Mental Health practice Qs

A client was recently admitted to the inpatient unit after a suicide attempt and has not responded to SSRIs or tricyclic antidepressants. The client asks the nurse, "I heard about monoamine oxidase inhibitors (MAOIs). Why can't they be added to what I am on now? Wouldn't adding one help?" Which is the appropriate nursing response? "There is no reason why an MAOI couldn't be added to your therapy." "Electroconvulsive therapy is your best option at this point." "Combined use can lead to a life-threatening condition called hypertensive crisis." "They can't be used together because their mechanisms of action are very different."

"Combined use can lead to a life-threatening condition called hypertensive crisis." (If MAOIs are taken with other antidepressants, a hypertensive crisis could result.)

A client with depression and substance abuse has an interrupted sleep pattern. She demands that her psychiatrist prescribe her a sedative. What teaching would the nurse provide about the rationale for the use of nonpharmacological interventions instead? "Sedative-hypnotics work best in combination with other techniques." "Sedative-hypnotics are potentially addictive and gradually lose their effectiveness as one builds up tolerance to them." "Sedative-hypnotics are not as effective as the antidepressant medications for treating sleep disturbances." "Sedative-hypnotics are not permitted for use in patients with substance abuse disorders."

"Sedative-hypnotics are potentially addictive and gradually lose their effectiveness as one builds up tolerance to them." (Sedative-hypnotics are potentially addictive and should be used with caution by clients with a history of substance abuse. Tolerance can easily develop).

A client began taking lithium for the treatment of bipolar disorder approximately 1 month ago and asks why he has gained 12 lbs. since then. Which is the appropriate nursing response? "Weight gain is a common, but troubling side effect. Let's talk about some strategies for safely improving your nutrition and exercise habits." "I'm surprised you have gained; weight loss is the typical pattern when taking lithium." "Your weight gain is more likely related to food intake than medication." "There's not much you can do about the weight gain. It's better than being emotionally unstable, though.."

"Weight gain is a common, but troubling side effect. Let's talk about some strategies for safely improving your nutrition and exercise habits." (Weight gain is a common side effect of lithium therapy. To ensure compliance the nurse should help the client develop strategies to prevent excessive weight gain.)

A client is diagnosed with bipolar disorder: manic episode. Which nursing intervention would be implemented to achieve the outcome of "Client will gain 2 lbs. by the end of the week?" 1. Provide client with high-calorie finger foods throughout the day. 2. Accompany client to cafeteria to encourage adequate dietary consumption. 3. Initiate total parenteral nutrition to meet dietary needs. 4. Teach the importance of a varied diet to meet nutritional needs.

1. Provide client with high-calorie finger foods throughout the day.

A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family members report that the client has experienced anorexia, insomnia, and recent job loss. Which nursing diagnosis should a nurse prioritize? 1. Risk for suicide R/T hopelessness 2. Anxiety: severe R/T hyperactivity 3. Imbalanced nutrition: less than body requirements R/T refusal to eat 4. Dysfunctional grieving R/T loss of employment

1. Risk for suicide R/T hopelessness

A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights and a 12-lb. weight loss over the past 2 weeks. Which should be this client's priority nursing diagnosis? 1. Knowledge deficit R/T bipolar disorder AEB concern about symptoms 2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss 3. Risk for suicide R/T powerlessness AEB insomnia and anorexia 4. Altered sleep patterns R/T mania AEB insomnia for the past 3 nights

2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss

A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate (Lithobid) because of excessive weight gain. In order to increase adherence, which medication should a nurse anticipate that a physician may prescribe? 1. Sertraline (Zoloft) 2. Valproic acid (Depakote) 3. Trazodone (Desyrel) 4. Paroxetine (Paxil)

2. Valproic acid (Depakote)

A client began taking lithium carbonate (Lithobid) for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing response? 1. "That's strange. Weight loss is the typical pattern." 2. "What have you been eating? Weight gain is not usually associated with lithium." 3. "Weight gain is a common, but troubling, side effect." 4. "Weight gain only occurs during the first month of treatment with this drug."

3. "Weight gain is a common, but troubling, side effect."

A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the client outcomes in the exhibit? The following are the outcomes: 1. Maintains nutritional status. 2. Interacts appropriately with peers. 3. Remains free from injury. 4. Sleeps 6 to 8 hours a night. 1. 2, 1, 3, 4 2. 4, 1, 2, 3 3. 3, 1, 4, 2 4. 1, 4, 2, 3

3. 3, 1, 4, 2

A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior? 1. "Rates mood 8/10. Exhibiting looseness of association. Euphoric." 2. "Mood euthymic. Exhibiting magical thinking. Restless." 3. "Mood labile. Exhibiting delusions of reference. Hyperactive." 4. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

4. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients? 1. "Treatment is compromised when clients can't sleep." 2. "Treatment is compromised when irritability interferes with social interactions." 3. "Treatment is compromised when clients have no insight into their problems." 4. "Treatment is compromised when clients choose not to take their medications."

4. "Treatment is compromised when clients choose not to take their medications."

A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The client's spouse asks the nurse how Zyprexa works. Which is the appropriate nursing response? 1. "Zyprexa in combination with Eskalith cures manic symptoms." 2. "Zyprexa prevents extrapyramidal side effects." 3. "Zyprexa increases the effectiveness of the immune system." 4. "Zyprexa calms hyperactivity until the Eskalith takes effect."

4. "Zyprexa calms hyperactivity until the Eskalith takes effect."

A client diagnosed with bipolar disorder has been taking lithium carbonate (Lithobid) for one year. The client presents in an emergency department with a temperature of 101F (38C), severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms? 1. Symptoms indicate consumption of foods high in tyramine. 2. Symptoms indicate lithium carbonate discontinuation syndrome. 3. Symptoms indicate the development of lithium carbonate tolerance. 4. Symptoms indicate lithium carbonate toxicity.

4. Symptoms indicate lithium carbonate toxicity.

A client was recently admitted to the inpatient unit after a suicide attempt and is prescribed a selective serotonin reuptake inhibitor (SSRI). The nurse teaches the client about serotonin syndrome. Which of the following is a symptom of serotonin syndrome? Blood pressure lability Change in mental status Priapism Myoclonus

Priapism (Impotence may be a side effect of an SSRI antidepressant.).

A client was recently admitted to the inpatient unit after a suicide attempt. He has been placed on a tricyclic antidepressant. In terms of medication, what steps should be taken to maintain the client's safety when he is discharged? Encourage him to increase fluid intake to counteract the common side effect of diarrhea. Provide a 6-month supply to ensure long-term compliance. Provide a 1-week supply of medication, with refills authorized only after he visits his provider. Educate him not to eat foods that contain tyramine.

Provide a 1-week supply of medication, with refills authorized only after he visits his provider. (To prevent suicide through overdose on antidepressant medication, a limited supply should be given at discharge . Clients with a history of depression who have a lifting of mood may have an increased risk for suicide. Giving the client a larger supply of antidepressant medication increases the chances of overdose.).

The nurse is assessing a client who has a diagnosis of schizophrenia and takes an antipsychotic agent daily. Which finding requires further nursing assessment? Temperature of 101oF Weight gain of 8 lbs. in 2 months Respirations of 22 beats/minute Excess salivation

Temperature of 101oF (A fever could be one of the first signs of an infection caused by reduced immunity from agranulocytosis secondary to antipsychotic medication.)

After threatening to jump off of a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first? a. "Are you currently thinking about harming yourself?" b. "Why do you want to harm yourself?" c. "Have you thought about the consequences of your actions?" d. "Who is your emergency contact person?"

a. "Are you currently thinking about harming yourself?" (The nurse should first assess the client for current harmful or suicidal thoughts to minimize risk of harm to the client and provide appropriate interventions. A suicidal client is experiencing a psychiatric emergency. The crisis team's priority is to assess client safety.)

An aging client with chronic schizophrenia takes a beta-adrenergic blocking agent (propranolol) for hypertension and an antipsychotic. Given the combined side effects of these drugs, what teaching should the nurse provide? a. "Rise slowly when you change position from lying to sitting or sitting to standing." b. "Watch your diet and try to engage in some regular physical activity." c. "Wear sunscreen and try to avoid midday sun exposure." d. "Make sure you concentrate on taking slow, deep, cleansing breaths."

a. "Rise slowly when you change position from lying to sitting or sitting to standing." (The antipsychotic medication can cause orthostatic hypotension that could be magnified by the propranolol.)

A newly admitted client asks, "I'm here to get some rest." Which is the most appropriate nursing response? Why do we need a unit schedule? I'm not going to these groups. a. "The purpose of group therapy is to learn and practice new coping skills." b. "Group therapy is mandatory. All clients must attend." c. "Group therapy is optional. You can go if you find the topic helpful and interesting." d. "Group therapy is an economical way of providing therapy to many clients concurrently."

a. "The purpose of group therapy is to learn and practice new coping skills." (The nurse should explain to the client that the purpose of group therapy is to learn and practice new coping skills.)

A client at the mental health clinic tells the case manager, "I can't think about living another day, but don't tell anyone about the way I feel. I know you are obligated to protect my confidentiality." Which case manager response is most appropriate? a. "The treatment team is composed of many specialists who are working to improve your ability to function. Sharing this information with the team is critical to your care." b. "Let's discuss steps that will resolve negative lifestyle choices that may have increased your suicidal risk." c. "You seem to be preoccupied with self. You should concentrate on hope for the future." d. "This information is secure with me because of client confidentiality."

a. "The treatment team is composed of many specialists who are working to improve your ability to function. Sharing this information with the team is critical to your care." (The most appropriate response by the case manager is to explain that sharing the information with the treatment team is critical to the client's care. This case manager's priority is to ensure client safety and to inform others on the treatment team of the client's suicidal ideation.)

What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client? a. Clarify personal attitudes, values, and beliefs b. Obtain thorough assessment data c. Determine the client's length of stay d. Establish personal goals for the interaction

a. Clarify personal attitudes, values, and beliefs (The most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client is to clarify personal attitudes, values, and beliefs. Understanding one's own attitudes, values, and beliefs is called self-awareness.)

To promote self-reliance, how should a psychiatric nurse best conduct medication administration? a. Encourage clients to request their medications at the appropriate times. b. Refuse to administer medications unless clients request them at the appropriate times. c. Allow the clients to determine appropriate medication times. d. Take medications to the client's bedside at the appropriate times.

a. Encourage clients to request their medications at the appropriate times. (The psychiatric nurse promoting self-reliance would encourage clients to request their medications at the appropriate times. Nurses are responsible for the management of medication administration on inpatient psychiatric units, but nurses must work with clients to encourage self-reliance and responsibility, which may result in independent decision-making, leading to medication adherence.)

Which medication does not require periodic blood-level monitoring? a. Paxil (paroxetine). b. Depakote (valproic acid). c. Clozaril (clozapine). d. Eskalith (lithium carbonate).

a. Paxil (paroxetine). (Blood level monitoring is usually not done for Paxil (paroxetine).

A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness? a. Schizophrenia spectrum disorder b. Major depressive disorder c. Body dysmorphic disorder d. Parkinson's disease

a. Schizophrenia spectrum disorder

Without authorization, a nurse administers an extra dose of narcotic tranquilizer to an agitated client. The nurse's coworker observes this action but does nothing for fear of retaliation. What is the ethical interpretation of the coworker's lack of involvement? a. Taking no action is still considered an unethical action by the coworker. b. Taking no action releases the coworker from ethical responsibility. c. Taking no action is advised when potential adverse consequences are foreseen. d. Taking no action is acceptable, because the coworker is only a bystander.

a. Taking no action is still considered an unethical action by the coworker.

Which client action should a nurse expect during the working phase of the nurse-client relationship? a. The client gains insight and incorporates alternative behaviors. b. The client establishes rapport with the nurse and mutually develops treatment goals. c. The client explores feelings related to reentering the community. d. The client explores personal strengths and weaknesses that impact behavioral choices.

a. The client gains insight and incorporates alternative behaviors. (The nurse should expect that the client will gain insight and incorporate alternative behaviors during the working phase of the nurse-client relationship.)

Which information suggests that caution is necessary in prescribing a benzodiazepine to an anxious client? a. The client has a history of alcohol dependence. b. The client has a history of schizophrenia c. The client has a history of hypertension d. The client has a history of diabetes mellitus.

a. The client has a history of alcohol dependence. (Tolerance and psychological dependence are common problems with the long-term use of benzodiazepines. They should be used cautiously with clients who have a history of substance abuse.)

A nurse reviews the laboratory data of a client suspected of having the diagnosis of major depressive episode. Which lab value would potentially rule out this diagnosis? a. Thyroid-stimulating hormone (TSH) level of 25 U/mL b. Potassium (K+) level of 4.2 mEq/L c. Sodium (Na+) level of 140 mEq/L d. Calcium (Ca2+) level of 9.5 mg/dL

a. Thyroid-stimulating hormone (TSH) level of 25 U/mL (A diagnosis of major depressive episode may be ruled out if the client's lab results reveal a TSH level of 25 U/mL. Normal levels of TSH range from 2 to 10 U/mL. High levels of TSH indicate low thyroid function. The client's high TSH value may indicate hypothyroidism, which can lead to depressive symptoms. The DSM-5 criteria for the diagnosis of major depressive episode states that this diagnosis must not be attributable to the direct physiological effects of another medical condition.)

A Native American client is admitted to an emergency department (ED) with an ulcerated toe, secondary to uncontrolled diabetes mellitus. The client refuses to talk to a physician unless a shaman is present. Which nursing intervention is most appropriate? a. Try to locate a shaman who will agree to come to the ED. b. Explain to the client that "voodoo" medicine will not heal the ulcerated toe. c. Ask the client to explain what the shaman can do that the provider can not d. Inform the client that refusing treatment is a client's right.

a. Try to locate a shaman who will agree to come to the ED.

A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, "I heard about something called a monoamine oxidase inhibitor (MAOI). Can't my doctor add that to my medications?" Which is an appropriate nursing response? a. "This combination of drugs can lead to delirium tremens." b. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis." c. "That's a good idea. There have been good results with the combination of these two drugs." d. "The only disadvantage would be the exorbitant cost of the MAOI."

b. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis." (The nurse should explain to the client that combining an MAOI and fluvoxamine, an SSRI, can lead to a life-threatening hypertensive crisis. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches, with occasional photophobia, sensations of choking, palpitations, and a feeling of "dread.")

A nursing instructor is teaching about case management. What student statement indicates that learning has occurred? a. "Case management is a method used to achieve independent client care." b. "Case management provides coordination of services required to meet client needs." c. "Case management exists mainly to facilitate client admission to needed inpatient services." d. "Case management is a method to facilitate physician reimbursement."

b. "Case management provides coordination of services required to meet client needs." (The instructor evaluates that learning has occurred when a student defines case management as providing coordination of services required to meet client needs. Case management strives to organize client care so that specific outcomes are achieved within allotted time frames.)

According to Maslow's hierarchy of needs, which situation on an inpatient psychiatric unit would require priority intervention by a nurse? a. A client rudely complaining about limited visiting hours b. A client exhibiting aggressive behavior toward another client c. A client stating that no one cares d. A client verbalizing feelings of failure.

b. A client exhibiting aggressive behavior toward another client

What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive episode? a. The attention during the assessment is beneficial in decreasing social isolation. b. Depression can generate somatic symptoms that can mask actual physical disorders. c. Physical health complications are likely to arise from antidepressant therapy. d. Depressed clients avoid addressing physical health and ignore medical problems

b. Depression can generate somatic symptoms that can mask actual physical disorders. (The nurse should determine that a client with a diagnosis of major depressive episode needs a full physical health assessment, because depression can generate somatic symptoms that can mask actual physical disorders.)

What should be the priority nursing action during the orientation (introductory) phase of the nurse-client relationship? a. Acknowledge the client's actions, and generate alternative behaviors. b. Establish rapport and develop treatment goals. c. Attempt to find alternative placement. d. Explore how thoughts and feelings about this client may adversely impact nursing care.

b. Establish rapport and develop treatment goals. (The priority nursing action during the orientation phase of the nurse-client relationship should be to establish rapport and develop treatment goals. Rapport implies feelings on the part of both the nurse and the client, based on respect, acceptance, a sense of trust, and a nonjudgmental attitude. It is the essential foundation of the nurse-client relationship.)

A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, "I can't function any longer under all this stress." Which type of crisis is the client experiencing? a. Maturational/developmental crisis b. Psychiatric emergency crisis c. Anticipated life transition crisis d. Traumatic stress crisis

b. Psychiatric emergency crisis (The nurse should determine that the client is experiencing a psychiatric emergency crisis. Psychiatric emergencies occur when crisis situations result in severe impairment, incompetence, or an inability to assume personal responsibility.)

A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment? a. Peer pressure b. Structured programming. c. Visitor restrictions

b. Structured programming. (The milieu, or therapeutic community, provides the client with structured programming that may be missing in the home environment. The therapeutic community provides a structured schedule of activities in which interpersonal interaction and communication with others are emphasized. Time is also devoted to personal problems and focus groups)

Which potential client should a nurse identify as a candidate for involuntary commitment? a. The client living under a bridge in a cardboard box. b. The client threatening to commit suicide. c. The client who never bathes and wears a wool hat in the summer. d. The client who eats waste out of a garbage can.

b. The client threatening to commit suicide.

A client takes a maintenance dosage of lithium carbonate for a bipolar disorder. She has come to the community health clinic, stating that she "has had the flu for over a week." She describes her symptoms as coughing, runny nose, chest congestion, fever, and gastrointestinal upset. Her temperature is 100.9°F. What situation does the nurse anticipate? a. She has probably developed a tolerance to the lithium carbonate. b. The lithium carbonate may be producing a symptom of toxicity. c. She has stopped taking her lithium carbonate. d. She has consumed some foods high in tyramine.

b. The lithium carbonate may be producing a symptom of toxicity. (Blurred vision, gastrointestinal upset, and tinnitus are symptoms of lithium toxicity).

Which statement about the tricyclic group of antidepressant medications is accurate? a. They should not be given with anti-anxiety agents. b. Their full therapeutic potential may not be reached until 4 weeks. c. Strong or aged cheese should not be eaten while taking them. d. They may cause hypomania or recent memory impairment.

b. Their full therapeutic potential may not be reached until 4 weeks. (It may take several weeks for tricyclic medications to reach their full therapeutic effect.)

A client who has been newly diagnosed with depression is beginning tricyclic antidepressant therapy. The nurse has just completed teaching with this client. Which statement by the client indicates the need for further education? a. "I will continue to take this medication even if the symptoms have not subsided." b. "I may experience drowsiness or dizziness while taking this medication." c. "I do not need to quit smoking." d. "I will stop drinking alcohol now that I am taking this medication."

c. "I do not need to quit smoking." (Clients should not smoke when taking this medication, as smoking increases the metabolism of tricyclic antidepressants.)

Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse-client relationship? a. "I can't bear the thought of leaving here and failing." b. "I might have a hard time working with you, because you remind me of my mother." c. "I really don't want to talk any more about my childhood abuse." d. "I'm not sure that I can count on you to protect my confidentiality."

c. "I really don't want to talk any more about my childhood abuse."( The nurse should identify that the client statement, "I really don't want to talk any more about my childhood abuse," reflects that the client is in the working phase of the nurse-client relationship. The working phase includes overcoming resistance behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues.)

The nurse educator is lecturing a group of nursing students on depression in adolescents. Which statement indicates that teaching has been effective? a. "Adolescents are not likely to suffer from depression." b. "Depressed adolescents always seek immediate treatment." c. "Many symptoms are attributed to normal adjustments of adolescents." d. "Suicide is not common among depressed adolescents."

c. "Many symptoms are attributed to normal adjustments of adolescents." (Many symptoms of depression may attributed to normal adjustments of adolescents.)

During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, "I'm here for my heart, not my head problems." Which is the nurse's best response? a. "It is just a routine part of our assessment. All clients are asked these same questions." b. "Why are you concerned about these types of questions? c. "Psychological factors, like excessive stress, have been found to affect medical conditions." d. "We can skip these questions, if you like. It isn't imperative that we complete this section."

c. "Psychological factors, like excessive stress, have been found to affect medical conditions."

Which medication is most likely to be prescribed for the extrapyramidal side effects of antipsychotic medications? a. Diazepam (Valium) b. Amitriptyline (Elavil) c. Benztropine (Cogentin) d. Methylphenidate (Ritalin)

c. Benztropine (Cogentin)

An angry client on an inpatient unit approaches a nurse stating, "Someone took my lunch! People need to respect others, and you need to do something about this now!" The nurse's response should be guided by which basic assumption of milieu therapy? a. Conflict should be avoided at all costs on inpatient psychiatric units. b. Conflict should be resolved by the nursing staff. c. On inpatient units, every interaction is an opportunity for therapeutic intervention. d. Conflict resolution should only be addressed during group therapy.

c. On inpatient units, every interaction is an opportunity for therapeutic intervention. (The nurse's response should be guided by the basic assumption that every interaction is an opportunity for therapeutic intervention.

A psychiatrist prescribes a MAOI for a client. When teaching the client about the effects of tyramine, which foods will the nurse caution the client to avoid? a. Potato chips and Diet Coke b. Bagels with cream cheese and tea c. Pepperoni pizza and red wine d. Apple pie and coffee

c. Pepperoni pizza and red wine

A client diagnosed with major depressive episode hears voices commanding self-harm. Which should be the nurse's priority intervention at this time? a. Obtaining an order for locked seclusion until client is no longer suicidal b. Conducting 15-minute checks to ensure safety c. Placing the client on one-to-one observation while continuing to monitor suicidal ideations d. Encouraging client to express feelings related to suicide

c. Placing the client on one-to-one observation while continuing to monitor suicidal ideations (The nurse's priority intervention when a depressed client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideations. By providing one-to-one observation, the nurse will be able to interrupt any attempts at suicide. )

The nurse should identify that a realistic long-term outcome for this client is to return to previous adaptive levels of functioning. The nurse should work with the client to develop attainable outcomes that reflect immediacy of the situation. a. Ineffective coping R/T situational crisis AEB powerlessness b. Anxiety R/T fear of failure c. Risk for self-directed violence R/T hopelessness. d. Risk for low self-esteem R/T loss events AEB suicidal ideations

c. Risk for self-directed violence R/T hopelessness. (The priority nursing diagnosis for this client is risk for self-directed violence R/T hopelessness. Nurses should prioritize diagnoses and outcomes based on potential safety risk to the client or others.)

A nursing instructor is teaching about the Community Health Centers Act of 1963. What was a deterring factor to the proper implementation of this act? a. Many prospective clients did not meet criteria for mental illness diagnostic-related groups. b. Zoning laws discouraged the development of community mental health centers. c. States could not match federal funds to establish community mental health centers. d. There was not a sufficient employment pool to staff community mental health centers.

c. States could not match federal funds to establish community mental health centers. (A deterring factor to the proper implementation of the Community Mental Health Centers Act of 1963 was that states could not match federal funds to establish community mental health centers. This act called for the construction of comprehensive community mental health centers to offset the effect of deinstitutionalization, the closing of state mental health hospitals.)

1. A nurse is implementing care within the parameters of tertiary prevention. Which nursing action is an example of this type of care? a. Teaching an adolescent about pregnancy prevention b. Teaching an adolescent about pregnancy prevention c. Teaching a client to cook meals, make a grocery list, and establish a budget d. Teaching a client about his or her new diagnosis of bipolar disorder

c. Teaching a client to cook meals, make a grocery list, and establish a budget (The nurse who teaches a client to cook meals, make a grocery list, and establish a budget is implementing care within the parameters of tertiary prevention. Tertiary prevention consists of services aimed at reducing the residual effects that are associated with severe and persistent mental illness. It is accomplished by preventing complications of the illness and promoting rehabilitation that is directed toward achievement of maximum functioning.)

A nurse administers 100 percent oxygen to a client during and after electroconvulsive therapy treatment (ECT). What is the rationale for this procedure? a. To prevent increased intracranial pressure resulting from anoxia b. To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation c. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles d. To prevent blocked airway, resulting from seizure activity

c. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles (The nurse administers 100 percent oxygen during and after ECT to prevent anoxia resulting from medication-induced paralysis of respiratory muscles.)

A nurse admits an older client with memory loss, confused thinking, and apathy. A psychiatrist suspects a depressive disorder. What is the rationale for performing a mini-mental status exam? a. To rule out bipolar disorder b. To rule out schizophrenia c. To rule out neurocognitive disorder d. To rule out personality disorder

c. To rule out neurocognitive disorder (A mini-mental status exam should be performed to rule out neurocognitive disorder. The client may be experiencing reversible dementia, which can occur as a result of depression.)

A client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which blood cell counts would reveal a potentially fatal side effect of this medication? a. WBCs, <3,000/mm3; granulocytes, >2,000/mm3 b. WBCs, >3,000/mm3; granulocytes, >2,000/mm3 c. WBCs, <3,000/mm3; granulocytes, <2,000/mm3 d. WBCs, >3,000/mm3; granulocytes, <2,000/mm3

c. WBCs, <3,000/mm3; granulocytes, <2,000/mm3 (These blood test results are indicative of agranulocytosis).

A client was admitted with major depression that was a single episode and moderate. During her stay, she was started on Prozac (fluoxetine) at 40 mg orally every day. The nurse's discharge teaching should include all of the following except: a. Continue taking Prozac as prescribed. You will continue to see improvement over the next few weeks. b. Make sure that you follow up with outpatient psychotherapy as you and the social worker have arranged. c. You should avoid foods with tyramine, including beer, beans, processed meats, and red wine d. You may be able to discontinue the medication within 6 months to 1 year, but only under a doctor's supervision. However, there is a chance of recurring episodes.

c. You should avoid foods with tyramine, including beer, beans, processed meats, and red wine).

A client on an inpatient unit angrily says to a nurse, "Peter is not cleaning up after himself in the community bathroom. You need to address this problem." Which is the appropriate nursing response? a. "I'll talk to Peter and present your concerns." b. "Why are you overreacting to this issue? c. "You should bring this to the attention of your treatment team." d. "I can see that you are angry. Let's discuss ways to approach Peter with your concerns."

d. "I can see that you are angry. Let's discuss ways to approach Peter with your concerns." (The most appropriate nursing response involves restating the client's feeling and developing a plan with the client to solve the problem. According to Skinner, every interaction is an opportunity for therapeutic intervention to improve communication and relationship-development skills.)

A client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which potentially fatal side effect will the nurse teach the client about? a. Akinesia b. Dystonia c. Akathisia d. Agranulocytosis

d. Agranulocytosis (Agranulocytosis is a potentially fatal disorder in which the client's white blood cell count drops to extremely low levels, placing the client at great risk for infections.

As part of discharge teaching, which guideline regarding lithium therapy will the nurse plan to include? a. Consume at least 2500 to 3000 mL of fluid per day. b. Maintain a consistent sodium intake. c. Avoid excessive use of beverages containing caffeine. d. All of the above

d. All of the above (Caffeine, a stimulant, should be limited in clients with mania. Adequate sodium and fluid intake is necessary to prevent lithium toxicity).

A client has been diagnosed with major depression and is prescribed imipramine (Tofranil). What information specifically related to this class of antidepressants will the nurse plan to include in client and family education? a. The medication may cause dry mouth. b. The medication may cause nausea. c. The medication may cause photosensitivity. d. All of the answers are correct.

d. All of the answers are correct.

When intervening with a married couple experiencing relationship discord, which nursing action reflects an intervention at the secondary level of prevention? a. Teaching assertiveness skills in order to meet assessed needs. b. Supplying the couple with guidelines related to marital seminar leadership c. Teaching the couple about various methods of birth control. d. Counseling the couple related to open and honest communication skills

d. Counseling the couple related to open and honest communication skills ( a reflection of a nursing intervention at the secondary level of prevention. Secondary prevention aims at minimizing symptoms and is accomplished through early identification of problems and prompt initiation of effective treatment.)

If a client demonstrates transference toward a nurse, how should the nurse respond? a. Promote safety and immediately terminate the relationship with the client. b. Encourage the client to ignore these thoughts and feelings. c. Immediately reassign the client to another staff member. d. Help the client to clarify the meaning of the relationship, based on the present situation.

d. Help the client to clarify the meaning of the relationship, based on the present situation. (The nurse should respond to a client's transference by clarifying the meaning of the nurse-client relationship based on the present situation. Transference occurs when the client unconsciously displaces feelings about a person from the past toward the nurse.)

Which statement should a nurse identify as correct regarding a client's right to refuse treatment? a. Clients can refuse pharmacological but not psychological treatment. b. Clients can refuse any treatment at any time. c. Clients can refuse only electroconvulsive therapy (ECT). d. Professionals can override treatment refusal by an actively suicidal or homicidal client.

d. Professionals can override treatment refusal by an actively suicidal or homicidal client.

An older client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). A nurse assesses that the client is experiencing restlessness, tachycardia, diaphoresis, and tremors. Which complication should a nurse suspect, and why? a. Neuroleptic malignant syndrome; caused by ingestion of two different serotonin reuptake inhibitors (SSRIs) b. Neuroleptic malignant syndrome; caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) c. Serotonin syndrome; possibly caused by ingestion of an SSRI and an MAOI d. Serotonin syndrome; possibly caused by ingestion of two different SSRIs

d. Serotonin syndrome; possibly caused by ingestion of two different SSRIs (The nurse should suspect that the client is suffering from serotonin syndrome; possibly caused by ingesting two different SSRI's (sertraline and paroxetine). Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor.)

A client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which signs and symptoms of a potentially fatal side effect will the nurse teach the client about? a. Blurring vision and muscular weakness b. Tremor, shuffling gait, and rigidity c. Fine tremor, tinnitus, and nausea d. Sore throat, fever, and malaise

d. Sore throat, fever, and malaise (symptoms of agranulocytosis, which is a potentially fatal disorder in which the client's white blood cell count drops to extremely low levels. This places the client at great risk for infections).

A nurse assesses a client suspected of having the diagnosis of major depressive episode. Which client symptom would rule out this diagnosis? a. The client is disheveled and malodorous. b. The client refuses to interact with others and isolates self in room c. The client is unable to feel any pleasure. d. The client has maxed-out charge cards and exhibits promiscuous behaviors.

d. The client has maxed-out charge cards and exhibits promiscuous behaviors. (The nurse should assess that a client who has maxed-out credit cards and exhibits promiscuous behavior is exhibiting signs of mania. The DSM-5 criteria state that there must never have been a manic episode or a hypomanic episode to meet the criteria for the diagnosis of major depressive episode.)

A geriatric client is confused and wandering in and out of every door. Which scenario reflects the least restrictive alternative for this client? a. The client is placed in seclusion. b. The client is placed in a geriatric chair with tray. c. The client is placed in soft Posey restraints. d. The client is monitored by an ankle bracelet.

d. The client is monitored by an ankle bracelet.

A client's wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client's therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapist's recommendations? a. The therapist is using an interpersonal approach. b. The client has an alteration in neurotransmitters. c. It is routine practice to remind clients about nutrition, exercise, and rest. d. The client is susceptible to illness because of effects of stress on the immune system.

d. The client is susceptible to illness because of effects of stress on the immune system.

A client comes to a psychiatric clinic experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What long-term outcome is realistic in addressing this client's crisis? a. The client will change his type-A personality traits to more adaptive ones by one week. b. The client will list five positive self-attributes. c. The client will examine how childhood events led to his overachieving orientation. d. The client will return to previous adaptive levels of functioning by week six.

d. The client will return to previous adaptive levels of functioning by week six. (The nurse should identify that a realistic long-term outcome for this client is to return to previous adaptive levels of functioning. The nurse should work with the client to develop attainable outcomes that reflect immediacy of the situation.).

A client diagnosed with major depressive disorder asks, "What part of my brain controls my emotions? a. The occipital lobe governs perceptions, judging them as positive or negative. b. The parietal lobe has been linked to depression. c. The medulla regulates key biological and psychological activities. d. The limbic system is largely responsible for one's emotional state.

d. The limbic system is largely responsible for one's emotional state.

A client is experiencing a psychotic episode. He is in good physical health but has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Which antipsychotic medication would be contraindicated for the client? a. Risperidone, because it exacerbates symptoms of depression. b. Clozapine, because it is incompatible with desipramine. c. Haloperidol, because it is used only in elderly patients. d. Thioridazine, because of cross-sensitivity among phenothazines.

d. Thioridazine, because of cross-sensitivity among phenothazines.( There may be cross-sensitivity among phenothiazines. Both prochlorperazine (Compazine) and thioridazine (Mellaril) are phenothiazines. Since the client has a known allergy to one phenothiazine, he should not be given another phenothiazine.)

A new mother is concerned about her ability to perform her parental role. She is quite anxious and ambivalent about leaving the postpartum unit. To offer effective client care, a nurse should be familiar with what information about this type of crisis? a. This type of crisis is precipitated by unexpected external stressors. b. This type of crisis is precipitated by preexisting psychopathology. c. This type of crisis is precipitated by an acute response to an external situational stressor. d. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

d. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client. (The nurse should understand that this type of crisis is precipitated by normal life-cycle transitions that overwhelm the client. Reassurance and guidance should be provided as needed, and the client should be referred to services that can provide assistance.)