final study guide

A nurse is providing health education to a patient who has been diagnosed with bipolar disorder and who will soon begin treatment with lithium carbonate and olanzapine (Zyprexa). What teaching should the nurse prioritize with this patient? Select one: a. Adverse effects of olanzapine and foods to avoid during therapy b. Signs of lithium toxicity and the need for regular blood work c. Guidelines for matching daily lithium and olanzapine doses to symptom severity d. The importance of managing activity levels and diet during therapy

B

A patient has been admitted to the emergency department in an acutely psychotic state. When planning this patient's immediate care, the psychiatric-mental health nurse should prioritize which of the following nursing actions? Select one: a. Assessing the patient's known risk factors for schizophrenia b. Assessing the patient's risk of self‐harm and ensuring safety c. Administering lorazepam (Ativan) as ordered to promote safety and calm d. Assessing the patient's candidacy for electroconvulsive therapy (ECT)

B

A patient is being treated for depression, and the nurse observes an unprecedented improvement in the patient's body language and demeanour this morning. What is the nurse's most appropriate response? Select one: a. Report this assessment finding promptly to the patient's primary care provider or psychiatrist. b. Commend the patient, but monitor closely and assess for suicidal ideation. c. Validate this observation with the patient and assess for the diagnostic criteria for major depressive disorder. d. Perform a comprehensive assessment in light of the fact that the patient may be experiencing mania.

B

A patient with a diagnosis of schizophrenia is being treated with depot preparations of risperidone (Risperdal). When preparing to administer this medication to the patient, which of the nurse's actions is most appropriate? Select one: a. Educate the patient about the need for another injection in 7 to 10 days. b. Withdraw the medication from the ampoule using a filtered needle. c. Select a 22‐guage needle that is at least 3.8 cm (1.5 inches) in length. d. Landmark an injection site that has abundant subcutaneous tissue.

B

A patient with a history of depression was admitted to the health care facility after expressing suicidal ideation to a community mental health worker. After the psychiatric-mental health nurse's assessment, a nursing diagnosis of risk for suicide was identified. When planning this patient's care, what outcome best addresses this nursing diagnosis? Select one: a. The patient will agree not to commit suicide. b. The patient will refrain from attempts at self‐harm. c. The patient will comply with interventions aimed at reducing suicide risk. d. The patient will identify triggers that exacerbate his dysthymia.

B

A patient with a recent psychiatric diagnosis has begun pharmacologic treatment and the care team is monitoring the patient closely for anticholinergic effects. What assessment question by the psychiatric-mental health nurse best addresses those adverse effects? Select one: a. How has your appetite been since you started your meds?" b. "Have you noticed any changes in your bowel or bladder function?" c. "Are you having headaches or feeling sensitive to bright lights?" d. "Have you felt like your mood is worse than starting the meds?"

B

A patient was diagnosed with depression and began taking citalopram (Celexa) 40 mg PO OD several weeks ago. The patient has told the PMH nurse that his depression has resolved and he would like to begin tapering down his medication. What is the nurse's most appropriate response?" Select one: a. "That's excellent that you're feeling better, but it shows that your medication is working, not that you don't need it anymore." b. "It might be possible to reduce your dose somewhat over time, but it's more common to take an antidepressant for life." c. "I'm glad you're feeling better, but it might not actually be due to your medication, since you recently began it." d. "You'll have to speak with your psychiatrist, of course, but in most cases, you need to take an antidepressant for at least 3 months."

A

Inpatient care is being considered for a patient with depression who has been unable to achieve adequate symptom control in the community. Which of the following factors would indicate a possible need for this type of care? Select all that apply. Select one or more: a. The patient has made recent allusions to self-harm. b. The patient has been treated with electroconvulsive therapy (ECT) in the past. c. The patient has been wholly neglecting his functional needs. d. The patient's initial diagnosis was made more than 3 years ago. e. The patient's spouse is experiencing caregiver burnout. f. The patient states that he believes he would benefit from hospitalization.

A & C

A psychiatric-mental health nurse is a member of an interdisciplinary team that has been commissioned to address the mental health needs of underserved Canadians. The team is most likely to address which of the following groups? Select one: a. Individuals who have chronic physical diseases. b. Aboriginal people. c. Individuals who are simultaneously providing care for young children and aging parents. d. Teenagers and young adults.

B

A community health nurse has been working with a client who has recently begun exhibiting many of the diagnostic signs and symptoms of depression. The client has stated adamantly that he does not want to discuss this matter with his primary care provider. The nurse believes that the client may be experiencing the effects of self‐stigmatization. After validating the client's concerns, what is the nurse's best response? Select one: a. Dialogue around the fact that depression is not shameful and is not a sign of personal weakness. b. Encourage the client to explore his culture's understanding of mood, affect, and depression. c. Encourage the client to defer the decision to trusted family members or friends. d. Present some of the evidence supporting the efficacy of modern antidepressants.

A

A psychiatric-mental health nurse is working with a patient whose treatment and follow‐up have been inadequate. When determining the adequacy of the patient's access to health services, the nurse should assess which of the following domains? Select all that apply. Select one or more: a. The patient's mobility. b. The patient's income. c. The patient's level of social support. d. The patient's proximity to tertiary care centres. e. The patient's language abilities f. The patient's spiritual beliefs.

A, B, C, D, & E

A nurse therapist has been conducting CBT with a patient who lives with intense anxiety and who tends to assume that bad things will happen when she takes risks. How can the therapist best collaborate with the patient to test her beliefs? Select one: a. Work with the patient to plan a situation where the patient will present a proposal for change in her workplace. b. Encourage the patient to seek impartial feedback from a trusted peer or family member about her abilities. c. Brainstorm with the patient to speculate on all of the positive outcomes that could result from risk taking. d. Ask questions that address the core beliefs underlying the patient's anxiety.

A

A patient has presented in the emergency department stating that she is having a "heart attack." Assessment reveals, however, that the patient is having a panic attack. The nurse will most likely administer what drug? Select one: a. Alprazolam (Xanax) b. Phenelzine (Nardil) c. Sertraline (Zoloft) d. Clomipramine (Anafranil)

A

A psychiatric-mental health nurse is conducting a comprehensive assessment of a new patient and is applying the bio/psycho/social/spiritual model to care. Which of the following assessment questions best addresses the domain that encompasses all of the other domains of this model? Select one: a. "How would you describe your overall mental health over the course of your life?" b. "What is it that gives you meaning and purpose in your day‐to‐day life?" c. "Can you tell me who is in your immediate family and describe the quality of your relationships?" d. "How would you describe your ability to cope with change?"

B

A psychiatric-mental health nurse is contributing to the care of a patient who is Indigenous and who has been diagnosed with a mental health disorder. What principle should inform the care that the nurse provides? Select one: a. The patient's mental health has likely been compromised by harmful lifestyle choices. b. The patient likely possesses a holistic view of health and illness. c. The patient likely places less emphasis on mental health than non‐ Indigenous Canadians. d. The patient likely conceptualizes mind, body, and spirit as discrete entities.

B

A psychiatric-mental health nurse is preparing to admit a patient who is thought to be experiencing an acute manic state and who is unknown to the health care team. How should the nurse best adapt the health assessment to the patient's current status? Select one: a. Perform a comprehensive assessment before proceeding to a focused assessment that addresses mania. b. Prioritize assessments that relate directly to the patient's presenting symptoms and her safety. c. Defer assessments related to physical status, culture, and spirituality until the patient's symptoms abate. d. Prioritize physical assessments that may potentially be affecting the patient's affect.

B

A psychiatric-mental health nurse is teaching a patient's family about the concepts of mental health, wellbeing, and mental disorders. Which of the nurse's following statements is most accurate? Select one: a. "In most cases, we prefer to use the term 'mental illness' rather than 'mental disorder'. b. "It is certainly possible for a person with a mental disorder to experience mental health." c. "Mental health and mental disorder can be visualized as two extremes on a continuum of wellbeing." d. "Mental illness and mental disorders are two terms for essentially the same concept."

B

A psychiatric-mental health nurse is working with a patient experiencing numerous psychosocial and mental health challenges. Which of the following aspects of the nursing process most clearly demonstrates the application of the Erik Erikson theory of psychosocial development? Select one: a. Assessing the patient's understanding and attainment of her self-actualization needs. b. Determining whether the patient has achieved tasks specific to her stage in life. c. Assessing the patient's functional status and ability to adapt to new circumstances. d. Determining the congruity between the patient's aspirations and her current circumstances.

B

A psychiatric-mental health nurse is working with a patient whose challenging behaviours and statements made it difficult to establish therapeutic rapport. The nurse is aware of the need to address the phenomenon of countertransference. How can the nurse best achieve this goal? Select one: a. Dialogue with the patient about the potential psychological roots of the challenging behaviours. b. Reflect critically on the beliefs and experiences that may influence her view of the patient. c. Address the patient's behaviours and statements assertively yet empathetically. d. "Triangulate" the interactions with the patients by having a colleague accompany her when working with the patient.

B

The interdisciplinary teal is planning a patient's psychotherapy with reference to feminist theory. Which of the following statements will guide this aspect of the patient's care? Select one: a. The approach will begin to explore the patient's negative experiences with men, beginning in her childhood. b. The approach will emphasize the importance role of power in the patient's relationships and interactions. c. Sexuality will be the major construct from which assessments and interventions will be chosen. d. The approach is appropriate because the patient is a woman and not a man.

B

The nurse is creating a plan of care for a patient who is receiving inpatient treatment for schizophrenia. Which of the following interventions should the nurse include in the patient's care plan? Select one: a. Arrange the milieu to minimize the patient's interactions with other patients who also have schizophrenia b. Include the patient's family in support groups and educational groups whenever possible c. Maintain a high level of stimulation in order to prevent hallucinations and delusional thinking d. Respect the patient's choices around the use of antipsychotics, the drug schedule, and dosing levels

B

The nurse is providing care for a patient who is currently being treated for panic disorder. The nurse is speaking with the patient, and the patient has been restless for the past few minutes. The patient suddenly becomes wide‐eyed and says, "Help me." What is the nurse's most appropriate response? Select one: a. Maintain eye contact with the patient and attempt to continue the dialogue. b. Say to the patient, "Look at me and let's breath together slowly." c. Say to the patient, "You're having a panic attack. Try to ignore it." d. Take a full set of vital signs and auscultate the patient's apical heart rate for 1 minute.

B

A nurse can best demonstrate contemporary principles of psychiatric-mental health care by performing what action? Select one: a. Exploring the role that stigma has played in the patient's illness. b. Educating the patient about his or her legal rights. c. Prioritizing the quality of the nurse-patient relationship. d. Holding each member of the care team accountable for his or her actions.

C

A patient who acknowledges low self‐esteem is participating in CBT. The advanced practice psychiatric-mental health nurse is encouraging the patient to engage in inductive reasoning when challenging his beliefs around inferiority and unworthiness. How can the nurse best apply the principle of inductive reasoning in this patient's therapy? Select one: a. Help the patient to identify the character traits of people he or she knows to have high self‐esteem. b. Promote the benefits of frequently reminding himself, "I'm okay and I deserve respect from myself and others" c. Encourage the patient to reflect critically on the evidence that leads him to conclude that he or she is unworthy. d. Ask the patient frequent questions that cast doubt on the usefulness of his core beliefs

C

A patient with a history of bipolar disorder is experiencing an acute manic state. Which of the following nursing diagnoses should the nurse prioritize when planning the patient's care? Select one: a. Decreased cardiac output due to adverse effects of mood stabilizers b. Spiritual distress due to compromised cognitive function c. Risk for injury due to compromised judgement d. Chronic confusion due to organic brain changes

C

A patient with depression began treatment 1 week ago using escitalopram oxalate (Lexapro). Which of the following assessments should the nurse prioritize during this patient's immediate care? Select one: a. Assessment for signs of localized tissue irritation or infection at injection sites b. Assessments for cardiac dysrhythmias and orthostatic hypotension c. Assessments for suicide risk and suicidal ideation d. Assessment for anticholinergic effects.

C

A patient with schizophrenia has been deemed a threat to her own safety and has been admitted involuntarily to the health care facility. Within the ethical framework of principlism, which of the following considerations is central? Select one: a. The ethical "rightness" of the admission is appraising within the principle of justice. b. The patient's admission is best understood in the context of other similar cases involving other patients. c. The principle of beneficence temporarily overrides the patient's autonomy. d. The health care system's duty to ensure safety and prevent harm is paramount.

C

A psychiatric-mental health nurse has accepted a position in a community with a high level of cultural diversity. The nurse can best foster cultural safety by performing which of the following actions? Select one: a. Collaborating with members of the interdisciplinary team who are from different cultures. b. Performing cultural assessment at the commencement of every interaction with a new patient. c. Identifying and addressing inequities surrounding power in health care interactions d. Encouraging patients to reflect thoughtfully and critically on the characteristics of their own culture.

C

A psychiatric-mental health nurse is organizing a group with the goal of promoting coping strategies for patients living with anxiety. The nurse is aware of the importance of communication in the formation and work of the group and can best promote communication by doing what action? Select one: a. Modeling clear and open communication when speaking with the group. b. Teaching the group members about effective verbal and nonverbal communication techniques. c. Facilitating the development of a safe and empathic environment within the group. d. Encouraging members to give each other feedback on their communication after the first meeting.

C

A psychiatric-mental health nurse is working with a patient who has been diagnosed with paranoid personality disorder (PPD) and who has sought care for an unrelated physical ailment. The patient has been exceedingly aloof in response to the nurse's attempts to establish rapport and questions the nurse's motives for collecting detailed assessment data. How should the nurse best interact with this patient? Select one: a. Respect the patient's boundaries and avoid contact with the patient except when absolutely necessary. b. Educate the patient about the ways that his PPD is affecting his ability to form relationships. c. Remain persistent in relationship building while avoiding an overbearing approach. d. Maximize interaction with the patient in an effort to convince him that your motives are altruistic.

C

An adult patient with generalized anxiety disorder has been prescribed lorazepam (Ativan). What health education should the nurse provide to this patient? Select one: a. "Grapefruit juice interferes with the way your body processes this drug, so it's best to avoid it." b. "Make sure to promptly report any abnormal movements that you experience." c. "It's important that you abstain from drinking alcohol while you're taking this medication." d. "For the first 24 to 48 hours, you may find your anxiety gets slightly worse before it improves."

C

Interdisciplinary assessment of a patient who has been exhibiting unusual behaviour has resulted in a diagnosis of schizophrenia. How can the nurse best avoid labeling this patient when planning and providing care? Select one: a. Use the term "persistent psychosis" rather than "schizophrenia" whenever possible. b. Avoid using the diagnosis as a synonym for the patient's identity. c. Make attempts to normalize the patient's behaviour, even when it is culturally inappropriate. d. Referring the patient's behaviours rather than referring explicitly to schizophrenia.

b

A nursing student is reviewing brain anatomy with a colleague in preparation for a practice placement on a psychiatric mental health unit. What statements regarding brain structure and function are accurate? Select all that apply. Select one or more: a. The basal ganglia are located in the right hemisphere and mediate communication between the two hemispheres. b. The temporal loves involve the control of hearing, memory, and speech c. The limbic system is known to have close involvement to many mental health disorders. d. The hippocampus is located in the temporal love and is involved in forming and storing memories e. The hypothalamus is located deep inside the brain and is known as the 'seat of emotions.' f. The brain consists of two hemispheres, each of which is subdivided into four lobes.

C, D, & F

A psychiatric-mental health nurse is working with the family of a patient with a mental health disorder and is describing the phenomenon of neuroplacticity. Which of the following nursing statements are accurate? Select all that apply. Select one or more: a. Neuroplasticity involves changes to brain function without changes in structure. b. The positive symptoms of schizophrenia are related to neuroplasticity while the negative symptoms result from other factors. c. Toxins and chemicals have the potential to alter brain structure and function. d. Brain plasticity is higher in young people than in older people. e. Neuroplasticity is absent in some individuals with mental health disorders. f. The principle of neuroplasticity can be applied to deliberate effects to improve brain function.

C, D, & F

A nursing student is preparing for her first clinical placement in a psychiatric-mental health setting. In order to facilitate the development of therapeutic relationships with patients in this setting, the student should first perform what action? Select one: a. Practice techniques of therapeutic communication with a student colleague. b. Work through psychiatric-mental health scenarios in the simulation laboratory. c. Seek out a trusted and experienced mentor who demonstrates high‐quality psychiatric-mental health care. d. Reflect thoughtfully and critically on her own values and beliefs

D

A patient with a history of schizophrenia is describing to the nurse a complex conspiracy involving the local police, secret societies, and the U.S. government. What assessment finding would most clearly suggest that the patient lacks insight? Select one: a. The patient blames other individuals and organizations for her current problems. b. The patient's symptoms have not responded appreciably to pharmacologic treatment. c. The patient's suggested solution to this delusion is illogical. d. The patient does not acknowledge that her thinking is delusional.

D

A patient with generalized anxiety disorder describes herself as "a mess," stating that she has been unable to maintain her daily routine because of the increasing severity of her anxiety. She exhibits a heightened state of arousal and says, "I honestly don't see a way out of this right now." What nursing diagnosis is most consistent with these assessment data? Select one: a. Disturbed personal identity b. Acute confusion c. Risk for self‐harm d. Ineffective coping

D

A patient with schizophrenia is well known to the care team, and she drafted a psychiatric advance directive (PAD) prior to the last time that she was discharged from the hospital. The patient is currently experiencing an exacerbation of her symptoms. How will the PAD be applied to the patient's subsequent care? Select one: a. The PAD will state whether the care team can legally admit the patient on an involuntary basis. b. Treatment options will be limited to those actions explicitly stated in the PAD. c. The PAD will contain an interdisciplinary plan of care that must be enacted. d. The care team will consult the PAD in order to determine the patient's preferences for treatment.

D

A psychiatric-mental health nurse consulted the Diagnostic and Statistical Manual of Mental Disorders (DSM, 5th edition) while planning the care of a patient. This resource will provide the nurse with which of the following? Select one: a. Updates on the current understanding of the aetiology of recognized psychiatric diagnoses. b. Standardized, interdisciplinary plans of care for patients with diagnosed psychiatric diagnoses. c. Evidence-based medical and nursing interventions that may form the basis for treatment. d. A description of the criteria by which a mental disorder is clinically identified.

D

A psychiatric-mental health nurse is participating in a care conference that is addressing the progress of a patient who lives with a chronic mental disorder. Which of the following aspects of the patient's current status would best suggest that she is experiencing recovery? Select one: a. The patient is willing to disclose to members of the care team about her struggles with adhering to treatment. b. The patient is readily adhering to her treatment plan despite experiencing some adverse effects. c. The patient demonstrates insight into the aetiology of her disorder and the triggers that exacerbate her symptoms. d. The patient acknowledges that she is satisfied with her life and is living at a high functional level.

D

A psychiatric-mental health nurse is speaking with a patient in the context of an assessment. The patient states, "I think that all of this is happening to me because God's paying me back for the life I've lived." Which of the nurse's responses is most appropriate? Select one: a. "Mental illnesses are rooted in life experiences and brain chemistry, not a vengeful God." b. "You must think that God is vindictive. Is that how you see things?" c. "You're not a bad person. I'd like you to try and focus on forgiving yourself." d. "Do you believe that your health problems are something that you deserve?"

D

An advanced practice psychiatric-mental health nurse is planning the CBT of a patient who has a history of generalized anxiety disorder. What outcome should the nurse prioritize when planning this patient's treatment? Select one: a. The patient will successfully avoid situations and interactions that trigger anxiety. b. The patient will remain free of anxiety in the 3 months following the completion of treatment. c. The patient will not experience anxiety during CBT sessions. d. The patient will articulate and change her dysfunctional thoughts.

D

The interdisciplinary team is using Orem's nursing model to inform a patient's care. Within this model, what outcome would the team most likely prioritize? Select one: a. The patient will comply with prescribed drug therapy. b. The patient will collaborate actively with family members during recovery. c. The patient will express insight into the mental health disorder. d. The patient will perform self‐care activities independently.

D

The nurse is facilitating an established group for patients who are being treated for depression. The nurse observes that a member is uncharacteristically quiet and withdrawn, with a despondent look on her face. What should the nurse do? Select one: a. Begin a group discussion about the variations in mood and affect that accompany depression. b. Put out an open call for anyone in the group to share their impressions of the group today c. Provide informal education about managing symptoms of depression on a day‐to‐day basis. d. Acknowledge the member's appearance and behaviour and encourage her to discuss it.

D

The treatment of psychiatric and mental health care during the years predating the mid-20th century was primarily influenced by which of the following factors? Select one: a. Scarce financial and labour resources. b. Lack of clarity around the role of government in the provision of care. c. The belief that mental illness was self-limiting and generally curable. d. Lack of understanding regarding the aetiology of mental illness.

D

A nurse is coordinating the establishment of a consumer/survivor organization involving community residents with a history of depression. How can the nurse best promote the wellness of participants in this organization? Select one: a. Encourage each member to be accountable to all of the other members for adherence to their treatment plans. b. Encourage members to plan outreach and education activities within the larger community. c. Recruit an advanced practice PMH nurse to provide oversight and direction to the group d. Encourage the participants to take ownership of the structure and activities of the group.

d

A psychiatric-mental health nurse is advocating for an integrated approach to primary care in the community. What activity is most likely to meet this goal? Select one: a. Liaising with multidisciplinary members to increase efficiency of care. b. Empowering patients to advocate for their mental health with their primary care providers. c. Teaching health care providers about the diagnostic criteria for mental health disorders. d. Combining the treatment of mental health and physical health whenever possible.

d

A young man has been referred to the mental health outreach team by his primary care provider, who suspects that the man may have a mental health disorder. Which of the following characteristics of the man's status would suggest a diagnosis of schizoaffective disorder (SCA) rather than schizophrenia? Select one: a. The man states, "I sometimes lose all my ambition, and for days or weeks at a time." b. The man's family describes his moods as "wildly erratic," and the man agrees with this description. c. The man's family describes a recent episode where he was convinced that organized crime syndicates were spying on him. d. The man is employed, but he has missed more than 20 days over the past year due to illness.

** no confirmed ANS*** B

A patient was diagnosed with schizoaffective disorder several months ago and has responded favourably to treatment with atypical antipsychotics. The patient has asked the nurse, "Now that I've been doing better, when do you think I'll be able to get off of my meds? I'm hating the side effects." What is the nurse's most appropriate response? Select one: a. It's fantastic that you're feeling better, and the care team has noted this too, but it's important to stick with treatment long‐term so the benefits continue." b. There are no guarantees, but when people are free of symptoms for 6 months, it's usually safe to start weaning them off their meds." c. "We're really happy with the improvements in health as well, but schizoaffective disorder is a life‐long diagnosis." d. "Your psychiatrist will likely conduct a comprehensive assessment and then let you know right away what he thinks is best."

A

A patient with a history of schizophrenia has been referred to the community mental health outreach team. When enacting collaborative care, the PMH nurse should do which of the following? Select one: a. Closely coordinate the patient's care with the relevant members of different health disciplines. b. Ask each member of the care team to be accountable to a designated psychiatric-mental health nurse. c. Teach the patient that he has the same level of responsibility in planning his care as each health care professional. d. Ensure that the patient's psychiatrist acts as the "hub" of the interdisciplinary team.

A

A patient with schizophrenia is describing a conspiracy to the nurse that involves the Roman Catholic Church, secret societies, and the United Nations. The patient states that he or she is in danger because he or she is aware of this conspiracy. When responding to this patient's delusional thinking, what response is most appropriate? Select one: a. "It must be scary to feel that you're under threat. Do you feel frightened right now?" b. "That must be very stressful for you, but it's important to remember that it's not true." c. "Why don't we see what's on TV right now. I seem to recall that you really like watching game shows." d. "You're experiencing delusions right now. How can we best help you?"

A

A psychiatric-mental health nurse is dialoguing with a patient who is being treated for depression. The patient states, "You must know how it is. Aren't there times in your own life when you've felt like you're living in a black hole?" What is the nurse's most appropriate response? Select one: a. "Let's focus on what's happening with your feelings." b. "I have, after the death of my father, but I learned that treatment is effective." c. "In mental health care, we try to avoid disclosing personal experiences." d. "I'd prefer not to talk about that because it's confidential."

A

A psychiatric-mental health nurse is working with a patient in an outpatient setting and is planning assessments and interventions in light of the Canadian Standards of Psychiatric‐Mental Health Nursing. Within the context of these standards, what action should the nurse prioritize? Select one: a. Establishing a trusting and respectful relationship with the patient. b. Establishing the community, rather than the patient, as the object of care. c. Encouraging the patient to independently plan and guide the care that the nurse provides. d. Linking interventions directly to valid and reliable evidence sources.

A

During a group session, a new member has monopolized the conversation and often interjected his own conclusions in response to other member's statements. What response by the nurse who is facilitating the group is most appropriate? Select one: a. "Mark, it's important that we get to hear from each person who wants to share today." b. 'Mark, it seems like you believe your contributions are more important than others'. Can we change that?" c. "Mark, if you're not able to let others share openly and freely you need to reconsider your membership." d. "Mark, for the rest of the meeting I'm going to ask you to not speak unless I or someone else asks you a question."

A

The psychiatric-mental health nurse is preparing to conduct an assessment of an individual who has presented to the health facility in distress. Which of the following actions should the nurse perform? Select all that apply. Select one or more: a. Adapt the assessment to the individual's current symptoms and mental health status b. Reassure the individual that assessment findings are strictly confidential and will not be shared with anyone without his or her permission c. Deliberately address each of the interdependent dimensions of the individual's health status d. Prioritize the development of therapeutic partnership and rapport with the individual during the assessment e. Corroborate the assessment findings with the individual's primary care provider as soon as possible before documenting them f. Prioritize objective, measurable data while disregarding subjective findings whenever possible.

A, C, & D

A patient with bipolar disorder is being treated in the community with lithium. Which of the following should the psychiatric-mental health nurse include in this patient's care plan? Select all that apply. Select one or more: a. Educate the patient about the need to use adequate contraception to prevent pregnancy. b. Teach the patient how to titrate her lithium dose based on acute exacerbations of her symptoms. c. Teach the patient how to safely and effectively self‐administer subcutaneous injections. d. Teach the patient about the need to adopt a tyramine‐restricted diet. e. Educate the patient about the importance of having blood work drawn as ordered. f. Inform the patient that she may experience increased urination during treatment.

A, E, & F

An advanced practice psychiatric-mental health nurse has been leading a support group in which a member has borderline personality disorder (BPD). The nurse has fostered a therapeutic relationship with the patient, but the nurse was forced to set boundaries during some recent interactions with the patient. The patient told the nurse, "I was so sure that we were friends, and now I find out you stabbed me in the back." What is the nurse's most therapeutic response? Select one: a. "Do you think that your BPD might be coloring the way that you're perceiving my actions?" b. "You're overreacting to this situation. I had to set a boundary, but I did not 'stab you in the back.'" c. "It sounds like you are feeling betrayed. Perhaps, we could talk more about how you feel." d. "It is important that I maintain professional boundaries with you. I can't control the way that you interpret this."

C

The nurse is conducting a mental status exam of a patient with a history of mental illness. The nurse asks the patient, "If you were walking down the street and saw flames coming out of a window, what would you do?" In response, the patient states, "I'd certainly watch it very closely." How should the nurse best interpret this assessment finding? Select one: a. The patient likely lacks insight. b. The patient affect is flat, and his or her capacity for empathy is blunted. c. The patient has a possible deficit in judgment. d. The patient's function is emotionally impaired.

C

The psychiatric-mental health nurse is performing health education with a patient who lives with an anxiety disorder. The patient states that he is eager to adopt new strategies that will help him to deal more effectively with his anxiety. Which of the following actions should the nurse suggest? Select one: a. Learning self‐hypnosis techniques and performing these on a regular basis, especially when stressors are anticipated. b. Taking a PRN dose of a benzodiazepine before any situation that is likely to provoke anxiety. c. Repeating positive statements to himself when he feels anxious, such as "I'm anxious now, but I'll be okay." d. Deliberately seeking out situations that provoke intense anxiety or order to desensitize his anxiety response.

C

A psychiatric-mental health nurse is speaking with a patient who states that he sometimes "loses it" and strikes his girlfriend and children. How does the ethical principle of confidentiality affect the nurse's subsequent actions? Select all that apply. Select one or more: a. The nurse must seek the patient's permission to share this information because of a duty to protect his family. b. The nurse should explicitly tell the patient that all members of the facility staff will be made aware of his disclosure. c. Ethically, the nurse must inform appropriate authorities of what the patient has said. d. The patient's statement is protected by nurse-patient privilege, but the nurse should strongly encourage the patient to report this. e. The nurse should apply an ethical decision‐making model in an effort to determine whether to report the patient's statement. f. The nurse's legal obligation to report this disclosure supersedes the patient's right to confidentiality.

C & F