Psych T1

After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department (ED) with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5C). The nurse expects the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing Thorazine and administering dantrolene (Dantrium) B. Neuroleptic malignant syndrome and treat by increasing Thorazine dosage and administering an antianxiety medication C. Dystonia and treat by administering trihexyphenidyl (Artane) D. Dystonia and treat by administering bromocriptine (Parlodel)

ANS: A The nurse should expect that an ED physician would diagnose the client with neuroleptic malignant syndrome and treat the client by discontinuing chlorpromazine (Thorazine) and administering dantrolene (Dantrium). Neuroleptic malignant syndrome is a potentially fatal condition characterized by muscle rigidity, fever, altered consciousness, and autonomic instability. The use of typical antipsychotics is largely being replaced by atypical antipsychotics due to fewer side effects and lower risks.

Which client response should a nurse expect during the working phase of the nurse-client relationship? A. The client gains insight and incorporates alternative behaviors. B. The client and nurse establish rapport and mutually develop treatment goals. C. The client explores feelings related to reentering the community. D. The client explores personal strengths and weaknesses that impact behaviors.

ANS: A The nurse should expect that the client would gain insight and incorporate alternative behaviors during the working phase of the nurse-client relationship. The client may also overcome resistance, problem solve, and continually evaluate progress toward goals.

A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately? A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention

ANS: A The nurse should intervene immediately if the client experiences a sore throat, fever, and malaise when taking the atypical antipsychotic drug clozapine (Clozaril). Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. Symptoms of infectious processes would alert the nurse to this potential.

A client has made the decision to leave her alcoholic husband. She is feeling very depressed. Which nontherapeutic statement by the nurse conveys sympathy? A. "You are feeling very depressed. I felt the same way when I decided to leave my husband." B. "I can understand you are feeling depressed. It was a difficult decision. I'll sit with you." C. "You seem depressed. It was a difficult decision to make. Would you like to talk about it?" D. "I know this is a difficult time for you. Would you like a prn medication for anxiety?"

ANS: A The nurse's statement, "You are feeling very depressed. I felt the same when I decided to leave my husband," is a nontherapeutic statement that conveys sympathy. Sympathy implies that the nurse shares what the client is feeling and by this personal expression alleviates the nurse's distress

How is the DSM-IV-TR useful in the practice of psychiatric nursing? (Select all that apply.) A. It considers level of functioning as well as problems. B. It represents progress toward a more holistic view of mind-body. C. It provides a framework for interdisciplinary communication. D. It provides a template for nursing care plans. E. It provides a framework for communication with the client.

ANS: A, B, C The DSM-IV-TR is useful in the practice of psychiatric nursing because it facilitates comprehensive evaluation of the client. It considers the client's current level of functioning, represents a holistic view, and provides a framework for interdisciplinary communication.

Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems? A. Medical history is of little significance and can be eliminated from the nursing assessment. B. Assessment provides a holistic view of the client including biopsychosocial aspects. C. Comprehensive assessments can be performed only by advanced practice nurses. D. Psychosocial evaluations are gained by subjective reports rather than objective observations.

ANS: B The assessment of clients diagnosed with psychiatric problems should provide a holistic view of the client. A thorough assessment involves collecting and analyzing data from the client, significant others, and health-care providers that may include the following dimensions: physical, psychological, sociocultural, spiritual, cognitive, developmental, economic, lifestyle, and functional abilities.

A client diagnosed with paranoid schizophrenia becomes agitated when asked to play a game. The client responds, "Do you want to be my girlfriend?" Which nursing response is most appropriate? A. "You are upset now. It would be best if you go to your room until you feel better." B. "Remember, we have a professional relationship. Are you feeling uncomfortable?" C. "We have discussed this before. I am not allowed to date clients." D. "I think you should discuss your fantasies with your therapist."

ANS: B The nurse should promote the client's insight and perception of reality by confirming appropriate roles in the nurse-client relationship and identifying what is troubling the client in this situation.

What is the purpose when a nurse gathers client information? A. It enables the nurse to modify client behaviors related to personality disorders. B. It enables the nurse to make sound clinical judgments and plan appropriate client care. C. It enables the nurse to prescribe the appropriate medications. D. It enables the nurse to assign the appropriate Axis I diagnosis.

ANS: B The purpose of gathering client information is to enable the nurse to make sound clinical judgments and plan appropriate care. The nurse should complete a thorough assessment of the client including information collected from the client, significant others, and health-care providers.

After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, "You are incompetent!" Which is the nurse's best response? A. "Do you believe that I was the cause of your blood test being canceled?" B. "I see that you are upset, but I feel uncomfortable when you swear at me." C. "Have you ever thought about ways to express anger appropriately?" D. "I'll give you some space. Let me know if you need anything."

ANS: B This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify.

Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? A. "My sister has the same diagnosis as you and she also hears voices." B. "I understand that the voices seem real to you, but I do not hear any voices." C. "Why not turn up the radio so that the voices are muted." D. "I wouldn't worry about these voices. The medication will make them disappear."

ANS: B This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client.

A client diagnosed with schizophrenia states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing reply? A. "Did you take your medicine this morning?" B. "You are not going to hell. You are a good person." C. "I'm sure the voices sound scary. The devil is not talking to you. This is part of your illness." D. "The devil only talks to people who are receptive to his influence."

ANS: C The most appropriate reply by the nurse is to reassure the client with an accepting attitude while not reinforcing the hallucination. Reminding the client that "the voices" are a part of his or her illness is a way to help the client accept that the hallucinations are not real.

A client on an inpatient psychiatric unit tells the nurse, "I should have died because I am totally worthless." In order to encourage the client to continue talking about feelings, which should be the nurse's initial response? A. "How would your family feel if you died?" B. "You feel worthless now, but that can change with time." C. "You've been feeling sad and alone for some time now?" D. "It is great that you have come in for help."

ANS: C This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted

Which nursing intervention would be most appropriate when caring for an acutely agitated client diagnosed with paranoid schizophrenia? A. Provide neon lights and soft music. B. Maintain continual eye contact throughout the interview. C. Use therapeutic touch to increase trust and rapport. D. Provide personal space to respect the client's boundaries.

ANS: D The most appropriate nursing intervention is to provide personal space to respect the client's boundaries. Providing personal space may serve to reduce anxiety and thus reduce the client's risk for violence.

A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort the neck. This client is exhibiting which extrapyramidal reaction? a. Dystonia b. Akinesia c. Akathisia d. Tardive dyskinesia

a. Dystonia

Which of the following should the nurse identify as being effectively treated by conventional antipsychotics? Select all a. auditory hallucinations b. withdrawal from social situations c. delusions of grandeur d. severe agitation e. anhedonia

a. auditory hallucinations c. delusions of grandeur d. severe agitation conventional/traditional antipsychotics only treat positive symptoms

The nurse is performing a mental status examination on a client, and the client states, "Glass breaks if you throw stones or shoot at it with a gun. My cousin shoots guns at the police all the time at target practice. People who live in glass houses shouldn't throw stones." Which interpretation by the nurse is appropriate? a. Speech is incoherent and tangential. b. Speech is illogical and loosely associated. c. Speech is distractible and contains flight of ideas. d. Speech is pressured and contains clang associations.

b. Speech is illogical and loosely associated. Rationale: Loose associations are speech patterns in which there is a lack of a logical relationship between thoughts and ideas; this causes speech and thought to seem inexact, vague, unfocused, and diffuse.

Which of the following should the nurse identity as extrapyramidal symptoms? Select all a. decreased level of consciousness b. drooling c. involuntary arm movements d. urinary retention e. continual pacing

b. drooling c. involuntary arm movements e. continual pacing

A client with schizophrenia tells the nurse he hears the voices of his dead parents. To help the client ignore the voices, the nurse should recommend that he: a. sit in a quiet, dark room and concentrate on the voices. b. listen to a personal stereo through headphones and sing along with the music. c. call a friend and discuss the voices and his feelings about them. d. engage in strenuous exercise

b. listen to a personal stereo through headphones and sing along with the music.

The history assessment of a client diagnosed with schizophrenia confirms a routine that includes smoking two packs of cigarettes and drinking 10 cups of coffee daily. The nurse recognizes that which is the greatest risk for injury these behaviors present for this client? a. Developing lung cancer and/or other respiratory disorders b. Withdrawal symptoms triggering a stress-induced relapse c. Diminishing the effectiveness of psychotropic medication d. Developing gastrointestinal disorders, including bleeding ulcers

c. Diminishing the effectiveness of psychotropic medication Rationale: Both caffeine and nicotine can inhibit the action of psychotropic medications, which are commonly prescribed for schizophrenia.

The nurse should identify which best goal for a client experiencing hallucinations? a. Support the client through the hallucination in a caring, therapeutic manner. b. Provide the client with insight as to why he is experiencing the hallucination. c. Facilitate the client's awareness that the hallucination is not the reality of the world. d. Help the client understand that he can learn to ignore the hallucination through appropriate coping mechanisms.

c. Facilitate the client's awareness that the hallucination is not the reality of the world.

A mental health nurse is assigned to care for a client with a diagnosis of acute schizophrenia. The nurse should use which approach when planning care for this client? a. Allow the client to set the goals for the plan of care. b. Let the client act out initially, and use the quiet room and restraints as needed. c. Provide assistance with grooming and nutrition until the client's thinking has cleared. d. Repeatedly point out inconsistencies in the client's communication during initial treatment.

c. Provide assistance with grooming and nutrition until the client's thinking has cleared. Rationale: In the acute phase, the nurse must assume responsibility for planning for the client's basic human needs, such as nutrition, hygiene, sleep, and activities of daily living (ADLs). As the nurse plans care for the schizophrenic client, it is important to understand the client's developmental stage and ability to accept the disease. The client lacks insight and may not be aware of the illness because of the severe decompensation in thinking.

A nurse is caring for a client with schizophrenia that exhibits a lack of grooming and a flat affect. The nurse should anticipate a prescription of which of the following medications? a. Chlorpromazine (Thorazine) b. Thiothixene (Navane) c. Risperidone (Risperdal) d. Haloperidol (Haldol)

c. Risperidone (Risperdal) because it is an atypical antipsychotic that treats positive and negative symptoms. The symptoms the client is displaying are negative symptoms

A nurse who is reviewing the record of a client admitted to the mental health unit notes that the client was admitted by voluntary status. Which statement describes voluntary status? a. The admission was mandated by court order. b. The admission was made without the client's consent. c. The client has the right to demand and obtain release from the hospital. d. The client was committed by a group of designated mental health professionals.

c. The client has the right to demand and obtain release from the hospital.

The nurse should provide which information to the parents of a teenager about their child's new diagnosis of schizophrenia? a. Their child will very likely experience difficulty in school. b. The prognosis for their child is good because he is so young. c. Their child likely has an imbalance of the chemical dopamine. d. With medication, their child is not likely to experience relapses.

c. Their child likely has an imbalance of the chemical dopamine.