Mental Health NCLEX practice
A 65-year-old retired baker is admitted to the hospital with the diagnosis of dementia. The nurse's question that best tests the client's capacity for abstract thinking is: a) "How are a television and a radio alike?" b) Can you give me today's complete date?" c) "What would you do if you fell and hurt yourself?" d) "Repeat the following numbers for me: 8, 3, 7, 1, 5."
a) "How are a television and a radio alike?" The question "How are a television and a radio alike?" forces the client to find a characteristic common to two things, an ability that is the criterion for abstract thinking. The question "Can you give me today's complete date?" tests orientation, not abstract thinking. The question "What would you do if you fell and hurt yourself?" tests judgment, not abstract thinking. The question "Repeat the following numbers for me: 8, 3, 7, 1, 5" tests short-term memory, not abstract thinking.
A nurse knows individuals who are alcoholics use alcohol to: a) Blunt reality b) Precipitate euphoria c) Promote social interaction d) Stimulate the central nervous system
a) Blunt reality Alcohol, by depressing the central nervous system and distorting or altering reality, reduces anxiety. Alcohol depresses the central nervous system; it may cause lability of mood, impaired judgment, and aggressive actions rather than euphoria. Although alcohol is used as a social lubricant, alcoholics frequently drink in isolation. Also, alcohol can lead to inappropriate and aggressive behavior that may impair social interaction. Alcohol depresses the central nervous system; amphetamines and cocaine are stimulants.
A nurse plans to establish a trusting relationship with a client who is using paranoid ideation. How should the nurse begin to accomplish this? a) By being available on the unit but waiting for the client to approach b) By seeking the client out frequently to spend long blocks of time together c) By sitting on the unit and observing the client's behavior throughout the day d) By calling the client into the office to establish a contract for regular therapy sessions
a) By being available on the unit but waiting for the client to approach The recommended approach for working with suspicious clients is to allow them to set the pace of the relationship. It is less threatening if they are the one to initiate contact. Seeking the client out frequently to spend long blocks of time together, sitting and watching the client, and calling the client into the office may all be perceived as threatening and may add to feelings of paranoia.
Which paired drugs does the nurse expect the practitioner to prescribe for a client admitted for acute alcohol detoxification? a) Chlordiazepoxide (Librium) and thiamine b) Clonidine (Catapres) and propranolol (Inderal) c) Buprenorphine (Subutex) and naloxone (Narcan) d) Chlorpromazine (Thorazine) and disulfiram (Antabuse)
a) Chlordiazepoxide (Librium) and thiamine Chlordiazepoxide (Librium) is used to prevent seizures and to lower vital signs during alcohol detoxification. Thiamine is used to lessen the Wernicke-Korsakoff symptoms of alcohol withdrawal. Clonidine (Catapres) and propranolol (Inderal) will lower vital signs during alcohol withdrawal but will not help prevent seizures. Buprenorphine (Subutex) and naloxone (Narcan) are indicated for the treatment of opioid withdrawal. Chlorpromazine (Thorazine) is contraindicated because it lowers the seizure threshold. Disulfiram is used to maintain alcohol abstinence.
The nurse is caring for a client with a somatoform disorder, conversion-type paralysis. What is the best nursing approach? a) Discussing topics other than the paralysis b) Explaining the reason for the physical problem c) Asking how the client feels about being paralyzed d) Encouraging the client to slowly walk around the room
a) Discussing topics other than the paralysis Discussion of signs and symptoms should not be initiated by the nurse; the signs and symptoms should be accepted by the nurse. Discussion should be focused on the client's feelings and current situation. Explaining the reason for the physical problem may take away the client's unconscious defense and increase anxiety. Asking how the client feels about being paralyzed focuses on the paralysis rather than feelings. Encouraging the client to slowly walk around the room denies the client's symptoms; in reality this client cannot make the legs move to walk.
A client arrives at the mental health clinic disheveled, agitated, and demanding that the nurse "do something to make these feelings stop." What clinical manifestation is evident? a) Feelings of panic b) Suicidal tendencies c) Narcissistic ideation d) Demanding personality
a) Feelings of panic The client can no longer control or tolerate these overwhelming feelings and is seeking help. The client has not indicated plans for self-harm. Narcissistic ideation is not typical of a narcissistic personality. The client's behavior does not indicate a demanding personality.
A young client is admitted to the hospital with a diagnosis of acute schizophrenia. The family reports that one day the client looked at a linen sheet on a clothesline and thought it was a ghost. What is the most appropriate conclusion to make about what the client was experiencing? a) Illusion b) Delusion c) Hallucination d) Confabulation
a) Illusion An illusion is a misinterpretation of an actual sensory stimulus. A delusion is a false, fixed belief. A hallucination is a false sensory perception that occurs with no stimulus. Confabulation is a filling in of blanks in memory.
At a staff meeting, the question of a staff nurse's returning to work after completing a drug rehabilitation program is discussed. What is the most therapeutic way for the staff to handle the nurse's return? a) Offering the nurse support in a straightforward manner b) Avoiding mention of the problem unless the nurse brings it up c) Having another staff member keep the nurse under close observation d) Ensuring that the nurse is assigned to administer only noncontrolled medications
a) Offering the nurse support in a straightforward manner Offering the nurse support in a straightforward manner allows the individual to include the staff in her support system and removes an opportunity to deny the problem. Avoiding mentioning the problem unless the nurse brings it up supports and permits denial; both the individual and the staff know that a problem exists. Having another staff member keep the nurse under close observation is a nonprofessional approach that is nontherapeutic. Although refraining from handling controlled medications may be part of a return-to-work contract, it is not necessarily therapeutic; it simply reduces legal risks.
A nurse concludes that a client has successfully achieved the long-term goal of mobilizing effective coping responses when the client states that when he feels himself getting anxious he will: a) Perform a relaxation exercise. b) Get involved in some type of quiet activity. c) Avoid the situation that precipitated the anxiety. d) Examine carefully what precipitated the anxiety.
a) Perform a relaxation exercise. Relaxation techniques refocus energy and eventually ease physical and emotional stress. Getting involved in some type of quiet activity is not always possible; forced quiet activity may increase stress and anger rather than reduce it. Avoiding the situation that precipitated the anxiety is not always possible; stress can develop from a variety of feelings stimulated by many situations. What precipitated feelings of anxiety is not easy to identify; it is better to learn to deal with feelings once they develop.
During the intake interview at a mental health clinic, a client in withdrawal reveals to the nurse long-term, high-dose cocaine use. Which signs and symptoms support the conclusion that the client has been abusing cocaine for a prolonged time? Select all that apply. a) Sadness b) Euphoria c) Loss of appetite d) Impaired judgment e) Psychomotor retardation
a) Sadness e) Psychomotor retardation Although cocaine is an alkaloid stimulant, depressant effects such as a decreased mood, hypotension, and psychomotor retardation are associated with long-term, high-dose use. Cocaine is a stimulant, and euphoria, loss of appetite, and impaired judgment are all associated with cocaine intoxication, not prolonged high-dose cocaine use.
The nurse is leading a relapse-prevention group for clients who experience bipolar disorder manic episodes. Which strategies should the nurse teach to help prevent or identify impending relapse? Select all that apply. a) Watch for changes in libido. b) Keep dietary changes to a minimum. c) Maintain a regular sleeping schedule. d) Plan multiple varied activities every day. e) Monitor yourself for increased irritability or mood instability
a) Watch for changes in libido. b) Keep dietary changes to a minimum. c) Maintain a regular sleeping schedule. e) Monitor yourself for increased irritability or mood instability Increased sex drive often indicates the beginning of a manic episode. Changes in the eating pattern can trigger a manic episode. Changes in the sleeping pattern may increase anxiety and trigger a manic episode. An elevated, expansive, or irritable mood often indicates the beginning of a manic episode. Too many activities may be too stimulating and precipitate a manic episode. Simple, repetitive routines should be followed to limit change or anxiety.
An older female client who is hospitalized for depression is receiving citalopram (Celexa). During discharge teaching, she asks the nurse whether there is anything she should know about taking this medication. The nurse replies: a) "You're concerned about taking this medication." b) "You should take each dose of medication as prescribed." c) "You must discontinue the medication if side effects occur." d) "You may find it necessary to adjust the dosage if side effects occur."
b) "You should take each dose of medication as prescribed." The client should be encouraged to follow the medical regimen to maximize her response to drug therapy. The client asked a direct question; telling her that she should take each dose as prescribed does not answer her question. The practitioner should be notified of side effects. Legally it is the practitioner who is responsible for discontinuing a medication. The practitioner should be notified of side effects. Legally it is the practitioner who is responsible for adjusting a medication dosage.
A client who uses a complex ritual says to the nurse, "I feel so guilty. None of this makes any sense. Everyone must really think I'm crazy." What is the most therapeutic response by the nurse? a) "Your behavior is bizarre, but it serves a useful purpose." b) "You're concerned about what other people are thinking about you." c) "I am sure people understand that you can't help this behavior right now." d) "Guilt serves no useful purpose. It just helps you stay stuck where you are."
b) "You're concerned about what other people are thinking about you." Paraphrasing encourages further ventilation of feelings and concerns by the client. Telling the client that his behavior is bizarre but that it serves a useful purpose is a negative response that may increase the client's fears about being "crazy." "I'm sure people understand that you can't help this behavior right now" provides false reassurance and implies that the client is out of control, which may increase is fears. Telling the client that guilt serves no useful purpose and just helps him stay stuck where he is denies the client's feelings.
The nurse is caring for a female client who is confused and delirious. What is the most therapeutic intervention when the nurse is interacting with this client? a) Reassuring the client that she will get better b) Directing the client's daily activities on the unit c) Helping the client clarify her experience and gain insight into her behavior d) Providing the client with solutions to past and current problems she has experienced
b) Directing the client's daily activities on the unit The client needs to have her activities decided and directed until delirium and confusion clear. Reassuring the client that she will get better is false reassurance. Clients who are delirious are unable to develop insight into their behavior. Providing the client with solutions to past and current problems experienced is not therapeutic and does not help the client develop insight.
While assessing an older adult client before noon the nurse smells alcohol on the man's breath. After noting certain other signs, the nurse suspects that the client is an alcoholic. What are these signs? Select all that apply. a) Good nutritional habits b) Excessive mood swings c) Family conflict d) Poor hygiene e) Irritability f) Maintenance of cognition
b) Excessive mood swings c) Family conflict d) Poor hygiene e) Irritability Irritability is often seen in alcoholics and is a definite sign to look for. Alcoholics tend to forget to bathe, wash their clothes, or even eat correctly. Many alcoholics have been pushed away by their families because of their drinking and the habits it fosters. Excessive mood swings are a sign of alcoholism. Alcoholics have poor nutritional habits and often skip meals in favor of alcohol. Elders who drink to excess are susceptible to cognitive decline. Test-Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass.
When planning care for a 72-year-old client who has been admitted to the hospital because of bizarre behavior, forgetfulness, and confusion, the nurse should give priority to: a) Preserving the dignity of the client b) Promoting a structured environment c) Determining or ruling out an organic origin d) Limiting the acceleration of symptomatology
b) Promoting a structured environment This client requires a structured environment, regardless of the cause of the behavior; this helps ensure the client's safety. Preserving the dignity of the client is important but is secondary to promotion of an environment conducive to safety and security. A battery of screening tests will probably be used in an attempt to determine the cause of the dementia; however, provision for safety is necessary first. Limiting the acceleration of symptomatology is important but is secondary to promotion of an environment conducive to safety and security.
A 54-year-old client has demonstrated increasing forgetfulness, irritability, and antisocial behavior. After being found walking down a street, disoriented and semi-naked, the client is admitted to the hospital, and a diagnosis of dementia of the Alzheimer type is made. The client expresses fear and anxiety. What is the best approach for the nurse to take? a) Exploring the reasons for the client's concerns b) Reassuring the client with the frequent presence of staff c) Initiating the program of planned interaction and activity d) Explaining the purpose of the unit and why admission was necessary
b) Reassuring the client with the frequent presence of staff The client needs constant reassurance because forgetfulness blocks previous explanations; frequent presence of staff serves as a continual reminder. This client will be unable to explain the reasons for concerns. Too many varied activities will increase anxiety in a confused client. Clients with dementia need simple, structured, routine environments and activities. This client will not remember the explanation from one moment to the next.
A client whose wife recently died appears extremely depressed. The client says, "What's the use in talking? I'd rather be dead. I can't go on without my wife." What is the best response by the nurse? a) "Would you rather be dead?" b) "What does death mean to you?" c) "Are you thinking about killing yourself?" d) "Do you understand why you feel that way?"
c) "Are you thinking about killing yourself?" The response "Are you thinking about killing yourself?" is the most important assessment to make because suicide is a possibility with every depressed client. The client has already said that he would rather be dead, and the response addresses only part of the client's statement. The response "What does death mean to you?" is a philosophical approach that will not encourage discussion of feelings. The client is probably unable to explain why he feels the way he does.
A nurse is discharging a client from the mental health unit who has been treated for major depression. Which statement is most therapeutic at this time? a) "I'm going to miss you; we've become good friends." b) "I know that you're going to be all right when you go home." c) "Call the contact number we gave you if you have an emergency." d) "This is my phone number; call and let me know how you're doing."
c) "Call the contact number we gave you if you have an emergency." Instructing the client to call the contact number that was provided in case of emergency demonstrates an understanding that the newly discharged client needs to have a support system. Clients need to feel that in a crisis there will be someone there for them. The role of the nurse is not to become a good friend but instead to help the client become a functioning being again. "I know you're going to be all right when you go home" provides false reassurance; the nurse does not know this. "This is my phone number; call and let me know how you're doing" is unprofessional and blurs the roles of nurse and client.
A male client with cyclothymic disorder with hypomanic symptoms is admitted to the psychiatric unit. He has progressively lost weight and does not take the time to eat his food. How can the nurse best respond to this situation? a) By providing a tray for him in his room b) By assuring him that he is deserving of food c) By ordering food that he can hold in his hand to eat while moving around d) By pointing out that he must replace the energy that he is burning up by eating
c) By ordering food that he can hold in his hand to eat while moving around The client with hypomanic symptoms cannot tolerate sitting still long enough to eat an adequate meal; handheld foods will help meet the client's nutritional needs and do not require the client to sit down. This client will most likely ignore the tray. Unworthy feelings are related to a depressive, not manic, episode. It is unlikely that this client will understand or care about the need to replace energy with food.
Which nursing action is most important when providing counseling to an adolescent with anorexia nervosa? a) Avoiding talk of food b) Limiting discussion of trivial topics c) Helping the client express concerns about body image d) Identifying the role played by the parents in the development of the disorder
c) Helping the client express concerns about body image Expression of thoughts, feelings, and concerns helps the client clarify eventually the underlying factors of the disorder, which may be associated with issues such as identity, intimacy, sexuality, and adult responsibilities. Food can be discussed with a matter-of-fact approach as long as the talk is not pervasive, authoritarian, or guilt producing. Helping the client express concerns about body image may interfere with the nurse-client relationship; the nurse must listen because what appears trivial or insignificant to the nurse may not be trivial or insignificant to the adolescent. Blame for the disorder should not be placed on anyone.
A client tells the nurse, "That man on the television is talking only to me." What should the nurse document that the client is exhibiting? a) Illusion b) Hallucination c) Idea of reference d) Autistic thinking
c) Idea of reference An idea of reference, also called a delusion of reference, is a fixed, false personal belief that public events and people are connected directly to the client. An illusion is a misinterpretation of a sensory stimulus. A hallucination is a perceived experience that occurs in the absence of an actual sensory stimulus. Autistic thinking is a distortion in the thought process that is associated with schizophrenic disorders.
A nurse is assigned to care for a group of clients who have been found to have depression. Which clinical manifestations does the nurse anticipate? Select all that apply. a) Labiality of affect b) Specific food cravings c) Neglect of personal hygiene d) "I don't know" answers to questions e) Apathetic response to the environment
c) Neglect of personal hygiene d) "I don't know" answers to questions e) Apathetic response to the environment Clients with depression are uninterested in their appearance because of low self-esteem. "I don't know" answers to questions type response requires little thought or decision-making, typical of depression. These clients' sense of futility leads to a lack of response to the environment. With depression there is little or no emotional involvement and therefore little alteration in affect. Clients with depression are uninterested in food of any kind.
A nurse is counseling a client who is experiencing substance abuse delirium. What communication strategies should be used by the nurse when working with this client? a) Encouraging the client to practice self-control b) Using humor when communicating with the client c) Offering an introduction to the client at each meeting d) Approaching the client from the side rather than the front
c) Offering an introduction to the client at each meeting Clients with delirium have short-term memory loss; therefore it is necessary to reinforce information. A client experiencing delirium is unable to participate in a discussion about self-control. Humor is inappropriate and may cause the client to feel uncomfortable. Approaching the client from the side rather than the front may initiate a startle response, causing the client to become fearful.
A client with the diagnosis of schizophrenia refuses to get out of bed and becomes upset. What is the nurse's initial therapeutic response? a) Requiring the client to get out of bed at once b) Allowing the client to stay in bed for a while c) Staying at the bedside until the client calms down d) Giving the prescribed as-needed tranquilizer to the client
c) Staying at the bedside until the client calms down Staying at the bedside until the client calms down provides support and security without rejecting the client or placing value judgments on behavior. Eventually limits will have to be set, but this is not the immediate nursing action. Allowing the client to stay in bed for the time being ignores the problem, and isolation may imply punishment. Although medication will calm the client, it does not address the problem.
A nurse sits with a depressed client twice a day, but there is little verbal communication. One afternoon the client asks, "Do you think they'll ever let me out of here?" What is the best reply by the nurse? a) "We should ask your doctor." b) "Everyone says you're doing fine." c) "Do you think you're ready to leave?" d) "How do you feel about leaving here?"
d) "How do you feel about leaving here?" The nurse's response urges the client to reflect on feelings and encourages communication."We should ask your doctor" shifts responsibility from the nurse to the health care provider; it is an evasive response. "Everyone says you're doing fine" is not what the client is asking the nurse; it closes the door to further communication. "Do you think you're ready to leave?"may elicit a yes or no answer; it does not encourage communication. Study Tip: Enhance your organizational skills by developing a checklist and creating ways to improve your ability to retain information, such as using index cards with essential data, which are easy to carry and review whenever you have a spare moment.
A client with an obsessive-compulsive disorder continually walks up and down the hall, touching every other chair. When he is unable to do this, the client becomes upset. What should the nurse do? a) Distract the client, which will help the client forget about touching the chairs b) Encourage the client to continue touching the chairs as long as he wants until fatigue sets in c) Remove chairs from the hall, thereby relieving the client of the necessity of touching every other one d) Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed
d) Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed It is important to set limits on the behavior, but it is also important to involve the client in the decision-making. Distracting the client, which will help the client forget about touching the chairs, is nontherapeutic; rarely can a client be distracted from a ritual when anxiety is high. Encouraging the client to continue touching the chairs for as long he desires until fatigue sets in is a nontherapeutic approach; some limits must be set by the client and nurse together. Removing chairs from the hall, thereby relieving the client of the necessity of touching every other one, will increase the client's anxiety because he client uses the ritual as a defense against anxiety.
A client with a long history of alcohol dependence spends 28 days in an alcohol-rehabilitation unit. What type of referral does the nurse anticipate will be included in the discharge plan? a) Halfway house b) Family therapist c) Psychoanalytic therapy group d) Community-based self-help group
d) Community-based self-help group Referral to a community-based self-help group is an essential component of the discharge plan to provide ongoing support. The client probably does not need a halfway house. Although some forms of therapy may be helpful, the most successful intervention for alcohol abuse is Alcoholics Anonymous.
A nurse is assigned to care for an adolescent who has been admitted to the psychiatric hospital with a diagnosis of anorexia nervosa. What should the nurse's initial intervention be? a) Scheduling an endocrinology consult because of amenorrhea b) Confronting those behaviors that reflect an inflated self-importance c) Arranging for psychotherapy sessions to help develop a desire to accommodate others d) Developing a contract to achieve a weekly weight gain with consequences for nonachievement
d) Developing a contract to achieve a weekly weight gain with consequences for nonachievement Treatment usually includes a contract for weight gain, signed by the client, whereby privileges are revoked if the weight is not gained; the diet and the amount of food eaten are not the focus of care. Menstruation usually ceases because of severe malnutrition, not because of endocrine pathology. These clients have a low self-esteem and usually do not feel important.
A client who has a diagnosis of paranoid schizophrenia and has been violent in the past is admitted to the psychiatric unit. What should the nurse do before conducting an admission interview? a) Move to the client's side and sit down. b) Alert the assault response team about the client's history. c) Have two other staff members present when talking with the client. d) Enter the room with another staff member while remaining between the client and the door.
d) Enter the room with another staff member while remaining between the client and the door. Making sure to stay between the client and the door provides safety for the nurse and the other staff member because it will enable them to make a rapid exit. Moving to the client and sitting down invades the client's territory and may precipitate an aggressive client response. Alerting the assault response team is premature; the team is alerted when a client is out of control, harming self or others, and cannot be managed by the staff on the unit. Having two other staff members present may be viewed by the client as confrontational and may precipitate an aggressive response.
After a conference with the psychiatrist, a client with a borderline personality disorder cries bitterly, pounds the bed in frustration, and threatens suicide. What is the most helpful response by the nurse? a) Leaving the client for a short period and waiting until the client regains control b) Patting the client reassuringly on the back and saying, "I know that it's hard to bear." c) Asking about the client's troubles and answering, "Other people also have problems." d) Staying with the client and listening attentively if the client wishes to talk about the problem
d) Staying with the client and listening attentively if the client wishes to talk about the problem Sitting with the client indicates acceptance and demonstrates that the nurse feels that the client is worthy of the nurse's time. It is better to stay with the client quietly until control is regained; staying prevents a follow-through on the client's threat. Patting the client reassuringly on the back and saying, "I know that it's hard to bear" provides little comfort for the client. Asking about the client's troubles and answering, "Other people also have problems" may close off further communication.
The serum lithium blood level of a client with a mood disorder, manic episode, is 2.3 mEq/L. What should the nurse expect when assessing this client? a) Elevation in mood b) Nausea, thirst, and fine hand tremor c) Decrease in manic signs and symptoms d) Vomiting, diarrhea, and decreased coordination
d) Vomiting, diarrhea, and decreased coordination Vomiting, diarrhea, and decreased coordination are reflective of lithium toxicity. During the active phase of a manic episode a lithium level of 2.3 mEq/L is more than the therapeutic range of 0.8 to 1.4 mEq/L. An improvement in mood may occur when the therapeutic level is approached early in lithium therapy. Nausea, thirst, and fine hand tremor are common early side effects of lithium treatment. They are not related to lithium toxicity, which is indicated by a 2.3 mEq/L lithium level. During the acute phase of mania the therapeutic serum level of lithium should be between 0.8 and 1.4 mEq/L. The maintenance therapeutic serum level ranges from 0.4 to 1.0 mEq/L. A reduction in symptoms is expected when the therapeutic level of lithium is reached.