Mental Health Exam 1

When the nurse wishes to obtain assessment data about possible use of complementary substances, which query would have the best potential to yield accurate information?

"Tell me every pill and supplement you take regularly."

What is the most effective nursing intervention regarding the accurate assessment of sleep disorders?

A sleep diary

A client newly diagnosed with hypersomnolence asks about what medication will be prescribed to manage this disorder. The nurse will base his/her response based on what knowledge?

A stimulant will most likely be prescribed.

The client tells the nurse, "The CAM practitioner asked me to try to relax my mind and let go of my pain. She then passed her hands over me, beginning at my head and working down to my feet, never actually making physical contact with any part of my body. She told me that when the pain begins to bother me, I can relax and let the pain go." The client is describing which complementary therapy?

Therapeutic touch

A client says to the nurse, "I am going to stop taking these antidepressants and start using herbs. What is the most likely reason for the client's decision to use herbals?

They generally cost less.

What therapeutic communication technique is the nurse using by asking a newly admitted client, "Can you tell me what was happening to you that led to your being hospitalized here?"

Using an open-ended question

The nurse would address which of the following goals in attempting to establish a therapeutic nurse-client relationship? (Select all that apply.)

Facilitating communication of distressing thoughts and feelings Helping patients examine self-defeating behaviors and test alternatives Promoting self-care and independence Assisting patients with problem solving to help facilitate activities of daily living

Which severe mental illness has a prevalence of over 6% among the populace of the United States?

Major depressive disorder

A client reports insomnia and shares that a friend has recommended a nonprescription hormone product that can be purchased at the local health food store. The nurse suspects that the medication contains which component?

Melatonin

A client states, "I found out that I was in the section of the research study not actually taking the medicine. I don't understand that, because all my symptoms improved!" This reaction may be related to what concept?

Mind-body effect

Role-playing is associated with which type of psychotherapy?

Modeling

A 43-year-old client being seen in the mental health clinic states, "I have always been a practicing Jew, but in the past few months I am questioning everything. I just don't know if I believe in it anymore." Which of the following nursing diagnoses best describes the client's comment?

Spiritual distress

Which of the following is a herb commonly used to treat mild depression?

St. John's wort

A client reports to the nurse that falling asleep can often take hours. Which intervention should the nurse implement?

Teach the client how to do progressive relaxation.

Which phase of the nurse-client relationship may cause client anxieties to reappear and past losses to be reviewed?

Termination phase

During a clinical interview the client falls silent after disclosing that she was sexually abused as a child. The nurse should engage in which intervention in response to the client's silence?

Allow the client to break the silence.

The nurse caring for a client prescribed risperidone observes the client carefully for which possible side effects? (Select all that apply.)

A weight gain Daytime sleepiness Sexual dysfunction

The nurse planning care for a mentally ill client bases interventions on which concept?

Every client has a certain degree of resilience.

How can a nurse best differentiate whether an Asian client is demonstrating a mental illness after having attempted suicide?

Identify the client's culture's view regarding suicide.

Based on the current understanding of brain physiology, which neurotransmitter would be the expected target of medication prescribed to manage depression? (Select all that apply.)

Serotonin Norepinephrine Dopamine

Which theorist is associated with behavioral therapy?

Skinner

Which function is classified as a circadian rhythm?

Sleep cycle

The client makes the decision to sit about 5 feet away from the nurse during the assessment interview. The nurse can accurately make what assumption about the client's perception of the nurse?

They view the nurse as a stranger.

Which client statement demonstrates the mental health concept of resilience?

"Losing my job was hard but my skills will help me get another one."

A registered nurse has accepted a position as staff nurse on a psychiatric unit. Which statement made by the nurse requires additional instructions regarding the therapies provided on the unit?

"You will attend a psychotherapy group that I lead that will help you care for yourself."

When a nurse and client meet informally or have an otherwise limited but helpful relationship, what term is used to identify this relationship?

Therapeutic encounter

A client tells the nurse, "I just don't sleep more than 5 hours at night." The nurse assesses the client best for individual sleep requirements by asking which question?

"Do you usually feel rested and alert when you get up?"

A client reports symptomatology that supports the diagnosis of sleep paralysis. The nurse effectively assesses the client by asking which question?

"Have you ever fallen asleep while driving?"

The nurse appropriately assesses an obese, hypertensive, Type 2 diabetic client when asking which question?

"How much sleep do you usually get each night?"

Which statement by a patient who was educated about the importance of acquiring adequate sleep indicates a need for further teaching?

"I will be sure to try to get 8 hours of sleep every night, and 9 or 10 hours of sleep if I can."

One criterion for the diagnosis of primary insomnia is met when the client makes which statement?

"I've actually missed work because I'm too tired to go."

What client assessment data demonstrates parity related to mental health care?

A client's mental health coverage is equal to his/her medical/surgical coverage.

A 17-year-old client confides to the nurse that they have been thinking of ways to kill a peer. What response should the nurse give when the client states, "you have to keep it a secret because its confidential information"?

"Issues of this kind have to be shared with the treatment team and your parents."

A client diagnosed with a chronic sleep disorders begins to cry and states, "I can't keep going like this! I work in a bank and if I can't function correctly I'll lose my job. I just don't think I'll get better." Which statement provides a therapeutic response to the client's concerns?

"There is much hope for improvement through treatment. Let's talk about some strategies for your problems at work."

A cognitive therapist would help a client restructure the thought "I am stupid!" to which statement?

"What I did was stupid."

What is the usual time period that medications to treat insomnia are usually prescribed?

2 weeks

A client has been diagnosed with acute anxiety attacks. Which herbal remedy should the nurse caution the client to avoid because of its potential to damage the liver?

Kava

The client at the alcohol treatment center tells the outpatient group, "I went to an oriental medicine place to see if they could do something to help me stay away from alcohol. I ended up with tiny silver rods placed in various spots in my body. They twirled the rods, then removed them. So far I haven't had any cravings since I went there several days ago." The client is describing which integrative therapy?

Acupuncture

A chiropractic practitioner will explain to clients that chiropractic treatments are effective based on what information?

Adjustments put the spinal column in a normal position allowing improved energy flow.

Which alternative and complementary treatment modality involves the use of essential oils to release neurotransmitters in the brain?

Aromatherapy

Which communication techniques should the nurse use with a client who has been identified as having difficulty expressing thoughts and feelings?

Asking open-ended questions and seeking clarification

What is the premise underlying behavioral therapy?

Behavior is learned and can be modified.

According to current information what factor is associated with the most disabling mental disorders?

Biological influences

A nurse is asked to explain the difference between alternative and complementary therapy. The is the best response?

Complementary therapy is used in conjunction with conventional Western remedies, whereas alternative therapies replace conventional Western remedies.

A client asks which herbal tea would be good to drink at bedtime. What should the nurse suggest?

Chamomile tea

Freud believed that individuals cope with anxiety by implementing which mechanism?

Defense mechanisms

A client tells the nurse he has been taking St. John's wort. On the basis of this information, the nurse should gather additional assessment data related to what possible experience?

Depression

Which client problem would be most suited to the use of interpersonal therapy?

Dysfunctional grieving

A depressed client is likely to report a sleep disorder that includes which characteristics?

Frequent awakenings during the night

When providing possible interventions to promote the safety of a client reporting symptoms of somnambulism, the nurse should include which intervention?

Gating the stairways

The nurse describing alternative and complementary therapies would best describe them using which phrase?

Holistically focused

Using a minute amount of a substance that produces the same symptom as the client's chief symptom, so as to stimulate the body's immune system, is the rationale for which form of complementary therapy?

Homeopathy

What is the best example of an alternative medical system?

Homeopathy

A 38-year-old patient referred for sleep studies reports frequent daytime lethargy, unintended lapses into sleep, and never feeling rested on awakening in the morning. These symptoms support which sleep-related diagnosis?

Hypersomnolence

Which statements are true regarding the differences between a social relationship and a therapeutic relationship? (Select all that apply.)

In a social relationship, both parties' needs are met; in a therapeutic relationship, only the patient's needs are to be considered. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship, solutions are discussed but are only implemented by the patient.

A nurse expresses an exclusive belief in the biological model for mental illness when stating "it's the only one I really believe." What conclusion should be drawn from this statement?

In believing only in the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account.

What term is used to describe care that places the attention on a patient's physical, mental, and spiritual needs while focusing on prevention and wellness?

Integrative

What are the risks associated with the use of complementary and alternative medicine (CAM) therapies? (Select all that apply.)

Interactions between CAM products and prescribed medication. Insurance companies do not always cover these forms of treatment. Lack of standards or regulations that ensure safety for herbal products.

A 53-year-old client with a pacemaker implant has been prescribed warfarin. The patient tells the nurse, "I feel so much better now that I've been taking ginseng to relieve my menopausal symptoms." The nurse's response should be based on what knowledge about ginseng?

It has anticoagulation effects.

The nurse cautions a client about the fact that, when using herbal preparations, the client does not know the actual dose being ingested. What is the basis for this caution?

No manufacturing standardization exists.

A client is sitting with arms crossed over their chest, with their left leg is rapidly moving up and down, and there is an angry facial expression. When approached by the nurse, the client states harshly, "I'm fine! Everything's great." Which statement related to communication should the nurse focus on when working with this client?

Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message.

The mental status examination aids in the collection of what type of data?

Objective

During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established?

Orientation

An older adult client is reporting symptomatology that suggests rapid eye movement (REM) sleep behavior disorder (RSBD). Which comorbid condition should the nurse assess for?

Parkinson's disease

A slightly obese client reports falling asleep during the daytime even though she has slept all night. Her husband says she snores, and her blood pressure is noted to be in the low hypertensive range. The nurse anticipates that the client will be scheduled for which diagnostic test?

Polysomnography

Which imaging technique can provide information about brain function?

Positron emission tomography (PET) scan

What three structural components comprise a nursing diagnosis?

Problem, probable cause, supporting data

What non-habit-forming melatonin receptor agonist is often prescribed for insomnia?

Ramelteon

A client tells the mental health nurse "I am terribly frightened! I hear whispering in my head that someone is going to kill me." Which criteria of mental health can the nurse assess as lacking?

Rational thinking

A nurse is asked by a client about the basis for the nutritional treatment of health problems. The best reply would incorporate the information that alternative and complementary therapies are based on what factual information?

Research-based findings

Which supplement may be helpful in managing the symptoms of depression? (Select all that apply.)

SAMe Fish oil St. John's wort

A client asks the nurse to explain what basal sleep requirement is. What is the nurse's best response?

The amount of sleep needed to be fully awake and perform well in the daytime.

Homeostasis is promoted by interaction between the brain and internal organs and is mediated by component of the nervous system?

The autonomic nervous system

An individual is found to consistently wear only a bathrobe and neglect the cleanliness of his apartment. When neighbors ask him to stop his frequent outbursts of operatic arias, he acts outraged and tells them he must sing daily and will not promise to be quieter. This behavior supports what conclusion about this client?

The client is not conforming with social norms.

What factors are consistently observed to increase the risk for sleep disturbances?

alcohol and caffeine

What is the primary source for data collection during a psychiatric nursing assessment?

client's own words and actions.

What is the basic functional unit of the nervous system called?

neuron.

A term is a synonym for the characteristic of genuineness?

Authentic

Which nursing statement illustrates the concept of client advocacy?

"Dr. Raye, during the admission interview, the client stated they will refuse fluoxetine because of adverse effects they experienced previously."

Consider both Sullivan's term security operations and Freud's term defense mechanisms. Which statement suggests that the client's specialized treatment goal has been successfully met?

"I'm experiencing much less anxiety about school now."

The nurse being aware that certain mental illness have a prevalence among a specific gender, will a (Select all that apply.)

"I've been depressed most of my adult life." "I've been arrested 6 times in the last 15 years."

A nurse on the psychiatric unit has a past history of alcoholism and has regular meetings with a mentor. Which statement made to the nurse's mentor would indicate the presence of countertransference?

"My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!"

A 38-year-old client diagnosed with major depression states, "my provider said something about the medicine I've been prescribed will affect my neurotransmitters. What exactly are neurotransmitters?" What is the nurse's best response to the client's question?

"Neurotransmitters are chemical messengers in the brain that help regulate specific functions such as depression."

Which response should the nurse provide a client who asks, "Why you need to conduct an assessment interview"?

"We will be able to form a relationship together where we can discuss the current problems and come up with goals and a plan for treatment."

Which of the following statements represent a nontherapeutic communication technique? (Select all that apply.)

"What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" "Why didn't you attend group this morning?" "If I were you, I would quit the stressful job and find something else." "I'm really proud of you for the way you stood up to your brother when he visited today."

The nurse best assesses the client's spiritual life by asking which question?

"What role does religion play in your life?"

How does Harry Stack Sullivan's Interpersonal Theory view anxiety?

A painful emotion arising from social insecurity.

The nurse is conducting an admission interview with a client who was raped 2 weeks ago. When asked about the rape, the client becomes very anxious and upset and begins to sob. What should be the nurse's response to the client's reaction?

Acknowledge that the topic of the rape is upsetting and reassure the client that it can be discussed at another time when she feels more comfortable.

Which organ secretes hormones that are a normal component of the body's general response to stress? (Select all that apply.)

Adrenal glands Pituitary gland Hypothalamus

A nurse, active in local consumer mental health groups and in local and state mental health associations, keeps aware of state and national legislation affecting mental illness treatment. How can this nurse positively affect the climate for effective, mental health treatment?

By educating the public on the effects that stigmatizing has on mental health clients.

During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this?

Content of messages may be contradicted by process.

The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to which outcome?

Decreased client communication

The nurse caring for a client prescribed an antidepressant medication that produces anticholinergic side effects should assess for which possible side effects? (Select all that apply.)

Dry mouth Constipation Blurred vision (Can't see, pee, sit or S***)

The nurse is planning care for a 14-year-old. The nurse demonstrates an understanding of the developmental task appropriate for this client by providing which experience?

Encouraging them to talk about their school plans to help achieve identity

What term is used to identify the quantitative study of the distribution of mental disorders in human populations?

Epidemiology

A nursing diagnosis for a client with a psychiatric disorder serves what purpose with considering the plan of care?

Establishing a framework for selecting appropriate interventions.

Which criterion is NOT essential when the nurse plans nursing interventions designed to meet a specific goal?

Evidence based Safe Individualized Realistic

A recent immigrant to the United States from which country would tend to display little facial emotion when dealing with emotional stress?

Germany

Which statement best describes the Diagnostic and Statistical Manual, fifth edition (DSM-5) DSM-5?

It is a medical psychiatric assessment system.

The nurse providing anticipatory operant conditioning guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by which intervention?

Ignoring the tantrum and giving attention when the child acts appropriately

Which nursing diagnosis for a psychiatric client is correctly structured and worded?

Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting "I'm not worthy of eating"

When a tumor of the cerebellum is present, the nurse should expect that the client would initially demonstrate which sign/symptom?

Impaired balance

What principle forms the basis of nursing outcome planning?

Individuals have the right to outcomes that is reflective of their abilities.

Which tool can the novice nurse might refer to when writing nursing outcomes?

International Classification for Nursing Practice (ICNP)

A nurse is providing care to a 28-year-old client diagnosed with bipolar disorder who was admitted in a manic state. According to Maslow's Hierarchy of Needs theory, the nurse should identify which client symptom as having priority?

Lack of sleep

The medication prescribed for a client acts by blocking reuptake of both serotonin and norepinephrine. The nurse evaluates the treatment as successful when observing which client behavior?

Laughing at a joke

The nurse responsible for the care of a client prescribed clonazepam should evaluate treatment as being successful when the client demonstrates which behavior?

Less anxiety

A prescription for which medication would require the nurse to monitor the client for potential development of the side effect of hypothyroidism?

Lithium

The nurse is working with a client experiencing depression stemming from low self-esteem. The client is distrustful of unit staff and "just wants to go home." Initially what is the nurse's priority?

Making the client feel physically and emotionally safe

A 49-year-old client diagnosed with schizophrenia at 22 years old is prescribed risperidone. Which nursing assessment is the priority for this client?

Monitoring for abnormal involuntary movements

The mental health status of a particular client can best be assessed by considering which factor?

Position placement on a continuum from health to illness

A client tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the client may be experiencing which unconscious emotion?

Positive transference

During a therapeutic encounter the nurse remarks to a client, "I noticed anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the nurse using?

Reflecting and exploring

The client's priority nursing diagnosis has been established as risk for self-directed violence: suicide related to multiple losses. What is the priority outcome for this client?

Refrain from attempting suicide.

The incoherent thought and speech patterns of the client diagnosed with schizophrenia are related to the brain's inability to perform which function?

Regulate conscious mental activity.

Which nursing intervention demonstrates the theory behind operant conditioning?

Rewarding the client with a token for avoiding an argument with another client

A client states, "I will always be alone because nobody could ever love me." The nurse recognizes that the client is expressing what cognitive-behavioral concept?

Schema

The preferred seating arrangement for a nurse-client interview should incorporate which positioning?

The nurse and client sitting at a 90-degree angle to each other.

When preparing to hold an admission interview with a client, the nurse pulls up a chair and sits facing the client with their knees almost touching. When the nurse leans in close to speak, the client becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for client's behavior?

The nurse violated the client's personal space by physically being too close.

What is the focus during clinical supervision?

The nurse's behavior in the nurse-client relationship

A 55-year-old client recently came to the United States from England on a work visa. The client was admitted for severe depression following the death of a life partner weeks ago. While discussing the death and its effects the client shows little emotion. Which of the following explanations is most plausible for this lack of emotion?

The response may reflect cultural norms.

Which assessment should the nurse perform to evaluate the pharmacokinetic effect of a monoamine oxidase inhibitors (MAOIs) antidepressant medication?

The results of the liver function test

What is the primary difference between a social and a therapeutic relationship?

Type of responsibility involved

Cells that respond to stimuli, conduct electrical impulses, and release neurotransmitters are called

neurons.

According to Freud, a client experiencing dysfunction of the conscious as part of the mind will have problems with which aspect of memory?

All memories

A client is presenting with behaviors that indicate anger. When approached, the client states harshly, "I'm fine! Everything's great." Which response should the nurse provide to the client?

"It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"

What is the most helpful nursing response to a client who reports thinking of dropping out of college because it is too stressful?

"School is stressful. What do you find most stressful?"

A nurse's identification badge includes the term, "Psychiatric Mental Health Nurse." A client with a history of paranoia asks, "What does that title mean?" Keeping in mind the diagnosis of the client, how should the nurse respond to this question?

"We have the specialized skills needed to care for those with mental illnesses."

A 26-year-old client is brought to the emergency room by a friend. The client is unable to give any coherent history. Which response should the nurse provide when the client's friend offers to provide information regarding the client?

"Yes, I will be happy to get any information and history that you can provide."

A client has been admitted to an inpatient psychiatric unit with suicidal ideation. In a one-to-one session with the nurse, he shares the terrible guilt he feels over sexually abusing his stepdaughter and wanting to die because of it. Which response reflects a helpful trait in a therapeutic relationship?

"You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."

Of the following environments, which would be most conducive to a therapeutic session?

A quiet section of the day room

With which client should the nurse make the assessment that not using touch would probably be in the client's best interests?

A very private client

When treating mental illnesses with psychotropic drugs what is the focus of the treatment?

Altering brain neurochemistry.

When a client states "That nurse never seems comfortable being with me." How is the client characterizing the nurse?

As not seeming genuine to the client.

Using Maslow's model of needs, the nurse providing care for an anxious client identifies which intervention as being a priority?

Assessing the client for strengths upon which a nurse-client relationship can be based

A nurse is about to interview an older client whose glasses and hearing aid were placed in the bedside drawer for safe keeping. Before beginning the interview, which nursing intervention that will best facilitate data collection?

Assist the client in putting on glasses and hearing aid.

The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for which characteristic of a dysfunctional nurse-patient relationship?

Boundary blurring

When discussing her husband, a client shares that "I would be better off alone. At least I would be able to come and go as I please and not have to be interrogated all the time." What therapeutic communication technique is the nurse using when responding, "Are you saying that things would be better if you left your husband?"

Clarification

After a client discusses a personal relationship with a parent, the nurse asks, "Tell me if I'm correct that you feel dominated and controlled by this person?" What is the purpose of the nurse's question?

Clarifying the message

Which branch of epidemiology is the nurse involved in when seeking outcomes for clients whose depression was treated with electroconvulsive therapy (ECT)?

Clinical