Mental Health Final Exam

A nurse is reinforcing teaching with a client who has a prescription for nortriptyline. Which of the following client statements indicates an understanding of the teaching?

"I should sit on the side of the bed before standing up in the morning."

A nurse is providing medication teach for ca client with depression and who is taking a monoamine oxidase inhibitor (MAOI) instead of a selective serotonin reuptake inhibitor (SSRI). Which of the following nursing statements is appropriate to include in teaching?

"You will need to be off the SSRI for a period of time before starting the MAOI."

A nurse on an inpatient unit is collecting data from a group of clients. Which of the following findings should the nurse report to the provider?

A client who has borderline personality disorder and is pacing restlessly

A nurse is assisting with screening a group of clients for major depressive disorder (MDD). The nurse should identify that which of the following clients is at an increased risk for the development of MDD?

A client who just gave birth

A client with schizophrenia is admitted to the psychiatric unit in an acutely disturbed violent state. The client is given several doses of haloperidol (Haldol) and becomes calm and approachable. During rounds, the nurses notices the client has the head rotated to one side in the stiffly fixed position. The lower jaw is thrust forward and the client appears severely anxious. The client is mostly experiencing what?

A dystonic reaction

A nurse is assisting the charge nurse with the preparation for an in-service about negligence for a group of newly licensed nurses. Which of the following scenarios should the charge nurse use as an example to identify negligence?

A nurse does not notify the provider of a change in condition for a client who has schizophrenia

A client has a new prescription for citalopram (Celexa). Which of the following must the nurse make sure the client is not also taking? (Select all that apply) A. A monoamine oxidase inhibitor (MAOI) B. A tricyclic antidepressant (TCA) C. St. John's Wort D. A non steroidal anti inflammatory drug (NSAID) E. Supplemental iron

A. A monoamine oxidase inhibitor (MAOI) B. A tricyclic antidepressant (TCA) C. St. John's Wort

A nurse is caring for a client who is 2 day postoperative following a hip arthroplasty. When a news report about military action comes on the television, the client says to the nurse, "My youngest child died 6 months ago while serving in the military." Which of the following responses should the nurse make? (Select all that apply) A. This must be a very difficult time for you. B. Your child's death must be a terrible loss. C. It's just awful what is going on in the world. D. You need to focus on getting better. E. Tell me something you remember about your child.

A. This must be a very difficult time for you B. Your child's death must be a terrible loss E. Tell me something you remember about your child

A nurse on a mental health unit is prioritizing care for a group of clients. Which of the following actions should the nurse take first?

Administer haloperidol to a client who has schizophrenia and is yelling at other clients

Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages?

Antipsychotics

Requires firm consistent limits, need to outline inappropriate behavior and be aware they may attempt to split staff.

Antisocial and Borderline personality disorder

Affects men more than women. Characteristics can be seen in children. Smooth talkers. Deceitful, manipulative, risk takers.

Antisocial personality disorder

Treatment is usually forced and substance abuse is often present. No capacity for intimacy.

Antisocial personality disorder

Selective serotonin reuptake inhibitors are the first line of treatment for which of the following disorders?

Anxiety disorders

A nurse in a mental health facility is collecting data from a client who has schizophrenia. The nurse should identify that which of the following findings is referred to as a negative symptom of schizophrenia?

Apathy

A nurse is caring for a client who has major depressive disorder (MDD). The client states, "I have noting to live for anymore. I just can't go on." Which of the following responses should the nurse make?

Are you thinking about ending your life?

Displays low self esteem, terrified in social situations. Linked to excessive parental criticism and peer rejection.

Avoidant personality disorder

Characterized by unstable moods, poor relationships with others, impulsivity. Can be self destructive.

Borderline personality disorder

May see abuse -physical, sexual and emotional abuse in the history of these individuals. Suicidal and aggressive behaviors are usually present.

Borderline personality disorder

A nurse is assisting with the admission of a client who has schizophrenia. Which of the following action should the nurse take first?

Conduct an abnormal involuntary movement scale test

A nurse is collecting data from a client who has bulimia nervosa. Which of the following manifestations should the nurse expect?

Dental caries

May be related to profound learning experiences as a child with a chronic illness. "Learned helplessness"

Dependent personality disorder

These individuals have moderate to low problems in functioning. Are submissive and like to be taken care of.

Dependent personality disorder

A nurse is caring for a client who has bipolar disorder. The client suddenly appears agitated and begins pacing at the end of the hallway with clenched fists. Which of the following actions should the nurse take first?

Determine the client's intentions

A nurse is collecting data from a client who is experiencing alcohol withdrawal. Which of the following manifestations should the nurse expect?

Diaphoresis

A nurse is assisting with the planning of an interdisciplinary care conference for a newly admitted client who is in the acute stage of anorexia nervosa. Which of the following members of the interdisciplinary treatment team should the nurse include?

Dietitian

A nurse is reinforcing discharge teaching with a client who has a new prescription for alprazolam. Which of the following instructions is the priority for the nurse to include?

Do not drive until your reaction to the medication is determined.

A nurse is collecting data from a newly admitted client. Which of the following questions should the nurse include to gather psychosocial information?

Do you have a hobby that you enjoy?

A nurse is collecting data from a client who is having difficulty coping with the death of his child. Which of the following questions by the nurse is the priority?

Do you think about harming yourself?

A nurse is caring for an adult client who has visible injuries as a result of intimate partner violence. Which of the following actions should the nurse take?

Encourage the client to develop a safety plan

A nurse is contributing to the plan of care for a client who has borderline personality disorder and exhibits manipulative behaviors. Which of the following interventions should the nurse include in the plan to address limit setting?

Establish and explain consequences for the client's behavior

A client diagnosed with major depression began taking escitalopram (Lexipro) 5 days ago. The client new says, "This medicine isn't working." The nurse's best intervention would be to:

Explain the time lag before antidepressants relieve symptoms

A nurse is caring for a client who has been hospitalized for treatment of bipolar disorder and will be discharge with a prescription for Lithium. The nurse should reinforce teaching on which of the following behaviors that could cause Lithium toxicity?

Fasting

A nurse is collecting data from a client who has major depressive disorder. Which of the following findings is the priority for the nurse to report to the provider?

Feelings of hopelessness

A nurse is contributing to the plan of care for a client who has bipolar disorder and is exhibiting mania. Which of the following interventions should the nurse include to improve the nutritional status of the client?

Have the client's favorite snacks available at all times

These individuals have a good quality of life. Display excessive emotion, can be provocative and impulsive.

Histrionic personality disorder

A nurse is assisting with a mental status examination for a client who has schizophrenia. Which of the following statements should the nurse make to gather information about the client's ability to think abstractly?

How is an orange similar to an apple?

A nurse in an urgent care clinic is collecting data from a client who friend reports a suspicion of cocaine use. The nurse should identify that which of the following manifestations is an indicator of the client's use of this substance?

Hypertension

A nurse at an outpatient mental health clinic is assisting with a group therapy session. One of the participants is having difficulty staying seated and states loudly to the therapist, "I know more than you do about the people in this room!" The nurse should identify that which of the following findings is the likely explanation for the client's behavior?

Hypomania

A nurse is caring for a client who takes naltrexone for the treatment of alcohol use disorder. The nurse should identify that which of the following client statements indicates the medication is effective?

I drink less alcohol in a day while taking naltrexone

A nurse is reinforcing teaching with a client who has generalized anxiety disorder and is to start therapy with busiprone. Which of the following statements should the nurse identify as an indication that the client understands the information?

I should expect some improvement of my symptoms in about 10 days

A nurse is reinforcing teaching about expected withdrawal manifestations with a client who has enrolled in a smoking cessation course. Which of the following client statements indicates an understanding of the information?

I will probably feel irritable with 24 hours of my last cigarette.

A nurse is reinforcing teaching about thought stopping with a client who has a phobia of riding in automobiles. Which of the following client statements indicates an understanding of the instructions?

I will snap a rubber band on my wrist when I feel anxious about riding in a car

A nurse is developing countertransference toward a client during the working phase of the nurse-client relationship. To correct the situation, which of the following action should the nurse take?

Identify personal response to the client

A nurse is reinforcing teaching with the parent of a child who has ADHD and is exhibiting disruptive behaviors at home. Which of the following actions should the nurse instruct the parent to take?

Initiate a point system for the child

A nurse is caring for a client who gave birth to a stillborn fetus one week ago. She states to the nurse, "I am so angry that my doctor didn't take better care of me and my baby." Which of the following responses should the nurse make?

It is important to share what you are feeling, even if it is anger

A client is experiencing a sudden episode of anxiety. The nurse understand that _____ will assist in decreasing the client's anxiety and is often ordered PRN.

Lorazepam (Ativan)

Approach when taking care of wounds or injuries with someone that has Borderline personality disorder

Matter of fact. Avoid rescuing or rejecting.

An outpatient diagnosed with bipolar disorder takes lithium carbonate 200 mg three times daily. The client reports nausea. To reduce the nausea most effectively, the nurse suggests that the lithium be taken with:

Meals

The nurse is caring for a client that was recently started on a second generation antipsychotic medication. The nurse understands that the second generation antipsychotic medications can cause which of the following?

Metabolic syndrome

Not very common. Display self importance, entitlement. Poor relationships. Actually feel shame, fear of abandonment.

Narcissistic personality disorder

Nursing approach with this disorder is to convey confidence, avoid power struggles and defensiveness.

Narcissistic personality disorder

May see in the workplace. Display rigidity, are inflexible. Actions/behaviors may be self defeating, but have no insight. Their way or highway.

Obsessive compulsive personality disorder

Strive for perfectionism and orderliness is a must.

Obsessive compulsive personality disorder

A nurse in a mental health facility is caring for a client who has dementia. The client's agitation is increasing. Which of the following action should the nurse take first?

Offer diversionary activities

A nurse is organizing care for a group of clients. According to Maslow's hierarchy of needs, which of the following interventions should the nurse plan to perform first?

Offer finger foods to a client who is in the manic phase of bipolar disorder

Characterized by suspiciousness, hypervigilant behavior. Can be hostile and controlling.

Paranoid personality disorder

A nurse is collecting data from a newly admitted client who has anorexia nervosa. Which of the following manifestations should the nurse expect?

Peripheral edema

What people see, what makes us "us"

Personality

A nurse is collecting data from a client who has bipolar disorder and a history of mania. Which of the following findings should the nurse identify as an indication that the client is relapsing?

Pressured speech

A nurse is collecting data from a client who has paranoid personality disorder. Which of the following manifestations should the nurse expect?

Projects blame onto others

A nurse is attempting to establish a therapeutic relationship with a newly admitted client. Which of the following actions should the nurse plan to take during the working phase of the nurse-client relationship?

Promote the development of problem-solving skills

A nurse is collecting data from a client who is experiencing opioid withdrawal. Which of the following manifestations should the nurse expect?

Pupillary dilation

A nurse is speaking with a client who is expressing an intense disapproval of the current social worker. When the social worker approaches the nurse a client a few moments later, the client cheerfully states, "Now, here is my favorite social worker!" The nurse should identify the client is using which of the following defense mechanisms?

Reaction formation

A nurse is caring for a client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse take first?

Remove harmful objects from the client's room

A nurse is caring for a client with Alzheimer's disease in a day treatment program. Which of the following actions should the nurse take if the client states, "my stomach hurts," "I feel more sad and alone every day," client was taking St. John's Wort to improve mood; BP 172/94 mmHg, T 100.8F, P 110/min, R 24/min

Request a transport for the client to an emergency department.

A nurse cares for a client diagnosed with a morphine (Opioid) overdose. Which focused assessment has the highest priority?

Respiratory

A nurse is contributing to the plan of care for a client has obsessive-compulsive disorder and continually washes her hands. Which of the following interventions should the nurse include?

Schedule times from the client to wash her hands during the day

For these personality disorders, you want to avoid being "too nice" or friendly. You want to be calm and confident.

Schizoid and Paranoid personality disorders

Characteristics: "loner, shy, emotionally detached." (Uncommon)

Schizoid personality disorder

You are unable to reason with the person that has this personality disorder and these individuals have very odd beliefs. They have severe social and interpersonal deficits

Schizotypal personality disorder

A nurse is reinforcing teaching with the family of a client who has histrionic personality disorder. Which of the following high-risk behaviors should the nurse instruct the family to observe for in the client?

Seductive behavior

A nurse is assisting with discharge planning for a client who needs a day treatment center and has limited community and financial support. Which of the following referrals should the nurse recommend for inclusion in the client's discharge plan?

Social worker

A client diagnosed with major depression began take a tricyclic antidepressant 1 week ago. Today the client says, "I don't think I can keep taking these pills. They make me so dizzy, especially when I stand up." The nurse will:

Teach the client strategies to manage postural hypotension.

A nurse in a provider's office is collecting data from an older adult client whose adult child reports that she "seems confused and can't seem to remember much." Which of the following findings should lead the nurse to suspect delirium?

The client's level of consciousness changes during the interview

A nurse is caring for a client who has schizophrenia. Which of the following actions by the nurse is a violation of the client's confidentiality?

The nurse places the client's diagnosis on the white board in the client's room

A nurse is reinforcing teaching with a client who has schizophrenia and a new prescription for chlorpromazine. Which of the following statements should the nurse include in the teaching?

The voices you have been hearing should decrease

Key feature of all individuals with personality disorders.

They accept and are comfortable with their altered behaviors and personality.

A client has begun taking a psychotropic medication. The nurse is providing education to the client on the purpose of psychotropic drug therapy and is correct in stating that the drug therapy is used for which of the following reasons?

To decrease symptoms and facilitate other therapies

A nurse in a long-term care center is caring for an adult client who has Alzheimer's disease and whose partner died several years ago. The client appears upset and asks the nurse when his partner will visit again. The nurse states, "It seems like you are feeling lonely. Let's take a walk outside and talk." Which of the following communication strategies is the nurse using?

Validation therapy

A nurse is preparing to administer clozapine for the first time to a client who ha schizophrenia. The nurse explains the therapeutic and adverse effects of the medication to the client prior to administration. Which of the following ethical concepts is the nurse demonstrating?

Veracity

A nurse is reinforcing teaching with a newly admitted client who has generalized anxiety disorder. Which of the following statements should the nurse make?

We will demonstrate for you how to use relaxation techniques.

A nurse on an inpatient unit is assisting with a group therapy session. During the session, a client begins to shout, using aggressive language. Which of the following statements should the nurse make to the client?

When you raise your voice, it makes me feel uncomfortable and unsafe

A client has been started on Clozapine to treat the positive and negative symptoms of schizophrenia. Which lab result noted by the nurse would be of concern for this client?

White blood cell count of 3000