Evolve Adaptive Quiz - Mental Health Concepts and Psychopharmacology

A client demonstrating manic behavior is elated and sarcastic. The client is constantly cursing and using foul language and has the other clients on the unit terrified. What should the nurse do initially? 1. Demand that the client stop the behavior immediately. 2. Tell the client firmly that the behavior is unacceptable. 3. Ask the client to identify what is precipitating the behavior. 4. Increase the client's medication or get a prescription for another drug.

2

After an automobile accident a person is arrested for driving while intoxicated and is admitted to the hospital. When the client becomes angry and blames the family for personal problems, the nurse can be most therapeutic by using which statement? 1. "You know that you are to blame for your alcohol abuse." 2. "You need help now or you're just going to get even sicker." 3. "I'll talk to your family about their behavior if you want me to." 4. "I can see that you're upset about your family, but we need to focus on what you need right now."

4

What is important when the nurse plans care for a client with paranoid ideation? 1. Avoiding placing demands on the client 2. Eliminating stress so that the client can relax 3. Giving the client difficult tasks to provide stimulation 4. Providing the client with opportunities for nonthreatening social interaction

4

A client is admitted to the psychiatric unit for severe depression with the potential for suicide. What is the most therapeutic nursing intervention when the client becomes more energized and communicative? 1. Continuing to assess the client at regular intervals 2. Encouraging the client to participate in group activities 3. Giving the client more autonomy to decide about privileges 4. Starting to teach the client about medications in preparation for discharge

1

What is the most appropriate nursing intervention for clients who exhibit mild cognitive impairment? 1. Reality orientation 2. Behavioral confrontation 3. Reflective communication 4. Reminiscence group therapy

1

What should the nurse do when talking with a client with a history of panic disorder who is displaying many of the emotional and physiologic symptoms of a panic attack? 1. Use short sentences and an authoritative voice. 2. Describe the possible reasons for the client's anxiety. 3. Keep asking questions, because the client is probably not going to volunteer much information. 4. Suggest that the client refrain from crying, because most of the time crying makes matters worse.

1

A client is admitted to the mental health unit of the hospital because of agitation and unprovoked hostile verbal attacks toward others in the workplace. What is the priority nursing intervention for this client? 1. Developing trust 2. Maintaining safety 3. Refocusing hostile energy 4. Preventing hostile outbursts

2

A 32-year-old client is hospitalized with a diagnosis of a bipolar disorder, manic episode. The client becomes loud and vulgar and disturbs the other clients. What is the best reaction by the nurse to this situation? 1. Telling the client that the behavior is bothering the other clients 2. Ignoring the vulgar talk because it is part of the illness 3. Segregating the client until this phase of the illness passes 4. Commenting that this kind of talk is not appreciated on the unit

3

A client calls the emergency department of the hospital after taking 24 sleeping pills. Which statement best describes the psychodynamics of calling the emergency department during the very act of a suicide attempt? 1. A need for attention 2. A need to punish others 3. Ambivalence about dying 4. An inability to stick to a decision

3

A practitioner prescribes routine checks of the client's lithium level to be performed. How many hours after the last dose of lithium should the nurse plan to obtain the blood specimen? 1. 2 to 4 2. 4 to 6 3. 6 to 8 4. 8 to 12

4

A registered nurse who is a beginning group leader in a community mental health center has been assigned to start a new group with regressive long-term clients. The nurse manager explains that in the beginning new group leaders are expected to do what? 1. Talk extensively about their own experiences. 2. Confront group members about a variety of issues. 3. Feel uncomfortable handling conflicts between members of the group. 4. Have little difficulty with long-term clients who do not have acute emotional problems.

4

A client is admitted to the hospital with a history of increasingly bizarre behavior. The client says, "I'm wired to the TV, and it told me that my family is out to kill me." What is the best initial action by the admitting nurse? 1. Taking the client to the dayroom and introducing the other clients on the unit 2. Reassuring the client that the unit is safe and that the client will be protected from the family 3. Telling the client that the door is locked and that no one will be permitted to enter the unit to harm anyone 4. Introducing the client to the primary nurse who will be assigned to work on a one-on-one basis with the client

4

A client is found to have generalized anxiety disorder. For what behavior should the nurse assess the client to determine the effectiveness of therapy? 1. Participating in activities 2. Learning how to avoid anxiety 3. Taking medications as prescribed 4. Recognizing when anxiety is developing

4

A nonviolent client on the psychiatric unit suddenly refuses to take the prescribed antipsychotic medication. What should the nurse do? 1. Honor the client's decision and document the behavior and all interventions. 2. Use an authoritarian approach to induce the client to take the prescribed medication. 3. Call the primary healthcare provider and request that the client be discharged against medical advice. 4. Start proceedings to have the client declared incompetent and seek a court order permitting medication.

1

A nurse encourages a client to join a self-help group after being discharged from a mental health facility. What is the purpose of having people work in a group? 1. Support 2. Confrontation 3. Psychotherapy 4. Self-awareness

1

A nurse understands that value clarification is a technique useful in therapeutic communication because initially it helps clients do what? 1. Become aware of their personal values 2. Gain information related to their needs 3. Make correct decisions related to their health 4. Alter their value systems to make them more socially acceptable

1

A nursing team holds a conference to develop goals for the care of a withdrawn, shy male client with low self-esteem who is afraid to talk to members of the opposite sex. Which objective should be given priority and documented in the client's plan of care? 1. "The client will increase his self-esteem." 2. "The client will understand his sexual disorder." 3. "The client will examine his feelings toward women." 4. "The client will increase his knowledge of sexual function."

1

During group therapy, the working phase usually begins when the group displays what? 1. Cohesiveness 2. Confrontation 3. Imitative behavior 4. Corrective recapitulation

1

A college student is brought to the mental health clinic by parents with a diagnosis of borderline personality disorder. Which factors in the client's history support this diagnosis? Select all that apply. 1. Impulsiveness 2. Lability of mood 3. Ritualistic behavior 4. Psychomotor retardation 5. Self-destructive behavior

1, 2, 5

On the fifth day of hospitalization the nurse notes that a depressed client remains lying on the bed when the clients are called to the dining room for lunch. What should the nurse do to encourage the client to eat? 1. Have a lunch tray sent to the client's room. 2. Offer to accompany the client to the dining room. 3. Explain that all clients are expected to go to the dining room for meals. 4. Provide information about the importance of eating to maintain health.

2

Which individual is coping with issues concerning dependence versus independence? 1. Infant 2. Toddler 3. School-aged child 4. Preschool-aged child

2

A nurse is assisting with an electroconvulsive therapy (ECT) treatment. The healthcare provider administers the electrical shock, and a seizure of 60 seconds' duration results. Place in priority order the nursing actions that should be taken after the seizure ends. 1. Checking vital signs 2. Ensuring an open airway 3. Assessing the client for the presence of short-term memory loss 4. Providing nourishment because the client has been on nothing-by-mouth (NPO) status 5. Orienting the client to place and time

2, 1, 5, 3, 4 Ensure open airway Check vitals Orient Assess for memory loss Provide nourishment

A client on the psychiatric unit tells the nurse, "I'm a movie star, and the other clients are my audience." What is an appropriate conclusion for the nurse to document about what the client is experiencing? 1. Flight of ideas 2. Idea of reference 3. Delusion of grandeur 4. Auditory hallucination

3

A client is admitted to the psychiatric unit during the first episode of an acute psychotic disorder. The plan of care calls for psychiatric, medical, and neurologic evaluation. What essential intervention should be included in the plan? 1. Assessing the symptoms and teaching the client about the disorder 2. Encouraging participation in cognitive and social skills enhancement 3. Maintaining a daily routine and instituting family and group therapies 4. Instituting psychopharmacologic prescriptions and supportive communication

4

An older adult is being admitted to a nursing home with the diagnosis of dementia. The history reveals confusion, difficulty recognizing family members, and nighttime wandering. What should the nurse include in the client's plan of care? 1. Ordering a vest restraint for the client to be applied at night 2. Obtaining a prescription for a sedative so the client will sleep better at night 3. Requesting that the family provide a companion to stay with the client at night 4. Assigning the client to a room near the nurses' station for closer supervision at night

4

The nurse tells a client that talking with the staff members is part of the therapy program. The client responds, "I don't see how talking to you can possibly help." What is the most appropriate response by the nurse? 1. "I can see how you might feel that way now, but I hope you'll change your mind." 2. "You'll never know whether or not it's helpful unless you're willing to give it a try." 3. "The one-on-one relationship has proved helpful for others, and you should give it a try." 4. "I hope I'll be able to help you sort out your thoughts and feelings so you can understand them better."

4

A client is found to have a borderline personality disorder. What is a realistic initial intervention for this client? 1. Establishing clear boundaries 2. Exploring job possibilities with the nurse 3. Initiating a discussion of feelings of being victimized 4. Spending 1 hour twice a day discussing problems with the nurse

1

A nurse is caring for several extremely depressed clients. What type of setting does the nurse recognize these clients do best in? 1. Multiple stimuli 2. Varied activities 3. Simple daily routines 4. Opportunities for decision-making

3

A nurse is assisting with the administration of electroconvulsive therapy (ECT) to a severely depressed client. What side effect of the therapy should the nurse anticipate? 1. Loss of appetite 2. Postural hypotension 3. Total memory loss 4. Confusion immediately after the treatment

4

A client with the diagnosis of schizophrenia, paranoid type, appears very suspicious of the nurse. What is the most effective therapeutic nursing approach? 1. Assigning various caregivers to the client 2. Making brief, frequent contacts with the client 3. Initiating a discussion about the client's thoughts 4. Allowing the client to stay alone without interruption

2

A single mother of two children who recently lost her job because her company is downsizing comes to the emergency department. The woman does not know what to do and is in crisis. The most critical factor for the nurse to determine during crisis intervention is the client's what? 1. Developmental history 2. Available situational supports 3. Underlying unconscious conflict 4. Willingness to restructure the personality

2

A client who has a history of a conversion reaction that involves weakness in the right arm that periodically progresses to paralysis is hospitalized on the mental health unit. While listening to instructions for a group project, the client experiences a feeling of weakness and is unable to move the right arm. After assessing the client, what should the nurse ask? 1. "Exactly when did the weakness begin?" 2. "Is this similar to what you usually experience?" 3. "Would you like to leave the group for a while?" 4. "What emotion were you feeling before you felt the weakness?"

4

A client comes to the mental health clinic with the complaint of a progressing inability to be in enclosed spaces. The primary healthcare provider makes the diagnosis of claustrophobia and prescribes desensitization therapy. The nurse recalls that desensitization therapy is used successfully with clients experiencing phobias because it is focused on what? 1. Imagery 2. Modeling 3. Role-playing 4. Assertiveness training

1

A client is admitted to a psychiatric hospital after a month of unusual behavior that has included eating and sleeping very little, talking and singing constantly, and going on frequent shopping sprees. In the hospital, the client is demanding, bossy, and sarcastic. Which disorder does the nurse associate with these behaviors? 1. Bipolar disorder, manic phase 2. Antisocial personality disorder 3. Obsessive-compulsive disorder 4. Chronic undifferentiated schizophrenia

1

A client with bipolar disorder, manic episode, has a superior, authoritative manner and constantly instructs other clients in how to dress, what to eat, and where to sit. The nurse should intervene to prevent these behaviors from causing the other clients to feel what? 1. Angry 2. Dependent 3. Inadequate 4. Ambivalent

1

A client with schizophrenia, paranoid type, is delusional, withdrawn, and negativistic. What should the nurse plan to do? 1. Invite the client to play a game of cards or board game. 2. Explain to the client the benefits of joining a group activity. 3. Encourage the client to become involved in group activities. 4. Mention to the client that the primary healthcare provider has prescribed increased activity.

1

A nurse is caring for a client with an antisocial personality disorder. What consistent approach should the nurse use with this client? 1. Warm and firm without being punitive 2, Indifferent and detached but nonjudgmental 3. Conditionally acquiescent to client demands 4. Clearly communicative of personal disapproval

1

A nurse develops a relationship with a client who has bipolar disorder with episodes of mania. The nurse concludes that their therapeutic interaction has entered the working stage when the client does what? 1. Identifies goals for the client-nurse interaction 2. Explores the effect of bipolar behavior on the family 3. Expresses ambivalence about meeting with the nurse 4. Informs the nurse that other family members are bipolar

2

An older widow with lung cancer is now in the terminal stage of her illness. Her family is puzzled by her mood changes and apparent anger at them. The nurse explains to the family that the client is doing what? 1. Trying to avoid her situation 2. Coping with her impending death 3. Attempting to reduce family dependence on her 4. Hurting because the family will not take her home to die

2

What should the nurse consider when caring for clients who are at risk for suicide? 1. A client who fails in a suicide attempt will probably not try again. 2. Formal suicide plans increase the likelihood that a client will attempt suicide. 3. It is best not to talk to clients about suicide, because it may give them the idea. 4. Clients who talk about suicide are not planning it; they are using the threat to gain attention.

2

A client has recently undergone what was personally considered "a third unsuccessful cosmetic surgery." The primary healthcare provider diagnoses body dysmorphic disorder. What is the primary nursing objective? 1. Controlling the client's manipulative behavior 2. Teaching the client about relaxation techniques 3. Exploring the issues that influence the client's self-perception 4. Developing a progressive desensitization program with the client

3

A client scheduled to begin electroconvulsive therapy (ECT) to treat severe depression that has not responded to any of the antidepressant medications tells the nurse, "I'm scared that I'll lose my memory forever after the treatment." What is the most therapeutic response by the nurse? 1. "Your memory loss may be permanent, but usually it's just temporary." 2. "You won't experience a permanent memory loss, so there's no need to be frightened." 3. "You'll experience a temporary loss of memory, and feeling frightened about it is expected." 4. "Your memory loss will be temporary, and it will help block out many of your painful past experiences."

3

A client who is to be discharged from an inpatient mental health facility is referred to a mental health daycare center in the community. What should the nurse identify as the primary reason for this referral? 1. Improving social skills 2. Getting out of the house for a few hours daily 3. Maintaining gains achieved during hospitalization 4. Avoiding direct confrontation with the community

3

A nurse is considering Erikson's stages of psychosocial development while caring for a client. Which behavior is consistent with a problem involving trust versus mistrust? 1. Woman in an abusive relationship who refuses to leave the abuser 2. Man with paranoid schizophrenia who demands placement in a private room 3. Woman whose parents were chronic alcoholics and who has problems making friends 4. Man with borderline personality disorder who has been caught stealing from other clients

3

A client who is hallucinating actively approaches the nurse and reports, "I'm hearing voices that are saying bad things about me." What should the nurse do? 1. Respond, "I don't hear the voices." 2. Suggest that the client join other clients in playing cards. 3. Encourage the client not to listen to what the voices are saying. 4. Reply, "I'll stay with you for a while; you seem frightened."

4

A mother and her three young children arrive at the mental health clinic. The woman says that she is seeking help in leaving her husband. She reports that he has been beating her for years but just started hitting the children. What is the best initial action by the nurse? 1. Arranging for a staff member to watch the children so the mother and nurse can talk 2. Calling a facility where the mother and her children will be safe until the crisis is resolved 3. Determining whether the mother is ambivalent about this decision before making permanent plans 4. Suggesting that the mother and her husband return for couples counseling so the marriage can be saved

1

A nurse is accompanying a client with a diagnosis of anxiety disorder who is pacing the halls and crying. When the client's pacing and crying worsen, the nurse suddenly feels uncomfortable and experiences a strong desire to leave. What is the most likely reason for what the nurse is experiencing? 1. An empathic communication of anxiety 2. A fear of the client becoming assaultive 3. A desire to go off duty after a busy workday 4. An inability to tolerate any more bizarre behavior

1

An extremely depressed client signed the consent for electroconvulsive therapy (ECT) but continues to express anxiety about the procedure. What is most important for a nurse to emphasize when discussing ECT with the client? 1. "The procedure may cause a headache." 2. "The procedure will make you feel better." 3. "You won't be left alone during the procedure." 4. "You will have periods of amnesia after the procedure."

3

A client whose depression is beginning to lift remains aloof from the other clients on the mental health unit. How can a nurse help the client participate in an activity? 1. Find solitary pursuits that the client can enjoy. 2. Speak to the client about the importance of entering into activities. 3. Ask the primary healthcare provider to speak to the client about participating. 4. Invite another client to take part in a joint activity with the nurse and the client.

4

A nurse is caring for a terminally ill client who is considering signing an "allow natural death" (AND) document rather than having the healthcare provider complete a traditional do-not-resuscitate (DNR) order. In light of the grieving process, which feeling associated with end-of-life decisions is the AND advance directive attempting to alleviate for the client and his or her family? 1. Guilt 2. Anger 3. Denial 4. Sadness

1

In an outpatient mental health clinic a nurse is working with a client who is beginning to address more effective ways to handle stressful situations. The best nursing action to include in the plan of care is to have the client do what? 1. Identify unhealthy habits that need to be altered. 2. Determine the benefits of a rehabilitation program. 3. Learn about the benefits of antianxiety medications. 4. Develop a consistent method for performing self-care.

1

A 5-year-old with attention deficit-hyperactivity disorder (ADHD) exhibits a short attention span and demonstrates intermittent head-banging and hair-pulling, as well as excessive motor activity. What is the priority nursing objective for this child? 1. Facilitating sleep 2. Maintaining safety 3. Promoting body image 4. Increasing nutritional intake

2

A primary nurse notes that a client has become jaundiced after 2 weeks of antipsychotic drug therapy. The nurse continues to administer the antipsychotic until the primary healthcare provider can be consulted. What does the nurse manager conclude about this situation? 1. Jaundice is sufficient reason to discontinue the antipsychotic. 2. Jaundice is a benign side effect of antipsychotic agents that has little significance. 3. The blood level of an antipsychotic drug must be maintained once it has been established. 4. The prescribed dosage for the antipsychotic agent should have been reduced by the nurse.

1

The night nurse reports that a young client with paranoid schizophrenia has been awake for several nights. The day nurse reviews the client's record and finds that this client did not have an interrupted sleep pattern disorder before transfer from a private room to a four-bed room 3 days ago. What factor should the nurse identify as most likely related to the client's sleeplessness? 1. Fear of the other clients 2. Concern about family at home 3. Watching for an opportunity to escape 4. Trying to work out emotional problems

1

While watching television in the dayroom, a client who has demonstrated withdrawn, regressed behavior suddenly screams, bursts into tears, and runs from the room to the far end of the hallway. What is the most therapeutic intervention by the nurse? 1. Walking to the end of the hallway where the client is standing 2. Accepting the action as the impulsive behavior of a sick person 3. Asking another client in the dayroom why the client acted in this way 4. Documenting the incident in the client's record while the memory is fresh

1

A nurse overhears a client in a mental health hospital talking on the unit telephone. The conversation concerns a "fix" to be brought to the unit during visiting hours. The nurse knows that the client, who has a history of drug use, has a contract with the primary healthcare provider promising not to use street drugs while being treated in the inpatient unit. What is the best nursing intervention? 1. Phoning the client's primary healthcare provider and asking how the situation should be handled 2. Calling an immediate staff meeting to share the information and develop a plan for intervention 3. Calling security to make certain that hospital policies are enforced to maintain a safe environment 4. Confronting the client regarding the telephone conversation, then reporting the incident to the primary healthcare provider

2

The emergency department nurse is conducting an interview and assisting with the physical examination of a female sexual assault victim. What is most important for the nurse to document on this client's record? 1. Observations about the client's reaction to male staff members 2. Statements by the client about the sexual assault and the rapist 3. Information about the client's previous knowledge of the rapist 4. Summary statement about the client's description of the assault and the rapist

2

The husband of a woman who has been sexually assaulted arrives at the hospital after being called by the police. After reassuring him about his wife's condition, the nurse should give priority to what? 1. Arranging for the rape counselor to meet with the wife 2. Discussing with him his own feelings about the situation 3. Helping him understand how his wife feels about the situation 4. Making him comfortable until the practitioner has finished examining his wife

2

The nurse is talking with a delusional client who has been hospitalized for 2 weeks. In the middle of the conversation the client suddenly stops talking, seems preoccupied, and then states, "I hear voices." Because the nurse has already assessed the content of the hallucinations, what is the most therapeutic response? 1. Asking the client, "What are the voices saying?" 2. Telling the client, "I didn't hear any voices," and then focusing on the conversation 3. Saying nothing, remaining observant, and later documenting the incident in the client's record 4. Challenging the client by emphasizing that there is no one else there and reminding the client that there are just the two of them

2

The practitioner prescribes a tricyclic antidepressant medication to ease a suicidal client's depression. What factor should the nurse consider when initiating treatment with this type of medication? 1. Eating aged cheese may cause a hypertensive crisis. 2. There may not be a noticeable improvement for 2 to 3 weeks. 3. They must be given with milk to avoid gastrointestinal irritation. 4. Blood specimens are required weekly for 3 months to check for a therapeutic drug level.

2

What should a nurse who is caring for a hospitalized older client with dementia consider before planning care? 1. Physical contact will increase dependency needs. 2. Routines provide stability for clients with dementia. 3. Regressive behavior should be interrupted immediately. 4. Procedures do not have to be explained to clients with dementia.

2

After a nurse works with an adolescent with anorexia nervosa for 1 week, the adolescent becomes hostile and says to the nurse, "You're just like my mother. I hate you." What concept does the client's statement reflect? 1. Insight 2. Universality 3. Transference 4. Identification

3

After a week on the mental health unit, a client with the diagnosis of paranoid schizophrenia continues to say, "They're trying to kill me. They all are." What is the best response by the nurse? 1. "We're here to protect you." 2. "No one wants to hurt anyone." 3. "You're having very frightening thoughts." 4. "Tell me more about their wanting to kill you."

3

An older woman who has been a widow for 20 years comes to the community health center with a vague list of complaints. Her only child died at birth. She has lived alone since her husband's death and performs all of her own daily tasks of living. She had a very active social life in the past, but has outlived many of her friends and family members. When taking this client's health history, what is it important for the nurse to ask? 1. "Do you feel alone?" 2. "Do you still miss your husband?" 3. "What unfulfilled hopes do you have?" 4. "How did you feel when your child died?"

3

How can a nurse minimize agitation in a disturbed client? 1. By ensuring constant staff contact 2. By increasing environmental sensory stimulation 3. By limiting unnecessary interactions with the client 4. By discussing the reasons for the client's suspicions

3

Three days after a stressful incident a client can no longer remember why it was stressful. The nurse, in relating to this client, can be most therapeutic by identifying that the inability to recall the situation is an example of what defense mechanism? 1. Denial 2. Regression 3. Repression 4. Dissociation

3

What is the priority outcome in the planning of care for a client in crisis? 1. Referring the client for occupational therapy 2. Arranging follow-up counseling for the client 3. Restoring the client's psychological equilibrium 4. Having the client work to gain insight into the problem

3

What should the nurse assess first when evaluating memory impairment in a client with dementia? 1. Disorientation of self 2. Recollection of past events 3. Remembrance of recent events 4. Impaired ability to name objects

3

What should the nurse do to develop a trusting relationship with a disturbed child who acts out? 1. Ask the child's feelings about the parents. 2. Implement one-on-one interactions every half hour. 3. Offer support and encourage safety during play activities. 4. Begin setting limits and explain the rules that must be followed.

3

While admitting a young client with anorexia nervosa to the unit, the nurse finds a bottle of assorted pills in the client's luggage. The client tells the nurse that they are antacids for stomach pains. What is the best initial response by the nurse? 1. "Let's talk about your drug use." 2. "These pills don't look like antacids." 3. "Some people take pills to lose weight." 4. "Tell me more about these stomach pains."

3

A hospice nurse visits the home of a female client in the terminal stage of cancer 3 days each week to provide physical care and emotional support. The nurse observes that the client's adolescent children are having difficulty talking with their mother. The nurse suggests a family meeting, knowing what? 1. It is important to solve family problems before death occurs. 2. They will be unable to deal with their feelings until after their mother dies. 3. A deeper level of knowledge will help the children understand what their mother is going through. 4. The opening of communication increases the ability of family members to work through their reactions to the terminal illness.

4

What is a goal for a client who has difficulty with verbal communication precipitated by psychologic barriers? 1. The client will be free of injury. 2. The client will demonstrate decreased acting-out behavior. 3. The client will identify consequences of acting-out behavior. 4. The client will interact with other people in the environment.

4