Psych Exam 1 Study Guide

Which nursing questions should be included in a holistic assessment?

"Are you taking any herbal supplements or other natural remedies?" "have you undergone any surgeries in the past?" "what gives you a sense of meaning and purpose in life?" "What methods do you use to cope with stress?" "Do you feel safe in your relationship?" "Do you have regular physical exams?"

You are caring for Maria, a patient who states that she has ghost sickness. Which is the appropriate nursing response?

"How does ghost sickness make you feel?"

A hospitalized client diagnosed with major depression tells the nurse, "I need my belt to keep my pants up. They keep falling down." Which respond should the nurse provide?

"I cannot provide your belt, but I will help you get some pants with an elastic waistband."

A nurse is providing teaching to a client has a new prescription for amitriptyline. Which of the following client statements indicates understanding of the teaching?

"I may feel drowsy for a few weeks after starting this medication."

When a family ask a nurse for reassurance about a clients condition, which of the following is an appropriate response?

"I understand you are concerned. Let's discuss what concerns you specifically."

A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone. Which of the following client statements indicates understanding of the teaching?

"I will be careful not to gain too much weight while taking this medication."

A nurse is caring for a client who is to begin taking fluoxetine for treatment of generalized anxiety disorder. Which of the following statements indicates the client understands the use of this medication?

"I will need to discontinue this medication slowly."

A nurse is discussing the use of methadone with a newly licensed nurse. Which if the following statements by the newly licensed nurse indicates a need for further teaching?

"Methadone increases the client's risk for acetaldehyde syndrome."

A nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. When collecting a medical history from the clients adult daughter, which of the following statements is the highest priority to report to the provider?

"My mother is currently on furosemide for her congestive heart failure."

You are performing a spiritual assessment on a patient. Which patient statement would indicate that there is an experiential concern in the patient's spiritual life?

"My sister will never forgive me for what I did."

A nurse is caring for a client who is on lithium therapy. The client states that he wants to take ibuprofen for osteoarthritis pain relief. Which of the following statements by the nurse is appropriate?

"Regular aspirin would be a better choice than ibuprofen."

A charge nurse is discussing mirtazapine with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding?

"This medication increases the release of serotonin and norepinephrine."

A nurse is providing teaching to a client who has a new prescription for carbamazepine. Which of the following should the nurse include in the teaching?

"This medication will help prevent seizures during alcohol withdrawal."

A charge nurse is discussing mental status examination's with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching?

"To assess remote memory, I should have the client repeat a list of objects."

A nurse is evaluating a client's understanding of a new prescription for clonidine. Which of the following statements by the client indicates an understanding of the teaching?

"While taking this medication, i should keep a pack of sugarless gum."

You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his mew psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic?

"You say you look forward to the meeting, but you appear anxious or unhappy."

James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, "Last night demons came to my room and tried to rape me." Which response would be the most therapeutic?

"You seem very upset; please tell me more about what you experienced last night."

You are caring for Georgia, who questions you about the safety of an herbal supplement. Which nursing response is true?

"Your primary care provider needs to be aware of any supplements you take."

A nurse is caring for a group of clients. Which of the following clients should a nurse consider for referral to an assertive community treatment (ACT) group?

A client who lives at home and keeps forgetting to come in for his monthly antipsychotic injection for schizophrenia.

A nurse is caring for several clients who are attending community based mental health programs. Which of the following clients should the nurse plan to visit first?

A client who says he is hearing a voice that tells him he is not worthy of living anymore

Primary prevention promotes health and prevents mental health problems from occurring. List an example.

A nurse leads a group for parents of toddlers, discussing normal toddler behavior and ways to promote healthy development.

Tertiary prevention focuses on rehabilitation and prevention of further problems in clients previously diagnosed. List an example.

A nurse leads a support group for clients who have completed a substance use disorder program.

Secondary prevention focuses on early detection of mental illness. List and example.

A nurse screens parents of children who have developmental disorders.

A nurse is discussing routine follow-up needs for a client who has a new prescription for valproic acid. The nurse should inform the client of the need for routine monitoring of which of the following?

AST/ALT and LDH

EPS or 1st gen. Antipsychotics

Acute dystonia, parkinsonism, Akathisia, tardive dyskinesia, neuroendocrine effects, neuroleptic malignant syndrome, orthostatic hypotension, sedation, seizures, severe dysrhythmias, sexual dysfunction, skin effects

A nurse is teaching a school-age child and his parents about a new prescription for lisdexamfetamine dimesylate. Which of the following is appropriate for the nurse to include in the teaching?

Administer the medication right before breakfast Monitor blood pressure while taking this medication

A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the nurse notes that the lithium blood level is 1.2 mEq/L. Which of the following is an appropriate action by the nurse?

Administer the next dose of lithium carbonate as scheduled.

Tyramine rich foods

Aged cheese, pepperoni, salami, avocados, figs, bananas, smoked fish, protein, some dietary supplements, some beers, and red wine.

Serotonin Syndrome (ATI- symptoms)

Agitation, confusion, disorientation, difficulty concentrating, anxiety, hallucinations, hyperreflexia, fever, diaphoresis, incoordination, tremors, abdominal pain, diarrhea Usually begins 2-72 hr after initiation of treatment

Blockage of dopamine transmission can lead to increased pituitary secretions of prolactin. In women, this hyperprolactinemia can result in:

Amenorrhea

Depression meds: TCAs

Amitriptyline, imipramine, doxepin, nortiptyline, amoxapine, trimipramine

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

Antipsychotics

A nurse is caring for a client who takes ziprasidone. The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change to which of the following medications?

Aripiprazole Clozapine

A friend recognizes that his depression has returned and tells you he is suicidal and afraid he will harm himself. He wishes to be hospitalized but does not have health insurance. Which of the following responses best meets his immediate care needs and reflects the options for care a person in his position typically has?

Assist him in obtaining an outpatient counseling appointment at an area community mental health center, and call him frequently to assure he is safe until his appointment occurs

Children and adolescent meds: norepinephrine selective reuptake inhibitor

Atomoxetine

A nurse in an acute mental health facility is caring for a client who has a severe mental illness and soon will be ready for discharge but still requires supervision much of the time. The clients wife works all day but is home by late afternoon. Which of the following should the nurse suggest as appropriate follow-up care?

Attending a partial hospitalization program

A nurse is conducting therapy with several clients and their families. Effective communication with clients and families is based on

Attending to verbal and nonverbal behaviors.

A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following should the charge nurse identify as being effectively treated by conventional antipsychotics?

Auditory hallucinations, delusions of grandeur, severe agitation

A nurse is teaching a client who had tobacco use disorder about the use of nicotine gum. Which of the following is appropriate to include in the teaching?

Avoid eating 15 min prior to chewing the gum

In traditional Chinese healing, which event occurs first?

Awakening

Shelly is having menstrual problems and ask you which supplement might be helpful for her. Which supplement should you suggest for the patient to discuss with her primary care provider?

Black cohosh

Nicotine withdrawal/abstinence medications

Bupropion Nicotine replacement therapy (gum, patch, nasal spray) Varenicline

Depression meds: atypical antidepressants

Bupropion, venlafaxine, duloxetine, desvenlafaxine, mirtazapine, reboxetine, trazodone

Anxiety meds: atypical anxiolytic/ nonbarbiturate anxiolytics

Buspirone

Alcohol withdrawal/abstinence medications: adjunct medications

Carbamazepine Clonidine Propanolol

Bipolar meds: mood stabilizing antiepileptic drugs

Carbamazepine, valproic acid, lamotrigine

Antipsychotics: 1st generation

Chlopromazine, haloperidol, fluphenazine, loxapine, thioridazine, thiothixene, perphenazine, trifluoperazine

Alcohol withdrawal/abstinence medications: benzodiazepines

Clordiazepoxide Diazepam Lorazepam Oxazepam

A nurse is caring for a client who takes paroxetine to treat posttraumatic stress disorder. The client states that he grinds his teeth during the night which causes pain in his mouth. The nurse should identify which of the following as possible measures to manage the clients bruxism?

Concurrent and ministration of buspirone use of a mouthguard changing to a different class of antianxiety medication

A nursing student new to psychiatric mental health nursing asks a peer what resources he can use to figure out which symptoms are present in a specific psychiatric disorder. The best answer would be

DSM-5

Children and adolescent meds: tricyclic antidepressants

Desipramine, imipramine, clomipramine

Anxiety meds: benzodiazepines sedative hypnotic Anxiolytics

Diazepam, lorazepam, chlordiazepoxide, clorazepate, oxazepam, clonazepam, alprazolam

Which Western cultural feature may result in establishing unrealistic outcomes for patients of other cultural groups?

Direct confrontation to solve problems

A nurse is assisting in the discharge planning for a client following alcohol detoxification. The nurse should anticipate prescriptions for which of the following medications to promote long-term abstinence from alcohol?

Disulfiram Naltrexone Acamprosate

Alcohol abstinence maintenance following detox medications

Disulfiram Naltrexone Acamprosate

A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom?

Drooling, involuntary arm movements, continual pacing

Anticholinergic effects (ATI- SE to TCA)

Dry mouth Blurred vision Photophobia Urinary hesitancy or retention Constipation Tachycardia

A nurse is teaching an adolescent client who has a new prescription for clomipramine for OCD. Which of the following should the nurse teach the client to minimize one of the adverse effects of his medication?

Eat a diet high in fiber

A nurse is working in a community mental health facility. Which of the following services are appropriate for clients to receive?

Educational groups, medication dispensing programs, individual counseling programs

You are assessing a 6-year-old patient. When assessing a child's perception of a difficult issue, which methods of assessment are appropriate?

Engage the child in a specific therapeutic game Ask the child to draw a picture Provide the child with an anatomically correct doll to act out a story Allow the child to tell a story

As a nurse assesses a new client, the nurse makes sure the door remains open. Which type of communication factor is this action?

Environmental

Which are the purposes of a thorough mental health nursing assessment?

Establish a rapport between the nurse and patient Assess for risk factors affecting the safety of the patient or others Identify the nurse's goals for treatment Formulate a plan of care

A nurse taught a client about important precautions associated with a new prescription. Afterward, the client accurately summarized major self-management strategies associated with this drug. Which step of the nursing process applies to the client's summarization?

Evaluation

Depression meds: ssri's

Fluoxetine, citalopram, escitalopram, paroxetine, sertraline, vilazodone

A nurse administering a benzodiazepine should understand that the therapeutic effect of benzodiazepines results from potentiating the neurotransmitter

GABA

One advantage of alternative medicine is that it

Gives the patient more control over his or her treatment

Children and adolescent meds: alpha-2 adrenergic agonist

Guanfacine, clonidine

A nurse is assessing a client four hours after receiving an initial dose of fluoxetine. Which of the following findings should the nurse report to the provider as an indication of serotonin syndrome?

Hallucinations diaphoresis agitation

Anna, a patient at the community mental health center, tends to stop taking her medications in intervals, usually leading to decompensation. Which of the following interventions would most likely improve her adherence to her medication?

Help Anna to understand her illness and share in decisions about her care

Select the example of tertiary prevention

Helping a person diagnosed with a serious mental illness learn to manage money

A patient states he has "given up on life." His wife left him, he was fired from his job, and he is four payments behind on his mortgage, meaning he will soon lose his house. Which nursing diagnosis is appropriate?

Hopelessness related to multiple losses

A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the following is a priority nursing action?

Identify the clients level of orientation

A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview. When conducting the interview, which of the following is the highest priority action?

Identify the clients perception of her mental health status.

Epidemiological studies contribute to improvements in care for individuals with mental disorders by:

Identifying who in the general population will develop a specific disorder

Which of the following nursing actions is appropriate in maintaining a safe therapeutic inpatient milieu?

Interact frequently with both individuals and groups on the unit Initiate and support group interactions via therapeutic groups and activities Provide and encourage opportunities to practice social and other life skills Assess patient belongings and the unit for any dangerous items that could be used by patients to hurt themselves or others

In which part of the nursing care plan would the nurse expect to find this statement: offer snacks and finger foods frequently.

Intervention

A charge nurse is conducting a class on therapeutic communication to a group of newly licensed nurses. Which of the following responses by the newly licensed nurse requires additional teaching regarding nonverbal communication?

Intonation

The criteria for admission to an in patient psychiatric unit is that the patient

Is in imminent danger of harming himself or others, or the patient cannot properly care for his basic needs and cannot protect himself from harm

In the DSM-5, a major change in how culture is viewed within each disorder is that

Issues related to culture and mental illness are now integrated into the discussion of each disorder rather than separately discussing culture bound syndromes

Julio is a 31-year-old patient who comes to your mental health outpatient clinic. Which of the following would alert you to the potential for somatization?

Julio presents with concerns involving headaches, dizziness, and fatigue

The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving

Lithium

Bipolar meds: mood stabilizers

Lithium carbonate

A nurse stops in to interview a patient on a medical unit and finds the patient lying supine in her bed with the head elevated at 10 degrees. Which initial response would most enhance the chances of achieving a therapeutic interaction?

Locate a chair or stool that would place the nurse at approximately the level of the patient

A 43-year-old female patient is brought to the emergency department with complaints of bizarre speech, visual hallucinations, and changes in behavior. She has no psychiatric history. Before ordering a psychiatric consultation, the emergency room physician orders a battery of blood tests as well as an MRI of the brain. The rationale for this is

Medical conditions and physical illnesses may mimic psychiatric illnesses; therefore, physical causes of symptoms must be ruled out

Which statement about mental illness is true?

Mental illness changes with culture, time in history, political systems, & the groups defining it

Opioids withdrawal/abstinence medications

Methadone Clonidine Buprenorphine

Children and adolescent meds: central nervous system stimulants

Methylphenidate, dexmethylphenidate, dextroamphetine, amphetamine mixture, lisdexamfetamine

A nurse is planning care for a client who has a mental health disorder. Which of the following is appropriate to include as a psychological intervention?

Monitor the client for adverse affects of medications.

A nurse is communicating with a newly admitted client. Which of the following is a barrier to therapeutic communication?

Offering advice

Which of the following patients may benefit from biofeedback? The one who:

Once to relax and promote well-being

A nurse is caring for a client who is taking phenelzine. For which of the following adverse affects should the nurse observe?

Orthostatic hypotension Headache

The nurse is planning care for a patient of the Latin American culture. Which goal is appropriate?

Patient will visit with spiritual healer once weekly.

Depression meds: MAOIs

Phenelzine, isocarboxazid, tranylcypromine, selegiline

Which nursing actions demonstrate cultural competence?

Planning mealtime around the patients prayer schedule, advising a patient to visit with the hospital chaplain, researching foods that A lacto-ovo- vegetarian patient will eat, providing time for a patients spiritual healer to visit

A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following in the teaching?

Polyuria Muscle weakness

The intervention that can be practiced by an advanced practice registered nurse in psychiatric mental health but cannot be practiced by a basic level registered nurse is

Psychotherapy

A nurse is caring for a school age child who has a new prescription for methylphenidate to treat ADHD. Which of the following should the nurse teach the client and family about this medication?

Remove the patch each day after 9 hr

A nurse working in a mental health clinic is providing teaching to a client who has a new prescription for diazepam for generalized anxiety disorder. Which of the following is appropriate for the nurse to include in the teaching?

Report confusion as a potential indication of toxicity.

A nurse is communicating with a client on the acute mental health facility. The client states, "I Can't sleep. I stay up all night." The nurse response, "you were having difficulty sleeping?" Which of the following therapeutic communication techniques is the nurse demonstrating?

Restating

A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should anticipate a prescription of which of the following medications?

Risperidone

Antipsychotics: 2nd generation

Risperidone, aripiprazole, asenapine, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, ziprasidone

Children and adolescent meds: antipsychotics atypical

Risperidone, olanzapine

A nurse assesses a newly admitted client diagnosed with Alzheimer's disease and a urinary tract infection. The nurse asks the client's siblings for information about the home environment, ADLs, & medications. What type of information source is the sibling?

Secondary

An occupational health nurse screens factory workers for depression. Which level of prevention is applicable to this activity?

Secondary

A nurse is teaching the parents of a child with a new prescription for imipramine and his parents about indications of toxicity. Which of the following should the nurse include in the teaching?

Seizures Agitation Irregular pulse

Venlafaxine exerts its antidepressant effect by selectively blocking the reuptake of

Serotonin & norepinephrine

Anxiety meds: ssri's

Sertraline, escitalopram, fluoxetine, fluvoxamine, paroxetine

Which team is broader?

Spirituality

Which of the following factors contribute to the movement of patients out of large state institutions and into community based mental health treatment?

States desire to save money by moving the patients to the community where the federal government would pick up more of the cost A system of coordinated and accessible community care was developed by forward thinking communities and offered more effective treatment The community mental health centers act of 1963 required states to develop and offer care in community based treatment programs Patient advocates exposed deficiencies of state hospitals & took legal actions, leading to the identification of a right to treatment in the least restrictive setting New psychotropic medications controlled symptoms more effectively allowing many patients to live and receive care in less restrictive settings

Which student behavior is consistent with therapeutic communication?

Summarizing the essence of the patient's comments in your own words

Caitlin is being seen in the outpatient clinic for medication follow-up. She tells you that she's taking St. John's wort to help her symptoms of depression. Your response to make sure to let her primary care provider know that she's taking St. John's wort is guided by what knowledge?

Taking St. John's wort along with an SSRI antidepressant may cause serotonin syndrome.

Levels of prevention strategies prominent in outpatient psychiatric care consists of primary prevention, secondary prevention, & ___________ prevention.

Tertiary

A nurse is working on promotion of healthy coping skills with older adult clients who had all previously been hospitalized for severe depression and are now in a residential care facility. The nurse should recognize that this is an example of which of the following?

Tertiary prevention

Which statement best describes a major difference between a DSM-5 diagnosis & a nursing diagnosis?

The DSM-5 is associated with present symptoms, whereas a nursing diagnosis considers past, present, & potential responses to actual mental health problems

A nurse is planning a peer group discussion about the diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Which of the following is appropriate to include in the discussion?

The DSM-V is used to identify mental health disorders The DSM-V establishes diagnostic criteria The DSM-V assists nurses in planning care The DSM-V indicates expected assessment findings

A nurse is told during change of shift report that a client is stuporous. When assessing the client, which of the following is an expected finding?

The client arouses briefly in response to a sternal rub.

A nurse is reviewing the medical record of a client who has a new prescription for bupropion for depression. Which of the following findings is the highest priority for the nurse to report to the provider?

The client had a motor vehicle crash last year and sustained a head injury

Allopathic, mainstream, or orthodox medicine; regular medicine; and biomedicine are terms that refer to

The conventional health care system

Which statement about nonverbal behavior is accurate?

The meaning of nonverbal behaviors varies with cultural and individual differences

A nurse is teaching a client who has a new prescription for imipramine how to minimize anticholinergic effects. Which of the following should the nurse include in the teaching?

Void just before taking the medication. Wear sunglasses Chew sugarless gum

A nurse is providing teaching to an adolescent who is to begin taking atomoxetine for ADHD. The nurse should instruct the client to monitor for and report which of the following indications if liver damage?

Yellowing skin Fever Malaise