Exam 1 Pysch

An isolative client was admitted 4 days ago with a diagnosis of MDD. Which nursing statement would best motivate this client to attend a therapeutic group being held in the milieu?

"I'll walk with you to the dayroom. Group is about to start."

The nurse learns at report that a newly admitted client experiencing mania is demonstrating grandiose delusions. The nurse should recognize that which client statement provides supportive evidence of this symptom?

"I'm the world's most perceptive attorney."

After undergoing two of nine electroconvulsive (ECT) procedures, a client states, "I can't even remember eating breakfast, so I want to stop the ECT." Which reply by the nurse is appropriate?

"It is within your right to discontinue the treatments, but let's talk about your concerns."

A suicidal client says to a nurse, "There's nothing to live for anymore." Which is the best nursing reply?

"It sounds like you are feeling pretty hopeless."

Which statement indicates that the nurse is acting as an advocate for a client who was hospitalized after a suicide attempt and is now nearing discharge?

"Let's review the resources that you may need after discharge."

A labor and delivery nurse listens to a new mother relate thoughts regarding her healthy, 8-lb baby. Which statement by the mother indicates to the nurse the use of the cognitive error of selective abstraction?

"My baby is wonderful, but I'm depressed because I had my heart set on having twins."

Which response by the instructor is accurate regarding blood pressure cuff placement on the client's lower leg during an electroconvulsive therapy (ECT) procedure?

"The cuff functions to prevent succinylcholine from reaching the foot."

A client who is diagnosed with MDD asks the nurse what causes depression. Which is the nurse's most accurate response?

"The exact cause of depressive disorders is unknown. A number of things, including genetic, biochemical, and environmental influences, likely play a role."

A nurse practitioner uses cognitive behavior therapy with depressed clients. The nurse asks clients to keep a daily record of dysfunctional thoughts (DRDT). Which of the following are appropriate nursing replies to a client asking about the purpose of this exercise? Select all that apply.

"The purpose of this exercise is to identify automatic thoughts."; "The purpose of this exercise is to modify cognitive errors."; "The purpose of this exercise is to identify rational alternatives."

A nursing instructor is teaching about specific phobias. Which student statement indicates that learning has occurred?

"These clients have overwhelming symptoms of panic when exposed to the phobic stimulus."

A client living on the beachfront seeks help with an extreme fear of crossing bridges, which interferes with daily life. A psychiatric-mental health nurse practitioner decides to try systematic desensitization. Which explanation of this therapy should the nurse convey to the client?

"Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety."

student nurse asks an instructor which resource is best to use when developing nursing outcomes for clients. Which reply most accurately answers the student's question?

"Use the Nursing Outcomes Classification (NOC) as a reference for nursing outcomes."

Which example of a therapeutic communication technique would be most effective in the planning phase of the nursing process?

"We've discussed past coping skills. Let's see if these coping skills can be effective now."

After a teenager reveals that he is gay, his parent responds by beating him. The next morning, the teenager is found to have committed suicide. Which parental grief responses should a nurse anticipate?

"Well, that was a selfish thing to do."; "If only I had been more understanding.";"How dare he do this to me!";"I can't believe this is happening.";"I'm just going to have to accept that he was gay.".

A client diagnosed with posttraumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which utterance made by the nurse is an example of a broad opening?

"What would you like to talk about?"

A client on an inpatient psychiatric unit tells the nurse, "I should have died, because I am totally worthless." To encourage the client to continue talking about feelings, which should be the nurse's initial response?

"You've been feeling sad and alone for some time now?"

Nursing care of a client with a diagnosis of substance-induced anxiety disorder must take into consideration the nature of the substance and if the symptoms are in the context of which of the following? Select all that apply.

Withdrawal, Intoxication.

Nursing care of a client with a diagnosis of substance-induced anxiety disorder must take into consideration the nature of the substance and if the symptoms are in the context of which of the following?

Withdrawal, intoxication.

A client diagnosed with panic disorder states, "When an attack happens, I feel like I am going to die." Which is the nurse's most appropriate reply?

"I know it's frightening, but try to remind yourself that it will only last a short time."

Which statement reflects the therapeutic communication technique the nurse should use when communicating with a client who is experiencing auditory hallucinations?

"I understand that the voices seem real to you, but I do not hear any voices."

The psychiatric-mental health nurse is providing discharge teaching for a client diagnosed with bipolar disorder. Which statement indicates that the nurse's teaching is effective?

"I'll be the designated driver since I shouldn't have alcohol with lamotrigine."

Which is a typical part of the fight-or-flight syndrome?

Decreased peristalsis.

The nurse is assessing a client diagnosed with schizophrenia and asks, "Do you ever get messages through things, like the television or microwave?" Which symptom of schizophrenia is the nurse assessing for?

Delusions of reference.

What is the priority reason for the nurse to perform a full physical health assessment on a client admitted with a diagnosis of MDD?

Depression is a symptom of several medical conditions.

Which datum indicates a suicidal client is participating in a safety plan?

Disclosing a plan for suicide to staff.

Which statement is true regarding the priority focus of recovery models?

Empowerment of the client to make decisions related to individual health care.

A client diagnosed with MDD was raised in a strongly religious family where bad behavior was equated with sins against God. Which nursing intervention is most appropriate to help the client address spirituality as it relates to the illness?

Encourage the client to bring into awareness underlying sources of guilt.

A nurse is working with a client who has recently been under a great deal of stress. Which nursing recommendations would be most helpful to assist the client to cope with stress?

Enjoy a pet, focus on the stressors, journal your feelings, spend time with a loved one, listen to music.

An adolescent client was recently admitted to the psychiatric unit because of impulsivity and acting-out behavior at school. Which nursing action should the nurse implement first?

Explain the unit rules and consequences of breaking the rules.

A nurse uses the commitments of the Tidal Model of Recovery in psychiatric-mental health nursing practice. Which nursing actions reflect the use of the Develop Genuine Curiosity commitment? Select all that apply.

Expresses interest in the client's story; Asks for clarification of certain points; Assists the client to unfold the story at his or her own rate.

A newly admitted client diagnosed with MDD states, "I have never considered suicide." Later, the client confides to the nurse about plans to "end it all" by medication overdose. Which is the most helpful nursing reply?

"Bringing this up is a very positive action on your part."

A client is diagnosed with an anxiety disorder. The nurse counselor recommends the behavioral technique of reciprocal inhibition. The client asks, "What's that?" Which is the best nursing reply?

"By introducing an adaptive behavior that is mutually exclusive to your maladaptive behavior, we will expect subsequent behavior to improve."

A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred?

"Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder."

A nursing instructor is teaching about suicide. Which student statement indicates that learning has occurred?

"Fifty to eighty percent of all people who kill themself have a history of a previous attempt."

A client's spouse asks, "What evidence supports the possibility of genetic transmission of bipolar disorder?" Which is the best nursing reply?

"Higher rates of relatives diagnosed with bipolar disorder are found in families of clients diagnosed with this disorder."

Which situation describes an example of the basic concept of a recovery model?

A client diagnosed with schizophrenia schedules follow-up appointments and group therapy.

A newly admitted client is diagnosed with bipolar disorder: manic episode. Which symptom related to altered thought is the nurse most likely to find on assessment?

Flight of ideas.

A nurse on an inpatient unit helps a client understand the significance of treatments and provides the client with copies of all documents related to the plan of care. This nurse is employing which commitment in the Tidal Model of Recovery?

be transparent.

While trying to control aggressive behavior, a client asks an assertiveness training nurse to give an example of an "I" statement. Which of the following statements is the best example of this assertive communication technique?

"I feel angry when you come home late without calling."

During an inpatient educational group, a client shouts out, "This information is worthless. Nothing you have said can help me." These statements indicate to the nurse leader that the client is assuming which group role?

Aggressor.

The nursing instructor asks a nursing student to describe concepts of the Recovery Model. Which concepts should the nursing student include?

Allows client primary control over care decisions, uses personal values to determine meaning in life.

Based on epidemiological factors, who is at the greatest risk for suicide?

An 82-year old Caucasian male.

In which way can anxiety be distinguished from fear?

Anxiety is an emotional process while fear is a cognitive one.

A client diagnosed with psychosis asks the nurse to make the voices stop talking so he can go to sleep. Which is the most important nursing intervention?

Ask the client what the voices are saying.

Which should the nurse perform to maximize client education prior to discharge teaching?

Assess the client's readiness to learn.

A first-time parent is crying and asks the nurse, "How can I go to work if I can't afford child care?" Which is the appropriate initial response by the nurse to assist with problem-solving?

Assess the facts of the situation.

Using a cognitive approach, which intervention would the nurse choose to assist clients in managing anger without the use of violence?

Assist the client in identifying thoughts that trigger anger and substitute reality-based thinking.

A client with cognitive deficits is extremely suicidal. The client has not responded to antidepressants, and the treatment team is considering electroconvulsive therapy (ECT). What client information would impact the feasibility of this treatment option?

Because informed consent is required for ECT, cognitive deficits could preclude this option.

Which of the following is considered a predisposing factor for depression?

Genetic factors.

A client begins to smash furniture, cannot be "talked down," and refuses medications. Which is the priority nursing intervention?

Call a violence code.

A student nurse has just entered a psychiatric rotation. The student asks a nursing instructor, "How will we know if someone may get violent?" Which is the most appropriate reply by the nursing instructor?

Certain behaviors indicate a potential for violence, such as rigid posture, clenched fists, and raised voice."

Two clients are roommates on an inpatient psychiatric unit. At breakfast, client A, who had been missing her gold locket, notices client B wearing it. Which does the nurse recognize as a nonassertive or passive behavioral response from client A?

Client A ignores the situation and decides to buy another necklace.

How would the nurse differentiate a client diagnosed with a social phobia from a client diagnosed with a schizoid personality disorder (SPD)?

Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life.

A nurse maintains a client's confidentiality, addresses the client appropriately, and does not discriminate based on sex, age, race, or religion. Which guiding principle of recovery has this nurse employed?

Recovery is based on respect.

Which concepts has SAMHSA described as major dimensions of support for a life in recovery?

Health, Home, Community, Purpose.

Which risk factor should a nurse recognize as the most reliable indicator of potential client violence?

History of assaultive behavior.

A client diagnosed with alcohol abuse disorder is referred to a residential care facility after discharge. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), which dimension of recovery is supporting this client?

Home.

A nursing student is developing a study guide related to historical facts about suicide. Which of the following facts should the student include?

In the Middle Ages, suicide was viewed as a selfish and criminal act; During the Renaissance, suicide was discussed and viewed more philosophically; Old Norse traditions set a person who committed suicide adrift in the North Sea; During the Roman Empire, suicide was followed by incineration of the body; Suicide was an offense in ancient Greece, and a common-site burial was denied.

The nurse is a volunteer for the American Red Cross and has visited victims of a tornado that occurred a month ago. Many of the area's adult residents' responses have included sadness and an increase in alcohol use, while the children have separation anxiety to the point of sleeping with their parents. Which is the correctly written priority nursing diagnosis for this population?

Ineffective community coping related to (R/T) natural disaster.

A client diagnosed with OCD spends hours bathing and grooming. During a one-on-one interaction, the client discusses the rituals in detail, but avoids any feelings that the rituals generate. Which defense mechanism should the nurse identify?

Intellectualization.

A client who has been diagnosed with bipolar I disorder states, "God has taught me how to decode the Bible." The nurse should anticipate which combination of medications would be ordered to address this client's symptoms?

Lithium carbonate (Lithobid) and risperidone (Risperdal).

"You've been feeling sad and alone for some time now?"

MMSE.

Which of the following interventions should the nurse utilize when caring for an inpatient client who is expressing anger inappropriately? Select all that apply.

Maintain a calm demeanor, Clearly delineate the consequences of the behavior, Set firm limits on the behavior.

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should the nurse teach the client?

Ways to make eye contact when communicating.

A 20-year-old female has a diagnosis of PMDD. Which of the following should the nurse identify as consistent with this diagnosis?

Mood swings occur the week before onset of menses; Client reports subjective difficulty concentrating; Client-rated mood is 2/10 for the past 6 months; Symptoms are causing significant interference with daily activities.

A client has experienced the death of a close family member and at the same time becomes unemployed. The client's 6-month score on the Recent Life Changes Questionnaire is 110. The nurse:

Needs further assessment of the client's coping skills to determine susceptibility to stress-related illness.

Which statement regarding nursing interventions is accurate?

Nursing interventions occur independently but align with overall treatment team goals.

The clinic nurse is reviewing the medication list of a client diagnosed with medication-induced bipolar disorder. The nurse recognizes which may have precipitated the client's mood disturbance?

Oral contraceptives, antihypertensives, corticosteroids.

Which concepts are included in Hobfoll's Conservation of Resources theory? Select all that apply.

Past experiences, availability of resources, genetics.

A client is diagnosed with bipolar I disorder: manic episode. Which nursing intervention should be implemented to achieve the outcome of "Client will gain 2 lb by the end of the week?"

Provide client with high-calorie finger foods throughout the day.

The master's-prepared nurse with specialized training is serving as a group leader, where the client becomes an "actor" in a life-situation scenario. This scenario provides the client a safe atmosphere to work through unresolved conflicts. What is this type of therapeutic group?

Psychodrama.

A client diagnosed with obsessive-compulsive disorder states, "I really think my future will improve because of my successful treatment choices. I'm going to make my life better." Which guiding principle of recovery has assisted this client?

Recovery emerges from hope.

A client diagnosed with brief psychotic disorder states, "The voices keep telling me I must kill the president." Which is the priority nursing diagnosis?

Risk for violence: other directed.

The nurse observes that a client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication does the nurse anticipate the provider will prescribe?

Risperidone

Which of the following interventions should the nurse utilize when caring for an inpatient client who is expressing anger inappropriately?

Set firm limits on behavior, clearly delineate the consequences of the behavior, maintain a calm demeanor.

An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which is the nurse's priority intervention?

Set firm limits on the behavior.

A teenager gets a C in algebra. The mother angrily states, "All you ever do is listen to music and text your friends." The teenager replies, "What is it that you're really upset about, mom?" Which response pattern is the teenager expressing?

Shifting from content to process.

A client admitted to a Veterans Administration hospital with a diagnosis of major depressive disorder tells the nurse, "I failed my battalion by giving the wrong order. Fortunately, no one was injured." Which nursing diagnosis will the nurse assign this client?

Situational low self-esteem.

During the implementation phase of the nursing process, a nurse is teaching an adult client who is experiencing depression and has a cochlear implant about medications. Which modification in the teaching plan would be best for this client?

Speaking face-to-face.

A client is experiencing a severe panic attack. Which nursing intervention would meet this client's immediate need?

Stay with the client and offer reassurance of safety.

A client experiences an exacerbation of psychiatric symptoms to the point of threatening self-harm. Which action step of the Wellness Recovery Action Plan (WRAP) Model should be employed, and which action reflects this step?

Step 6: Following a client-designed plan, caregivers now become decision-makers.

A client was diagnosed with depression resulting from the loss of her twin sister in a skiing accident. Her parents reported that all the client has done since the accident was lay in her bed and cry, asking why she survived the accident. The physician prescribed Prozac to treat the depression and suggested that the parents "keep a close eye on her." After a week, the client began to show some signs of improvement, even coming out of her room to eat with the family. After 2 months, the client committed suicide despite seeming to come out of the depression. What is the likeliest reason?

Suicide risk can increase early in treatment with antidepressants.

Which of the following are most appropriate when performing a nursing assessment with an individual in crisis?

Tell me, in your own words, what happened.", "What coping methods have you used, and did they work?","Describe to me what your life was like before this happened.", "I'll assist you in selecting functional coping strategies.","Let's focus on the current problem.".

The following North American Nursing Diagnosis Association (NANDA) nursing diagnostic stem was developed for a client on an inpatient unit: "Risk for injury."Which assessment data most likely led to the development of this problem statement?

The client is receiving ECT and is diagnosed with parkinsonism.

The following clients are seen in the emergency department. The psychiatric unit has one remaining bed. Which client should the triage nurse expect to be admitted?

The client who is a single parent and hears voices stating, "Kill your infant."

A client experienced bradycardia during electroconvulsive therapy (ECT). A nurse assigns a nursing diagnosis of decreased cardiac output related to (R/T) vagal stimulation occurring during ECT. Which outcome would the nurse expect the client to achieve?

The client will continue adequate tissue perfusion 1 hour after treatment.

A client is diagnosed with bipolar disorder and admitted to an inpatient psychiatric unit. Which is the priority outcome for this client?

The client will remain safe from harm throughout hospitalization.

A client comes to a psychiatric clinic, experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. Which long-term outcome is realistic to address the client's crisis?

The client will return to previous adaptive levels of functioning by week 6.

A client has a nursing diagnosis of "Insomnia R/T paranoid thinking AEB midnight awakenings, difficulty falling asleep, and daytime napping." Which is a correctly written and appropriate outcome for this client's problem?

The client will sleep 7 uninterrupted hours by day 4 of hospitalization.

Which client information does the nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)?

The client's cognitive ability to understand information about the medication.

Which nurse group leader activity is most important in the final (termination) phase of group development?

The group leader helps the members to process feelings of loss.

A nurse states to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique?

The nontherapeutic technique of "giving false reassurance".

During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style?

The nurse sits silently as the group members stray from the assigned topic.

During the debriefing after a violent episode, the client states that they acted out on their perceived threat from which of the staff behaviors?

The staff member attempted to soothe the client by stroking their arm and shoulder and talking in a firm tone.

The parents of a 10-year-old child come to the office to discuss the issues raised during the most recent parent-teacher conference. One parent states that the child is able to act age appropriately unless given a task to complete, such as making their bed. In this case, the child crawls on the floor and begins to speak "baby talk" until the other parent relents and does the task for the child. What is the most appropriate reason for this maladaptive behavior?

This is an example of classical conditioning.

A parent is concerned about her ability to perform in her new role. She is quite anxious and refuses to leave the postpartum unit. To offer effective client care, a nurse should recognize which information about this type of crisis?

This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

The nurse is providing assertiveness training to a client. One of the instructions is for the client to close their eyes and to shout aloud "STOP" to shift ideas from intrusive to pleasant and desirable. What is the technique called?

Thought stopping.

What is the purpose of a nurse providing appropriate feedback?

To give the client critical information.

Which is the best nursing rationale for holding a debriefing session with clients and staff after clients have witnessed a peer being "taken down" after a violent outburst?

To process feelings and concerns related to the witnessed intervention.

The nurse admits an older client who is experiencing memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a Mini-Mental Status Examination?

To rule out a neurocognitive disorder (NCD).