psych mental health

10. A nurse working on an acute mental health unit is admitting a patient who has major depressive disorder. Which of the following is the highest nursing priority? a. Placing the patient on one to one observation b. Assisting the patient to perform ADLs c. Encouraging the patient to participate in counseling d. Teaching the patient about medication side effects

a

13. The nurse has just completed an admission assessment for a male patient with depression obtaining the following data: 20 lb. weight loss in 6 weeks, fatigue, trouble sleeping, overwhelming sadness, disheveled, no eye contact, and hasn't showered or shaved in 2 days. Which of the following outcomes is the priority for this patient? The patient will: a. Eat at least 50% of meals and snacks in 2 days b. Report improved feelings of self-worth in 1 week c. Sleep at least 8 hours in 4 days d. Takes a shower and shave in 2 days

a

14. A patient with mania is demonstrating hypersexual behavior, blowing kisses to other patients, making suggestive remarks, and removing some articles of clothing. Which of the following interventions is indicated at this time? a. Accompany patient to her room to get dressed b. Put patient in seclusion for her own protection c. Tell other patients to ignore the behavior since it is harmless d. Tell the patient that the behaviors have to stop right now

a

15. The community mental health nurse is facilitating a discussion group for families whose relatives have been diagnosed with a depressive disorder. The nurse teaches family members that which of the following is most helpful when someone is depressed? a. Encouraging the person to continue in treatment b. Ignoring the symptoms of depression c. Lowering the expectation that improvement can occur d. Urging the person to look on the bright side

a

16. Using cognitive therapy, which of the following would be involved in the treatment of a patient with depression? a. Challenging negative thinking b. Encouraging analysis of dreams c. Prescribing antidepressant medications d. Using ultraviolet light therapy

a

24. A patient with mania is not eating sufficient food. Which approach by the nurse would probably be best in trying to get this patient to eat more? a. Offer finger foods while patient moves about b. Convey tactfully that patient has to eat more c. Ignore patient's not eating at this time d. Sit with patient until meal is eaten

a

34. A patient admitted to the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if found. This belief is an example of which of the following? a. Delusion of persecution b. Delusion of reference c. Delusion of external control d. Delusion of grandeur

a

4. With of the following is the most serious side effect of the atypical antipsychotic clozapine (Clozaril)? a. Agranulocytosis b. Anticholinergic effects c. Postural hypotension d. Pseudoparkinsonism

a

43. Which of the following responses is most typical when a patient is withdrawing from cocaine? a. Depression b. Euphoria c. Hallucinations d. Insomnia

a

48. A patient with a diagnosis of antisocial personality disorder and hospitalized in a psychiatric unit would have difficulty with which of the following aspects of milieu therapy? a. Accepting and respecting others b. Maintaining reality orientation c. Maintaining self-care activities d. Verbalizing wants and needs

a

49. The nurse sets limits in a therapeutic manner by doing which of the following? a. Identifying limits in a clear manner without apologizing b. Negotiating limits appropriate for the individual patient c. Providing various reasons that limits are important d. Substituting persuasive statements for specific limits

a

5. A nurse is caring for a patient with Generalized Anxiety Disorder and is experiencing severe anxiety. Which of the following communication statements by the nurse is appropriate? a. Tell me how you're feeling right now b. You should focus on positive things in your life to decrease your anxiety c. Why do you believe you are experiencing this anxiety d. Let's discuss the medication your provider is prescribing to decrease your anxiety

a

8. The patient who is depressed, refused to eat stating, "How can I eat when my intestines are being chewed up by worms?" Which of the following would be the most appropriate, initial response to this statement? a. That must be a frightening feeling for you b. You really need to try and eat anyway c. You are intelligent and know that is not possible d. Not eating will only make you feel worse

a

21. A patient has just been admitted to the psychiatric unit with a diagnosis of Major Depressive Disorder. Which of the following assessments would the nurse expect to see? Chose all that apply. a. Slumped posture b. Delusional thinking c. Feelings of despair d. Energy early in AM but worse later in PM e. Anorexia

a,b,c,e

4. Specific nursing interventions for the patient with Post Traumatic Stress Syndrome (PTSD) are listed below. Chose all that apply a. Refer to post-trauma support groups and substance abuse groups b. Validate with patient that event was very stressful c. Help patient adopt attitude of survivor rather than victim d. Do not force exposure to phobic object unless part of treatment e. Validate with patient that event was very stressful

a,b,c,e

23. A female patient is admitted with Major Depressive Disorder and repeatedly makes negative statements about herself. Which of the following interventions promotes positive self-esteem in the patient? a. Teach assertive communication skills b. Give recognition when patient completes a goal or task c. Refuse to communicate with patient if negative statements persist d. Spend time with patient using a nonjudgmental, accepting approach

a,b,d

10. A community mental health nurse is working with a family who has a member with chronic persistent mental illness. The family expresses concern about the patient's ability to properly manage a small inheritance received from a relative. The nurse would respond to the family's concerns using which of the following legal principles as a basis? a. ANA code of ethics b. Autonomy c. Confidentiality d. Beneficence

b

12. A nurse is caring for a patient with bipolar disorder. The patient states, "I am very rich, and I feel I must give my money to you." Which of the following is an appropriate communication response by the nurse? a. "Why do you feel the need to give money away?" b. I am here to provide care and cannot accept this from you c. "I can request that your case manager discuss appropriate charity options with you." d. 'You should know that giving away your money is inappropriate."

b

17. A patient with manic behavior is creating considerable chaos in a day treatment program with dominating and manipulative behavior. Which of the following nursing interventions is most appropriate? a. Allow the peer group to intervene b. Describe acceptable behavior and set realistic limits with the patient c. Recommend the patient be hospitalized for treatment d. Tell patient his behavior is not appropriate

b

19. A nurse is teaching a patient and her family about the most significant factor in the causation of depression. Which of the following causative factors would the nurse emphasize? a. Brain structure abnormalities b. Chemical imbalance in the brain c. Social environment d. Recessive gene transmission

b

22. An acutely depressed patient isolates herself in her room and just sits and stares into space. Which of the following is the best example of a therapeutic communication approach with this patient? a. Do you like to exercise b. Come with me. I will go with you to group therapy c. "Would you like to go to group therapy or play cards in the dayroom?" d. "Why do you stay in your room all the time?'

b

26. Which of the following examples would best illustrate a delusion of reference? a. "The FBI is plotting to steal my invention." b. The TV news announcer is talking about me c. "The night shift nurse doesn't like me." d. "The food is being poisoned."

b

27. The mother of a patient with schizophrenia calls the nurse at the partial program and says, "I just can't stand this anymore. I don't know why he can't snap out of this." The nurse encourages the mother to come to the mental health center to talk based on what rationale? a. Mother has to discipline her son more effectively. b. Mother who receives support for herself will be more helpful to her son c. Mother needs to understand how she contributes to son's problems. d. Mother should refrain from any anger response toward her son.

b

29. In caring for a patient with schizophrenia, the nurse should be concerned primarily with which outcome or goal? a. Assist family to understand patient's needs b. Develop a mutual trusting relationship c. Clarify and reinforce reality d. Increase social interaction

b

35. The nurse is interviewing a patient on the psychiatric unit. The patient tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes these behaviors as symptoms of the patient's illness. What is the most appropriate nursing intervention for this behavior? a. Ask patient to describe his physical symptoms b. Ask patient to describe what he is hearing c. Administer his prn Xanax. d. Call the physician for further orders.

b

39. When a nurse revises a patient's nursing care plan based on the patient's responses that show evidence that goals were not attained, the phase of the nursing process being implemented is: a. Planning b. Evaluation c. Assessment d. Intervention

b

41. The nurse is teaching the concept of drug tolerance when presenting a program of drug and alcohol awareness to a community group. Which of the following situations could be used to illustrate this concept? a. A patient has a measured blood alcohol level above the legal limit after drinking a 6 pack of beer. b. A patient demonstrates good performance on screening tests for intoxication, i.e., walking a straight line, yet has elevated blood alcohol levels c. A patient arrives in the ER following a car accident and has slurred speech and incoordination. d. A patient is able to drink at night and yet can get up and go to work in the morning.

b

46. Which of the following responses would most likely describe an antisocial patient when asked about his past behavior? a. Im too ashamed to talk about the situation b. Its not really my fault as to what happened c. "I'm so sorry I hurt so many people." d. "I don't recall that particular incident."

b

47. A patient has the psychiatric diagnosis of borderline personality disorder. The nurse would expect to assess for which of the following symptoms in relation to the expression of anger: a. Controlled, subtle anger b. Explosive, intense anger c. Inability to recognize anger d. Physical symptom substitution of anger

b

6. A patient with major depression and suicidal ideas suddenly demonstrates a cheerful affect and increased goal-direction. The patient tells the nurse, "I know what I'm going to do now." The nurse would analyze this behavior as which of the following? a. Evidence of depression ending b. Possible covert suicide cues c. Evidence of confused thinking d. Possible psychomotor agitation

b

9. The nurse applying psychodynamic theory in working with patients with a depressive disorder, understands that the causation of depression can best be described as which of the following? a. Aggressive impulses that are activated by relationship difficulties b. Experience of loss along with self-criticism, guilt and anger turned inward c. Increased stress that is denied and suppressed but affects moods d. Physiological alterations in substances in the causing mood symptoms

b

1. Sertraline (Zoloft), an SSRI is prescribed for a patient with major depression. After 1 week the patient complains of no improvement and refuses to take the medication from the nurse. Which of the following would be the nurse's first response? a. Charting the patient's refusal to take this dose b. Informing the patient's physician about noncompliance c. Informing the patient that 2 to 4 weeks is needed for a positive response d. Reviewing the patient's symptoms on admission and current complaints

c

1. The nurse is working with a patient with a dissociation disorder and having difficulty expressing feelings. Which of the following interventions would be most helpful? a. Distraction b. Systemic desensitization c. Journaling d. Reality orientation

c

11. A nurse is interviewing a 25 year-old patient who has a diagnosis of dysthymia. Which of the following assessments should the nurse expect? a. There are wide fluctuations in mood b. The report of a minimum of five clinical findings of depression c. The presence of symptoms for at least 2 years d. The presence of an inflated sense of self esteem

c

20. A patient in an acute psychiatric hospital tells a nurse about his plans for suicide. The primary nursing intervention is to: a. Allow patient time alone for reflection b. Encourage patient to use problem solving c. Follow agency protocol for suicide precautions d. Stimulate the patient's interest in activities

c

25. A man calls the crisis hotline and says he is going to kill himself. If you could ask him only one question, what would be the most important to ask? a. What makes you say that b. Who is in your support system c. How will you carry out your plan d. What will you accomplish by taking your life

c

3. Specific nursing interventions for the patient with Obsessive Compulsive Disorder (OCD) are listed below. Which one is not therapeutic? a. Encourage use of diary to record instances of OCD and feelings at the time b. Allow time for rituals initially c. Once in treatment no rituals are permitted d. Encourage limit setting as part of treatment plan

c

31. Which of the following interactions would be most therapeutic for a patient experiencing auditory hallucinations? a. Place patient in quiet room b. Offer prn med for agitation c. Tell the patient you do not hear the voices d. Encourage patient to evaluate the voices

c

32. A patient with schizophrenia exhibit extreme withdrawal behavior. The nursing intervention that would be most appropriate to establish a relationship would be: a. Allow time for medications to act prior to establishing contact. b. Encourage attendance at all group activities on unit. c. Keep interactions short, frequent, and non-demanding d. Focus on in depth one to one therapeutic conversations

c

33. The patient with schizoaffective disorder has been prescribed both Risperdone (Risperdal) and Valproic Acid (Depakote). When the patient asked the nurse to explain the reason for this drug combination, the best response is: a. "Risperdone makes your moods calmer and Valproic Acid prevents tight muscles. b. "This combination is good for people who have problems like yours." c. Risperidone improves your thinking and valproic acid stabilizes your moods d. "This is an old combination of drugs that keeps people thinking and feeling in balance."

c

36. When a patient suddenly becomes aggressive and violent on the unit, which of the following approaches should be implemented initially by the staff? a. Provide physical activities to relieve the patient's pent-up anxieties. b. Administer prn chlorpromazine to keep the patient calm. c. Call a violence code per hospital protocol to control the situation safely d. Convey to the patient that his behavior is unacceptable.

c

38. A patient with schizophrenia repeatedly says to the nurse, "No moley, jandu! No moley jandu." The nurse understands that this is called: a. Echolalia b. Concrete thinking c. Neologisms d. Paleologic thinking

c

45. The nurse assesses the following withdrawal symptoms: restlessness, nausea and vomiting, anxiety, fever, muscle aches, sweating, and insomnia. The patient has abused which of the following substances? a. Amphetamines b. Cocaine c. Opiates d. Phencyclidine

c

1. The certified clinical specialist or nurse practitioner of psychiatric nursing performs which of the following functions not performed by the psychiatric basic level registered nurse? a. Case management and health promotion b.Counseling and establishing nursing diagnosis c.Health teaching and milieu therapy d.Psychotherapy and prescribing medications

d

18. According to biological theory, the individual with depression has a deficiency in which of the following neurotransmitters? a. Tyramine and thyroxin b. GABA and acetylcholine c. Cortisone and epinephrine d. Serotonin and norepinephrine

d

28. Which of the following behaviors would cause the nurse to suspect that a patient is experiencing auditory hallucinations? a. Anger at the nurse b. Avoidance of other patients c. Making obscene gestures d. Laughing or talking to self

d

30. A patient with schizophrenia is referred to the day program for Social Skills Training. The nurse would expect which of the following treatment methods to be used? a. Cognitive reframing b. Insight promotion c. Money management d. Role playing

d

37. What is the primary goal of family therapy for the patient and family living with schizophrenia? a. To discuss concrete problem-solving and adaptive coping behaviors b. To introduce the family to others with the same problem c. To keep patient and family in touch with the health care system d. To promote family interaction and understanding of the illness

d

42. A patient is receiving methadone 40mg po daily. The nurse recognizes that methadone maintenance can be used as an effective drug replacement for individuals addicted to: a. Amphetamines b. Barbiturates c. Hallucinogens d. Opiates

d

44. A client on a substance abuse unit tells the nurse, "I can handle drugs better than anyone I know. My wife is a nag. I haven't missed any more days at work than my co-workers." The nurse understands that the patient is using which defense mechanism? a. Reaction formation b. Displacement c. Projection d. Rationalization

d

7. A patient with bipolar disorder, manic type, exhibits poor attention span, overactivity, and flight of ideas. The nurse working within a milieu environment focus, will understand that this patient a. May become calm when limits are set b. May benefit from group activities c. Will provide leadership for the community group d. Will be easily stimulated by the environment

d

39. Exacerbations in schizophrenia do not affect the patient's long term mental health status. a. True b. False

false

47. Priority restructuring shifts the balance from stress-reducing to stress producing activities a. True b. False

false

40. The person with a borderline personality disorder uses the defense mechanism of splitting and projection which refers to polarized thinking about self and others. a. True b. False

true

45. Distress is negative draining energy resulting in anxiety, depression, and hopelessness a. True b. False

true

46. Journal keeping and writing are extremely useful ways of identity stressors. a. True b. False

true

48. Use of humor as a cognitive approach is a good example of how a stressful situation can be "turned upside down". a. True b. False

true

49. Assertiveness Training is a form of behavior therapy designed to help one stand up for oneself or empower oneself. a. True b. False

true

11. A patient comes to a mental health center in crisis after living in his car for one week. Recent stressors include a divorce, job loss and being evicted from his apartment due to failure to pay rent. Which of the following would be priority nursing intervention? a. Assist patient to obtain temporary shelter b. Discuss patient's feelings related to the loss c. Encourage patient to remain hopeful d. Refer patient to employment agency

a

14. A patient with a phobia is treated by flooding. The nurse understands that this method involves which of the following? a. Confronting patient with phobic object until anxiety decreases b. Helping patient recognize levels of anxiety associated with phobic object c. Subjecting patient to graded intensities of phobic object d. Teaching patient techniques to handle anxiety related to phobic object

a

16. While working with a patient, a nurse assists the client in feeling less alone and isolated. As a result, the patient begins to open up and talk about himself. The nurse has developed which of the following? a. Rapport b. Empathy c. Boundaries d. Closure

a

18. A patient says "it's been so long since I've been with my family." Which statement by the nurse is an example of restating? a. You say you haven't seen your family in a while b. Tell me when you last saw your family c. Go on. Tell me more d. When was the last time you saw your family?

a

2. Which of the following would be most important for the nurse to teach the patient taking the monoamine oxidase inhibitor phenelzine (Nardil)? a. The avoidance of foods and beverages containing tyramine b. The importance of maintaining regular follow-up visits c. The possible adverse effects, such as hypertension d. The rationale for the therapeutic effect of mood elevation

a

21. A nurse understands that the therapeutic effects of the typical antipsychotics medications are associated with which of the following neurotransmitter changes? a. Decreased dopamine b. Increased acetylcholine c. Stabilization of serotonin d. Stimulation of GABA

a

23. When leading a medication education group which method is least effective? a. Lecture b. Audiovisual materials c. Videotapes or CDs d. Handouts

a

35. Criteria for diagnosing a general anxiety disorder is based on persistent symptoms that include irritability, restlessness, feeling on edge, difficulty concentrating, easily fatigued etc. These symptoms must occur more days than not for at least: a. 6 months b. 9 months c. 12 months d. 3 months

a

37. A nurse is caring for a patient who has an acute stress disorder and is experiencing severe anxiety. Which of the following statements by the nurse is therapeutic and appropriate? a. Tell me how you are feeling right now b. You should focus on the positive things in your life to decrease your anxiety c. Why do you believe you are experiencing this anxiety d. Lets discuss the medications your provider is prescribing to decrease your anxiety

a

38. A nurse observes a patient who is pacing and wringing his hands. The patient says "I don't know why but I have been worried over a year that my son will die a horrible death." The nurse identifies that this finding is consistent with which of the following disorders? a. Generalized anxiety disorder b. Panic disorder c. Posttraumatic stress disorder d. Acute stress disorder

a

41. A nurse is assigned to a patient who has a domineering and demanding attitude, similar to the nurse's own mother. The nurse seeks out a colleague to share feelings about this situation. The nurse's action indicates: a. Appropriate self-awareness b. An inability to cope effectively c. Lack of knowledge about the patient's problems d. A need to change patient assignment

a

43. A patient hospitalized under the involuntary admission procedure wants to call a lawyer about a personal matter involving a lawsuit. Which of the following nursing interventions would be most appropriate? a. Allow phone call without seeking further information b. Ask patient questions about pending lawsuit c. Call the lawyer and explain that the patient is in the hospital d. Tell the patient the lawsuit would be best settled after discharge from the hospital

a

48. A patient arrives in the Emergency department with suspected alcohol intoxication. He fell at home hitting his head and sustaining some lacerations. The nurse, assessing the patient, asks him if he drinks alcohol. The patient responded that he didn't have a drink and "never touches the stuff." The patient is utilizing which defense mechanism? a. Denial b. Displacement c. Rationalization d. Regression

a

5. Which of the following nursing interventions would be the priority for a patient immediately after receiving an ECT (Electroconvulsive ) treatment? a. Assessing vital signs and reorienting restraints to prevent injury b. Applying restraints to prevent injury c. Administering previously held medications d. Encouraging intake of fluids and nutritious foods

a

35. In the mid-1990s, psychiatric in-patient admissions declined rapidly because of many changes in health care. Select all the changes in health care that apply from the list below: a. Improvements in managed care b. Insurance reimbursement limitations c. Development of a patient advocate d. Partial hospitalizations e. Cultural beliefs and values

a,b,d

36. The following stressors can predispose a person to Mental illness. Select those that apply: a. Alterations in brain neurotransmitter b. Immune system dysfunction c. Gastrointestinal malformation d. Chaotic environment e. Cardiac hyperplasia

a,b,d

34. Culturally diverse populations at risk for developing mental illness are listed below. Select those that apply: a. Immigrants b. Refugees c. Native Indians d. Poverty e. Homeless

a,b,d,e

12. A patient has a diagnosis of Obsessive-Compulsive Disorder. The nurse observes that morning rituals for the patient include washing the hair three (3) times, and washing the hands after each item of clothing is put on. The nurse analyzes the purpose of this behavior as follows: a. Avoid contamination by germs b. Increases sense of control c. Provides self-fulfillment d. Substitutes for violent outbursts

b

13. The nurse assesses that a number of parents in a child-care clinic have misconceptions about child development in relation to discipline. In which of the following types of groups would the nurse address this issue? a. An activity group b. An education group c. A self-help group d. A support group

b

14. A primary nurse encourages a patient to record her ongoing thoughts in a daily diary. The nurse then reviews the diary with the patient to identify thought patterns that contribute to feelings of depression and anxiety. Which of the following conceptual theories is the nurse using? a. Behavioral b. Cognitive c. Interpersonal d. Psychodynamic

b

2. 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 history. Before ordering a psychiatric consultation, the emergency room physician orders a history of blood tests as well as an MRI of the brain. The rationale for this is: a. To avoid a major lawsuit b. Medical conditions and physical illnesses; therefore, physical causes of symptoms must be ruled out c. Emergency room physicians are required to order a certain number of tests for the emergency room to be reimbursed d. To comply with hospital standards of care

b

24. The nurse understands that the primary gain experienced by the patient when giving in to a compulsion is which of the following? a. Attention from others b. Decreased in anxiety c. Disability payments d. Relief from responsibility

b

28. A patient says to the nurse, "I'm too much of a perfectionist. The therapist told me to be more realistic and focus on my strengths and past achievements." In this situation, the therapist is utilizing which therapeutic approach? a. Behavior modification b. Cognitive c. Developmental d. Psychoanalytical

b

29. Expression of anger that communicates feelings of anger directly and in a nonthreatening way to the person involved is termed: a. Passive anger b. Assertive anger c. Aggressive anger d. Violent anger

b

32. Frequent tantrums, arguments, self-harm like cutting, and early sexual activity are examples of a. Denial b. Acting out c. Reaction formation d. Suppression

b

32. The nurse providing appropriate care for a patient who has been involuntarily committed to a psychiatric unit is aware that the patient has the right to do which of the following? a. Right to confidentiality b. Right to least restrictive treatment c. Right to policy d. Right to refuse medications

b

36. A patient says she is experiencing increased stress because her significant other is pressuring her and her children to go live with him. "I love him but I'm not ready to do that." She also states that her significant other "keeps nagging at my oldest son, which makes me mad, since he's my son, not his". Which of the following should the nurse recommend to promote a change in the patient's situation? a. Learn to practice mindfulness b. Use assertive behavior techniques c. Exercise regularly particularly yoga d. Rely on the support of a close friend

b

38. A young patient, who is a mother for the first time, is very anxious about her new parenting role. With the nurse's encouragement, she has joined the new mothers support group at the local "Y". this represents an example of: a. Tertiary prevention b. Primary prevention c. Secondary prevention d. Therapeutic prevention

b

4. Which patient would a nurse determine to be the most likely candidate for involuntary commitment? It would be the patient who: a. Refuses to take the prescribed medication b. Is screaming in the streets disturbing the neighbors c. Refuses to participate in the planned therapy d. Is homeless and diagnosed with a mental disorder

b

40. The nurse should first discuss terminating the nurse-patient relationship with a patient during the: a. Working phase when the patient brings it up b. Orientation phase when a contract is established c. Working phase after patient shows some progress d. Termination phase when discharge plans are being made

b

41. A nurse is teaching a group of patients about antianxiety medications. The nurse would explain that benzodiazapines affect a brain chemical called a. Acetylcholine b. Gamma-aminobutyric acid (GABA) c. Norepinephrine d. Serotonin

b

42. A nurse is assessing a patient for recent stressful life events. The nurse recognizes that stressful life events are both a. Desirable and growth-promoting b. Positive and negative c. Undesirable and harmful d. Predictable and controllable

b

44. A patient has becoming increasingly unable to maintain self-care, with worsening symptoms of a chronic mental illness and refusal to accept psychiatric treatment. The community psychiatric nurse explains to the patient's family that a legal procedure can be initiated to empower another person to give consent for treatment. Which of the following would a court hearing legally establish about this patient? a. Autonomy b. Competence c. Sanity d. Rights

b

46. When a nurse establishes a therapeutic relationship with a patient, which of the following is the primary focus for the patient's care? a. The medical diagnosis b. The patients needs and problems c. The nursing diagnosis d. The patients social interaction skills

b

47. A nurse employed in a managed care system collaborates with the treatment team in monitoring a patient's progress from psychiatric inpatient care to a community-assisted living program. The role of the nurse can best be described as a. Advanced practice nurse b. Case manager c. Nurse manager d. Staff nurse

b

5. While working in a community mental health treatment center, a nurse overhears one of the receptionists saying that one of the patients is "really psych". Later in the day the nurse talks with the receptionist about the comment. This action by the nurse demonstrates an attempt to address which issue? a. Lack of knowledge b. Public stigma c. Aversive stimulus d. Self-stigma

b

7. A nurse observes that a m other is highly anxious when caring for her infant. Which of the following theorists would state that the mother's anxiety is communicated and internalized by the infant? a. Freud b. Sullivan c. Maslow d. Erikson

b

3. To prevent lithium toxicity from occurring, the nurse would teach the patient to maintain an adequate intake of a. Fruits and vegetables b. Low fat diet c. Protein and vitamin C d. Water and sodium

d

9. Which of the following assessments would the nurse expect to make on a patient who has an acute dystonic response to an antipsychotic medication? a. Motor restlessness and irritability b. Muscle spasm of face and neck c. Shuffling gait d. Urinary retention

b

13. The nurse is working with a patient with a dissociation disorder having difficulty expressing feelings. Which of the following interventions would be most helpful? a. Distraction b. Systematic desensitization c. Journaling d. Reality orientation

c

15. A patient with the diagnosis of social phobia tells the nurse she has fears of speaking or eating in public place. The nurse would know that if the patient is exposed to these phobic situations, which of the following would occur? a. Feelings of depression b. Mild anxiety c. Panic anxiety d. Refusal to speak or eat

c

19. Prior to development of his own theoretical framework, Sullivan embraced the psychological theory of Freud. Later his focus changed. Select the one concept that does not reflect Sullivan's theory. a. Anxiety is the chief disruptive factor from interpersonal conflict b. Relationship development is a major psychiatric intervention c. Anxiety is the chief disruptive factor from intrapersonal conflict d. Anxiety arises from one's ability to achieve interpersonal security

c

2. Which nursing intervention for a patient with panic levels of anxiety is not therapeutic? a. Maintain a calm, non-threatening manner b. Move patient to a quiet area with minimal stimuli c. Place patient in a private room by himself d. Encourage participate in relaxation exercises

c

20. A mother whose son was killed by a drunk driver channels her anger and energy into being the president of the local chapter of mothers against drunk drivers. The mother is utilizing which defense mechanism? a. Suppression b. Repression c. Sublimation d. Undoing

c

22. Anger that is internalized when dealing with the situation and contributes to the feelings of anger when communicating is termed: a. Aggressive b. Assertive c. Passive d. Transformed

c

25. A patient with post-traumatic stress disorder has symptoms of isolation and avoidance of feelings. He states, "I know that everyone thinks that I'm cold and unfeeling and that's OK with me. I really don't need to become involved with anyone after my experiences." The priority nursing diagnosis is: a. Ineffective Role Performance related to persistent fear of trauma b. Ineffective Coping related to use of defense mechanisms secondary to post-trauma c. Impaired social interaction related to self-perceived feelings of rejection by peers d. Distress related to feelings of guilt secondary to surviving traumatic event

c

25. Which behavior would be considered a "usual or expected" response during the early group therapy sessions? a. Showing up late for the session b. Being confrontational with nurse and other group members c. Rambling due to nervousness d. Bragging about sexual conquests

c

26. Which theorist was widely known for the belief that the cornerstone of all nursing care is the therapeutic relationship? a. Dorothea Dixon b. Linda Richards c. Hildegard Peplau d. Harry stack Sullivan

c

27. The nurse has a patient who seems like the nurse's sister, with whom the nurse has a close positive relationship. This phenomenon is best called: a. Transference b. Free association c. Countertransference d. Reaction formation

c

28. An action or behavior that results in a verbal or physical attack is termed: a. Anger b. Explosion c. Aggression d. Implosion

c

3. A young college student has decided to spend a semester studying abroad in Rome Italy as part of her college education. According to Campinha Bacote (2008), this is an example of a. Cultural awareness b. Cultural skill c. Cultural encounter d. Cultural holiday

c

30. The level of anxiety that prepares the individual for action by sharpening senses, increasing motivation for productivity, and increasing the perceptual field is termed: a. Severe anxiety b. Moderate anxiety c. Mild anxiety d. Panic anxiety

c

31. A patient who is hospitalized in an inpatient psychiatric unit tells the nurse, "those other people on this unit think im no good; that's why I can't gain any extra privileges." The nurse identifies the defense mechanism used here as a. Introjection b. Identification c. Projection d. Undoing

c

31. Which nursing intervention for a patient with panic levels of anxiety is not therapeutic? a. Maintain a calm, nonthreatening manner b. Move patient to a quiet area with minimal stimuli c. Place patient in a private room by himself d. Encourage participation in relaxation exercises

c

33. A risk factors that predispose a person to development of anxiety and anxiety disorders includes: a. Good ego strength b. Outgoing and social c. Younger people - late 20s d. Healthy relationships with parents

c

33. When communicating with a patient, which of the following would a nurse use to convey a positive body image? a. Sitting erect with back against chair b. Crossing the arms over the chest c. Sitting at the patient's eye level d. Keeping the feet flat on the floor with legs crossed

c

34. When can anxiety be considered a problem? a. When it motivates a person to study for a test b. When the person makes a doctor's appointment for routine examination c. When the person plans a trip to see the ailing grandmother d. When the person experiences sleep disturbances that interfere with the job

d

37. Which statement about mental illness is true? a. Mental illness is a matter of individual nonconformity with societal norms b. Mental illness is present when individual irritation and illogical behavior occurs c. Mental illness changes with culture, time in history, and the groups defining it d. Mental illness is evaluated solely by considering individual control over behavior and appraisal over reality

c

39. A nurse working on an acute mental health unit is caring for a patient who has posttraumatic stress disorder (PTSD). Which of the following is an expected finding? a. Obsessive need to talk about the traumatic event b. Exaggerated displays of emotion c. Recurring nightmares d. Diminished reflexes

c

43. Which statement about violence and nursing is accurate? a. Unless working in psychiatric mental health settings, nurses are unlikely to experience patient violence. b. Violence primarily affects inexperienced or unskilled staff that cannot calm their patients c. Emergency, psychiatric, and geriatric units have the highest rates of violence toward staff d. Since violence is so uncommon in nursing, there is no need to include it in a nursing curriculum.

c

45. Which of the following is the overall purpose of therapeutic communication? a. To analyze patient problems b. To elicit patient cooperation c. To facilitate a helping relationship d. To provide emotional support

c

8. The nurse could administer any of the following prn medications to a patient taking an antipsychotic (neuroleptic) and exhibiting tremors, drooling and shuffling gait. Which medication would not be appropriate for these side effects? a. Trihexyphenidyl (artane) b. Benztropine (Cogentin) c. Lamotrigine (Lamitcal) d. Biperden (Akineton)

c

A patient is taking Lithium Carbonate (Lithobid) for bipolar disorder. The nurse would teach the patient to call the doctor if experiencing the following signs of toxicity: a. Constipation and abdominal distention b. Decreased appetite and urinary retention c. Gait unsteadiness and tremors d. Fatigue and sleep difficulties

c

22. During the termination phase, a patient begins to raise old problems that already been resolved. Which nursing strategies would be most appropriate? Select all that apply a. Immediately stop the patient and inform him that the nurse is running the session b. Get angry at the patient and request he leave the group session c. Reassure the patient that they already covered these issues d. Review the patient strategies previously discussed to control the problem e. Ignore the issue and continue on with the session as planned

c, d

30. Ego defense mechanisms are mental processes first described by Freud (1946) and are used for the following purposes. Select all those that apply. a. Improve insight b. Protect family members c. Reduce anxiety d. Resolve a mental conflict e. Protect self esteem

c,d,e

10. The nurse teaches the patient with an anxiety disorder relaxation techniques and deep breathing exercises. Which of the following is the best rationale for use of these measures? a. Enables patient to avoid anxiety-provoking situations b. Increases patient understanding of reasons for symptoms c. Provides relief of excess thinking from anxiety d. Stimulates physiological relaxation response

d

11. A nurse and patient are talking comfortably about the patient's progress as well as feelings about the therapeutic relationship. Which phase of the therapeutic relationship is this typical of? a. Assessment b. Orientation c. Working d. Termination

d

12. The nurse group leader of a support group in a partial hospitalization community program notes that the group atmosphere has become negative and nonaccepting of members. Which of the following nursing interventions would be best? a. Asking members to be more accepting b. Ignoring this observation until the group decides to discuss it c. Selecting the most prominent offenders for private discussion d. Sharing this observation with the group

d

15. In planning care for a client, the nurse identifies privileges (e.g. telephone privileges, participation in recreational activities) to be used as rewards for desirable behavior. These privileges serve as a. A behavioral technique b. A negative reinforcer c. Operant conditioning d. A positive reinforcer

d

16. Which of the following questions would the nurse ask to evaluate that a patient has achieved the outcome, "Patient will manage anxiety without resorting to use of rituals." a. Does the patient perform self-care activities independently? b. Does the patient demonstrate ability to fulfill role responsibilities c. Can patient discuss appropriate use of medications d. Can patient refrain from compulsive behaviors when anxiety arises?

d

17. When preparing for the first clinical experience, the instructor discussed the many mental health disorders of patients that they could encounter on the units such as alcoholics, pedophiles, drug addicts, elderly abusers etc. The instructor then discusses students' feelings and fears about working with these patients. The primary reason for discussing personal beliefs is to: a. Practice reflective communication skills in a role-playing situation b. Assign the most compatible patients to the students c. Assess appropriateness of the setting for implementing nursing skills d. Become aware of possible barriers to developing therapeutic relationships

d

18. Which of the following symptoms would a nurse assess in a patient with generalized anxiety disorder? a. Flat affect, feelings of unreality b. Sadness, lack of hope, poor self esteem c. Suspicion, withdrawal from others, anger d. Restless, sleep disturbance, difficulty concentrating

d

19. Campinha Bacote developed a blueprint for proving culturally effective care. Bacote organized his research according to constructs. Which construct listed below is not part of his research? a. Cultural desire b. Cultural knowledge c. Cultural awareness d. Cultural events

d

20. Assessment of a patient who is taking haloperidol (Haldol) reveals a temperature of 102 degrees Fahrenheit, blood pressure of 180/92mm Hg, and profuse diaphoresis. Which of the following adverse effects would the nurse suspects? a. Agranulocytosis b. Extrapyramidal reaction c. Hepatotoxicity d. Neuroleptic malignant syndrome

d

21. A patient is showing no facial expression when engaging in a game with peers during an outing at a park. When documenting, the nurse describes the patient's affect as such: a. Blunt affect b. Restricted affect c. Broad affect d. Flat affect

d

23. The single best predictor of repeated violence in a patient is: a. A diagnosis of schizophrenia b. Alcohol addiction c. Personality disorder d. Known history of violence

d

24. A nurse is leading a group in which members are encouraged to discuss their feelings and emotions. The group session is just starting when a patient stomps into the room, slams a notebook on a table and sits down. The patient's affect is one of anger and hostility. Which strategy by the nurse would be most effective? a. Keep focus off the patient so he has time to deescalate his anger b. Suggest that the patient make a counseling appointment to address anger issues c. Ask the patient to leave the group until he learns how to control anger d. Encourage the patient to discuss his anger with the group

d

26. The nurse teaching stress management to a group of patients with an anxiety disorder emphasizes which of the following points about the best coping with anxiety? a. Avoiding anxiety is important b. Medications can help reduce anxiety c. Reducing guild is essential before reducing anxiety d. Self-help anxiety-reducing techniques can be learned

d

27. The technique of exposing a patient to a fear-producing sensation in a gradual manner is called a. Biofeedback b. Imaging c. Relaxation techniques d. Systemic desensitization

d

29. During the team treatment meeting, the therapist states that the patient's Major Depressive Disorder is due to unresolved issues from early childhood that affected the ego's ability to handle stress situations. The nurse understands that the theoretical perspective of the therapist is which of the following? a. Behavioral theory b. Cognitive theory c. Interpersonal theory d. Psychoanalytical theory

d

40. A variety of medications are used in the treatment of severe anxiety disorders. Which class of medication used to treat anxiety is potentially addictive? a. Beta blockers b. Antihistamines c. Selective serotonin reuptake inhibitors d. Benzodiazepines

d

42. Shortly after a voluntary admission to a psychiatric inpatient unit, a patient tells the nurse, "I don't know if I should be here. What will my family think?" Using reflection, which of the following is the most appropriate response from the nurse? a. Your family can visit you here, and they will see that this is a helpful place b. You think your family will be upset because you have a psychiatric problem c. There is still a stigma associated with mental illness. Hopefully, your family won't feel this way d. You are wondering if you made the right decision, and you are concerned about your family's reaction

d

44. Which theorists conducted research that showed children learn aggression by imitating others and that people repeat behavior that is rewarded? a. Psychodynamic b. Cognitive c. Menningerian d. Social theory

d

49. A patient who has tried several different antidepressant medications tells the nurse that the uncomfortable side effects make him want to stop taking any medications again. What is the nurse's best response? a. If you think that is best for you, I agree b. Antidepressants rarely have side effects c. All of our patients o antidepressant meds have some side effects, but manage okay d. Tell me what it is about the medication is most troubling

d

6. A nurse explains to a mental health technician that a patient's obsessive-compulsive behaviors are related to unconscious conflict between id impulses and the superego (or conscience). On which of the following theories does the nurse base this statement? a. Behavior theory b. Cognitive theory c. Interpersonal theory d. Psychodynamic theory

d

6. A nurse observes a patient pacing in the hall. Which of the following may the nurse say to help the patient recognize anxiety? a. "I guess you're worried about something, aren't you" b. "can I get you some medication to help calm you" c. "have you been pacing for a long time" d. "I notice that you're pacing. How are you feeling"

d

7. The nurse assessing a patient diagnosed with agoraphobia would expect which of the following behaviors? a. Panic anxiety when riding elevators b. Fear of eating in a public place c. Refusal to fly in an airplane d. Refusal to leave home

d

8. On a home visit to an older adult who has chronic heart failure, the nurse observes that a 6 month-old grandchild lies quietly in a crib, rarely smiles or babbles, and barely has basic needs attended. The patient is the primary care-giver for the infant because the mother is in rehab due to drug addiction. The nurse should: a. Advise purchasing appropriate toys designed for this age level b. Inform the patient that the child will be retarded if not stimulated c. Explain the need for the family to hire a mother's helper for the home d. Initiate a referral to an appropriate agency to assess the need for a home health aide

d

9. The patient tells the nurse, "I don't think you can help me. Every time I talk to you, I am reminded of my mother, and I hated her." The nurse should recognize this as a. Confrontation b. Countertransference c. Incongruence d. Transference

d