Mental Health - BOB Q's
1 A category 5 tornado hits a small Midwestern town and causes the major destruction of homes and buildings. Many fatalities occur. Place in sequence the psychologic stages that the people of this community will experience. 1 Disillusionment phase 2 Heroic phase 3 Honeymoon phase 4 Reconstruction phase
(2, 3, 1, 4)
6 A patient with an adjustment disorder participates in a series of outpatient therapy sessions. The goals of the therapy are stress inoculation and assisting the patient with self-management. Place these statements by the nurse in the correct sequence for this treatment modality. 1 "Let's talk while you make a list of the biggest problems in your life and discuss some possible solutions for each problem." 2 "Choose one problem-solving technique to decide how to handle arguments with your spouse." 3 "The purpose of our group today is to understand stressful events and how they affect one's abilities to manage life."
(3, 1, 2)
Prioritize these outcomes for a patient with mental illness. 1 The patient will consume at least 50% of every meal within 3 days. 2 The patient will identify his or her assets and strengths within 1 week. 3 The patient will describe characteristics of healthy relationships with others within 1 week. 4 The patient will have a contract with the team to report the incidence of suicidal thoughts within 24 hours.
(4, 1, 2, 3)
3 A nurse counsels the parents of a child with autistic disorder. The parents say, "We are going to completely redecorate our child's room. We think that will help." Select the nurse's best response. 1 "Children with autistic disorder usually prefer that things stay the same." 2 "Bright colors are often stimulating for children with autistic disorder." 3 "Remember to not use rugs so that your child will not slip and fall." 4 "New toys and games will help develop your child's intellectual abilities."
1 "Children with autistic disorder usually prefer that things stay the same." 2 "Bright colors are often stimulating for children with autistic disorder."
3 A nurse assesses an elderly person for depression. Select the best question for the nurse to ask? 1 "How do you compare your activities and health now to 6 months ago?" 2 "Would you say you are currently having a major depressive episode?" 3 "What is your family history related to depressive illnesses?" 4 "Are you having crying spells every day?"
1 "How do you compare your activities and health now to 6 months ago?"
3 A nurse talks with a patient who is engaged in an arts and crafts activity. The patient says, "I've never been artistic. I shouldn't even come to these silly groups." The patient also attends cognitive behavioral therapy sessions two times a week. Which comment by the nurse would be supportive of the cognitive behavioral therapy? 1 "I noticed that you made interesting color combinations and encouraged others." 2 "What activities do you think you would enjoy more than arts and crafts?" 3 "You should try harder to finish projects that you start. You give up too easily." 4 "These are simply recreational activities. Talk to your therapist about your reactions."
1 "I noticed that you made interesting color combinations and encouraged others."
4 Which statement by a person with paranoid schizophrenia most clearly indicates that the antipsychotic medication that he or she is taking is effective? 1 "I used to hear scary voices, but now I don't hear them anymore." 2 "My medicine is working fine. I'm not having any problems." 3 "Sometimes it's hard for me to fall asleep, but I usually sleep all night." 4 "I think some of the staff members don't like me. They're mean to me."
1 "I used to hear scary voices, but now I don't hear them anymore."
1 Which statement made by a family member of a person with schizophrenia demonstrates effective learning about the disease? 1 "The disease was probably caused by problems with several genes. These genes cause changes in how certain brain chemicals work." 2 "The disease could be cured if our politicians and laws allowed for more stem cell research. Adult stem cells hold so much promise." 3 "The disease probably resulted from the mother's smoking during pregnancy. Nicotine is actually a neurotransmitter." 4 "If our family had more money, we could afford the promising psychoneuroimmunologic treatments available in other countries."
1 "The disease was probably caused by problems with several genes. These genes cause changes in how certain brain chemicals work."
2 A young adult is hospitalized with undifferentiated schizophrenia. The parents are distraught and filled with guilt. Which of the following would be an appropriate nursing response? 1 "There are many theories about the cause of schizophrenia, but this illness is not your fault." 2 "Does anyone in your family have mental illness? Schizophrenia is a genetically transmitted disease." 3 "Look on the bright side. With the right medications and treatment, this disease can be cured." 4 "I'll recommend some excellent Web sites with information about schizophrenia and other mental illnesses."
1 "There are many theories about the cause of schizophrenia, but this illness is not your fault."
1 A nurse assesses five new patients who have been admitted to the psychiatric unit. Which patients would have the highest risk for suicidality? You may select more than one answer. 1 87-year-old white man 2 37-year-old African-American man 3 66-year-old white woman 4 23-year-old African-American woman 5 21-year-old Native-American man
1 87-year-old white man 4 23-year-old African-American woman 5 21-year-old Native-American man
A nurse is assigned to the following four patients. Which patient should receive the nurse's priority attention? 1 A newly admitted patient who has been diagnosed with major depression whose assessment is incomplete 2 A patient with schizophrenia who is having auditory hallucinations of someone crying 3 A patient who recently became unemployed and who has a 10-year history of daily alcohol use 4 A patient with disorganized schizophrenia who has difficulty completing activities of daily living
1 A newly admitted patient who has been diagnosed with major depression whose assessment is incomplete
4 A nurse plans care for the following five patients. Which patients would most likely benefit from a psychiatric partial hospitalization program? You may select more than one answer. 1 A patient who was recently discharged from an acute psychiatric facility 2 A patient who has been diagnosed with a borderline personality disorder 3 A patient who is actively abusing alcohol and cocaine 4 A patient with acute, disabling, new-onset panic attacks
1 A patient who was recently discharged from an acute psychiatric facility 4 A patient with acute, disabling, new-onset panic attacks
3 The following patients are scheduled to undergo MRI. For which patients should additional assessment information be gathered before the diagnostic procedure? You may select more than one answer. 1 A patient with a history of wounds caused by exploding shrapnel during military service 2 A patient with a concurrent diagnosis of bleeding peptic ulcers for the past 3 years 3 A patient with current complaints of extreme sensitivity to loud noises 4 A patient with reports of allergies to iodine, eggs, and shellfish 5 A patient with a 3-year history of Parkinson's disease
1 A patient with a history of wounds caused by exploding shrapnel during military service 3 A patient with current complaints of extreme sensitivity to loud noises 5 A patient with a 3-year history of Parkinson's disease
2 A nurse assesses a 15-year-old boy for substance abuse and dependence. Abuse of which of the following substances would be most likely? You may select more than one answer. 1 Alcohol 2 Cocaine 3 Heroin 4 Methaqualone 5 Nicotine
1 Alcohol 5 Nicotine
3 A patient describes an experience of having a blackout. The nurse would suspect the use of which of the following substances? You may select more than one answer. 1 Alcohol 2 Caffeine 3 Ephedrine 4 Lorazepam 5 Rohypnol
1 Alcohol 5 Rohypnol
3 An individual with an obsessive-compulsive personality disorder is consistently late for outpatient appointments as a result of writing and rewriting the list of topics to bring up during the session. Which nursing diagnosis applies? 1 Anxiety 2 Social isolation 3 Disturbed personality identity 4 Situational low self-esteem
1 Anxiety
Select the nursing diagnosis that best matches the following etiology and defining characteristics. __________ related to lack of approval and perceived lack of respect from others as evidenced by exaggerated or rejected negative feedback about self. 1 Chronic low self-esteem 2 Social isolation 3 Disturbed personal identity 4 Powerlessness
1 Chronic low self-esteem
2 A community psychiatric nurse counsels a patient who was recently approved for Social Security Disability and Medicare benefits. The patient has schizoaffective disorder and takes 80 mg of ziprasidone (Geodon) orally twice daily. The nurse should first assist the patient with which aspect of case management? 1 Determining how Medicare Plan D applies to the patient's case 2 Applying for housing assistance through Medicaid 3 Coaching the patient about how to obtain a driver's license 4 Referring the patient to vocational rehabilitation for employment
1 Determining how Medicare Plan D applies to the patient's case
4 A patient draws a picture of dark skies shadowing a cemetery. How would a nurse document this level of suicidal behavior? 1 Ideation 2 Threat 3 Gesture 4 Attempt
1 Ideation
5 A nurse assesses an individual with schizotypal personality disorder. Which characteristics are most likely? You may select more than one answer. 1 Male gender 2 Complaints of depression 3 Charges pending for assault 4 Chronic physical illness 5 Sibling diagnosed with schizophrenia
1 Male gender 2 Complaints of depression 5 Sibling diagnosed with schizophrenia
5 A nurse plans the care for an adult with a tumor in the brain's frontal lobe. Initial interventions should focus on the patient's anticipated problems with which of the following? 1 Motor function and judgment 2 Sensory and calculation abilities 3 The interpretation of visual stimuli 4 Hearing and hygiene
1 Motor function and judgment
Which of the following statements about PMHN are true? 1 Nurses may be certified in their specialty at the entry level or at the advanced practice level. 2 The art of PMHN is more important than the science of nursing. 3 Integrated care is reserved for psychiatrists and is not for nurses. 4 None of the above
1 Nurses may be certified in their specialty at the entry level or at the advanced practice level.
6 The capacity of human beings to cope with crisis and catastrophe in ways that are positive and that allow them to "bounce back" to a balanced state after the crisis is referred to as which of the following? 1 Resilience 2 Homeostasis 3 Adaptive crisis response 4 Equilibrium
1 Resilience
3 A family in the emergency department has just been told that their family member has been killed as a result of a fatal gunshot wound. Several of the family members begin yelling until it escalates into physical fighting. Which of the following is an appropriate nursing diagnosis in this situation? 1 Risk for posttrauma syndrome. 2 Disabled family coping 3 Risk for complicated grieving 4 Caregiver role strain
1 Risk for posttrauma syndrome.
5 Select the nursing diagnosis that is most likely to apply to a person with an acute exacerbation of schizophrenia, paranoid type. 1 Social isolation related to impaired ability to trust others 2 Deficient diversional activity related to unstable control of hostile impulses 3 Impaired social interaction related to inadequately developed superego 4 Fear related to lack of confidence in significant others
1 Social isolation related to impaired ability to trust others
3 An adult who was recently diagnosed with multiple sclerosis says, "I'm worried that I won't be able to support my family or send my children to college." This person begins drinking alcohol heavily and omitting prescribed medications. Select the correct analysis of the patient's condition. 1 The patient is in a state of situational crisis. 2 The patient is in a state of equilibrium. 3 The patient is reflecting on the situational event. 4 The patient is perceiving the event in a distorted way.
1 The patient is in a state of situational crisis.
5 A nurse cares for a patient with gastrointestinal bleeding who was admitted to a medical unit 3 days ago. Today, the patient is irritable and restless, and she says to the nurse, "There are roaches everywhere in this hospital. They've been crawling on me. I'm scared of bugs." The admission assessment shows that the patient drinks socially. How would the nurse analyze this situation? 1 The patient may have minimized her use of alcohol and is experiencing withdrawal symptoms. 2 The facility's infection control nurse should be consulted about the insect infestation. 3 The patient probably has dementia, which was inadequately assessed at admission. 4 Caring behaviors by nursing staff have been inadequate, and the patient is lonely.
1 The patient may have minimized her use of alcohol and is experiencing withdrawal symptoms.
2 Which of the following is the most common point of injury seen with weapon-related assault? 1 The spinal cord 2 The abdomen 3 The neck 4 The chest
1 The spinal cord
5 A child's parent enters the nurse's station yelling, "What is wrong with you people? My daughter cut herself and you allowed it to happen. I thought my child would be safe here." Select the assertive response for the nurse. 1 "I can't help you right now. Your child is assigned to another nurse today." 2 "I can't hear you if you're yelling. Let's sit down and talk about it." 3 "Why are you always screaming when you come for visits?" 4 "I am sorry this incident happened. We were short staffed today."
2 "I can't hear you if you're yelling. Let's sit down and talk about it."
5 After a major hurricane destroys a community, which statement best indicates that an individual is likely to maintain or promptly return to a state of equilibrium? 1 "This storm wasn't so bad. It could have killed more people or destroyed the water and sewer lines." 2 "I've been through big storms before. If we pull together, we can help each other and rebuild our community." 3 "When my parent died 8 years ago, I got so depressed I was unable to care for my children or return to work." 4 "I think we'll be fine. We're getting plenty of support and assistance from other communities."
2 "I've been through big storms before. If we pull together, we can help each other and rebuild our community."
4 A nurse directs the nursing assistant to offer fluids to a patient who is being detoxified from alcohol. The nursing assistant responds, "That patient doesn't deserve my help. Will power and faith could have avoided this situation." What is the nurse's best response? 1 "You always help our other patients. Why are you making such unkind comments about this one?" 2 "It sounds like you're being judgmental, but we accept alcoholism as a disease and provide compassionate care." 3 "In addition to giving oral fluids, maybe you would pray with the patient for relief from this problem." 4 "Regardless of the reasons, the patient still needs our help. Offer the fluids as I have instructed."
2 "It sounds like you're being judgmental, but we accept alcoholism as a disease and provide compassionate care."
5 The leader opens the discussion during the first meeting of a new group. Which of the following comments would be appropriate for this phase? 1 "Let's start by asking each person here to define his or her problems." 2 "Let's begin by establishing the ground rules for our group." 3 "I would like each person to explain why you are attending this group." 4 "Bringing family members to our group will help us achieve our goals."
2 "Let's begin by establishing the ground rules for our group."
A psychiatric nurse who works in a day treatment program for patients with serious and persistent mental illness helps a group of patients to plan a Halloween party. One patient says, "Halloween is a celebration of demons and evil." Select the nurse's most therapeutic response. 1 "Perhaps you could stay home from the center on the day of the party." 2 "Maybe it would be better if we provided you with alternative activities on the day of the party." 3 "Don't be silly, your participation doesn't mean you believe in demons." 4 "The party is part of the programming here at the center. You are expected to participate."
2 "Maybe it would be better if we provided you with alternative activities on the day of the party."
2 A patient says to the nurse, "The treatment team wants me to attend individual therapy sessions to help me with my problems, but I'm not going. I've seen psychotherapy in movies, and it's not for me." Select the nurse's most therapeutic response. 1 "Psychoanalysis is an effective short-term approach to the solving of problems. You should follow the recommendation." 2 "Psychotherapy is just one type of individual therapy. You and your therapist can decide which type is best for you." 3 "It is your right to decide whether or not to participate in any type of therapy, regardless of the team's recommendation." 4 "It doesn't sound like you like this plan. Perhaps you should consider changing to a new psychiatrist."
2 "Psychotherapy is just one type of individual therapy. You and your therapist can decide which type is best for you."
Risk factors for the development of physical and mental disorders include which of the following? 1 A parent who gets drunk every night after work and says that it is relaxing 2 A school in which students either ignore or bully the new students 3 A higher-than-average intelligence level and many satisfying hobbies 4 A large circle of friends who play sports together
2 A school in which students either ignore or bully the new students 3 A higher-than-average intelligence level and many satisfying hobbies
5 A patient says to the nurse, "Life doesn't have any joy in it anymore. Things I once did for pleasure aren't fun." How would the nurse document this complaint? 1 Dysthymia 2 Anhedonia 3 Euphoria 4 Psychomotor retardation
2 Anhedonia
4 A nurse suggests activities for a 7-year-old child with autistic disorder. Which activity is most likely to engage this child? 1 Playing checkers with one other child 2 Building with blocks alone 3 Playing kickball with a small group of children 4 Having a birthday party with six to eight other children
2 Building with blocks alone
5 A nurse reviews the report from a depressed patient's positron emission tomography scan. Which finding is most likely if the patient has demonstrated high-lethality suicide attempts? 1 Increased serotonin activity in the medulla, the midbrain, and the hypothalamus 2 Decreased serotonin activity in the ventral, medial, and lateral prefrontal cortex 3 Decreased dopamine and glutamate receptors in the parietal and temporal lobes 4 Increased norepinephrine and acetylcholine reserves in the thalamus and the pons
2 Decreased serotonin activity in the ventral, medial, and lateral prefrontal cortex
1 The highest percentage of visible injuries related to sexual assault is found in the genital area as compared with other areas of the body. 1 True 2 False
2 False
5 Fathers of homicide victims are more likely to experience PTSD than mothers of homicide victims. 1 True 2 False
2 False
The therapeutic alliance is a vehicle for patients to accomplish which of the following? 1 Identifying other patient's problems in group therapy 2 Gaining insight into their own problems 3 Forgetting about past emotional abuse 4 Gaining courage to eliminate support systems after discharge
2 Gaining insight into their own problems
4 A nurse prepares the plan of care for a person having a manic episode. Which nursing diagnosis is most likely to apply? You may select more than one answer. 1 Imbalanced nutrition: more than body requirements 2 Sleep deprivation 3 Risk for deficient fluid volume 4 Social isolation 5 Disturbed thought processes
2 Sleep deprivation 3 Risk for deficient fluid volume 5 Disturbed thought processes
1 A nurse plans a series of psychoeducational groups for persons with schizophrenia. Which topic would take priority? 1 How to complete an application for employment 2 The importance of taking your medication correctly 3 The ways to dress and behave when attending community events 4 How to give and receive compliments
2 The importance of taking your medication correctly
2 A nurse administers medications to a patient who is on suicide observation. Which action by the nurse is most important? 1 Inform the patient about the name, action, and side effects of the medication. 2 Verify that the patient swallowed the entire dose of the medication. 3 Document the patient's willingness to voluntarily take the medication. 4 Tell the patient that it takes several weeks for the drug to reach a therapeutic level.
2 Verify that the patient swallowed the entire dose of the medication.
1 A patient with undifferentiated schizophrenia lives in a community care home and takes olanzapine (Zyprexa) daily with supervision. During the patient's monthly outpatient visits with a psychiatric nurse, which assessment parameter takes priority? 1 Height 2 Weight 3 Integrity of mucous membranes 4 Pupillary response to light
2 Weight
2 A nurse prepares the plan of care for an adolescent with moderate mental retardation. Select the highest level of achievable outcomes for this patient. You may select more than one answer. 1 Within 5 years, the patient will complete high school or pass a general educational development test. 2 Within 5 years, the patient will safely use local public transportation. 3 Within 5 years, the patient will live independently in an apartment. 4 Within 5 years, the patient will know how to correctly use a telephone. 5 Within 5 years, the patient will attain employment in a sheltered workshop.
2 Within 5 years, the patient will safely use local public transportation.
Which individual has the highest risk for major depression? 1 8-year-old girl 2 16-year-old boy 3 35-year-old woman 4 60-year-old man
3 35-year-old woman
Which of the following scenarios identifies a mental disorder? 1 A 67-year-old woman says that she has not spent one day without crying several hours a day since her husband died last month. 2 A mother says that her 15-year-old child spends all of his spare hours in his room with the computer and even misses meals. 3 A 19-year-old man begins to hear voices that no one else hears during lectures in his college math course. 4 All of the above
3 A 19-year-old man begins to hear voices that no one else hears during lectures in his college math course.
The nurse completes a thorough nursing assessment of a new patient. What is the nurse's next action? 1 Implementing the plan of care 2 Developing behavioral goals and outcomes 3 Formulating the nursing diagnoses 4 Constructing interventions with rationale statements
3 Formulating the nursing diagnoses
The nurse uses which question to assess the patient's judgment? 1 What situations in your life have caused you the most anxiety? 2 What does the saying "People in glass houses shouldn't throw stones" mean to you? 3 If you had a high fever and were vomiting for 3 days, what would you do? 4 How would you rate your anxiety level on a scale of 1 to 10, where 10 means panic?
3 If you had a high fever and were vomiting for 3 days, what would you do?
2 A nurse who is on vacation comes upon a severe automobile accident. The driver emerges from the car without apparent physical injuries. Which behaviors would be expected from the driver immediately after this traumatic event? You may select more than one answer. 1 Urinary or fecal incontinence 2 Long-term memory loss 3 Inability to recall the spouse's phone number 4 Difficulty finding a driver's license 5 Diaphoresis and trembling
3 Inability to recall the spouse's phone number 4 Difficulty finding a driver's license 5 Diaphoresis and trembling
1 The nurse explains to a patient with a borderline personality disorder that the patient's former psychiatrist resigned and that a new psychiatrist has been hired. Which reaction is most likely? 1 Silence 2 Withdrawal 3 Rage 4 Anxiety
3 Rage
Select the statement that best describes the successful treatment of mental disorders in the United States. 1 Treatment outcomes were most successful when they focused on biologic interventions. 2 The treatment of mental disorders has greatly improved during the 21st century, and this is reflected in the reduction of the number of mental disorders. 3 Statistics regarding the prevalence of mental disorders in the United States remain static. 4 The combination of medications with interactive and biologic therapies has been the most successful for reducing the prevalence of mental disorders.
3 Statistics regarding the prevalence of mental disorders in the United States remain static.
A psychiatric nurse designs an hour-by-hour plan for working with patients for the day. Select the best analysis of this nurse's action. 1 The nurse has demonstrated goal-directed behavior. 2 The nurse is likely to feel rewarded at the end of the day. 3 The plan is likely to result in feelings of frustration for the nurse. 4 The plan will support the development of the nurse's organizational skills.
3 The plan is likely to result in feelings of frustration for the nurse.
1 A nurse assesses a 9-year-old girl for the risk of violence. School officials report that, although the patient is very intelligent, she was suspended for bringing illicit drugs onto the school campus. The child has lived with her mother since her parents were divorced 2 years ago, and her father is in prison. How many risk factors for committing a violent act are present for this child? 1 One 2 Two 3 Three 4 Four
3 Three
4 A parent seeks counseling after the rape and murder of a child. The parent tearfully says, "I hate the man who did this. He's being tried for the murder, but I don't know what I will do if he's not found guilty." What is the nurse's highest priority response? 1 "Have you talked to a psychiatrist about taking some medication to help you cope?" 2 "Do you have enough support from your family and friends?" 3 "What resources do you need to help you cope with this situation?" 4 "Are you thinking of killing yourself or the man who killed your child?"
4 "Are you thinking of killing yourself or the man who killed your child?"
A military wife tearfully tells a nurse about her husband's death in a helicopter crash 6 months earlier. The patient cries on a daily basis. She says, "I think I'm losing it. I'll never be the same." What is the nurse's best response? 1 "You will eventually get back to normal. Just start doing the things that used to be fun for you." 2 "When you find yourself starting to cry or feel sad, distract yourself by getting busy with an activity." 3 "Your husband died for our country. You should be proud of him rather than absorbed in grief." 4 "Crying and the feelings that you describe are normal after such a loss. It may take you a long time to grieve his death."
4 "Crying and the feelings that you describe are normal after such a loss. It may take you a long time to grieve his death."
3 A patient with bipolar disorder tells a nurse in the local mental health clinic, "I want to tell you about something I did that was bad, but you've got to promise me that you won't write it in my chart or tell anyone about it." Select the nurse's best response. 1 "I'm here for you and want to be supportive. I understand how important it is to keep everything you tell me confidential." 2 "Your privacy is guaranteed by the Health Insurance Portability and Accountability Act and state regulations. You've signed forms that state that you understand this protection." 3 "Tell me about what happened; then you and I can decide what the best course of action will be." 4 "I will protect your confidentiality to the extent the law allows, but I cannot keep secrets from the treatment team; we are all here to help you."
4 "I will protect your confidentiality to the extent the law allows, but I cannot keep secrets from the treatment team; we are all here to help you."
A nurse assesses a newly admitted patient. Which of the following examples demonstrates the offering of the self? 1 "I've had some very stressful experiences in my life, too. Hospitalization isn't so bad, really." 2 "Tell me why you felt you had to be hospitalized for the treatment of your depression." 3 "I know you will feel better after we get your medication adjusted." 4 "I'd like to spend some time helping you to get comfortable talking with me."
4 "I'd like to spend some time helping you to get comfortable talking with me."
A patient with paranoid schizophrenia tells the nurse, "I'm here on a top secret mission for the President. Don't tell anyone I am here." Which response by the nurse would be most therapeutic? 1 "Let's talk about something other than your mission for the President." 2 "Your admission papers do not list you as an employee of the President." 3 "You have lost touch with reality, which is a symptom of your illness." 4 "It sounds like you have some concerns about your privacy. You are safe here."
4 "It sounds like you have some concerns about your privacy. You are safe here."
3 When counseling a patient with suicidal ideation, which comment by the nurse would be most therapeutic? 1 "I'm glad to see you taking ownership of your problems and trying to find solutions." 2 "When you experience negative feelings, try to focus on something more positive." 3 "Let's make a chart of all your problems and try to create solutions for each one." 4 "Let's talk about which problems are most important and which are least important."
4 "Let's talk about which problems are most important and which are least important."
5 The parent of a child with Tourette's disorder says to the nurse, "I think my child is faking the tics, because they're absent during sleep." Select the nurse's accurate response. 1 "Perhaps your child was misdiagnosed." 2 "This finding indicates a worsening of the child's condition." 3 "Your observation indicates that the medication is effective." 4 "Tics are often reduced or absent during sleep."
4 "Tics are often reduced or absent during sleep."
4 The following comments are made by members of a group. Which comment best contributes to the group's cohesiveness? 1 "I need to talk about how my problems developed and get some ideas for solving them." 2 "We aren't making progress, because our group leader has as many problems as we do." 3 "No one in this group wants to hear anything else about failed romantic relationships." 4 "We started out talking about losses, but we have strayed from that subject."
4 "We started out talking about losses, but we have strayed from that subject."
Which activity of the core PMH disciplines is considered to be the most important for national mental health care? 1 The promotion and protection of mental health 2 The prevention and treatment of mental disorders 3 Recovery and rehabilitation 4 All of the above
4 All of the above
4 A primary nurse who is responsible for caring for a prisoner who has a history of violence should pay special attention to all except which one of the following symptoms? 1 Anger 2 Anxiety 3 Agitation 4 Anhedonia
4 Anhedonia
4 An adult has panic attacks. Which neurotransmitter is most likely to be implicated in this problem? 1 Norepinephrine 2 ACh 3 Serotonin 4 GABA
4 GABA
Which of the following diagnostic documentation formats would the nurse expect to see in a psychiatric acute care setting? 1 I.Congestive heart failure II 30/60 III Schizophrenia, undifferentiated type IV Ran away from board and care home 3 days ago V Paranoid personality disorder 2 I.Substance abuse, alcohol II Antisocial personality disorder III 65/85 IV Chronic renal failure V Arrested for domestic violence 5 days ago 3 I.Generalized anxiety disorder II Hypertension III 65/75 IV No personality disorder V Loss of employment 1 month ago 4 I.Major depression II Dependent personality disorder III Diabetes, type 2 IV Home foreclosed on 2 weeks ago V 60/80
4 I.Major depression II Dependent personality disorder III Diabetes, type 2 IV Home foreclosed on 2 weeks ago V 60/80
1 A patient says to the nurse, "I had my first depression after my father died about 10 years ago, but I didn't get any treatment. Now it seems even little life events cause me to get depressed again." Which theory of neurotransmission may explain the patient's complaint? 1 Stress increases the activity of monoamine oxidase. 2 Dysfunctional grieving inhibits metabolism of sero-tonin. 3 Prolonged grief depletes neuronal supplies of G-proteins. 4 Kindling may alter neuronal cell structure and function.
4 Kindling may alter neuronal cell structure and function.
6 A patient with catatonic schizophrenia has been sitting mute and rigid for 2 hours. Which nursing intervention would be the most appropriate? 1 Encourage the patient to participate in a group sporting activity. 2 Put the patient's extremities through passive range-of-motion exercises. 3 Seclude the patient until voluntary movement is observed. 4 Offer short but frequent verbal phrases to communicate caring.
4 Offer short but frequent verbal phrases to communicate caring.
A beginning psychiatric nurse grew up with a mother who had schizophrenia. The nurse recalls feelings of embarrassment and anger about her mother's behavior in the community. Select the best ways for this nurse to cope with her memories. You may select more than one answer. 1 Recognize that the memories are unhealthy. The nurse should try to forget them while working with patients. 2 Reexamine the choice of psychiatric nursing as an appropriate area of practice. Explore other specialties. 3 Begin each new patient relationship with the statement, "My mother had mental illness, so I know what you're going through." 4 Recognize that early experiences have the potential to positively influence the nurse's practice. 5 Seek ways to use the information and experience gained from childhood to help patients cope with their own illnesses.
4 Recognize that early experiences have the potential to positively influence the nurse's practice. 5 Seek ways to use the information and experience gained from childhood to help patients cope with their own illnesses.
1 A nurse interacts with a woman who was recently widowed when her husband was killed in a plane crash. While supporting and comforting this patient, the nurse experiences distressing personal feelings associated with the death of a parent 5 years earlier. What is the nurse's best action? 1 Acknowledge the transference that is evident in this relationship, and discuss the phenomenon with the patient. 2 Carefully select the words that he or she uses during interactions with this patient to avoid influencing the patient. 3 Disregard his or her personal feelings and proceed with helping this patient to resolve her grief. 4 Recognize the development of countertransference, and introspectively explore ways to cope with it.
4 Recognize the development of countertransference, and introspectively explore ways to cope with it.
1 An emergency department nurse assesses a patient who is suspected of drug abuse. Assessment findings reveal the following vital signs: temperature, 103°F; blood pressure, 178/104 mm Hg; extreme anxiety; and a serum sodium level of 138 mEq/L. Which problem will the nurse suspect? 1 Steroid-induced psychosis 2 Marchiafava-Bignami disease as a result of alcohol abuse 3 Wernicke-Korsakoff syndrome as a result of alcohol dependence 4 Serotonin syndrome as a result of MDA or MDMA use
4 Serotonin syndrome as a result of MDA or MDMA use
2 Which assessment finding best indicates the release of norepinephrine? 1 The pulse rate changes from 70 bpm to 62 bpm. 2 The pupil size changes from 8 mm to 3 mm. 3 The patient begins complaining of intestinal cramping. 4 The blood pressure changes from 126/70 mm Hg to 158/84 mm Hg.
4 The blood pressure changes from 126/70 mm Hg to 158/84 mm Hg.
3 A person with disorganized schizophrenia participates in a rehabilitative outpatient program. Select the most appropriate initial outcome for this individual. 1 The individual will identify environmental triggers that produce feelings of fear. 2 The individual will have increased organization of thought patterns. 3 The individual will report the absence of auditory and visual hallucinations. 4 The individual will set lunch tables correctly and fill cups with ice daily.
4 The individual will set lunch tables correctly and fill cups with ice daily.
5 A patient who is homeless 5 A psychiatric nurse visits a patient in the community. The patient has paranoid schizophrenia and takes 2 mg of risperidone (Risperdal) twice daily. The nurse determines that this patient needs medication education on the basis of which observation? 1 The patient consumes a soft drink that contains caffeine. 2 The patient eats a hamburger that has aged cheese on it. 3 The patient gains 4 pounds over a 2-month period. 4 The patient has a sunburn after an outing at a local swimming pool.
4 The patient has a sunburn after an outing at a local swimming pool.
2 A nurse manages the care of an individual with a personality disorder. Select the most attainable outcome for this patient. 1 Within 2 weeks, the patient will establish a satisfying intimate relationship with another adult. 2 Within 5 days, the patient will identify factors that led to the development of the personality disorder. 3 Within 1 week, the patient will make a permanent commitment to never self-mutilate. 4 Within 4 weeks, the patient will describe the personal characteristics of his or her reactions to stress.
4 Within 4 weeks, the patient will describe the personal characteristics of his or her reactions to stress.
A patient with bipolar disorder who has been taking lithium is admitted to the mental health unit. In what part of the nursing care plan would the nurse record the following item? "Monitor the patient closely for nausea and vomiting, muscle weakness, lack of coordination, drowsiness, confusion, and seizures." 1Assessment 2Diagnosis 3Outcomes 4Planning 5Implementation 6Evaluation
4Planning
10. Restraints
Apply for shortest duration necessary, and only if the less restrictive measures are not sufficient
8. Standardized assessment tools that are appropriate for the older adult population include the following:
MMSE
9. If the nurse becomes aware that a client's right to privacy is being violated, for example fi a conversation in the elevator is overheard, he should immediately take action to
Stop the violation
3 An 8-year-old patient is referred by his teacher for individual therapy. The patient has been aggressive at school, and he has missed many days of school. In addition, the teacher recently found bruises on his back. Which of the following would be the best short-term goal for this patient? a The patient will develop a trusting relationship with the therapist. b The patient will be free from aggressive behavior. c The parents will attend parenting classes. d The patient will consistently attend school.
a The patient will develop a trusting relationship with the therapist.
2 A 24-year-old patient is admitted to the emergency department with a broken wrist, a swollen and bruised eye, and a fractured jaw. The patient agreed to tell the nurse what actually happened if she promised not to tell anyone. The patient admitted that her husband abused her and that he has abused her in the past, approximately four to five times, but only when he was drunk. Which of the following would be the most appropriate nursing intervention? a Treat her physical injuries, suggest she talk to a counselor, but keep the patient's secret to maintain trust. b Ask her to bring in her husband so that he can get a referral for therapy. c Report the abuse to the police. d Have her talk to another victim of domestic violence.
b Ask her to bring in her husband so that he can get a referral for therapy.
1 A patient walks into the doctor's office complaining of headaches. She is accompanied by her husband, who answers the physician's questions despite the physician asking the patient the questions. The patient avoids eye contact and has a depressed affect, and her shoulders are slumped. The nurse assesses that the patient may have which of the following issues? a She is suffering from major depression. b She is a battered wife. c She is afraid to be with people. d She is experiencing migraine headaches.
b She is a battered wife.
3. A nurse is conducting a family therapy session. The adolescent son tells the nurse that he plans ways to make his sister look bad so his parents will think he's the better sibling, which he believes will give him more privileges. The nurse should identify this dysfunctional behavior as which of the following? a. Placation b. Manipulation c. Blaming d. Distraction
b. Manipulation
5. A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in the teaching? (SATA) a. use caffeine in moderation to prevent relapse b. difficulty sleeping can indicate a relapse c. begin taking your medications as soon as a relapse begins d. participating in psychotherapy can help prevent a relapse e. anhedonia is a clinical manifestation of a depressive relapse
b. difficulty sleeping can indicate a relapse d. participating in psychotherapy can help prevent a relapse e. anhedonia is a clinical manifestation of a depressive relapse
7. A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect? (SATA) a. bradycardia b. fine tremors of both hands c. hypotension d. vomiting e. restlessness
b. fine tremors of both hands d. vomiting e. restlessness
5 A 75-year-old female patient is admitted to the hospital for pneumonia. The nurse observes that the patient's clothes are old and dirty and that they have holes. The patient also has decubiti on her sacral area. The best question to assess for the possibility of abuse would be which of the following? a "How long have you lived with your son?" b "How much money do you have in your bank account?" c "Describe a typical day at home. What do you have to eat, what you do during the day, and what time you bathe?" d "Who buys your clothes for you?"
c "Describe a typical day at home. What do you have to eat, what you do during the day, and what time you bathe?"
6. A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates and understanding of the teaching? a. "I can promote my client's sense of control by establishing a schedule." b. "I should encourage clients who have a schizoid personality disorder to increase socialization." c. "I should practice limit-setting to help prevent client manipulation." d. "I should implement assertiveness training with clients who have antisocial personality disorders
c. "I should practice limit-setting to help prevent client manipulation."
. A client tells a nurse, "Don't tell anyone, but I hid a sharp knife under my mattress in order to protect myself from my roommate, who is always yelling at me and threatening me." Which of the following actions should the nurse take? a. Keep the client's communication confidential, but talk to the client daily, using therapeutic communication to convince him to admit to hiding the knife b. Keep the client's communication confidential, but watch the client and his roommate closely c. Tel the client that this must be reported to the health care team because it concerns the health and safety of the client and others d. Report the incident to the health care team, but do not inform the client of the intention to do so.
c. Tel the client that this must be reported to the health care team because it concerns the health and safety of the client and others
4. A nurse is interviewing a 25-year-old client who has a new diagnosis of dysthymic disorder. Which of the following findings should the nurse expect? a. wide fluctuation in mood b. report of a minimum of five clinical findings of depression c. presence of manifestations for at least 2 years d. inflated sense of self-esteem
c. presence of manifestations for at least 2 years
4 High-risk factors for childhood sexual abuse include which of the following? a Undereducated parents b Low-income families c Multiple siblings d Parents who were sexually abused as children
d Parents who were sexually abused as children
2. A nurse in an acute mental health facility is communicating with a client. The client states, "I can't sleep. I stay up all night." The nurse responds, "You are having difficulty sleeping?" Which of the following therapeutic communication techniques is the nurse demonstrating? a. Offering general leads b. Summarizing c. Focusing d. Restating
d. Restating
