N129 Psych SMU exam 1

SSRIs

selective serotonin reuptake inhibitors block the reuptake of serotonin thererby making MORE serotonin available

TCAs

tricyclic antidepressants, Block reuptake and destruction of both norepinephrine and serotonin, increasing the levels of norepinephrine and serotonin at the synapse. it may also cause ANTICHOLINERGIC reactions

When considering client rights, which client can be legally medicated against his or her wishes? The client has accepted the medication in the past. The client may cause imminent harm to self or others. The client's primary provider orders the medication. The client's mental illness may relate to cognitive impairment.

B.The client may cause imminent harm to self or others. A patient may be medicated against their will without a court hearing in an emergency if the patient poses a danger to himself or herself or to others. The other options are not legally valid reasons to give medication against a patient's will.

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? The biological model is the oldest and most reliable model for explaining mental illness. The biological model has been proven to be successful in finding the cause of most symptoms of mental illness. The biological model is the most popular theory among leading psychiatrists and therefore the one that should be fully embraced. In believing only in the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account.

D. In believing only in the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account. In believing only in the biological model to the exclusion of other theories and perspectives, influences such as educational, social, spiritual, cultural, environmental, and economic are not considered, and these have also been proven to play a part in mental health and mental illness. The other options are untrue.

Eskalith

Lithium (mood stabilizer) SE: cardiac arrhythmias, hypothyroidism THERAPEUTIC LEVEL: 0.6-1.2

Lithobid

Lithium (mood stabilizer) SE: cardiac arrhythmias, hypothyroidism THERAPEUTIC LEVEL: 0.6-1.2

Venlafaxine (Effexor)

SNRI antidepressant SE: ↑BP. Causes ↑↑sexual dysfunction. (very similar to SSRIs but not the same)

Fluexetine (Prozac)

SSRI antidepressant Takes 4-6 weeks to work Dont stop abruptly---> risk for serotonin discontinuation syndrome Report any symptoms of high fever, fast heartbeat, or abdominal pain. BLACK BOX WARNING- suicidal ideation (esp for adolescents)

Paroxetine (Paxil)

SSRI antidepressant Takes 4-6 weeks to work Dont stop abruptly---> risk for serotonin discontinuation syndrome Report any symptoms of high fever, fast heartbeat, or abdominal pain. BLACK BOX WARNING- suicidal ideation (esp for adolescents)

Sertraline (Zoloft)

SSRI antidepressant Takes 4-6 weeks to work Dont stop abruptly---> risk for serotonin discontinuation syndrome Report any symptoms of high fever, fast heartbeat, or abdominal pain. BLACK BOX WARNING- suicidal ideation (esp for adolescents)

Medications dangerous in overdose

TCAs -Imipramine -Desipramine, -Amitriptyline MAOIs Lithium -Eskalith -Lithobid

MAOIs

monoamine oxidase inhibitors 3rd Line after SSRIs and TCAs Check LFTs AVOID FOODS HIGH IN TYRAMINE (happy hour foods) HIGH LEVELS OF TRYAMINE CAN LEAD TO SIGNIFICANT VASOCONSTRICTION--> ELEVATED BP---> RISK OF HYPERTENSIVE CRISIS

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 client in denial. The response may reflect cultural norms. The response may reflect personal guilt. The client may have an antisocial personality.

B.The response may reflect cultural norms. Showing little emotion while in distress may be a cultural phenomenon. Some cultures, such as the British and German cultures, tend to value highly the concept of self-control and may show little facial emotion in the presence of emotional turmoil. There is no evidence to suggest the client's lack of emotion is a result of any of the other options.

A 38-year-old client is admitted with major depression. Which statement made by the client alerts the nurse to a common accompaniment to depression? "I still pray and read my Bible every day." "My mother wants to move in with me, but I want to independent." "I still feel bad about my sister dying of cancer. I should have done more for her!" "I've heard others say that depression is a sign of weakness."

C. "I still feel bad about my sister dying of cancer. I should have done more for her!" Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible describes a coping mechanism; the other responses do not describe a common accompaniment to depression.

A 31-year-old client admitted with acute mania tells the staff and the other clients that he is on a secret mission for the President of the United States. He states, "I am the only one he trusts, because I am the best!" What term will the nurse use when documenting this behavior? Unpredictability Rapid cycling Grandiosity Flight of ideas

C. Grandiosity Grandiosity is inflated self-regard. People with mania may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. Although clients with mania are unpredictable, the scenario does not describe unpredictability: rapid cycling is switching between mania and depression in a given time period. The scenario does not describe flight of ideas, which means a continuous flow of speech with abrupt topic changes.

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? Rapid, pressured speech Grandiose thoughts Lack of sleep Hyperactive behavior

C. Lack of sleep Based on Maslow's theory, physiological needs such as food, water, air, sleep, etc., are the priority and must be taken care of first. The other options are symptoms of mania but not as critical as lack of sleep.

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

C. Lithium Long-term use of lithium may cause hypothyroidism. The other options refer to drugs whose long-term use does not cause hypothyroidism.

The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation? A client and family members attend counseling sessions together at a neighborhood clinic Implementation of a more flexible work schedule for staff Improved reimbursement for services provided in the community A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months.

D. A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months. A primary goal of ACT is working intensely with the client in the community to prevent rehospitalization. The other options are not goals of ACT.

Lithium

mood stabilizer for bipolar disorder SE: cardiac arrhythmias, hypothyroidism THERAPEUTIC LEVEL: 0.6-1.2

SNRIs

serotonin and norepinephrine reuptake inhibitors Blocks the reuptake of both serotonin and norepinephrine making more available

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." "Dr. Raye, during the admissions interview the client stated that there is a family history of three other suicide attempts in the past." "I'd like you tell me more about your depression and your suicide attempt?" "I will take you on a tour of the unit and orient you to the rules so you can get adjusted here."

A. "Dr. Raye, during the admission interview, the client stated they will refuse fluoxetine because of adverse effects they experienced previously." By letting the provider know that the client does not want the treatment the provider is prescribing, you have advocated for the client and her right to make decisions regarding her treatment. The other selections do not describe client advocacy since they do not represent actions by the nurse that the client is incapable of on their own.

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." "Neurotransmitters are too complicated to explain easily. Just know that the medication will help your mood and make you less depressed." "Neurotransmitters are chemicals in the brain that are the reason you are depressed." "I will ask your provider to give you a more in-depth explanation about why this medication will help your depression."

A. "Neurotransmitters are chemical messengers in the brain that help regulate specific functions such as depression." Neurotransmitters are chemicals released from neurons that function as a neuromessenger and influence brain functions. Telling the client that the answer is too complicated belittles the client by implying she cannot understand, while stating that neurotransmitters are the reason, she is depressed is too simplistic. Asking the provider to give the education abdicates your responsibility to provide client education.

When considering the duty to warn and protect third parties, which client statement should the nurse report to the treatment team members? "That judge is going to really regret putting me in here." "All politicians need to be shot." "When I'm elected president, I'll make them all pay for doubting me." "The man out there who is laughing at me is going to die."

A. "That judge is going to really regret putting me in here." The duty to protect is an ethical and legal obligation of health care workers to protect patients from physically harming themselves or others. This duty arises when the patient presents a serious danger to another. While all that statements infer the client's intention to harm, only the correct option is credible since it actually identifies the possible victim.

Which hospitalized patient should the nurse identify as being a candidate for the appropriate use of a release from hospitalization known as against medical advice (AMA)? A 37-year-old patient scheduled for discharge in 24 hours wishes to be discharged immediately A 75-year-old patient with dementia who demands to be allowed to go back to his own home A 21-year-old actively suicidal patient who wants to be discharged to home and do outpatient counseling A 32-year-old female patient who wishes to stay in the hospital but whose husband demands that she be discharged into his care

A. A 37-year-old patient scheduled for discharge in 24 hours wishes to be discharged immediately AMS discharges are sometimes used when the patient does not agree with the provider, as long as the patient is not a danger to himself or herself or to others. The patient with dementia and the patient who is actively suicidal would pose a safety risk and would be not allowed to be discharged AMA. A patient who wishes to stay in the hospital can make that decision; a family member's opinion doesn't impact an AMA discharge.

Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide? Break-away closet bars to prevent hanging Bedroom and dining areas with locked windows to prevent jumping Double-locked doors to prevent escaping from the unit Platform beds to prevent crush injuries

A. Break-away closet bars to prevent hanging Hangings are the most common method of inpatient suicide. The other options are important safety measures but don't directly address the suicide method of hanging.

Which of the following describe the symptoms of the manic phase of bipolar disorder? (Select all that apply.) Excessive energy Fatigue and increased sleep Low self-esteem Pressured speech Purposeless movement Racing thoughts Withdrawal from environment Distractibility

A. Excessive energy D. Pressured speech E. Purposeless movement F. Racing thoughts H. Distractibility All these options describe mania. The other options more aptly describe the opposite of what happens in mania.

Which nursing intervention demonstrates the theory behind operant conditioning? Rewarding the client with a token for avoiding an argument with another client Showing the client how to be assertive without being aggressive Demonstrating deep breathing techniques to a group of clients Explaining to the client the consequences of not following unit rules

A. Rewarding the client with a token for avoiding an argument with another client Operant conditioning is the basis for behavior modification and uses positive reinforcement to increase desired behaviors. For example, when desired goals are achieved or behaviors are performed, clients might be rewarded with tokens. These tokens can be exchanged for food, small luxuries, or privileges. This reward system is known as a token economy. None of the remaining options demonstrate reward for positive behaviors, climate, and structure, for healing.

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. The client has issues with sharing personal information. The nurse failed to explain the purpose of the admission interview. The client is responding to the voices by ending the conversation.

A. The nurse violated the client's personal space by physically being too close. By sitting and leaning in so closely, the nurse has entered into intimate space (0 to 18 inches), rather than social distance. This has likely made the client may feel uncomfortable with being so close to someone unknown to them. All the other options lack evidence and jump to conclusions regarding the client's behavior.

When considering mental illness, recovery is best described to a client by which statement? Working, living, and participating in the community Never having to visit a mental health provider again Being able to understand the nature of the diagnosed illness A period of time when signs and symptoms are being managed

A. Working, living, and participating in the community Recovery is described as the ability of the individual to work, live, and participate in the community. Never having to visit a mental health provider is unrealistic. While important to recovery understanding of the disorder is not a demonstration of recovery. Remission is a period of time when signs and symptoms are being managed.

Which of the following statements represent a nontherapeutic communication technique? (Select all that apply.) "Why didn't you attend group this morning?" "From what you have said, you have great difficulty sleeping at night." "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" "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." "You mentioned that you have never had friends. Tell me more about that." "It sounds like you have been having a very hard time at home lately."

A."Why didn't you attend group this morning?" C. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" D."If I were you, I would quit the stressful job and find something else." E. "I'm really proud of you for the way you stood up to your brother when he visited today." All these options reflect the nontherapeutic techniques of (in order) asking "why" questions; using excessive questioning; giving advice; and giving approval. The other options describe therapeutic techniques of restating, exploring, and reflecting.

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 really think I can succeed in school now." "I'm experiencing much less anxiety about school now." "Going back to school is hard and I'll need support." "I know that I'm not the only person who has a difficult time in school."

B. "I'm experiencing much less anxiety about school now." Both Sullivan and Freud coined terms to mean actions that individuals do that are an attempt to reduce anxiety. The terms to do not refer to activities that increase self-esteem. Security operations and defense mechanisms are not conscious and therefore do not increase self-awareness. These terms do not refer to reducing cognitive distortions.

Which client statement demonstrates the mental health concept of resilience? "My mother made decisions about my husband's funeral when I just couldn't do that." "Losing my job was hard but my skills will help me get another one." "In spite of all the treatment, I know I'll never be really healthy." "My kids, happiness is worth any sacrifice I have to make."

B. "Losing my job was hard but my skills will help me get another one." Resilience is a characteristic that helps individuals cope with loss and trauma that may occur in life. Dependence is described as relying on others for decision making and care. Pessimism is a life philosophy that things are more likely to go wrong than right. Altruism is described as putting others before yourself.

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 is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again." "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!" "My patient started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA (Alcoholics Anonymous) meetings five times a week after discharge." "My patient, is an elderly woman with depression. She calls me by her daughter's name because she says I remind her of her daughter."

B. "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!" This statement indicates countertransference; the nurse may be overidentifying with the patient because of a past history of alcoholism. Providing adamant advice to the patient that, besides being nontherapeutic, may be more relevant to personal past experiences than to the patient's. The discharge teaching for a patient being discharged and focusing on the treatment plan for the alcoholic patient are appropriate and show no signs of countertransference. The patient calling the nurse by her daughter's name is transference rather than countertransference.

Which of the following clients would be appropriate to refer to a partial hospitalization program (PHP)? A depressed client with a suicidal plan A client being discharged from an inpatient alcohol rehabilitation unit A client who has stopped taking his or her antipsychotic medication and is neglecting his or her basic needs Jeff, who has mild depression symptoms and is starting outpatient therapy

B. A client being discharged from an inpatient alcohol rehabilitation unit PHP is for clients who may need a "step-down" environment from inpatient status or for those who are being diverted from hospitalization with intensive, short-term care from which they return home each day. This client would be a good candidate after completing alcohol rehab; PHP could possibly help prevent relapse in the early stages after rehab. This client can be managed with regular outpatient therapy and does not need intensive short-term therapy such as PHP. Someone who is suicidal would require inpatient hospitalization for safety as would someone who is decompensated and not caring for herself. A client exhibiting mild depression would be managed with outpatient therapy and would not need intensive short-term therapy such as PHP.

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? Push gently for more information about the rape because the information needs to be documented. 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. Use silence as a therapeutic tool and wait until the client is done sobbing to continue discussing the rape. Reassure the client that anything she says to you will remain confidential.

B. 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. The best atmosphere for conducting an assessment is one with minimal anxiety on the client's part. If a topic causes distress, it is best to abandon the topic at that time. It is important not to pry or push for information that is difficult for the client to discuss. The use of silence continues to expect the client to discuss the topic now. Reassurance of confidentiality continues to expect the client to discuss the topic now.

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 becoming active in politics leading to a potential political career. By educating the public on the effects that stigmatizing has on mental health clients. Advocating for laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons. Advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions.

B. By educating the public on the effects that stigmatizing has on mental health clients. Nurses who are aware of legislative concerns and who are active in organizations that promote mental health awareness and appropriate and equal treatment for mental illness help achieve the goal of parity, or equality of treatment for mentally ill individuals. Becoming active in politics may be a personal goal but does not directly or necessarily reduce stigma or encourage treatment equality. The other options are undesirable outcomes.

A recent Hispanic immigrate comes to the mental health clinic after being referred to by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. During the initial intake assessment, the client reports headaches and backaches "almost every day" and "can't sleep at night." The client looks away when asked about anxiety or depression and states, "I don't know why I was referred to the mental health clinic." Which assessment information should the nurse further explore to assess for possible somatization? Impaired sleep patterns Denial of anxiety or depression Unexplained physical pain Recent immigration to the United States

B. Denial of anxiety or depression Somatization is described as experiencing and expressing emotional or psychological distress as physical symptoms. The client's behavior associated with the denial of any mental illness or understanding of the possible connection between the symptom/signs and a mental illness presents a need to explore the possibility of somatization. None of the other options support this possibility as directly.

The nurse is caring for an admitted client with a history of becoming aggressive when angry and has caused physical injury to another client and two staff members. When this client begins to demonstrate signs of anger while in the day room what intervention should the nurse implement to address the safety of the milieu? Alert security to come to the unit for a show of strength Request that the client accompany the nurse to the client's room Inform the client that restraints will be used if the behavior continues Prepare to administer a prn chemical restraint to the client

B. Request that the client accompany the nurse to the client's room Least restrictive alternative doctrine requires using the least drastic means of achieving a specific goal. By first attempting to remove the client to a safer location, the nurse is respecting the client's right to treatment that is less restrictive than the other options.

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? Emotional consequence Schema Actualization Aversion

B. Schema Schemas are unique assumptions about ourselves, according to Beck's theory. This statement is an example of a negative schema. Emotional consequence is the end result of negative thinking process, as described by Ellis. Actualization is a level of Maslow's Hierarchy of Needs. Aversion is a therapy characterized by punishment.

A 52-year-old Chinese American client comes to the emergency room reporting anxiety and states, "I am a failure." During the assessment interview, the client shares that they have recently been reprimanded at work for an error they were responsible for. The nurse should explore which possible trigger for the client's anxiety and feelings of failure? The inability to achieve her personal goals in the workplace Shaming the family by being responsible for the error Feeling personally inadequate regarding dependability Traditional belief that failure may result in a changed fate

B. Shaming the family by being responsible for the error Eastern tradition, such as in China, sees the family as the basis for one's identity, and family interdependence as the norm. The views expressed in options A and C demonstrate Western tradition where self-reliance, individuality, and autonomy are highly valued. In the Eastern view one is born into an unchangeable fate.

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? Ineffective coping Spiritual distress Risk for self-harm Hopelessness

B. Spiritual distress The client is expressing distress regarding his religion and spiritual well-being. The client could be experiencing ineffective coping, but this does not directly relate to his comment. There is nothing in the client's comment that would lead to the conclusion that the client is having thoughts of harming himself or experiencing hopelessness.

What is the major reason for the hospitalization of a depressed client? Inability to go to work Suicidal ideation Loss of appetite Psychomotor agitation

B. Suicidal ideation Suicidal thoughts are a major reason for hospitalization for clients with major depression. It is imperative to intervene with such clients to keep them safe from self-harm. The other options describe symptoms of major depression but aren't by themselves the major reason for hospitalization.

Which of the following is true of the relationship between bipolar disorder and suicide? Clients need to be monitored only in the depressed phase because this is when suicides occur. Suicide is a serious risk those diagnosed with bipolar disorder commit suicide. Clients with bipolar disorder are not considered high risk for suicide. As long as clients with bipolar disorder adhere to their medication regimen, there is little risk for suicide.

B. Suicide is a serious risk those diagnosed with bipolar disorder commit suicide. Mortality rates for bipolar disorder are severe because substantial numbers of individuals with bipolar disorder will make a suicide attempt at least once in their lifetime. Suicides occur in both the depressed and the manic phase. Bipolar clients are always considered high risk for suicide because of impulsivity while in the manic phase and hopelessness when in the depressed phase. Although staying on medications may decrease risk, there is no evidence to suggest that only clients who stop medications commit suicide.

When the nurse asks whether a client is having any thoughts of suicide, the client becomes angry and defensive, shouting, "I'm sick of you people! All you ever do is ask me the same question over and over. Get out of here!" What fact concerning hostility should the nurse's response be based upon? The client is getting better and is able to be assertive. The client may be at high risk for self-harm. The client is probably experiencing transference. The client may be angry at someone else and projecting that anger to staff.

B. The client may be at high risk for self-harm. Overt hostility is highly correlated with suicide; therefore the client may be considered high risk, and appropriate precautions should be taken. The other responses are incorrect with no evidence to support them.

Which assessment should the nurse perform to evaluate the pharmacokinetic effect of a monoamine oxidase inhibitors (MAOIs) antidepressant medication? The status of the client's appetite The results of the liver function test The level of depression exhibited by the client The client's current sleeping patterns

B. The results of the liver function test Pharmacokinetics refers to the movement of a drug through the body. Four basic processes of pharmacokinetics which determine the concentration of a drug at its sites of action are easily remembered with the acronym ADME: absorption, distribution, metabolism, and excretion. MAOIs can affect liver function and require monitoring. The other options are related to the medication's pharmacodynamic effects.

A client prescribed fluoxetine demonstrates an understanding of the medication teaching when making which statement? "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." "I will not take any over-the-counter medication while on the fluoxetine." "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." "I will report increased thirst and urination to my provider."

C. "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." This describes symptoms of serotonin syndrome, a life-threatening complication of SRRI medication. The other options are incorrect because the client should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the provider, and would not have been educated to report increased thirst and urination as a side effect of fluoxetine.

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"? "I will keep it a secret, but you and I need to discuss ways to deal with this situation appropriately without committing a crime." "Yes, I will keep it confidential. We have laws to protect clients' confidentiality." "Issues of this kind have to be shared with the treatment team and your parents." "I will have to share this with the treatment team, but we will not share it with your parents."

C. "Issues of this kind have to be shared with the treatment team and your parents." Although adolescent clients request confidentiality, issues of sexual abuse, threats of suicide or homicide, or issues that put the client at risk for harm must be shared with the treatment team and the parents. A threat of this nature must be discussed with the treatment team and the parents. Confidentiality laws do not protect information that would lead to harm to the client or others.

Which statement made by the nurse would acknowledge that they understand the difference between the ethnicity and culture? "So, ethnicity refers to having the same life goals whereas culture refers to race." "So, ethnicity refers to norms within a culture, and culture refers to shared likes and dislikes." "So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values." "So, ethnicity refers to race, and culture refers to having the same worldview."

C. "So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values." Ethnicity is sharing a common history and heritage. Culture comprises the shared beliefs, values, and practices that guide a group's members in patterned ways of thinking and acting. The other options are all incorrect definitions of either ethnicity and/or culture.

A patient who recently loss a parent begins crying during a one-to-one session with the nurse. Which response by the nurse illustrates empathy? "I'm so sorry. My father died 2 years ago, so I know how you are feeling." "You need to focus on yourself right now. You deserve to take time just for you." "That must have been such a hard situation for you to deal with." "I know that you will get over this. It just takes time."

C. "That must have been such a hard situation for you to deal with." This response reflects understanding of the patient's feelings, which is empathy. Feeling sorry for the client represents sympathy, whereas not addressing the patient's concern belittles the patient's feelings of grief she is expressing by changing the subject. Telling the patient, she will get over it does not reflect empathy and is closed-ended.

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? "I'm sorry, but I cannot take any information from you as it would violate confidentiality laws." "There is no need for that as I will call his primary care provider to obtain the information we need." "Yes, I will be happy to get any information and history that you can provide." "Yes, however, we will have to get a release signed from the client for you to be able to talk with me."

C. "Yes, I will be happy to get any information and history that you can provide." The friend is a secondary source of information that will be helpful since the client is not able to give any history or information at this time. Confidentiality laws do not prohibit obtaining information from a secondary source. The friend can provide information and/or history immediately and may be able to relate events that happened just before coming to the hospital. A release would not be necessary to take information about the client from a secondary source, and a psychotic client would not be competent to sign a release.

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 participate in unit activities and groups daily." "You will be given a schedule daily of the groups we would like you to attend." "You will attend a psychotherapy group that I lead that will help you care for yourself." "You will see your provider daily in a one-to-one session."

C. "You will attend a psychotherapy group that I lead that will help you care for yourself." Basic level RNs cannot perform psychotherapy. The other options are all appropriate expectations of a client's schedule on a psychiatric unit.

Which of the following clients meets the criteria for an involuntary admission to a psychiatric mental health unit? A 23-year-old college student who has developed symptoms of anxiety and is missing classes and work A 30-year-old accountant who has developed symptoms of depression A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road A 76-year-old retired librarian who is experiencing memory loss and some confusion at times

C. A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road Inpatient involuntary admission is reserved for clients who are at risk for self-harm or who cannot adequately protect themselves from harm because of their illness (e.g., a psychotic client). The other options can all be managed at this point in the community setting and don't meet criteria (risk of harm to self and/or others) for admission.

Which scenarios describe a Health Insurance Portability and Accountability Act (HIPAA) violation associated with a nurse's behavior? An ED (Emergency Department) nurse gives the intensive care unit nurse a client report from a telephone at the nurse's station. A nurse on the medical-surgical floor calls a patient's primary care provider to obtain a list of current medications. A nurse on the cardiac unit gives report to the nurse on the step-down unit while transporting a client in the staff elevator. A nurse on the psychiatric unit gives discharge information to the counseling office regarding a client's outpatient treatment.

C. A nurse on the cardiac unit gives report to the nurse on the step-down unit while transporting a client in the staff elevator. Discussing a patient's information in public places where it may be overheard is a violation of a patient's confidentiality. The other options describe appropriate interactions for patient continuity of care and support of the treatment plan by the health care team.

Which nursing behavior best demonstrates the concept of cultural competence? Acquiring knowledge about different cultures Educating clients about the cultural norms of the United States Adjusting personal practice to meet the clients' cultural preferences, beliefs, and practices Engaging in continuing education classes on culture in the process of becoming culturally competent

C. Adjusting personal practice to meet the clients' cultural preferences, beliefs, and practices Cultural competence means that nurses adjust and conform to their clients' cultural needs, beliefs, practices, and preferences rather than their own. This option does not describe cultural competence. Although nurses are continually learning regarding culture, it is a career-long process. The goal is not to educate clients about our own culture but rather to adjust to their cultural preferences. Although nurses may take continuing education regarding culture, this does not describe the term cultural competence. The other options do not describe cultural competence.

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? Verbal communication is always more accurate than nonverbal communication. Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.

C. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. Communication is roughly 10% verbal and 90% nonverbal, so nurses must pay close attention to nonverbal cues to accurately assess what the client is really feeling. The other options are all untrue of verbal and nonverbal communication and are actually the opposite of what is believed of communication.

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? "Okay, but we are all here to help you, so come get one of the staff if you need to talk." "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." "I don't believe you. You are not being truthful with me." "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"

D. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?" This response uses the therapeutic technique of clarifying; it addresses the difference between the client's verbal and nonverbal communication and encourages sharing of feelings. The other options do not address the client's obvious distress or are confrontational and judgmental. None of the other options provides this support.

Consider the nurse-patient relationship on an inpatient psychiatric unit. Which statement made by the nurse reflects an accurate understanding of when the issue of termination should first be discussed? "You are being discharged today, so I'd like to bring up the subject of termination—discussing your time here and summarizing what coping skills you have attained." "I haven't met my new patient yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself." "Now that we are working on your problem-solving skills and behaviors, you'd like to change; I'd like to bring up the issue of termination." "Now that we've discussed your reasons for being here and how often we will meet; I'd like to talk about what we will do at the time of your discharge."

D. "Now that we've discussed your reasons for being here and how often we will meet; I'd like to talk about what we will do at the time of your discharge." The issue of termination is brought up first in the orientation phase. All the other options describe other phases of the nurse-patient relationship—the termination phase, the preorientation phase, and the working phase.

Which response should the nurse provide a client who asks, "Why you need to conduct an assessment interview"? "I need to find out more about you and the way you think in order to best help you." "The assessment interview lets you have an opportunity to express your feelings." "You are able to tell me in detail about your past so that we can determine why you are experiencing mental health alterations." "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."

D. "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." Some of the purposes of the assessment interview are to establish rapport, learn more about the presenting issues, and form mutual goals and a plan for treatment. The other options do not appropriately explain the assessment purpose.

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? "It's good that you feel guilty. That means you still have a chance of being helped." "Of course you feel guilty. You did a horrendous thing. You shouldn't even forget what you did." "The biggest question is, will you do it again? You will end up having even worse guilt feelings because you hurt someone again." "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."

D. "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." This response demonstrates suspending value judgment, a helpful trait in establishing and maintaining a therapeutic relationship. Although it is difficult, nurses are more effective when they don't use their own value systems to judge patients' thoughts, feelings, or behaviors. The other options are all judgmental responses. Judgment on the part of the nurse will most likely interfere with further explorations of feelings and hinder the therapeutic relationship.

A client admitted with major depression and suicidal ideation with a plan to overdose is preparing for discharge and asks you, "Why did I get a prescription for only 7 days of amitriptyline?" The nurse's response is based on what fact? Amitriptyline is very expensive, so the client may have to buy fewer at a time. The goal is to see how the client responds to the first week of medication to evaluate its effectiveness. The health care provider wants to see whether any side effects occur within the first week of administration. Amitriptyline is lethal in overdose.

D. Amitriptyline is lethal in overdose. Amitriptyline is a tricyclic antidepressant (TCA); these drugs are known to be lethal in smaller doses than other antidepressants. Because the client had a plan of overdose, the best course of action is to give a small prescription requiring her to visit her provider's office more often for monitoring of suicidal ideation and plan. Tricyclics are not known to be expensive. Antidepressant therapy usually takes several weeks to produce full results, so the client would not be evaluated after only 1 week. Side effects are always a consideration but not the most important consideration with TCAs.

A client hospitalized for a psychotic relapse is being discharged home to family. Which topic is important to address when teaching both the client and the family to recognize possible signs of impending mania? Increased appetite Decreased social interaction Increased attention to bodily functions Decreased sleep

D. Decreased sleep Changes in sleep patterns are especially important because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania. The other options do not indicate impending mania.

Amitriptyline (Elavil)

tricyclic antidepressant, No longer first-line because they have more side effects (very sedating), take longer to reach an optimal therapeutic dose RISK FOR FATAL OVERDOSE SECONDARY TO ARRHYTHMIA/CARDIAC CONDUCTION disturbances (excessive sodium channel blockade) - may also cause orthostatic hypotension

Desipramine (Norpramin)

tricyclic antidepressant, No longer first-line because they have more side effects (very sedating), take longer to reach an optimal therapeutic dose RISK FOR FATAL OVERDOSE SECONDARY TO ARRHYTHMIA/CARDIAC CONDUCTION disturbances (excessive sodium channel blockade) - may also cause orthostatic hypotension

Imipramine (Tofranil)

tricyclic antidepressant, No longer first-line because they have more side effects (very sedating), take longer to reach an optimal therapeutic dose RISK FOR FATAL OVERDOSE SECONDARY TO ARRHYTHMIA/CARDIAC CONDUCTION disturbances (excessive sodium channel blockade) - may also cause orthostatic hypotension