Foundations of Psychiatric Nursing

A client in group therapy is restless. His face is flushed and he makes sarcastic remarks to group members. The nurse responds by saying, "You look angry." The nurse is using which technique? Making observations A nurse is instructing a client with bipolar disorder on proper use of lithium carbonate, the drug's adverse effects, and symptoms of lithium toxicity. Which client statement indicates that additional teaching is required? not correct: "When my moods fluctuate, I'll increase my dose of lithium." Correct teaching: "A good blood level of the drug means the drug concentration has stabilized." "I can still eat my favorite salty foods." "Eating too much watermelon will affect my lithium level." (is this a thing?) - too much water will dilute sodium levels so...yea? The treatment team recommends that a client take an assertiveness training class offered in the hospital. Which behavior indicates that the client is becoming more assertive? The client asks his roommate to put away his dirty clothes after telling the roommate that this bothers him. (x) A client with a chronic mental illness who does not always take her medications is separated from her husband and receives public assistance funds. She lives with her mother and older sister and manages her own medication. The client's mother is in poor health and also receives public assistance benefits. The client's sister works outside the home, and the client's father is dead. Which issue should the nurse address first? medication compliance The nurse is caring for a client who has been physically abused. Which statement by the nurse expresses empathy for this client? "It must be difficult what you have been going through." (x) A client doesn't make eye contact with the nurse during an interview. The nurse suspects that the client's behavior has a cultural basis. What should the nurse do first? Observe how the client and the client's family and friends interact with one another and with other staff members. (x) Accept the client's behavior because it's probably culturally-based. A client is admitted to the hospital because of threatening, aggressive behavior toward his family. In the first group meeting after the client is admitted, another client sits near the nurse and says loudly, "I'm sitting here because I'm afraid of Ted. He's so big, and I heard him talk about hitting people." The nurse should say to the client: "It's frightening to have new people on the unit. We're here to talk about things like being afraid." Which approach by the nurse would most likely foster a therapeutic relationship with a client who tries to manipulate people? consistency sympathy strictness aloofness A nurse is explaining electroconvulsive therapy (ECT) to a depression support group. Which statement would indicate understanding? "ECT treatments are given for severe depression when other meds have failed." The nurse is performing an assessment on a client after her third electroconvulsive therapy (ECT). Which finding should she anticipate most frequently? Short-term memory loss The nurse is admitting a client with Borderline Personality Disorder. When planning care for this client, the nurse should give priority to which item? Manipulation Splitting Empathy Safety A nurse is developing a care plan for a client who has undergone electroconvulsive therapy (ECT). The nurse should include which intervention? Reorienting the client to time and place The client approaches various staff with numerous requests and needs to the point of disrupting the staff's work with other clients. The nurse meets with the staff to decide on a consistent, therapeutic approach for this client. Which approach will be most effective? having the client discuss needs with the staff person assigned In addition to teaching assertiveness and problem-solving skills when helping the client cope effectively with stress and anxiety, the nurse should also address the client's ability to: use conflict resolution skills. (x) The nurse is working with a client with depression in a mental health clinic. During the interaction, the nurse uses the technique of self-disclosure. In order for this technique to be therapeutic, which of the following steps must be a priority for the nurse? Ensuring relevance to, and quickly refocusing upon, the client's experience (x)

level 4 to 5

When planning the care for a client who is being abused, which measure is most important to include? developing a safety plan teaching the client about abuse and the cycle of violence The nurse manager of a psychiatric unit notices that one of the nurses commonly avoids a 75-year-old client's company. Which factor should the nurse manager identify as being the most likely cause of this nurse's discomfort with older clients? fears and conflicts about aging dislike of physical contact with older people recent experiences with her mother's elderly friends a desire to be surrounded by beauty and youth A client who has had AIDS for years is being treated for a serious episode of pneumonia. A psychiatric nurse consult was arranged after the client stated that he was tired of being in and out of the hospital. "I am not coming in here anymore. I have other options." The nurse would evaluate the psychiatric nurse consult as helpful if the client makes which statements? "I realize that I really do have more time to enjoy my friends and family." An elderly client who has been diagnosed with delusional disorder for many years is exhibiting early symptoms of dementia. His daughter lives with him to help him manage daily activities, and he attends a day care program for seniors during the week while she works. A nurse at the day care center hears him say, "If my neighbor puts up a fence, I will blow him away with my shotgun. He has never respected my property line, and I have had it!" Which action should the nurse take? Report the comment to the neighbor, the daughter, and the police since there is the potential for a criminal act. A woman who was raped in her home was brought to the emergency department by her husband. After being interviewed by the police, the husband talks to the nurse. "I do not know why she did not keep the doors locked like I told her. I cannot believe she has had sex with another man now." The nurse should respond by saying: "Let us talk about how you feel. Maybe it would help to talk to other men who have been through this." When developing the plan of care for a client with PTSD who lost her sister in a boating accident, which intervention should the nurse initiate? facilitating progressive review of the accident and its consequences telling the client to avoid details of the accident helping the client to evaluate her sister's behavior postponing discussion of the accident until the client brings it up

5 to 6

What is a generally accepted criterion of mental health? Absence of anxiety Ability to control others Happiness Self-acceptance (x) Assertive behavior involves: saying what is on one's mind at the expense of others. expressing an air of superiority. avoiding unpleasant situations and circumstances. standing up for one's rights while respecting the rights of others. (x) Which questions that the nurse asks a client suspected of being abused would most encourage her to admit and describe her abuse? "Who is doing this to you?" (x) "How did you hurt yourself?" "When were you in an accident?" "How long have you had these bruises?" A nurse assesses a client with psychotic symptoms & determines that the client likely poses a safety threat & needs vest restraints. The client is adamantly opposed to this. What would be the best nursing action? Contact the physician and obtain necessary orders. (x) Ask a family member to come in to supervise the client. Restrain the client with vest restraints. Apply wrist restraints instead of vest restraints. A client is admitted to the psychiatric unit following a suicide attempt. The client has suffered identity theft through the Internet and states, "My savings, checking, and retirement accounts are empty. I have nothing left to pay my bills or buy food and medicines. The only thing left is to die." After 1 week, the nurse would conclude that the client has been helped upon hearing which statements? Select all that apply. "The government has given me a lot of options, but I am not sure they are even possible." "I realize that I still can get monthly public assistance benefits." (x) "I know all the actions I can take, but they take so much time and energy. I am so tired." "With all the help I got here, I think I may be able to survive after all." (x) *"I filed identity theft claims with the bank, my retirement account, and the government authorities." (x)

LvL 2 to 3

During an appointment with the nurse, a client says, "I could hate God for that flood." The nurse responds, "Oh, do not feel that way. We are making progress in these sessions." The nurse's statement demonstrates a failure to do what? Explain to the client why he may think as he does. Give the client credit for solving his own problems. Add to the strength of the client's support system. Look for meaning in what the client says. (x) The nurse is teaching a CNA about the care of clients with self-mutilation. Which statement by the CNA would indicate teaching about self-mutilation has been effective? "It is a form of manipulation." "It is a non-serious event that can be ignored." "It is a way to express anger and rage." "It is a means of getting what the person wants." A client suddenly behaves in an impulsive, hyperactive, unpredictable manner. Which approach would be best for the nurse to use first if the client becomes violent? Get help to handle the situation safely. (x) Use sedation to keep the client calm. Let the client know that her behavior is not acceptable. Provide a physical outlet for the client's energies. A client who has been physically abused by her spouse agrees to meet with the nurse. Before the nurse terminates the meeting with the client, the nurse should: ask the client what she could do to de-escalate the situation at home. advise the client to leave her husband. tell the client not to do anything that could upset her husband. give the client the telephone numbers of a shelter or a safe house and the crisis line. (x) The HCP refers a client diagnosed with somatization disorder to the outpatient clinic because of problems with nausea. The client's past symptoms involved back pain, chest pain, and problems with urination. The client tells the nurse that the nausea began when his wife asked him for a divorce. Which intervention is most appropriate? directing the client to describe his feelings about his impending divorce (x) asking the client to describe his problem with nausea allowing the client to talk about the HCPs he has seen and the medications he has taken informing the client about a different medication for his nausea A nurse is using drawing, puppetry, and other forms of play therapy while treating a terminally ill, school-age child. The purpose of these techniques is to help the child: have a good time while he's in the hospital. internalize his feelings about death and dying. accept responsibility for his situation. express feelings that he can't articulate Nursing implications for a client taking central nervous system (CNS) stimulants include monitoring the client for which conditions? Hypotension, weight gain, and listlessness Hyperpyrexia, slow pulse, and weight gain Tachycardia, weight loss, and mood swings (x) Increased appetite, slowing of sensorium, and arrhythmias In group therapy, a client angrily speaks up and responds to a peer, "You're always whining, and I'm getting tired of listening to you! Here is the world's smallest violin playing for you." Which role is the client playing? Aggressor (x) Blocker Recognition seeker Monopolizer As the nurse stands near the window in the client's room, the client shouts, "Come away from the window! They will see you!" Which response by the nurse would be best? "Who are 'they'?" "What will happen if they do see me?" "You have no reason to be afraid." "No one will see me."

LvL 3 to 4