Mental Health: Exam 1

After trying several cognitive therapy sessions, which drug class is most likely to be recommended for a patient who is reporting disturbing flashbacks after serving in the army? 1. Selective serotonin reuptake inhibitor (SSRI) 2. Alpha blocker 3. Benzodiazepine 4. Monoamine oxidase inhibitor (MAOI)

1. Selective serotonin reuptake inhibitor (SSRI) Rationale: SSRIs are recommended for flashbacks related to a posttraumatic stress or trauma after other cognitive therapies have been tried.

Which response by the nurse indicates the use of clarifying as a therapeutic communication technique with a patient experiencing depression who reports feeling like an old used sock that has been put away in a drawer? 1. "Are you saying that nobody pays attention to you?" 2. "Why do you compare yourself to an old used sock?" 3. "Has anyone ever told you that you are not appreciated? 4. "Can you see that many people sometimes feel that way?"

1. "Are you saying that nobody pays attention to you?" Rationale: After the nurse clarifies what the patient is saying, then it would be appropriate to ask which person makes the patient feel this way.

Which statement by the nurse would be the most effective initial statement to a patient brought to the emergency department for evaluation after a violent rape? 1. "I'll stay here and sit with you." 2. "What are you thinking about?" 3. "Could you describe specifically what happened?" 4. "Let's discuss some ways you could prevent this from happening again."

1. "I'll stay here and sit with you." Rationale: Offering to sit with the patient does not require the patient to respond or behave in any certain manner and would be most therapeutic at this time in the nurse-patient interaction

A patient diagnosed with major depressive disorder says to the nurse, "You're assigned to take care of me, but you keep talking to other patients. You need to spend more time with me." Which response by the nurse would be therapeutic? 1. "It sounds like you're saying you need more attention." 2. "I have other patients whose needs are greater than yours." 3. "My time is equally divided among all patients assigned to me." 4. "Thank you, but I will decide how much time to spend with my patients."

1. "It sounds like you're saying you need more attention." Rationale: Telling the patient that it sounds like the patient is expressing a need for more attention demonstrates the therapeutic technique of reflecting.

An adult patient experiencing a recent exacerbation of ulcerative colitis tells the nurse, "I had an accident while I was at the grocery store. It was so embarrassing." Which response would be therapeutic? 1. "Tell me more about how you felt." 2. "Most grocery stores have public restrooms." 3. "People usually have compassion about those types of events." 4. "Your disease is now in remission, so that will not happen again."

1. "Tell me more about how you felt." Rationale: Asking the patient to talk more about how they felt is a therapeutic technique that encourages description and helps the patient express feelings related to this experience.

Which statement best reflects the nurse's use of exploring in a conversation? 1. "Tell me more about the accident." 2. "Have you had an accident before?" 3. "Why do you think this accident happened?" 4. "How could you prevent a similar accident in the future?"

1. "Tell me more about the accident." Rationale: Encouraging the patient to tell the nurse more about the accident encourages exploration of the issue.

The nursing instructor is speaking with a recent nursing graduate who failed the national licensing exam on the first attempt. The instructor asks the student: "Why didn't you complete a review course like I suggested?" Which alternative question might be more therapeutic? 1. "What strategies did you use to study for the exam?" 2. "How angry are your parents that you failed on the first try?" 3. "Do you really believe that you did all you could to pass the exam?" 4. "Do you feel that the school did not prepare you well enough for the licensing exam?"

1. "What strategies did you use to study for the exam?" Rationale: It is better to ask questions such as what strategies the student nurse used to focus more on facilitating problem solving.

Which finding would the nurse note in a 6-year-old child with a diagnosis of posttraumatic stress disorder (PTSD) resulting from parental abuse? 1. Overeating 2. Hypervigilance 3. Perfectionism 4. Passivity

2. Hypervigilance Rationale: Child abuse may be associated with irritability and hypervigilance. Overeating, perfectionism, and passivity are not typically associated with PTSD in children.

For which patient situation would the use of restraints or seclusions be contraindicated? Select all that apply. 1. A patient who keeps interrupting group therapy 2. A patient with a diagnosis of Alzheimer's disease 3. A patient who is delirious because of alcohol withdrawal 4. A patient presenting with a suspected heroin overdose 5. A patient who just attempted to hang herself with a bed sheet 6. A patient who has a blood pressure of 210/210 mmHg and is complaining of chest pain

1. A patient who keeps interrupting group therapy 2. A patient with a diagnosis of Alzheimer's disease 3. A patient who is delirious because of alcohol withdrawal 4. A patient presenting with a suspected heroin overdose 5. A patient who just attempted to hang herself with a bed sheet 6. A patient who has a blood pressure of 210/210 mmHg and is complaining of chest pain Rationale: Conditions in which restraint and seclusion are contraindicated include the convenience of staff, delirium or dementia, severe drug reaction or overdose, severe suicidal tendencies, and extremely unstable medical condition.

Which action would be the nurse's priority when a combat veteran tells the nurse, "Every day something happens that makes me feel like I'm still at war. My family has grown impatient with me. They say it's time for me to move on from that time in my life, but I can't"? 1. Assessing the veteran for suicide risk 2. Referring the veteran for specialized mental health services 3. Assessing the veteran for evidence of traumatic brain injury (TBI) 4. Referring the veteran's family to a posttraumatic stress disorder (PTSD) group

1. Assessing the veteran for suicide risk Rationale: Patients with PTSD, particularly veterans, have a dramatically increased risk for suicide.

Which is the first thing the nurse would do to prepare for communication with patients from different cultures? 1. Becoming aware of the nurse's own cultural identities and biases 2. Learning effective communication techniques for each specific culture 3. Studying the predominant cultures of the patients for whom the nurse will be caring 4. Informing the director of nursing if there are certain cultures with whom the nurse feels uncomfortable working

1. Becoming aware of the nurse's own cultural identities and biases Rationale: It is important for nurses to understand their own cultural identity and biases to provide effective, respectful care when communicating with patients who have different cultural backgrounds.

Which substance is activated when an individual runs to escape a tornado? 1. Epinephrine 2. Amino acids 3. Fatty acids 4. Cortisol

1. Epinephrine Rationale: Epinephrine is a short-term neurotransmitter working to help the patient run and take flight to prevent injury.

Which action would the nurse take first for a depressed spouse of a patient who received a heart transplant 5 years ago and had multiple medical complications? 1. Exploring the spouse's feelings, showing care and compassion 2. Encouraging the spouse to attend a community support group 3. Teaching stress-reduction and relaxation techniques to the spouse 4. Referring the spouse to the primary health care provider for a health assessment

1. Exploring the spouse's feelings, showing care and compassion Rationale: Exploring the spouse's feelings is the nurse's first step because this will center any care on the patient's needs and will guide subsequent interventions.

Which phrase accurately described negligence toward a patient? 1. Failure to act in a way that a responsible employee would act 2. Applies only when the patient is abandoned or mistreated 3. Action that puts the patient in fear of being harmed by the employee 4. When an employee has given malicious false information about the patient

1. Failure to act in a way that a responsible employee would act Rationale: Behaving as a wise and prudent person would act under the same circumstances is one way of judging whether the standard of care has been violated.

Which factor accounts for the reason mental health issues often go unaddressed? Select all that apply. One, some, or all responses may be correct. 1. Fear of stigma 2. Problems with transportation 3. Scarcity of health care providers in remote areas 4. Lack of research on mental health disorders 5. Ineffective treatment methods for most mental health disorders

1. Fear of stigma 2. Problems with transportation 3. Scarcity of health care providers in remote areas Rationale: Many mental health issues go unaddressed because of fear of stigma, problems with transportation, and a scarcity of health care providers, particularly in rural or remote areas.

Which symptom would the nurse assess in a patient with posttraumatic stress disorder (PTSD)? 1. Mood alterations 2. Undisturbed sleep 3. Talking about memories 4. Unchanged concentration levels

1. Mood alterations Rationale: Mood alterations like chronic depression are a feature of PTSD.

Which nonverbal communication would the nurse observe during a conversation with a patient to discuss behavioral expectations on the unit? Select all that apply. One, some, or all responses may be correct. 1. Posture 2. Voice pitch 3. Eye contact 4. Hand movements 5. Facial expressions

1. Posture 2. Voice pitch 3. Eye contact 4. Hand movements 5. Facial expressions **Voice pitch should not be marked as correct Rationale: The nurse should observe the patient's posture, voice pitch and tone, amount of eye contact, hand movements, and facial expressions when assessing nonverbal communication.

Which behavior would the nurse note in a preschool child who has been diagnosed with posttraumatic stress disorder (PTSD)? Select all that apply. One, some, or all responses may be correct. 1. Reluctance to engage in previously enjoyed activities 2. Frequent displays of irritability and negativity 3. Engaging in specific ritual behaviors 4. Sharing that he or she "hears voices when no one is there" 5. Expressing concern that "something bad is going to happen"

1. Reluctance to engage in previously enjoyed activities 2. Frequent displays of irritability and negativity 5. Expressing concern that "something bad is going to happen" Rationale: Posttraumatic stress disorder in preschool children may manifest as feelings of detachment or estrangement from others and diminished interest or participation in significant activities

During a home visit, the nurse identifies that a patient is experiencing suicidal ideation but refuses to seek treatment. Which nursing action could result in the nurse being guilty of abandonment? 1. Respects the patient's rights and does not force the patient to seek treatment 2. Enlists the assistance of the legal system for involuntary admission of the patient 3. Ensures that the patient is in a safe environment with minimal risk for injury 4. Informs the family members and advises them to keep the patient safe

1. Respects the patient's rights and does not force the patient to seek treatment Rationale: Abandonment happens when the nuse fails to ensure the patient's safety despite knowing the risk for harm.

Which outcome indicates to the nurse that attending yoga sessions has helped a college student successfully manage stress associated with academic demands? 1. The student reports improved feelings of well-being. 2. The student increases the use of caffeine to enhance concentration. 3. The student reports, "Now I am sleeping about 10 hours every day." 4. The student says, "I withdrew from two courses to reduce my academic load."

1. The student reports improved feelings of well-being. Rationale: Yoga and other physical activities can be effective ways to manage stress. These activities deepen breathing, relieve muscle tension, and can elevate levels of the body's own endorphins, which induces a sense of well-being.

While interacting with a patient involved in an automobile accident with injuries, the nurse states: "I know you are upset, but it could have been far worse, so let's focus on taking care of you for now." Which nontherapeutic communication did the nurse employ? 1. False reassurance 2. Minimizing feelings 3. Making a value judgment 4. Giving premature advice

2. Minimizing feelings Rationale: Stating that the accident could have been far worse minimizes the patient's feelings and indicates that the nurse does not empathize with the patient.

Which activity supports the process of active listening? Select all that apply. One, some, or all responses may be correct. 1. Including frequent periods of silence. 2. Monitoring own nonverbal responses. 3. Observing the patient's nonverbal behaviors. 4. Learning to quiet oneself to avoid the urge to help. 5. Providing patients with feedback about themselves of which they may be unaware.

2. Monitoring own nonverbal responses. 3. Observing the patient's nonverbal behaviors. 4. Learning to quiet oneself to avoid the urge to help. 5. Providing patients with feedback about themselves of which they may be unaware. Rationale: Active listening requires the nurse to be available psychologically, socially, and emotionally.

Which question would the nurse ask when interviewing a patient who has been diagnosed with posttraumatic stress disorder (PTSD) related to a sexual assault? 1. "Are you hearing voices?" 2. "Do you experience flashbacks of the assault?" 3. "What are you doing to cope with your anxiety?" 4. "Have you developed any compulsive behaviors since being assaulted?"

2. "Do you experience flashbacks of the assault?" Rationale: Intrusive re-experiencing of the initial trauma such as flashbacks is one of the four cardinal symptoms of PTSD.

The nurse is discussing the upcoming transfer of a patient to a long-term care facility with the patient's spouse, who is struggling with the decision for long-term care. The spouse asks the nurse, "Have I done the right thing?" Which statement would be most therapeutic in this situation? 1. "Yes, you have done all that you can, this nursing home will provide good care." 2. "Tell me more about how you feel about your spouse going into long-term care." 3. "Everything will be all right; your spouse may not need to be there long anyway." 4. "I'm glad you have made this decision; even though it was a hard one, it is the right one."

2. "Tell me more about how you feel about your spouse going into long-term care." Rationale: Asking the spouse to talk more about their feelings allows reflection and supports decision making.

Which response by the nurse demonstrates the therapeutic use of reflecting with a patient who is experiencing conflict about ending a marriage and asking the nurse for advice? 1. "What are your options if you ended the marriage?" 2. "Which choice would bring you the most happiness?" 3. "Have you both considered professional counseling?" 4. "Can you create a pros and cons list to make the decision?"

2. "Which choice would bring you the most happiness?" Rationale: The nurse should use reflecting to direct feelings and questions back on the patient.

Which symptom would the nurse expect a patient with depersonalization disorder to exhibit? 1. Aimless wandering with confusion and disorientation 2. A feeling of detachment from one's body or mental processes 3. Existence of two or more personalities that take control of behavior 4.Anxiety about having a serious disease based on symptom misinterpretation

2. A feeling of detachment from one's body or mental processes Rationale: Depersonalization is characterized by a sense of unreality or feeling of detachment from one's body or mental processes.

Which action by the nurse would be helpful in treating a patient with a mental health disorder who is refusing medication and has attempted suicide? 1. Motivating the patient to be admitted to the clinic 2. Admitting the patient in the clinic regardless of consent 3. Taking written consent from the patient for admission 4. Seeking advice from the primary health care provider for admission

2. Admitting the patient in the clinic regardless of consent Rationale: Patients in need of psychiatric medications are admitted to mental health care centers without prior consent.

Which communication technique would the nurse effectively use when he or she is comfortable and confident with the interviewing process? 1. Filling each void in the conversation 2. Allowing for moments of uninterrupted silence 3. Avoiding topics that could possibly be embarrassing 4. Relying on verbal rather than nonverbal communication

2. Allowing for moments of uninterrupted silence Rationale: Allowing for uninterrupted silence is appropriate because using silence is an effective tool in encouraging patients to open up.

A nurse force's a patient who presents no danger to self or others to take medication against the patient's will. Which term describes what the nurse is legally liable for? 1. Assault 2. Battery 3. Defamation 4. Invasion of privacy

2. Battery Rationale: Battery is the harmful, non-consensual touching of another person.

Which nursing action will best ensure that a psychiatric patient's rights are respected and preserved? 1. Educating each patient as to his or her legally protected rights 2. Being knowledgeable about the state laws that regulate patient rights 3. Participating as a member of the patient's multidisciplinary health care team 4. Referring all issues of a legal nature to the appropriate facility committee

2. Being knowledgeable about the state laws that regulate patient rights Rationale: The legal context of care is important for all psychiatric nurses because it focuses concern on the rights of the patients and the quality of care they receive.

A psychiatric patient is shouting loudly but shows no signs of becoming physically violent; the nurse secludes the patient in the patient's room. Which illegal action does this exemplify on the part of the nurse toward the patient? 1. Assault 2. False imprisonment 3. Breach of duty 4. Invasion of privacy

2. False imprisonment Rationale: False imprisonment occurs when a patient is unnecessarily confined to a specific area when there is no legal need for seclusion.

Which term includes an indication of whether or not the nature of the message sent was correctly interpreted by the receiver? 1. Media 2. Feedback 3. Message 4. Stimulus

2. Feedback Rationale: The feedback sent by the receiver often indicates if the message sent by the sender was correctly interpreted.

Which action would the nurse take when a patient living near a military base where loud jets are heard tells the nurse, "They're so loud I can't hear myself think"? 1. Directing the patient to report the jet noise to local authorities 2. Teaching relaxation and stress-reduction techniques to the patient 3. Assessing the patient for sensory impairments, particularly auditory 4. Encouraging the patient to form a community action group to oppose noise pollution

2. Teaching relaxation and stress-reduction techniques to the patient Rationale: Teaching relaxation and stress-reduction techniques directly addresses the patient's stress.

The nurse reads the medical record and learns that a patient has agreed to receive treatment and abide by hospital rules. Which condition does this imply that the patient was admitted under? 1. Per legal requirements 2. For a non emergency 3. Voluntary 4. Involuntary

3. Voluntary Rationale: Voluntary admission occurs when the patient is willing to be admitted and agrees to comply with hospital and unit rules.

A patient diagnosed with paranoid delusions tells the nurse, "Do you see Jesus standing over there? He is right in front of the window." Which response would be the most therapeutic? 1. "I do see someone that looks a bit like Jesus by the window." 2. "What makes you think Jesus is standing over by the window?" 3. "That is one of the therapists standing in front of the window, not Jesus." 4. "That is just another one of your delusions; let's find something to distract you."

3. "That is one of the therapists standing in front of the window, not Jesus." Rationale: Stating that the person in front of the window is not Jesus is presenting reality, which indicates what is real without arguing or trying to convince the patient.

Which response by the nurse is the most therapeutic response when a patient who has a long history of mental illness cries spontaneously when talking about the unexpected death of a spouse? 1. "This loss is harder to accept because you have mental illness. Try to focus on other activities." 2. "I'm concerned that you are crying so much. Your grief over your spouse's death has gone on too long." 3. "The sudden death of your spouse is hard to accept. I am glad you are able to tell me about how you are feeling." 4. "Your tears let me know you are not coping appropriately with your loss. Let's make an appointment with your health care provider."

3. "The sudden death of your spouse is hard to accept. I am glad you are able to tell me about how you are feeling." Rationale: Through sharing his or her experience, the patient can begin to heal and integrate what happened into his or her life.

Which technique would the nurse be using when stating, "I am not sure I understand you; can you repeat what you just told me?" 1. Restating 2. Exploring 3. Clarifying 4. Reflecting

3. Clarifying Rationale: When the nurse needs to verify understanding of what the patient stated, clarification is an effective communication technique.

Which immediate action would the nurse take when a patient begins to yell obscenities and pace around the milieu? 1. Speak softly while asking the patient to stop cursing. 2. Leave the patient alone unless he or she asks for help. 3. Engage the patient in conversation to determine why he or she is upset. 4. Offer 5 mg of olanzapine to calm the patient and determine what is upsetting him or her.

3. Engage the patient in conversation to determine why he or she is upset. Rationale: Verbal interventions and enlisting the cooperation of the patient are first-line interventions.

Which symptom would lead the health care provider to suspect posttraumatic stress disorder (PTSD) in an adult patient? Select all that apply. One, some, or all responses may be correct. 1. Visiting the scene of the accident over and over 2. Talking with strangers about the events of the accident 3. Flashbacks of the accident 4. Hypervigilance 5. Irritability 6. Difficulty concentrating

3. Flashbacks of the accident 4. Hypervigilance 5. Irritability 6. Difficulty concentrating Rationale: Flashbacks of the accident, hypervigilance, irritability, and difficulty concentrating are symptoms of PTSD.

Which factor would support a positive outcome for treatment of a recently divorced veteran who has come for treatment for depression and has diabetes and heart disease? 1. Self-medicates with alcohol 2. Takes prescription drugs for chronic pain 3. Has reliable family support 4. Is employed at a local factory

3. Has reliable family support Rationale: A reliable and supportive family is a predictor for a positive outcome for depression.

Which interpretation of what eye contact means as a type of nonverbal communication in the United states is accurate? 1. It is considered rude. 2. It is accepted as a challenge. 3. It is associated with attentiveness. 4. It is avoided as a sign of arrogance.

3. It is associated with attentiveness. Rationale: In the United States, eye contact is linked with attentiveness and respect.

Which documentation of a hospitalized patient's behavior best communicates the nurse's observation? 1. Speech is pressured and shows flight of ideas 2. Frequently demonstrates agitation and hyperactivity 3. Moved rapidly from place to place and said, "I have so much to do" 4. Was calmer today and reported getting a good night's sleep last night

3. Moved rapidly from place to place and said, "I have so much to do" Rationale: A record's usefulness is determined by how accurately and completely it portrays the patient's behavioral status at the time it was written.

A patient may experience which short-term reaction in response to a traffic accident involving death on the scene? 1. Heart attack 2. Diabetes 3. Psychological stress 4. Gastric ulcers

3. Psychological stress Rationale: Psychological stress may be experienced as a short-term, or acute, reaction to a traumatic event.

As a community mental health nurse prepares to administer a regularly scheduled antipsychotic medication injection to a patient diagnosed with schizophrenia, the patient stands and says, "I'm leaving. I don't want any more of that medicine." Which initial action by the nurse is appropriate? 1. Postpone the injection and reschedule the patient's visit in 1 week 2. Confer with the pharmacist about preparing the medication in oral form 3. Stop with the procedure and say to the patient, "I's like to talk with you about how you are feeling about this matter." 4. Say to the patient, "You have been taking this medication for 2 years and have never had any problems with it in the past."

3. Stop with the procedure and say to the patient, "I's like to talk with you about how you are feeling about this matter." Rationale: The nurse should stop the procedure and discuss the patient's feelings before taking any other actions to discuss the importance of medication.

Which question by the nurse would be considered seeking clarification with a patient who thinks that he or she is being watched by the government? 1. "You feel that you are being watched?" 2. "Can you describe who you think is watching you?" 3. "I am here to take care of you today; do you have any questions before we start?" 4. "I'm unclear; could you give me an example of when you thought you were being watched?"

4. "I'm unclear; could you give me an example of when you thought you were being watched?" Rationale: When the nurse states that the patient is unclear, the nurse is using the technique of seeking clarification from the patient.

Which is the nurse's best response when a patient, who was a soldier, states, "Sometimes I still hear explosions, but I know I am safe in my home," during the initial interview? 1. "Your description indicates flashbacks, which are commonly associated with acute stress disorder. You need to have additional treatment." 2. "Exposure to intermittent explosive devices often damages a person's ears. Let's arrange for some tests of your hearing and balance." 3. "Your experience in the war is over, and you are safe. It is time for you to recognize that the experience is over and move on with your life." 4. "You are describing flashbacks. These often happen after traumatic events such as war. I'd like to arrange for you to talk more about your feelings and reactions."

4. "You are describing flashbacks. These often happen after traumatic events such as war. I'd like to arrange for you to talk more about your feelings and reactions." Rationale: Flashbacks are dissociative experiences during which the event is relived and the person behaves as though he or she is experiencing the event at that time.

The student nurse is analyzing the process recording of an interaction with a depressed patient admitted after a suicide attempt. Which aspect of the process recording would the student nurse label as nontherapeutic? 1. Allowing a period of silence after introducing self 2. Asking "What would you like to discuss?" 3. Stating "I'll sit with you awhile if you would like to talk." 4. Asking "Why did you feel so sad that you tried to commit suicide?"

4. Asking "Why did you feel so sad that you tried to commit suicide?" Rationale: 'Why' questions such as "why did you feel so sad that you tried to commit suicide," imply criticism and are nontherapeutic.

Which method of treatment would the nurse use when treating a war veteran who comes to the clinic demonstrating signs of posttraumatic stress disorder (PTSD)? 1. Low-carbohydrate diet 2. Herbal supplements 3. Manipulative practices 4. Cognitive behavioral therapy

4. Cognitive behavioral therapy Rationale:

Which counselling approach would likely be used to counsel a patient who is diagnosed with acute stress disorder? 1. Psychoanalysis 2. Aversion therapy 3. Stress-reduction therapy 4. Cognitive behavioral therapy

4. Cognitive behavioral therapy Rationale: Cognitive behavioral therapy uses a range of strategies such as psychoeducation, behavior modification, cognitive therapy, exposure therapy, and stress management to help the victim manage behavior and change maladaptive beliefs and thoughts resulting from the traumatic experience.

A nurse colleague tells the staff nurse, "I have not been able to sleep for the past 3 days, and now I feel like a robot." Which action would the staff nurse implement? 1. Directing the colleague to leave the facility immediately 2. Observing the colleague closely for evidence of impaired practice 3. Offering to administer medications to patients assigned to the colleague 4. Conferring with the supervisor about the nurse's ability to safely deliver care

4. Conferring with the supervisor about the nurse's ability to safely deliver care Rationale: If a colleague may be practicing irresponsibly, the nurse has an obligation to protect the rights of the patients who could potentially be harmed by reporting the concern to a supervisor.

Which term applies to a patient who says, "Sometimes I feel like I'm floating above my body, watching it from the outside"? 1. Fugue 2. Amnesia 3. Dissociation 4. Depersonalization

4. Depersonalization Rationale: Depersonalization is an uncomfortable feeling of being an observer of one's own body or mental processes.

Which therapy would the nurse adopt to help a child survivor of a motor vehicle crash regain memory? 1. Cognitive behavioral therapy 2. Psychopharmacological therapy 3. Dialectical developmental psychotherapy 4. Eye movement desensitization and reprocessing (EMDR) therapy

4. Eye movement desensitization and reprocessing (EMDR) therapy Rationale: Eye movement desensitization and reprocessing (EMDR) therapy is an evidence-based therapy.