Mental health midterm quiz

A client receiving long-term therapy with lithium carbonate (Lithobid) exhibits muscle tremors, confusion, vomiting, and diarrhea. The nurse anticipates that the results of the latest test of the serum lithium level will be between: __?

1.5 and 2.0 mEq/L (The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L.. Serum lithium concentrations of 1.5 to 2.0 mEq/L may produce a variety of symptoms, including vomiting, diarrhea, drowsiness, incoordination, coarse hand tremors, muscle tremors, and mental confusion.)

In preparing for the orientation phase of the therapeutic relationship, the nurse suggests addressing which of the following subjects?

Establishing the parameters of the relationship During the orientation phase of the therapeutic nurse-client relationship, four subjects need to be addressed. These subjects include the parameters of the relationship, the formal or informal contract, confidentiality, and termination of the relationship. Promoting problem-solving skills and self-esteem and facilitating behavioral change are subjects of the working phase of the nurse-client relationship.

Which nursing diagnosis is written correctly? Select one: a. Low self-esteem related to major depressive disorder evidenced by childhood abuse. b. Conduct disorder related to childhood sexual abuse evidenced by hostile and aggressive behaviors. c. Imbalanced nutrition: less than body requirements related to suspiciousness evidenced by 20 lbs. weight loss. d. Risk for social isolation related to low self-esteem evidenced by staying in room during the day.

Imbalanced nutrition: less than body requirements related to suspiciousness evidenced by 20 lbs. weight loss.

A mental health nurse is assigned to care for a client with a diagnosis of undifferentiated schizophrenia with acute exacerbation. The nurse uses which of the following approaches when planning care for this client?

Provide assistance with grooming and nutrition until the client's thinking has cleared.

The nurse is assisting in developing a plan of care for a client with a psychotic disorder who is experiencing altered thought processes that include the belief that the food is being poisoned. The nurse develops strategies that will encourage the client to discuss feelings and plans to:

Use open-ended questions and silence.

A client hates her mother because of childhood neglect.The nurse determines which client statement represents the use of the use of the defense mechanism of reaction formation?

d. "I have a very wonderful mother whom I love very much." ...

The following patients are seen in the emergency department. Which of the following patients meets the severity of illness and intensity of care required for the admitting officer to recommend admission to the psychiatric unit? The patient who:

d. who is a single parent and hears voices saying, "Smother your infant." Admission to the hospital would be justified by the risk of patient danger to self or others. The other patients have issues that can be handled with less restrictive alternatives than hospitalization.

In the shift-change report, an off-going nurse criticizes a patient who wars heavy makeup. Which comment by the nurse who receives the report best demonstrates advocacy?

"Our patients need our help to learn behaviors that will help them get along in society."

For the last year, a college student continually and unrealistically worries about academic performance and love life performance. The student is irritable and suffers from severe insomnia.This behavior is associated with which diagnosis?

Generalized Anxiety Disorder (GAD) Correct (GAD may be diagnosed when excessive, unrealistic worry and anxiety become chronic and last for at least 6 months. The anxiety experienced is generalized rather than specific.The anxiety is not associated with a specific object as in phobia, or event as in PTSD.)

The nurse is preparing a client for discharge who was hospitalized following a suicide attempt. The nurse evaluates that the client could benefit from further development of coping strategies if the client was overheard making which of the following statements prior to discharge?

a. "I know that I won't become depressed again after the treatment I received here." (Depression is a mood disorder that can be a recurrent illness. The client must learn to recognize symptoms of the disorder and to know who and when to call to resume more active treatment. Each of the incorrect options indicates a successful coping mechanism or health-promoting behavior.)

The nurse is developing a care plan that will include goals that will help the client achieve an optimal level of functioning and appropriate resource utilization. When the nurse enters the client's room, the client asks the nurse, "Could you ask the physician to let me have a pass for the weekend?" The nursing response that assists the client in achieving these goals is:

a. "When the physician arrives on the unit, I will let him or her know that you have a question." (The nurse should become aware of the client's strengths and encourage the client to work at the optimal level of functioning. In "When the physician arrives on the unit, I will let him or her know that you have a question." the nurse is helping the client develop resources. The nurse does not act for clients unless absolutely necessary and then only as a step toward helping clients act on their own. Consistently encouraging clients to use their own resources helps minimize clients' feelings of helplessness and dependency and also validates their potential for change.)

A nurse is having a conversation with a depressed client on an inpatient psychiatric unit. The client says to the nurse, "Things would be so much better for everyone if I just weren't around." Which of the following responses by the nurse would be appropriate at this time?

a. "You sound very unhappy. Are you thinking of harming yourself?" (Clients who are depressed may be at higher risk for suicide. When clients make statements such as the one in the question, it is critical for the nurse specifically to assess suicidal ideation and plan. The best method is to ask the client directly about whether a specific plan has been formed.)

The goal for a patient is to increase resiliency. Which outcome should a nurse add to the plan of care? Within 3 days, the patient will:

a. identify healthy coping behaviors in response to stressful events. (The patient's ability to identify healthy coping behaviors indicates adaptive, healthy behavior and demonstrates an increased ability to recover from severe stress. Describing feelings associated with loss and stress does not move the patient towards adaptation. The remaining options are maladaptive behaviors.)

A client who attempted suicide by hanging is brought to the emergency department by emergency medical services. The immediate nursing action is which of the following?

a. Assess the client's respiratory status and for the presence of neck injuries. (The immediate nursing action for a client who attempted suicide is to assess physiological status. Airway is always the priority. Therefore, assessing the client's respiratory status and for the presence of neck injuries is the immediate action that the nurse takes. Although "take the client's vital signs," "call the mental health crisis team and notify them that a client who attempted suicide is being admitted to the hospital," and "perform a focused assessment, paying particular attention to the client's neurological status" identify appropriate nursing actions, they are not the priority.)

The nurse in the pediatric unit is admitting a 2-year-old child. The nurse plans care, knowing that the child is in which stage of Erikson's psychosocial stages of development?

a. Autonomy versus shame and doubt (A 2-year-old child, a toddler, is in the autonomy versus shame and doubt stage. In this stage, the toddler develops a sense of control over the self and bodily functions and exerts himself or herself. Trust versus mistrust characterizes the stage of infancy. Initiative versus guilt characterizes the preschool age. Industry versus inferiority characterizes the school-age child.)

When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented?

a. Communicate with simple words and brief message

The nurse is talking with a male client who is actively hallucinating. The client is fearful that the voices he hears will direct him to kill himself or will hurt him directly. Which of the following nursing statements would be therapeutic at this time?

b. "I don't hear them, but it must be frightening to hear voices that others can't hear." (It is important for the nurse to let the client know that what the client is hearing is not heard by the nurse and to avoid reinforcing the client's altered reality. The nurse avoids confronting the client but rather says supportive things such as, "This must be very frightening to you" or "It's difficult to understand all that you are experiencing right now." "I can hear the voices too, but they are telling you to go to bed now." "I know whose voices you are hearing and told them not to hurt you." and "I know you believe they are going to cause you harm, but it's not true." reinforce the client's altered reality.)

A voluntarily hospitalized patient tells the nurse, "Get me the forms for discharge against medical advice so I can leave now." What is the nurse's best initial response?

b. "I will get them for you, but let's talk about your decision to leave treatment." (A patient who has been voluntarily admitted as a psychiatric inpatient has the right to demand and obtain release in most states. However, as a patient advocate, the nurse is responsible for weighing factors related to the patient's wishes and best interests. By asking for information, the nurse may be able to help the patient reconsider the decision. The statement that discharge forms cannot be given without the health care provider's knowledge is not true. Facilitating discharge without consent is not in the patient's best interest before exploring the reason for the request.)

Cognitive therapy was provided for a patient who frequently said, "I'm stupid." Which statement by the patient indicates the therapy was effective?

b. "Sometimes I do stupid things ("I'm stupid" is an irrational thought. A more rational thought is, "Sometimes I do stupid things." The latter thinking promotes emotional self-control. The incorrect options reflect irrational thinking.")

An acutely depressed client is receiving cognitive-behavioral therapy. The nurse is developing a plan of care for the client and includes interventions that focus on this type of therapy. Which of the following interventions would the nurse include? Select all that apply.

b. Assisting the client to identify and test negative cognition c. Assisting the client to rehearse new cognitive and behavioral responses d. Assisting the client to participate in the treatment process e. Assisting the client to develop alternative thinking patterns Rationale: The goal of cognitive-behavioral therapy is to change the way clients think and thus relieve the depressive syndrome. This is accomplished by assisting the client to identify and test negative cognition, develop alternative thinking patterns, and rehearse new cognitive and behavioral responses. Although some clients are treated with antidepressant medications, this is not a component of cognitive-behavioral therapy. The focus of this therapy is on the client, not the family.

A client who has sustained severe injuries in a motorcycle accident was diagnosed with intensive care unit (ICU) psychosis. The nurse would be most likely to conclude that the client's status is improving if the client:

b. Increases the number of hours slept at one time and is increasingly alert (The foreign environment of a hospital's critical care unit, the loss of a normal sleep-wake cycle, effects of injuries, and succumbing to placement of invasive lines, tubes, and possibly restraints can lead to delirium and feelings of powerlessness. The symptoms of psychosis are more likely to resolve when the client resumes a more normal sleep cycle and is physiologically stable. Improvement from ICU psychosis is evidenced by decreased hallucinations, anxiety, and aggressive behavior, along with increased sleep and absence of injuries.)

A mental health nurse who has been meeting with a client with a diagnosis of post-traumatic stress disorder is in the termination phase of the nurse-client relationship. The nurse notes that the client has been quiet and withdrawn and interprets the client's behavior as:

d. A normal behavior that can occur during termination

The client admitted to the mental health unit with major depression 3 days ago could hardly get out of bed without coaxing and needed constant encouragement to get dressed and participate in unit activities. Today, the client appears in the dayroom dressed and well-groomed, without any guidance from the staff. The client appears to be calm and relaxed, yet more energetic than before. The nurse should take which initial action after noting this client's behavior?

b. Speak to the client personally about the nurse's observations, and ask if the client is thinking about suicide. (A sudden improvement in a depressed client's mood may indicate that the client has decided to commit suicide. The most direct way to validate the nurse's impression is to ask the client directly about suicidal ideation or plans. The other options are not the most appropriate initially.)

A nursing student is conducting a clinical conference and is describing the characteristics associated with milieu therapy. Which of the following statements, if made by the student, indicates an understanding of the focus of this form of therapy?

c. "A living, learning, or working environment is the focus of milieu therapy." (Milieu therapy, or "therapeutic community," has as its focus a living, learning, or working environment. Such therapy may be based on any number of therapeutic modalities, from structured behavioral therapy to spontaneous, humanistically oriented approaches. Although milieu therapy may include behavioral approaches, its primary focus is described in the correct option.)

A client admitted to the inpatient unit is being considered for electroconvulsive therapy (ECT). The client is calm, but the client's daughter is hypervigilant and anxious. The daughter says to the nurse, "My mother's brain will be shocked with electricity. How can the doctor even think about doing this to her?" Which of the following responses by the nurse would be therapeutic?

c. "It sounds as though you are very concerned about the procedure. Let's discuss the procedure." (The most effective responses to a client or family member who is visibly anxious and upset are those that use therapeutic communication techniques. Therapeutic communication includes active collaboration that facilitates problem solving, change, learning, and growth. The correct option addresses the daughter's concerns while upholding the dignity of the client. When these concerns are verbalized, the nurse can then give information that may help allay fears. "I think you need to speak directly to the psychiatrist." "Maybe you'll feel better if you see the ECT room and speak to the staff." and "Your mother has decided to have this treatment. You should support her." are nontherapeutic responses.)

The nurse has been caring for a client with a diagnosis of depression. The client says to the nurse, "I wish you would just be my friend." The appropriate response by the nurse is:

c. "Our relationship is a therapeutic and helping one." (Nurses may struggle with requests by clients to "be my friend." When this occurs, the nurse should make it clear that the relationship is a therapeutic and helping one. This does not mean that the nurse is not friendly toward the client at times. It does mean, however, that the nurse follows the stated guidelines regarding a therapeutic relationship. "I am your friend." "I can't be your friend. I'm the nurse, and you're the client." and "You have plenty of friends. You don't need me to be your friend, too." are inappropriate.)

Two students fail their introductory nursing course. One student plans to seek tutoring and retake the course next fall. The second student attempts suicide. Which of the following factors would have been influential in the development of the second student's crisis?

c. A lack of adequate coping mechanisms Correct Adequate coping mechanisms can influence how an individual responds to the development of a crisis. Resilience is key; if a person can draw on past successful coping strategies, a crisis may be diverted. The second student had a lack of adequate coping mechanisms.

A client has been admitted to the inpatient psychiatric unit because the client has displayed violent behavior and is at risk for potentially harming others. Which of the following should the nurse avoid doing when caring for this client?

c. Closing the door to the client's room when giving care to the client The nurse should not isolate herself or himself with a potentially violent client. The door to the client's room should remain open when giving care. The client should be placed in a room near the nurses' station and not at the distant end of a corridor. The nurse should never turn away from the client. A security officer or male aide should be readily available if there is a possibility of imminent violence.

The nurse is told that the result of a serum carbamazepine (Tegretol) level for a client who is receiving the medication for the control his mood swings is 10mcg/mL. Based on this laboratory result, the nurse anticipates that the physician will prescribe:

c. Continuation of the presently prescribed dosage (When carbamazepine is administered, blood levels need to be monitored periodically to check for the client's absorption of the medication. The amount of the medication prescribed is based on the blood level achieved. The therapeutic serum range of carbamazepine is 4 to 12 mcg/mL. The nurse would anticipate that the physician will continue the presently prescribed dosage.)

The nurse is working with a client who shows signs of benzodiazepine withdrawal. The nurse suspects that the client has suddenly discontinued taking which of the following prescribed medications?

c. Diazepam (Valium) (`The only benzodiazepine presented in the options is diazepam (Valium). Benzodiazepines are effective only when used for short-term therapy. Short-acting benzodiazepines can produce withdrawal symptoms within 1 to 2 days, whereas long-acting benzodiazepines take 5 to 10 days for withdrawal symptoms to occur following discontinuation. Manifestations include insomnia, agitation, anxiety, irritability, nausea, and diaphoresis. The other options list an antipsychotic ("sertraline (Zoloft)") and antidepressants ("haloperidol (Haldol)" and "fluoxetine (Prozac)").

The nurse is assigned to a client who is psychotic, pacing, agitated, and using aggressive gestures and rapid speech. The nurse determines that the priority of care at this time is which of the following?

c. Providing safety for the client and other clients on the unit (Safety for the client and other clients is the priority. "Providing safety for the client and other clients on the unit" is the only option that addresses the client's and other clients' safety needs. "Offering the client a less stimulated area in which to calm down and gain control" and "assisting in caring for the client in a controlled environment, such as a quiet room" address only the client's needs. "Providing the other clients on the unit with a sense of comfort and safety by isolating the client" addresses only the needs of the other clients on the unit.)

Psychotherapy involves all below except Select one: a. neural plasticity b. a therapeutic relationship c. appropriate medications d. positive expectancy

c. appropriate medications

A client has recently been diagnosed with mild to moderate NCD due to Alzheimer's disease.Which medication would the nurse expect the physician to order for the client's cognitive impairment?

d. Donepezil (Aricept) (Donepezil is used to improve cognition in clients diagnosed with mild to moderate dementia associated with Alzheimer's disease.Its action improves cholinergic function by inhibiting acetlycholinesterase.)

A patient begins therapy with a phenothiazine medication. What teaching should a nurse provide related to the drug's strong dopaminergic effects?

d. Report muscle stiffness. Phenothiazines block dopamine receptors in both the limbic system and basal ganglia. Dystonia is likely to occure early in the course of treatment and is often heralded by sensations of muscle stiffness. Early intervention with an antiparkinsonian medication can increase the patient's comfort, prevent dystonic reactions and promote medication adherence.

The client who is diagnosed with a borderline personality is admitted to the psychiatric unit. Based on a thorough understanding of personality disorders, the nurse would select which nursing diagnosis as the priority?

d. Risk for self-mutilation

A client is admitted to the psychiatric unit with a diagnosis of bipolar affective disorder and mania. The nurse would prioritize that which of the following symptoms or behaviors requires immediate intervention?

a. Constant physical activity and poor oral intake (Mania is a period when the mood is predominantly elevated, expansive, or irritable. The client's mood may be characterized by excitement, euphoria, hyperactivity, excessive energy, decreased need for sleep, and impaired ability to concentrate or complete a single train of thought. Each of the options is reflective of possible symptoms. Using Maslow's Hierarchy of Needs theory, however, you would select as a priority an option that clearly presents a nursing problem at the most fundamental level (physiological integrity).

A nurse in the emergency department is preparing to care for a female client who has just been sexually assaulted. Which of the following client behaviors would demonstrate denial?

b. The client is calm and quiet.

The nurse is describing medication side effects to a client who is taking a benzodiazepine. The nurse tells the client to take the medication only as prescribed because of the most serious risk of:

b. dependence (A benzodiazepine carries with it a high risk for abuse and physical and psychological dependence. For this reason, limited amounts of these medications are given to a client at one time. The other symptoms may be side effects of some benzodiazepines but are not as serious as the risk of dependence.)

A newly admitted client, diagnosed with obsessive-compulsive disorder (OCD), spends 1 hour packing and unpacking, folding and refolding personal belongings. What is the most likely reason for this behavior?

c. It relieves anxiety

The nurse is preparing for the arrival of a new client at a drug abusers' residential treatment center and prepares to explain to the client that the emphasis of the center is on group and social interaction, and that rules and expectations are mediated by peer pressure. The most likely focus of therapy of this residential center is:

c. Milieu therapy (Milieu therapy, or "therapeutic community," has as its focus a living, learning, or working environment. Such therapy may be based on any number of therapeutic modalities, from structured behavioral therapy to spontaneous, humanistically oriented approaches. Its characteristics include an emphasis on group and social interaction, and rules and expectations that are mediated by peer pressure. Systematic desensitization is a form of behavior modification therapy that involves increased exposure to an object or situation that causes anxiety. Exposure to the object increases until the anxiety about the object ceases. Cognitive-behavioral therapy is used to help clients identify and examine dysfunctional thoughts, as well as identify and examine values and beliefs that maintain these thoughts. In aversion conditioning, a stimulus attractive to the client is paired with an unpleasant event in an attempt to endow it with negative properties.)

A client with a potential for violence is exhibiting aggressive gestures, making belligerent comments to the other clients, and is continuously pacing in the hallway. Which of the following comments by the nurse would be therapeutic at this time?

"What is causing you to become agitated?" (The appropriate response is to ask the client what is causing the anger. This helps make the client aware of the behavior and may assist the nurse in planning appropriate interventions. "Please stop so I don't have to put you in seclusion." and "You are going to be restrained if you do not change your behavior." constitute threats to the client, which are inappropriate. "Why are you intent on upsetting the other clients?" is confrontational and could further escalate the client's behavior.)