Psych Exam 2

Place these Kubler-Ross stages of grief in the order in which they are experienced by a dying patient. Wondering, "Why is this happening to me?" Offering anything to keep living Refusing to believe the reality of death Giving up hope

1. Refusing to believe the reality of death 2. Wondering, "Why is this happening to me?" 3. Offering anything to keep living 4. Giving up hope

A patient is refusing to take a court-ordered psychotropic medication. How should the nurse proceed? A. Seclude the patient B. Admonish the patient C. De-escalate the patient D. Temporarily restrain the patient with the designated team

D. The nurse may use physical means to restrain the patient in order to administer the medication to the patient.

What health care team member Maintains a structured therapeutic milieu?

Nurse

What health care team member Works with the health care provider to manage medications?

Pharmacist and nurse

Which step is most beneficial for the nurse to take in regards to Mr. Jones's care? a. Call Mr. Jones by his proper name b. Engage Mr. Jones in many activities c. Provide Mr. Jones with many meal choices d. Allow Mr. Jones to develop and maintain his own schedule

a. Call Mr. Jones by his proper name Using proper names deters infantilizing and patronizing the patient.

Which physical assessment finding would alert the nurse to further assess the cognitive status of an older adult patient seen in the emergency department following a fall at home? a. Kyphosis b. Cyanotic nail beds c. Blood pressure of 152/94 mm Hg d. Bilateral lower extremity edema

b. Cyanotic nail beds Cyanotic nail beds are a sign of hypoperfusion and decreased oxygenation. Lack of blood and oxygen may be affecting the patient's cognitive status and may have contributed to the fall. Further assessment is warranted.

How should the nurse explain the key difference between delirium and dementia? a. Delirium and dementia are not different from one another. b. Delirium has a rapid onset, while dementia has a gradual onset. c. Delirium and dementia are both chronic, but delirium is caused by medical condition or substance. d. Delirium affects the patient's ability to speak, while dementia does not.

b. Delirium has a rapid onset, while dementia has a gradual onset. Delirium develops over hours to days, while dementia develops over months to years.

A patient with depression is prescribed tricyclic antidepressants (TCAs). Which appropriate advice would the nurse give to the patient's family? a. This medication is contraindicated with cataracts. b. Do not give full dose to the patient at bedtime c. Advise the patient to be cautious while driving. d. DOuble the dose if the patient forgets to take the bedtime dose.

c. Advise the patient to be cautious while driving.

Which grief ritual is common to patients of Asian American decent? a. Music and singing at the funeral b. Medicine man moderating the funeral c. Funeral clergy assistance in planning burial d. Dressing the body of the deceased in heavy clothing

d. Dressing the body of the deceased in heavy clothing Respect is shown for the deceased by people of Asian American descent by providing warm clothing for burial.

In which area of a hospital are nursing staff most likely to be assaulted by patients? a. Pediatrics b. Obstetrics c. Psychiatric d. Emergency

d. Emergency

A person has turned to excessive alcohol use to numb the pain of losing a close relative and can no longer function at work. Which type of grief is this patient experiencing? a. Chronic b. Masked c. Delayed d. Exaggerated

d. Exaggerated Exaggerated grief occurs when the survivor is overwhelmed by grief and cannot function. People experiencing exaggerated grief may often turn to drugs and alcohol to cope.

A patient who has recently loss a spouse refuses to bathe, dress, or get out of bed until the spouse comes home. Which type of grief is the patient experiencing? a. Chronic b. Masked c. Delayed d. Exaggerated

d. Exaggerated -Exaggerated grief occurs when the survivor is overwhelmed by grief and cannot function, and includes the inability to accept the loss and perform daily tasks, such as bathing or dressing.

Which is a characteristic of bipolar II? a. Clang associations b. Decreased social function c. Continuous, accelerated speech d. Excessive involvement in pleasurable activities

d. Excessive involvement in pleasurable activities Bipolar II is characterized by excessive involvement in pleasurable activities that have a potential for painful consequences.

Which nursing action is indicated when an angry patient threatens to hurt his psychiatrist? a. Place the patient in seclusion. b. Initiate an investigation into the patient's past behavior and file the necessary report. c. Administer an antipsychotic to the patient to address paranoid delusions. d. Explore the patient's potential for violence and warn the psychiatrist of potential danger.

d. Explore the patient's potential for violence and warn the psychiatrist of potential danger. The nurse has the duty to protect the psychiatrist from potential harm. A Tarasoff warning should be issued to warn the psychiatrist of the possible impending danger.

Which task is most likely to give patients with a terminal illness a sense of completion in a relationship with family and friends? a. Recognition of a transcendent realm b. Transmission of knowledge and wisdom c. Transfer of fiscal, legal, and formal social responsibilities d. Expression of regret, forgiveness, and gratitude to family and friends

d. Expression of regret, forgiveness, and gratitude to family and friends

The health care provider diagnoses Ms. Spears with major depressive disorder (MDD). Which of Ms. Spears' symptoms is an objective one? CASE STUDY DETAILS a. Mood b. Dizziness c. Nausea and vomiting d. Expressions of worthlessness

d. Expressions of worthlessness Ms. Spears' statements about her life being pointless and there being no reason for her to be alive are expressions of worthlessness, which are objective symptoms of MDD.

Which factor has been shown to increase the risk of bipolar disorder up to 10 times in an individual? a. Substance use b. Hypothyroidism c. Low education status d. First-degree relative with bipolar disorder

d. First-degree relative with bipolar disorder Persons with a relative who has bipolar disorder are 5-10 times more likely than the general population to develop the disorder.

Which tool is most helpful in identifying specific stages of dementia? a. Memory Impairment Screen b. Mini-Mental State Examination c. Dementia Severity Rating Scale d. Functional Assessment Staging Tool

d. Functional Assessment Staging Tool The FAST tool helps to identify specific stages of AD.

A patient with borderline personality disorder is treated with antipsychotic medications. The patient does not maintain good hygiene and avoids drinking milk. According to the principles of beneficence, which action would the nurse adopt while caring for the patient? a. Give maximum attention to this patient only. b. Inform that the medications are very safe. c. Firmly instruct the patient to drink milk. d. Give instructions to the patient to maintain good hygiene.

d. Give instructions to the patient to maintain good hygiene.

Which kind of thought content is displayed when a patient states, "I am King of the Northern Hemisphere." a. Hallucination b. Loose association c. Tangential speech d. Grandiose delusion

d. Grandiose delusion

If a patient experiencing suicidal ideation is to be treated outside the hospital, which intervention would the nurse incorporate into the plan of care? a. Arrange for a police visit every 24 hours. b. Provide a 1-week supply of antidepressant medication c. Make sure the patient has enough food enough to last for 2 to 3 days. d. Have the patient identify three people to call if the patient is overwhelmed by hopelessness.

d. Have the patient identify three people to call if the patient is overwhelmed by hopelessness.

Within the past 48 hours, Ms. Bader has developed symptoms of arousal, aggression, and hyperactivity. The nurse recognizes these symptoms as being associated with which disorder?CASE STUDY DETAILS a. Dementia b. Amnesia c. Hypoactive delirium d. Hyperactive delirium

d. Hyperactive delirium Hyperactive delirium is characterized by arousal, aggression, increased strength, and hyperactivity.

Which factor has been shown to contribute to early-onset AD? a. Obesity b. Smoking c. Socioeconomic status d. Inherited mutated gene

d. Inherited mutated gene An inherited mutated gene may contribute to an early-onset of AD.

Which action would the nurse take on learning that the serum lithium level is 1.8 mEq/L in a patient with mania? a. Advise the patient to limit fluids for 12 hours. b. Continue to administer medication as prescribed c. Advise the patient to curtail salt intake for 24 hours d. Withhold medication and notify the healthcare provider

d. Withhold medication and notify the healthcare provider

Avoidance of coping with grief matches what type of complicated grief?

delayed

What is distorted beliefs?

delusions

Which nursing assessment is Assessing the state of mind?

emotional status

Turning to alcohol to cope matches what type of complicated grief?

exaggerated

What is verbalized racing thoughts?

flight of ideas

What is inflated sense of self?

grandiosity

What is sensations that are not really present?

hallucinations

Aggression in which type of delirium?

hyperactive

Pulmonary embolism in which type of delirium?

hypoactive

What type of loss influences threats sense of security?

loss related to murder

What type of loss influences feelings of a loss of control?

loss related to sudden death

What type of loss influences feelings of shame, fear, guilt, rejection, and anger?

loss related to suicide

Failure to recognize the intensity of grief matches what type of complicated grief?

masked

Sudden shift in behavior in which type of delirium?

mixed

Spiritual beliefs can offer comfort and support matches which factor?

religion

Grieg counseling can help people cope with intense emotions matches which factor?

social support

People with a higher education can obtain more support and coping skills matches which factor?

socioeconomic status

What type of loss influences grieving of a dream?

stillbirth

Direct or indirect thoughts or fantasies about suicide is which level of suicide behavior?

suicidal ideation

Serious self-directed actions that result in minor or major injury is which level of suicide behavior?

suicide attempts

Self-directed actions that result in no injury or minor injury is which level of suicide behavior?

suicide gestures

Actual or written or verbal expression of intent to commit suicide is which level of suicide behavior?

suicide threats

What is pressured speech?

unrelenting, rapid, often loud talking without pauses

Which factors contribute to the late-onset of Alzheimer's disease? Select all that apply. a. Obesity b. Smoking c. Employment status d. High blood pressure e. Recurrent urinary tract infections

a. Obesity -Obesity is a lifestyle factor that contributes to late-onset Alzheimer's disease. b. Smoking -Smoking is a lifestyle factor that contributes to late-onset Alzheimer's disease. d. High blood pressure -Conditions that damage the heart such as high blood pressure, stroke, diabetes, and high cholesterol contribute to late-onset Alzheimer's disease.

Which action would the nurse take when a patient reports, "I want to kill myself with a gun"? a. Observe the patient 24 hours a day. b. Instruct the staff to stay away from the patient. c. Encourage the patient to interact with other patients. d. Instruct the staff to chart the patient's whereabouts and record mood every 5 hours.

a. Observe the patient 24 hours a day.

Which nursing action would be contraindicated in a patient who is in the final stages of dying? a. Oral feedings b. Oral suctioning c. Oxygen administration d. Foley catheter insertion

a. Oral feedings Oral feedings would be contraindicated at the end of life because of the risk of aspiration.

Which statement is true regarding persistent depressive disorder (PDD)? a. PDD is a chronic condition. b. PDD includes psychotic features. c. PPD is caused solely by genetic factors. d. PDD is characterized by acute episodes.

a. PDD is a chronic condition. PDD is characterized by chronic symptoms that persist for at least 2 years.

Which nursing diagnosis is the highest priority for Ms. Cocoschelli? a. Risk for Injury b. Acute Confusion c. Sleep Deprivation d. Impaired Verbal Communication

a. Risk for Injury The patient's safety is of utmost importance. Delirium presents a major risk to safety.

Which nursing diagnosis has highest priority when a patient hospitalized with sudden onset confusion and disorientation wanders and becomes agitated without any apparent stimulus? a. Risk for injury b. Acute confusion c. Impaired memory d. Self-care deficit, bathing, or hygiene

a. Risk for injury

Which nursing diagnosis would be the top priority when caring for a patient with Alzheimer's disease? a. Risk for injury b. Caregiver strain c. Anticipatory grieving d. Level of communication

a. Risk for injury

Which nursing diagnoses are appropriate for the patient diagnosed with bipolar disorder? a. Risk for injury b. Hopelessness c. Low self-esteem d. Defensive coping e. Impaired verbal communication

a. Risk for injury -Risk for injury is a crucial nursing diagnosis for the patient diagnosed with bipolar disorder. d. Defensive coping -Defensive coping is a nursing diagnosis for the patient diagnosed with bipolar disorder. e. Impaired verbal communication -Impaired verbal communication is a nursing diagnosis for the patient diagnosed with bipolar disorder.

When a patient is to begin lithium therapy, which laboratory results would the health care team be sure to check before administering the patient's first dose? Select all that apply. a. TSH b. LFTs c. BUN d. Glucose e. Magnesium

a. TSH -Lithium can cause hypothyroidism. c. BUN -Lithium is excreted through the kidneys, and lithium toxicity as well as long-term use, can impair renal function.

Which nursing assessment is Remembering immediate, recent, and remote events?

Memory

Place Sheldon's stages of grief in the order in which they are experienced: Inability to live without the deceased A deep sadness at the loss of the deceased A feeling of disbelief Building a life without the deceased

1. A feeling of disbelief 2. A deep sadness at the loss of the deceased 3. Inability to live without the deceased 4. Building a life without the deceased

Place the Bowlby stages of grief in the order in which they are experienced: Ability to live life without the deceased. Inability to feel emotion. Withdrawal and pain surface as longing for deceased diminishes. Emergence of strong negative emotions and longing for the deceased.

1. Inability to feel emotion 2. Emergence of strong negative emotions and longing for the deceased 3. Withdrawal and pain surface as longing for deceased diminishes 4. Ability to live life without the deceased

Place the necessary tasks of grieving and mourning in order, according to Worden: Not believing the loss Making necessary changes to adjust to the loss Developing new relationships Acknowledging the loss

1. Not believing the loss 2. Acknowledging the loss 3. Making necessary changes to adjust to the loss 4. Developing new relationships

The nurse must immediately report which situation to a higher authority? a. Patient's report of homicidal ideation. b. Patient's refusal of a psychotropic medication. c. Patient's demand for a psychiatric advance directive. d. Patient's use of the telephone to notify local police of desire to be discharged.

A. A Tarasoff warning is indicated for homicidal ideation if the potential victim is identifiable.

A highly seductive patient reports the decision to stop the sexual relationship with the outpatient therapist and asks the nurse for a date after discharge. Which responses by the nurse would be appropriate? Select all that apply. a. Decisively decline the date. b. Kindly explain that the nurse can only offer friendship to the patient. c. Tell the patient the date will depend on status upon discharge. d. Closely monitor the patient for sexual interactions with other patients on the unit. e. Initiate an investigation into the report of sexual activity between the outpatient therapist and the patient.

A. Romantic or sexual contact is prohibited during and after hospitalization. D. Highly sexualized behavior may be a sign of mental illness. The nurse has the duty to protect this patient and other patients on the unit. E. Sexual contact between the patient and the therapist is unethical and unprofessional conduct, which should be reported.

A patient's out-of-control behavior necessitated emergency medication and seclusion. What are the nursing goals for this patient? Select all that apply. a. Assist the patient to re-establish control. b. Monitor the other patients' reactions to the seclusion. c. Maintain the seclusion to keep other patients safe. d. Discontinue seclusion as soon as it is safely possible. e. Administering additional medications, despite patient refusal, to maintain therapeutic blood levels.

A. Seclusion is indicated only during the period where the patient is out of control to the extent that he/she poses a risk of harm to self or others. D. The patient has a right to treatment in the least restrictive environment possible once the danger has passed.

A patient with paranoid schizophrenia who lives with her mother states to the nurse that she has rigged her bedroom door at home with explosives. Which action is urgently indicated? a. Notify the psychiatrist and the police of the danger. b. Reassure the patient of her confidentiality on the unit. c. Administer a single dose of a psychotropic medication. d. Assure the patient of her right to refuse any visitor, including her mother.

A. The patient's mother and others in the house may be in danger and are in need of a Tarasoff warning.

Inability of mentally ill to provide for self despite means?

Gravely disabled

What issue may the older adult patient with mental health concerns challenge when Medicaid may limit where a patient can receive care?

Access to care

Which nursing assessment is initiating, sustaining, and terminating an activity?

Attention spam

A patient is undergoing court-ordered ECT as a treatment for severe depression. The patient is refusing psychotropic medication. What should the nurse do? A. Hide the medication in the patient's food. B. Honor the patient's refusal and document it C. Briefly restrain the patient to administer the medication. D. Inform the patient that the court has mandated the medication.

B. The patient has a right to refuse the medication.

Which nursing assessment is Assessing delusions and hallucinations?

Behavior

A patient is receiving court-ordered psychotropic medications. A researcher insists that an experimental psychotropic be given to the patient. Which nursing action is indicated? a. Inform the researcher that the Psychotropic Consent form must be completed. b. Include the experimental medication with other court-ordered psychotropic medication. c. Advise the researcher to obtain the patient's informed consent to participate in the research. d. Encourage the patient to consent to the experimental medication or the patient will be discharged immediately.

C. Psychiatric patients are a specially protected population in terms of research due to their vulnerability. They have the right to consent or refuse to participate in research.

Incarceration of person who pleads guilty by reason of insanity?

Civil commitment

Person appointed?

Conservator

What phase addresses patient education needs and maintains medication regimen?

Continuation phase

What mood state is hypomania that alternates with minor depressive episodes over at least 2-year period

Cyclothymic disorder

A patient with suicidal ideation is being admitted and asks to wear her grandmother's scarf as a reminder of her. Which response by the nurse is most appropriate? a. "Be sure you tie the scarf very loosely." b. "It is a very nice scarf. Allow me tie it for you?" c. "It is your decision to wear the clothing you desire." d. "I understand; however, it is best for you not to wear the scarf. We will put it in a safe place."

D. As the patient advocate, it is most important for the nurse to ensure protection from harm for both the patient and others.

Which legal tool is used when the mental health patient is unable to participate in the decision-making process regarding his or her own care? A. Patient's civil rights B. Patient's basic rights C. Patient's bill of rights D. Patient's psychiatric advance directives

D. Psychiatric advance directives govern the patient's mental health care when the patient is unable to make decisions for himself or herself.

The nurse is reviewing discharge paperwork with the patient when the patient states, "I am eager to have vengeance upon my neighbor for triggering this admission." Which nursing intervention is indicated? a. Discharge the patient as ordered. b. Medicate the patient to stabilize his mood. c. Remind the patient of coping skills learned during hospitalization. d. Explore the potential for violence and confer with the psychiatrist about the need to delay discharge.

D. The nurse's duty to protect society necessitates urgently notifying the psychiatrist and the possible need for a Tarasoff warning for the neighbor.

The statement "I want to be left alone." is with which associated stage of Bowlby's model of grief?

Disorganization and despair

What issue may the older adult patient with mental health concerns challenge when Prescriptions may go unfilled to pay for necessities?

Financial burden

What culture cremates ashes scattered in sacred rivers?

Hinduism

What issue may the older adult patient with mental health concerns challenge when Fixed income may necessitate selling the family home?

Housing

What prevents recurrent admissions for those in drug therapy?

Involuntary outpatient commitment

What culture does immediate burial?

Islam

What culture does involvement of rabbi?

Judaism

What phase Prevent relapse?

Maintenance phase

The statement "I think I am going to be okay." is with which associated stage of Bowlby's model of grief?

Reorganization

The statement "I am so furious that this happened." is with which associated stage of Bowlby's model of grief?

Searching and yearning

The statement "I do not feel any pain." is with which associated stage of Bowlby's model of grief?

Shock and numbness

What health care team member Helps patient with placement options?

Social worker

What issue may the older adult patient with mental health concerns challenge when Access to a vehicle and driving are limited?

Socialization

What health care team member Uses sensory stimuli and memory in guiding the patient?

Therapist

A patient has just been started on lithium. The patient reports to the nurse that she has been experiencing increased urination, nausea, and a slight tremor. How should the nurse respond to the patient? a. "Those are typical side effects of lithium. We will continue to monitor you." b. "Those are signs of lithium toxicity. If you skip tonight's dose of lithium, the symptoms should subside. You should be able to continue with your regular lithium dose in the morning." c. "We need to alert your doctor immediately." d. "Let's check your lithium level before continuing with this medication."

a. "Those are typical side effects of lithium. We will continue to monitor you." This response accurately identifies the expected side effects of lithium and identifies that in a non-emergent, non-toxic state, the patient should continue to be monitored.

Based on state law in this scenario, when will Mr. Seib need to be evaluated by a psychiatrist? CASE STUDY DETAILS a. Before 0930 the next day. b. By midnight on the day of admission. c. Within 12 hours of admission. d. By 1530 on the day of admission

a. Before 0930 the next day. Most state laws require evaluation within 24-48 hours of admission. In Mr. Seib's state the requirement is 24 hours.

A patient has been admitted to an inpatient psychiatric unit for a suicide attempt via cutting her wrists. On the second day of her admission, she superficially recuts her wrist. How should the health care team members respond? a. "What triggered you to cut yourself?" b. "Fortunately, that doesn't look too bad fortunately." c. "Oh no! More cutting? I'm worried about you. That's really a risky way to handle stress." d. "Do you want a bandaid just in case?"

a. "What triggered you to cut yourself?" This response aims to identify the trigger to the patient's maladaptive behavior in order to prompt the patient to identify alternative, healthy coping techniques.

What response should the nurse provide when a patient being admitted after a suicide attempt asks, "Why did the doctor say that I can't have my shoelaces or belt?" a. "Any item that could be potentially harmful is kept secure during your hospital stay." b. "No one gets to keep those on the unit here." c. "I can call your doctor and ask for you." d. "I will retrieve those for you. May I get you anything else?"

a. "Any item that could be potentially harmful is kept secure during your hospital stay." Items such as shoelaces, belts, or scarves can be used as a means to strangulate. When an item poses a harm risk, the item should be kept as contraband.

Brandon admits that he has been thinking about hanging himself and says, "Please don't tell anyone!" How should the nurse respond? CASE STUDY DETAILS a. "I can't keep a secret. I have to keep you safe." b. "I understand. You can trust me; I will not tell anybody until you tell me it is alright to do so." c. "How long have you been thinking this?" d. "Why did you decide to tell me?"

a. "I can't keep a secret. I have to keep you safe." This response accurately informs the patient that patient information revealing risk of danger to the patient or someone else is imperative to disclose to the rest of the treatment team. Additionally, it acknowledges that sharing information among the treatment team allows for most effective care.

Which overt statement made by a patient indicates a risk for suicide? a. "I can't take my life anymore. I can't handle this." b. "Nothing feels good anymore. I'm not able to enjoy anything." c. "Things never seem to work out for me, even when times seem good." d. "I'm sure everything will be fine eventually. That's what everyone says."

a. "I can't take my life anymore. I can't handle this."

Which statement made by the older adult patient would be documented and reported to the healthcare provider? a. "I have lied too long and just wish I could die." b. "Could I please call my daughter and let her know I am in the hospital?" c. "I do not know if Medicare will cover the cost of my admission to the hospital." d. "Could you tell me if there are any community services that accept senior volunteers?"

a. "I have lied too long and just wish I could die."

Which statement by a patient with chronic depression indicates the need for further assessment? a. "I think things will be better soon." b. "I know a lot of people care about me and want me to get better." c. "I don't have a good support system, but I am planning on joining a recovery group." d. "I have suicidal thoughts at times, but I don't have any plan and don't think I would ever actually hurt myself."

a. "I think things will be better soon."

How would the nurse best describe the importance of having a safety plan to the patient who expresses suicidal ideation? CASE STUDY DETAILS a. "In order to promote your safety, it is important to preventatively plan for how you can handle crises that arise outside of the hospital." b. "The treatment team can't provide for your safety unless you agree not to attempt suicide." c. "Your insurance company will need this documentation in order to agree to your discharge." d. "The safety plan will serve as a legal contract that approves resources for you to use in order to stay safe after discharge."

a. "In order to promote your safety, it is important to preventatively plan for how you can handle crises that arise outside of the hospital." This response accurately informs the patient about the purpose of a safety plan.

The nurse is caring for a patient with chronic renal failure who has been referred for palliative care. The patient voices concern about the costs his family will incur if he is admitted to the hospital to receive this service. How would the nurse correctly respond to the patient? a. "Palliative care can take place in the home." b. "You will likely be admitted for only a short time." c. "You won't be admitted until your prognosis worsens." d. "Palliative care can be given in a long-term care facility."

a. "Palliative care can take place in the home." The nurse would educate the patient and family that palliative care can take place in many settings, including the patient's home.

The nurse is caring for a withdrawn patient diagnosed with a depressive disorder. Which statements made by the nurse exemplify appropriate nursing interventions for this patient? Select all that apply. a. "Would you like to go for a walk or watch a movie?" b. "You are very sweet and kind to everyone on the unit." c. "I know you're not much of a runner, but you should go for a jog." d. "You seem overwhelmed, so I will give you some alone time." e. "You're in a tough spot now, but you're doing the work to pull yourself through."

a. "Would you like to go for a walk or watch a movie?" -A key nursing intervention for a patient with a depressive disorder is to offer the patient choices to aid in decision-making. b. "You are very sweet and kind to everyone on the unit." -A key nursing intervention for a patient with a depressive disorder is to focus on the patient's strengths. e. "You're in a tough spot now, but you're doing the work to pull yourself through." -A key nursing intervention for patients with a depressive disorder is to accept the patients where they are in the process.

Which patients should be recommended to receive palliative care? Select all that apply. a. A patient suffering from AIDS b. A patient with cancer who is in remission c. A patient recently diagnosed with hypertension d. A patient with rapidly progressing multiple sclerosis e. A patient with epilepsy who is having trouble with daily tasks

a. A patient suffering from AIDS -AIDS is a terminal illness. A patient with AIDS would qualify for palliative care to help manage pain and provide a peaceful death. d. A patient with rapidly progressing multiple sclerosis -A patient with a rapidly progressing illness like multiple sclerosis (MS) would be a good candidate for palliative care services. Palliative care will help treat any pain or discomfort from MS flare ups and improve patient quality of life. e. A patient with epilepsy who is having trouble with daily tasks -A patient with epilepsy who is having trouble with daily tasks is experiencing a decreased quality of life. Palliative care would help aid the patient with performing daily tasks.

Which situations describe a person experiencing complicated grief? Select all that apply. a. A person searches for the deceased many months after the death. b. A person is not able to maintain normal daily routines because of the grief. c. A person is still actively grieving the death of a friend 2 years after the death. d. A person thinks about the deceased every now and then 3 years after the death. e. A person is trying to establish new interests, but is still grieving the deceased 2 months after the death.

a. A person searches for the deceased many months after the death. -Complicated grief is characterized by denial of the death, such as searching for the person in familiar places. b. A person is not able to maintain normal daily routines because of the grief. -Complicated grief is characterized by an inability to maintain daily routines. c. A person is still actively grieving the death of a friend 2 years after the death. -Complicated grief is characterized by distressing symptoms at least 6 months after the relevant death.

Which behavior would qualify for an emergency inpatient psychiatric evaluation? Select all that apply. a. A young man is threatening to hurt himself. b. A woman is threatening to hurt her employer. c. An elderly man with anxiety refuses to take his medication. d. A young woman who is gainfully employed has not been caring for herself. e. A homeless man has been living on the street for two weeks with no money for housing.

a. A young man is threatening to hurt himself. -Behavior that is a threat to self is an indicator for emergency admission. b. A woman is threatening to hurt her employer. -Behavior that is a threat to self or others is an indicator for emergency for admission. d. A young woman who is gainfully employed has not been caring for herself. -Gravely disabled, as determined by the inability to care for oneself despite having the means to do so, is an indicator for emergency admission.

Which genetic mutations are associated with the early onset of AD? Select all that apply. a. APP on chromosome 21 b. Presenlin-1 on chromosome 14 c. Chromosome 19, which codes for the Apo-E type 4 allele d. An unbalanced translocation involving chromosome 21 having extra genetic material e. Chromosome 1 change that leads to the production of presenting-2 on chromosome 1

a. APP on chromosome 21 -APP on chromosome 21 gene is associated with early onset AD. b. Presenlin-1 on chromosome 14 -APP on chromosome 21 gene is associated with early onset AD. e. Chromosome 1 change that leads to the production of presenting-2 on chromosome 1 -This gene mutation is associated with early onset AD.

The nurse is caring for a patient at the end of life who has developed dyspnea. Which actions should the nurse take? Select all that apply. a. Administer oxygen b. Suction the airway c. Prepare for intubation d. Administer an expectorant e. Teach the patient that dyspnea is expected

a. Administer oxygen -Administering oxygen would be indicated to improve the respiratory effort in a patient with dyspnea. b. Suction the airway -Suctioning the airway would improve the patient's respiratory status and this would be done during hospice care to relieve dyspnea. d. Administer an expectorant -An expectorant would be administered to promote expectoration of sputum. This would improve the respiratory effort in a patient with dyspnea.

An older adult patient who is a veteran has a history of depression and takes serotonin. Which type of risk factor for suicidality is associated with serotonin deficiency? a. Biological b. Sociological c. Psychological d. Biopsychosocial

a. Biological Serotonin deficiency is a biological risk factor for suicide.

When assessing a patient with terminal cancer, the nurse notes dyspnea, tachycardia, and cool extremities. Which actions should the nurse take? Select all that apply. a. Administer oxygen b. Cover with a blanket c. Listen to lung sounds d. Administer an antidysrhythmic e. Administer intravenous (IV) fluids

a. Administer oxygen -Administering oxygen would help promote comfort and decrease dyspnea in a patient with terminal cancer. b. Cover with a blanket -Covering the patient with a blanket would help increase comfort related to cool extremities. c. Listen to lung sounds -Auscultating for lung sounds is part of the focused assessment in a patient with breathing difficulty and increased pulse.

An 86-year-old African-American female patient recently lost her spouse. The patient has a history of cancer and is receiving treatment that includes medication for pain control. Which factors place her at high risk for suicide? Select all that apply. a. Age b. Sex c, Disease process d. Recent loss of spouse e. Strong religious affiliation

a. Age -Suicides are increasing at the fastest rate among males who are 85 years of age and older. c, Disease process -Persons with chronic diseases such as cancer and pain syndromes are more vulnerable to suicide. d. Recent loss of spouse -Significant losses, such as losses due to divorce or death, can increase risk for suicide.

Which factors are associated with increased risk for suicidal behavior? Select all that apply. a. Alcohol abuse b. Pain syndromes c. Terminal cancer d. Spouse deployed e. Asthma exacerbation

a. Alcohol abuse -Alcohol and/or other substance abuse may lead to an increased risk for suicidal behavior. b. Pain syndromes -People with pain syndromes are particularly at risk for suicidal behavior. c. Terminal cancer -People with cancer are particularly at risk for suicidal behavior.

Which are the subjective symptoms of depressive disorder? SATA. a. Anxiety b. Insomnia c. Poor eye contact d. Inappropriate guilt e. Sad facial expressions

a. Anxiety Anxiety is a subjective symptom of a depressive disorder. b. Insomnia Insomnia is a subjective symptom of a depressive disorder. d. Inappropriate guilt Inappropriate guilt is a subjective symptom of a depressive disorder.

The nurse is caring for an older adult patient with acute delirium who is unable to ambulate independently. When left alone in the room, the patient attempts to get out of bed. Which action would the nurse take first? a. Apply a pressure-sensitive alarm to the patient's bed. b. Request an order for an anxiolytic to help calm the patient. c. Ask the family to be available to stay with the patient when the staff is not in the room. d. Apply soft wrist restraints to the patient and attach them to the frame of the bed with a quick-release knot.

a. Apply a pressure-sensitive alarm to the patient's bed. Before applying any restraint to a patient, the nurse attempts to provide the least restrictive environment first. This would include applying a pressure sensitive alarm to the patient's bed.

The nurse is caring for a patient who is in the process of dying. The nurse notices that the patient is having shortness of breath and is struggling for air. The nurse also notes crackles and drooling. Which actions would the nurse take? Select all that apply. a. Apply oxygen b. Prepare for intubation c. Suction the oral cavity d. Obtain a STAT chest X-ray e. Elevate the head of the bed

a. Apply oxygen -Allowing the family time with the patient provides privacy and opportunity to say final goodbyes to their deceased loved one. c. Suction the oral cavity -Allowing the family time with the patient provides privacy and opportunity to say final goodbyes to their deceased loved one. e. Elevate the head of the bed -Allowing the family time with the patient provides privacy and opportunity to say final goodbyes to their deceased loved one.

A patient was recently diagnosed with congestive heart failure and was told they would benefit from palliative care services. When should palliative care begin? a. As soon as the patient is ready b. After symptoms become more frequent c. Once financial planning has been completed d. When the patient's prognosis is 6 months left to live

a. As soon as the patient is ready Palliative care should begin at any stage of the patient's illness and, most importantly, as soon as the patient is ready to receive services.

The nurse is caring for the family of a patient who died unexpectedly after a motor vehicle accident. Which actions would the nurse consider doing next? Select all that apply. a. Ask the family about organ donation b. Ask the family if a chaplain is desired c. Allow the family some time alone with the patient d. Immediately remove the tubes and drains from the patient e. Allow the family to clean the patient's body in preparation for the coroner

a. Ask the family about organ donation -The statement of the patient's sister is an example of bargaining. In this stage, the family member offers to make a lifestyle change if the patient's life is spared. b. Ask the family if a chaplain is desired -The statement of the patient's sister is an example of bargaining. In this stage, the family member offers to make a lifestyle change if the patient's life is spared. c. Allow the family some time alone with the patient -Allowing the family time with the patient provides privacy and opportunity to say final goodbyes to their deceased loved one.

Which findings would indicate to the nurse that a patient is close to death? Select all that apply. a. BP of 60/40 b. Acute constipation c. Absent bowel sounds d. Capillary refill >5 seconds e. Rectal temperature of 101.7° F

a. BP of 60/40 -Decreasing blood pressure is a sign of impending death, and is one of the cardiovascular responses as death approaches. c. Absent bowel sounds -Decreased gastrointestinal motility leads to absent bowel sounds in a dying patient and therefore the nurse can expect to see this in the dying patient. d. Capillary refill >5 seconds -The nurse can expect to see cardiovascular changes at the time of death which leads to decreased peripheral perfusion and delayed capillary refill.

Which assessment findings would cause the nurse to suspect that a patient is experiencing acute delirium? a. Changes in behavior occur rapidly. b. The patient appears distressed and agitated. c. The patient reports forgetting how to get home from the store. d. The patient is not anxious about the symptoms being experienced. e. The patient's family reports that the patient was found wandering outside one evening.

a. Changes in behavior occur rapidly. -Being an acute process, change is rapid, and the patient cannot express what is happening. b. The patient appears distressed and agitated. -The older adult with acute delirium is highly anxious, and while they are unable to clearly verbalize what is happening, they are significantly distressed.

Ten years after the death of her child, a mother is still outwardly grieving, experiencing physical and emotional symptoms. Which type of grief is the patient experiencing? a. Chronic b. Masked c. Delayed d. Exaggerated

a. Chronic Grief reactions that do not diminish over time indicate chronic grief.

Which medication should the nurse anticipate will be ordered for a manic patient who is highly agitated? a. Clonazepam b. Citalopram c. Clozapine d. Clonidine

a. Clonazepam Clonazepam, which is a benzodiazepine, is useful in controlling agitated behavior.

A patient with breast cancer who receives palliative care services is told that chemotherapy is no longer effective and a prognosis of 2 months to live is indicated. Which actions should the nurse take? Select all that apply. a. Contact the patient's chaplain b. Continue to administer pain medication c. Teach the patient about hospice services d. Notify the family of the patient's condition e. Ask the family about funeral arrangements

a. Contact the patient's chaplain -The nurse would contact the patient's chaplain, who would provide the patient with spiritual support. b. Continue to administer pain medication -Even if the patient is referred for hospice care, pain medications are still administered to relieve pain. c. Teach the patient about hospice services -Palliative care nurses must act as patient advocates. When the patient receives a terminal diagnosis, the nurse should teach the patient about hospice services and advocate for them when necessary to ensure the patient receives optimal care.

A patient receiving palliative care services after a diagnosis of COPD develops shortness of breath and chest tightness. Which actions should the nurse take? Select all that apply. a. Contact the respiratory therapist b. Assist the patient with relaxation exercises c. Administer the prescribed albuterol (bronchodilator drug) d. Verify that a DNR is present in the patient's electronic medical record e. Contact the social worker and advocate for hospice care as these are signs of a terminal condition

a. Contact the respiratory therapist -The nurse should contact the respiratory therapist to report the patient's symptoms. b. Assist the patient with relaxation exercises -Relaxation exercises would help decrease the patient's anxiety related to shortness of breath, so this is an appropriate action for the nurse to take. c. Administer the prescribed albuterol (bronchodilator drug) -The palliative care nurse would administer albuterol, a bronchodilator agent, to relieve the patient's symptoms. This drug relaxes muscles in the airways and increases airflow to the lungs.

The palliative care nurse is caring for a patient with chronic renal failure. The patient reports that he has been unable to work because of dialysis treatments and is worried that he cannot pay his rent. Which actions would be appropriate for the nurse to take? Select all that apply. a. Contact the social worker b. Talk to the patient about his financial concerns c. Provide the patient information on support groups d. Administer diazepam (anxiolytic drug) as prescribed e. Suggest decreasing the frequency of dialysis treatment

a. Contact the social worker -The nurse would contact the social worker for patients with financial difficulties. The social worker can help in identifying resources to alleviate the financial burden associated with chronic illness. b. Talk to the patient about his financial concerns -Asking the patient to talk about his concerns would be appropriate because it will help the patient to discuss options and may help relieve his worry. c. Provide the patient information on support groups -The nurse can give the patient information on support groups which may be able to point the patient to financial resources he can use.

Which nursing action reflects culturally competent care when caring for a patient with an expressed indigenous worldview? a. Coordinating care with a traditional healer. b. Applying knowledge of the variations in health beliefs. c. Participating in learning to understand cultural preferences. d. Advocating for policies to promote the health of the Indigenous culture.

a. Coordinating care with a traditional healer.

Which conditions are patients with delirium at direct risk for if the underlying cause of delirium is not identified and treated? a. Death b. Stroke c. Seizures d. Myocardial infarction e. Irreversible brain damage

a. Death -If effective management of delirium is not successful, instead of returning to baseline functioning level, the patient is at risk of dying due to hypoxic injury. c. Seizures -Seizure is an imminent risk for patients with untreated delirium due to fever and alcohol withdrawal. e. Irreversible brain damage -If effective management of delirium is not successful, instead of returning to baseline functioning level, the patient is at risk for irreversible brain damage related to impaired oxygenation.

Which circumstances increase the risk for complicated grief? Select all that apply. a. Death of friend to suicide b. Death due to a car accident c. Death of an older adult parent d. Death due to a drive-by shooting e. Death of a child after a long fight with cancer

a. Death of friend to suicide -The risk for complicated grief is increased in cases of suicide. b. Death due to a car accident -The risk for complicated grief is increased in cases of sudden or unexpected death. d. Death due to a drive-by shooting -The risk for complicated grief is increased in cases of homicide.

A nurse is orienting to a hospital unit as a new hire. Prior to going into the room of a patient with delirium, the preceptor tells the new nurse to introduce herself to the patient despite this being the third time the new nurse has seen the patient this shift. What importance does this serve for the nurse's patient with delirium? a. Delirium impairs memory and orientation. b. Reintroduction helps the patient to memorize the nurse's name. c. Delirium causes aggression, and re-introduction is a polite way to ease into interaction. d. The patient may not remember which nurse is the orientee and which one is the preceptor.

a. Delirium impairs memory and orientation. Due to memory and orientation impairment, the nurse should make it a habit to re-introduce herself each time a new interaction with a patient takes place in order to prevent the patient from experiencing confusion and fear.

A patient, who expressed suicidal ideations upon admission has begun planning to finish his college degree. This goal demonstrates improvement associated with which of the patient's original nursing diagnoses? a. Despondency b. Poor coping skills c. Denial of problems d. Poor social interaction

a. Despondency Setting a goal for the future suggests that the patient is future oriented and hopeful rather than despondent.

Ms. Harris develops lithium toxicity. Which symptoms may the nurse expect to Ms. Harris to develop? a. Diarrhea b. Confusion c. Blurred vision d. Severe hypertension e. Small output of concentrated urine

a. Diarrhea -Early signs of lithium toxicity include diarrhea. b. Confusion -Advanced signs of lithium toxicity include confusion. c. Blurred vision -Signs of severe lithium toxicity include blurred vision.

Which characteristic exhibited by John would cause the nurse to suspect Alzheimer's disease? a. Difficulty with word-finding b. Recall of recently learned information c. Resting hand tremor and shuffling gait d. He was beginning to have some memory problems

a. Difficulty with word-finding Demonstrating difficulty in finding and expressing words is a characteristic of John's that is indicative of AD.

A nurse is caring for a patient in hospice care. Which changes to the sensory system indicate the patient is approaching death? Select all that apply. a. Diminished taste or smell b. Hypersensitive cough reflex c. Difficulty hearing soft sounds d. Persistent stare with no blinking e. Lack of sensation when skin is touched

a. Diminished taste or smell -Patients approaching death will developed a decreased acuity to taste and smell. c. Difficulty hearing soft sounds -Patients approaching death will developed a decreased acuity to taste and smell. d. Persistent stare with no blinking -Patients approaching death will have an absent blink reflex. e. Lack of sensation when skin is touched -Patients nearing death will have a reduced sensation to both pain and touch.

Which situations may negatively affect the grieving process? Select all that apply. a. Divorce b. Lack of friends to turn to c. High-stress work environment d. Caring for a chronically ill parent e. Acceptance of a higher-paying job

a. Divorce -Concurrent issues, including family issues such as divorce, negatively affect the grieving process. b. Lack of friends to turn to -A lack of support negatively affects the grieving process. c. High-stress work environment -Concurrent issues, including workplace demands, negatively affect the grieving process. d. Caring for a chronically ill parent -Concurrent issues, including caregiving concerns, negatively affect the grieving process.

When conducting a suicide risk assessment, why would the nurse decide to interview the patient's family separately? a. Family may be hesitant to speak in front of the patient. b. Family may be disappointed by actions of the patient. c. The nurse may need to confront the family about abuse. d. Family may tell the nurse more about the patient's feelings.

a. Family may be hesitant to speak in front of the patient. The nurse may interview the family separately in case they are hesitant to speak openly in front of the patient.

Which are common emotions that influence the grieving process of a person suffering loss of a relative to suicide? Select all that apply. a. Fear b. Anger c. Shame d. Vulnerability e. Loss of a dream

a. Fear -Those suffering a loss of a family member to suicide often feel fear that another family member will commit suicide, thus intensifying the loss. b. Anger -Those suffering a loss to suicide often feel anger, interfering with the ability to cope. c. Shame -Shame is a common feeling for suicide survivors related to the social stigma of suicide, and may influence the grieving process.

The nurse notices Ms. Harris has developed fine hand tremors. What does the nurse understand about this symptom? a. Fine hand tremors are a normal side effect of lithium carbonate. b. Fine hand tremors are likely due to a cause unrelated to bipolar disorder. c. Fine hand tremors are a sign of severe lithium toxicity and emergency measures should be taken. d. Fine hand tremors are a sign of advanced lithium toxicity and a drug level should be drawn STAT.

a. Fine hand tremors are a normal side effect of lithium carbonate. A normal side effect of lithium carbonate is fine hand tremors.

The nurse is preparing to assess a patient who has shared they are a refugee from the Middle East. Which assessment finding is a common mental health condition the patient may be experiencing. a. Flashbacks b. Delusions c. Disorganized thinking d. Decreased need for sleep

a. Flashbacks

A patient with a deep self-inflected cut to his left wrist tells the nurse, "I can't see anything about my life getting better." Which nursing diagnoses should be included in the patient's plan of care? Select all that apply. a. Fluid loss b. Suicide risk c. Despondency d. Wrist wound e. Denial of problems f. Risk for other-directed violence

a. Fluid loss -Considering that the patient cut himself deeply, it is expected that blood loss occurred, thereby putting the patient at risk for fluid loss and insufficiency. b. Suicide risk -Considering that the patient has just attempted suicide, this would be a priority problem for this patient. c. Despondency -Considering the patient's statement, this would be an appropriate nursing diagnosis. d. Wrist wound -Considering that the patient attempted suicide by cutting his skin, this would be an appropriate nursing diagnosis.

An ICU nurse has just been assigned to a patient transferred for treatment of lithium toxicity. Which treatments should the nurse expect to be ordered for this patient? a. Gastric lavage b. Mannitol c. LFT monitoring d. Urea e. Aminophylline f. Haloperidol

a. Gastric lavage -Gastric lavage is an indicated treatment for lithium toxicity. b. Mannitol -Mannitol is an indicated treatment for lithium toxicity. d. Urea -Urea is an indicated treatment for lithium toxicity. e. Aminophylline -Aminophylline is an indicated treatment for lithium toxicity.

Which are thought to be the causes of bipolar disorder? a. Genetics b. Hypothyroidism c. Immune response d. Neurotransmitter disorders e. Hyperactive pituitary gland

a. Genetics -Persons with a first-degree relative who has bipolar disorder are 5-10 times more likely than the general population to develop the disorder. b. Hypothyroidism -Hypothyroidism is associated with bipolar disorder. d. Neurotransmitter disorders -Neurotransmitter disorders are associated with bipolar disorder.

The nurse is caring for a patient who is actively dying. The patient becomes agitated, combative, and confused. Which actions should the nurse take? Select all that apply. a. Give IV lorazepam b. Palpate the bladder c. Assess for constipation d. Assess oxygen saturation e. Allow more visitors into the room

a. Give IV lorazepam -The nurse would administer lorazepam, an anxiolytic drug, as prescribed to decrease the patient's agitation. b. Palpate the bladder -The nurse would palpate the bladder because a distended bladder can lead to mental status changes, such as confusion and agitation. c. Assess for constipation -Constipation may occur with decreased GI motility, and can cause discomfort which leads to agitation. d. Assess oxygen saturation -Hypoxia can lead to mental status changes, such as agitation and confusion. The nurse should assess the patient's oxygen saturation.

Which nursing activities align with the goals or focus of hospice care? Select all that apply. a. Giving pain medications b. Suctioning oral secretions c. Administering chemotherapy d. Assisting in removal of a tumor e. Collaborating with religious leaders

a. Giving pain medications -Hospice care is focused on improving a patient's comfort level. Thus, administering pain medication supports this goal. b. Suctioning oral secretions -Hospice care is directed at symptom management. Suctioning oral secretions supports this focus as it improves a patient's respiratory effort. e. Collaborating with religious leaders -Hospice care focuses on providing spiritual care. Referring a patient and their family to their religious leaders supports this directive.

Which terms describe a person's reaction to the death of a loved one? a. Grief b. Mourning c. Depression d. Bereavement

a. Grief

An adolescent male reaches out to a teacher at school when he begins to have thoughts of suicide. Which internal protective factor may mitigate risk of suicide in this patient? a. Help-seeking b. Community support c. Effective clinical care d. Strong interpersonal bonds

a. Help-seeking Help-seeking is an internal protective factor that can mitigate suicide risk. The young man demonstrates this factor by reaching out to a teacher.

Which events are considered suicide risk factors? a. History of abuse b. History of suicide attempts c. Being asked about suicidality d. Examples of ineffective coping e. Verbalization of knowledge of self-destructive language

a. History of abuse -A history of abuse is commonly seen in individuals who attempt suicide. b. History of suicide attempts -A history of suicide attempts is a predictor of suicide risk. d. Examples of ineffective coping -A pattern of ineffective and impulsive coping suggests that a patient could see suicide as a way to cope and impulsively take action to follow through on suicide when stressed.

A patient diagnosed with bipolar disorder is seen by the outpatient psychiatric nurse for the medication evaluation. The patient states, "I just can't see things getting better in the future. Why am I even here anymore?" Which nursing diagnosis is most appropriate for this patient? a. Hopelessness b. Risk for injury c. Ineffective coping d. Self-care deficit

a. Hopelessness Based on the statement made by the patient, he describes a lack of hope for the future.

Which are characteristics of hypomania associated with bipolar I? a. Impulsivity b. Distractibility c. Risky behavior d. Poor global functioning e. Resistance to somatic treatments

a. Impulsivity b. Distractibility c. Risky behavior

A nurse is providing education on the psychiatric involuntary commitment process. Which is true of involuntary commitment? Select all that apply. a. It is time-limited. b. It is determined by state law. c. It is for an indefinite time period. d. The person must be a threat to self or others. e. Anyone can place another under commitment. f. The court system is not involved in the process.

a. It is time-limited. -The length of an involuntary commitment is time-limited and this time is stated in the legal documentation provided to the patient. b. It is determined by state law. -The length of time for emergency commitment is determined by state law and is usually 24-48 hours. d. The person must be a threat to self or others. -A person must be determined to be a danger to self, others, or gravely disabled.

The charge nurse on a neurology unit is assigning patients to nurses for the next day. What should the charge nurse keep in mind when assigning a nurse to the patient diagnosed with delirium? a. Keep the nurse assigned to the patient as consistently as possible. b. Alternate nurses assigned to this patient due to their demanding care needs. c. The patient's behavior will be less demanding for staff if he is physically restrained. d. The patient will require extensive care, thus two nurses will need to be assigned to the patient.

a. Keep the nurse assigned to the patient as consistently as possible. In order to avoid worsening disorientation, consistency in staffing is ideal for a patient with delirium.

How should the day shift nurse of a patient with delirium arrange the patient's room in order to promote recovery? Select all that apply. a. Limit wires and cords around the patient. b. Close the window curtains to promote rest. c. Turn on the television and tune to a news program. d. Make sure a calendar and clock are in view of the patient. e. Leave the side rails of the bed down to let the patient move in and out of bed easily.

a. Limit wires and cords around the patient. -By limiting wires and cords in the patient's environment, this prevents falls, limits stimuli, and promotes free movement in a safe manner. d. Make sure a calendar and clock are in view of the patient. -The presence of a calendar and a clock helps to orient the patient to time.

A patient presents to a psychiatric outpatient office and reports a history of bipolar disorder and epilepsy. Which medication would present a high risk for treatment for this patient? a. Lithium b. Carbamazepine c. Valproate d. Lamotrigine

a. Lithium Lithium can cause seizures when serum level exceeds therapeutic range.

Which nursing consideration is a primary focus when planning care for a patient in the acute phase of mania? a. Medical stabilization b. Focus on the prevention of relapse c. Decreasing the risk of lithium toxicity d. Limiting the severity of future episodes of mania

a. Medical stabilization

What are the most common cognitive assessment tools used for assessing patients with possible cognitive disorders? Select all that apply. a. Mini-Cog b. The Burden Interview c. Memory Impairment Screen d. Geriatric Depression Scale (GDS) e. Mini-Mental State Examination (MMSE)

a. Mini-Cog -The Mini-Cog is a short (three-section) test used in primary care settings to screen for dementia. c. Memory Impairment Screen -The Memory Impairment Screens is a brief, 4-item scale that shows good sensitivity and specificity in classifying dementia. e. Mini-Mental State Examination (MMSE) -The MMSE is a cognitive assessment tool used to assess patients with dementia and cognitive impairments associated with head trauma.

Which tool is useful in assessing the patient diagnosed with bipolar disorder? a. Mood Disorder Questionnaire b. Beck Depression Inventory c. Patient Health Questionnaire-9 d. Healthy Living Questionnaire

a. Mood Disorder Questionnaire The Mood Disorder Questionnaire determines the patient's risk for mood disorders, including bipolar disorder.

Mrs. Gilbert is admitted to the geriatric psychiatric unit for medication adjustment. Who should sign the admission paperwork? CASE STUDY DETAILS a. Mr. Jones b. Mr. Gilbert c. Mrs. Gilbert d. The attorney

a. Mr. Jones As the legal conservator, Mr. Jones should sign all paperwork for Mrs. Gilbert.

Which observation of Mrs. M's condition would cause the nurse to suspect acute delirium? a. Mrs. M's disorganized speech b. Finding Mrs. M's purse in the oven c. Mrs. M calling Elsa by her daughter's name d. Mrs. M presenting with dry mucous membranes e. Failure to note a fever during Mrs. M's physical assessment

a. Mrs. M's disorganized speech -Disorganized, tangential speech, as a change from baseline, is a finding associated with acute delirium in the setting of a clinical infection such as a urinary tract infection (UTI). b. Finding Mrs. M's purse in the oven -Acute confusion, disorientation, and sudden change from routine behaviors are findings that would cause the nurse to suspect acute delirium in the setting of a clinical infection such as a UTI. c. Mrs. M calling Elsa by her daughter's name -Acute onset confusion, as a change from baseline, is associated with acute delirium in the presence of clinical signs of infection.

Which medications are associated with the highest risk of developing delirium? a. Narcotics b. Benzodiazepines c. Antihistamine agents d. Anticholinergic agents e. Antithrombotic agents

a. Narcotics -Narcotics are highly associated with delirium. The CNS depression that occurs with narcotics is associated with symptoms of delirium. b. Benzodiazepines -Narcotics are highly associated with delirium. The CNS depression that occurs with narcotics is associated with symptoms of delirium. d. Anticholinergic agents -Narcotics are highly associated with delirium. The CNS depression that occurs with narcotics is associated with symptoms of delirium.

A patient with atherosclerosis and chronic heart disease is being evaluated for palliative care services. Which health care professionals may be involved in the patient's care? Select all that apply. a. Nurse b. Dietitian c. Cardiac surgeon d. Respiratory therapist e. Primary health care provider

a. Nurse -The nurse is a part of the palliative care team, and plays a key role in the administration of medications and provision of care. b. Dietitian -Dietitians are a part of the health care team and their services may be required in a palliative care team that is managing a patient with atherosclerosis and chronic heart disease. d. Respiratory therapist -A respiratory therapist would be a part of the palliative care team for a patient with atherosclerosis and chronic heart disease to help treat the patient's respiratory symptoms. e. Primary health care provider -Health care providers would be a part of the palliative care team for a patient with atherosclerosis and chronic heart disease. They are responsible for evaluating the patient's condition and prescribing medication and treatment.

Which health care team member is most likely to provide patient teaching to patients diagnosed with depressive disorders? a. Nurse b. Social worker c. Spiritual counselor d. Mental health technician

a. Nurse Since the nurse is the patient's main point of care, the nurse spends the most time educating patients.

Which assessment aspects are most important for a nurse to address in patients with delirium? a. Pain level b. Temperature c. Bowel activity d. Pulse oximetry e. Level of consciousness f. Musculoskeletal deformities

a. Pain level -Pain control is necessary for prevention and treatment of delirium. b. Temperature -Fever could indicate an infection is the underlying cause of delirium. d. Pulse oximetry -Hypoxia could be the cause of the delirium; oxygenation is extremely important in order to prevent or alleviate delirium. e. Level of consciousness -Proper neurological function is extremely important in order to prevent or alleviate delirium.

A patient who has recently suffered a loss presents with insomnia and loss of appetite. Which type of reaction to the loss is the patient experiencing? a. Physical b. Cognitive c. Emotional d. Behavioral

a. Physical Sleep disturbances and changes in appetite exemplify a physical reaction to a loss.

After a manic patient has been acutely stabilized, what are the desired treatment outcomes for this patient? a. Prevent relapse b. Taper off medication c. Eliminate mood changes d. Restore level of functioning e. Create dependent relationship with case manager

a. Prevent relapse -Preventing relapse is an essential outcome to improving patient's quality of life and health. d. Restore level of functioning -Restoring level of functioning is imperative for the patient to be able to achieve and maintain highest level of independence.

Which is the priority of care for a patient experiencing hyperactive mania? a. Preventing injury b. Improving self-esteem c. Encouraging mobility d. Improving verbal communication

a. Preventing injury

When teaching nursing students about the Patient Self-Determination Act of 1990, which responsibilities of the health care institution would the instructor include in the discussion?a.Provide consistent, safe, equitable care to all patients. b. Include documentation in the medical record regarding a patient's existing advance directives. c. Mandate that all patients complete an advance directive within 24 hours of admission to the facility. d. Maintain policies pertaining to provision of information to all patients regarding advance directives. e. Provide verbal information to the patient regarding their right to make decisions about their medical care.

a. Provide consistent, safe, equitable care to all patients. -Health care institutions cannot provide differing levels of care or discriminate in any way based on whether a patient has an advance directive. b. Include documentation in the medical record regarding a patient's existing advance directives. -Documentation of any existing advance directives must be included in the patient's medical record. d. Maintain policies pertaining to provision of information to all patients regarding advance directives. -Policies that govern the dissemination of information on advanced directives to all patients interfacing with the institution is a responsibility of the institution.

An older adult patient whose husband recently died has experienced insomnia and significant weight loss for the past six months. Which techniques should the nurse use when communicating with this patient? Select all that apply. a. Provide spiritual referrals. b. Explore the patient's childhood. c. Encourage supportive relationships. d. Encourage activities that can raise self-esteem. e. Encourage the patient to rest as much as possible.

a. Provide spiritual referrals. -A patient who has major depressive disorder may benefit from spiritual referrals, which may encourage hope and diminish feelings of worthlessness. c. Encourage supportive relationships. -A patient who has major depressive disorder needs to be encouraged to engage in supportive relationships to help foster self-esteem. d. Encourage activities that can raise self-esteem. -A patient who has major depressive disorder needs to be encouraged to participate in activities that raise self-esteem.

Which nursing intervention supports the patient with dementia in achieving the highest level of independence and function possible? a. Providing a consistent and predictable schedule b. Asking "why" questions to help the patient explore feelings c. Providing a minimum of 3-5 hours of cognitive therapy a day d. Increasing the amount of time the patient spends at social events during the day

a. Providing a consistent and predictable schedule A consistent schedule aids the patient in achieving the highest level of independence and function possible.

Which behaviors suggest a person is experiencing complicated grief? Select all that apply. a. Questioning the reality of the death b. Expressing deep need for the deceased c. Sadness immediately following the death d. Attempt to rebuild a life without the deceased e. Avoiding restaurants and stores the deceased frequented

a. Questioning the reality of the death -A symptom of complicated grief is denial or disbelief of the death. b. Expressing deep need for the deceased -A symptom of complicated grief is an intense longing or deep need for the deceased, often more than 6 months after the death. e. Avoiding restaurants and stores the deceased frequented -A symptom of complicated grief is avoidance of things that are reminders of the loss.

Which explanation would the instructor provide to the nursing student when asked why medication reconciliation is part of the hospital discharge process? a. Redundancies in medication are eliminated. b. The nurse can adjust the dosing if needed based on overall medication profile. c. It ensures that the patient is paying the lowest price for all prescription medications. d. The medications covered by insurance are separated from those that have to be paid for out of pocket.

a. Redundancies in medication are eliminated. Reconciliation of current medication is important to ensure the individual is taking exactly what is prescribed safely and that redundancies are discovered in a timely manner. The older adult may have multiple medications from different providers, leading to duplicate medications, which creates a dangerous situation for the patient.

A patient diagnosed with bipolar disorder presents for his medication evaluation with the outpatient psychiatric nurse. The patient states that he has significantly decompensated since his last appointment, now endorsing fatigue, anhedonia, insomnia, and suicidal ideation. He also admits to smoking more cigarettes to help him try to relax. Which nursing diagnoses apply to this patient? a. Risk for injury b. Sleep deprivation c. Ineffective coping d. Interrupted family processes e. Impaired verbal communication

a. Risk for injury -Risk for injury presents the highest imminent priority for this patient due to his suicidal risk. b. Sleep deprivation -The patient is at risk for sleep deprivation due to excessive fatigue caused by manic and depressive states. c. Ineffective coping -The patient is at risk for ineffective coping as evidenced by the increase in cigarette smoking to help him relax

Which are examples of nursing diagnoses for a patient with depressive disorder? a. Risk for suicide b. Self-care deficit c. Low-self esteem d. Ineffective denial e. Readiness for enhanced coping

a. Risk for suicide Risk for suicide is an important nursing diagnosis for the patient with depressive disorder because it addresses the patient's safety. b. Self-care deficit Patients with depressive disorders typically experience poor hygiene and nutrition due to self-care deficits. c. Low-self esteem Most patients with depressive disorders suffer from low-self-esteem.

Which tool is an example of collaborative care of the patient with a depressive disorder? a. Safety plan b. Face-to-face checks c. No restraints policy d. Electroconvulsive therapy (ECT) consent

a. Safety plan The safety plan includes resources and coping strategies for patient to use, including relaxation exercises, physical activities to reduce stress, and how to access support from family, significant others, and the therapist. The patient identifies at one or more reasons for living.

Which warning sign displayed by Mr. Steiner could be an indication of suicidal ideation? Select all that apply. CASE STUDY DETAILS a. Sleeping until late afternoon every day b. Ignoring his son's attempts to visit him c. Making plans to visit his wife's grave with his son d. Reliving memories of war tragedies with other veterans e. Yelling at his son for telling the nurse Mr. Steiner is ignoring social obligations

a. Sleeping until late afternoon every day -Sleeping all of the time could be a warning sign of suicide. b. Ignoring his son's attempts to visit him -Withdrawing from friends, family, and society could be a warning sign of suicidal ideation. e. Yelling at his son for telling the nurse Mr. Steiner is ignoring social obligations. -Feeling rage and uncontrolled anger could be a warning sign of suicidal ideation.

Which reactions are examples of bereavement? Select all that apply. a. Sorrow b. Insomnia c. Excessive crying d. Denial of the loss e. Wearing black for a period after the loss

a. Sorrow -According to Worden, finding other avenues of support and companionship, is necessary for the bereaved to redefine life after a loss. b. Insomnia -Sleep disturbances are an example of physical bereavement after loss. c. Excessive crying -Excessive crying is an example of behavioral bereavement after loss. e. Wearing black for a period after the loss -Excessive crying is an example of behavioral bereavement after loss.

Which therapeutic communication strategies are important for the nurse to use when caring for patients with delirium? a. Speak slowly and clearly. b. Encourage practice with abstract concepts. c. Allow ample time for the patient to respond. d. Presume the patient will be confused by verbal statements. e. Communicate the behavior that is desired from the patient.

a. Speak slowly and clearly. -When the nurse speaks slowly and clearly, the patient will have time to absorb and interpret what is the nurse is saying, thereby easing communication. c. Allow ample time for the patient to respond. -Giving the patient time to respond will allow the patient to collect his or her thoughts and carefully respond, thereby easing communication. e. Communicate the behavior that is desired from the patient. -Giving the patient time to respond will allow the patient to collect his or her thoughts and carefully respond, thereby easing communication.

Which goals are appropriate for the patient with bipolar disorder? a. Stable relationships with family b. Adherence to medication regimen c. Reduced stress d. Decreased crying e. Improved appetite

a. Stable relationships with family -Stable relationship with family is an appropriate goal for the patient with bipolar disorder. b. Adherence to medication regimen -Adherence to medication regimen is an appropriate goal for the patient with bipolar disorder. c. Reduced stress -Reduced stress is an appropriate goal for the patient with bipolar disorder.

Which behavior is demonstrated by the comment "All of the patients who live on the south side of the city come to the emergency department constantly seeking pain prescriptions," and would be avoided when providing cultural care? a. Stereotyping b. Cultural idiom c. Ethnocentrism d. Cultural incompetence

a. Stereotyping

A patient reports unpleasant side effects from antidepressant therapy. Which nonpharmacological options might the nurse recommend to the patient for treating depression? Select all that apply. a. Suggest the patient enroll in art therapy. b. Encourage the patient to undergo acupuncture. c. Refer the patient to a cognitive behavioral therapist. d. Ask the health care provider to change the patient's antidepressant dosage. e. Ask the health care provider to change the patient's antidepressant to a mood stabilizer.

a. Suggest the patient enroll in art therapy. -Art and music therapy are nonpharmacological approaches to managing depressive disorders. b. Encourage the patient to undergo acupuncture. -Acupuncture is a nonpharmacological therapy that can help manage the side effects of antidepressants. c. Refer the patient to a cognitive behavioral therapist. -Cognitive behavioral therapy is a nonpharmacological intervention that can help the patient identify depressive symptoms and learn the management of these symptoms.

A patient being treated after a violent domestic argument was threatening intimate partner violence and violence toward children. The patient's symptoms are beginning to subside, and the team has documented improvement. However, several times in the course of group therapy, the patient has continued to express violent thoughts toward family members. Which action falls within the healthcare provider's responsibility? a. The healthcare provider may have a duty to inform and protect third parties. b. The healthcare provider must always inform the police of any threat of violence. c. The healthcare provider's duty to the patient and confidentiality must be assured. d. The healthcare provider only needs to be concerned if actual physical violence has occurred.

a. The healthcare provider may have a duty to inform and protect third parties.

Which factors influence the grieving process of a female patient who suffers the loss of a close male friend who was of a similar age? Select all that apply. a. The manner of death b. The age of the deceased c. The gender of the patient d. The gender of the deceased e. The relationship between the patient and the deceased

a. The manner of death -The circumstances surrounding the death of the friend is a factor related to grief and bereavement. b. The age of the deceased -The age of a person at the time of death has an impact on the process of grief and bereavement. c. The gender of the patient -The gender of the patient will influence the grieving process, as men and women experience grief differently. e. The relationship between the patient and the deceased -The nature of the relationship to the deceased is a factor related to grief and bereavement.

A patient who was originally admitted involuntarily for suicidal ideation has since signed in voluntarily with the approval of her psychiatrist. Which patient right should guide the nurse's delivery of care? a. The patient has the right to participate in the plan of care. b. The patient has the right to refuse any treatment modality. c. The patient has the right to choose which staff members provide care. d. If the patient declines to participate in treatment, she must be discharged. e. The patient has the right to receive an explanation of her mental condition.

a. The patient has the right to participate in the plan of care. The patient has the right to participate in the plan of care and in the periodic review of the plan of care. b. The patient has the right to refuse any treatment modality. The patient has the right not to receive a course of treatment if the patient declines that course of treatment. e. The patient has the right to receive an explanation of her mental condition. The patient has a right to receive a reasonable explanation of her mental condition, as well as the objectives of treatment and reasons for treatment.

Which mental health patient rights are important for the nurse to maintain? Select all that apply. a. The patient has the right to receive visitors. b. To participate in recreation and exercise c. To send and receive unopened mail. d. To refuse a court-ordered treatment. e. To call emergency medical services to free the patient from a legal hold.

a. The patient has the right to receive visitors. The patient has the right to receive visitors, usually under staff supervision, to prevent the transfer of dangerous contraband. b. To participate in recreation and exercise The patient has the right to recreation and exercise in order to maintain health. c. To send and receive unopened mail. The patient has the right to send and receive mail that is unopened and not reviewed by health care staff.

The patient tells their pastor, "I want to return to heaven." Which action is the pastor's best course of action, knowing the patient has firearms? a. The patient requires emergency intervention. b. The pastor should inform the patient's family. c. There is no way for the pastor to stop the patient. d. The pastor should inform the patient that suicide is a sin.

a. The patient requires emergency intervention.

Which statement describes the civil rights of individuals with mental illness who are hospitalized for treatment? a. Their rights are the same as those for any other citizen. b. Civil rights are altered to prevent use of poor judgment. c. Patient rights are limited to provision of humane treatment. d. An appointment of a guardian ensures patient rights are promoted.

a. Their rights are the same as those for any other citizen.

The Tarasoff court case involves which nursing duty? a. To protect others from harm b. To protect the patient's privacy c. To provide ethical care to patients d. To treat psychiatric patients with dignity and respect

a. To protect others from harm Nurses have the duty to protect a readily-identifiable victim from potential harm.

Which findings from the physical exam would cause the nurse to suspect that a patient is a high-risk for suicide? Select all that apply. a. Track marks b. Scars on the wrists c. Flat affect and mood d. Chronic medical condition e. Poor concentration and memory

a. Track marks -Track marks found during the physical exam could be a sign of a substance abuse problem that would increase the patient's risk for suicide. b. Scars on the wrists -Scars on the wrists could indicate a previous suicide attempt and lead the nurse to determine that the patient is high-risk. d. Chronic medical condition -A chronic or debilitating medical condition revealed during the physical exam could indicate the patient is high-risk for suicide.

A patient has just been put into seclusion. Which information should the nurse include in her documentation of the event? a. Type of behavior exhibited by the patient b. What items have been permitted in the seclusion room with the patient c. Time patient entered seclusion d. Time when patient is planned to be released e. Less restrictive interventions used first

a. Type of behavior exhibited by the patient -Documentation of the behavior that led to the seclusion is important to include in documentation to show the necessity of seclusion. c. Time patient entered seclusion -The time that the patient entered seclusion is important to document in order to know when seclusion orders need to be discontinued or re-ordered. e. Less restrictive interventions used first -Documentation of less restrictive interventions used first is important to include in documentation to show the necessity of seclusion.

Which disease process is responsible for the sudden onset of dementia symptoms? a. Vascular dementia b. Alzheimer's disease c. Frontotemporal dementia d. Creutzfeldt-Jakob disease (CJD)

a. Vascular dementia Vascular dementia symptoms can come on suddenly, as in the case of a stroke patient.

Which nursing action has the highest priority when administering medications to a patient on suicide precautions? a. Verify that the patient swallowed the entire dose of the medication. b. Document the patient's willingness to take medication voluntarily. c. Inform the patient of the name, action, and side effects of the medication. d. Teach the patient about delays associated with the drug's peak effectiveness.

a. Verify that the patient swallowed the entire dose of the medication.

A patient presents to the local behavioral health facility requesting admission for severe depression. What type of admission status will this patient fit? a. Voluntary b. Involuntary c. Short-term observation d. Long-term treatment

a. Voluntary When a patient consents to be admitted and treated, it is considered a voluntary admission.

Which are the examples of nonpharmacological interventions that are used for treating depressive disorders? SATA. a. Yoga b. Anxiolytics c. Mood stabilizers d. Omega-3 fatty acids e. Cognitive behavioral therapy (CBT)

a. Yoga Yoga is a type of mind-body practice that is a nonpharmacological intervention used in the treatment of depressive disorders. d. Omega-3 fatty acids Omega-3 fatty acids are supplements that comprise nonpharmacological intervention. It is used in the treatment of depressive disorders. e. Cognitive behavioral therapy (CBT) Cognitive behavioral therapy is a type of therapy that is a nonpharmacological intervention. It is used in the treatment of depressive disorders.

What phase maintains safety and medically stabilize patients?

acute phase

The nurse is assisting a patient with dementia to the bathroom. Which communication example is most appropriate for the nurse to use with this patient? a. "Do you need to go to the bathroom right now?" b. "The bathroom is right here." Point to the bathroom and repeat the message if needed. c. "It's time to use the bathroom; I can help you go now." State this while pointing to the bathroom. d. "You need to use the bathroom before you go to lunch." Point to the bathroom and ask, "Are you ready now?"

b. "The bathroom is right here." Point to the bathroom and repeat the message if needed. The nurse used simple verbiage, accompanied by a visual cue and repeats the message.

The hospital unit's psychiatrist has ordered a mood stabilizer and antipsychotic for a patient with bipolar disorder. The nurse is now administering medications and recognizes the patient has not been educated on the newly ordered medications. Which would be the appropriate education to provide this patient? a. "Valproate will help make you happier, and risperidone will help control the side effects of valporate." b. "Valproate will help to control your mood while risperidone will help your mind to think clearly." c. "Risperidone will give you more energy during the day while valproate will speed your thoughts." d. "Valproate and risperidone are common medications for bipolar disorder. You should notice improvement in a few weeks."

b. "Valproate will help to control your mood while risperidone will help your mind to think clearly." This response accurately identifies the effect of valproate, a mood stabilizer, and risperidone, an atypical antipsychotic.

Which assessment question would the nurse ask of either the patient or their family to determine the presence of delirium? Select all that apply. a. "Do you think you are confused?" b. "Would you please tell me the names of your grandchildren?" c. "When did you first notice that your mother seemed confused?" d. "How would you feel if your mother's confusion becomes a chronic situation?" e. "What did you mean when you said that your mom has always been a little confused?"

b. "Would you please tell me the names of your grandchildren?" c. "When did you first notice that your mother seemed confused?" e. "What did you mean when you said that your mom has always been a little confused?"

The onset of bipolar II is typically around what age? a. 18 b. 25 c. 30 d. 35

b. 25 The onset of bipolar II is typically in the mid-20s.

Which statement, if made by a nursing student, indicates that additional learning regarding aging is needed? a. Older adults are often the victims of crime. b. Adults over 65 years tend to be financially stable. c. The quality of sleep declines significantly with aging. d. Older adults who lose a spouse adjust to the loss better than younger adults.

b. Adults over 65 years tend to be financially stable. Many older adults continue to work well past retirement age due to financial instability; lack of savings; and increased cost of living, including spending for health care, especially prescription medications.

Which intervention is best to help orient a patient experiencing confusion associated with a neurocognitive disorder? a. Remind the patient frequently of upcoming events. b. Offer a consistent daily routine and easy-to-read clocks c. Repeatedly rehearse spheres of orientation with the patient d. Provide frequent opportunities for the patient to make choices

b. Offer a consistent daily routine and easy-to-read clocks

A nurse educating staff at an adult day care facility would discuss which conditions as placing an older adult at increased risk for suicide? a. Female sex b. Alcohol misuse c. Professional retirement d. Having a physical disability e. Living with chronic pain

b. Alcohol misuse -Alcohol misuse is a risk factor for suicide in older adults because alcohol may be used to "self-medicate" to blunt feelings of loneliness or hopelessness. d. Having a physical disability -A physical disability, such as paraplegia, is a risk factor for suicide in older adults. The older adult may not be able to overcome the loss of power and independence caused by the disability. e. Living with chronic pain -Chronic and/or uncontrollable pain is a risk factor for suicide in older adults. The change in health status, loss of power, and sense of hopelessness make death more attractive than life for some in this situation.

The nurse is collecting an admission history from an older adult patient who was brought to the health care provider's office by their child, who is concerned that their parent may be depressed following the recent death of their spouse. Which assessment strategies would the nurse use to obtain an accurate history? a. Ask the patient why they are depressed. b. Allow the patient's child to add supplemental information. c. Go at a pace that allows the patient time to answer questions. d. Ask the patient "Can you tell me how you have been doing recently? e. "Reassure the patient before the interview that everything is going to be fine.

b. Allow the patient's child to add supplemental information. -Including family in the interview allows for clarification of information and additional data and provides support to the older adult patient. c. Go at a pace that allows the patient time to answer questions. -Pacing the interview questions in a way that is comfortable for the patient allows time to formulate answers. The nurse would also avoid interrupting the patient or answering for them. d. Ask the patient "Can you tell me how you have been doing recently? -Open-ended questions that allow the patient to use their own words provide the most information, while also giving the nurse an opportunity to assess affect, mood, behavior, and quality of speech.

Which statement best explains the etiology of amyloid plaques? a. Amyloid plaques form inside the neuron. b. Amyloid plaques form outside and between neurons. c. Amyloid plaques increase the amount of acetylcholine (ACh). d. Amyloid plaques hinder the production of neurofibrillary tangles.

b. Amyloid plaques form outside and between neurons. Amyloid plaques are formed outside and between neurons, which interferes with cell-to-cell communication.

A patient says to the nurse, "Life doesn't have any joy in it anymore. Things I once did for pleasure aren't fun." Which term would the nurse use to document this report? a. Dysthymia b. Anhedonia c. Euphoria d. Psychomotor retardation

b. Anhedonia

In which phase of the Kubler-Ross model is the patient attempting to deal with overwhelming feelings of vulnerability and helplessness? a. Anger b. Bargaining c. Acceptance d. Denial and isolation

b. Bargaining

Which is a depression assessment tool? a. The Braden Scale b. Beck Depression Inventory c. Patient Health Questionnaire-10 d. Family Cultural Heritage Assessment Tool

b. Beck Depression Inventory The Beck Depression Inventory is a depression assessment tool that helps determine behavioral changes over time.

Which method is the best for the nurse to use to ensure that rights are respected and preserved for a patient being treated for a mental health disorder? a. Educating each patient as to their legally protected rights. b. Being knowledgeable of the state laws that regulate patient rights. c. Participating as a member of the patient's multidisciplinary healthcare team. d. Referring all issues of a legal nature to the appropriate facility committee

b. Being knowledgeable of the state laws that regulate patient rights.

Which statement is true regarding the practice of bioethics? a. Ethical guidelines should override laws. b. Bioethics pertain to the health care team members. c. Nurses are allowed to befriend mental health patients after discharge. d. It is the study of morals and ethics as they relate to the specialty of mental health.

b. Bioethics pertain to the health care team members. Bioethics pertains to all health care providers, including nurses.

Which group is at greatest risk for suicide associated with post traumatic stress disorder (PTSD)? a. College students b. Combat veterans c. High school students d. Middle Eastern immigrants

b. Combat veterans Combat veterans have an increased risk for suicide related to PTSD due to trauma endured during combat.

A patient who was found wandering in the community, disoriented, and not wearing proper clothing for the weather conditions was brought to the ED. She was also not carrying any identification. Once she is cleared medically, it is determined that she suffers from mental illness. Which type of legal procedure is most appropriate for this patient? a. Civil commitment b. Conservatorship c. Voluntary observation d. Mandated involuntary outpatient treatment

b. Conservatorship Conservatorship is used for naming a guardian for a gravely disabled person.

A patient receiving palliative care for stage 3 ovarian cancer begins to hyperventilate. She is tearful and appears anxious. Which actions would be appropriate for the nurse to take? Select all that apply. a. Restrain the patient b. Contact the patient's chaplain c. Ask family members to leave the room d. Encourage the patient to slow her breathing e. Administer diazepam (anxiolytic drug) as prescribed

b. Contact the patient's chaplain -A counselor or chaplain may provide emotional support to a patient undergoing palliative care, which may help ease the patient's anxiety . d. Encourage the patient to slow her breathing -Having the patient slow her breathing will improve the hyperventilation and can help prevent possible respiratory alkalosis. e. Administer diazepam (anxiolytic drug) as prescribed -Administering an anxiolytic agent would help to improve the patient's anxiety. This drug is indicated for short-term or episodic relief of severe anxiety.

Which conditions would the nurse be concerned about in an older adult patient who reports consuming four to five alcohol drinks every evening? a. Mania b. Dementia c. Homelessness d. Physical injury e. Increased appetite f. Nutritional imbalance

b. Dementia -The older adult with excessive, prolonged alcohol use can develop alcohol-related diseases including alcoholic dementia, in which the chronic exposure to alcohol causes brain damage and results in symptoms similar to those seen with neurocognitive dementia. d. Physical injury -The older adult who misuses alcohol is at high risk for falls related to intoxication, and/or drug-alcohol interactions. f. Nutritional imbalance -The older adult who misuses alcohol is at high risk for nutritional imbalances because the alcohol decreases the absorption of important nutrients and contains empty calories.

A patient recently diagnosed with cancer refuses to accept chemotherapy and states, "I don't need chemotherapy. I'm sure the diagnosis is wrong and I'll get better on my own." Which stage of grief will the nurse consider in caring for this patient? a. Anger b. Denial c. Bargaining d. Acceptance

b. Denial Denial is present when the patient refuses to accept the diagnosis and declines treatment.

Which misperception about depression in the older adult exists and may cause the condition to go untreated? a. Depression is difficult to diagnose in the older adult patient. b. Depressive symptoms are mistaken as symptoms of dementia. c. The medications to treat depression cause dangerous adverse effects in the older adult patient. d. Older adult patients do not see their health care provider routinely enough to confirm a diagnosis.

b. Depressive symptoms are mistaken as symptoms of dementia. Depression in the older adult may be misinterpreted as dementia and therefore considered inevitable and unchanging.

Which factor contributes to a high risk of suicide in the veteran population? Select all that apply. a. Promotions in rank b. Disciplinary actions c. Changes in fitness for duty d. Time away from loved ones e. Trauma related to combat experiences

b. Disciplinary actions -Depression related to disciplinary actions may increase risk for suicide. c. Changes in fitness for duty -Career-threatening changes in fitness may be related to an increase in suicide risk in military and veteran populations. e. Trauma related to combat experiences -Trauma related to deployment and combat experiences increases risk for suicide.

Which symptoms are supportive of the DSM-5 diagnosis of delirium? a. Blurred vision b. Disorientation c. Impaired memory d. Impaired elimination e. Disturbance in perception

b. Disorientation -Disorientation is a hallmark feature of delirium included in its diagnostic criteria. c. Impaired memory -Impaired memory is a symptom included in the diagnostic criteria of delirium. e. Disturbance in perception -A disturbance in perception, such as illusions, is a feature of delirium.

Which purpose does the grieving process serve when experiencing the death of a loved one? a. Outlines the required steps to managing the deceased's affairs b. Enables people to accept and reconcile with the loss and adapt to change c. Provide simple, sequential, linear steps to follow after losing a loved one. d. Allows for a long period of time for feeling pervasive guilt and unhappiness

b. Enables people to accept and reconcile with the loss and adapt to change

A nurse is caring for a psychiatric inpatient with schizophrenia who exhibits social isolation. Which nursing intervention could directly improve this patient's socialization in a therapeutic manner? a. Requiring the patient to eat meals in the communal patient dining room b. Encouraging the patient to attend nurse-facilitated group therapy c. Encouraging the patient to go outside to smoke with the rest of the patients d. Requiring the patient to share feelings with staff

b. Encouraging the patient to attend nurse-facilitated group therapy Being that a nurse leads the group, the patient's participation and response to being around others can be facilitated and monitored in a therapeutic way.

A nurse counsels a patient diagnosed with depression to begin a mild exercise regime. Which physiological basis supports the nurse's recommendation? a. Exercise reduces inflammation. b. Exercise stimulates serotonin production. c. Exercise will stabilize the client's sleep pattern. d. Exercise eliminates toxins from the client's body.

b. Exercise stimulates serotonin production.

Mr. Seib tells the nurse that he does not understand why he is being admitted to the hospital. What is the best response by the nurse?CASE STUDY DETAILS a. Tell the patient to write down what he wants to know. b. Explain the legal process of his involuntary admission in simple and direct terms c. Provide the patient with the information for how he can discharge himself. d. Tell the patient that because it is an involuntary admission there is not a need for him to know.

b. Explain the legal process of his involuntary admission in simple and direct terms. When the patient is involuntarily committed, the nurse may explain the legal process in simple and direct terms. This may promote a positive reaction and acceptance by the patient.

When caring for a patient demonstrating suicidal behaviors, which intervention should be implemented by the treatment team? a. Avoid being direct with the patient when communicating. b. Form a therapeutic relationship with the patient. c. Provide firm commands. d. Implementing the care of two nurses to one patient.

b. Form a therapeutic relationship with the patient. Forming a therapeutic relationship with the patient and providing a safe environment are important actions for the team to take to build patient trust.

Which grief ritual is common to patients of African American decent? a. Making promises to the deceased b. Gathering at the home of the deceased c. Spiritual healer moderating the funeral d. Family bringing religious materials and burning incense

b. Gathering at the home of the deceased Friends and family will often gather in the home of the deceased to offer support in African American culture

Which nursing actions are aligned with the goals of palliative care? Select all that apply. a. Administering curative chemotherapy b. Giving pain medication to cancer patients c. Facilitating rehabilitative therapy after a car accident d. Providing remote telemonitoring for atrial fibrillation e. Teaching respiratory clearance techniques to patients with chronic obstructive pulmonary disease (COPD)

b. Giving pain medication to cancer patients -One important goal of palliative care is treating the patient's pain. The nurse would be expected to give pain medication to patients with cancer. e. Teaching respiratory clearance techniques to patients with chronic obstructive pulmonary disease (COPD) -Respiratory clearance techniques would help relieve the breathing difficulty in patients with COPD, and this is part of the goals of palliative care.

A patient with delirium has been given the nursing diagnosis of Impaired verbal communication. The nurse should know that this is most related to which problem? a. Coma b. Hypoxic injury c. Tracheostomy tube d. Abnormal oral anatomy

b. Hypoxic injury Impaired verbal communication is due to decreased oxygenation to the brain leading to hypoxic injury.

A patient receiving hospice care is experiencing abdominal distention and nausea. The nurse notes diminished bowel sounds. Which action would the nurse take? a. Obtain an abdominal CT b. Increase oral fluids and fiber c. Notify the health care provider d. Encourage the patient to lie still

b. Increase oral fluids and fiber Increasing oral fluids and fiber will promote regular bowel elimination in a patient with a distended abdomen and decreased bowel sounds. This action is part of the activities involved with hospice care.

Which are signs of suicidal ideation? a. Changing careers b. Increased risk-taking c. Giving away belongings d. Influx of substance abuse e. Breaking up with significant other

b. Increased risk-taking -Risk-taking is directly associated with increased risk for suicide . c. Giving away belongings -Giving away belongings shows that a patient is no longer looking to the future and is at risk for suicide . d. Influx of substance abuse -Substance abuse is impairing, and using more substances than usual suggests impulsive behavior, which is associated with suicide risk.

Which behavior is associated with parasuicidal behavior? a. Writing a suicide note b. Inflicting superficial skin cuts c. Verbalizing thoughts of suicide d. Buying rope with a plan to hang self

b. Inflicting superficial skin cuts Inflicting superficial skin cuts is a parasuicidal behavior. Parasuicidal behavior involves unsuccessful attempts that are unlikely to be lethal.

Which statements best describes Parkinson's disease? Select all that apply. a. It typically develops in individuals beginning at age 65. b. It is caused by the loss of dopamine-producing brain cells. c. Patients may experience emotional changes such as depression. d. Primary symptoms include tremors, rigidity, and bradykinesia. e. Symptoms progress quickly, with early symptoms being distinct and noticeable.

b. It is caused by the loss of dopamine-producing brain cells. -People with Parkinson's lose dopamine at a more rapid rate than most people. c. Patients may experience emotional changes such as depression. -Patients with Parkinson's disease can experience symptoms of depression and anxiety and may develop a blunted affect. d. Primary symptoms include tremors, rigidity, and bradykinesia. -Tremors, rigidity, bradykinesia, abnormal posture, flat affect, and shuffling gait are all primary symptoms of Parkinson's.

How does palliative care address the needs of the family? Select all that apply. a. It provides respite care for caregivers. b. It provides emotional support for the family. c. It helps explain patient care concepts to the family. d. It provides care free of cost in order to help the family. e. It monitors family members for potential hereditary medical problems.

b. It provides emotional support for the family. -The palliative care team provides emotional support to the family experiencing a chronic, debilitating illness by alleviating a portion of the burden placed on them when caring for the patient. c. It helps explain patient care concepts to the family. -The palliative care team provides emotional support to the family experiencing a chronic, debilitating illness by alleviating a portion of the burden placed on them when caring for the patient.

Why are laws needed to govern the care of patients with mental illness? a. Patients with mental illness are always incapable of making decisions. b. Laws are established for the protection of the patient and the public. c. Patients with mental illness are automatically entered into the court system. d. Any patient diagnosed with a mental illness must be appointed a legal guardian.

b. Laws are established for the protection of the patient and the public. Because many patients with mental illness suffer from problems with disorientation and reality testing, it is essential that nurses are aware of and follow the laws designed to protect these patients.

The nurse notes a patient who attempted suicide 2 weeks ago and has been receiving antidepressant therapy has a brighter attitude and is more social. Which intervention would the nurse need to incorporate into the plan of care? a. Begin discharge planning for the patient. b. Maintain continuous supervision of the patient c. Consider discontinuation of suicide precautions d. Refer the patient for cognitive behavioral therapy

b. Maintain continuous supervision of the patient

Which is the only FDA-approved medication for Alzheimer's disease that is not an AchE inhibitor? a. Donepezil b. Memantine c. Galantamine d. Rivastigmine

b. Memantine Memantine is not an AchE inhibitor. It blocks abnormal signaling by glutamate.

Which FDA-approved medication is prescribed in the treatment of Alzheimer's disease (AD) to temporarily delay progression of some of the symptoms of AD? a. Donepezil b. Memantine c. Galantamine d. Rivastigmine

b. Memantine Memantine regulates glutamate and may improve memory, attention, reasoning, language, and the ability to perform simple tasks. Its main effect is to delay progression of some of the symptoms in moderate to severe AD.

Which statement is an example of a myth of aging? a. Muscle strength decreases with age b. Older adults are unable to learn new tasks c. Older adults tend to become victims of crime d. Older widows tend to adjust better than younger ones

b. Older adults are unable to learn new tasks

Which protective factors may mitigate Ms. Kaplan's risk of committing suicide? Select all that apply. a. Higher education level b. Optimistic outlook c. Gainful employment d. Ongoing health care support e. Child-rearing responsibilities

b. Optimistic outlook -An optimistic outlook is a positive personal trait that can mitigate the risk of suicide. c. Gainful employment -Employment is an example of a social support system that can mitigate the risk of suicide. d. Ongoing health care support -Employment is an example of a social support system that can mitigate the risk of suicide. e. Child-rearing responsibilities -Child-rearing responsibilities indicate a social support system, which can mitigate the risk of suicide.

Which notation in the patient's medical record supports the diagnosis of mania? SATA. a. Patient demonstrates ritual behaviors b. Patient reports, "God talks directly to me." c. Patient is disheveled and in need for a bath. d. Patient reports, "I haven't slept in 4 days; don't need to." e. Patient presents with a happy, near euphoric demeanor.

b. Patient reports, "God talks directly to me." d. Patient reports, "I haven't slept in 4 days; don't need to." e. Patient presents with a happy, near euphoric demeanor.

Which nursing goal is the priority outcome for a patient with delirium? a. Patient will verbalize his feelings. b. Patient will remain free from falls. c. Patient will learn to cope with memory deficit. d. Patient's family will verbalize understanding of patient's clinical needs.

b. Patient will remain free from falls. Preventing falls and subsequent injury is of highest importance when caring for a patient with delirium.

The nurse develops a plan of care for a patient with major depressive disorder (MDD). Which nursing outcomes are appropriate for this patient? Select all that apply. a. Patient will report any presence of suicidal ideation. b. Patient will verbalize two resources of emotional support. c. Patient will report decreased crying spells during day shift. d. Patient will report ability to sleep soundly for 18 hours a day. e. Patient will remain without self-harm during hospitalization.

b. Patient will verbalize two resources of emotional support. -Being able to identify sources of emotional support is an appropriate nursing outcome for a patient with MDD. c. Patient will report decreased crying spells during day shift. -A decrease in crying spells during the day is an appropriate and measurable nursing outcome for a patient with MDD. e. Patient will remain without self-harm during hospitalization. -Remaining free from self-harm is an appropriate nursing outcome for a patient with MDD.

Which intervention would be included in the plan of care for a patient who takes lithium? a. Dietary teaching to restrict daily sodium intake. b. Periodic laboratory monitoring of renal and thyroid function c. Required laboratory tests to monitor serum potassium level d. Importance of discontinuing the medication if weight gain occurs

b. Periodic laboratory monitoring of renal and thyroid function

Which food is safe for a patient taking monoamine oxidase inhibitors (MAOIs)? a. Avocados b. Pineapple c. Chocolate d. Cheddar cheese

b. Pineapple

What information can the nurse obtain by performing a mental status examination? a. Family history b. Potential for self-harm c. Possible substance abuse d. Signs of previous self-harm attempts

b. Potential for self-harm A mental status exam can assist the nurse in determining the patient's potential for self-harm.

Which impairments are indicative of Alzheimer's disease stage 6, severe cognitive decline? a. Forgetting people's names and losing needed items b. Potential for unsafe wandering and aggressive behavior c. Unable to keep up with bills and poor short-term memory d. Inability to respond to the environment or to communicate

b. Potential for unsafe wandering and aggressive behavior These impairments are indicative of stage 6, severe cognitive decline.

During the implementation phase of providing nursing care to a depressed patient, what is the primary goal of the nurse? a. Develop a discharge plan. b. Provide for patient safety. c. Eliminate negative thoughts. d. Encourage patient participation in support groups.

b. Provide for patient safety. The nurse's main goal in providing patient care during the implementation phase is to provide for patient safety.

According to Worden, which physical adjustments are necessary for the bereaved to restructure and redefine life after a loss? Select all that apply. a. Accepting the loss of the deceased b. Restructuring financial responsibilities c. Removing the deceased's clothes and personal items d. Finding other avenues of support and companionship e. Ensuring the deceased maintains a primary presence in the bereaved person's life

b. Restructuring financial responsibilities -According to Worden, financial adjustment, as in restructuring the financial responsibilities, is necessary for the bereaved to redefine life after a loss. c. Removing the deceased's clothes and personal items -According to Worden, physical adjustment, as in removing the deceased's clothes from the home, is necessary for the bereaved to redefine life after a loss. d. Finding other avenues of support and companionship -According to Worden, finding other avenues of support and companionship, is necessary for the bereaved to redefine life after a loss.

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? a. Dopamine b. Serotonin c. Acetylcholine d. y-Aminobutyric acid

b. Serotonin

What is the nurse primarily trying to determine when assessing a patient's intent for suicide and the imminence of the suicide risk? a. Risk factors b. Severity of risk c. Coping patterns d. Nursing diagnosis

b. Severity of risk When the nurse assesses a patient's intent to complete suicide and the imminence of the patient's risk, the nurse is attempting to determine how severe the risk of suicide is for that patient.

Which information refers to an ethnic group? a. Sharing the same practices. b. Sharing a common heritage. c. Coming from the same sociocultural group. d. Sharing a religious identity that differs from the majority of the population.

b. Sharing a common heritage.

Which type of statements may indicate the presence of depression? a. Statements about chronic medical illnesses b. Statements that reflect negative thoughts about self c. Statements that reflect negative thoughts about others d. Statements about the presence of interpersonal stressors

b. Statements that reflect negative thoughts about self Negative thoughts about self can aid in the development of depression.

What information is especially important for the nurse to include in the discharge education of a patient being discharged after a suicide attempt? a. Healthy eating regimen b. Substance treatment centers c. Crisis hotlines d. Support groups for patients or families e. Physical activity habits

b. Substance treatment centers -Information on substance treatment centers should be given to the suicidal patient at discharge. c. Crisis hotlines -Information on crisis hotlines should be given to the suicidal patient at discharge. d. Support groups for patients or families -Information on support groups for patients or families should be given to the suicidal patient at discharge.

What are the criteria needed to plead guilty by reason of insanity? a. The individual has a diagnosis of schizophrenia. b. The inability of the individual to understand the charges filed against him or her. c. The individual has a diagnosed mental illness and was on drugs at the time of the crime. d. The individual does not have the mental capacity to advise an attorney and defend the charges. e. The individual does not have the mental ability to understand legal processes and the consequences of the charges.

b. The inability of the individual to understand the charges filed against him or her. -The individual must be able to understand the charges in order to face criminal charges. A person with mental incompetence would not be able to understand the legal system. d. The individual does not have the mental capacity to advise an attorney and defend the charges. -A mentally incompetent person would not be able to adequately assist an attorney to defend themselves against criminal charges and may be unable to stand trial by reason of insanity. e. The individual does not have the mental ability to understand legal processes and the consequences of the charges. -The individual must be able to understand the legal process and the consequences of the charges. A person declared mentally incompetent would have difficulty understanding consequences.

A patient is prescribed a tricyclic antidepressant (TCA) for feelings of hopelessness due to severe insomnia. What should the nurse teach the patient about this medication? a. A potential toxic effect of TCA use is stroke. b. The patient may experience constipation when taking a TCA. c. TCAs work by flooding the brain with serotonin and dopamine. d. The patient will take a high loading dose of the TCA in the beginning and then will be given a lower daily dose.

b. The patient may experience constipation when taking a TCA. Reactions to TCAs are similar to those for anticholinergic drugs: dry mouth, blurred vision, tachycardia, constipation, urinary retention, and esophageal reflux.

Which outcome would be indicative that Ms. Cocoschilli's delirium has not successfully been resolved? a. The patient experiences a fall. b. The patient struggles to recall the date. c. The patient complains of a depressed mood. d. The patient experiences extrapyramidal symptoms.

b. The patient struggles to recall the date. Disorientation is a sign of delirium. This would need to be resolved for the patient to be considered recovered.

A patient with congestive heart failure (CHF) may be referred for palliative care services for which reasons? Select all that apply. a. To prepare for hospice care b. To deal with activity intolerance c. To help manage shortness of breath d. To establish a primary health care provider e. To receive prescription for antidysrhythmic medications

b. To deal with activity intolerance -Patients with CHF often have activity intolerance. Palliative care would be administered to improve the patient's ability to participate in activities of daily living. c. To help manage shortness of breath -Patients with CHF often suffer from shortness of breath. Palliative care would be given to help improve the patient's respiratory effort.

Which ethical concept is the nurse applying when educating a patient about the possible side effects of the long-term use of a prescribed medication? a. Justice b. Veracity c. Dilemma d. Beneficence

b. Veracity

Which factor presents the greatest safety risk to the patient with dementia? a. Anxiety b. Wandering c. Hopelessness d. Impaired social interactions

b. Wandering Wandering is an urgent safety/health risk of the patient with dementia because it could increase the risk for falling and becoming lost.

Which mood state is a manic phase that lasts at least one week?

bipolar 1

What mood state is a hypomanic episode that last at least four days?

bipolar 2

Brandon shares with the nurse, "I think my parents would be better off without me." How should the nurse respond? CASE STUDY DETAILS a. "I'm sure that is not true. Brandon, your parents love you." b. "What makes you feel like that?" c. "Are you thinking about harming yourself?" d. "We should really contact your parents to let them know that you feel this way."

c. "Are you thinking about harming yourself?" This response addresses the immediate necessity to assess the patient for suicidality. It does so in a direct manner and assists with the need to determine the collaborative team members needed.

Which statement by a patient who is taking lamotrigine would receive the nurse's priority attention? a. "Last night I slept for only 7.5 hours." b. "I have not had a bowel movement in 2 days." c. "I have a new rash on my chest and abdomen." d. "I bumped into a table yesterday and got a bruise on my elbow."

c. "I have a new rash on my chest and abdomen."

Which statement by a patient indicates understanding of the medication teaching provided concerning a prescribed selective serotonin reuptake inhibitor (SSRI)? a. "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." b. "I will not take any over-the-counter medication while on this medication." c. "I will immediately report any symptoms of high fever, fast heartbeat, or abdominal pain." d. "I will report increased thirst and urination to my healthcare provider."

c. "I will immediately report any symptoms of high fever, fast heartbeat, or abdominal pain."

A patient with stage 2 lung cancer was referred to palliative care. The patient's spouse voices concern and asks the nurse, "So, does this mean my partner is going to die soon?" How should the nurse respond? a. "Yes, palliative care is given at the end of life." b. "Likely, your spouse's prognosis is not very good." c. "Palliative care is given to patients at all stages of their disease." d. "You should talk with your spouse's health care provider about the prognosis."

c. "Palliative care is given to patients at all stages of their disease." The nurse should reassure the patient's spouse that palliative care is indicated at all stages of the disease, not because the patient is more likely to die.

Which instruction will the nurse include when teaching a patient and their family about lithium therapy. SATA. a. "Restrict the sodium in your diet." b. "Take lithium on an empty stomach." c. "Taker lithium with meals to avoid an upset stomach." d. "Lithium is a mood stabilizer that helps prevent relapse." e. "Maintain a consistent fluid intake of 1500 to 3000 mL per day." f. "You should stop taking lithium if you have excessive diarrhea, vomiting, or sweating."

c. "Taker lithium with meals to avoid an upset stomach." d. "Lithium is a mood stabilizer that helps prevent relapse." e. "Maintain a consistent fluid intake of 1500 to 3000 mL per day." f. "You should stop taking lithium if you have excessive diarrhea, vomiting, or sweating."

The nurse requests that the father of a newly admitted patient attend a care planning meeting. Considering the role of the family, what is the nurse's best response when he states, "Why should I come? I didn't try to kill myself." a. "It was just a courtesy. No problem at all if you are busy!" b. "The treatment team finds it helpful to talk to the family before discharging a patient." c. "The family's understanding of your son's plan of care is important to his recovery." d. "The doctor suggested that I ask. I can have her call you."

c. "The family's understanding of your son's plan of care is important to his recovery." This answer describes the importance of family support system involvement and identifies clear reasons why treatment team communication with family support is beneficial for both the patient and the family in coping effectively.

A patient on one-to-one observation angrily refuses to be accompanied to the shower. Considering the patient's immediate needs, what is the nurse's best response? a. "Okay, if that is your choice, I will wait outside." b. "I realize this is uncomfortable for both of us." c. "This must be frustrating, but I must be able to ensure your safety." d. "I understand but I will need to stand here with the door ajar."

c. "This must be frustrating, but I must be able to ensure your safety." This is a therapeutic response that validates the patient's feelings and ensures the patient's safety.

The family of a dying patient expresses concern that their loved one will have to die alone in the hospital. Which statement made by the nurse is correct? a. "We do not have to start hospice services if you prefer." b. "The patient's condition will require inpatient hospitalization." c. "Would you like information about hospice care in the home?" d. "Someone from the hospital staff will be with your family member at all times."

c. "Would you like information about hospice care in the home?" The statement of the patient's sister is an example of bargaining. In this stage, the family member offers to make a lifestyle change if the patient's life is spared.

A patient admitted on involuntary status is now calm, cooperative, alert, oriented, and is requesting to be discharged. What is the best response by the nurse? a. "You can sign out against medical advice when you are ready to leave. b. "You will not be able to leave because you are here on a court order." c. "You will be evaluated by a psychiatrist shortly and she will work with you to make a determination about your discharge." d. "Because you are here on an involuntary hold, it is mandatory that you stay here for at least 48 hours. You cannot be released before your time is up."

c. "You will be evaluated by a psychiatrist shortly and she will work with you to make a determination about your discharge." Depending on state law, a patient on an involuntary hold will be evaluated within 24-48 hours. Depending on the findings, the patient may be released or kept for further treatment.

Which patient has the highest potential risk for substance abuse and violent crime? a. An adolescent of a family newly immigrated to the United States. b. A refugee who perceives they are not welcome in the United States. c. A young adult who aged out of foster care in the United States and is currently homeless. d. A patient experiencing a language barrier during the adjustment period of immigration.

c. A young adult who aged out of foster care in the United States and is currently homeless.

The nurse is caring for a patient at the end of life. The patient states they are having a conversation with their mother who died 10 years ago. Which action would the nurse take? a. Administer lorazepam b. Contact the patient's chaplain c. Acknowledge the patient's experience d. Reorient the patient to place and time

c. Acknowledge the patient's experience -Allowing the family time with the patient provides privacy and opportunity to say final goodbyes to their deceased loved one.

Which nursing diagnoses are most appropriate for Mr. Jones's cognitive disturbances? Select all that apply. a. Insomnia b. Wandering c. Acute Confusion d. Feeding Self-Care Deficit e. Impaired Verbal Communication

c. Acute Confusion -Mr. Jones shouts out for his wife and does not recognize the nurse. A nursing diagnosis of Acute Confusion addresses Mr. Jones's cognitive disturbance. e. Impaired Verbal Communication -Mr. Jones's ability to communicate is diminished, so Impaired Verbal Communication is an appropriate nursing diagnosis that addresses perceptual and cognitive disturbances.

At which point in the end-of-life process does anticipatory grief occur? a. Immediately after the death of a loved one b. When curative efforts for a serious illness behgin c. Once a life-threatening diagnosis has been received d. For several months after the death of a loved one

c. Once a life-threatening diagnosis has been received

In an older adult patient diagnosed with dementia, which aspect of the plan of care would the nurse adjust to decrease patient agitation? a. Help the patient to bathe and dress each morning at 9:00 AM. b. Avoid asking the patient to deliver menus to other resident rooms. c. Allow the patient to go to the dining room for meals anytime it is open. d. Provide the patient 10 minutes of quiet time after breakfast before morning exercise in the day room.

c. Allow the patient to go to the dining room for meals anytime it is open. Patients with dementia can become agitated when it is unclear what is needed or expected of them. Having a repetitive routine, including posting a visible schedule can be helpful in decreasing agitation. The aspect of the plan of care that allows the resident with dementia to go to meals at any time would be adjusted.

What is the difference in clinical presentation between delirium and amnestic disorders? a. Delirium is chronic. b. Delirium does not impair memory. c. Amnestic disorders do not impair alertness. d. Amnestic disorders primarily affect memory.

c. Amnestic disorders do not impair alertness. Individuals with amnestic disorders do not have an abnormal level of alertness.

A patient has been admitted to the inpatient mental health facility after being placed on involuntary status for being gravely disabled. After the involuntary treatment period has expired, the patient is asked to remain in the facility voluntarily. What is the next course of action if the patient refuses to stay? a. Call the police and report the situation. b. Call the next of kin and report the situation. c. Ask the patient to sign out against medical advice. d. Keep the patient in the facility with close monitoring.

c. Ask the patient to sign out against medical advice. Patients might be asked to remain voluntarily in the facility for further treatment, and if they refuse, they may be asked to sign out against medical advice.

On Marco's safety plan, his neighbor has been identified as a social support he can contact if needed during a crisis. The client desires to no longer have this neighbor as his social support. What would be the priority next step of the treatment team? CASE STUDY DETAILS a. Proceed with discharge paperwork. b. Obtain information to contact the neighbor. c. Ask the social worker to speak with the patient to revise the safety plan. d. Assess whether the previous neighbor on the safety plan knows of the change.

c. Ask the social worker to speak with the patient to revise the safety plan. Not having an identified support person may affect the safety of the patient at discharge. It is important to verify support to ensure a safe disposition for the patient. The social worker should be made aware and a new safety plan may be needed.

When communicating with a withdrawn patient who has depressive disorder, which techniques should the nurse use? a. Use humor b. Speak loudly c. Avoid platitudes d. Allow time for a response e. Use simple, concrete words

c. Avoid platitudes Nurses should avoid platitudes such as "You'll be alright" when communicating to patients with depressive disorders because platitudes tend to negate patients' feelings. d. Allow time for a response Patients with depressive disorders may have slowed cognitive function and slow speech, so it is important for nurses to allow these patients time to respond. e. Use simple, concrete words Patients with depressive disorders may have slowed cognitive function, so it is important for nurses to use simple, concrete words when communicating with these patients.

A patient who has recently been diagnosed with terminal lung cancer vows to quit smoking if cured. Which Kubler-Ross stage of grief is this patient experiencing? a. Anger b. Denial c. Bargaining d. Acceptance

c. Bargaining Bargaining involves the initial understanding of the loss with the hope that negotiation, such as quitting smoking, can change the circumstances.

While caring for a 26-year-old patient who suffered serious injuries in a car accident, the patient's sister cries out, "I'll go to church every Sunday. Just let my sibling be okay." Which stage of grief will the nurse need to address? a. Anger b. Denial c. Bargaining d. Depression

c. Bargaining The statement of the patient's sister is an example of bargaining. In this stage, the family member offers to make a lifestyle change if the patient's life is spared.

The plan of care for a patient hospitalized with suicidal ideations would appropriately include which goals? a. Defer decision making to the treatment team b. Rely on usual methods of stress management c. Be safe and free from injury throughout hospitalization d. Develop a plan of community support to use in a crisis e. Verbalizing knowledge of self-destructive language and behaviors

c. Be safe and free from injury throughout hospitalization -It is of paramount importance that the patient remains safe and is free from injury throughout hospitalization. The nurse's main priority is to keep the patient safe. d. Develop a plan of community support to use in a crisis -Identifying and maintaining support systems is an appropriate goal or outcome for a suicide patient. e. Verbalizing knowledge of self-destructive language and behaviors -Articulating the knowledge of self-destructive language and behaviors is important for the suicidal patient. It is important for the patient to understand the difference between self-destructive and affirming language and behaviors.

What action must a patient take to complete the despair level of Sheldon's stages of grief? a. Accept the reality of the loss b. Experiencing the pain of grief c. Begin to build a life without the deceased d. Centralizing the deceased in the bereaved person's life

c. Begin to build a life without the deceased The last level of Sheldon's stages of grief is completed by relocating the deceased to an important, but not central, place in bereaved person's life and moving on, such as by building a life without the deceased.

What is the purpose of an emergency hospitalization for a patient with a mental illness? a. To process patient requests for medication adjustment b. Helps patients who are unable to afford their psychiatric medications c. Cares for patients who are a danger to self or others and refuse voluntary treatment d. Assists patients who request to return to the hospital after being placed in a group home

c. Cares for patients who are a danger to self or others and refuse voluntary treatment. Patients are admitted on an emergency basis when they are considered a danger to self or others or cannot meet his or her basic needs.

Which medical procedures may be used to treat patients with depressive orders? a. Light therapy b. St. John's wort c. Deep brain stimulation (DBS) d. Electroconvulsive therapy (ECT) e. Transcranial magnetic stimulation (TMS)

c. Deep brain stimulation (DBS) DBS is a medical procedure that uses electrodes implanted into the brain to treat depressive disorders, but carries a risk of intracranial hemorrhage. d. Electroconvulsive therapy (ECT) ECT is a medical procedure that works by sending an electrical current through the brain of an anesthetized patient. The current causes seizures that alter neurotransmitters in the brain. e. Transcranial magnetic stimulation (TMS) TMS is a medical procedure that uses MRI-strength pulses to stimulate focal areas of the cerebral cortex.

A patient in inpatient psychiatric treatment has a conservator who is not one of her sons or daughter. The nurse receives a call from her son requesting his mother be moved to a different facility. Which is the priority action of the nurse? a. Notify the other children of the wishes of the son. b. Facilitate a meeting with the children and the conservator to discuss the change of facility. c. Do not discuss the care of Mrs. Smith with her son without the consent of the conservator. d. Organize a family meeting with Mrs. Smith's children to discuss the care plan for the patient.

c. Do not discuss the care of Mrs. Smith with her son without the consent of the conservator. When a patient is on a conservatorship, the conservator speaks for the conservatee on matters involving their mental health treatment. Therefore, the nurse must obtain consent from conservators for decisions that are otherwise made by patients.

A patient in the mental health facility has been charged with a crime. The psychiatrist must evaluate the patient to determine competency to stand trial and the individual indicates that a plea will be entered as not guilty by reason of insanity. Which criteria are used to determine the plea of insanity? Select all that apply. a. Can the individual afford an attorney? b. Does the individual understand English? c. Does the individual understand the criminal charges? d. Does the individual understand the consequences of the charges? e. Can the individual advise the attorney and defend the charges?

c. Does the individual understand the criminal charges? -One of the criteria for the plea of insanity is whether or not the individual understands the criminal charges. d. Does the individual understand the consequences of the charges? -One of the criteria for the plea of insanity is whether or not the individual understands the consequences of the charges. e. Can the individual advise the attorney and defend the charges? -One of the criteria used to determine the plea of insanity is whether or not the individual can advise the attorney to defend the charges.

What are the most common side effects of SSRIs? a. Diarrhea and weight gain b. Jaundice and agranulocytosis c. Dry mouth and blurred near vision d. Convulsions and respiratory difficulties

c. Dry mouth and blurred near vision SSRIs have anticholinergic properties that can result in dry mouth and blurred vision.

Which medical procedure does the nurse anticipate that the health care provider to order for the patient who experiences catatonia due to depression? a. Deep brain stimulation (DBS) b. Vagal nerve stimulation (VNS) c. Electroconvulsive therapy (ECT) d. Transcranial magnetic stimulation (TMS)

c. Electroconvulsive therapy (ECT) ECT is used in depressive patients who have marked agitation, marked vegetative symptoms, or catatonia.

A patient has been exhibiting significant and worsening mania. He has developed paranoia that has advanced to the point that the patient is not eating because he believes food is poison. The treatment team wants to choose a treatment that will act quickly. What would be an appropriate option considering the patient's state? a. Lamotrigine b. Mirtazepine c. Electroconvulsive therapy (ECT) d. Phototherapy

c. Electroconvulsive therapy (ECT) Electroconvulsive therapy (ECT) is sometimes used to reduce severe manic behavior. It can be especially useful in decreasing severe depression, catatonia, paranoid-destructive symptoms, and treatment-resistant depression.

Which outcome would the nurse incorporate into the plan of care for a patient with a nursing diagnosis of hopelessness? a. Remains free from injury b. Describes feelings of self-worth c. Expresses willingness to call on others for help d. Identifies coping mechanisms to assist in crises

c. Expresses willingness to call on others for help

A patient is struggling with the loss of a family member to suicide. Which factors may affect the way that this patient copes with the loss? Select all that apply. a. Age of the patient b. Gender of the deceased c. Fact that the deceased was family d. Which other family members have died e. Manner in which the family member died

c. Fact that the deceased was family -The nature of the relationship to the deceased, particularly if close such as with family, affect the way the bereaved copes with the loss. e. Manner in which the family member died -The circumstances surrounding a death, such as in a suicide, affect the way the bereaved copes with the loss.

In addition to physiologic is sues, the nurse understands that an older adult patient who misuses alcohol is at risk for which problems? a. Self-neglect b. Legal difficulty c. Family discord d. Difficulty making friends e. Nonadherence with medical treatments

c. Family discord The use of alcohol by the older adult may cause distress for family members who are concerned about the individual.

A patient on a 24-hour emergency psychiatric hold is believed to need further treatment. In order to keep the patient in the facility, what legal action is required? a. Informed consent b. Notification of a family member c. Filing of a probable cause statement d. Appointment of a conservator for the patient

c. Filing of a probable cause statement A probable cause statement is written, indicating that the person is a danger to self or others or is gravely disabled. This statement is then filed with the court and a hearing takes place to determine if there is just cause to keep the person for treatment.

Nursing's implementation of the Hospital Elder Life Program (HELP) program has been effective in directly reducing which adverse outcomes? a. Aggression b. Sudden death c. Functional decline d. Incidence of delirium e. Excessive health care costs

c. Functional decline -The HELP prevention model has led to a 67% reduction in functional decline. d. Incidence of delirium -The HELP prevention model has led to a 40% reduction in the incidence of delirium.

The nurse is caring for an unresponsive patient at the end of life who does not have a document listing the patient's wishes for medical treatment. The patient will require new treatments to be added to the plan of care. Which end of life form would the nurse use in this situation? a. The living will b. Patient's medical record c. Health care power of attorney d. Do not resuscitate (DNR) order

c. Health care power of attorney The health care power of attorney identifies a surrogate who is responsible for making medical decisions in the event the patient is incapacitated.

Which assessment finding for Ms. Kaplan is most predictive of her risk for completing suicide? CASE STUDY DETAILS a. Age 35 b. Female gender c. History of suicide attempts d. History of broken relationships

c. History of suicide attempts The majority of people who complete suicides have made previous attempts.

Ms. Spears tells the health care provider, "My life is so pointless now." Which diagnostic criteria for a depressive disorder does her statement express?CASE STUDY DETAILS a. Guilt b. Agitation c. Hopelessness d. Social withdrawal

c. Hopelessness The statement, "My life is so pointless now" demonstrates feelings of hopelessness that are associated with depressive disorders.

In which clinical setting is delirium most common? a. Rehab b. Hospice c. Hospital d. Nursing home

c. Hospital Delirium is most common in the hospital setting with a prevalence of 14-56%.

During the course of treatment, Mrs. Gilbert's husband calls to obtain information regarding her condition. This information can be released under which circumstance? CASE STUDY DETAILS a. If Mr. Gilbert calls the security office first b. If Mr. Gilbert comes to the facility and shows ID c. If the conservator has authorized release of information to Mr. Gilbert d. If Mr. Gilbert comes to see his wife during regular visiting hours and talks with the nurse.

c. If the conservator has authorized release of information to Mr. Gilbert Information can be released to only parties authorized by the conservator.

In which situation may the nurse legally administer a psychotropic medication, despite the patient's refusal? a. If the patient is under a legal hold. b. If the medication is medically beneficial to the patient. c. If the patient is an imminent danger to self or another person. d. If the patient shows medical proof that the medication is not required.

c. If the patient is an imminent danger to self or another person. A single dose of psychotropic medication may be given in a psychiatric emergency, despite the patient's refusal.

A patient who cared for a dying parent presents with an acute illness after the parent's death. How does the health of the patient affect the grief process? a. Health and grieving are unrelated b. Illness enhances the ability to cope with loss c. Illness may interfere with the ability to cope with loss d. Illness often helps the grieving process by distracting the bereaved

c. Illness may interfere with the ability to cope with loss Physical health influences the grieving process, such that poor physical health can interfere with the ability to cope with loss.

Which is an objective symptom of depressive disorder? a. Fatigue b. Headache c. Inability to solve problems d. Feelings of doom and gloom

c. Inability to solve problems The inability to solve problems is an example of objective symptom of depressive disorders.

A patient who has recently lost a child finally gives away the child's clothes. Which of Sheldon's stages of grief has the patient completed? a. Despair b. Adjustment c. Initial shock d. Pangs of grief

c. Initial shock The initial shock stage is completed by accepting the reality of the loss, as exhibited by giving away the child's clothes.

Which description of ageism is accurate? a. Used to describe older adults b. Only applies to people 75 years of age and older c. Is a bias against older adults because of negative stereotypes d. Is discrimination based on gender and socioeconomic status

c. Is a bias against older adults because of negative stereotypes

The nurse cares for an adult who repeatedly says, "My dead relatives try to talk to me and penetrate my body." This comment is associated with which disorder? a. Disruptive mood dysregulation disorder. b. Substance-induced depressive disorder. c. Major depressive disorder with psychosis. d. Seasonal affective disorder.

c. Major depressive disorder with psychosis.

Which item would the nurse remove from the meal tray before serving it to a patient who is suicidal? a. Plastic plate b. Cloth napkin c. Metal utensils d. Styrofoam cup

c. Metal utensils

The nurse is working in the local jail and cares for a number of prisoners with underlying mental illness. What is the focus of the nurse working in the justice system? a. Educating about the disease process b. Documenting for forensic evaluation c. Monitoring for compliance with treatment d. Providing resources for treatment after discharge

c. Monitoring for compliance with treatment The nurse working in the justice system must monitor for compliance with treatment.

Which therapeutic strategy provides dementia patients with the opportunity to participate in different activities that may engage sight, hearing, taste, smell, and touch? a. Group therapy b. Cognitive psychotherapy c. Multisensory environment d. Cognitive behavioral therapy (CBT)

c. Multisensory environment Multisensory environment is a controlled, safe, and comfortable environment that provides a multitude of sensory experiences to benefit patients with cognitive impairment.

Which statement regarding the adequacy of pain management in older adults is true? a. Older adults need smaller doses of pain medication to achieve adequate pain relief. b. Older adults excrete analgesics more rapidly and therefore need more frequent doeses. c. Older adults receive fewer analgesics than younger adults, which makes pain relief inadequate. d. Older adults respond better to meperidine than to morphine sulfate when opiates are necessary.

c. Older adults receive fewer analgesics than younger adults, which makes pain relief inadequate.

In order to protect themselves and others in the workplace, nurses may engage in which professional activity? a. Educate mental health patients about dangers of violence b. Inform all unit staff to take a mandatory self-defense course c. Participate in setting policies that create a safe environment d. Hold a meeting with patients' families to ask for support in maintaining a safe environment

c. Participate in setting policies that create a safe environment Nurses can work in a professional capacity to help set policies that create a safe environment at work. These policies can be followed by all health care staff to create a safe environment for all.

How do past experiences with loss and grief affect current coping abilities? a. Past experiences limit coping options. b. Past experiences make it harder to cope with new experiences. c. Past experiences enhance current coping by providing coping skills and strategies. d. Past experiences support current coping by allowing the bereaved to suppress the feelings.

c. Past experiences enhance current coping by providing coping skills and strategies. People who have lived through previous loss will have used various coping skills, and thus have an array of strategies available for dealing with a current loss.

Difficulty making decisions is a symptom of which depressive disorder? a. Schizophrenia disorder b. Premenstrual dysphoric disorder c. Persistent depressive disorder (PDD) d. Disruptive mood dysregulation disorder

c. Persistent depressive disorder (PDD) Patients with PDD experience symptoms for long periods of time, which can impact cognitive processes. The patient with impaired cognition may have difficulty making decisions.

Which risk factor for delirium is a direct result of external factors? a. Fractures b. Older age c. Polypharmacy d. Multiple comorbidities

c. Polypharmacy

Which intervention is a cognitive stimulation activity that engages older adults with memory impairment in socialization and rapport building? a. Distraction b. Mindfulness c. Reminiscence d. Family therapy

c. Reminiscence

Which nursing diagnosis for the patient with dementia requires the nurse's immediate attention? a. Risk for Injury b. Risk for Infection c. Risk for Aspiration d. Impaired Verbal Communication

c. Risk for Aspiration Risk for aspiration is a safety health risk that addresses airway and should be prioritized as urgent.

Which example is reflective of a cultural norm? a. Shared family history b. Family origin from Mexico. c. Shaking hands when meeting someone. d. Common genetic traits within a group of people.

c. Shaking hands when meeting someone.

Which communication techniques would be most helpful for the nurse to use when speaking to Mr. Mackey during the dressing change?CASE STUDY DETAILS a. Be descriptive and thorough in explanations to the patient. b. Avoid eye contact in order to prevent the patient from becoming aggressive. c. Speak slowly in simple sentences to explain the next steps in the dressing change. d. Avoid repetition of statements if the patient is not paying attention to limit ineffective stimulation.

c. Speak slowly in simple sentences to explain the next steps in the dressing change. When the nurse speaks slowly and in simple statements, the patient has an easier time processing the information provided. Explanation of a procedure before it is being done helps to alleviate the patient's fear or anxiety about being touched or about unexpected movements.

Inappropriate guilt is which type of depressive symptom? a. Primary b. Objective c. Subjective d. Secondary

c. Subjective Feelings of inappropriate guilt are a subjective symptom of depressive disorders.

Which situation would indicate a patient might need long-term involuntary outpatient treatment? Select all that apply. a. The patient cannot afford medication for anxiety. b. The patient takes his antidepressant sporadically. c. The patient is in a court-mandated drug treatment program. d. The patient calls to reschedule her appointment at the clinic. e. The patient had 3 admissions within 2 months due to psychiatric treatment noncompliance. f. The patient requires a long-term injectable antipsychotic to manage his condition and has demonstrated noncompliance in the past.

c. The patient is in a court-mandated drug treatment program. -Long-term involuntary outpatient treatment is often used for court-mandated drug treatment programs. This allows regular drug testing, counseling, and group therapy. e. The patient had 3 admissions within 2 months due to psychiatric treatment noncompliance. -Patients who have proved to be a persistent danger to themselves or others due to noncompliance may be ordered to receive outpatient care to better maintain stabilization and prevent re-hospitalization. f. The patient requires a long-term injectable antipsychotic to manage his condition and has demonstrated noncompliance in the past. -In order to protect the patient and the public, it is important that psychiatric patients receive scheduled medications. Many will be court-mandated to keep scheduled appointments for psychiatric treatments.

A patient, upon learning that her husband is filing for divorce, responds by sobbing and stating, "I want to kill myself." Based on the knowledge that the patient has a history of impulsive suicidal attempts, how should the nurse interpret the patient's immediate behavior? a. The patient is displaying manipulative behavior. b. The patient should be medicated immediately for her own safety. c. The patient is showing progress by verbalizing her feelings rather than acting on her thoughts. d. The patient requires physical restraints to assure personal safety.

c. The patient is showing progress by verbalizing her feelings rather than acting on her thoughts. The patient has resisted acting impulsively and instead verbalized their feelings, demonstrating progress and a positive outcome.

A patient with delirium has become acutely agitated and has started to pull out the urinary catheter. How should the nurse interpret this behavior? a. The patient is inappropriately attention-seeking. b. The patient feels able to urinate independently. c. The patient is struggling to communicate an unmet need. d. The patient is becoming aggressive and may try to hurt the nurse.

c. The patient is struggling to communicate an unmet need. Erratic behavior should be interpreted as the patient trying to communicate that he or she is in need of something. The need itself is not necessarily related to the particular behavior the patient is exhibiting.

Which patient outcome is most important for the nurse to write in the plan of care for an older adult patient with depression? a. The patient will eat regular meals every day and maintain a healthy weight. b. The patient will spend at least 2 hours a day socializing with friends and family. c. The patient's quality of life will be optimized as measured by the patient's verbalization of satisfaction. d. The patient will maintain adherence to the treatment plan as measured by taking all prescribed medications and attending scheduled office visits.

c. The patient's quality of life will be optimized as measured by the patient's verbalization of satisfaction. The most important goal when planning care for an older adult patient with any mental health concern is to optimize the quality of their life in a way that is meaningful and satisfying to them.

What legally qualifies a person to be placed in conservatorship? a. The person is homeless. b. The person cannot afford medication. c. The person is gravely disabled because of a mental illness. d. The person has had at least 3 hospitalizations within 1 year because of mental illness.

c. The person is gravely disabled because of a mental illness. A person must be declared gravely disabled by the court system in order to be placed in a conservatorship. This means that they cannot provide food, clothing, or shelter for themselves based on their mental illness.

The nurse requests to assess Mr. Steiner and his son, both together and then individually. What is the nurse's primary reason for conducting the assessments in this manner? CASE STUDY DETAILS a. The son can assist the nurse in understanding Mr. Steiner's isolative behavior. b. The nurse can ask more sensitive questions of Mr. Steiner with the son present. c. The son may be hesitant to speak about his father's behavior in Mr. Steiner's presence. d. The son may assist in translating complex medical concepts into simpler language for Mr. Steiner.

c. The son may be hesitant to speak about his father's behavior in Mr. Steiner's presence. Interviewing Mr. Steiner and his son both together and separately is a therapeutic approach the nurse should use in case the son is hesitant to speak openly in front of Mr. Steiner.

Intense grief 8 months after the death matches what type of complicated grief?

chronic

A patient who has admitted to having suicidal ideations, receives flowers in a glass vase as a gift. How should the nurse respond when the patient demands to know why the vase was replaced with a plastic cup? a. "It's glass, so it is too heavy to sit on the night table." b. "Don't be concerned; the vase will be returned when you are discharged." c. "It appears that replacing the vase is very important to you." d. "Glass objects are not allowed here because they could be used to harm oneself."

d. "Glass objects are not allowed here because they could be used to harm oneself." Part of ensuring an adequate safety plan is removing any object which the patient could use for self-harm.

The nurse is caring for an angry patient on an involuntary emergency hold refusing antianxiety medication. Which is the best response by the nurse? a. "It is within your rights to refuse all medications." b. "If you do not take your medication, we will call security." c. "I see that you are angry. Your behavior is what brought you here and your uncooperative behavior is what can keep you here." d. "I understand you are angry about your admission. This medication can help you relax and we can sit and talk about what brought you here."

d. "I understand you are angry about your admission. This medication can help you relax and we can sit and talk about what brought you here." The nurse advocates for the patient by explaining the benefits of medication and treatment to the patient during involuntary commitments.

An older adult patient attempted suicide after losing a job he held for nearly 40 years. Which statement made by the patient to the health care team members demonstrates effective cognitive reframing? a. "I will get a job!" b. "Being fired isn't my fault." c. "I'm close enough to retirement." d. "If I apply to jobs, I could find a workplace where I would be an asset."

d. "If I apply to jobs, I could find a workplace where I would be an asset." This exemplifies cognitive reframing in that this thought is realistic and constructive.

Which statement by the nurse is appropriate when talking to the family of a patient who died suddenly and unexpectedly? a. "Your loved one is with God now." b. "At least your loved one did not suffer." c. "I know how hard it is to lose your loved one." d. "It must be shocking to lose you loved one so suddenly."

d. "It must be shocking to lose you loved one so suddenly."

A patient was admitted to an inpatient psychiatric unit for acute mania. The patient has since stabilized and is preparing for discharge with his treatment team who has recommended he enter psychotherapy. The patient asks his nurse why psychotherapy is necessary. Which is the best response by the nurse? a. "Psychotherapy will give you someone to talk to." b. "Psychotherapy will show your doctor you are invested in treatment." c. "Psychotherapy will eventually replace your medication." d. "Psychotherapy will help you cope with stressors that present after discharge."

d. "Psychotherapy will help you cope with stressors that present after discharge." When the patient is not experiencing acute mania, psychotherapy may be used to help the patient cope more positively to stressors in the environment and decrease the risk of relapse.

A patient who was diagnosed with terminal cancer 6 months ago was placed on hospice care. The family voices concern that the patient will stop receiving hospice care. Which statement would the nurse make? a. "By law, hospice services automatically end after 6 months." b. "We will need approval from two health care providers to remain on hospice care." c. "It will be up to the insurance company to determine if hospice care will continue." d. "The patient's case will be reviewed by the provider to determine if hospice care is still necessary."

d. "The patient's case will be reviewed by the provider to determine if hospice care is still necessary." If the patient survives longer than 6 months, the case will be reevaluated and may be recertified if necessary.

The nurse conducts the MMSE-2 on Mr. Mackey while his wife is present. The wife gets irritated and says, "Didn't he already do this? Why does he have to answer these questions again?" How should the nurse respond?CASE STUDY DETAILS a. "The health care provider ordered that he have it done again." b. "We want to see if he remembers doing it because this will show he is getting better." c. "Oh, I apologize. If he already did this screening, there is no need to repeat it." d. "This is a screening tool that is done periodically to assess if his cognitive performance is improving with treatment."

d. "This is a screening tool that is done periodically to assess if his cognitive performance is improving with treatment." This response demonstrates that the nurse understands that the MMSE-2 measures cognitive performance and should be done serially to assess cognitive changes over time.

A patient with delirium secondary to a urinary tract infection has been receiving pharmacologic treatment for 3 days, including the antibiotic doxycycline and the benzodiazepine lorazepam. The health care provider has ordered for the patient to be tapered off of lorazepam. The patient's husband is concerned about this decision and asks, "Why is lorazepam being decreased if it was helping her?" What would be the best response by the nurse? a. "Your wife no longer needs this medication." b. "I understand your concern. I'll get the health care provider to clarify." c. "We are concerned that your wife is showing signs of benzodiazepine dependence." d. "This medication needs to be lowered in order to know if your wife's cognitive function is improving."

d. "This medication needs to be lowered in order to know if your wife's cognitive function is improving." Medications, such as benzodiazepines, should be administered at the lowest effective dose, carefully monitored, and lowered or discontinued as soon as possible in order to assess for clinical improvement.

Which written document states how a patient wants medical decisions to be made and what sort of life-prolonging measures would be taken if there is no hope for recovery? a. Dying will b. Individual liberty c. Informed consent d. Advance directive

d. Advance directive

The nurse receives orders from a new resident psychiatrist for a patient being held on an involuntary short-term commitment petition. Which order should the nurse question? a. Change diet to regular. b. Begin sertraline 25 mg po daily. c. Administer acetaminophen 325 mg po now for headache. d. Allow patient to be accompanied by staff to attend son's graduation.

d. Allow patient to be accompanied by staff to attend son's graduation. Patients on court order petitions are not allowed to leave the facility, even if accompanied by staff.

Which term describes the period after the death of a loved one? a. Grief b. Mourning c. Depression d. Bereavement

d. Bereavement

Which antianxiety medication is frequently prescribed to patients with acute mania? a. Citalopram b. Propranolol c. Labetalol d. Clonazepam

d. Clonazepam

Which diagnostic test is useful in diagnosing vascular diseases of the brain? a. Presenelin-1 test b. Apo-E genotype test c. τ protein correlation test d. Computed tomography scanning

d. Computed tomography scanning CAT scans are useful in the diagnosis of vascular disease, trauma, and tumors of the brain.

Which statements, if made by a nursing student, indicate an understanding of the challenges of managing pain in the older adult patient? a. The patient's bowel status will need to be carefully assessed. b. Interactions between the pain medication and existing medications create challenges. c. Acetaminophen should be avoided because it does not provide adequate pain relief in older adult patients. d. Confusion may not necessarily be related to analgesics, and the patient should be fully assessed for a source. e. The therapeutic effect of analgesics is shorter in duration in older adults, so they need to be medicated more frequently.

d. Confusion may not necessarily be related to analgesics, and the patient should be fully assessed for a source. If acute confusion occurs, the nurse would assess for other contributing factors before changing the medication or stopping analgesic use. Confusion may be associated with unrelieved pain rather than with opiate use. This statement indicates understanding.

A conserved older adult is admitted to the acute hospital for an emergent surgical procedure. The patient appears alert and oriented and verbalizes understanding of the need for surgery. How is consent obtained for the necessary procedure? a. The patient may sign himself in for the emergency because he is alert, oriented, and understands need for surgery. b. The patient's doctor may sign him in hospital in case of an emergency. c. The patient's wife can sign in her husband in the case of an emergency d. Conservator is contacted for consent.

d. Conservator is contacted for consent. When a patient is on a conservatorship, the conservator speaks for the conservatee on matters involving the patient's mental health treatment. Therefore, the nurse must obtain consent from conservators for decisions that are otherwise made by patients.

Which change in neurotransmission occurs in Alzheimer's disease? a. Increased dopamine b. Decreased serotonin c. Increased epinephrine d. Decreased acetylcholine

d. Decreased acetylcholine

Which problems reported by a patient may represent cognitive reactions to a loss? Select all that apply. a. Chest pain b. Irritability c. Loss of interest in hobbies d. Difficulty performing daily tasks e. Inability to remember the day of the week

d. Difficulty performing daily tasks -A cognitive reaction to loss may manifest in an inability to concentrate and result in difficulty performing daily tasks. e. Inability to remember the day of the we -A cognitive reaction to loss may manifest in forgetfulness, such as an inability to remember the day of the week.

A patient feels as though it would be inappropriate to attend the funeral of a much younger friend, and is experiencing difficulty coping with this loss. Which type of grief is this patient experiencing? a. Chronic grief b. Masked grief c. Exaggerated grief d. Disenfranchised grief

d. Disenfranchised grief Disenfranchised grief occurs after a loss that cannot be openly acknowledged or publicly shared by the grieving person.

Which Bowlby stage of grief is a patient experiencing when the patient loses all sense of joy from previously enjoyable activities? a. Reorganization b. Shock and numbness c. Searching and yearning d. Disorganization and despair

d. Disorganization and despair Disorganization and despair marks the beginning of apathy, withdrawal, and anguish, which may manifest as loss of joy in previously enjoyable activities.

The nurse is caring for a patient with suicidal ideations who has a plan with a high level of lethality. The patient's inpatient psychiatric managed care benefits have expired. Which is the best action by the nurse? a. Discharge the patient to outpatient care. b. The nurse must discharge the patient due to insurance regulations. c. Send the patient to a medical surgical unit where different benefits apply. d. Maintain the patient on inpatient psychiatric care with a high level of suicide observation.

d. Maintain the patient on inpatient psychiatric care with a high level of suicide observation. -The patient requires high-level inpatient psychiatric care, despite managed care benefits. The nurse could be held liable if the patient harms self or others if discharged based on insurance criteria.

Which group is most at-risk for suicide? a. Native American females, aged between b. 16-21 c. Young adults, aged between 25-44 d. Middle-aged adults, aged between 45-54 e. Caucasian males over the age of 85

d. Middle-aged adults, aged between 45-54 Middle-aged adults and youths between the ages of 15 and 24 are the age groups most at-risk for suicide.

Antidepressants administered alone can cause an adverse reaction in patients with bipolar disorder. Which additional drug class should be prescribed? a. Sedative b. Anxiolytic c. Antipsychotic d. Mood stabilizer

d. Mood stabilizer

Which statement is a myth regarding older adults? a. As much as 50% of restorative sleep is lost as the result of aging. b. As a group, older adults are major consumers of prescription drugs. c. The senses of vision, hearing, touch, taste, and smell decline with age. d. Most adults past the age of 65 years have some form of cognitive disorder.

d. Most adults past the age of 65 years have some form of cognitive disorder.

In which age group does delirium most commonly occur? a. School-aged children b. Adolescents c. Young adults d. Older adults

d. Older adults Delirium occurs most commonly in the older adult population.

Which statement is true regarding the diathesis-stress model of depression? a. Depression symptoms result from the feelings of helplessness and unworthiness. b. Depression symptoms occur as a result of cultural and ethnic perspectives. c. People predisposed to depression can develop depression that is triggered by hormonal changes. d. People predisposed to depression can develop depression that is triggered by a stressful life event.

d. People predisposed to depression can develop depression that is triggered by a stressful life event. The diathesis-stress model of depression purports that some people may be born with a predisposition toward depression that can be triggered by a stressful life event.

A patient experiencing both poor concentration and hallucinations is assessed as being a high risk for destructive behavior. Which form of mental health disturbance is the cause for this concern? a. Flat affect b. Poor memory c. Mood disturbance d. Poor impulse control

d. Poor impulse control Poor impulse control can result when an individual is experiencing problems with concentration and hallucinations, and may increase potential for self-harm.

What is the most critical risk factor for the nurse to consider when determining the seriousness of suicide risk? a. History of depression b. Prior suicide attempts c. Low socioeconomic status d. Presence of a lethal suicide plan

d. Presence of a lethal suicide plan One of the most critical factors indicating imminent suicide risk is the presence of a suicide plan.

The nurse uses the depressive patient's statement, "I don't want to be around anyone right now. I want to be alone," to help formulate which nursing diagnosis? a. Hopelessness b. Self-care deficit c. Low self-esteem d. Risk for loneliness

d. Risk for loneliness The nurse's main goal in providing patient care during the implementation phase is to provide for patient safety.

A patient on one-to-one supervision indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." Which action would the nurse take? a. Leave the patient's room and wait outside in the hall. b. Say "I understand" and allow the patient to close the door. c. Keep the door open, but step to the side out of the patient's view. d. Say "For your safety, you must be within my sight at all times."

d. Say "For your safety, you must be within my sight at all times."

Which collaborative team member would be the most appropriate team lead for a depressed patient who has recently left priesthood? a. Pharmacist b. Social worker c. Patient's family d. Spiritual counselor

d. Spiritual counselor The spiritual counselor provides emotional and spiritual support to the patient and provides information about the community and facility spiritual resources.

The nurse is evaluating a patient's chart for evidence that supports the need for a long-term involuntary commitment of an inpatient psychiatric patient. Which evidence supports the need for a court petition? Select all that apply. a. The patient attends group therapy. b. The patient is compliant with medications. c. The patient sometimes responds to unseen stimuli. d. The patient continues to require 1:1 care due to suicidality on day 10 of inpatient care. e. The patient ranks his depression as a 10 on a scale of 1-10 with 10 being the worse and is actively suicidal. f. The patient has threatened to harm people at her place of employment if she leaves the hospital and has verbalized a working plan.

d. The patient continues to require 1:1 care due to suicidality on day 10 of inpatient care. -Patients who are at a direct risk to self and others and do not respond to short term inpatient treatment are candidates for long-term involuntary treatment petitions. e. The patient ranks his depression as a 10 on a scale of 1-10 with 10 being the worse and is actively suicidal. -Severe depression and suicidality indicate a danger to self that may be an indicator for a long-term commitment. f. The patient has threatened to harm people at her place of employment if she leaves the hospital and has verbalized a working plan. -Patients who are a danger to others are candidates for long-term involuntary commitments.

On which fact would the nurse predicate their response when the spouse of a patient with mania asks about genetic transmission of bipolar disorder? a. No research exists to suggest genetic transmission b. Lower socioeconomic class increases the risk of bipolar disorder c. Highly creative people very rarely develop the disorder d. The rate of bipolar disorder is higher in relatives of people with bipolar disorder

d. The rate of bipolar disorder is higher in relatives of people with bipolar disorder