Mental Health Exam 3

What is phase 4 of a crisis?

Mobilization of internal and external resources Goal is to return the client to at least a precrisis level of functioning

What are some examples of a adventitious crisis?

Natural disasters National disasters A crime of violence

What is crisis intervention?

A directive, time-limited, and goal-directed strategy designed to assist individuals who are experiencing a crisis Has been shown to be effective in helping people adaptively cope with stressful events Knowledge of crisis intervention techniques is an important skill of all nurses no matter the practice speciality or clinical setting

What is phase 1 of a crisis?

External precipitating event

What is important about interventions for patients with dementia?

A person-centered approach has shown evidence in decreasing agitation in those with dementia

What is the best medication for treating psychosis?

Antipsychotic medications (ex. Aripiprazole, Clozapine, Olanzapine, and Risperidone)

What is Rape-trauma syndrome?

Applies to the physical and psychological effects of rape Is defined as sustained and maladaptive response to a forced, violent sexual penetration against the victim's will and consent

Which patient has the highest risk for violence? A. A patient with poor coping skills B. A patient with a history of violence C. A patient with a diagnosis of schizophrenia D. A patient with a diagnosis of avoidant personality disorder

B. A patient with a history of violence

Which of the following responses to anger from others should the nurse expect as common in clients? A. Increased self-esteem B. Feelings of invulnerability C. Fear of harm D. Powerlessness

C. Fear of harm

What are the different types of rape?

Completed rape and attempted rape

What is the cycle of violence?

Consists of three stages: tension-building stage, acute battering stage, and honeymoon stage

What is phase 3 of a crisis?

Failure of coping Increasing disorganization Emergence of physical symptoms Relationship problems

What is the primary intervention for those who have suicidal ideation and have attempted suicide?

Includes activities that provide support, information, and education to prevent suicide

What is intimate partner violence?

Includes physical violence, rape, and/or stalking and psychological aggression Females between the age of 18-34 experience the highest rate of intimate partner violence 1 out of 10 homicides is due to spousal murder, and about a third of females who are killed are or were with an intimate relationship with their killer

What can be noted about crisis intervention techniques?

Involves listening for the emotional feeling message underlying the verbal message, especially when the patient presents as angry, hostile, and overwhelmed

What is a completed suicide?

One in which self-injurious acts committed by an individual results in death

What is phase 2 of a crisis?

Perception of the threat Increase in anxiety Client may cope or resolve the crisis

What are examples of hard methods of suicide?

Using a gun Hanging Jumping off of a building Poisoning with carbon monoxide Staging a car crash

What is Robert's seven-stage model of crisis interventions?

1. Plan and conduct crisis assessment (including lethality measures) 2. Establish rapport and rapidly establish relationship 3. Identify major problems (including the "last straw" of crisis precipitants) 4. Deal with feelings and emotions (including active listening and validation) 5. Generate and explore alternatives 6. Develop and formulate a plan of action 7. Follow-up plan and agreement

What is the biochemistry for a patient who is suicidal?

Is noted to be genetic SKA2 gene expression is lower in patients with suicidal ideation Low serotonin levels are related to depressed mood, which has been noted in studies it has been noted that low levels of serotonin or its metabolites have been found in cerebrospinal fluid of patient who are suicidal

A woman who was raped in her home was brought to the emergency department by her husband. After being interviewed by the police, the husband talks to the nurse. "I don't know why she didn't keep the doors locked like I told her to. I can't believe she had sex with another man now." The nurse should respond by saying: A. "Let's talk about how you feel. Maybe it would help to talk to other men who have been through this" B. "Maybe the doors were locked, but the man broke in away" C. "Your wife needs your support right now, not your criticism" D. "It was not consensual sex. Let's see your wife was physically injured"

A. "Let's talk about how you feel. Maybe it would help to talk to other men who have been through this"

When the nurse finishes addressing a group of college women about rape, the following comments are heard during the discussion period. Which comment calls for additional teaching by the nurse? A. "So if you dress conservatively, your risk of being raped is small" B. "Who would have guessed that most rape victims know the rapist?" C. "It makes sense that rape is a crime of violence, not a crime of sex" D. "I always thought rapes happened at night, but now I know that isn't true"

A. "So if you dress conservatively, your risk of being raped is small"

During the immediate post-rape period what verbal nursing intervention would best lower patient anxiety and increase feelings of safety? A. "You are safe here. I will stay with you while you have your examination" B. "I know you feel confused. We will make all the necessary decisions for you" C. "Please tell me as much about the details of the rape as you can remember" D. "When you leave you will be given follow-up appointments for pregnancy and sexually transmitted disease screening"

A. "You are safe here. I will stay with you while you have your examination"

When considering community suicide prevention programs, what population should the nurse plan to service with regular suicide screenings? Select all that apply A. 10-34-year olds B. Males C. College-educated adults D. Rural population E. Native Americans

A. 10-34-year olds B. Males E. Native Americans

MD writes an order for Xanax 2 mg by mouth a day. Pharmacy dispenses you with 1 mg per tablet of Xanax. How many tablets do you administer per dose? A. 2 tablets B. 3 tablets C. 3.7 tablets D. 1 tablet

A. 2 tablets

MD writes an order for Lactulose 20 grams by mouth BID. Pharmacy dispenses you with 10 gram/15 ml. How many ml will you administer per dose? A. 30 mL/dose B. 15 mL/dose C. 20 mL/dose D. 7.5 mL/dose

A. 30 mL/dose

MD writes an order for Posaconazole 75 mg by mouth once a day. Pharmacy dispenses you with 20 mg/ 2 ml. How many ml will you administer per dose? A. 7.5 mL/dose B. 3 mL/dose C. 2.5 mL/dose D. 12 mL/dose

A. 7.5 mL/dose

Based upon current information regarding successful suicide attempts among the male population, which factor is relevant? Select all that apply A. Access to firearms B. 75 years of age and older C. History of alcohol consumption D. American Indian and Alaskan natives E. History of antidepressant medication therapy

A. Access to firearms B. 75 years of age and older C. History of alcohol consumption D. American Indian and Alaskan natives

Which intervention(s) should the nurse implement when helping a patient expresses anger in an inappropriate manner? Select all that apply A. Approach the patient in a calm, reassuring manner B. Provide suggestions regarding acceptable ways of communicating anger C. Warn the patient that being angry is not a healthy emotional state D. Set limits on the angry behavior that will be tolerated E. Allow any expression of anger as long as no one is hurt

A. Approach the patient in a calm, reassuring manner B. Provide suggestions regarding acceptable ways of communicating anger D. Set limits on the angry behavior that will be tolerated

The expected outcome at the conclusion of crisis intervention therapy is that the patient will function in which of the following ways? A. At the pre-crisis level B. At a higher level than before the crisis C. Only marginally below the pre-crisis level D. Without aid from identified support systems

A. At the pre-crisis level

A young woman has been stalked and then beaten by an ex-boyfriend. Treatment of her injuries is complete and she is ready for discharge. To ensure the woman's safety and security prior to discharge, the nurse should do which if the following? Select all that apply A. Determine the current location of the ex-boyfriend B. Ask if she plans to see the ex-boyfriend again C. Provide information on resources and a safety plan D. Ensure that she has a safe place to stay after discharge E. Obtain consent to send her emergency department records to her family primary health care provider

A. Determine the current location of the ex-boyfriend B. Ask if she plans to see the ex-boyfriend again C. Provide information on resources and a safety plan D. Ensure that she has a safe place to stay after discharge

The emergency department nurse is caring for an adult client who is a victim of family violence. Which priority information should be included in the discharge instructions? A. Information regarding shelters B. Instructions regarding calling the police C. Instructions regarding self-defense classes D. Explaining the importance of leaving the violent situation

A. Information regarding shelters

Which racial identification places a woman at the greatest risk of being sexually assaulted in her lifetime? A. Multiracial B. American Indian C. Black non-Hispanic D. Caucasian

A. Multiracial

The nurse is planning care for a client being admitted to the nursing unit who attempted suicide. Which priority nursing intervention should the nurse include in the plan of care? A. One-to-one suicide precautions B. Suicide precautions with 30-minute checks C. Checking the whereabouts of the client every 15 minutes D. Asking the client to report suicidal thoughts immediately

A. One-to-one suicide precautions

Which factors concerning the needs and wishes of suicide survivors should be considered when formulating interventions for this population? Select all that apply A. Suicide often is considered a taboo subject by society B. Surviving family and friends may experience both shame and guilt C. Talking about a loved one increases the survivor's feelings of grief D. A family history of suicide is a strong risk factor for future suicide attempts E. Most surviving friends and relatives will not seek treatment despite their suffering

A. Suicide often is considered a taboo subject by society B. Surviving family and friends may experience both shame and guilt D. A family history of suicide is a strong risk factor for future suicide attempts E. Most surviving friends and relatives will not seek treatment despite their suffering

The community health nurse is teaching about prevention of abuse. Which are examples of tertiary prevention? Select all that apply A. Support groups for survivors B. Reduction of stress for the abuser C. Teaching of coping skills to the abuser D. Legal advocacy programs for survivors E. Screening programs for high-risk individuals

A. Support groups for survivors D. Legal advocacy programs for survivors

A grandson who calls the crisis center expressing concern about his grandmother, who lost her husband a month ago states, "She has been in bed for a week and is not eating or showering. She told me that she did not want to kill herself, but it's not like her to do nothing for herself. She won't even talk to me when I visit her." The nurse encourages the grandson to bring his grandmother to the center for evaluation based on which of the following criteria? A. The behaviors may reflect passive suicidal thoughts B. The behaviors reflect altered role performance C. Seeing the grandson and grandmother together will be helpful D. Refusing to talk to the grandson alone indicates a major problem

A. The behaviors may reflect passive suicidal thoughts

What are some interventions for a patient who is actively experiencing command hallucinations?

Ask them if they are planning on hurting themselves Ask them what the voices are saying to them Reorient them to self, place, and time if needed Help the client establish what is real and unreal Stay with the client if they are frightened Speak to the client in a simple, direct, and concise manner

What is one important thing that a nurse should assess and performing intervention on a patient with suicidal ideation?

Asking about it

What are some interventions that should be implemented for a patient who is suicidal?

Assess for suicidal intent or ideation and initiate suicide precautions The client's statements, behaviors, and mood are documented every 15 minutes Remove harmful objects Do not leave the client alone Provide a nonjudgemental, caring attitude

A nurse is giving postvention to the wife of a depressive patient who committed suicide. What statements indicate that the nurse understands postvention? Select all that apply A. "You should be strong for your family" B. "Don't be afraid to talk about your husband" C. "Donating your husband's belongings may help you let go" D. "I can't allow you to meet your husband's primary health care provider" E. "Why didn't you admit your husband immediately for treatment of his depression?"

B. "Don't be afraid to talk about your husband" C. "Donating your husband's belongings may help you let go"

Which patient statement does not demonstrate an understanding of a suicide safety plan? A. "I know that when I start thinking about my dad, I'm going to start thinking about killing myself" B. "Going for a really long, hard run helps clear my mind and stops suicidal thoughts" C. "My sister is always there for me when I start getting suicidal" D. "I keep the suicide prevention number in my wallet"

B. "Going for a really long, hard run helps clear my mind and stops suicidal thoughts"

Which of the following physiologic responses should the nurse expect as unlikely to occur when a client is angry? A. Increased respiratory rate B. Decreased blood pressure C. Increased muscle tension D. Decreased peristalsis

B. Decreased blood pressure

In a true crisis state, involving a period of severe disorganization, is difficult to endure emotionally and physically. The nurse recognizes that a client will only be able to tolerate being in a crisis for which of the following lengths of time? A. 1-2 weeks B. 4-6 weeks C. 12-14 weeks D. 24-26 weeks

B. 4-6 weeks

The nurse has been closely observing a client who has been displaying aggressive behaviors. The nurse observes that the client is escalating. Which nursing intervention is most helpful to this client at this time? Select all that apply A. Initiate confinement measures B. Acknowledge the client's behavior C. Assist the client to an area that is quiet D. Maintain a safe distance from the client E. Allow the client to take control of the situation

B. Acknowledge the client's behavior C. Assist the client to an area that is quiet D. Maintain a safe distance from the client

Which of the following is a nursing intervention directed at the psychological needs of an abused person? A. Encourage the patient to immediately leave the abuser B. Affirm that the patient did not deserve or cause the abuse C. Provide a referral to social services for economic problems D. Facilitate contact with law enforcement to take legal action

B. Affirm that the patient did not deserve or cause the abuse

Kara is a 23-year-old patient admitted with depression and suicidal ideation. Which intervention(s) would be therapeutic for Kara? Select all that apply A. Focus primarily on developing solutions to the problems leading the patient to feel suicidal B. Assess the patient thoroughly and reassess the patient at regular intervals as levels of risk fluctuate C. Avoid talking about the suicidal ideation as this may increase the patient's risk for suicidal behavior D. Meet regularly with the patient to provide opportunities for the patient to express and explore feelings E. Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group F. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic

B. Assess the patient thoroughly and reassess the patient at regular intervals as levels of risk fluctuate D. Meet regularly with the patient to provide opportunities for the patient to express and explore feelings E. Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group F. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic

A major role in crisis intervention is getting a client's significant other involved in helping with the immediate crisis as soon as possible. The nurse should determine that the support persons are prepared to help when they verbalize which of the following? A. The name and phone number of the client's primary health care provider B. Emergency resources and when to use them C. The coping strategies they are using D. Long-term solutions they plan to tell the client to use

B. Emergency resources and when to use them

In developing a plan of care for a client who has had previous episodes of angry, verbal outbursts, the nurse plans to take an educational approach to the problem. Arrange the following steps the nurse should take from first to last. A. Assisting the client to recognize the early cues that he is angry B. Helping the client identify triggers for his anger C. Practicing with the client appropriate ways to express his anger D. Identifying alternate ways to express his anger

B. Helping the client identify triggers for his anger A. Assisting the client to recognize the early cues that he is angry D. Identifying alternate ways to express his anger C. Practicing with the client appropriate ways to express his anger

The nurse is assessing a client who has just experienced a crisis. The nurse should first assess the client for which of the following behaviors? A. Effective problem-solving skills B. Level of anxiety C. Attention span D. Help-seeking behavior

B. Level of anxiety

As an angry client becomes more agitated while talking about his problems, the nurse decides to ask for staff assistance in taking control of the situation when the client demonstrates which of the following behaviors? A. Swearing about his wife's behaviors when discussing martial problems B. Picking up a pool cue stick and telling the nurse to get out of the way C. Making a fist and pounding loudly on the table D. Coming out of his room instead of staying in time-out

B. Picking up a pool cue stick and telling the nurse to get out of the way

A 16-year-old who is being seen by a crisis nurse after making several superficial cuts on her wrist, states that all of her friends are siding with her ex-boyfriend and won't talk to her anymore. She says she knows that the relationship is over, but "If I can't have him, no one else will." Which of the following client problems takes the highest priority? A. Situational low self-esteem B. Risk for other-directed violence C. Risk for suicide D. Risk-prone health behavior

B. Risk for other-directed violence

Which nursing diagnosis is the priority when planning care for a patient who displays considerable anger and occasional aggression? A. Social isolation B. Risk for other-directed violence C. Ineffective coping: maladaptive D. Ineffective coping: overwhelmed

B. Risk for other-directed violence

A nurse is conducting crisis intervention for a patient who is a victim of physical assault and learns that the patient is confused and overwhelmed. Which strategy does the nurse implement while interacting with the patient to make the patient feel comfortable? A. The nurse avoids making eye contact with the patient B. The nurse summarizes the information given by the patient C. The nurse advises the patient to have regular follow-up visits D. The nurse refrains from giving frequent feedback to the patient

B. The nurse summarizes the information given by the patient

A female victim of sexual assault is being seen in the crisis center. The client states that she still feels "as though the rape just happened yesterday," even though it has been a few months since the incident. Which is the most appropriate nursing response? A. "You need to try to be realistic. The rape did not just occur" B. "It will take some time to get over these feelings about your rape" C. "Tell me more about the incident that causes you to feel like the rape just occurred" D. "What do you think that you can do to alleviate some of your fears about being raped again?"

C. "Tell me more about the incident that causes you to feel like the rape just occurred"

The nurse is conducting an initial assessment of a client in crisis. When assessing the client's perception of the precipitating even that led to the crisis, which is the most appropriate question? A. "With whom do you live?" B. "Who is available to help you?" C. "What leads you to seek help now?" D. "What do you usually do to feel better?"

C. "What leads you to seek help now?"

The nurse is preparing a client with schizophrenia with a history of command hallucinations for discharge by providing instructions on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggests to the nurse that the client has a need for additional information? A. "My medications will help my anxious feelings" B. "I'll go to support group and talk about what I am feeling" C. "When I have command hallucinations, I'll call a friend for help" D "I need to get enough sleep and eat well to help prevent feeling anxious"

C. "When I have command hallucinations, I'll call a friend for help"

MD writes an order for Mucomyst 300 mg by mouth one dose before heart cath. Pharmacy dispenses you with 600 mg/2 ml. How many ml will you administer per dose? A. 150 mL/dose B. 2 mL/dose C. 1 mL/dose D. 0.25 mL/dose

C. 1 mL/dose

The doctor writes an order for a liquid oral medication. The order says to administer 15 mg by mouth every 4 hours as needed for sore throat. Pharmacy dispenses you with 30 mg/3ml. How many ml will you administer per dose? A. 0.5 mL/dose B. 3 mL/dose C. 1.5 mL/dose D. 6 mL/dose

C. 1.5 mL/dose

A client is being discharged after 3 days of hospitalization for a suicide attempt that followed the receipt of a divorce notice. Which of the following, if verbalized by the client, indicates to the nurse that the client is ready for discharge? A. A readiness for discharge B. Names and phone numbers of two divorce lawyers C. A list of support persons and community resources D. Emotional stability

C. A list of support persons and community resources

The nurse understands that with the right help at the right time, a client can successfully resolve a crisis and function better than before the crisis, based primarily on which of the following factors? A. Relinquishment of dysfunctional coping B. Reestablishment of lost support systems C. Acquisition of new coping skills D. Gain of crisis prevention knowledge

C. Acquisition of new coping skills

The nurse is performing crisis intervention for a patient who has been sexually assaulted. What appropriate action does the nurse take first? A. Assess the vital signs of the patient B. Assess the coping skills of the patient C. Assess the patient for any suicidal intentions D. Learn the patient's perception of the situation

C. Assess the patient for any suicidal intentions

A client is admitted to the mental health unit after an attempted suicide by hanging. The nurse can best ensure client safety by which action? A. Requesting that a peer remain with the client at all times B. Removing the client's clothing and placing the client in a hospital gown C. Assigning the client a staff member who will remain with the client at all times D. Admitting the client to a seclusion room where all potentially dangerous articles are removed

C. Assigning the client a staff member who will remain with the client at all times

A moderately depressed client who was hospitalized 2 days ago suddenly begins smiling and reporting that the crisis is over. The client says to the nurse, "I'm finally cured." Based on the client's behavior and statement, which intervention should the nurse include in the plan? A. Suggesting a reduction of medication B. Allowing increased "in-room" activities C. Increasing the level of suicide precautions D. Encourage and assist the client to ventilate feelings

C. Increasing the level of suicide precautions

When a client is about to lose control, the extra staff who come to help commonly stay at a distance from the client unless asked to move closer by the nurse who is talking to the client. Which of the following best explains the primary rationale for staying at a distance initially? A. The client is more likely to act out if there is an audience, even additional staff B. The nurse if talking to the client makes the decisions about other staff actions C. The client is likely to receive others as being closer than they are and feel threatened D. When the extra staff is viable, the client is less likely to regain self-control

C. The client is likely to receive others as being closer than they are and feel threatened

What are examples of soft methods of suicide?

Cutting one's wrists Inhaling natural gas Ingesting pills

A 35-year-old man was experiencing marital discord with his wife of 4 years. When his wife walked out, he became angry, throwing things and breaking dishes. A friend talked him into seeking help at the local mental health center. Which of these questions should the nurse ask initially to begin to assess this man's immediate problem? A. "Do you feel in control of yourself at this time?" B. "What did you do to cause your wife to leave?" C. In hindsight, how might you have managed this situation differently?" D. "What led you to come in for help today?"

D. "What led you to come in for help today?"

The nurse is creating a plan of care for a client in a crisis state. When developing the plan, the nurse should consider which factor? A. A crisis state indicates that the client has a mental illness B. A crisis state indicates that the client has an emotional illness C. Presenting symptoms in a crisis situation are similar for all clients experiencing a crisis D. A client's response to a crisis in individualized and what constitutes a crisis for one client may not constitute a crisis for another client

D. A client's response to a crisis in individualized and what constitutes a crisis for one client may not constitute a crisis for another client

The nurse manager on a psychiatric unit is reviewing the outcomes of staff participation in an aggression management program. Evaluation of such a program would be based primarily on which of the following indicators? A. Fewer client injuries during restraint procedures B. A reduction of complaints by clients's relatives C. Fewer staff injuries during restraint procedures D. A reduction in the total number of restraint procedures

D. A reduction in the total number of restraint procedures

When planning the care of a client experiencing aggression, the nurse incorporates the principle of "least restrictive alternative," meaning that less restrictive interventions must be tried before more restrictive measures are employed. Which of the following measures should the nurse consider to be most restrictive? A. Tension reduction strategies B. Haloperidol (Haldol) given orally C. Voluntary seclusion or time-out D. Haloperidol (Haldol) given intramuscularly

D. Haloperidol (Haldol) given intramuscularly

The nurse judges that a client is ready to be released from seclusion and restraints when the client demonstrates which of the following behaviors? A. Is adequately sedated B. Struggles less against the restraints C. Stops swearing and yelling D. Shows signs of self-control

D. Shows signs of self-control

What are some examples of nursing diagnoses for a patient who is a victim of sexual assault?

Disturbed personal identity Situational low self-esteem Interrupted family processes

What is to be noted about the care of the family for a patient who has committed suicide?

Health care providers are often involved in providing mental healthcare to these survivors, which is referred to as postvention

What is completed rape?

Is defined as "penetration," no matter how slight, of the vagina or anus with any body part of object, or oral penetration by a sex organ of another person, without the consent of the "victim"

What is attempted rape?

Is defined as threats or intentions of rape that is unsuccessful

What are some examples of a maturational crisis?

Leaving home for the first time Marriage The birth of a child Retirement Death of a parent

What are some examples of a situational crisis?

Loss or change of a job Death of a loved one An abortion A change in financial status Divorce Severe physical or mental illness

What is Seasonal Affective Disorder (SAD)?

SAD is a subtype of major depressive disorder associated with the winter season and short days SAD is characterized by atypical symptoms of depression (e.g., oversleeping and overeating) and a heavy feeling in the limbs ("leaden paralysis") Many SAD patients improve in response to full-spectrum light exposure