurse assesses the client's ability to use abstract thinking, which is to make associations or interpretations about a situation or comment. The nurse usually can do so by asking the client to interpret a common proverb. If the client can explain the proverb correctly, his or her abstract thinking abilities are intact. Judgment refers to the ability to interpret one's environment and situation correctly and to adapt one's behavior and decisions accordingly. Insight is the ability to understand the true nature of one's situation and accept some personal responsibility for that situation. The nurse assesses the client's ability to concentrate by asking the client to perform certain tasks such as "serial sevens."
21. A nurse and a client of Chinese heritage are collaborating on treatment goals. The nurse would document which of the following as the client's priority goal? A) The client will be free of pain and excess stress. B) The client will express a feeling of balance and harmony. C) The client will be free of physical symptoms of illness. D) The client will express gratefulness to God for recovery
Ans: B Feedback: Chinese and many other Asian cultures view health as a balance of body, mind, and spirit. Pain-free is a major focus of African American culture. Russians and Latino cultures focus largely on physical aspects of health. Arab cultures view health as a gift of God.
25. A Filipino client meets the nurse for the first time. The client simply smiles at the nurse when introduced. The nurse interprets this behavior as A) a display of being shy and introverted. B) a typical greeting for a Filipino client. C) constricted verbal skills associated with the client's illness. D) a sign that the client may be suspicious of the nurse.
Ans: B Feedback: Smiles rather than handshakes are a common form of greeting in Pilipino culture. Filipino clients consider direct eye contact impolite, so there is little direct eye contact with authority figures such as nurses and physicians.
16. Which of the following factors would be the most influential in determining a client's response to a particular stressor? A) The client's experience with stress B) The client's perception of the stressor C) Duration of the stressor D) Severity of the stressor
Ans: B Feedback: The client will respond to the stressor based on his or her appraisal (perception) of the stressor. Resilience is related to positive outlook. The client's experience with stress, the duration of the stressor, and the severity of the stressor would not be the most influential in determining a client's response to a stressor.
10. It is recorded in the client's chart that the family is resilient. The nurse concludes which of the following characteristics about the family life of this client? Select all that apply. A) Family members are independent of one another. B) Family members spend time together. C) Family members engage in recreational activities together. D) Family members share the same personal goals. E) Family members allow individual members to develop unique daily routines.
Ans: B, C Feedback: Factors that are present in resilient families include positive outlook, spirituality, family member accord, flexibility, family communication, and support networks. Resilient families also spend time together, share recreational activities, and participate in family rituals and routines together. Personal goal setting reflects self-efficacy.
The nurse is educating a patient and family about strategies to minimize the side effects of antipsychotic drugs. Which of the following should be included in the plan? Select all that apply. A) Drink plenty of fruit juice. B) Developing an exercise program is important. C) Increase foods high in fiber. D) Laxatives can be used as needed. E) Use sunscreen when outdoors. F) For missed doses, take double the dose at the next scheduled time.
Ans: B, C, E Feedback: Drinking sugar-free fluids and eating sugar-free hard candy ease dry mouth. The client should avoid calorie-laden beverages and candy because they promote dental caries, contribute to weight gain, and do little to relieve dry mouth. Methods to prevent or relieve constipation include exercising and increasing water and bulk-forming foods in the diet. Stool softeners are permissible, but the client should avoid laxatives. The use of sunscreen is recommended because photosensitivity can cause the client to sunburn easily. If the client forgets a dose of antipsychotic medication, he or she can take the missed dose if it is only 3 or 4 hours late. If the dose is more than 4 hours overdue or the next dose is due, the client can omit the forgotten dose.
6. Which of the following individual factors can a person modify to improve mental and emotional health? Select all that apply. A) Serotonin deficiency B) Lack of exercise C) Poor nutrition D) Type I diabetes E) Sleeplessness
Ans: B, C, E Feedback: Personal health practices, such as exercise, poor nutritional status, lack of sleep, or a chronic physical illness, can influence the client's response to illness. Unlike genetic factors, how a person lives and takes care of himself or herself can alter many of these factors. For this reason, nurses must assess the client's physical health even when the client is seeking help for mental health problems. Serotonin deficiency and type I diabetes are not under voluntary control.
Which of the following side effects of lithium are frequent causes of noncompliance? Select all that apply. A) Metallic taste in the mouth B) Weight gain C) Acne D) Thirst E) Lethargy
Ans: B, E Feedback: Lethargy and weight gain are difficult to manage or minimize and frequently lead to noncompliance.
12. Which of the following statements about hope and symptoms of mental illness are true? Select all that apply. A) Hope is not realistic and therefore is not related to mental well-being. B) Persons having more hope experienced fewer actual symptoms. C) Hope is a cause of mental illness. D) There is not a significant relationship between hopelessness and increased symptoms. E) A possible way to help clients manage and decrease symptoms would be to support the development of hope.
Ans: B, E Feedback: Persons having more hope experienced fewer actual symptoms. A significant relationship between hopelessness and increased symptoms was also demonstrated. This may indicate that one of the ways to help clients manage and decrease symptoms is having a wellness plan that includes a positive future outlook and support for the development of hope.
1. The nurse is assessing the anxiety level of a young school-age child. The nurse encourages the child to express feelings through the use of toys in a play situation. The purpose for this approach to assessment is largely related to which of the following? A) The child has cognitive impairment and has limited vocabulary skills. B) The child has not been intellectually stimulated and can only express self through play. C) Children may not have developed the language to fully describe their feelings. D) Children will not express themselves openly unless instructed to do so by parents.
Ans: C Feedback: A client's age can influence how he or she expresses illness. A young child may lack the understanding and ability to describe his or her feelings, which may make management of the disorder more challenging. Nurses must be aware of the child's level of language and work to understand the experience as he or she describes it.
26. Females from which of the following cultures are most likely to be expected to move in with husband's family? A) African Americans B) Mexican Americans C) South Asians D) Haitians
Ans: C Feedback: African Americans are more likely to have a nuclear family. Mexican Americans mostly live in nuclear families. South Asians expect the daughters to move in with the husband's family. Haitians may have an extended or a nuclear family.
18. A client reports feeling like he belongs among his peers with whom he shares a group home. The nurse incorporates this sense of belonging when formulating discharge plans because the nurse understands which of the following? A) Living with a peer group often increases anxiety. B) Peers may alienate the client from daily living activities. C) The client will likely feel needed by his peers. D) Peer groups often do too much for each other causing dependency.
Ans: C Feedback: An increased sense of belonging is associated with decreased levels of anxiety. Persons with a sense of belonging are less alienated and isolated, have a sense of purpose, believe they are needed by others, and feel productive socially.
23. A nurse is working with a Middle-Eastern client being treated for major depression. The client is expressing feelings of guilt for not being able to ìsnap out of it.î A therapeutic response by the nurse would be, A) ìYou have to keep trying to feel better.î B) ìWhat do you think could have caused your depression?î C) ìClinical depression is not something you have brought on yourself.î D) ìIt will take several weeks for your medicine to start to help you feel better.î
Ans: C Feedback: Arab Americans believe mental illness is something the person can control. Educating about the etiology reduces the guilt associated with having an illness. Suggesting the client keep trying or caused the depression in some way implies that the client is responsible for the illness. Informing about medication ignores the client's feelings of guilt.
Which of the following increases the risk for neuroleptic malignant syndrome (NMS)? A) Overhydration B) Intake of vitamins C) Dehydration D) Vegetarian diet
Ans: C Feedback: Dehydration, poor nutrition, and concurrent medical illness all increase the risk for NMS. Overhydration is opposite of dehydration and would therefore not increase the risk of NMS. Intake of vitamins would likely reduce the risk of NMS as it would improve nutritional status. Vegetarian diet would not relate to NMS.
23. A nurse assesses that a depressed patient is lethargic during the day and does not actively participate in unit activities. The notes from the night shift document that the patient did not sleep well. The most probable interpretation of these data is A) the patient's medications are ineffective. B) the patient is being kept awake at night due to noise on the unit. C) the patient's depressed mood is impairing restful sleep patterns. D) the patient is resisting treatment recommendations to participate in unit activities
Ans: C Feedback: Emotional problems often affect some areas of physiologic function. Emotional problems can greatly affect eating and sleeping patterns. Therefore, the nurse must assess the client's usual patterns of eating and sleeping and then determine how those patterns have changed.
A patient with bipolar disorder takes lithium 300 mg three times daily. The nurse evaluates that the dose is appropriate when the patient reports A) feeling sleepy and less energetic. B) weight gain of 7 pounds in the last 6 months. C) minimal mood swings. D) increased feelings of self-worth.
Ans: C Feedback: Mood-stabilizing drugs are used to treat bipolar disorder by stabilizing the client's mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania. Weight gain is a common side effect, and fatigue and lethargy may indicate mild toxicity. Inflated self-worth is a target symptom of bipolar disorder, which should diminish with effective treatment.
30. In the space of 5 minutes, the client has been laughing and euphoric, then angry, and then crying for no reason that is apparent to the nurse. This behavior would be best described as A) flight of ideas. B) lack of insight. C) labile mood. D) tangential thinking. `
Ans: C Feedback: Moods that shift rapidly, displaying a range of emotions, are termed labile. Flight of ideas is manifested by excessive amount and rate of speech composed of fragmented or unrelated ideas. Lack of insight would be manifested by the lack of the ability to understand the true nature of one's situation and accept some personal responsibility for that situation. Tangential thinking would be manifested by wandering off the topic and never providing the information requested.
24. A nurse suspects that a patient is abusing alcohol while taking prescribed medications. The nurse plans to educate the patient on the dangers of mixing medicine with alcohol. Which of the following would be the most effective way for the nurse to approach this subject with the patient? A) Firmly inform the patient of the dangers of mixing medications with alcohol. B) Recommend a higher level of care, so the patient can be more closely supervised. C) Emphasize the importance of truthful information using a nonjudgmental approach D) Recognize the patient's right to self-determination and avoid addressing the subject.
Ans: C Feedback: Noncompliance with prescribed medications is an important area. If the client has stopped taking medication or is taking medication other than as prescribed, the nurse must help the client feel comfortable enough to reveal this information. The nurse also explores the client's use of alcohol and over-the-counter or illicit drugs. Such questions require nonjudgmental phrasing; the nurse must reassure the client that truthful information is crucial in determining the client's plan of care.
A patient is seen for frequent exacerbation of schizophrenia due to nonadherence to medication regimen. The nurse should assess for which of the following common contributors to nonadherence? A) The patient is symptom-free and therefore does not need to adhere to the medication regimen. B) The patient cannot clearly see the instructions written on the prescription bottle. C) The patient dislikes the weight gain associated with antipsychotic therapy. D) The patient sells the antipsychotics to addicts in the neighborhood.
Ans: C Feedback: Patients with schizophrenia are less likely to exercise or eat low-fat nutritionally balanced diets; this pattern decreases the likelihood that they can minimize potential weight gain or lose excess weight. Antipsychotics should be taken regularly and not omitted when free of symptoms. Antipsychotics do not adversely affect vision, nor do they have addictive potential.
The nurse has completed health teaching about dietary restrictions for a client taking a monoamine oxidase inhibitor. The nurse will know that teaching has been effective by which of the following client statements? A) "I'm glad I can eat pizza since it's my favorite food." B) "I must follow this diet or I will have severe vomiting." C) "It will be difficult for me to avoid pepperoni." D) "None of the foods that are restricted are part of a regular daily diet."
Ans: C Feedback: Pepperoni is one of the foods containing tyramine, so it must be avoided. Particular concern to this client is the potential life-threatening hypertensive crisis if the client ingests food that contains tyramine. Answer choices A, B, and D are inappropriate statements toward effective teaching for the client receiving a monoamine oxidase inhibitor.
A client with bipolar disorder has been taking lithium, and today his serum blood level is 2.0 mEq/L. What effects would the nurse expect to see? A) Constipation and postural hypotension B) Fever, muscle rigidity, and disorientation C) Nausea, diarrhea, and confusion D) None; the serum level is in therapeutic range
Ans: C Feedback: Serum lithium levels of less than 0.5 mEq/L are rarely therapeutic, and levels of more than 1.5 mEq/L are usually considered toxic. The client would show signs of toxicity with a lithium level of 2.0 mEq/L. Toxic effects of lithium are severe diarrhea, vomiting, drowsiness, muscle weakness, and lack of coordination.
Which of the following was the first nonstimulant medication specifically designed and tested for ADHD? A) Methylphenidate (Ritalin) B) Amphetamine (Adderall) C) Atomoxetine (Strattera) D) Pemoline (Cylert)
Ans: C Feedback: Strattera was the first nonstimulant medication specifically designed and tested for ADHD. The primary stimulant drugs used to treat ADHD are methylphenidate (Ritalin), amphetamine (Adderall), and pemoline (Cylert)
Which of the following is the primary consideration with clients taking antidepressants? A) Decreased mobility B) Emotional changes C) Suicide D) Increased sleep
Ans: C Feedback: Suicide is always a primary consideration when treating clients with depression.
A client who is taking paroxetine (Paxil) reports to the nurse that he has been nauseated since beginning the medication. Which of the following actions is indicated initially? A) Instruct the client to stop the medication for a few days to see if the nausea goes away. B) Reassure the client that this is an expected side effect that will improve with time. C) Suggest that the client take the medication with food. D) Tell the client to contact the physician for a change in medication.
Ans: C Feedback: Taking selective serotonin reuptake inhibitors with food usually eliminates nausea. There is a delayed therapeutic response to antidepressants. The client should not stop taking the drug. It would be appropriate to reassure the client that this is an expected side effect that will improve with time, but that would not be done initially. A change in medication may be indicated if the nausea is intolerable or persistent, but that would not be done initially.
13. A patient is known to express tangential thinking. The nurse would assess for which of the following when interacting with the patient? A) Stopping abruptly in the middle of expressing himself B) Jumping from one idea to another C) Wandering off the topic and never answering the question D) Excessive and fast talking about an array of ideas
Ans: C Feedback: Tangential thinking is wandering off the topic and never providing the information requested. Thought blocking is stopping abruptly in the middle of a sentence or train of thoughts, sometimes unable to continue the idea. Loose associations are disorganized thinking that jumps from one idea to another with little or no evident relation between the thoughts. Flight of ideas is excessive amount and rate of speech composed of fragmented or unrelated ideas.
One week after beginning therapy with thiothixene (Navane), the client demonstrates muscle rigidity, a temperature of 103 F, an elevated serum creatinine phosphokinase level, stupor, and incontinence. The nurse should notify the physician because these symptoms are indicative of A) acute dystonic reaction. B) extrapyramidal side effects. C) neuroleptic malignant syndrome. D) tardive dyskinesia.
Ans: C Feedback: The client demonstrates all the classic signs of neuroleptic malignant syndrome. Dystonia involves acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. Tardive dyskinesia is a late-onset, irreversible neurologic side effect of antipsychotic medications characterized by abnormal, involuntary movements, such as blinking, chewing, and grimacing.
31. Throughout the assessment, the client displays disorganized thinking, jumping from one idea to another with no clear relationship between the thoughts. The nurse would assess the client as having which of the following? A) Tangential thinking B) Ideas of reference C) Loose associations D) Word salad
Ans: C Feedback: The client displayed ideas that were loosely associated to one another. Tangential thinking is manifested by wandering off the topic and never providing the information requested. Ideas of reference are the client's inaccurate interpretation that general events are personally directed to him or her. Word salad is a flow of unconnected words that convey no meaning to the listener.
29. A client is admitted to the psychiatric unit and states, "I am president of the largest corporation in the world. Everyone comes to me for advice." The client is exhibiting which of the following? A) Flight of ideas B) Thought broadcasting C) Delusion D) Loose associations
Ans: C Feedback: The client has a delusion (a fixed false belief not based in reality) about his superiority over others. Flight of ideas is excessive amount and rate of speech composed of fragmented or unrelated ideas. Thought broadcasting is a delusional belief that others can hear or know what the client is thinking. Loose associations are disorganized thinking that jumps from one idea to another with little or no evident relation between the thoughts.
2. Which of the following factors influencing assessment is under the nurse's control? A) Client participation and feedback B) Client's health status C) Nurse's attitude and approach D) Client's ability to understand
Ans: C Feedback: The factors that influence assessment include client participation and feedback, client's health status, client's ability to understand, client's previous experiences, and misconceptions about health care. The only one of these that is under the control of the nurse is the nurse's attitude and approach.
5. During the assessment, the nurse asks the client to describe his problems. The purpose of this question is to obtain information about the client's A) admitting diagnosis. B) communication skills. C) perception of the problem. D) personal needs.
Ans: C Feedback: The question will elicit information about the client's view or perspective of the problem.
Which one of the following drugs should the nurse expect the patient to require serum level monitoring? A) Anticonvulsants B) Wellbutrin C) Lithium D) Prozac
Ans: C Feedback: Toxicity is closely related to serum lithium levels and can occur at therapeutic doses. For clients taking lithium and the anticonvulsants, monitoring blood levels periodically is important.
9. The nurse is assessing suicide potential in a patient who has expressed hopelessness. In what order does the nurse question the patient about suicidal thoughts? A. "How would you carry out this plan?" B. "Do you have a plan to kill yourself?" C. "Are you thinking of killing yourself?" D. "How do you plan to kill yourself?"
Ans: C, B, D, A Feedback: Suicide assessment should be performed through direct questioning. First, the nurse would need to know if the patient has ideations: "Are you thinking about killing yourself?"; then if the patient has a plan, "Do you have a plan to kill yourself?" If the patient has a plan, then the nurse would ask about method: "How do you plan to kill yourself?" If the patient has ideations, a plan, a method, then does the patient have access to that method the nurse asks, "How would you carry out this plan? Do you have access to the means to carry out the plan?"
22. Knowing that relationships with others are significant to mental health, the nurse effectively assesses a patient's family relationships through which of the following? A) "Do you feel your family helps you?" B) "How many people are in your family?" C) "Whom are you closest to in your family?" D) "Describe your relationships with your family."
Ans: D Feedback: The nurse must assess the relationships in the client's life, the client's satisfaction with those relationships, or any loss of relationships. Open-ended questions and statements elicit more descriptive responses from the patient than direct questions.
6. A delusion represents a problem in which of the following areas? A) Memory B) Motivation C) Orientation D) Thinking
Ans: D Feedback: A delusion is a fixed false idea or thought. Memory relates to the client's knowledge of past events. Motivation relates to the client's interest in doing things. Orientation relates to the client's perception of reality.
A client is seen in the clinic with clinical manifestations of an inability to sit still and a rigid posture. These side effects would be correctly identified as which of the following? A) Tardive dyskinesia B) Neuroleptic malignant syndrome C) Dystonia D) Akathisia
Ans: D Feedback: Akathisia is reported by the client as an intense need to move about. The client appears restless or anxious and agitated, often with a rigid posture or gain and a lack of spontaneous gestures. The symptoms of tardive dyskinesia (TD) include involuntary movements of the tongue, facial and neck muscles, upper and lower extremities, and truncal musculature. Tongue thrusting and protruding, lip smacking, blinking, grimacing, and other excessive unnecessary facial movements are characteristic. Neuroleptic malignant syndrome is a potentially fatal reaction manifested by rigidity, high fever, and autonomic instability. Acute dystonia includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties.
Which drug classification is the primary medication treatment for schizophrenia? A) Anticoagulants B) Antidepressants C) Antimanics D) Antipsychotics
Ans: D Feedback: Antipsychotic drugs are the primary medical treatment for clients diagnosed with schizophrenia and are also used in psychotic episodes of acute mania, psychotic depression, and drug-induced psychosis.
The nurse knows that the client understands the rationale for dietary restrictions when taking MAOI when the client makes which of the following statements? A) "I am now allergic to foods that are high in the amino acid tyramine such as aged cheese, organ meats, wine, and chocolate." B) "Certain foods will cause me to have sexual dysfunction when I take this medication." C) "Foods that are high in tyramine will reduce the medication's effectiveness." D) "I should avoid foods that are high in the amino acid tyramine such as aged cheese, meats, and chocolate because this drug causes the level of tyramine to go up to dangerous levels."
Ans: D Feedback: Because the enzyme MAO is necessary to break down the tyramine in certain foods, its inhibition results in increased serum tyramine levels, causing severe, hypertension, hyperpyrexia, tachycardia, diaphoresis, tremulousness, and cardiac dysrhythmias. Taking an MAOI does not confer allergy to tyramine. Sexual dysfunction is a common side effect of MAOIs. There is no evidence that foods high in tyramine will increase sexual dysfunction or reduce the medication's effectiveness.
Which of the following would not be included as a symptom of drug-induced parkinsonism? A) Stooped posture B) Cogwheel rigidity C) Drooling D) Tachycardia
Ans: D Feedback: Bradycardia (not tachycardia), a stooped posture, cogwheel rigidity, and drooling are all symptoms of pseudoparkinsonism. Other symptoms of pseudoparkinsonism include mask-like facies, decreased arm swing, a shuffling, festinating gait, tremor, and coarse pill-rolling movements of the thumb and fingers while at rest.
For a client taking clozapine (Clozaril), which of the following symptoms should the nurse report to the physician immediately as it may be indicative of a potentially fatal side effect? A) Inability to stand still for 1 minute B) Mild rash C) Photosensitivity reaction D) Sore throat and malaise
Ans: D Feedback: Clozapine (Clozaril) produces fewer traditional side effects than do most antipsychotic drugs, but it has the potentially fatal side effect of agranulocytosis. This develops suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia. This side effect may not be manifested immediately and can occur up to 24 weeks after the initiation of therapy. Any symptoms of infection must be investigated immediately. Agranulocytosis is characterized by fever, malaise, ulcerative sore throat, and leukopenia. Mild rash and photosensitivity reaction are not serious side effects.
11. A patient shows no facial expression when engaging in a game with peers during an outing at a park. The nurse uses which of the following terms when documenting the patient's affect? A) Blunt affect B) Restricted affect C) Broad affect D) Flat affect
Ans: D Feedback: Common terms used in assessing affect include blunted affect: showing little or a slow-to-respond facial expression; broad affect: displaying a full range of emotional expressions; flat affect: showing no facial expression; inappropriate affect: displaying a facial expression that is incongruent with mood or situation, often silly or giddy regardless of circumstances; restricted affect: displaying one type of expression, usually serious or somber.
A patient with bipolar disorder asks the nurse, "Why did I get this illness? I don't want to be sick." The nurse would best respond with, A) People who develop mental illnesses often had very traumatic childhood experiences. B) There is some evidence that contracting a virus during childhood can lead to mental disorders. C) Sometimes people with mental illness have an overactive immune system. D) We don't fully understand the cause, but mental illnesses do seem to run in families.
Ans: D Feedback: Current theories and studies indicate that several mental disorders may be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. A compromised immune system could contribute to the development of a variety of illnesses, particularly in populations already genetically at risk. Maternal exposure to a virus during critical fetal development of the nervous system may contribute to mental illness.
Which of the following statements about the neurobiologic causes of mental illness is most accurate? A) Genetics and heredity can explain all causes of mental illness. B) Viral infection has been proven to be the cause of schizophrenia. C) There is no evidence that the immune system is related to mental illness. D) Several mental disorders may be linked to genetic and nongenetic factors.
Ans: D Feedback: Current theories and studies indicate that several mental disorders may be linked to a specific gene or combination of genes, but that the source is not solely genetic; nongenetic factors also play important roles. Most studies involving viral theories have focused on schizophrenia, but so far none has provided specific or conclusive evidence. A compromised immune system could contribute to the development of a variety of illnesses, particularly in populations already genetically at risk. So far, efforts to link a specific stressor with a specific disease have been unsuccessful. When the inflammatory response is critically involved in illnesses such as multiple sclerosis or lupus erythematosus, mood dysregulation and even depression are common.
In planning for a client's discharge, the nurse must know that the most serious risk for the client taking a tricyclic antidepressant is which of the following? A) Hypotension B) Narrow-angle glaucoma C) Seizures D) Suicide by overdose
Ans: D Feedback: Cyclic antidepressants (including tricyclic antidepressants) are potentially lethal if taken in an overdose. The cyclic antidepressants block cholinergic receptors, resulting in anticholinergic effects such as dry mouth, constipation, urinary hesitancy or retention, dry nasal passages, and blurred near vision. More severe anticholinergic effects such as agitation, delirium, and ileus may occur, particularly in older adults. Other common side effects include orthostatic hypotension, sedation, weight gain, and tachycardia. Clients may develop tolerance to anticholinergic effects (such as orthostatic hypotension and worsening of narrow-angle glaucoma, but these side effects are common reasons that clients discontinue drug therapy. The risk of seizures is increased by bupropion, which is a different type of antidepressant.
2. A nurse is teaching decision-making skills to a client with dependent personality disorder. According to Erikson, the likely cause of the client developing dependent personality is failure to meet the critical task of which developmental stage? A) Trust B) Autonomy C) Initiative D) Industry
Ans: D Feedback: Failure to complete the critical task results in a negative outcome for that stage of development and impedes completion of future tasks. Tasks of trust versus mistrust include viewing the world as safe and reliable and viewing relationships as nurturing, stable, and dependable. In autonomy versus shame and doubt, children achieve a sense of control and free will. In initiative versus guilt, the child begins to develop a conscience, and learns to manage conflict and anxiety. Industry versus inferiority involves school-age children building confidence in their own abilities and taking pleasure in accomplishments.
9. A client is actively involved in community service activities. The benefit of involvement in meaningful daily activities will most directly contribute to which of the following attributes? A) Self-efficacy B) Resilience C) Resourcefulness D) Hardiness
Ans: D Feedback: Hardiness is the ability to resist illness when under stress. Hardiness has three components: commitmentóactive involvement in life activities; controlóability to make appropriate decisions in life activities; and challengeóability to perceive change as beneficial rather than just stressful. Self-efficacy is a belief that personal abilities and efforts affect the events in our lives. Resilience is defined as having healthy responses to stressful circumstances or risky situations. Resourcefulness involves using problem- solving abilities and believing that one can cope with adverse or novel situations.
11. Spirituality is especially important in helping people cope primarily for which of the following reasons? A) Spirituality helps people set personal goals. B) Spirituality gives people meaningful daily activities in which to participate. C) Spirituality provides a reliable support network. D) Spirituality guides beliefs about the meaning of life events.
Ans: D Feedback: Spirituality involves the essence of a person's being and his or her beliefs about the meaning of life and the purpose for living. Spirituality is a genuine help to many adults with mental illness, serving as a primary coping device and a source of meaning and coherence in their lives. It may also help to provide a social network, but it serves primarily as a belief system. Personal goal setting is a demonstration of self-efficacy. Hardiness is enhanced through commitment to meaningful daily activities.
A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, his back is arched, and his eyes have rolled back in their sockets. The client has recently begun drug therapy with haloperidol (Haldol). Based on this assessment, the first action of the nurse would be to A) get a stat. order for a serum drug level. B) hold the client's medication until the symptoms subside. C) place an urgent call to the client's physician. D) give a PRN dose of benztropine (Cogentin) IM.
Ans: D Feedback: The client is having an acute dystonic reaction; the treatment is anticholinergic medication. Dystonia is most likely to occur in the first week of treatment, in clients younger than 40 years, in males, and in those receiving high-potency drugs such as Haldol. Immediate treatment with anticholinergic drugs usually brings rapid relief.
A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of A) extrapyramidal side effects B) loss of voluntary muscle control C) posturing D) tardive dyskinesia .
Ans: D Feedback: The client's behaviors are classic signs of tardive dyskinesia. Tardive dyskinesia, a syndrome of permanent involuntary movements, is most commonly caused by the long- term use of conventional antipsychotic drugs. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. The client's behavior is not a loss of voluntary control or posturing
A client has a lithium level of 1.2 mEq/L. Which of the following interventions by the nurse is indicated? A) Call the physician for an increase in dosage. B) Do not give the next dose, and call the physician. C) Increase fluid intake for the next week. D) No intervention is necessary at this time.
Ans: D Feedback: The lithium level is within the therapeutic range. Serum levels of less than 0.5 mEq/L are rarely therapeutic, and a level of more than 1.5 mEq/L is usually considered toxic. Answers A, B, and C are not appropriate interventions for the given lithium level.
A patient with schizophrenia is being treated with olanzapine (Zyprexa) 10 mg. daily. The patient asks the nurse how this medicine works. The nurse explains that the mechanism by which the olanzapine controls the patient's psychotic symptoms is believed to be A) increasing the amount of serotonin and norepinephrine in the brain. B) decreasing the amount of an enzyme that breaks down neurotransmitters. C) normalizing the levels of serotonin, norepinephrine, and dopamine. D) blocking dopamine receptors in the brain.
Ans: D Feedback: The major action of all antipsychotics in the nervous system is to block receptors for the neurotransmitter dopamine. SSRIs and TCSs act by blocking the reuptake of serotonin and norepinephrine. MAOIs prevent the breakdown of MAO, an enzyme that breaks down neurotransmitters. Lithium normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine, and dopamine.
10. The nurse best assesses a patient's memory by asking which of the following questions? A) "Do you have any problems with memory?" B) "What did you have for lunch yesterday?" C) "Do you know where you are?" D) "Who is the current president?"
Ans: D Feedback: The nurse directly assesses memory, both recent and remote, by asking questions with verifiable answers such as "What is the name of the current president?" The nurse may not be able to verify the accuracy of the client's responses to questions such as "Do you have any memory problems?" or "What did you do yesterday?" Orientation refers to the client's recognition of person, place, and time.
The nurse is preparing a patient for an MRI scan of the head. The nurse should ask the patient, A) "Have you ever had an allergic reaction to radioactive dye?" B) "Have you had anything to eat in the last 24 hours?" C) "Does your insurance cover the cost of this scan?" D) "Are you anxious about being in tight spaces?"
Ans: D Feedback: The person undergoing an MRI must lie in a small, closed chamber and remain motionless during the procedure, which takes about 45 minutes. Those who feel claustrophobic or have increased anxiety may require sedation before the procedure. PET scans require radioactive substances to be injected into the bloodstream. A patient is not required to fast before brain imaging studies. Verifying insurance benefits is not a primary role of the nurse.
8. When the nurse asks the client to restate the following in his or her own words, which sensorium and intellectual process is the nurse attempting to identify? The nurse states, "A stitch in time saves nine." A) The client's orientation B) The client's memory C) The client's ability to concentrate D) The client's ability to use abstract thinking
Ans: D Feedback: When the nurse states, "A stitch in time saves nine," and asks the client to restate it in his or her own words, the nurse is assessing the client's ability to use abstract thinking. The client's orientation is recognizing person, place, and time. The client's memory, both recent and remote, can be assessed by asking the client questions that have verifiable answers. The client's ability to concentrate can be assessed by asking the client to perform certain tasks including spelling the word "world" backward.
22. The nurse is preparing to conduct an admission assessment interview with a Mexican American client. During the interview, the nurse should respect the client's culture through which behavior? A) Greet the client with a hug, B) Encourage direct eye contact during questioning C) Prohibiting the next of kin to remain present D) Introduce self with a handshake
Ans: D Feedback: With Mexican Americans touch by strangers is not appreciated, but a handshake is polite and welcomed. Nonverbal communication generally avoids direct eye contact with authority figures. Socially, contact with families comes first.
17. The client says to the nurse, ìI know I can learn to cope with my family situation. By getting help here at the clinic, I'll be able to deal with them more effectively, and I won't be so stressed out all the time.î This client is demonstrating a high level of A)Hardiness B)resilience C)sense of belonging D)self-efficacy
Ans:D Feedback: Self-efficacy is a belief that personal abilities and efforts affect the events in our lives. A person who believes that his or her behavior makes a difference is more likely to take action. Persons with high self-efficacy are self-motivated, get needed support, and cope effectively. Hardiness is the ability to resist illness when under stress. Resilience is defined as having healthy responses to stressful circumstances or risky situations. Sense of belonging is the client's place in the group, family, etc.
