Mental Health exam 2 Chapters 2, 7, 10, 13, 14, 15
Consider both Sullivan's term security operations and Freud's term defense mechanisms. Which statement suggests that the client's specialized treatment goal has been successfully met? a) "I'm experiencing much less anxiety about school now." b) "I know that I'm not the only person who has a difficult time in school." c) "Going back to school is hard and I'll need support." d) "I really think I can succeed in school now."
a) "I'm experiencing much less anxiety about school now." Both Sullivan and Freud coined terms to mean actions that individuals do that are an attempt to reduce anxiety. The terms to do not refer to activities that increase self-esteem. Security operations and defense mechanisms are not conscious and therefore do not increase self-awareness. These terms do not refer to reducing cognitive distortions.
Using Maslow's model of needs, the nurse providing care for an anxious client identifies which intervention as being a priority? a) Assessing the client for strengths upon which a nurse-client relationship can be based b) Assessing the client's ability to fulfill appropriate developmental level tasks c) Planning one-on-one time to assist in identifying the fears trigger the client's anxiety d) Evaluating the client's ability to learn and retain essential information regarding their current condition
a) Assessing the client for strengths upon which a nurse-client relationship can be based The value of Maslow's model in nursing practice is twofold. First, the emphasis on human potential and the client's strengths is key to successful nurse-client relationships. The second value lies in establishing what is most important in sequencing of nursing actions in the nurse-client relationship.
A nurse is about to interview an older client whose glasses and hearing aid were placed in the bedside drawer for safe keeping. Before beginning the interview, which nursing intervention that will best facilitate data collection? a) Assist the client in putting on glasses and hearing aid. b) Give the client her glasses and hearing aid. c) Ask the client if she needs her glasses and hearing aid. d) Explain the importance of wearing her hearing aid and glasses.
a) Assist the client in putting on glasses and hearing aid. A client whose hearing or sight is impaired may have difficulty providing information if these items have been removed from his or her possession. Assisting the client in wearing these assistive devices is the best initial intervention. None of the other options will be as effective in facilitating the interview.
What is the first-line drug used to treat mania? a) Carbamazepine b) Clonazepam c) Lithium carbonate d) Lamotrigine
c) Lithium carbonate Lithium, a mood stabilizer, is the first-line drug for use in treating bipolar disorder. The other options are prescribed to manage other related symptoms of bipolar disorder.
Beck's cognitive theory suggests that the etiology of depression is related to what factor? a) Serotonin circuit dysfunction b) Sleep abnormalities c) Negative processing of information d) S belief that one has no control over outcomes
c) Negative processing of information
When the clinician mentions that a client has anhedonia, the nurse can expect that the client will demonstrate what behavior? a) Difficulty with tasks requiring fine motor skills b) A weight loss from anorexia c) No pleasure from previously enjoyed activities d) Poor retention of recent events
c) No pleasure from previously enjoyed activities
The relaxation response calls upon the initiation of what process? a) Increased cortisol production by the adrenals b) Brainstem deactivation c) Parasympathetic activation d) Sympathetic activation
c) Parasympathetic activation Sympathetic activation prepares the individual for the fight-or-flight response. Parasympathetic activation has the opposite effect. None of the other options would bring about relaxation.
A client diagnosed with bipolar disorder has a nursing care plan that includes several nursing diagnoses listed. Match the nursing diagnosis to the level of priority (1 to 4). 1) Self-care deficit, bathing, and hygiene 2) Knowledge, deficient 3) Risk for injury 4) Nonadherence
3, 1, 2, 4 Risk for injury Self-care deficit, bathing, and hygiene Knowledge, deficient Nonadherence
Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful? a) "I can be successful if I do all the things required to learn the job." b) "I can never learn all there is to know for the job." c) "I do not have the ability to handle that job." d) "I may be fired from the job but eventually I will find something else to do with my life."
a) "I can be successful if I do all the things required to learn the job." Cognitive reframing changes the individual's perceptions of stress by reassessing a situation and replacing irrational beliefs with more positive self-statements. The other options are all negative cognitive distortions that would prevent the individual from success.
Which behavior would be characteristic of a client during a manic episode? a) Going rapidly from one activity to another b) Being unwilling to leave home to see other people c) Taking frequent rest periods and naps during the day d) Watching others intently and talking little
a) Going rapidly from one activity to another Hyperactivity and distractibility are basic to manic episodes. None of the other options demonstrate such characteristics.
When a hyperactive manic client expresses the intent to strike another client, what is the initial nursing intervention? a) question the client's motive. b) initiate physical confrontation. c) prepare the client for seclusion. d) set verbal limits.
d) set verbal limits. Verbal limit setting should always precede more restrictive measures. Questioning motives does not address the safety issue that exists.
Delusionary thinking is a characteristic of which form of anxiety? a) Chronic anxiety b Panic level anxiety c) Severe anxiety d) Acute anxiety
b Panic level anxiety
A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. Which ego defense mechanism is in use? a) Projection b) Repression c) Displacement d) Reaction formation
b) Repression
A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." How should the nurse respond to this statement? a) "Depression is seen in people of all ages, from childhood to old age." b) "Depression is most often seen among the middle adult age group." c) "The age of onset for most depressive episodes is given as 18 years." d) "That is a good observation. Depression does mostly strike people older than 50 years."
a) "Depression is seen in people of all ages, from childhood to old age."
What is a desired outcome for the maintenance phase of treatment for a manic client? a) Adhere to follow-up medical appointments. b) Take medication more than 50% of the time. c) Use alcohol to moderate occasional mood "highs." d) Exhibit optimistic, energetic, playful behavior.
a) Adhere to follow-up medical appointments. The client would be living in the community during the maintenance phase. Keeping follow-up appointments is highly desirable. None of the other options are accurate.
Which nursing intervention demonstrates the theory behind operant conditioning? a) Showing the client how to be assertive without being aggressive b) Rewarding the client with a token for avoiding an argument with another client c) Explaining to the client the consequences of not following unit rules d) Demonstrating deep breathing techniques to a group of clients
b) Rewarding the client with a token for avoiding an argument with another client Operant conditioning is the basis for behavior modification and uses positive reinforcement to increase desired behaviors. For example, when desired goals are achieved or behaviors are performed, clients might be rewarded with tokens. These tokens can be exchanged for food, small luxuries, or privileges. This reward system is known as a token economy. None of the remaining options demonstrate reward for positive behaviors, climate, and structure, for healing.
What is the priority nursing diagnosis for a hyperactive manic client during the acute phase of treatment? a) Impaired verbal communication b) Risk for injury/suicide c) Ineffective role performance d) Risk for other-directed violence
b) Risk for injury/suicide
What is the major reason for the hospitalization of a depressed client? a) Inability to go to work b) Suicidal ideation c) Psychomotor agitation d Loss of appetite
b) Suicidal ideation
A client, whose friend recently committed suicide, asks the nurse about some ways to help cope with the stress regarding the event. Which option should the nurse discuss with the client? a) Isolation for a short time so that the pain isn't reinforced by explaining her feelings over and over b) Talking with friends and attending a loss support group c) Starting a hobby to keep her mind off the troubling event d) Antianxiety medication to help her relax
b) Talking with friends and attending a loss support group. Social supports and support groups are two effective ways to cope with stress and stressful events. Isolation is never a healthy option; talking about feelings usually decreases stress, not increases. There is no evidence to suggest Melissa is anxious. Trying to "keep her mind off" the stressor does not develop coping mechanisms to deal with stress but rather encourages not dealing with the problem.
Generally, which statement regarding ego defense mechanisms is true? a) They seldom make the person more comfortable. b) They often involve some degree of self-deception. c) They are usually effective in resolving conflicts. d) They are rarely used by mentally healthy people.
b) They often involve some degree of self-deception.
Meditation is successful in promoting stress reduction because it brings about which outcome? a) Prevents endorphin release b) quiets the sympathetic nervous system c) changes the client's energy field d) activates the parasympathetic nervous system
b) quiets the sympathetic nervous system Sympathetic nervous system stimulation prepares the body for fight or flight in response to stress. Meditation reduces this state of alert by eliciting a relaxation response by creating a hypometabolic state of quieting the sympathetic nervous system. None of the other options accurately describe the process.
Selective inattention is first noted when experiencing which level of anxiety? a) Mild b) Panic c) Severe d) Moderate
d) Moderate
Dysthymia cannot be diagnosed unless it has existed for what period of time? a) At least 6 months b) At least 1 year c) At least 3 months d) At least 2 years
d) At least 2 years
A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse should identify this cognitive distortion as what response? a) Discounting positive attributes b) Catatonia c) Learned helplessness d) Self-blame
c) Learned helplessness
Which assessment monitors the effect of stress attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex? a) Blood glucose levels b) Brain norepinephrine c) Triglycerides d) Heart rate
a) Blood glucose levels An increase in gluconeogenesis, stimulated by the release of cortisol, ensures that increased amounts of glucose are available to the individual. Increased glucose levels heighten and maintain energy levels to meet the demands of a crisis or stressor. None of the other options are as directly associated with the hypothalamus-pituitary-adrenal cortex.
A nurse teaches a client a technique for examining negative thoughts and restating them in positive ways. What term is used to identify this technique? a) Cognitive reframing b) Guided imagery c) Wishful thinking d) confrontational assertion
a) Cognitive reframing Cognitive reframing calls for changing the viewpoint of a situation and replacing it with another viewpoint that fits the facts but is less negative. That description does not apply to any of the other options.
What term is used to identify the condition demonstrated by a person who has numerous hypomanic and dysthymic episodes over a two-year period? a) Cyclothymia. b) Bipolar II disorder. c) Bipolar I disorder. d) Seasonal affective disorder.
a) Cyclothymia. Cyclothymia refers to mood swings involving hypomania and dysthymia of 2 years duration. The mood swings are not severe enough to prompt hospitalization. None of the other options meet that criteria.
Which of the following describe the symptoms of the manic phase of bipolar disorder? (Select all that apply.) a) Distractibility b) Low self-esteem c) Excessive energy d) Withdrawal from environment e) Racing thoughts f) Purposeless movement g) Pressured speech h) Fatigue and increased sleep
a) Distractibility c) Excessive energy e) Racing thoughts f) Purposeless movement g) Pressured speech
Which criterion is NOT essential when the nurse plans nursing interventions designed to meet a specific goal? a) Evidence based b) Safe c) Economical d) Individualized eRealistic
a) Evidence based b) Safe d) Individualized e) Realistic Although expense should be considered, interventions are chosen based on being safe, compatible and appropriate, realistic and individualized, and evidence based and not on their economic value.
A client prescribed a selective serotonin reuptake inhibitor mentions taking the medication along with the St. John's wort daily. What information should the nurse provide the client regarding this practice? a) Explain the high possibility of an adverse reaction. b) Agreeing that this will help the client to remember the medications. c) Caution the client to drink several glasses of water daily. d) Suggest that the client also use a sun lamp daily.
a) Explain the high possibility of an adverse reaction.
The first stage of the general adaptation syndrome (GAS) can be characterized by which response? a) Fight or flight b) Exhaustion c) Eustress d) Resistance
a) Fight or flight The initial adaptive response of the general adaptation syndrome prepares the individual to fight or flee in the face of acute stress. None of the other options are associated with the initial stage of GAS.
Which approach to reducing client stress is most effective for children experiencing postoperative pain? a) Guided Imagery b) Meditation c) Breathing exercises d) Journal keeping
a) Guided Imagery With guided imagery people are taught to focus on pleasant images to replace negative or stressful feelings. This focus diverts a person from less positive thoughts or obsessions, resulting in a refreshed outlook. It is especially useful for children experiencing pain and anxiety. The other options may be too complicated for a child to master effectively.
What tool should the nurse use in assessing the amount of stress a client has experienced in the past year? a) Life-Changing Event Questionnaire b) NANDA Handbook c) DSM-IV-TR d) Quick Mental Status Assessment This questionnaire calls for the client to review events of the past year and score each. This is the only tool listed that assesses stress.
a) Life-Changing Event Questionnaire This questionnaire calls for the client to review events of the past year and score each. This is the only tool listed that assesses stress.
The nurse is working with a client experiencing depression stemming from low self-esteem. The client is distrustful of unit staff and "just wants to go home." Initially what is the nurse's priority? a) Making the client feel physically and emotionally safe b) Teaching the client effective coping skills c) Identifying the client's positive traits d) Focusing on preparing the client for a speedy discharge
a) Making the client feel physically and emotionally safe. Maslow describes safety as a basic need, meaning that it is so basic to existence that it must be resolved to reduce the tension associated with it. These needs have the greatest strength and must be satisfied before a person turns his attention to higher level needs.
A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with which term? a) Psychomotor agitation b) Senile dementia c) Central serotonin syndrome d) Hypertensive crisis
a) Psychomotor agitation
What are the physiologic responses associated with successful guided imagery? Select all that apply. a) Reduction of obsessive thoughts b) Reduction of anxiety c) Increase in appetite d) Improved sleep patterns e) Reduction of muscle pain
a) Reduction of obsessive thoughts b) Reduction of anxiety d) Improved sleep patterns With guided imagery people are taught to focus on pleasant images to replace negative or stressful feelings. This focus diverts a person from less positive thoughts or obsessions and decreases anxiety or insomnia. Patients have successfully used progressive muscle relaxation to reduce pain-related distress. Guided imagery is not known to directly increase appetite.
What stress-reduction technique should a nurse teach an individual experiencing severe performance anxiety? a) deep breathing. b) journal keeping. c) restructuring and setting priorities. d) assertiveness.
a) deep breathing. Changing the breathing pattern can be highly effective in aborting or mitigating the high anxiety level associated with performance anxiety. None of the other options are typically associated with anxiety management.
Which client behavior illustrates eustress? a) A man is laid off from his job. b) A bride is planning for her wedding. c) An adolescent gets into a fight at school. d) A college student fails an exam.
b) A bride is planning for her wedding. Eustress is the result of a positive perception toward a stressor, such as having a baby, planning a wedding, or getting a new job. The other options all describe distress, or a negative energy.
A client prescribed fluoxetine demonstrates an understanding of the medication teaching when making which statement? a) "I will not take any over-the-counter medication while on the fluoxetine." b) "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." c) "I will report increased thirst and urination to my provider." d "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction."
b) "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away."
Which statement would best show acceptance of a depressed, mute client? a) "It is important for you to share your thoughts with someone who can help you evaluate your thinking." b) "I would like to sit with you for 15 minutes now and again this afternoon." c) "Each day we will spend time together to talk about things that are bothering you." d) "I will be spending time with you each day to try to improve your mood."
b) "I would like to sit with you for 15 minutes now and again this afternoon."
A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best address this cognitive distortion with which response? a) "Is this part of the reason you think no one likes you?" b) "Let's look at what you just said that you can 'never do anything right.'" c) "Tell me what things you think you are not able to do correctly." d) "That is the most unrealistic thing I have ever heard."
b) "Let's look at what you just said that you can 'never do anything right.'"
A patient admitted with anxiety asks, "What exactly are stressors?" What is the nurse's best response to the patient's question? a) "Instead of focusing on what stressors are, let's explore your coping skills." b) "Stressors are events that happen that threaten your current functioning and require you to adapt." c) "Stressors are complicated neuro stimuli that cause mental illness." d) "It's best if you ask questions like that of your provider for a complete answer."
b) "Stressors are events that happen that threaten your current functioning and require you to adapt." Stressors are psychological or physical stimuli that are incompatible with current functioning and require adaptation. Stressors are not complicated neuro stimuli; telling the patient to address these questions to her provider fails to educate the patient, which is the nurse's responsibility. Exploring coping skills would be a good intervention at a later time but does not address the patient's question and changes the subject.
Which room placement would be best for a client experiencing a manic episode? a) A shared room with a client with dementia b) A single room near the nurses' station c) A shared room away from the unit entrance d) A single room near the unit activities area
b) A single room near the nurses' station The room placement that provides a non-stimulating environment is best. Nearness to the nurses' station means close supervision can be provided. None of the other options provide low stimulation.
The nurse is conducting an admission interview with a client who was raped 2 weeks ago. When asked about the rape, the client becomes very anxious and upset and begins to sob. What should be the nurse's response to the client's reaction? a) Reassure the client that anything she says to you will remain confidential. b) Acknowledge that the topic of the rape is upsetting and reassure the client that it can be discussed at another time when she feels more comfortable. c) Use silence as a therapeutic tool and wait until the client is done sobbing to continue discussing the rape. d) Push gently for more information about the rape because the information needs to be documented.
b) Acknowledge that the topic of the rape is upsetting and reassure the client that it can be discussed at another time when she feels more comfortable.
According to Freud, a client experiencing dysfunction of the conscious as part of the mind will have problems with which aspect of memory? a) Recent memory b) All memories c) Painful memories d) Long-term memory
b) All memories
Which client problem would be most suited to the use of interpersonal therapy? a) Disturbed sensory perception b) Dysfunctional grieving c) Impaired sensory perception d) Medication noncompliance
b) Dysfunctional grieving Interpersonal therapy is considered to be effective in resolving problems of grief, role disputes, role transition, and interpersonal deficit.
A 31-year-old client admitted with acute mania tells the staff and the other clients that he is on a secret mission for the President of the United States. He states, "I am the only one he trusts, because I am the best!" What term will the nurse use when documenting this behavior? a) Flight of ideas. b) Grandiosity c) Rapid cycling d) Unpredictability
b) Grandiosity Grandiosity is inflated self-regard. People with mania may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. Although clients with mania are unpredictable, the scenario does not describe unpredictability: rapid cycling is switching between mania and depression in a given time period. The scenario does not describe flight of ideas, which means a continuous flow of speech with abrupt topic changes.
The nurse providing anticipatory operant conditioning guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by which intervention? a) Scolding the child when he/she displays tantrum behaviors b) Ignoring the tantrum and giving attention when the child acts appropriately c) Giving the child what he/she is asking for d) Spanking the child at the onset of the tantrum behaviors
b) Ignoring the tantrum and giving attention when the child acts appropriately
A nurse expresses an exclusive belief in the biological model for mental illness when stating "it's the only one I really believe." What conclusion should be drawn from this statement? a) The biological model has been proven to be successful in finding the cause of most symptoms of mental illness. b) In believing only in the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account. c) The biological model is the most popular theory among leading psychiatrists and therefore the one that should be fully embraced. d) The biological model is the oldest and most reliable model for explaining mental illness.
b) In believing only in the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account. In believing only in the biological model to the exclusion of other theories and perspectives, influences such as educational, social, spiritual, cultural, environmental, and economic are not considered, and these have also been proven to play a part in mental health and mental illness. The other options are untrue.
What would a client experience during a progressive relaxation session? a) Having a nurse enter the client's energy field to rebalance it and bring harmony b) Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed c) Being attached to a machine that monitors a physical parameter and receiving audible feedback about the state of that parameter d) Being led into a positive imaginary sensory experience
b) Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed Instruction on sequential tensing and relaxing muscles provides a description of Benson's method of progressive relaxation. Being attached to a machine that uses sound describes biofeedback. Rebalancing an energy field describes therapeutic touch. Positive imaging describes a component of guided imagery.
A nurse is providing care to a 28-year-old client diagnosed with bipolar disorder who was admitted in a manic state. According to Maslow's Hierarchy of Needs theory, the nurse should identify which client symptom as having priority? a) Rapid, pressured speech b) Lack of sleep c) Hyperactive behavior
b) Lack of sleep Based on Maslow's theory, physiological needs such as food, water, air, sleep, etc., are the priority and must be taken care of first. The other options are symptoms of mania but not as critical as lack of sleep
Stress can be attributed to stimulation of the hypothalamus-pituitary-adrenal cortex. Which assessment finding would confirm the long-term effects of such stress? (Select all that apply.) a) Chronic muscle tension b) Obesity c) Insulin resistance d) Digestive problems e) A high resting heart rate
b) Obesity c) Insulin resistance Insulin resistance and obesity are considered long-term sequelae of the high blood glucose levels incurred when the body responds to stress. None of the other options are related to the hypothalamus-pituitary-adrenal cortex.
The client's priority nursing diagnosis has been established as risk for self-directed violence: suicide related to multiple losses. What is the priority outcome for this client? a) Attend self-help group daily. b) Refrain from attempting suicide. c) State absence of feelings of powerlessness. d) Be placed on suicide precautions.
b) Refrain from attempting suicide. Refraining from suicidal attempts is the only outcome that addresses the risk for self-directed violence. The absence of a feeling of powerlessness is not appropriate for the stated nursing diagnosis. The remaining options are interventions.
A 38-year-old client is admitted with major depression. Which statement made by the client alerts the nurse to a common accompaniment to depression? a) "I still pray and read my Bible every day." b) "I've heard others say that depression is a sign of weakness." c) "I still feel bad about my sister dying of cancer. I should have done more for her!" d) "My mother wants to move in with me, but I want to independent."
c) "I still feel bad about my sister dying of cancer. I should have done more for her!"
Which response should the nurse provide a client who asks, "Why you need to conduct an assessment interview"? a) "The assessment interview lets you have an opportunity to express your feelings." b) "You are able to tell me in detail about your past so that we can determine why you are experiencing mental health alterations." c) "We will be able to form a relationship together where we can discuss the current problems and come up with goals and a plan for treatment." d) "I need to find out more about you and the way you think in order to best help you."
c) "We will be able to form a relationship together where we can discuss the current problems and come up with goals and a plan for treatment." Some of the purposes of the assessment interview are to establish rapport, learn more about the presenting issues, and form mutual goals and a plan for treatment. The other options do not appropriately explain the assessment purpose.
A cognitive therapist would help a client restructure the thought "I am stupid!" to which statement? a) "I am not as smart as others." b) "Things like this should not happen to anyone." c) "What I did was stupid." d) "Things usually go wrong for me."
c) "What I did was stupid." Cognitive therapists help clients identify, reality test, and correct distorted conceptualizations and dysfunctional beliefs, such as realizing that doing a stupid thing does not mean the person is stupid.
What defense mechanisms can only be used in healthy ways? a) Idealization and splitting b) Suppression and humor c) Altruism and sublimation d) Reaction formation and denial
c) Altruism and sublimation Altruism and sublimation are known as mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses. This statement is not true of the other options.
A client admitted with major depression and suicidal ideation with a plan to overdose is preparing for discharge and asks you, "Why did I get a prescription for only 7 days of amitriptyline?" The nurse's response is based on what fact? a)Amitriptyline is very expensive, so the client may have to buy fewer at a time. b) The health care provider wants to see whether any side effects occur within the first week of administration. c) Amitriptyline is lethal in overdose. d) The goal is to see how the client responds to the first week of medication to evaluate its effectiveness.
c) Amitriptyline is lethal in overdose.
The nurse can expect a client demonstrating typical manic behavior to be attired in clothing that includes with characteristics? a) Ill-fitted and ragged b) Dark-colored and modest c) Colorful and inappropriate d) Compulsively neat and clean
c) Colorful and inappropriate Manic clients often manage to dress and apply makeup in ways that create a colorful, inappropriate, even bizarre, appearance. None of the remaining options meet that criteria.
Freud believed that individuals cope with anxiety by implementing which mechanism? a) The superego b) Security operations c) Defense mechanisms d) Cognitive distortions
c) Defense mechanisms The ego develops defenses or defense mechanisms to ward off anxiety by preventing conscious awareness of threatening feelings. None of the other options were proposed by Freud as a mechanism for dealing with anxiety.
What statement about the comorbidity of depression is accurate? a) Substance abuse and depression are seldom seen as comorbid disorders. b) Depression most often exists in an individual as a single entity. c) Depression is commonly seen in individuals with medical disorders. d) Depression may coexist with other disorders but is rarely seen with schizophrenia.
c) Depression is commonly seen in individuals with medical disorders.
What can be said about the comorbidity of anxiety disorders? a) Substance abuse disorders rarely coexist with anxiety disorders. b) Anxiety disorders virtually never coexist with mood disorders. c) Depression may occur prior to onset of anxiety. d) Anxiety disorders generally exist alone.
c) Depression may occur prior to onset of anxiety.
The nurse is planning care for a 14-year-old. The nurse demonstrates an understanding of the developmental task appropriate for this client by providing which experience? a) Spending one-on-one time with staff to establish trust b) Assign them to help clean up the dayroom to develop a sense of industry c) Encouraging them to talk about their school plans to help achieve identity d) Providing them with the opportunity to select which unit activities they will participate in to gain autonomy
c) Encouraging them to talk about their school plans to help achieve identity According to Erikson, the task of adolescence is to achieve identity rather than to be left in role confusion. A sense of identity is essential to making the transition into adulthood. While appropriate activities none of the options are specifically identified with the developmental task for a 14-year-old.
What is the major distinction between fear and anxiety? a) Fear enables constructive action; anxiety is dysfunctional. b) Fear is a universal experience; anxiety is neurotic. c) Fear is a response to a specific danger; anxiety is a response to an unknown danger. d) Fear is a psychological experience; anxiety is a physiological experience.
c) Fear is a response to a specific danger; anxiety is a response to an unknown danger.
A symptom commonly associated with panic attacks? a) Apathy b) Obsessions c) Fear of impending doom d) Fever
c) Fear of impending doom The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is severely limited, and misinterpretation of reality may occur. None of the other symptoms are associated with a panic attack.
A bipolar client tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." What term should the nurse use to identify this behavior? a) Limit testing b) Flight of ideas c) Grandiosity d) Distractibility
c) Grandiosity Exaggerated belief in one's own importance, identity, or capabilities is seen with grandiosity. None of the other options are associated with this behavior.
What principle forms the basis of nursing outcome planning? a) The goal of nursing action is to create a dependency between the client and the caregiver. b) Nursing interventions are designed to solve individuals' problems for them. c) Individuals have the right to outcomes that is reflective of their abilities. d) Nurses have the best understanding of client problems and so they direct outcome selection.
c) Individuals have the right to outcomes that is reflective of their abilities. Outcome criteria are the hoped-for outcomes that reflect the maximal level of patient health that the patient can realistically achieve through nursing interventions. None of the other options accurately describes the guiding principle of outcome planning.
Which tool can the novice nurse might refer to when writing nursing outcomes? a) Nursing Interventions Classification (NIC) b) Joint Commission (formally JCAHO) c) International Classification for Nursing Practice (ICNP) d) North American Nursing Diagnosis Association (NANDA)
c) International Classification for Nursing Practice (ICNP) International Classification for Nursing Practice ([ICNP], 2017) provides a classification of nursing diagnoses. In addition to these diagnoses, the INCP also provides nursing interventions, and nursing outcomes. That is not the function of any of the other options
Jacob, a college student whose friend recently committed suicide, rates his stress as low. Melissa was also friend with the person who committed suicide, but she rates her stress as high. The difference in how Jacob and Melissa rate their stress may be explained by which coping mechanism? a) Projection b) Denial c) Perception d) Repression
c) Perception Perception, which is influenced by gender, culture, age, and life experience, plays a part in how someone will respond to a stress. The perception of a stressor determines the person's emotional and psychological reactions to it. The other options are all defense mechanisms that do not explain the difference in reactions to a stressor.
What three structural components comprise a nursing diagnosis? a) Unmet need, goal, outcome criterion b) Problem, outcome, intervention c) Problem, probable cause, supporting data d) Presenting symptom, treatment, goal
c) Problem, probable cause, supporting data
A client states, "I will always be alone because nobody could ever love me." The nurse recognizes that the client is expressing what cognitive-behavioral concept? a) Actualization b) Aversion c) Schema d) Emotional consequence
c) Schema Schemas are unique assumptions about ourselves, according to Beck's theory. This statement is an example of a negative schema. Emotional consequence is the end result of negative thinking process, as described by Ellis. Actualization is a level of Maslow's Hierarchy of Needs. Aversion is a therapy characterized by punishment.
Which theorist is associated with behavioral therapy? a) Sullivan b) Peplau c) Skinner d) Freud
c) Skinner B.F. Skinner (1904-1990) represented the second wave of behavioral theorists and is recognized as one of the prime movers behind the behavioral movement.
Self-help groups are useful for reducing stress because they provide the individual with the stress mediator that take what form? a) Cognitive reframing b) Cultural support c) Social support d) Life satisfaction
c) Social support Self-help groups often provide a high level of social support. Members meet and are encouraged and sustained by others who share the same problem. None of the other options are expected to be provided by the self-help group format.
Which of the following is true of the relationship between bipolar disorder and suicide? a) Clients need to be monitored only in the depressed phase because this is when suicides occur. b) As long as clients with bipolar disorder adhere to their medication regimen, there is little risk for suicide. c) Suicide is a serious risk those diagnosed with bipolar disorder commit suicide. d) Clients with bipolar disorder are not considered high risk for suicide.
c) Suicide is a serious risk those diagnosed with bipolar disorder commit suicide. Mortality rates for bipolar disorder are severe because substantial numbers of individuals with bipolar disorder will make a suicide attempt at least once in their lifetime. Suicides occur in both the depressed and the manic phase. Bipolar clients are always considered high risk for suicide because of impulsivity while in the manic phase and hopelessness when in the depressed phase. Although staying on medications may decrease risk, there is no evidence to suggest that only clients who stop medications commit suicide.
What factor exerts the greatest influence on the degree to which various life events upset a specific individual? a) The effect of the individual's health-sustaining behaviors b) The individual's degree of spirituality c) The individual's perception of the event d) The amount of social support available to the individual
c) The individual's perception of the event Researchers have looked at the degree to which various life events upset specific individuals. They have found that the perception of a recent life event determines the person's emotional and psychological reactions to it. While the other options may be factors none contribute to the degree of stress than one's perception of the stressor.
An acute phase nursing intervention aimed at reducing hyperactivity is demonstrated by which intervention? a) Directing unit activities b) Orienting a new client to the unit c) Writing in a diary d) Exercising in the gym
c) Writing in a diary Manic clients often respond well to the invitation to write. They will fill reams of paper. While writing they are less physically active. None of the remaining options presents this opportunity to reduce physical activity.
A client diagnosed with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The client uses relaxation techniques to lower her blood pressure and is informed of her ongoing success by the tone. This process describes this technique? a) guided imagery. b) therapeutic touch. c) biofeedback. d) assertiveness training.
c) biofeedback. Biofeedback is a technique for gaining conscious control over unconscious processes. The scenario describes one method that might accomplish this.
An obsession is defined as what? a) Thinking of an action and immediately taking the action b) An intense irrational fear of an object or situation c) A recurrent behavior performed in the same manner d) A recurrent, persistent thought or impulse
d) A recurrent, persistent thought or impulse Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind. None of the remaining statements are accurate when defining the term obsession.
A 17-year-old client confides to the nurse that they have been thinking of ways to kill a peer. What response should the nurse give when the client states, "you have to keep it a secret because its confidential information"? a) "I will have to share this with the treatment team, but we will not share it with your parents." b) "Yes, I will keep it confidential. We have laws to protect clients' confidentiality."c) "I will keep it a secret, but you and I need to discuss ways to deal with this situation appropriately without committing a crime." d) "Issues of this kind have to be shared with the treatment team and your parents."
d) "Issues of this kind have to be shared with the treatment team and your parents." Although adolescent clients request confidentiality, issues of sexual abuse, threats of suicide or homicide, or issues that put the client at risk for harm must be shared with the treatment team and the parents. A threat of this nature must be discussed with the treatment team and the parents. Confidentiality laws do not protect information that would lead to harm to the client or others.
The nurse best assesses the client's spiritual life by asking which question? a) "Do you practice a specific religion?" b) "To whom do you turn in times of crisis?" the client to define the role of religion in their life allows for discussion related to the other topics. c) "Do you attend church regularly?" d) "What role does religion play in your life?"
d) "What role does religion play in your life?" Asking the client to define the role of religion in their life allows for discussion related to the other topics.
A 26-year-old client is brought to the emergency room by a friend. The client is unable to give any coherent history. Which response should the nurse provide when the client's friend offers to provide information regarding the client? a) "Yes, however, we will have to get a release signed from the client for you to be able to talk with me." b) "There is no need for that as I will call his primary care provider to obtain the information we need." d) "Yes, I will be happy to get any information and history that you can provide." e) "I'm sorry, but I cannot take any information from you as it would violate confidentiality laws."
d) "Yes, I will be happy to get any information and history that you can provide." The friend is a secondary source of information that will be helpful since the client is not able to give any history or information at this time. Confidentiality laws do not prohibit obtaining information from a secondary source. The friend can provide information and/or history immediately and may be able to relate events that happened just before coming to the hospital. A release would not be necessary to take information about the client from a secondary source, and a psychotic client would not be competent to sign a release.
How does Harry Stack Sullivan's Interpersonal Theory view anxiety? a) A sign of guilt in adults. b) The result of trying to go beyond experiences of guilt and pain. c) An emotional experience felt after the age of 5 years. d) A painful emotion arising from social insecurity.
d) A painful emotion arising from social insecurity. According to Sullivan, the purpose of all behavior is to get needs met through interpersonal interactions and decrease or avoid anxiety. He viewed anxiety as a key concept and defined it as any painful feeling or emotion arising from social insecurity or blocks to getting biological needs satisfied.
What is the premise underlying behavioral therapy? a) Motives must change before behavior changes. b) Behavior is determined by cognitions; change in cognitions produces new behavior. c) Behavior is a product of unconscious drives. d) Behavior is learned and can be modified.
d) Behavior is learned and can be modified. The premise underlying behavior therapy is that behavior is learned and can be modified. Behaviorists agree that behavior can be changed without insight into the underlying cause. None of the remaining options are true statements when considering behavioral therapy.
A client hospitalized for a psychotic relapse is being discharged home to family. Which topic is important to address when teaching both the client and the family to recognize possible signs of impending mania? a) Decreased social interaction b) Increased appetite c) Increased attention to bodily functions d) Decreased sleep
d) Decreased sleep Changes in sleep patterns are especially important because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania. The other options do not indicate impending mania.
A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." What is the best initial approach to managing this behavior? a) Enforcing consequences by responding, "Let's walk down to the seclusion room.". b) Reprimand the client by stating, "What an offensive thing to suggest!" c) Clarifying the nurse-client relationship by stating, "I don't have sex with clients." d) Distracting the client by suggesting, "It's time to work on your art project."
d) Distracting the client by suggesting, "It's time to work on your art project." Distractibility works as the nurse's friend. Rather than discuss the invitation, the nurse may be more effective by redirecting the client. This intervention is both therapeutic and less restrictive.
Which side effects of lithium can be expected at therapeutic levels? a) Coarse hand tremor and gastrointestinal upset b) Nausea and thirst c) Ataxia and hypotension d) Fine hand tremor and polyuria
d) Fine hand tremor and polyuria The fact that fine hand tremor and polyuria are present at therapeutic levels is quite annoying to some clients. These and other side effects are factors in noncompliance.
Which nursing diagnosis for a psychiatric client is correctly structured and worded? a) Hopelessness related to severe chronic depression b) Spiritual distress as evidenced by client stating "God has abandoned me because I'm a bad person" c) Defensive coping related to lack of insight associated with illicit drug use d) Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting "I'm not worthy of eating"
d) Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting "I'm not worthy of eating" This diagnosis contains all the required components: problem statement, related factors, and defining characteristics
12. What information should the nurse provide the client concerning the function of the "id" and the ability to function as an adult? a) It provides an individual with the ability to differentiate believed and real experiences. b) It has control over the emotional frustration felt as an adult. c) It is severely damaged by abuse experienced before the age of 5 years. d) It is the source of one's survival instincts.
d) It is the source of one's survival instincts.
Role-playing is associated with which type of psychotherapy? a) Systematic desensitization b) Operant conditioning c) Psychoanalysis d) Modeling
d) Modeling In modeling, the therapist provides a role model for specific identified behaviors, and the client learns through imitation. The therapist may do the modeling, provide another person to model the behaviors, or present a video for the purpose. Some behavior therapists use role-playing in the consulting room for modeling therapy. Demonstration of specific behaviors are not supported by any of the remaining options.
The mental status examination aids in the collection of what type of data? a) Covert b) Physical c) Subjective d) Objective
d) Objective The mental status exam mostly aids in the collection of objective data.
Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? a) They tend to be more effective for men. b) They often cause the client to have diurnal variation. c) Recent memory impairment is commonly observed. d) Onset of action is from 1 to 3 weeks or longer.
d) Onset of action is from 1 to 3 weeks or longer.
When a client experiences four or more mood episodes in a 12-month period, which term is used to describe this behavior? a) Incongruent b) Cyclothymic c) Dyssynchronous d) Rapid cycling
d) Rapid cycling Rapid cycling implies four or more mood episodes in a 12-month period, as well as more severe symptomatology. None of the other options are associated with this characteristic behavior.
Assessment of the thought processes of a client diagnosed with depression is most likely to reveal what characteristic? a) Sexual preoccupation b) Good memory and concentration c) Delusions of persecution d) Self-deprecating ideation
d) Self-deprecating ideation
A 43-year-old client being seen in the mental health clinic states, "I have always been a practicing Jew, but in the past few months I am questioning everything. I just don't know if I believe in it anymore." Which of the following nursing diagnoses best describes the client's comment? a) Ineffective coping b) Risk for self-harm c) Hopelessness d) Spiritual distress
d) Spiritual distress The client is expressing distress regarding his religion and spiritual well-being. The client could be experiencing ineffective coping, but this does not directly relate to his comment. There is nothing in the client's comment that would lead to the conclusion that the client is having thoughts of harming himself or experiencing hopelessness.
When the nurse asks whether a client is having any thoughts of suicide, the client becomes angry and defensive, shouting, "I'm sick of you people! All you ever do is ask me the same question over and over. Get out of here!" What fact concerning hostility should the nurse's response be based upon? a) The client is probably experiencing transference. b) The client may be angry at someone else and projecting that anger to staff. c) The client is getting better and is able to be assertive. d) The client may be at high risk for self-harm.
d) The client may be at high risk for self-harm.
When the partner of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on which information? a) Much depends on the socioeconomic class of the individuals. b) Highly creative people tend toward development of the disorder. c) No research exists to suggest genetic transmission. d) The rate of bipolar disorder is higher in relatives of people with bipolar disorder.
d) The rate of bipolar disorder is higher in relatives of people with bipolar disorder. This understanding will allow the nurse to directly address the question. Responses based on the other statements would be tangential or untrue.
When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to implement which intervention? a) Prompting the client if the reply is slow b) Reviewing the client's medical record to support the client's response c) Repeating the question if the client does not answer promptly d) Waiting quietly for the client to reply
d) Waiting quietly for the client to reply
When a client reports that lithium causes an upset stomach, the nurse should make which suggestion associated with taking the medication? a) 2 hours after meals b) With an antacid c) 30 minutes before meals d) With meals
d) With meals Many clients find that taking lithium with or shortly after meals minimizes gastric distress. None of the other options present accurate information.
What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? a) Advise the client to curtail salt intake for 24 hours. b) Continue to administer medication as ordered. c) Advise the client to limit fluids for 12 hours. d) Withhold medication and notify the physician.
d) Withhold medication and notify the physician. The client's lithium level has exceeded desirable limits. Additional doses of the medication should be withheld, and the physician notified. None of the other options are accurate interventions.
What is the primary source for data collection during a psychiatric nursing assessment? a) client's nonverbal responses. b) client's medical treatment records. c) client's family and friends. d) client's own words and actions.
d) client's own words and actions. The client should always be considered the primary data source. At times, however, the client will be unable to fulfill this role.
