MH WEEK 1

Mary is a 39-year-old attending a psychiatric outpatient clinic. Mary believes that her husband, sister, and son cause her problems. Listening to Mary describe the problems the nurse displays therapeutic communication in which response?

"I understand you are in a difficult situation."

Which statement demonstrates the nurse's understanding of the effect of environmental factors on a patient's mental health?

"I'm not familiar with the patient's Japanese's cultural view on suicide."

Implied consent occurs when no verbal or written agreement takes place prior to a caregiver delivering treatment. Which of the following examples represents implied consent?

Care given to a heroin overdose victim

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

DSM-5

Which question should the nurse ask when assessing for what Sullivan's Interpersonal Theory identifies as the most painful human condition?

"Do you think of yourself as being lonely?"

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

-Identifying risk factors that contribute to the development of a disorder. -Identifying which individuals will respond favorably to a specific treatment.

A nurse in an emergency mental health facility is caring for a group of clients. The nurse should identify that which of the following clients requires a temporary emergency admission?

CORRECT: A client who is a current danger to self or others is a candidate for a temporary emergency admission.

Linda is terrified of spiders and cannot explain why. Because she lives in a wooded area, she would like to overcome this overwhelming fear. Her nurse practitioner suggests which therapy?

Systematic desensitization

Lucas has completed his inpatient psychiatric treatment, which was ordered by the court system. Which statement reveals that Lucas does not understand the concept of conditional release?

"I am finally free, no more therapy."

A patient has been voluntarily admitted to a mental health facility after an unsuccessful attempt to harm himself. Which statement demonstrates a need to better educate the patient on his patient's rights?

"I can hurt myself if I want too. It's none of your business."

Which statement made by the nurse concerning ethics demonstrates the best understanding of the concept?

"It isn't right to deny someone healthcare because they can't pay for it."

A patient is telling a tearful story. The nurse listens empathically and responds therapeutically with:

"Let's devise a plan on how you will react next time in a similar situation."

The patient expresses sadness at "being all alone with no one to share my life with." Which response by the nurse demonstrates the existence of a therapeutic relationship?

"Loneliness can be a very painful and difficult emotion."

When considering stigmatization, which statement made by the nurse demonstrates a need for immediate intervention by the nurse manager?

"My experience has been that the Irish have a problem with alcohol use."

Which patient statement demonstrates a value held regarding children?

"Nothing is more important to me than the safety of my children."

Morgan is a third-year nursing student in her psychiatric clinical rotation. She is assigned to an 80-year-old widow admitted for major depressive disorder. The patient describes many losses and sadness. Morgan becomes teary and says meaningfully, "I am so sorry for you." Morgan's instructor overhears the conversation and says, "I understand that getting tearful is a human response. Yet, sympathy isn't helpful in this field." The instructor urges Morgan to focus on:

"Using empathy to demonstrate respect and validation of the patient's feelings."

Which statement made by either the nurse or the patient demonstrates an ineffective patient- nurse relationship?

"Why do you think it's acceptable for you to be so disrespectful to staff?"

A patient needs supportive care for the maintenance treatment of bipolar disorder. The new nurse demonstrates an understanding of the services provided by the various members of the patient's mental healthcare team when he makes which statement:

"Your counselor asked me to remind you of the group session on critical thinking at 2:00 today."

Which statement made by a patient demonstrates a healthy degree of resilience? SATA

-"I try to remember not to take other people's bad moods personally." -"I've learned to calm down before trying to defend my opinions." -"I know that discussing issues with my boss would help me get my point across."

The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.

-"Is the patient expressing suicidal thoughts?" -"Does the patient have intact judgment and insight into his situation?" -"Does the patient require a therapeutic environment to support the management of psychotic symptoms?" -"Does the patient require the regular involvement of their family/significant other in planning and executing the plan of care?"

Pablo is a homeless adult who has no family connection. Pablo passed out on the street and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select all that apply.

-He requires stabilization of multiple symptoms. -He has nutritional and self-care needs. -He is in imminent danger of harming himself.

Which intervention demonstrates an attempt by nursing staff to meet the goals identified by the Joint Commission as National Patient Safety Goals? Select all that apply.

-Identifying patients using both name and date of birth before drawing blood. -Administering the Beck Scale on each patient at the time of admission. -Performing a medication history assessment on each new patient. -Using appropriate hand washing technique at all times.

The World Health Organization describes health as "a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity." Which statement is true in regards to overall health? Select all that apply.

-Poor physical health can lead to mental distress and disorders. -There is a strong relationship between physical health and mental health.

When discussing therapy options, the nurse should provide information about interpersonal therapy to which patient? Select all that apply.

-The teenager who is the focus of bullying at school. -The older woman who has just lost her life partner to cancer. -The middle-aged adult who recently discovered her partner has been unfaithful.

A nurse is teaching a client who has an anxiety disorder and is scheduled to begin classical psychoanalysis. Which of the following client statements indicates an understanding of this form of therapy?

. CORRECT: Classical psychoanalysis places a common focus on past relationships to identify the cause of the anxiety disorder

When considering facility admissions for mental healthcare, what characteristic is unique to a voluntary admission?

A request in writing is required before admission

A charge nurse is discussing mental status examinations with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? (Select all that apply.)

A. CORRECT: Counting backward by 7s is an appropriate technique to assess a client's cognitive ability. B. CORRECT: Observing a client's facial expression is appropriate when assessing affect. C. CORRECT: Writing a sentence is an indication of language ability.

Which action reflects therapeutic practices associated with operant conditioning?

Acknowledging a patient who is often verbally aggressive for complimenting a picture another patient drew.

Emily is a 28-year-old nurse who works on a psychiatric unit. She is assigned to work with Jenna, a 27-year-old who was admitted with major depressive disorder. Emily and Jenna realize that they graduated from the same high school and each has a 2-year-old daughter. Emily and Jenna discuss getting together for a play date with their daughters after Jenna is discharged. This situation reflects:

Boundary blurring

A nurse decides to put a client who has a psychotic disorder in seclusion overnight because the unit is very short‑staffed, and the client frequently fights with other clients. The nurse's actions are an example of which of the following torts?

CORRECT: A civil wrong that violates a client's civil rights is a tort. In this case, it is false imprisonment, which is the confining of a client to a specific area (a seclusion room) if the reason for such confinement is for the convenience of staff.

A nurse is planning care for several clients who are attending community‑based mental health programs. Which of the following clients should the nurse visit first?

CORRECT: A client who hears a voice saying life is not worth living anymore is at greatest risk for self‑harm, and the nurse should visit this client first.

A nurse in an acute mental health facility is assisting with discharge planning for a client who has a severe mental illness and requires supervision. The client's partner works all day but is home by late afternoon. Which of the following strategies should the nurse suggest for follow‑up care?

CORRECT: A partial hospitalization program can provide treatment during the day while allowing the client to spend nights at home, as long as a responsible family member is present.

A charge nurse is discussing the characteristics of a nurse‑client relationship with a newly licensed nurse. Which of the following characteristics should the nurse include in the discussion? (Select all that apply.)

CORRECT: A therapeutic nurse-client relationship is goal-directed. D. CORRECT: A therapeutic nurse-client relationship encourages positive behavioral change. E. CORRECT: A therapeutic nurse-client relationship has an established termination date.

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

CORRECT: An ACT group works with clients who are nonadherent with traditional therapy (the client in a home setting who keeps "forgetting" a scheduled injection).

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

CORRECT: Assessment is the priority action when using the nursing process approach to client care. Identifying the client's perception of their mental health status provides important information about the client's psychosocial history.

A nurse is caring for a client who has a new prescription for disulfiram for treatment of alcohol use disorder. The nurse informs the client that this medication can cause nausea and vomiting when alcohol is consumed. Which of the following types of treatment is this method an example?

CORRECT: Aversion therapy pairs a maladaptive behavior with unpleasant stimuli to promote a change in behavior.

A nurse is orienting a new client to a mental health unit. When explaining the unit's community meetings, which of the following statements should the nurse make?

CORRECT: Community meetings are an opportunity for clients to discuss common problems or issues affecting all members of the unit.

A nurse is planning care for the termination phase of a nurse‑client relationship. Which of the following actions should the nurse include in the plan of care?

CORRECT: Discussing ways for the client to incorporate new healthy behaviors into life is an appropriate task for the termination phase.

A nurse is working in a community mental health facility. Which of the following services does this type of program provide? (Select all that apply.)

CORRECT: Educational groups are services provided in a community mental health facility. B. CORRECT: Medication dispensing programs are services provided in a community mental health facility. C. CORRECT: Individual counseling programs are services provided in a community mental health facility. D. Detoxification programs are services provided in a partial hospitalization program. E. CORRECT: Family therapy is a service provided in a community mental health facility.

A nurse is discussing free association as a therapeutic tool with a client who has major depressive disorder. Which of the following client statements indicates understanding of this technique?

CORRECT: Free association is the spontaneous, uncensored verbalization of whatever comes to a client's mind.

A nurse is planning care for a client who has a mental health disorder. Which of the following actions should the nurse include as a psychobiological intervention?

CORRECT: Monitoring for adverse effects of medications is an example of a psychobiological intervention.

A nurse is preparing to implement cognitive reframing techniques for a client who has an anxiety disorder. Which of the following techniques should the nurse include in the plan of care? (Select all that apply.)

CORRECT: Priority restructuring is a cognitive reframing technique. B. CORRECT: Monitoring thoughts is a cognitive reframing technique.CORRECT: Journal keeping is a cognitive reframing technique.

A community mental health nurse is planning care to address the issue of depression among older adult clients in the community. Which of the following interventions should the nurse implement as a method of tertiary prevention?

CORRECT: Rehabilitation programs are an example of tertiary prevention. Tertiary prevention deals with prevention of further problems in clients already diagnosed with mental illness.

A nurse is assisting with systematic desensitization for a client who has an extreme fear of elevators. Which of the following actions should the nurse implement with this form of therapy?

CORRECT: Systematic desensitization is the planned, progressive exposure to anxiety‑provoking stimuli. During this exposure, relaxation techniques suppress the anxiety response.

A nurse is planning a peer group discussion about the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM‑5). Which of the following information is appropriate to include in the discussion? (Select all that apply.)

CORRECT: The DSM‑5 establishes diagnostic criteria for mental health disorders. C. The DSM‑5 does not indicate pharmacological treatment for mental health disorders. D. CORRECT: Nurses use the DSM‑5 to plan, implement, and evaluate care for client's who have mental health disorders. E. CORRECT: The DSM‑5 identifies expected findings for mental health disorders.

A nurse is caring for a client who is in mechanical restraints. Which of the following statements should the nurse include in the documentation? (Select all that apply.)

CORRECT: The amount and frequency of fluids offered is objective data that should be documented when caring for a client in mechanical restraints. C. CORRECT: A description of the client's verbal communication is objective data that should be documented when caring for a client in mechanical restraints. D. CORRECT: The dosage and time of medication administration is objective data that should be documented when caring for a client in mechanical restraints

A nurse hears a newly licensed nurse discussing a client's hallucinations in the hallway with another nurse. Which of the following actions should the nurse take first?

CORRECT: The greatest risk to this client is an invasion of privacy through the sharing of confidential information in a public place. The first action to take is to tell the newly licensed nurse to stop discussing the client's hallucinations in a public location.

A client tells a 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 threatening me." Which of the following actions should the nurse take?

CORRECT: The information presented by the client is a serious safety issue that the nurse must report to the health care team. Using the ethical principle of veracity, the student tells the client truthfully what must be done regarding the issue.

A nurse is talking with a client who is at risk for suicide following their partner's death. Which of the following statements should the nurse make?

CORRECT: This statement is an empathetic response that attempts to understand the client's feelings.

A nurse is in the working phase of a therapeutic relationship with a client who has methamphetamine use disorder. Which of the following actions indicates transference behavior?

CORRECT: When a client views the nurse as having characteristics of another person who has been significant to their personal life (an ex-partner) this indicates transference.

A Gulf War veteran has been homeless since being discharged from military service. He is now diagnosed with schizophrenia. The nurse practitioner recognizes that assertive community treatment (ACT) is a good option for this patient since ACT provides:

Care for hard-to-engage, seriously ill patients

An adolescent female is readmitted for inpatient care after a suicide attempt. What is the most important nursing intervention to accomplish upon admission?

Checking the patient's belongings for dangerous items

A nurse is assessing a patient who graduated at the top of his class but now obsesses about being incompetent in his new job. The nurse recognizes that this patient may benefit from the following type of psychotherapy:

Cognitive-behavioral

How can a newly hired nurse best attain information concerning the state's mental health laws and statutes?

Conduct an internet search using the keywords "mental + health + statutes + (your state)"

The nurse frequently includes daily sessions involving relaxation techniques. Which assessment data would most indicate a need for this intervention to be included in the initial plan of care for a patient?

Family history of anxiety and symptoms of anxiety

A nurse makes a post on a social media page about his peer taking care of a patient with a crime- related gunshot wound in the emergency department. He does not use the name of the patient. The nurse:

Has violated confidentiality laws and can be held liable.

Which statement about mental illness is true?

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

Which patient outcome is directly associated with the goals of a therapeutic nurse-patient relationship?

Patient will identify suicidal feelings to staff whenever they occur.

A newly divorced 36-year-old mother of three has difficulty sleeping. When she shares this information to her gynecologist, she suggests which of the following services as appropriate for her patient's needs?

Primary care provider

Which nursing intervention demonstrates the ethical principle of beneficence?

Providing frequent updates to the family of a patient currently in surgery

Recognizing the frequency of depression among the American population, the nurse should advocate for which mental health promotion intervention?

Providing regular depression screening for adolescent and teenage students.

When considering the suggestions of Hildegard Peplau, which activity should the nurse regularly engage in to ensure that the patient stays the focus of all therapeutic conversations?

Reflecting on personal behaviors and personal needs.

A male patient frequently inquires about the female student nurse's boyfriend, social activities, and school experiences. Which is the best initial response by the student?

She limits sharing personal information and stresses the patient-centered focus of the conversation.

A registered nurse is caring for an older male who reports depressive symptoms since his wife of 54 years died suddenly. He cries, maintains closed body posture, and avoids eye contact. Which nursing action describes attending behavior?

Sitting with the patient and taking cues for when to talk or when to remain silent

In providing care for patients of a mental health unit, Li recognizes the importance of standards of care. When Li notices that some policies fall short of the state licensing laws, which of the following statements represents the most appropriate standard of care pathway?

State board of nursing, professional association, facility policy

Which of the following activities would be considered nursing care and appropriate to be performed by a basic level nurse for a patient suffering from mental illness?

Teaching coping skills for a specific family dynamic

Emma is a 40-year-old married female who has found it increasingly difficult to leave her home due to agoraphobia. Emma's family is appropriately concerned and suggests that she seek psychiatric care. After investigating her options, Emma decides to try:

Telepsychiatry

What is the greatest trigger for the development of a patient's nurse focused transference?

The degree of authority the nurse has over the patient

when providing respectful, appropriate nursing care, how should the nurse identify the patient and his or her observable characteristics ?

The patient in room 234 is is displaying manic behavior.

A male patient reports to the nurse, "I'm told I have memories of childhood abuse stored in my unconscious mind. I want to work on this." Based on this statement, what information should the nurse provide the patient?

To seek the help of a trained therapist to help uncover and deal with the trauma associated with those memories.

In an outpatient psychiatric clinic, a nurse notices that a newly admitted young male patient smiles when he sees her. One day the young man tells the nurse, "You are pretty like my mother." The nurse recognizes that the male is exhibiting:

Transference

Which situations demonstrate liable behavior on the part of the staff? Select all that apply.

a. Forgetting to obtain consent for electroconvulsive therapy for a cognitively impaired patient b. Leaving a patient with suicidal thoughts alone in the bathroom to shower c. Promising to restrain a patient who stole from another patient on the unit

Based on Maslow's hierarchy of needs, physiological needs for a restrained patient include: Select all that apply.

a. Private toileting, oral hydration b. Checking the tightness of the restraints d. Maintaining a patent airway

According to Maslow's hierarchy of needs, the most basic needs category for nurses to address is:

physiological