Mental Health NCLEX practice, NCLEX style questions for Mental Health Final, Mental Health Final NCLEX questions

serious mental illness is characterid as -Any mental illness more than 2 weeks duration -A major long-term metnal illness marked by signification functional impairments -A mental ilnnes accompanied by physical impairment and severe social problems -A major mental ilnness that has episodes of poor functioning

-A major long-term metnal illness marked by signification functional impairments*

A client with the diagnosis of schizophrenia refuses to get out of bed and becomes upset. What is the nurse's initial therapeutic response? a) Requiring the client to get out of bed at once b) Allowing the client to stay in bed for a while c) Staying at the bedside until the client calms down d) Giving the prescribed as-needed tranquilizer to the client

c) Staying at the bedside until the client calms down Staying at the bedside until the client calms down provides support and security without rejecting the client or placing value judgments on behavior. Eventually limits will have to be set, but this is not the immediate nursing action. Allowing the client to stay in bed for the time being ignores the problem, and isolation may imply punishment. Although medication will calm the client, it does not address the problem.

which statement about crisis theory will provide a basis for nursing intervention? -A crisis is an acute time limited phenomenon experience as an overwhelm emotional rxn to problem perceive as unsolvable -A person in crisis has always has adjustment probs and has coped inadequately in his/her usual life situations -Crisis is precipitated by event that will enhance person self-concept -Nursing intervention in crisis situation rarely has the effect of remedying problem but is applying Band-Aid

-A crisis is an acute time limited phenomenon experience as an overwhelm emotional rxn to problem perceive as unsolvable*

in 2 months following wife death, paying less attention and feels useless since he does not have his wife to care for. He complains ficc concentration and sleeping and says lacks energy. His family has to remind to take showed, medication, what response -Arrange for apt for eval an treatment of suspected depression -Reorient mr smith by pointing out the day and date each time you interactive with hi -Meet with family and support persons to help them accept anticipate and prepare progression of stage III dementia -Avoid touch and proximity these are likely to be uncomfortable for mr smooth and may provoke aggression when he is disoriented

-Arrange for apt for eval an treatment of suspected depression

-schizo client begins to masturbate in the day room. What is the nurses initial action? -Tell other clients to leave the day room for a few minutes -Tell client this behavior is inappropriate -Ask the client if he is feeling anxious -Ask client if he needs privacy and escort him to his room

-Ask client if he needs privacy and escort him to his room [*model behavior, not shame]

client is starring at the wall and laughing what is first action of nurse? -Tell the client there is nothing funny on the wall -Ask the client what he is experiencing -Distract the client by asking him to play a game with nurse

-Ask the client what he is experiencing

in dev of therapeutic relationship w a new admission with the Dx of post self-inflicted GSW to the head. Which is the if the priority for the nurse? -Assess your feelings towards this client -Assess the clients level of suicidality -Assess the clients support systems -Assess the clients plan for suicide

-Assess your feelings towards this client [*avoid judgement, work out feelings]

A family brings in a non-responsive client. The family reports the client is catatonic due to schizo, history of diabetes, seizures and COPD, what is priority? -Pulse Ox -Implement seizure precautions -As family how long symptoms have been occurring -Check blood sugar

-Check blood sugar (medical dx more impt, all s/s can be due to blood sugars)

Charge nurse has 4 patients, who would CN assign you to? -Chronically depressed -Psychotic, hallucinations -Cluster B personality disorder (borderline, antisocial) -Paranoia

-Chronically depressed

what activity is most appropriate for bipolar client? -A game of twister -A football game with other clients -Riding on the stationary bike -Coloring activity with the nurse

-Coloring activity with the nurse

nurse is approaching client w schizo, best initial approach would be... -Tell me about the symptoms of schizo that you are having -What did you do that you have to come into hospital -I would like to hear about last job you hd -Discuss current events to develop rapport and assess reality orientation

-Discuss current events to develop rapport and assess reality orientation

a older adult prescribed digoxin and hydrochlorothiazide daily as well as lorazepam 2 mg, for anxiety. Pt has 3 doses of Ativan over 2 days w meds. The pt dev confusion, slurred speech and unsteady gait fluctuating levels of orientation. What I most likely reason for pts change in mental status? -Drug actions and interactions -Benzodiazepine withdrawal -Hypotensive episode -Renal failure

-Drug actions and interactions*

a client is schedule for ECT what family teaching should RN focus on? -Education on the importance of airway maintenance -Education on the clients memory loss -Education on the use of brevital as a anesthesia -Education on the purpose of ECT

-Education on the clients memory loss

a client as nurse if he hears the devil talking. What is nurses best response -"no I do not hear the devil -You are safe. The devil is not here -Let's go to a quiet place -Even though the voice seems real to you. I do not hear the voice speaking

-Even though the voice seems real to you. I do not hear the voice speaking [*must acknowledge that they are hallucinating, but also tell them reality

the parent of an adolescent diagnosed with depression asks the nurse "why do you want to do a family assessment? My teenage is the pt not the rest of us" what is nurse best response? -Family dysfunction might have caused this mental illness -Family members provide more accurate info than pt -Family assess is part of the protocol for care of all pt with mental illness -Every family members perception of events is diff and helps in planning how to improve functioning of the family

-Every family members perception of events is diff and helps in planning how to improve functioning of the family* [think why do you want to do a family assessment]

20 yo student becomes severely depressed after failing 2 exams, call parents to ask if she can go home. She gave her roommate 3 of her fav sweaters. Sign was:

-Giving away possessions

a male pt is coming down fm a manic period. He states "I feel bad about cheating on my wife?" what is nurse best response? -You can't help it. It's part of your illness -Let's discuss your feelings with your wife -Hyper sexuality is part of your illness. Let's discuss early signs of a manic episode -You better be or your wife will divorce you

-Hyper sexuality is part of your illness. Let's discuss early signs of a manic episode

a nurse expects which of the following in the hx of client with dissociative identity d/o? -A close relationship with his/her mother -Inability to recall certain event or experience associated w alternate personalities -A shis of performing poorly -Consistency in perf of certain tasks or skills

-Inability to recall certain event or experience associated w alternate personalities

A victim of spousal abuse has acceptable you suggestion of good safety plan and tell you has secret place to go and place her car keys and money abuser can't find. You tell her to complete safety plan by -Include a referral for special shelters for victim in her bedside stand -Encourage her to press charges and get a restraining order -Wait for ideal time when abuse returns to honeymoon phase in cycle of abuse -Including birth certificate, bank accounts and driver's license in secret stash

-Including birth certificate, bank accounts and driver's license in secret stash*

a terminal CA client states to nurse: " I wish my family would stop hoping for a cure. I know im going to die and I wish they would stop" best response -We cant control our familys feelings -It sounds as though you feeling angry

-It sounds as though you feeling angry

1a client is diagnosed with Major Depression. What is the most important part of the Mental Status Exam to assess? -Judgement -Mood -Insight -Behavior

-Mood (how are you feeling? How have you been discouraged")

ED calls the nurse and states a suicidal client needs a bed on herunit, hospital policy states suicidal clients must have room with locked windows. The only room w locked windows is coccupied by a post-op client who has been in pain all day and is not finally sleeping. What is nurse -Move the post-op pt to put the suicidal client in the room with locked windows -Advise the ED you cannot accept the client until the morning -Accept the suicidal client and place on 1:1 in another room until morning -Call the psychiatrist to restrain the pt

-Move the post-op pt to put the suicidal client in the room with locked windows* (policy!)

22 yo woman in outpatient frequent nightmares, feelings of guilt -PTSD -Phobic rxn

-PTSD

what is a good lunch for a manic client? -Ribs with mashed potatoes -Peanut butter sandwich and carton of milk -Pizza, cake and ice cream -Cheese burger and fries

-Peanut butter sandwich and carton of milk

a nurse educator is preparing a group of new nurse to help pt in crisis. Which statement would be best explain the assessments needed for ppl in crisis? -The first thing is to see if crisis actually has occurred of it it is self made overreaction -Perception of precipitating event, situation supports and personal coping skills are critical areas to assess -Situation supports can make a difference in keeping an event from becoming a crisis -Ppl in crisis usually do not need to be asked about their thoughts of self harm

-Perception of precipitating event, situation supports and personal coping skills are critical areas to assess*

which client is most at risk or dev PTSD? -Rescued client trapped under collapsed roof of a building -Client who witness friend die next to him after explosion -Mother of decreased victim in the explosion -Best friend of a victim who saw the explosion on TV

-Rescued client trapped under collapsed roof of a building** [person experienced it]

16 yo Asian client request outside provider give her coining treatment. What is RN response? -Respect beliefs and allow -Respect but do not allow treatment in hospital -Educate family on western medicine -Encourage client to try accepted practices

-Respect but do not allow treatment in hospital

-how does valproic acid levels affect my moods? What is best response -When levels go up mood improves -When level is 0.8 to 1.4 you have the best change -Serum levels of 50-125 measure stabilized mood -Measures amount of control of seizures

-Serum levels of 50-125 measure stabilized mood*

a client on psych unit states " I feel ike a bird" the best response is... -You are a patient not a bird -Birds can fly, can you? -That must be distressing for you, you don't look different to me -What you say indicates to me the reason you are in the hospital

-That must be distressing for you, you don't look different to me

Which of these statemens about suicide is accurate? -The majority in health care has a protective effect, leading to a lower rate of suice amount phys nurses than in general public -Most persons w previous suicide attempts survived bc they did not ruly intend to die -Repeated use of low-lethality

-The majority in health care has a protective effect, leading to a lower rate of suice amount phys nurses than in general public

Which of these statements about suicide is accurate? -The majority in health care has a protective effect, leading to a lower rate of suicide amount phys nurses than in general public -Most persons w previous suicide attempts survived bc they did not truly intend to die -Repeated use of low-lethality

-The majority in health care has a protective effect, leading to a lower rate of suicide amount phys nurses than in general public

a student nurse is debriefing w therapist after family session. Which statement indicated therapy was successful -Triangulation b/w mother, father teenager provide emotional support for mother but interferes with family problem solving -Their comm improves they were less angry at each other and the mother is letting the daughter be herself more -i just now recog triangulation wi mom and dad and emotions support that mom always needs from me

-Their comm improves they were less angry at each other and the mother is letting the daughter be herself more*

Which of the below symptoms are positive signs of schizophrenia (select all apply) -Visual hallucinations -Making up words -Withdrawal -Agitation -Introducing unrelated topics

-Visual hallucinations -Making up words -Agitation -Introducing unrelated topics

a pt tells nurse " I don't think ill ever get out of here" select nurse most therapeutic response? -Don't talk that way. Of course you will -Keep up the good work, you certainly will -You don't think you're making progress? -Everyone feels that way sometimes

-You don't think you're making progress? [*reflecting]

which state show nurse has empathy for pt who made suicide attempt -You must bene very upset when you tried to hurt yourself -It makes me sad to see you going thru such difficult experience -If you tell me what is troubling you I can help you solve your problems -Suicide is a drastic solution to a problem that may not be such a serious matter

-You must bene very upset when you tried to hurt yourself

which is an effective nursing intervention to assist an angry pt learn to manage anger w/o violence? -Help pt id a thought that produces anger evaluate validity of belief and substitute reality based thinking -Provide negative reinforcement such as restraint seclusion in response to angry outbursts -Use aversive conditioning such as popping a rubber band on wrist -Administer antipsychotic or antianxiety medication

-validity of belief and substitute reality based thinking*

A nurse is caring for a patient who has borderline personality disorder. The patient has previously identified another nurse as his favorite stating, " He's the best nurse ever." When the nurse calls in sick, which of the following statements indicates that the patient is using splitting as a method of coping? A. He's the worse nurse that's ever taken care of me. B. You're lying to me. he is not really sick. C. He's my favorite nurse and I am really worried about him. D. If anyone else tries to take care of me I am going to get really upset.

A.

A nurse is caring for a patient who has been unable to leave the house for the past 10 years without accompaniment. When attempting to go out alone, the patient becomes very anxious and must quickly return inside. The nurse should identify that the patient is exhibiting which of the following? A. Agoraphobia B. PTSD C. Panic Disorder D. OCD

A. Agoraphobia

A nurse is caring for a patient who has depression. The patient states, " I am too tired and depressed to attend group therapy today." Which of the following responses should the nurse make? A. Attending group therapy even if your tired is an important part of your treatment B. That's okay if you're too tired to attend today, but you will have to go tomorrow C. It is normal to feel tired when you're depressed. the others in the group feel the same way. D. I agree with you on your decision to wait to participate in therapy until you are better.

A. Attending group therapy even if you're tired is an important part of your treatment- most therapeutic

A nurse is conducting a counseling session with patient who has a substance abuse disorder. The patient repeatedly asks questions about the nurse. Which of the following actions should the nurse take? A. Explain that this time is designated to focus on the patient B. Answer the personal questions the patient is asking about you. C. Tell the patient that interest in someone besides himself is an indication of improvement. D. Request these personal questions be asked after the session is over.

A. Explain that this time is designated to focus on the patient

A nurse who works in a mental health facility is caring for a patient being admitted for self inflicted injuries. The nurse should identify which of the following interventions as their priority? A. Promoting and maintaining patient safety B. Discussing reasons for patients behavior C. Assisting the patient to recognize feelings D. Teaching the patient coping strategies

A. Promoting and maintaining patient safety

A nurse is caring for a patient with schizophrenia. The patient spends a great deal of time repeating rhyming syllables such as, " Me, see, tree, bee." The nurse recognizes that the patient is demonstrating which of the following positive manifestations of schizophrenia? A. Clang association B. Echolalia C. Magical thinking D. word salad

A. clang association

A nurse is caring for a patient who has OCD. The patient engages in repeated hand washing daily. Which of the following should the nurse recognize as the purpose of the patients behavior? A. Relieve anxiety B. Gaining attention C. Avoiding daily responsibilities D. Responding to auditory hallucinations.

A. relieve anxiety

A nurse is caring for a patient who has alcohol use disorder and is receiving treatment for alcohol withdrawal. The patient reports hand tremors 12 hours after admission. Which of the following statements should the nurse make? A. The tremors are permanent due to nerve damage caused by alcohol use. B. The tremors will persist over a few days as you are withdrawing from alcohol. C. Try not to worry about the tremors as everyone has these with alcohol withdrawal. D. These tremors are an indication of seizures that are associated with alcohol withdrawal.

B.

The nurse is assisting a patient with binge eating disorder. Which of the following findings should the nurse expect? A. Amenorrhea B. Abdominal pain C. Restricted caloric intake D. frequent use of laxatives

B. Abdominal pain- because of excessive volumes of food being eaten causes the gastrointestinal tract to dilate causing pain

A school nurse is caring for an adolescent child who has a history of a depressive episode 1 year ago. He appears withdrawn from social activities and his school performance is declining. which of the following actions should the school nurse take first? A. Initiate structure daily schedule of activities B. Conduct suicide risk assessment C. Encourage patient to express feelings in journal D. Ask other teachers to monitor behavior

B. Conduct suicide risk assessment.

A nurse is caring for a patient who has panic disorder and is experiencing anxiety at the panic level. Which of the following actions should the nurse take first? A. Identify cause of anxiety B. Instruct patient to take slow, deep breaths C. Teach the patient how to positive self talk D. Explain the physical manifestations of anxiety to patient.

B. Instruct patient to slow and deep breathe

An ED nurse is assessing a patient who has anxiety disorder. The patient is flushed, sweating profusely, and experiencing palpitations. The patient begins to scream, " I am going to die! This is it! I am having a heart attack!" The nurse should determine the patients anxiety level to be which of the following? A. moderate B. Panic C. Severe D. mild

B. Panic

A nurse is planning care for a patient who has thoughts of suicide. Which of the following goals should the nurse include in the patients plan of care? A. The patient will identify positive aspect of others B. The patient agrees to notify a staff member when having thoughts of self harm C. Patient will engage in individual diversion activity D. Patient will not verbalize thoughts of suicide or self harm.

B. Patient agrees to notify staff member when thought of self harm

A nurse is assessing a patient who is experiencing moderate level anxiety. Which of the following findings should the nurse expect? A. The patient has a heightened perceptual field B. Patient has difficult time concentrating C. Patient reports SOB D. Patient reports sense of impending doom

B. patient has difficult time concentrating

A nurse at a college campus is caring for a patient who reports manifestations of bulimia nervosa. The patient tells the nurse, " I know my eating binges and vomiting are not normal, but I can't control it." Which of the following responses should the nurse take? A. Why do you think you are experiencing these behaviors? B. Are other students in your dorm also experiencing this behavior? C. You are feeling helpless about changing this behavior? D. You know you must stop as you are endangering your health.

C.

A nurse is caring for a patient that has attempted suicide and refuses to sign a no-suicide contract. Which of the following actions should the nurse take when implementing suicide precautions? A. Assign the patient a private room B. Request that dietary provide patient with finger foods C. Place patient on one to one observation. D. Keep the door to the patients room closed.

C.

A nurse is caring for a patient with schizophrenia. The nurse notices the patient pacing up and down the hall very rapidly and mumbling in an angry matter. Which of the following actions should the nurse take? A. Apply restraints to patient B. Administer PRN haloperidol C. Approach patient in non threatening manner D. Place patient in seclusion

C. Approach patient in non threatening manner

The nurse is performing and admission assessment on a patient with schizophrenia. The nurse notices patients appearance unkempt and appears to be actively hallucinating. Which of the following should be the nurses priority assessment? A. Perception of reality B. Ability to follow directions C. Physical needs D. Mental Status

C. Physical Needs - think of Maslow's hierarchy of needs

A nurse in an acute mental health center is caring for a patient who is experiencing an acute manic episode. which of the following actions is the nurse's priority? A. Maintain the patients contact with family B. Discourage the patients vulgar language C. Protect patient from impulsive behavior D. Redirect excessive energy to creative tasks.

C. Protect patient from impulsive behavior- impulsive behavior puts patient at risk for self-harm so making sure the patient is kept safe

A nurse is assessing a patient who was sexually assaulted 6 months ago. Which of the following findings should the nurse report to the provider as an indication of rape-trauma syndrome? A. flat affect B. refusal to accept help from others C. report of intense guilt D. denial of the sexual assault

C. report of intense guilt- this can delay the healing process

A nurse is caring for a patient with borderline personality disorder. The nurse enters the patient room to find the patient cutting into his flesh with a paper clip. After providing first aid, which of the following actions should the nurse take first? A. Encourage the patient to discuss feelings about his self-injurious during group therapy. B. Fill out an incident report for risk management about the patients self-injurious behavior C. Document the patient self-injurious behavior in the chart. D. Identify the patients feelings that led to the self-injurious behavior.

D.

The nurse is assessing patient with schizophrenia. The patient states, "I need to get my gummamoshu from by my house." The nurse recognizes the statement an example of which of the following. A. Flight of ideas B. Echolalia C. Preservation D. Neologism

D. Neologism- an invented word which has no meaning to those around the patient.

A nurse is assessing a patient who has a history of mania. Which of the following findings indicates that the patient is experiencing relapse? A. weight gain B. Ritualistic behavior C. Anhedonia D. Pressured speech

D. Pressured speech

A nurse is performing an admission assessment for a patient with anorexia nervosa. The nurse should expect which of the following findings? A. recurrent binging B. compensatory vomiting C. loss of appetite D. Decreased caloric intake

D. decreased caloric intake- due to intense fear of weight gain

A nurse in an outpatient clinic is interviewing a patient with schizophrenia and appears to be experiencing auditory hallucinations. Which of the following actions should the nurse take first? A. Teach patient strategies to decrease hallucinations B. Identify if patient is on antipsychotic medications C. Distract patient from hallucination D. Explore what the voices are telling the patient

D. explore what the voices are telling the patient.

A nurse is caring for a patient who has major depressive disorder and is severely withdrawn. which of the following techniques should the nurse use to facilitate communication with the patient? A. Continue to talk if patient does not provide and immediate verbal response B. Use platitudes when talking with patient C. Ask the patient direct questions D. Speak to the patient using simple concrete terminology.

D. speak to patient using simple concrete terminology. - patient is impaired and has difficulty concentrating

A 65-year-old retired baker is admitted to the hospital with the diagnosis of dementia. The nurse's question that best tests the client's capacity for abstract thinking is: a) "How are a television and a radio alike?" b) Can you give me today's complete date?" c) "What would you do if you fell and hurt yourself?" d) "Repeat the following numbers for me: 8, 3, 7, 1, 5."

a) "How are a television and a radio alike?" The question "How are a television and a radio alike?" forces the client to find a characteristic common to two things, an ability that is the criterion for abstract thinking. The question "Can you give me today's complete date?" tests orientation, not abstract thinking. The question "What would you do if you fell and hurt yourself?" tests judgment, not abstract thinking. The question "Repeat the following numbers for me: 8, 3, 7, 1, 5" tests short-term memory, not abstract thinking.

A nurse knows individuals who are alcoholics use alcohol to: a) Blunt reality b) Precipitate euphoria c) Promote social interaction d) Stimulate the central nervous system

a) Blunt reality Alcohol, by depressing the central nervous system and distorting or altering reality, reduces anxiety. Alcohol depresses the central nervous system; it may cause lability of mood, impaired judgment, and aggressive actions rather than euphoria. Although alcohol is used as a social lubricant, alcoholics frequently drink in isolation. Also, alcohol can lead to inappropriate and aggressive behavior that may impair social interaction. Alcohol depresses the central nervous system; amphetamines and cocaine are stimulants.

A nurse plans to establish a trusting relationship with a client who is using paranoid ideation. How should the nurse begin to accomplish this? a) By being available on the unit but waiting for the client to approach b) By seeking the client out frequently to spend long blocks of time together c) By sitting on the unit and observing the client's behavior throughout the day d) By calling the client into the office to establish a contract for regular therapy sessions

a) By being available on the unit but waiting for the client to approach The recommended approach for working with suspicious clients is to allow them to set the pace of the relationship. It is less threatening if they are the one to initiate contact. Seeking the client out frequently to spend long blocks of time together, sitting and watching the client, and calling the client into the office may all be perceived as threatening and may add to feelings of paranoia.

Which paired drugs does the nurse expect the practitioner to prescribe for a client admitted for acute alcohol detoxification? a) Chlordiazepoxide (Librium) and thiamine b) Clonidine (Catapres) and propranolol (Inderal) c) Buprenorphine (Subutex) and naloxone (Narcan) d) Chlorpromazine (Thorazine) and disulfiram (Antabuse)

a) Chlordiazepoxide (Librium) and thiamine Chlordiazepoxide (Librium) is used to prevent seizures and to lower vital signs during alcohol detoxification. Thiamine is used to lessen the Wernicke-Korsakoff symptoms of alcohol withdrawal. Clonidine (Catapres) and propranolol (Inderal) will lower vital signs during alcohol withdrawal but will not help prevent seizures. Buprenorphine (Subutex) and naloxone (Narcan) are indicated for the treatment of opioid withdrawal. Chlorpromazine (Thorazine) is contraindicated because it lowers the seizure threshold. Disulfiram is used to maintain alcohol abstinence.

The nurse is caring for a client with a somatoform disorder, conversion-type paralysis. What is the best nursing approach? a) Discussing topics other than the paralysis b) Explaining the reason for the physical problem c) Asking how the client feels about being paralyzed d) Encouraging the client to slowly walk around the room

a) Discussing topics other than the paralysis Discussion of signs and symptoms should not be initiated by the nurse; the signs and symptoms should be accepted by the nurse. Discussion should be focused on the client's feelings and current situation. Explaining the reason for the physical problem may take away the client's unconscious defense and increase anxiety. Asking how the client feels about being paralyzed focuses on the paralysis rather than feelings. Encouraging the client to slowly walk around the room denies the client's symptoms; in reality this client cannot make the legs move to walk.

A client arrives at the mental health clinic disheveled, agitated, and demanding that the nurse "do something to make these feelings stop." What clinical manifestation is evident? a) Feelings of panic b) Suicidal tendencies c) Narcissistic ideation d) Demanding personality

a) Feelings of panic The client can no longer control or tolerate these overwhelming feelings and is seeking help. The client has not indicated plans for self-harm. Narcissistic ideation is not typical of a narcissistic personality. The client's behavior does not indicate a demanding personality.

A young client is admitted to the hospital with a diagnosis of acute schizophrenia. The family reports that one day the client looked at a linen sheet on a clothesline and thought it was a ghost. What is the most appropriate conclusion to make about what the client was experiencing? a) Illusion b) Delusion c) Hallucination d) Confabulation

a) Illusion An illusion is a misinterpretation of an actual sensory stimulus. A delusion is a false, fixed belief. A hallucination is a false sensory perception that occurs with no stimulus. Confabulation is a filling in of blanks in memory.

At a staff meeting, the question of a staff nurse's returning to work after completing a drug rehabilitation program is discussed. What is the most therapeutic way for the staff to handle the nurse's return? a) Offering the nurse support in a straightforward manner b) Avoiding mention of the problem unless the nurse brings it up c) Having another staff member keep the nurse under close observation d) Ensuring that the nurse is assigned to administer only noncontrolled medications

a) Offering the nurse support in a straightforward manner Offering the nurse support in a straightforward manner allows the individual to include the staff in her support system and removes an opportunity to deny the problem. Avoiding mentioning the problem unless the nurse brings it up supports and permits denial; both the individual and the staff know that a problem exists. Having another staff member keep the nurse under close observation is a nonprofessional approach that is nontherapeutic. Although refraining from handling controlled medications may be part of a return-to-work contract, it is not necessarily therapeutic; it simply reduces legal risks.

A nurse concludes that a client has successfully achieved the long-term goal of mobilizing effective coping responses when the client states that when he feels himself getting anxious he will: a) Perform a relaxation exercise. b) Get involved in some type of quiet activity. c) Avoid the situation that precipitated the anxiety. d) Examine carefully what precipitated the anxiety.

a) Perform a relaxation exercise. Relaxation techniques refocus energy and eventually ease physical and emotional stress. Getting involved in some type of quiet activity is not always possible; forced quiet activity may increase stress and anger rather than reduce it. Avoiding the situation that precipitated the anxiety is not always possible; stress can develop from a variety of feelings stimulated by many situations. What precipitated feelings of anxiety is not easy to identify; it is better to learn to deal with feelings once they develop.

During the intake interview at a mental health clinic, a client in withdrawal reveals to the nurse long-term, high-dose cocaine use. Which signs and symptoms support the conclusion that the client has been abusing cocaine for a prolonged time? Select all that apply. a) Sadness b) Euphoria c) Loss of appetite d) Impaired judgment e) Psychomotor retardation

a) Sadness e) Psychomotor retardation Although cocaine is an alkaloid stimulant, depressant effects such as a decreased mood, hypotension, and psychomotor retardation are associated with long-term, high-dose use. Cocaine is a stimulant, and euphoria, loss of appetite, and impaired judgment are all associated with cocaine intoxication, not prolonged high-dose cocaine use.

The nurse is leading a relapse-prevention group for clients who experience bipolar disorder manic episodes. Which strategies should the nurse teach to help prevent or identify impending relapse? Select all that apply. a) Watch for changes in libido. b) Keep dietary changes to a minimum. c) Maintain a regular sleeping schedule. d) Plan multiple varied activities every day. e) Monitor yourself for increased irritability or mood instability

a) Watch for changes in libido. b) Keep dietary changes to a minimum. c) Maintain a regular sleeping schedule. e) Monitor yourself for increased irritability or mood instability Increased sex drive often indicates the beginning of a manic episode. Changes in the eating pattern can trigger a manic episode. Changes in the sleeping pattern may increase anxiety and trigger a manic episode. An elevated, expansive, or irritable mood often indicates the beginning of a manic episode. Too many activities may be too stimulating and precipitate a manic episode. Simple, repetitive routines should be followed to limit change or anxiety.

An older female client who is hospitalized for depression is receiving citalopram (Celexa). During discharge teaching, she asks the nurse whether there is anything she should know about taking this medication. The nurse replies: a) "You're concerned about taking this medication." b) "You should take each dose of medication as prescribed." c) "You must discontinue the medication if side effects occur." d) "You may find it necessary to adjust the dosage if side effects occur."

b) "You should take each dose of medication as prescribed." The client should be encouraged to follow the medical regimen to maximize her response to drug therapy. The client asked a direct question; telling her that she should take each dose as prescribed does not answer her question. The practitioner should be notified of side effects. Legally it is the practitioner who is responsible for discontinuing a medication. The practitioner should be notified of side effects. Legally it is the practitioner who is responsible for adjusting a medication dosage.

A client who uses a complex ritual says to the nurse, "I feel so guilty. None of this makes any sense. Everyone must really think I'm crazy." What is the most therapeutic response by the nurse? a) "Your behavior is bizarre, but it serves a useful purpose." b) "You're concerned about what other people are thinking about you." c) "I am sure people understand that you can't help this behavior right now." d) "Guilt serves no useful purpose. It just helps you stay stuck where you are."

b) "You're concerned about what other people are thinking about you." Paraphrasing encourages further ventilation of feelings and concerns by the client. Telling the client that his behavior is bizarre but that it serves a useful purpose is a negative response that may increase the client's fears about being "crazy." "I'm sure people understand that you can't help this behavior right now" provides false reassurance and implies that the client is out of control, which may increase is fears. Telling the client that guilt serves no useful purpose and just helps him stay stuck where he is denies the client's feelings.

The nurse is caring for a female client who is confused and delirious. What is the most therapeutic intervention when the nurse is interacting with this client? a) Reassuring the client that she will get better b) Directing the client's daily activities on the unit c) Helping the client clarify her experience and gain insight into her behavior d) Providing the client with solutions to past and current problems she has experienced

b) Directing the client's daily activities on the unit The client needs to have her activities decided and directed until delirium and confusion clear. Reassuring the client that she will get better is false reassurance. Clients who are delirious are unable to develop insight into their behavior. Providing the client with solutions to past and current problems experienced is not therapeutic and does not help the client develop insight.

While assessing an older adult client before noon the nurse smells alcohol on the man's breath. After noting certain other signs, the nurse suspects that the client is an alcoholic. What are these signs? Select all that apply. a) Good nutritional habits b) Excessive mood swings c) Family conflict d) Poor hygiene e) Irritability f) Maintenance of cognition

b) Excessive mood swings c) Family conflict d) Poor hygiene e) Irritability Irritability is often seen in alcoholics and is a definite sign to look for. Alcoholics tend to forget to bathe, wash their clothes, or even eat correctly. Many alcoholics have been pushed away by their families because of their drinking and the habits it fosters. Excessive mood swings are a sign of alcoholism. Alcoholics have poor nutritional habits and often skip meals in favor of alcohol. Elders who drink to excess are susceptible to cognitive decline. Test-Taking Tip: The computerized NCLEX exam is an individualized testing experience in which the computer chooses your next question based on the ability and competency you have demonstrated on previous questions. The minimum number of questions will be 75 and the maximum 265. You must answer each question before the computer will present the next question, and you cannot go back to any previously answered questions. Remember that you do not have to answer all of the questions correctly to pass.

When planning care for a 72-year-old client who has been admitted to the hospital because of bizarre behavior, forgetfulness, and confusion, the nurse should give priority to: a) Preserving the dignity of the client b) Promoting a structured environment c) Determining or ruling out an organic origin d) Limiting the acceleration of symptomatology

b) Promoting a structured environment This client requires a structured environment, regardless of the cause of the behavior; this helps ensure the client's safety. Preserving the dignity of the client is important but is secondary to promotion of an environment conducive to safety and security. A battery of screening tests will probably be used in an attempt to determine the cause of the dementia; however, provision for safety is necessary first. Limiting the acceleration of symptomatology is important but is secondary to promotion of an environment conducive to safety and security.

A 54-year-old client has demonstrated increasing forgetfulness, irritability, and antisocial behavior. After being found walking down a street, disoriented and semi-naked, the client is admitted to the hospital, and a diagnosis of dementia of the Alzheimer type is made. The client expresses fear and anxiety. What is the best approach for the nurse to take? a) Exploring the reasons for the client's concerns b) Reassuring the client with the frequent presence of staff c) Initiating the program of planned interaction and activity d) Explaining the purpose of the unit and why admission was necessary

b) Reassuring the client with the frequent presence of staff The client needs constant reassurance because forgetfulness blocks previous explanations; frequent presence of staff serves as a continual reminder. This client will be unable to explain the reasons for concerns. Too many varied activities will increase anxiety in a confused client. Clients with dementia need simple, structured, routine environments and activities. This client will not remember the explanation from one moment to the next.

A client whose wife recently died appears extremely depressed. The client says, "What's the use in talking? I'd rather be dead. I can't go on without my wife." What is the best response by the nurse? a) "Would you rather be dead?" b) "What does death mean to you?" c) "Are you thinking about killing yourself?" d) "Do you understand why you feel that way?"

c) "Are you thinking about killing yourself?" The response "Are you thinking about killing yourself?" is the most important assessment to make because suicide is a possibility with every depressed client. The client has already said that he would rather be dead, and the response addresses only part of the client's statement. The response "What does death mean to you?" is a philosophical approach that will not encourage discussion of feelings. The client is probably unable to explain why he feels the way he does.

A nurse is discharging a client from the mental health unit who has been treated for major depression. Which statement is most therapeutic at this time? a) "I'm going to miss you; we've become good friends." b) "I know that you're going to be all right when you go home." c) "Call the contact number we gave you if you have an emergency." d) "This is my phone number; call and let me know how you're doing."

c) "Call the contact number we gave you if you have an emergency." Instructing the client to call the contact number that was provided in case of emergency demonstrates an understanding that the newly discharged client needs to have a support system. Clients need to feel that in a crisis there will be someone there for them. The role of the nurse is not to become a good friend but instead to help the client become a functioning being again. "I know you're going to be all right when you go home" provides false reassurance; the nurse does not know this. "This is my phone number; call and let me know how you're doing" is unprofessional and blurs the roles of nurse and client.

A male client with cyclothymic disorder with hypomanic symptoms is admitted to the psychiatric unit. He has progressively lost weight and does not take the time to eat his food. How can the nurse best respond to this situation? a) By providing a tray for him in his room b) By assuring him that he is deserving of food c) By ordering food that he can hold in his hand to eat while moving around d) By pointing out that he must replace the energy that he is burning up by eating

c) By ordering food that he can hold in his hand to eat while moving around The client with hypomanic symptoms cannot tolerate sitting still long enough to eat an adequate meal; handheld foods will help meet the client's nutritional needs and do not require the client to sit down. This client will most likely ignore the tray. Unworthy feelings are related to a depressive, not manic, episode. It is unlikely that this client will understand or care about the need to replace energy with food.

Which nursing action is most important when providing counseling to an adolescent with anorexia nervosa? a) Avoiding talk of food b) Limiting discussion of trivial topics c) Helping the client express concerns about body image d) Identifying the role played by the parents in the development of the disorder

c) Helping the client express concerns about body image Expression of thoughts, feelings, and concerns helps the client clarify eventually the underlying factors of the disorder, which may be associated with issues such as identity, intimacy, sexuality, and adult responsibilities. Food can be discussed with a matter-of-fact approach as long as the talk is not pervasive, authoritarian, or guilt producing. Helping the client express concerns about body image may interfere with the nurse-client relationship; the nurse must listen because what appears trivial or insignificant to the nurse may not be trivial or insignificant to the adolescent. Blame for the disorder should not be placed on anyone.

A client tells the nurse, "That man on the television is talking only to me." What should the nurse document that the client is exhibiting? a) Illusion b) Hallucination c) Idea of reference d) Autistic thinking

c) Idea of reference An idea of reference, also called a delusion of reference, is a fixed, false personal belief that public events and people are connected directly to the client. An illusion is a misinterpretation of a sensory stimulus. A hallucination is a perceived experience that occurs in the absence of an actual sensory stimulus. Autistic thinking is a distortion in the thought process that is associated with schizophrenic disorders.

A nurse is assigned to care for a group of clients who have been found to have depression. Which clinical manifestations does the nurse anticipate? Select all that apply. a) Labiality of affect b) Specific food cravings c) Neglect of personal hygiene d) "I don't know" answers to questions e) Apathetic response to the environment

c) Neglect of personal hygiene d) "I don't know" answers to questions e) Apathetic response to the environment Clients with depression are uninterested in their appearance because of low self-esteem. "I don't know" answers to questions type response requires little thought or decision-making, typical of depression. These clients' sense of futility leads to a lack of response to the environment. With depression there is little or no emotional involvement and therefore little alteration in affect. Clients with depression are uninterested in food of any kind.

A nurse is counseling a client who is experiencing substance abuse delirium. What communication strategies should be used by the nurse when working with this client? a) Encouraging the client to practice self-control b) Using humor when communicating with the client c) Offering an introduction to the client at each meeting d) Approaching the client from the side rather than the front

c) Offering an introduction to the client at each meeting Clients with delirium have short-term memory loss; therefore it is necessary to reinforce information. A client experiencing delirium is unable to participate in a discussion about self-control. Humor is inappropriate and may cause the client to feel uncomfortable. Approaching the client from the side rather than the front may initiate a startle response, causing the client to become fearful.

A nurse sits with a depressed client twice a day, but there is little verbal communication. One afternoon the client asks, "Do you think they'll ever let me out of here?" What is the best reply by the nurse? a) "We should ask your doctor." b) "Everyone says you're doing fine." c) "Do you think you're ready to leave?" d) "How do you feel about leaving here?"

d) "How do you feel about leaving here?" The nurse's response urges the client to reflect on feelings and encourages communication."We should ask your doctor" shifts responsibility from the nurse to the health care provider; it is an evasive response. "Everyone says you're doing fine" is not what the client is asking the nurse; it closes the door to further communication. "Do you think you're ready to leave?"may elicit a yes or no answer; it does not encourage communication. Study Tip: Enhance your organizational skills by developing a checklist and creating ways to improve your ability to retain information, such as using index cards with essential data, which are easy to carry and review whenever you have a spare moment.

A client with an obsessive-compulsive disorder continually walks up and down the hall, touching every other chair. When he is unable to do this, the client becomes upset. What should the nurse do? a) Distract the client, which will help the client forget about touching the chairs b) Encourage the client to continue touching the chairs as long as he wants until fatigue sets in c) Remove chairs from the hall, thereby relieving the client of the necessity of touching every other one d) Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed

d) Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed It is important to set limits on the behavior, but it is also important to involve the client in the decision-making. Distracting the client, which will help the client forget about touching the chairs, is nontherapeutic; rarely can a client be distracted from a ritual when anxiety is high. Encouraging the client to continue touching the chairs for as long he desires until fatigue sets in is a nontherapeutic approach; some limits must be set by the client and nurse together. Removing chairs from the hall, thereby relieving the client of the necessity of touching every other one, will increase the client's anxiety because he client uses the ritual as a defense against anxiety.

A client with a long history of alcohol dependence spends 28 days in an alcohol-rehabilitation unit. What type of referral does the nurse anticipate will be included in the discharge plan? a) Halfway house b) Family therapist c) Psychoanalytic therapy group d) Community-based self-help group

d) Community-based self-help group Referral to a community-based self-help group is an essential component of the discharge plan to provide ongoing support. The client probably does not need a halfway house. Although some forms of therapy may be helpful, the most successful intervention for alcohol abuse is Alcoholics Anonymous.

A nurse is assigned to care for an adolescent who has been admitted to the psychiatric hospital with a diagnosis of anorexia nervosa. What should the nurse's initial intervention be? a) Scheduling an endocrinology consult because of amenorrhea b) Confronting those behaviors that reflect an inflated self-importance c) Arranging for psychotherapy sessions to help develop a desire to accommodate others d) Developing a contract to achieve a weekly weight gain with consequences for nonachievement

d) Developing a contract to achieve a weekly weight gain with consequences for nonachievement Treatment usually includes a contract for weight gain, signed by the client, whereby privileges are revoked if the weight is not gained; the diet and the amount of food eaten are not the focus of care. Menstruation usually ceases because of severe malnutrition, not because of endocrine pathology. These clients have a low self-esteem and usually do not feel important.

A client who has a diagnosis of paranoid schizophrenia and has been violent in the past is admitted to the psychiatric unit. What should the nurse do before conducting an admission interview? a) Move to the client's side and sit down. b) Alert the assault response team about the client's history. c) Have two other staff members present when talking with the client. d) Enter the room with another staff member while remaining between the client and the door.

d) Enter the room with another staff member while remaining between the client and the door. Making sure to stay between the client and the door provides safety for the nurse and the other staff member because it will enable them to make a rapid exit. Moving to the client and sitting down invades the client's territory and may precipitate an aggressive client response. Alerting the assault response team is premature; the team is alerted when a client is out of control, harming self or others, and cannot be managed by the staff on the unit. Having two other staff members present may be viewed by the client as confrontational and may precipitate an aggressive response.

After a conference with the psychiatrist, a client with a borderline personality disorder cries bitterly, pounds the bed in frustration, and threatens suicide. What is the most helpful response by the nurse? a) Leaving the client for a short period and waiting until the client regains control b) Patting the client reassuringly on the back and saying, "I know that it's hard to bear." c) Asking about the client's troubles and answering, "Other people also have problems." d) Staying with the client and listening attentively if the client wishes to talk about the problem

d) Staying with the client and listening attentively if the client wishes to talk about the problem Sitting with the client indicates acceptance and demonstrates that the nurse feels that the client is worthy of the nurse's time. It is better to stay with the client quietly until control is regained; staying prevents a follow-through on the client's threat. Patting the client reassuringly on the back and saying, "I know that it's hard to bear" provides little comfort for the client. Asking about the client's troubles and answering, "Other people also have problems" may close off further communication.

The serum lithium blood level of a client with a mood disorder, manic episode, is 2.3 mEq/L. What should the nurse expect when assessing this client? a) Elevation in mood b) Nausea, thirst, and fine hand tremor c) Decrease in manic signs and symptoms d) Vomiting, diarrhea, and decreased coordination

d) Vomiting, diarrhea, and decreased coordination Vomiting, diarrhea, and decreased coordination are reflective of lithium toxicity. During the active phase of a manic episode a lithium level of 2.3 mEq/L is more than the therapeutic range of 0.8 to 1.4 mEq/L. An improvement in mood may occur when the therapeutic level is approached early in lithium therapy. Nausea, thirst, and fine hand tremor are common early side effects of lithium treatment. They are not related to lithium toxicity, which is indicated by a 2.3 mEq/L lithium level. During the acute phase of mania the therapeutic serum level of lithium should be between 0.8 and 1.4 mEq/L. The maintenance therapeutic serum level ranges from 0.4 to 1.0 mEq/L. A reduction in symptoms is expected when the therapeutic level of lithium is reached.

a pt w a somatic symptom disorder has been started on relaxation and has identified how negative assumptions make his symptoms worse, currently he believes his palpitations are chest due to heart attack. He has high pulse rate. The nurse is teaching him cognitive reframing. Which statement bet shows pt understands −I must have very high BP due ot blocked ateries for me to fee like this −I might consider that the pharmacy could have made a very critical mistake −A good explanation of how im feeling might be the extra coffee and stress im under at work −Im sure there is something wrong but I can tough it ou bc my faily does not die of heart attacks

−A good explanation of how im feeling might be the extra coffee and stress im under at work**

which client is most risk for committing suicide? -Mother whose son just died -Elderly single male with cancer -Teenage who broke up with gf -Married business man with alcoholism

-Elderly single male with cancer

what is a good activity for a client dx with schizo, who is paranoid? -Hide and seek -Allow client to initiate the activity -Coloring in a coloring book -Video game with the nurse

-Allow client to initiate the activity [*they choose whats comfortable, have power]

family systems theory suggest that the id pt ie) misbehaving child is best helps by -Getting anger mgmt. for child -Medication for ADHD to improve his psychological system -Attention to problems in family structure and interactions* -inpatient therapy with family visit once a week

-Attention to problems in family structure and interactions*

-benzo are effective short term acting for anxiety. Which if not caution for this class of drug? -Coffee and other caffeinated drinks enhance effect of most benzos -Synergistic effect when used with alcohol or other CNS depressants -May be abused, addictive or habituating -Are pregnancy D or X and cannot be used in person with sleep apnea

-Coffee and other caffeinated drinks enhance effect of most benzos*

looking at hands "as if I wasn't myself"

-Depersonalization, common stress-related

in a team mtg nurses decide to use cognitive therapy for a client with depression. Which of the following tech could be included -Analysis of storied randomly told -Use of unconditional positive regard -Examination of negative thought patterns

-Examination of negative thought patterns*

diathesis-stress model as an explanation for mental illness means that [Book p 254] -Nature is stronger than nurture as an explanation for mental illness -Stress is major cause of mental illness as was -Inherited traits and physiology combined with stressors best explain causes of mental illness -Mental illness is caused by the rewards ppl perceive for crazy behavior

-Inherited traits and physiology combined with stressors best explain causes of mental illness* (life events that impact abilities)

the nurse decides to use universality as a healing factor in her inpatient group which statement would be the best initiation of this therapy [Book p 608] -We will have a couple of ppl vent about things that have never been shared before and express the associated feelings -Group is a time to show respect as we assist others in -Lets each share the rejection that we have experience in our past lives and the results -Lets each share what this group has meant to our well-being and recovery

-Lets each share the rejection that we have experience in our past lives and the results*

nurse is instructing group of teenagers about marijuana use. Which of the following are serious risks -Regular mJ use in teens causes a loss of 8 points off the IQ -One in 12 young ppl use regularly develop schizo -Half of those use mj 5 or more times become addicted by age 25 -Mj is safe bc most teens use wit w/o any consequences

-Regular mJ use in teens causes a loss of 8 points off the IQ* -Half of those use mj 5 or more times become addicted by age 25*

parent of child with Tourettes disorder says "I think my child is faking tics -Tics often change frequency of severity. That doesn't mean they aren't real -This finding is unexpected. How have you been administer your childs pimozide (Orap)? Its an antipsychotic -Perhaps you child was misdiagnosed -Your observation indicates the medication is effective

-Tics often change frequency of severity. That doesn't mean they aren't real*

when a vittim sates "he only hurst me when hes drinking" -Accurately detling abubse episodes -Using the myth that alcholol causes abuse to excuase abuser

-Using the myth that alcholol causes abuse to excuase abuser*

A nurse suspects that a clients excessive guilt and anxiety may be from spiritual distress. Which is the best way to ask about spiritual orientation? -Did you parents bring you up in church -What gives you a sense of meaning and purpose in life -What makes you feel so guilty

-What gives you a sense of meaning and purpose in life*

for pts diagnosed with serious mental illness, what is the major advantage of case mgmt. -Case mgr can modify traditional psychotherapy -With one coordinator of services resources and follow up care can be more efficiently use -A case manager can focus on social skills training and esteem building -Case manager bring groups of pts together to discuss common problems

-With one coordinator of services resources and follow up care can be more efficiently use*

1. nurse asks the client the following" what does this mean, don't cry over spilt milk" what is nurse assessing a. Memory b. Recall c. Concrete thoughts (measuring how concrete their thoughts are, are they thinking of it literally --> someone spilled milk) d. Comprehension

c. Concrete thoughts (measuring how concrete their thoughts are, are they thinking of it literally --> someone spilled milk)