Foundations and Practice of Mental Health Nursing

A client is admitted to the psychiatric unit of the hospital with a diagnosis of conversion disorder. The client is unable to move either leg. Which finding should the nurse consider consistent with this diagnosis? 1 Feeling depressed 2 Appearing composed 3 Demonstrating free-floating anxiety 4 Exhibiting tension when discussing symptoms

2 Appearing composed

A client with a mood disorder is being discharged from a psychiatric hospital after agreeing to continue follow-up visits with a therapist. During the last interview with the nurse before discharge, the client says, "I've told you a lot about my life and my problems, but there are a few things that bother me that I've told no one." What is the most therapeutic response by the nurse once it has been determined that the client is not at risk for harming herself or others? 1 "The purpose of our getting together is to discuss your problems." 2 "Do you want to work on those during the few minutes we have left?" Incorrect3 "What kind of problem have you not shared with me during our time together?" 4 "One purpose of continuing counseling is to allow you to discuss things that bother you."

4 "One purpose of continuing counseling is to allow you to discuss things that bother you."

An older client whose family has been visiting him in the psychiatric unit is visibly angry and says to the nurse, "My daughter-in-law says they can't take me home until the doctor lets me go. She doesn't understand how important this is to me; she's not from our culture." What should the nurse do? 1 Ignore the statement for the present. 2 Say, "You feel she doesn't want you at home." 3 Reflect on the client's feelings about the cultural differences. 4 Respond, "The doctor is the one who makes decisions about discharge."

Correct2 Say, "You feel she doesn't want you at home"

A client on the psychiatric unit who is receiving high-dosage risperidone (Risperdal) is exhibiting tremors of the hands. What should be the nurse's first intervention? 1 Withholding the medication 2 Telling the client it is transitory 3 Giving the client finger exercises 4 Contacting the health care provider

Contacting the health care provider The health care provider is responsible for prescribing medications but depends on the nurse's observations before making decisions. This is not a severe enough finding to warrant withholding the drug. It is a reaction to the risperidone (Risperdal), and it is not transitory. Giving the client finger exercises will have no effect on the tremors.

A 25-year-old woman with the diagnosis of bipolar disorder, manic episode, is admitted to the psychiatric unit. A nurse on the unit reviews the admission information provided by the client's husband and assesses the client. In light of the information in the chart, what is an appropriate nursing intervention? 1 Assigning the client to a private room 2 Suggesting that the client play cards with several other clients Incorrect3 Encouraging the development of insight through introspection 4 Having the client sit at the communal dining table during meals

Correct1 Assigning the client to a private room

A nurse is caring for several clients who have severe psychiatric disorders. What is the major reason that a health care provider prescribes an antipsychotic medication for these clients? 1 To improve judgment 2 To promote social skills 3 To diminish neurotic behavior 4 To reduce the positive symptoms of psychosis

Correct4 To reduce the positive symptoms of psychosis

In which situation is the use of seclusion contraindicated? 1.The client has expressed severe suicidal thoughts. 2.The client appears to want to be placed in seclusion. 3.The client has been voluntarily admitted for treatment. 4.The client had minimal improvement despite being secluded before

1.The client has expressed severe suicidal thoughts.

Imipramine (Tofranil), 75 mg three times per day, is prescribed for a client. What nursing action is appropriate when this medication is being administered? 1.Telling the client that barbiturates and steroids will not be prescribed 2.Warning the client not to eat cheese, fermented products, and chicken liver 3.Monitoring the client for increased tolerance and reporting when the dosage is no longer effective 4.Having the client checked for increased intraocular pressure and teaching about symptoms of glaucoma

4.Having the client checked for increased intraocular pressure and teaching about symptoms of glaucoma

A mother and her 5-year-old daughter have been referred to a child advocacy center for a forensic pediatric sexual examination. Before the child is examined or interviewed, the mother gives a detailed history, relaying her suspicion that the child's maternal grandfather sexually assaulted her. As the interview progresses, the mother suddenly says, "My father sexually molested me when I was a child, but I try not to think about it." What defense mechanism does the nurse recognize that the mother's statement demonstrates? 1.Introjection 2.Suppression 3.Passive aggression 4.Reaction formation

2.Suppression

A nurse is caring for a 20-year-old client. According to Erikson's developmental psychosocial theory, what is expected by 20 years of age? 1.Having the capacity for love and a commitment to work 2.Being creative and productive and having concern for others 3.Having a coherent sense of self and plans for self-actualization 4.Accepting the worth, integrity, and uniqueness of one's past and present life

3.Having a coherent sense of self and plans for self-actualization

What should a nurse ensure when creating an environment that is conducive to psychological safety? 1. Realistic limits are set. 2 Passive acceptance is promoted. 3 The client's physical needs are met. 4 The physical environment is kept in order

1. Realistic limits are set.

In an attempt to remain objective and support a client during a crisis, the nurse uses imagination and determination to project the self into the client's emotions. This technique is known as: 1.Empathy 2.Sympathy 3.Projection 4.Acceptance

1.Empathy

A client with emotional problems is being discharged from a psychiatric unit. What should the nurse encourage the client to do? 1 Go back to regular activities. 2 Enroll in an aftercare program. 3 Call the unit whenever she is upset. 4 Find a group that has similar problems.

2 Enroll in an aftercare program.

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 Woman whose parents were chronic alcoholics and who has problems making friends

A client has been on the psychiatric unit for several days. The client arouses anxiety and frustration in the staff and manipulates them so well that staff members are afraid to approach the client. One morning the client shouts at the nurse, "You've worked it so I can't go for a walk with the group today. You're as cunning as a fox. I hate you! Get out, or I'll hit you!" What is the best response by the nurse? 1."Tell me what I did to upset you." 2"Go ahead and try to hit me if you need to." 3."I don't like hearing your threats, but tell me more about your feelings." 4"You're being rude and your behavior is stopping me from wanting to be with you."

3."I don't like hearing your threats, but tell me more about your feelings."

During a phone conversation to a crisis hotline a client states, "I'm falling apart and can't put myself together. This goes on and on." What is the most therapeutic response by the nurse? 1."Is there anyone there with you?" 2."What do you think this means?" 3."How do you usually handle this type of situation?" 4."What's happening right now that prompted you to call?"

4."What's happening right now that prompted you to call?"

As depression begins to lift, a client is asked to join a small discussion group that meets every evening on the unit. The client is reluctant to join because, she says, "I have nothing to talk about." What is the best response by the nurse? 1."Maybe tomorrow you'll feel more like talking." 2."Could you start off by talking about your family?" 3."A person like you has a great deal to offer the group." 4."You feel you won't be accepted unless you have something to say?"

4."You feel you won't be accepted unless you have something to say?"

A nurse administers an antipsychotic medication to a client. For which common manageable side effect should the nurse evaluate the client? 1.Jaundice 2.Melanocytosis 3.Drooping eyelids 4.Unintentional tremor

4.Unintentional tremor

A woman with five children comes to the emergency department with multiple facial injuries. The client says, "My husband is an alcoholic, and he just beat me up." The nurse concludes that the client appears to be a victim of abuse. What should the nurse do next? 1.Discuss birth control with her 2.Report her experiences to the police 3.Inquire about her and the children's safety 4.Discuss the possibility of her and the children leaving her husband

3.Inquire about her and the children's safety

A client who appears dejected, barely responds to questions, and walks very slowly about the mental health unit tells the nurse in a barely audible voice that life is no longer worth living. What is the most therapeutic response to this statement by the nurse? 1."Have you been thinking about suicide?" 2."What could be so bad to make you feel that way?" 3."We'll talk about your feelings after you've rested." 4."Let's talk about something pleasant to make you feel better."

1."Have you been thinking about suicide?"

A nurse is caring for a man who has inoperable cancer of the pancreas. His wife is trying to cope with the diagnosis. Place the wife's statements in order as the woman progresses through the grieving process, from the first stage to the last: 1."He shouldn't have gotten this because he doesn't smoke or drink." 2."I want him to get a second opinion." 3."All I do is cry, because I can't live without him." 4."If he can't be cured, I just want him to be comfortable." 5."His grandchildren need to get to know him."

1."I want him to get a second opinion." 2."He shouldn't have gotten this because he doesn't smoke or drink." 3."His grandchildren need to get to know him." 4."All I do is cry, because I can't live without him." 5."If he can't be cured, I just want him to be comfortable." Tip: Denial,Anger,Bargaining,Depression,Acceptance

A client on the psychiatric unit sits alone most of the day. The nurse approaches the client. As the nurse gets approximately 3 feet away, the client lets out a string of profanity and shouts, "Leave me alone; I don't want to talk to you!" What is the most appropriate response by the nurse? 1."I'll leave for now, but I'll be back later." 2."Why do you feel the need to greet me like that?" 3."Don't talk to me like that—I'm here to spend time with you." 4."I don't like it when you talk like that—are you trying to push me away?"

1."I'll leave for now, but I'll be back later."

The nurse should suspect that a client who had a recent myocardial infarction is experiencing denial when the client: 1.Attempts to minimize the illness 2.Lacks an emotional response to the illness 3.Refuses to discuss the condition with the client's spouse 4.Expresses displeasure with the prescribed activity program

1.Attempts to minimize the illness

A disturbed client who has been out of touch with reality has been hospitalized for several weeks. One day the nurse notes that the client's hair is dirty and asks whether the client wants to wash it. The client answers, "Yes, and I'd like to shower and change my clothes, too." What can the nurse conclude about the client in relation to this response? 1.He has some feelings of self-worth. 2.He is open to suggestions from others. 3.He may be entering a hyperactive phase. 4.He has a need for social reassurance from others

1.He has some feelings of self-worth.

On the first day of the month a practitioner prescribes an antipsychotic medication for a client with schizophrenia. The initial dosage is 25 mg once a day, to be titrated in increments of 25 mg every other day to a desired dosage of 175 mg daily. On what day of the month will the client reach the desired daily dose of 175 mg? 1.Day 7 2.Day 9 3.Day 13 4.Day 15

3.Day 13

A psychiatric client recently admitted to the inpatient unit has a history of angry outbursts. The client's anger appears to be escalating, although the client still appears to be in control. What should the nurse do first to prevent an incident from developing? 1.Set a contract with the client to verbalize frustrations before acting out 2.Establish firm control and use seclusion before the client acts out impulsively 3.Show the client the seclusion room as a method of deterring acting-out behavior 4.Call the health care provider for a prescription for an intramuscular sedative for the client

1.Set a contract with the client to verbalize frustrations before acting out

A recently hired nurse is caring for several clients on a mental health unit at a local community hospital. The nurse manager is evaluating the nurse's performance. What situation indicates that the nurse-client boundaries of the recently hired nurse are appropriate? 1.The nurse shares with the entire treatment team vital information the client disclosed in a private session. 2.The nurse is often busy doing other tasks when the client and nurse are scheduled for a counseling session. 3.A client enters the therapeutic group late with the nurse's permission even though group rules say that this is not allowed. 4.A client's overall behavior is significantly more independent and demonstrates higher function on the days that the nurse is not working

1.The nurse shares with the entire treatment team vital information the client disclosed in a private session.

Amitriptyline (Elavil) is an antidepressant medication used to treat anxiety disorders. Which class of antidepressant medications does it belong to? 1.Tricyclics 2.Monoamine oxidase inhibitors (MAOIs) 3.Selective serotonin reuptake inhibitors (SSRIs) 4.Serotonin-norepinephrine reuptake inhibitors (SNRIs)

1.Tricyclics

Oral chlordiazepoxide (Librium) 100 mg/ hr is prescribed for a client with a Clinical Institute Withdrawal Assessment (CIWA) score of 25. The client has had 300 mg in 3 hours but is still displaying acute alcohol withdrawal symptoms. What is the next nursing action? 1.Informing the client that the limit of chlordiazepoxide has been reached 2.Administering chlordiazepoxide as indicated by the client's CIWA score 3.Requesting a prescription for another medication to replace the chlordiazepoxide. 4.Informing the health care provider that the maximum dose of chlordiazepoxide has been reached

2.Administering chlordiazepoxide as indicated by the client's CIWA score

A nurse in the mental health clinic concludes that a client is using confabulation when: 1.The flow of thoughts is interrupted 2.Imagination is used to fill in memory gaps 3.Speech flits from one topic to another with no apparent meaning 4.Connections between statements are so loose that only the speaker understands them

2.Imagination is used to fill in memory gaps

A 65-year-old man is admitted to the hospital with a history of depression. The client, who speaks little English and has had few outside interests since retiring, says, "I feel useless and unneeded." The nurse concludes that the client is in Erikson's developmental stage of: 1.Initiative versus guilt 2.Integrity versus despair 3.Intimacy versus isolation 4.Identity versus role confusion

2.Integrity versus despair

A nurse is evaluating a young adult for evidence of achievement of the age-related developmental stage set forth in Erikson's developmental theory. What developmental crisis is associated with this age group? 1.Trust versus mistrust 2.Intimacy versus isolation 3.Industry versus inferiority 4.Generativity versus stagnation

2.Intimacy versus isolation

A nurse teaches dietary guidelines to a client who will be receiving tranylcypromine sulfate (Parnate), a monoamine oxidase inhibitor (MAOI). The client compiles a list of foods to avoid. Which foods included on the list indicate that the teaching has been effective? (Select all that apply.) 1.French fries 2.Pepperoni pizza 3.Bologna sandwich 4.Hamburger on a bun 5.Hash brown potatoes

2.Pepperoni pizza 3.Bologna sandwich

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.Statements by the client about the sexual assault and the rapist

A health care provider prescribes haloperidol (Haldol) for a client. What should the nurse teach the client to avoid while taking this medication? 1.Driving at night 2.Staying in the sun 3.Ingesting aged cheeses 4.Taking medications containing aspirin

2.Staying in the sun

A client with the diagnosis of schizophrenia is given one of the antipsychotic drugs. The nurse understands that antipsychotic drugs can cause extrapyramidal side effects. Which effect is cause for the greatest concern? 1.Akathisia 2.Tardive dyskinesia 3.Parkinsonian syndrome 4.Acute dystonic reaction

2.Tardive dyskinesia

A secretary in a home health agency gossips about coworkers and then writes them notes to tell them how valuable they are to the organization and how much she likes working with them. What defense mechanism is being used by the secretary? 1.Denial 2.Undoing 3.Displacement 4.Intellectualization

2.Undoing

A client is admitted to a psychiatric hospital with the diagnosis of schizoid personality disorder. Which initial nursing intervention is a priority for this client? 1 Helping the client enter into group recreational activities 2 Convincing the client that the hospital staff is trying to help 3 Helping the client learn to trust the staff through selected experiences 4 Arranging the client's contact with others so it is limited while she is in the hospital

3 Helping the client learn to trust the staff through selected experiences

A nurse leads an assertiveness training program for a group of clients. Which statement by a client indicates that the treatment has been effective? 1."I know that I should put the needs of others before mine." 2."I won't stand for it, so I told my boss he's a jerk and to get off my back." 3."It annoys me when people call me 'sweetie,' so I told him not to do it anymore." 4."It's easier for me to agree up front and then do just enough so that no one notices."

3."It annoys me when people call me 'sweetie,' so I told him not to do it anymore."

A terminally ill client repeatedly tells the nurse all the details of a daughter's wedding that will take place in 6 months and how important it is for her to attend. What Kübler-Ross stage of grieving does the nurse identify? 1.Anger 2.Denial 3.Bargaining 4.Acceptance

3.Bargaining

A nurse is administering medications to clients on a psychiatric unit. What does the nurse identify as the reason that so many psychiatric clients are given the drug benztropine (Cogentin) or trihexyphenidyl in conjunction with the phenothiazine derivatives neuroleptic medications? 1.It reduces postural hypotension. 2.It potentiates the effects of the other drug. 3.It combats the extrapyramidal side effects of the other drug. 4.It ameliorates the depression that may accompany schizophrenia

3.It combats the extrapyramidal side effects of the other drug.

A client has been in an acute care psychiatric unit for 3 days and is receiving haloperidol (Haldol) tablets orally to reduce agitation and preoccupation with auditory hallucinations. There has been no decrease in the client's agitation or preoccupation with auditory hallucinations since the medication was started. What should the nurse's priority intervention be? 1 Asking the health care provider to change the medication 2 Making certain that the client is swallowing the medication 3 Concluding that a therapeutic level of the drug has not been achieved 4 Securing a prescription for as-needed sedation until the client calms down

Correct2 Making certain that the client is swallowing the medication

A client with a history of aggressive, violent behavior is admitted to the psychiatric unit involuntarily. The nurse, who understands the need to use deescalation approaches during the preassaultive stage of the violence cycle, monitors the client's behavior closely for progression of signs of impending violence. List these client assessments in order of escalating aggression, from the lowest risk to the highest. 1. Pacing in the hall 2. Increasing tension in facial expression 3. Engaging in verbal abuse toward the nurse 4. Pushing another client while waiting in line to the dining room 5. Having difficulty waiting to take turns during a group project

Increasing tension in facial expression indicates increasing anxiety, but the client is still maintaining self-control. Impulsivity, as demonstrated by the inability to take turns with others, indicates that the client is having some difficulty setting limits on his or her own behavior. When anxiety escalates to the point of hyperactivity and pacing behaviors, the client is attempting to cope with the anxiety and to discharge physical and psychic energy. Engaging in verbal abuse may precipitate physical abuse and is a sign that the client is not able to maintain self-control. The laying on of the hands in an offensive manner is a physical act of aggression.

Which goal specific to a client with impaired verbal communication related to a psychological barrier should be documented in the client's clinical record? 1 Freedom from injury 2 Engaging independently in solitary craft activities 3 Identifying the consequences of acting-out behavior 4 Interacting appropriately with others in the therapeutic milieu

Interacting appropriately with others in the therapeutic milieu Interacting appropriately with others in the therapeutic milieu is a goal related to the identified problem and is appropriate and measurable. Freedom from injury is not related to the identified problem; this is true for everyone. Engaging independently in solitary craft activities will not encourage verbal communication. Identifying the consequences of acting-out behavior is inappropriate and not related to the identified problem.

A client with the diagnosis of schizophrenia is given one of the antipsychotic drugs. The nurse understands that antipsychotic drugs can cause extrapyramidal side effects. Which effect is cause for the greatest concern? 1 Akathisia 2 Tardive dyskinesia 3 Parkinsonian syndrome 4 Acute dystonic reaction

Tardive dyskinesia, an extrapyramidal response characterized by vermicular movements and protrusion of the tongue, chewing and puckering movements of the mouth, and puffing of the cheeks, is often irreversible, even when the antipsychotic medication is withdrawn. Akathisia, motor restlessness, usually can be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued. Parkinsonian syndrome (a disorder featuring signs and symptoms of Parkinson disease such as resting tremors, muscle weakness, reduced movement, and festinating gait) can usually be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued. Dystonia, impairment of muscle tonus, can usually be treated with antiparkinsonian or anticholinergic drugs while the antipsychotic medication is continued.