Psychosocial

The nurse interviews the client's caregiver with the goal of gathering assessment data. Which of the following would most likely create a block between the nurse and the caregiver? "Caring for your mother and three children must be difficult." "Did you actually hit your mother with your hands?" "Tell me how your mother got bruised." "What is your mother's behavior like most of the tim

"Did you actually hit your mother with your hands?"

A client who previously made a suicide plan develops a no-suicide contract with the nurse. The most appropriate wording for this written contract is "I will not make a suicide attempt for the next week." "I will not kill myself until I call you." "I will not harm myself during the next 24 hours." "During the next 24 hours I will not, for any reason, accidentally or on purpose, try to kill myself."

"During the next 24 hours I will not, for any reason, accidentally or on purpose, try to kill myself."

Which of the following statements made by a family member indicates a need for further teaching about donepezil (Aricept)? "I will be giving my father this drug twice a day with meals to prevent stomach upset." "I better not give my father an antihistamine for his allergy unless his doctor says it's okay." "I know this drug will not cure my father's disease, but hopefully the symptoms will slow down for a while." "If this drug doesn't work, maybe one of the other ones will."

"I will be giving my father this drug twice a day with meals to prevent stomach upset."

Which of the following statements by a client would indicate possible low self-esteem? "I am in charge of my life and make good choices." "I'll never get the hang of this. I'm just too dumb, I guess." "Math has never been my strongest area, but if I study, I can learn this." "I'm not necessarily in agreement with that decision, but will try to work with it."

"I'll never get the hang of this. I'm just too dumb, I guess."

A client says to the nurse, "Why should I talk to you? Everybody knows talking doesn't help!" Which of the following is the nurse's best response? "Why don't you let me be the judge of that?" "Your doctor said talking is part of your therapy." "Why do you think that talking won't help?" "I'm here to talk with you about your concerns."

"I'm here to talk with you about your concerns."

Which of the following client statements indicates understanding of the nurse's teaching regarding antipsychotic medications? "I will be able to stop taking the drug as soon as I feel better." "If I feel sleepy I will stop taking the drug and call my health provider." "My symptoms can come back if I don't take the medication exactly as ordered." "These drugs are highly addictive and must be withdrawn slowly."

"My symptoms can come back if I don't take the medication exactly as ordered."

A client has taken two doses of fluoxetine for treatment of depression. A family member calls the client to tell the nurse that the client is very confused, sweating a lot, and "seeing things." Which of the following should the nurse communicate to the family member? "This is a common reaction with the first few doses of fluoxetine and will go away in a few hours." "This is a very serious reaction to the drug. The drug must be stopped immediately." "You primary care provider will need to prescribe an MAOI to control these symptoms." "We will need to increase the drug dose to control these side effects."

"This is a very serious reaction to the drug. The drug must be stopped immediately."

A 6-year-old has been diagnosed with enuresis after tests revealed no organic cause of bed wetting. The child's mother is upset and blames the problem on his father. "It's all his father's fault!" Your initial response is "Why do you say that?" "It's usually nobody's fault." "You seem really upset by this." "Why are you blaming his father?"

"You seem really upset by this."

Match each framework below with the appropriate description. (A) Encouragement of activities to increase client's self-esteem (B) Major depressive disorder, single episode (C) Client expression of feelings of worthlessness, such as: "I'm not as good as anyone else." (D) Chronically low self-esteem related to a history of abusive relationships as evidenced by expressions of shame (E) Client identification of one support person that he can call if he feels suicidal

(A) Nursing intervention (B) Medical DX (C)Nursing Assessment (D) Nursing Diagnosis (E) Nursing outcome criteria

Match the letter of the description with the personality disorder to which it corresponds. (A) Perfectionistic and orderly; demands control of every situation (B) Evades all social situations and fears rejections (C) Emotionally detached and disinterested in others; not interested in praise or criticism (D) Deceitful, manipulative, and unlawful; does not take responsibility for actions (E) Emotional with unstable identity and relationships; fears abandonment but uses splitting, which angers others (F) Needs to be the center of attention in all situations.

(A) Obsessive-Compulsive (B) Avoidant (C) Schizoid (D) Antisocial (E)Borderline (F) Histrionic

A 21-year-old male college student has become increasingly suspicious of his professor and fellow classmates. He has accused the professor of conspiring with two other classmates to get him expelled from school. The client is admitted to a psychiatric unit after telephoning and threatening to kill the professor and his classmates. The client tells the nurse, "They are all out to get me expelled. I think they are even trying to kill me. I have to stop them." What would be the most appropriate response by the nurse? "What makes you think they are out to get you expelled or to kill you?" "I find it hard to believe that your professor and classmates are out to get you expelled or to kill you." "It's not right to kill others even if they are out to get you expelled or want to kill you." "Your professor and classmates are not out to get you expelled or to kill you. Let's look at the facts."

...

A client receiving lithium carbonate (Lithobid) complains of loose, watery stools, and difficulty walking. The nurse would expect the serum lithium level to be which of the following? 0.7 mEq/L 1 mEq/L 1.3 mEq/L 1.8 mEq/L

1.8 mEq/L

Which of the following is an example of a client who requires emergency admission to a mental health facility? A client with schizophrenia who has frequent hallucinations. A client with symptoms of depression who attempted suicide a year ago. A client with psychosis who assaulted a homeless man with a metal rod. A client with bipolar disease who paces quickly down the sidewalk talking to himself.

A client with psychosis who assaulted a homeless man with a metal rod.

A nurse decides to put a client with psychosis in seclusion overnight because the unit is very short-staffed and the client frequently fights with other clients. This is an example of Beneficence. A tort. A facility policy. Justice.

A tort

A client is started on valproic acid (Depakote) for treatment of bipolar disorder. Which of the following laboratory studies should be monitored regularly? AST/ALT and LDH Creatinine and BUN WBC and granulocyte counts Serum sodium and potassium

AST/ALT and LDH

The client with schizophrenia has been started on medication therapy with haloperidol (Haldol). The nurse determines that the client is experiencing the intended effects of the mediation if which of the following client behaviors is observed? Decreased appetite and food intake. Taking sips of water for dry mouth. Presence of a fixed stare. Absence of delusional statements.

Absence of delusional statements.

While performing a mental status examination on a client, the nurse notices that the client's facial expression constantly appears angry. This information should be recorded as part of the client's Behavior Appearance Affect Thought process

Affect

Grief is best defined as A mild to severe depressive mood. An individual's response to a significant loss. Emotional trauma, such as denial or anger as a result of a loss. The display of abnormal feelings following a loss.

An individual's response to a significant loss.

A nurse is speaking with a client with schizophrenia when he suddenly seems to stop focusing on the nurse's questions and begins looking at the ceiling and talking to himself. The most appropriate intervention by the nurse at this time would be to Stop the interview at this point and resume later when the client is better able to concentrate. Ask the client, "Are you seeing something on the ceiling?" Tell the client, "You seem to be looking at something on the ceiling. I see something there, too." Attempt to distract the client from his hallucinations by continuing the interview without comment on the client's behavior.

Ask the client, "Are you seeing something on the ceiling?"

Effective communication with clients and families is based on Discussing topics the client feels comfortable talking about. Using silence to avoid unpleasant or difficult topics. Attending to verbal and nonverbal behaviors. Requiring the client to ask for feedback.

Attending to verbal and nonverbal behaviors.

A 5-year-old boy is brought to a mental health agency by his mother. The mother says the child is unable to sit through meals and is so easily distracted that he cannot even sit through a 30-min cartoon video. A night he gets up while the family is sleeping and wanders about the house. His kindergarten teacher is unable to handle him either and says he talks constantly during school. As the nurse assesses the child's behavior, she know that his problems are most consistent with the DSM-IV-TR diagnosis of Mental retardation Oppositional defiant disorder Rett's disorder Attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder

17. A client is admitted to an acute care mental health facility. The following medical diagnoses and psychosocial information are available at the time of admission: hypothyroidism, mild mental retardation, bipolar I diagnosis. The client's highest level of functioning from a global assessment of function (GAF) performed a year ago was 45. Today, the highest level of functioning on the same scale is 15. The client has been fighting with other clients frequently at the group home. How should the nurse enter all of this information into the multiaxial system of the DSM-IV-TR?Axis I: _____Axis II: ______Axis III: _____Axis IV: _____Axis V: _____

Axis I- Bipolar I diagnosis, Axis II- Mild Retardation Axis III- Hypothyroidism Axis IV- Has been fighting with other clients frequently at the group home Axis V- 15/45

When assess a client who states she has been dealing with constant anxiety for the past few weeks, the nurse's questions should be Be open-ended. Be reassuring. Minimize the client's anxiety. Be postponed until the anxiety has subsided.

Be open-ended.

A nurse is caring for a client diagnosed with paranoid schizophrenia, asthma, generalized anxiety disorder, and borderline personality disorder. Which of the following diagnoses should the nurse expect to find included in Axis II of this client's DSM-IV-TR axis diagnoses? Paranoid schizophrenia Asthma Generalized anxiety disorder Borderline personality disorder

Borderline personality disorder

A nurse tells colleague that she feels she is the only one who truly understands one of the clients, and that the client has been treated unfairly by the rest of the health care team. This situation is best described as Positive regard. Transference. Boundary blurring. A therapeutic nurse-client relationship.

Boundary blurring.

A client describes himself by saying, "I feel like I'm floating in the air looking down at myself, but it's not really me." This statement describes Derealization. Rationalization. Depersonalization. Repression.

Depersonalization.

Scenario:A 68 year old client accompanied by her grown daughter comes to the community mental health facility. She tells the nurse that her husband of 45 years died suddenly in a motor vehicle crash over one year ago. He ran into another car while drunk killing both himself and a child passenger in the other car. Since that time the client has been unable to continue any of her normal activities. She states she has been too tired even to keep the home clean and has experienced long bouts of crying every day. She relates that she feels angry at her husband for drinking and leaving her alone since he was "supposed to be the one to take care of me." The client relates that she only came to the mental health agency because her daughter was visiting from across the country and "made me come." The daughter says that the client seldom leaves the house and will not see her old friends. Which of the following stages of mourning describes this client's situation? Numbing Yearning and searching Disorganization and despair Reorganization

Disorganization and despair

A nurse has been told that a client's anxiety is at the panic level. The nurse would assess the client for which of the following? Dizziness, palpitations, and nausea Feelings of 'butterflies" in the stomach Feelings of fatigue and inability to remain awake Obsessive thoughts and compulsive behavior

Dizziness, palpitations, and nausea

Which of the following is an antidote for benzodiazepine overdose or toxicity? Buspirone (BuSpar) Hydroxyzine (Vistaril) Flumazenil (Romazicon) Naloxone (Narcan)

Flumazenil (Romazicon)

Which of the following medications, if given concurrently with lithium, could produce a toxic effect? Insulin Prednisone Digoxin (Lanoxin) Furosemide (Lasix)

Furosemide (Lasix)

A client who is depressed will not get out of his bed in an acute care mental health facility. The nurse's best action is to Give positive reinforcement for any activity. Withhold rewards as long as the person stays in bed. Structure the activities of daily living to require the client's active participation. Insist that the client change his attitude and get up.

Give positive reinforcement for any activity.

An 8-year-old child has not been attending school, and a community nurse makes a home visit to find out why. The child has been staying home to care for a preschool sibling while the parents, ages 25 and 26, work outside the home. The mother tells the nurse that she got married 7 years ago when she became unexpectedly pregnant with her oldest child. Which of the following factors is the child's life makes her vulnerable to abuse? She is the oldest sibling. She is female. Both parents work outside the home. Her birth was unplanned.

Her birth was unplanned.

The purpose of a group recently formed on an acute care mental health unit is to teach members self-management skills for their psychotropic medications. Three members of the group have decided that they want the group to plan future activities for the ward and are working hard to accomplish this goal. This is an example of which of the following? Group norm Group process Subgroup Hidden agenda

Hidden agenda

When a child feels responsible for the physical abuse inflicted, the nurse knows the child is experiencing which of the following? Fear. Hostage response. Anxiety response. Guilt.

Hostage response.

Which would be the safest living environment for a client who inflicted harm on a family member earlier in the day? In a local respite home With a family member in another state In an open-door seclusion room In a closed-door seclusion room

In a closed-door seclusion room

A client states that is he is depressed and anxious because he has had to deal with role reversal with his spouse due to the permanent loss of his job because of a disability. Which of the following therapies would be most beneficial for this client? Behavioral therapy Psychoanalysis Psychodynamic psychotherapy Interpersonal psychotherapy

Interpersonal psychotherapy

The nurse concludes that a client has agoraphobia after the client states a fear of which of the following? Spiders Being embarrassed in public Leaving the home Losing control

Leaving the home

A rape victim reports top the nurse that his family is not very supportive. Which of the following is a myth or belief about rape that might contribute to the family's response to the client? Rape is an act of aggression. No one asks to be raped. Men do not get raped. The majority of rapists are known to the victims.

Men do not get raped.

A client with schizophrenia experiences blurred vision. Which of the following types of receptor blockade result in this adverse effect? D₂ receptors Muscarinic receptors alpha₁ receptors H₁ receptors

Muscarinic receptors

A client is going to begin electroconvulsive therapy (ECT). The nurse knows that ECT is usually prescribed for individuals who have major depression. The nurse prepares a teaching plan keeping in mind that clients with major depression. Need to be treated with respect and dignity. Need to be brought to the treatment suite on a stretcher. Should have the procedure explained to them many times because they cannot understand or retain the information. Should not receive ECT.

Need to be treated with respect and dignity.

During an assessment, a client tells the nurse that she removes her old makeup and reapplies new makeup every hour or so, because she is sure she looks horrible. This behavior is consistent with Generalized anxiety disorder Panic disorder Obsessive-compulsive disorder Posttraumatic stress disorder

Obsessive-compulsive disorder

Which of the following is a barrier to therapeutic communication? Offering advice Reflecting meaning Listening attentively Giving information

Offering advice

The nursing care for a 4-year-old boy with severe autistic disorder is most likely to include Psychotropic medications. Social skills training. Play therapy. Group therapy.

Play therapy.

During a mental status examination, a client who is hospitalized states that she is in the hospital "to help out with the other patients." The nurse should record this information as Poor insight Decreased level of knowledge. Decreased judgment. Poor remote memory.

Poor insight

A 4-year-old girl who is a victim of a bomb blast that demolished the building which housed her daycare constantly builds block houses and blows them up. She also has nightmares frequently. Which of the following diagnoses is appropriate for the nurse to make regarding this child? Post-trauma response related to terrorist attack as evidenced by destructive behaviors and sleep disturbances. Explosive disorder related to dysfunctional personality as evidenced by destructive behaviors. Sleep disturbance related to emotional trauma as evidenced by nightmares. Ineffective individual coping related to internal stressors as evidence by destructive behaviors and nightmares.

Post-trauma response related to terrorist attack as evidenced by destructive behaviors and sleep disturbances.

The termination phase centers on issues related to Separation and loss Transference and counter-transference Anxiety and anger Testing new behaviors

Separation and loss

A nurse has denied a request from a client with borderline personality disorder. The client says, "The nurse on the evening shift would never be nasty to me like you are! You are a horrible, awful person!" This is an example of Regression. Splitting. A conversion disorder. Identification.

Splitting

A nurse assesses a client at a community mental health facility using the SAD PERSONS tool. This tool provides data related to a client's Current anxiety level. Problem-solving ability. Suicide potential. Mood disturbance.

Suicide potential.

A client tells a student nurse, "Don't tell anyone, but I hid a sharp knife under my mattress in order to protect myself from my roommate, who is always yelling at me and threatening me." Thinking about the principles of client confidentiality and veracity, the student makes a correct decision to Keep the client's communication confidential but talk to the client daily, using therapeutic communication to convince him to admit to hiding the knife. Keep the client's communication confidential, but watch the client and his roommate closely. Tell the client that this must be reported to health care staff because it concerns health and safety. Report the incident but do not inform the client of having the intention to do so.

Tell the client that this must be reported to health care staff because it concerns health and safety.

A rape victim states, "I never should have been out on the street alone at night." The most therapeutic response by the nurse is, "Your actions had nothing to do with what happened." "Blaming yourself only increases your anxiety and discomfort." "You believe this wouldn't have happened if you hadn't been out alone?" "You're right. You should not have been alone on the street at night."

You believe this wouldn't have happened if you hadn't been out alone?"