Mental Health Practice Exam #1

Which medication classification blocks serotonin reuptake? a .Antidepressant b. Antianxiety c. Antibiotic d. Antimanic

a .Antidepressant The medication classification, selective serotonin reuptake inhibitors, blocks the reuptake of serotonin. Antianxiety, antibiotic, and antimanic medications do not block the reuptake of serotonin.

When describing the various neurotransmitters, which chemical would a nurse identify as the primary cholinergic neurotransmitter? a. Norepinephrine b. Acetylcholine c. Serotonin d. Dopamine

b. Acetylcholine Acetylcholine is the primary cholinergic neurotransmitter. Biogenic amines include dopamine, norepinephrine, and serotonin.

What part of the brain would be responsible for activities such as walking and dancing? a. Midbrain b. Cerebellum c. Brain stem d. Cerebrum

b. Cerebellum The cerebellum, which is located behind and below the cerebrum, controls and coordinates muscle movement integral to physical activities such as walking and dancing. Cerebrum, midbrain, and brain stem are incorrect.

The major goal of the Community Mental Health Act of 1963 was what? a. Facilitate the integration of biology with the psychosocial components of treatment. b. Attract more health care providers into local psychiatric clinics. c. Build mental health centers that would provide mental health care within the local community. d. Develop centers in which biopsychiatric research could take place within the community.

c. Build mental health centers that would provide mental health care within the local community. The 1963 Community Mental Health Act was designed to provide community-centered mental health care.

Interpersonal theorists, such as Harry Stack Sullivan, emphasize which tenet? a. Alleviating symptoms by utilizing biological tools, such as medicines b. The existence of the id, ego, and superego c. Interpersonal socialization of humans throughout their developmental stages d. The importance of conditioning responses in working with people

c. Interpersonal socialization of humans throughout their developmental stages Development is somewhat predictable as progression through stages and achieved by means of interactions with others. Freud emphasized the id, ego, and superego. Conditioning stems from the behavioral theory. Alleviating symptoms by utilizing biological tools, such as medications, is related to the biophysiological theory.

A client who has been taking clozapine for 6 weeks visits the clinic reporting fever, sore throat, and mouth sores. The nurse notifies the client's provider because the nurse suspects which condition? a. Severe anemia. b. Encephalitis. c. Neuroleptic malignant syndrome. d. Agranulocytosis.

d. Agranulocytosis. High fever, sore throat, and mouth sores are indicative of infection secondary to agranulocytosis, which has been associated with clozapine. The medication can suppress the bone marrow and cause a significant decrease in white blood cells. The client's signs and symptoms do not suggest anemia, neuroleptic malignant syndrome, or encephalitis.

During the stabilization phase of drug therapy for a client who is hospitalized with a psychiatric disorder, which action would be most appropriate? a. Discussing the timing of tapering the medication b. Instructing the client about relapse prevention c. Determining if the medication is losing its effect d. Assessing the client for target symptoms and side effects

d. Assessing the client for target symptoms and side effects During stabilization, the medication dosage is adjusted or titrated to achieve the maximum amount of improvement with a minimum of side effects. Psychiatric-mental health nurses assess target symptoms, looking for changes or improvements and side effects. Education about relapse prevention and target symptoms and assessing if the medication is losing its effect occur during the maintenance phase. Tapering occurs during the discontinuation phase.

A nurse working in a psychiatric inpatient facility correctly identifies the term "milieu therapy" to mean what? a. Inclusion of both art therapy and psychotherapy b. Therapy that does not include medication c. A multidisciplinary approach d. Maintenance of the therapeutic environment

d. Maintenance of the therapeutic environment Milieu therapy is also known as the maintenance of the therapeutic environment.

The working stage of group therapy is marked by which characteristic? a. Conflict and cooperation among group members. b. Members' propensity to leave the group. c. Therapists' tendency to "back off" to allow the group to work. d. Group members' concern about confidentiality issues.

a. Conflict and cooperation among group members. The group accomplishes its real work during the working phase. Conflict and cooperation indicate that trust has been established and group members are taking risks and working together to create behavior changes. In this stage, conflict and cooperation surface during the group's work.

Which mental health service is an advanced-level function? a. Psychotherapy b. Self-care activities c. Counseling d. Milieu therapy

a. Psychotherapy Psychotherapy is an advanced-level function. Milieu therapy, counseling, and self-care activities are basic level functions.

Initiatives that strive to strengthen links between primary care and specialized mental health services refer to ... a. collaborative mental health care. b. psychosocial rehabilitation programs. c. partial hospitalization programs. d. inpatient psychiatric units.

a. collaborative mental health care. Collaborative mental health care refers to activities or initiatives that strive to strengthen links between primary care and specialized mental health services.

Within a group, facilitating verbal and nonverbal communication to meet treatment goals individually and with the entire group refers to the ... a. gatekeeper. b. group leader. c. maintenance role. d. individual role.

b. group leader. One of the responsibilities of group leadership is to facilitate both verbal and nonverbal communication to meet the treatment goals of the individual members and the entire group.

Who was responsible for much of the reform of the mental health care system in the 19th century? a. Florence Nightingale b. Hildegard Peplau c. Dorothea Dix d. Sigmund Freud

c. Dorthea DIx Dorothea Dix, a vigorous crusader for the humane treatment of clients with mental illness, was responsible for much of the reform of the mental health care system in the 19th century.

Which is a true statement regarding Medicaid? a. It covers people 65 years of age and older. b. It covers people with certain disabilities. c. It covers individuals and families with low incomes. d. It covers people with permanent kidney failure.

c. It covers individuals and families with low incomes. Medicaid covers individuals and families with low incomes. Medicare covers people 65 years of age and older, those with permanent kidney failure, and those with certain disabilities.

Which indicates that the nurse, acting as a leader for a group of recovering clients with alcohol abuse, is addressing the responsibility of maintaining the group's process? a. Selecting individuals for membership in the group b. Deciding how often the group will meet c. Keeping the group on task by restating goals d. Determining that the group's format will be closed

c. Keeping the group on task by restating goals In a therapy group, the nurse-therapist has both task and maintenance role functions. Group task functions are concerned with the practical issues of leading a group, whereas group maintenance functions focus on less tangible group processes. Keeping the group focused on its goals is "maintenance" in nature. Deciding how often the group will meet, selecting individuals for membership in the group, and determining the group's format are considered tasks rather than maintenance items.

Which is considered the first-line treatment for bipolar disorder? a. Haloperidol b. Thioridazine c. Lithium d. Olanzapine

c. Lithium Lithium is considered the first-line treatment for bipolar disorder. Lithium is the most established mood stabilizer.

The parents of a client with a mental illness being cared for at home tell the nurse that they have been feeling overwhelmed lately. They say, "We need to get away for a few days to recharge ourselves." Which care setting should the nurse recommend? a, Assertive community treatment (ACT) b. Recovery center c. Respite residential care d. Psychosocial rehabilitation

c. Respite residential care Sometimes the family of a person with mental illness who lives at home may be unable to provide care continuously. In such cases, respite residential care can provide short-term, necessary housing for the client and provide periodic relief for the caregivers. The ACT model is a multidisciplinary clinical team approach providing 24-hour, intensive community-based services. The ACT model helps individuals with serious mental illness live in the community. Psychiatric rehabilitation programs, also termed psychosocial rehabilitation, focus on the reintegration of people with psychiatric disabilities into the community through work, education, and social avenues, all while addressing their medical and residential needs. Recovery centers assist in the mental health consumer's journey toward recovery by offering self-help groups and training in daily living. In addition, recovery centers offer illness self-management interventions, such as Wellness Recovery Action Planning (WRAP).

Dorothea Dix's solution to gain humane treatment for the mentally ill population included what? a. Community centers b. Asylums c. State hospitals d. Locked wards

c. State hospitals Dorothea Dix, a vigorous crusader for the humane treatment of clients with mental illness, was responsible for much of the reform of the mental health care system in the 19th century. Her solution was state hospitals.

An older adult reporting concerns of anxiety is prescribed diazepam (Valium) by a health care provider. The provider asks the office nurse to explain the problematic side effects of this medication to the client. Which instruction is most important for the nurse to emphasize about this drug? a. "You may feel dizzy and be prone to falls after taking this medication." b. "You need to use this medication cautiously because it can cause dependence." c. "You may experience minor urine incontinence from time to time." d. "You may find that you have temporary memory disturbances."

a. "You may feel dizzy and be prone to falls after taking this medication." Diazepam (Valium) is a benzodiazepine and may cause incontinence, memory disturbances, and dizziness in older adults. However, the risk for falls because of dizziness is a major concern, and this information needs to be emphasized with the client.

Which is the most restrictive setting in the continuum? a. Acute inpatient hospitalization b. Partial hospitalization c. Crisis intervention d. Residential care

a. Acute inpatient hospitalization Of the settings listed, acute inpatient hospitalization involves the most intensive treatment and is considered the most restrictive setting in the continuum. Inpatient treatment is reserved for acutely ill clients who, because of a mental illness, meet one or more of three criteria: (1) high risk for harming themselves, (2) high risk for harming others, or (3) unable to care for their basic needs.

A hospitalized client who has been taking an antipsychotic medication for 2 weeks begins pacing and walking throughout the unit. The client tells the nurse, "I just cannot sit still." The nurse documents this finding as which condition? a. Akathisia. b. Pseudoparkinsonism. c. Dystonia. d. Akinesia.

a. Akathisia. The client's inability to "sit still" and/or frequent pacing is termed "akathisia," an extrapyramidal effect of the antipsychotic medication. Akinesia is slowed movements. Dystonia involves involuntary muscle spasms that lead to abnormal postures, especially of the head and neck muscles. Pseudoparkinsonism includes rigidity, slowed movements, and tremor.

The nurse has been unsuccessful in the psychiatric clinical placement and will be obliged to repeat it next semester. The criteria for passing or failing were based on the Psychiatric-Mental Health Nursing Scope and Standards of Practice, which are? a. Descriptions of the responsibilities for which nurses are accountable b. The legal documents that allow a nurse to practice c. Explanations of the ideal character of the psychiatric or mental health nurse d. Future goals for the nursing profession as a whole

a. Descriptions of the responsibilities for which nurses are accountable Standards of practice are authoritative statements used by the nursing profession to describe the responsibilities for which nurses are accountable. They do not have the same standing as laws, and they are not future goals but are instead current standards.

When reviewing the evolution of mental health care in the United States, a psychiatric-mental health nurse reads about the creation of state hospitals for mental health care. The nurse would attribute this concept of care as the idea supported by: a. Dorothea Dix. b. Clifford Beers. c. Horace Mann. d. Sigmund Freud.

a. Dorthea Dix Dorothea Dix was a vigorous crusader for the humane treatment of clients with mental illness and was responsible for much of the reform of the mental health care system in the 19th century. Her solution was the creation of state hospitals. Horace Mann is credited with the mandate that states assume financial responsibility for the care of people with mental illnesses. Clifford Beers was an advocate for the human treatment of individuals with mental illness. Sigmund Freud developed a personality theory for mental illness based on unconscious motivations for behavior.

Which is a difference between counseling and psychotherapy? a. Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role. b. Psychotherapy is reserved for clients who have a documented history of failing to respond to counseling. c. Counseling may be used in the care of acutely psychotic clients, but psychotherapy is contraindicated. d. Transference and countertransference are significant obstacles in psychotherapy that can be avoided in a counseling mode.

a. Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role. The psychiatric nurse uses counseling interventions, but psychotherapy requires advanced certification according to the American Nurses Association. Psychotherapy is not reserved solely for those who have not responded to counseling. Transference and countertransference are significant obstacles in both modes, and neither intervention is appropriate during acute psychotic episodes.

A psychologist chose the profession because the psychologist was inspired by an aunt who was a successful psychologist. Which of Freud's ego defense mechanisms is this indicative of? a. Identification b. Displacement c. Compensation d. Denial

a. Identification Identification is an ego defense mechanism where a person models the actions and opinions of influential others while searching for identity or aspiring to reach a personal, social, or occupational goal. In this case the psychologist has taken up the profession as the psychologist admires an aunt who is successful in the same profession. Denial is the failure of an individual to accept his or her situation. Compensation is an ego defense mechanism where an individual tries to work hard and achieve well in one area in order to compensate for the perceived deficiencies in another area. Displacement is an ego defense mechanism where a client expresses intense feelings toward persons who are less threatening than the one who aroused those feelings.

To facilitate the understanding of a crisis, which intervention should the nurse employ? a. Listen and assist the client to articulate his or her feelings b. Provide direction of next steps for the client to take c. Focus on long-term resolutions to prevent reoccurrence of the crisis d. Allow the crisis to escalate to reach a quicker resolution

a. Listen and assist the client to articulate his or her feelings An important part of crisis intervention is helping individuals to develop an accurate understanding of the situation and its potential consequences. This usually involves listening to individuals' accounts of their experience and assisting them to identify and articulate their feelings about what is happening.

Which statement regarding those with serious and persistent mental illness (SPMI) is correct? a. Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation. b. Medicaid funding for those with mental illness has optimized patient care for poor individuals. c. Supplemental Security Income provides enough money for those with mental illness to pay for a home, food, and medication. d. Reinstitutionalization has resulted in many individuals being committed to mental hospitals and asylums.

a. Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation Reliance on Supplemental Security Income as the major source of financial support allows little opportunity for choices. The average monthly stipend barely meets their rent payments. Unlike the early institutions that housed those with mental illness in hospitals and asylums, the current reinstitutionalization is in both hospitals and jails. Medicaid funding, although limited in noninstitutional settings, remains the primary source for poor people, including most people with SPMI. The result has been inappropriate admissions to nursing facilities and other institutions so that clients can receive appropriate care. Opportunities to improve finances are limited or nonexistent because these people lack funds for education, clothing, and transportation.

During the mid-20th century, the focus of treatment centered on treating neurotransmitter dysfunction in the brain. As a result hospital stays were shortened due to the introduction of which? a. Psychopharmacology b. Hydrotherapy c. Psychosurgery d. Insulin shock therapy

a. Psychopharmacology Support for the biologic approaches received an important boost as successful symptom management with psychopharmacologic agents became a more widespread possibility in the early 1950s. Psychopharmacology revolutionized the treatment of mental illness and led to an increased number of clients discharged into the community, and the eventual focus on the brain became a key to understanding psychiatric disorders.

According to Maslow, an individual who has developed to the individual's fullest potential has achieved what level of his hierarchy? a. Self-actualization b. Love and belonging c. Esteem d. Physiological

a. Self-actualization Maslow used the term self-actualization to describe a person who has achieved all the needs of the hierarchy and has developed the individual's fullest potential in life. Few people ever become fully self-actualized.

Which theorist developed the psychoanalytic theory? a. Sigmund Freud b. Harry Stack Sullivan c. B. F. Skinner d. Erik Erikson

a. Sigmund Freud Sigmund Freud was responsible for the psychoanalytic theory. Erik Erikson formed developmental theory. Harry Stack Sullivan was responsible for interpersonal theory. B. F. Skinner proposed behavior theory.

A client will soon be completing a course of inpatient treatment for the treatment of schizophrenia. At what point should the care team review the client's eligibility for additional services, coverage, and programs in the community? a. Upon admission to the inpatient setting b. When the client and/or client's family advocates for such a review c. When requested by the client's health maintenance organization (HMO) d. Once the client experiences an exacerbation of symptoms

a. Upon admission to the inpatient setting It is important that a client's mental health benefits be reviewed during the discharge planning process, which should always aim to begin at the client's admission to the inpatient unit.

What is a group that has structure and authority known as? a. A formal group b. A primary group c. An informal group d. A secondary group

a. formal group A formal group has limited interaction, structure, and authority, which usually emanates from above. A faculty meeting is an example. Informal groups provide much of a person's education and contribute greatly to individual values. Members of primary groups have face-to-face contact, boundaries, norms, and explicit and implicit interdependent roles. An example is a family. Secondary groups usually are larger and more impersonal than primary groups. Members do not have emotional ties.

The nurse provides care to a client who is diagnosed with schizophrenia. A family member asks the nurse, "I don't know how she tolerates wearing that winter coat in the middle of the summer!" Which structure of the limbic system should the nurse base the response? a. hypothalamus b. thalamus c. hippocampus d. amygdala

a. hypothalamus Deregulation of the hypothalamus can be manifested in symptoms of certain psychiatric disorders. For example, in schizophrenia, clients often wear heavy coats during the hot summer months and do not appear hot. Before the role of the hypothalamus in schizophrenia was understood, psychological reasons were used to explain such symptoms. Now it is increasingly clear that such a symptom relates to deregulation of the hypothalamus's normal role in temperature regulation and is a biologically based symptom. The other structures of the limbic system are not appropriate to use a basis for the response.

The nurse is caring for a client who states "I wish my family would come to visit." Which need is the client trying to meet based on Maslow's hierarchy of needs? a. love and belonging needs b. self-actualization needs c. esteem needs d. safety and security needs

a. love and belonging needs The client who is looking for family members to visit is trying to fulfill love and belonging needs which relate to affection and acceptance from family and friends. Safety and security needs relate more to shelter and a stable physical environment. Esteem needs relate to having a positive self-image and self-worth. Self-actualization needs is the top of the hierarchy and involves the development of full personal potential.

A client diagnosed with depression is being prescribed an antidepressant medication. Which symptom(s) does the client identify as related to the low levels of serotonin in their body? Select all that apply. a. low mood b. increased pain sensitivity c. decreased appetite d. decreased memory e. insomnia f. uncontrolled muscle movements

a. low mood b. increased pain sensitivity c. decreased appetite e. insomnia Serotonin is primarily an excitatory neurotransmitter that plays a role in emotions, cognition, sensory perceptions, sleep, and appetite. Therefore, the client's symptoms including low mood, decreased appetite, insomnia, and increased pain sensitivity are being caused by the low serotonin levels in the client. The symptom of decreased memory is not associated with serotonin levels but may be associated with the acetylcholine and/or glutamate neurotransmitters. The symptom of uncontrolled muscle movement would be associated with the dopamine neurotransmitter.

After teaching a client who is prescribed imipramine, a tricyclic antidepressant (TCA), about the drug, the nurse determines that the education was effective when the client makes what statement? a. "I might notice some excess saliva in my mouth at different times." b. "I need to be careful because the drug can make me sleepy." c. "I need to avoid foods with fiber because diarrhea can occur." d. "I don't have to worry about getting dizzy when I get up from lying down."

b. "I need to be careful because the drug can make me sleepy." Imipramine is a TCA and is associated with sedation, orthostatic hypertension, and anticholinergic effects such as dry mouth and constipation. The client needs to be careful with activities because the drug is sedating. The client should change positions slowly to minimize orthostatic hypotension. Sugarless candies, good oral hygiene, and frequent mouth rinsing are helpful to combat dry mouth. A high-fiber intake would be appropriate to decrease possible constipation.

A client is prescribed medication for a psychiatric disorder. After 3 days, the client reports being constipated. Which instruction would the nurse give the client? a. "You need to eat more high-protein foods such as meat and peanut butter." b. "You need to eat more fruits and vegetables and drink more water." c. "This side effect should disappear within a week or so." d. "Ask your psychiatrist to prescribe a stool softener for you."

b. "You need to eat more fruits and vegetables and drink more water." The nurse should instruct the client to increase fiber and fluid intake. A mild laxative, exercise, and fiber supplement also may help the client's constipation. High-protein foods would have no effect on constipation. Stool softeners may be appropriate if an increase in fiber and fluids is ineffective. The side effect will not necessarily disappear.

A nurse administers a prescribed dose of lithium at 8 p.m. The nurse should schedule a specimen to be obtained for a blood level at which time? a. 4 a.m. b. 8 a.m. c. 12 p.m. d. 10 p.m.

b. 8 a.m. Blood levels should be monitored 12 hours after the last dose of medication.

Which client would not be able to undergo a magnetic resonance imaging scan (MRI)? a. A client with a diagnosed anxiety disorder b. A client with a pacemaker c. A client with a longstanding history of claustrophobia d. A client who is obese

b. A client with a pacemaker Clients with pacemakers or metal implants, such as heart valves or orthopedic devices, cannot undergo an MRI. There are not contraindications for obese clients can to undergo an MRI. Clients who are claustrophobic or those with anxiety can have an MRI but may need special intervention such as sedation.

In the 1970s, state mental hospitals came under increasing scrutiny and many were closed. What was the end result of this trend? a. Higher employment rates among previously institutionalized people b. A lack of suitable housing for persons with mental illness c. Increased numbers of training programs for the mentally ill d. Increased numbers of for-profit institutions for the mentally ill

b. A lack of suitable housing for persons with mental illness In 1970, the deinstitutionalization of clients from state mental hospitals to community living was considered a positive move; however, insufficient federal funding resulted in an increase in the number of homeless, mentally ill people.

Clients diagnosed with myasthenia gravis have a decrease in which receptor? a. Norepinephirine b. Acetylcholine c. Dopamine d. Serotonin

b. Acetylcholine Clients diagnosed with myasthenia gravis, a neuromuscular disorder, have a decreased amount of acetylcholine. Acetylacholine is a neurotransmitter found in the brain, spinal cord, and peripheral nervous system, particularly at the neuromuscular junction of the skeletal muscle. Dysfunction of dopamine is associated with with schizophrenia and other psychoses as well as Parkinson's disease. Serotonin plays an important role in anxiety, mood disorders, and schizophrenia. Norepinephrine dysfunction is implicated in several anxiety disorders, deficits may contribute to memory loss, social withdrawal, and depression.

A client taking lithium comes to the hospital for a 2-week follow-up. The client complains of a hand tremor that keeps from holding a coffee cup and states that the client feels confused, has stomach aches, and trips occasionally. Which would be the most therapeutic intervention of the psychiatric nurse? a. Ask the client to return 3 days later to see the psychiatrist, who will be in the clinic on that day b. Call the client's psychiatrist because her symptoms are indicative of moderate toxicity c. Explain to the client that these are common side effects and that they will subside soon d. Say that you and the client will monitor these side effects to be sure they do not increase in severity

b. Call the client's psychiatrist because her symptoms are indicative of moderate toxicity The client's complaints indicate lithium toxicity and should be reported to the client's physician for possible adjustment of the medication.

In a group therapy session, group members confront a 35-year-old client about the client's abuse of prescription pain medications. The client states, "The doctor prescribed me these pills, that doesn't make me a drug addict." The nurse identifies this as an example of which defense mechanism? a. Regression b. Denial c. Sublimation d. Projection

b. Denial Denial is refusing to recognize a reality that might be troublesome or traumatic. Regression refers to going back to an earlier and happier time of development. Projection is when a person refuses to recognize behavior in oneself and instead "projects" it or sees it in someone else. Sublimation means taking repressed feelings and transforming them into positive and constructive pursuits.

While a nurse is performing an admission assessment for a client in an inpatient mental health setting, the client states, "All of my problems are caused by my parents." The client statement reflects which factor that influences mental health? a. Neuroanatomy b. Emotional development c. Religion d. Values and beliefs

b. Emotional development Psychological influences on mental health include interactions, intelligence quotient, self-concept, skills, creativity, and emotional developmental level. Neuroanatomy is a biologic influence on mental health. Values, beliefs, and religion are sociocultural influences on mental health.

Which provides the best definition for mental illness? a. Existence of cognitive dysfunction resulting in a lack of autonomy b. Inability to function in a manner that manages both external and internal stressors effectively c. Result of genetic or environmental alterations resulting in mental dysfunction d. Manifestation of altered sensory perceptions

b. Inability to function in a manner that manages both external and internal stressors effectively While mental illness is difficult to define with precision, it is best described as a state of being characterized by impairment in functioning. Not all mental illnesses are characterized by cognitive impairment or altered sensory perceptions. Genetic and environmental factors are not the only known causes of mental illness.

While participating in a group therapy session, one group member consistently asks for clarification of the topic the group is discussing. The nurse leading the group interprets this behavior as reflecting which group role? a. Standard setter b. Information seeker c. Coordinator d. Recorder

b. Information seeker For any group to be successful, it must have members who assume task roles. The task role of information seeker is one in which the group member asks for clarification. The coordinator shows or clarifies the relationships among various ideas and suggestions. The recorder writes suggestions, keeps minutes, and serves as the group memory. The standard setter expresses the standards for the group to achieve.

Which is an example of group cohesiveness? a. Discussing a client's personal issues in front of other group members b. Members wearing T-shirts that they made to a group session c. Monopolizing the therapy session d. Using a member as a scapegoat

b. Members wearing T-shirts that they made to a group session Cohesion is a way in which group members stick together. Using a member as a scapegoat, monopolizing the therapy session, and discussing a client's personal issues in front of other group members are not examples of group cohesiveness.

A client has recently joined a group and presented a scenario in which the client ran out of funds to pay the rent this month. The therapist states, "Has anyone else in the group had this experience? Can you share any ideas about how you resolved this situation when it happened to you?" The therapist's intervention utilizes which theory to intervene? a. Psychoanalysis group b. Problem-solving group c. Reeducational group d. Personality reconstruction group

b. Problem-solving group The intervention attempts to engage the entire group in a problem-solving approach to the client's current problem.

Which sets professional standards of care? a. Hospitals b. Professional nursing organizations c. Provinces d. States

b. Professional nursing organizations States and provinces grant the legal authority to practice nursing, but professional nursing organizations set standards of care and professional nursing activities.

A client suffers from low mood and disturbed sleep. This client is most likely experiencing a change in which neurotransmitter? a. Melatonin b. Serotonin c. Calcitonin d. Parathyroid

b. Serotonin Abnormalities of serotonin are involved in mental depression and sleep disorders. Calcitonin is a hormone produced by the thyroid gland. Melatonin is a peptide hormone not a neurotransmitter. Parathyroid is a gland that secretes parathyroid hormone.

A client is being seen in the mental health clinic. The client has been on haloperidol for 8 months and is now exhibiting tongue protrusion, lip smacking, and rapid eye blinking. A nurse would document this chronic syndrome as: a. neuroleptic malignant syndrome (NMS). b. tardive dyskinesia. c. akathisia. d. dystonia.

b. Tardive dyskinesia Tardive dyskinesia involves irregular, repetitive, involuntary movements of the mouth, face, and tongue, including chewing, tongue protrusion, lip smacking, puckering of the lips, and rapid eye blinking. NMS, a serious complication that may result from antipsychotic medications, is characterized by rigidity and high fever. Akathisia is characterized by the inability to sit still or restlessness and is more common in middle-aged clients. Dystonia is impaired muscle tone that generally is the first extrapyramidal symptom to occur, usually within a few days of initiating use of an antipsychotic.

The nurse is caring for a 4-year-old child during a well-child visit. According to the Sullivan's stages of development, which behavior would the nurse expect to find in this child? a. The child spends more time with friends than family. b. The child performs actions to earn praise from parents. c. The child may prefer to be in the mother's lap. d. The child expresses individual views and ideas to the child's parents.

b. The child performs actions to earn praise from parents. According to Sullivan's life stages, this child is in the childhood stage. During this stage, children look at their parents as sources of praise and appreciation. If the child is in the infant stage (0-language), the child's primary need is to have bodily contact and tenderness and would most likely prefer to sit in the mother's lap. The preadolescent child (8-12 years) tends to move away from family as the primary satisfaction in the relationship and start making friends. In the juvenile stage (5-8 years), the child learns to negotiate individual needs. Expressing views and ideas to the parents begin at this age.

Which is necessary as a defining feature in mental illness? a. The individual must have physiological symptoms that match with behaviors that are impaired. b. The individual must have difficulties in functioning that cause distress and/or impairment of some type. c. The individual must acknowledge that he or she is having difficulties in functioning. d. The individual must need medications in order for the diagnosis to be of psychiatric origin.

b. The individual must have difficulties in functioning that cause distress and/or impairment of some type. Mental illness is considered a clinically significant behavioral or psychological syndrome experienced by a person and marked by distress, disability, or the risk of suffering, disability, or loss of freedom. The symptoms of the disorder must be above and beyond expected reactions to an everyday event and not merely a cultural expectation. An individual can be diagnosed with a mental illness and not need psychopharmacological intervention. The individual may or may not acknowledge that he or she is having impaired functioning. The experience and consequences of mental illness are much more complicated than a list of symptoms.

A college's nursing program has added an elective in forensic nursing to the curriculum. Which phenomenon underlies the expectation of an expanded role for forensic nursing in the future? a. People with mental illness are the most common victims of crime. b. There are high rates of mental illness among incarcerated populations. c. Most crimes are committed by people who have mental illness. d. Many states now require incarcerated individuals to be frequently assessed by a mental health nurse.

b. There are high rates of mental illness among incarcerated populations. Forensic nursing is expected to become one of the fastest growing nursing specialties of the 21st century because recent studies have noted the high rates of mental illness among the incarcerated population. People with mental illness are not responsible for most crimes. They are vulnerable to crime, but this fact does not underlie the growth of forensic nursing.

A nurse is performing an admission assessment. The client reports taking larger and larger doses of medication to get the desired effect. Based on this information, the nurse interprets this as suggesting what possible outcome? a. Decreased therapeutic index b. Tolerance c. Toxicity d. Desensitization

b. Tolerance Tolerance is a gradual decrease in the action of a drug at a given dose or concentration in the blood. This decrease may take days or weeks to develop and results in a loss of the therapeutic effect of a drug, necessitating an increase in medication to achieve the desired effect. Desensitization is a rapid decrease in drug effects that may develop within a few minutes of exposure to a drug. Toxicity generally refers to the point at which concentrations of the drug in the bloodstream are high enough to become harmful or poisonous to the body. Individuals vary widely in their responses to medications. Some clients experience adverse reactions more easily than others. The therapeutic index is the ratio of the maximum nontoxic dose to the minimum effective dose. A high therapeutic index means that there is a large range between the dose at which the drug begins to take effect and a dose that would be toxic to the body.

During the moral treatment period, clients were routinely placed into which environment? a. group homes b. asylums c. community mental health centers d. psychosocial rehabilitation centers

b. asylums In the moral treatment period (1790-1900), moral treatment and the use of kindness, compassion, and a pleasant environment was adopted. Clients were routinely removed from their communities and placed in asylums, which was thought to be best for their safety and comfort. Community mental health centers, by and large, ignored the legions of people with serious mental illnesses and instead focused on the treatment of those with alcoholism and drug addiction. Clients were not placed in psychosocial rehabilitation centers or group homes during the moral treatment period.

One of the primary reforms accomplished by Dorothea Lynde Dix was the ... a. use of exercise therapy to treat mentally ill clients. b. establishment or enlargement of state hospitals. c. use of music to treat mentally ill clients. d. establishment of "commitment" laws in state legislatures.

b. establishment or enlargement of state hospitals. One of the primary reforms accomplished by Dorothea Lynde Dix was the establishment or enlargement of state hospitals to treat the mentally ill. She also was instrumental in the establishment of mental hospitals in England, Canada, and Europe in the 19th century.

When caring for an older adult taking a psychotropic medication, the psychiatric nurse must be aware that older adults: a. are always reluctant to take these medications because of stigma and stereotyping. b. usually require a lower dose of these medications than do younger counterparts. c. are not as sensitive to the effects of the psychotropics, and so are usually d. given slightly higher doses than in younger people. are often refractory to psychotropic medications.

b. usually require a lower dose of these medications than do younger counterparts. The pharmacologic actions of psychotropic medications change dramatically for older persons as a result from differences in drug absorption secondary to diminished gastrointestinal motility, decreased plasma proteins, decreased kidney function, congestive heart failure, or normal age-related changes in body composition, lean body mass, and muscle mass or increased fatty tissue.

The family member of a client who experienced a stroke tells the nurse, "He just isn't the same anymore. His personality is different. I don't understand how a stroke can affect him in this way." Which response by the nurse is best? a. "I will let the doctor know that you are concerned." b. "This is to be expected because the stroke affected the parietal lobe." c. "The stroke affected his frontal lobe, which is responsible for personality." d. "Tell me what changes you have noted with the personality."

c. "The stroke affected his frontal lobe, which is responsible for personality." The nurse must address the client's family member's concern in addition to providing accurate information in a therapeutic manner; therefore, the best response by the nurse is "The stroke affected his frontal lobe, which is responsible for personality." Telling the client's family that the concern will be communicated with the health care provider is appropriate; however, the nurse has the knowledge to provide the family member with the reason for the personality change, so this response is not best. Asking for specific personality changes noted is appropriate; however, it does not address the cause of the change. Parietal lobe strokes do not affect personality; rather, a stroke in this area of the cerebrum affects sensory function.

A client is newly prescribed a medication that will block the effects of histamine postsynaptically for the treatment of a mental health disorder. The client asks, "What side effects should I anticipate with this new medication?" Which response by the nurse is accurate? a. "You should expect to experience insomnia." b. "You should expect weight loss." c. "You should expect to feel drowsy." d. "You should expect your blood pressure to increase."

c. "You should expect to feel drowsy." The function of histamine is not well known, but it appears to have a role in autonomic and neuroendocrine regulation. Many psychiatric medications can block the effects of histamine postsynaptically and produce side effects such as hypotension, sedation, and weight gain. Based on this information, the response by the nurse that is accurate is "You should expect to feel drowsy." This is due to the sedative effect. Blood pressure decreases, not increases. Sedation is a side effect; therefore, insomnia is not anticipated. Weight gain, not loss, is another anticipated side effect.

Clients diagnosed with myasthenia gravis have a decrease in which receptor? a. Norepinephrine b. Serotonin c. Acetylcholine d. Dopamine

c. Acetylcholine The binding of acetylcholine to its receptor activates the muscle and causes a muscle contraction. In myasthenia gravis, antibodies (immune proteins produced by the body's immune system) block, alter, or destroy the receptors for acetylcholine at the neuromuscular junction, which prevents the muscle from contracting.

Chlorpromazine is a drug in which classification? a. Antimanic b. Antidepressant c. Antipsychotic d. Antianxiety

c. Antipsychotic Thorazine (chlorpromazine) is a first-generation antipsychotic medication.

When comparing the theories of mental illness popular in ancient Greece with those popular in the Middle Ages, which is more applicable to the Middle Ages? a. Mental illness was considered a disturbance of the four body fluids, or "humors." b. Emotional disorders were believed to be an organic dysfunction. c. Belief in demonic possession and exorcism was common. d. Treatment included sedation, good nutrition and hygiene, and music and recreation.

c. Belief in demonic possession and exorcism was common. While some of these answers are true of both ancient Greece and the Middle Ages, belief in demonic possession and exorcism was more common in the Middle Ages.

Which would not be considered an impediment to successful discharge planning? a. Noncompliance with medications b. Alcohol and drug abuse c. Compliance with the therapeutic regimen d. Criminal or violent behavior

c. Compliance with the therapeutic regimen Compliance with the therapeutic regimen is not an impediment to successful discharge planning. Criminal or violent behavior, alcohol and drug abuse, and noncompliance with medications are all barriers to successful discharge planning.

A nursing instructor informs a class that the trend in the United States today is to receive treatment without institutional-based intervention. What else is true concerning mental health care today? a. Treatment settings for patients with mental illnesses have remained constant the last century. b. Insurance and Medicaid/Medicare are lenient in regards to payment for this care. c. Criteria for admission to inpatient care have become legally regulated. d. Changes in health care reimbursement have had no effects on outcomes.

c. Criteria for admission to inpatient care have become legally regulated. Treatment settings for patients with mental illnesses have undergone a paradigm shift in recent years. Changes in health care reimbursement have greatly affected the U.S. behavioral health care system. Insurances and Medicaid/Medicare have affected the level of care given to patients. Criteria for admission to inpatient care have thus become very regulated, which has led to fewer services offered.

Which is one common mistake that people working in the helping professions do when applying theory to the therapeutic process? a. Deny access to care by restricting clients to only one form of therapy. b. Provide a biological approach to helping with psychiatric disorders by giving several medications at one time. c. Develop an overzealous commitment to one form of therapy, ignoring the benefits that other types of therapies may have for a given individual. d. Give medications along with psychotherapy.

c. Develop an overzealous commitment to one form of therapy, ignoring the benefits that other types of therapies may have for a given individual. All theories can contribute beneficial knowledge in various situations. An eclectic approach to care is the most comprehensive and effective.

The nurse is caring for a group of clients in a residential treatment facility. While the intensive outpatient programs promote education in the areas of stress management and relapse prevention, the residential treatment facility emphasizes what? a. Drug abuse prevention b. Spiritual aspects of care c. Ensuring a sustainable living situation d. Nutritional therapies

c. Ensuring a sustainable living situation A client's living environment affects his or her level of functioning, rate of reinstitutionalization, and duration of the remaining time in the community setting. Finding a quality living situation requires ensuring sustainability of the placement as this minimizes the possibility of future hospitalization due to decompensation of mental status.

When providing care to a client, the psychiatric-mental health nurse is implementing the therapeutic use of self. The nurse is applying concepts based on the work of which individual? a. Dorothea L. Dix b. Florence Nightingale c. Hildegard E. Peplau d. Sigmund Freud

c. Hildegard E. Peplau Hildegard E. Peplau conceptualized nursing practice as independent of physicians and emphasized the use of self as a nursing tool. Florence Nightingale identified the need to view clients holistically, was sensitive to human emotions, and recommended interactions that today would be classified as therapeutic communication. Dorothea L. Dix crusaded for the humane treatment of clients with mental illness. Sigmund Freud developed a personal theory based on unconscious motivations for behavior.

In the Freudian model, which is true regarding the id? a. It is the sum of certain mental mechanisms such as perception. b. It is associated with ethics and standards of behavior. c. It is formed by unconscious desires and primitive instincts. d. It is able to control movement and contact with reality.

c. It is formed by unconscious desires and primitive instincts. In the Freudian model, the id is formed by unconscious desires and primitive instincts. The libido, or sexual instinct, resides in the id

A client refuses to interact with a student nurse during a clinical session. Which would be the most helpful in the immediate situation? Select all that apply. a. Share something personal with the client b.Ask to be assigned to another client c. Listen to the client d. Show genuine interest in the client's situation e. Ask another student for support

c. Listen to the client d. Show genuine interest in the client's situation Clients experiencing emotional distress typically welcome the opportunity to have someone listen to them and take a genuine interest in their situation. Having another client assigned to the student nurse instead or asking for help from a colleague may not solve the problem. The student nurse should learn to build skills to manage such situations. Sharing something personal with the client would be ineffective. It is important to remember not to ask questions involving personal matters or to share personal matters initially when attempting to establish a therapeutic relationship.

A 46-year-old client sustained a closed-head injury 4 hours ago. The client now presents to the emergency department because the client is having difficulty breathing. This is a result of swelling surrounding which brain structure? a. Pituitary b. Thalamus c. Medulla oblongata d. Cerebrum

c. Medulla oblongata The hindbrain, which runs from the top of the spinal cord into the midbrain, is the most primitive area of the brain and contains the brain stem, where the pons and medulla oblongata are located. These areas of the brain control basic, vital functions, such as the respiratory centers, which control breathing; the cardiovascular centers, which regulate blood pressure; the chemoreceptor trigger zone and emetic zone, which control vomiting; the swallowing center, which coordinates the complex swallowing reflex; and the reticular activating system (RAS), which controls arousal and awareness of stimuli and contains the sleep center.

A client demonstrates sexually inappropriate behavior toward a student nurse. What is an effective way for the student to respond while protecting and respecting the client? a. Immediately inform the client that the behavior is unacceptable and will be reported to staff. b. React to the incident with a sense of humor at the time but minimize contact with the client in the future. c. Report the incident to staff and the clinical instructor so boundaries can be reenforced with the client. d. Ignore the behavior at the time it occurs but report it to staff before leaving clinicals for the day.

c. Report the incident to staff and the clinical instructor so boundaries can be reenforced with the client. Some clients have difficulty recognizing or maintaining interpersonal boundaries. When a client seeks contact of any type outside the nurse-client relationship, it is important for the student (with the assistance of the instructor or staff) to clarify the boundaries of the professional relationship. The behavior should not be ignored or minimized but rather addressed in a professional, matter-of-fact manner so that the client understands the limits being placed on such behaviors. A student may initially be unskilled at dealing with such behavior while at the same time protecting the client's privacy and dignity, so the student should enlist the assistance of the instructor and staff.

The client has a longstanding history of depression. A psychoanalytic theorist might say what about the client? a. The client has seen the client's mother being depressed and has learned that this is one way to receive attention. b. When the client exhibits depressive symptoms, the client has always been taken care of by a spouse until the client is less depressed. c. The client may be unconsciously repressing feelings of anger that arise due to early childhood abuse experiences, and these feelings emerge as depression. d. The client's depression is a result of a poor family upbringing, living in a hostile environment growing up, and frequently seeing violent fighting in the client's neighborhood.

c. The client may be unconsciously repressing feelings of anger that arise due to early childhood abuse experiences, and these feelings emerge as depression. Psychoanalytic theory explores a person's past to explain current behaviors. In addition, the explanations of levels of conscious and defense mechanisms are derived from psychoanalytic theory.

A psychiatric-mental health nurse is describing the various programs offered by the local community mental health center. When explaining how these programs work, the nurse would emphasize which concept? a. autocratic leadership b. paternalistic decision-making c. collaboration d. complete autonomy

c. collaboration In today's environment, the traditional medical model, which is viewed as autocratic and paternalistic, is being replaced by a collaborative model whereby mental health professionals work in partnership with consumers to help rebuild their lives. Consumer advocacy efforts have led to the implementation of recovery philosophy and practices.

Which client is at the greatest risk for developing tardive dyskinesia due to long-term use of antipsychotic agents? a. male client, 50 years of age, who is diagnosed with depression b. female client, 45 years of age, who experiences panic attacks c. female client, 55 years of age, who is diagnosed with a history of traumatic brain injury d. male client, 40 years of age, whose dose of medication has increased significantly

c. female client, 55 years of age, who is diagnosed with a history of traumatic brain injury To determine which client has the greatest risk for developing tardive dyskinesia, the nurse must determine how many specific risk factors each client has for developing this adverse reaction to the prescribed antipsychotic agent. The female client who is 45 years of age has one risk factor: gender. The male client who is 50 years of age has one risk factor: depression. The female client who is 55 years of age has three risk factors: gender, age, and history of brain damage. The male client who is 40 years of age has one risk factor: a higher dose of prescribed medication. Based on this data, the female client who is 55 years of age with a history of traumatic brain injury has the greatest risk for developing tardive dyskinesia.

The nurse provides care to a client who is diagnosed with a traumatic brain injury (TBI) because of a motor vehicle accident. The client is noted to have mood and affect changes, specifically impulsive behavior. Which lobe of the brain is likely affected based on the client's symptoms? a. temporal b. occipital c. frontal d. parietal

c. frontal Symptoms vary widely from individual to individual with frontal lobe syndrome. In general, after damage to the dorsolateral (upper and outer) areas of the frontal lobes, the symptoms include a lack of drive and spontaneity. With damage to the most anterior aspects of the frontal lobes, the symptoms tend to involve more changes in mood and affect, such as impulsive and inappropriate behavior. The client's presentation does not support injury to the parietal, occipital, or temporal lobes of the brain.

Which concept states that if a certain behavior is rewarded with praise, the behavior will probably be repeated? a. behaviorism b. modeling c. operant conditioning d. self-efficacy

c. operant conditioning In operant conditioning, the focus is on the consequences of a behavioral response, not a specific stimulus. If a behavior is reinforced or regarded with success, praise, money, and so on, the behavior will probably be repeated. Modeling is one person trying to be similar to another. Self-efficacy is a person's sense of the individual's ability to deal effectively with the environment. Behaviorism is a learning theory that focuses only on objectively observable behaviors and discounts any independent activities of the mind.

A client brings a spouse to the mental health clinic with reports that the spouse has been exhibiting a tendency to self-mutilate, experiences fits of intense rage, and is increasingly aggressive toward others. How should the nurse elaborate on the type of symptoms this client is demonstrating? a. "Lack of norepinephrine in the body produces symptoms such as obesity, fibromyalgia, and panic attacks." b. "Lack of histamine in the body produces symptoms such as anxiety, hypertension, and difficulty regulating body temperature." c. "Lack of dopamine in the body produces symptoms such as depression, fatigue, and lack of motivation." d. "Lack of serotonin in the body produces symptoms such as aggression, hostility, and compulsiveness."

d. "Lack of serotonin in the body produces symptoms such as aggression, hostility, and compulsiveness." Serotonin plays a role in emotions, cognition, sensory perceptions, and essential biologic functions such as sleep and appetite. Serotonin also controls food intake, irritability, sleep and wakefulness, compulsiveness, temperature regulation, pain control, sexual behaviors, and regulation of emotions. Norepinephrine, histamine, and dopamine are not correct. Lack of norepinephrine may lead to conditions such as attention deficit hyperactivity disorder, depression, and hypotension. Lack of histamine means dopamine levels will be elevated and this may result in anxiety, paranoia, being suspicious, and hallucinations. Lack of dopamine may lead to imbalance difficulties, speech problems, and postural changes.

Which client may be the most appropriate candidate for telepsychiatry? a. An inpatient who is on visual checks every 15 minutes as a suicide precaution b. A client with bipolar disorder who has been admitted to the hospital during a manic episode c. A client who has been brought to the emergency department because of acute psychosis d. A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health

d. A client whose depression does not warrant inpatient or outpatient care but who is motivated to maintain the client's health Cybertherapy may be most appropriate for persons who do not qualify for therapeutic intervention but who are motivated for treatment. Acute illnesses are not likely to be effectively treated by this method.

Which individual has experienced the consequences of deinstitutionalization? a. A man who was denied inpatient psychiatric treatment by his health maintenance organization (HMO) b. A woman who has been the frequent object of stigma due to her history of psychiatric illness c. A man who has been unable to obtain health insurance but who receives Medicare benefits d. A woman who was transferred from a psychiatric hospital to the community because of the hospital's impending closure

d. A woman who was transferred from a psychiatric hospital to the community because of the hospital's impending closure The process of deinstitutionalization involves moving chronically mentally ill clients from state psychiatric hospitals back to their homes or to community-supervised facilities.

Which is the key common element in the various psychotherapeutic approaches? a. The therapist's ability to manage the clients' symptoms b. The underlying origin of the clients' issues c. The clients' history of therapeutic success in the past d. An effective client-therapist relationship

d. An effective client-therapist relationship The key common element in the various psychotherapeutic approaches is an effective client-therapist relationship. The nurse-client relationship is critical to the success of the use of any therapeutic modality because the client is unlikely to engage authentically if trust in the relationship is lacking.

The nurse is planning care for a client who has been newly diagnosed with a mental illness. Which should be the nurse's first step in managing this client's nursing care? a. Implementation b. Evaluation c. Planning d. Assessment

d. Assessment The first step in caring for a client with mental illness is the initial data collection process (i.e., assessment) so as to arrive at a diagnosis. The second step is establishing a plan of care, followed by implementation of the identified plan. Lastly, the client has to be evaluated for progress.

A nurse has transferred recently to a forensic practice setting from an acute care medical setting. During the orientation period, the nurse's mentor helps the nurse learn the culture of a forensic setting. The nurse learns to be alert to one of the most dominant barriers to building a therapeutic relationship with forensic clients. What is this barrier? a. Clients are transferred frequently to other forensic institutions. b. Nurses often transgress professional boundaries with the clients. c. The lifestyle of the incarcerated client is solitary. d. Clients commonly struggle with trusting others.

d. Clients commonly struggle with trusting others. Recurring themes of power and control, negotiation, and trust building dominate therapeutic interventions in this setting; clients have, in varying degrees, learned to adapt to an environment that rewards distrust, manipulation, and deceit. The criminal history, frequent diagnoses of antisocial and borderline personality disorder, and aggressive interpersonal style of many forensic clients can evoke strong emotional responses, and countertransference and splitting reactions are common.

Which action by the group leader demonstrates effective leadership? a. Using autocratic leadership strategies b. Firmly disciplining negative behavior c. Conducting meetings based on personality attributes d. Encouraging participation by all members

d. Encouraging participation by all members The key to being a good leader is to integrate group leadership, knowledge, and skills with nursing interventions that fit a selected group. Firmly disciplining negative behavior, using autocratic leadership strategies, and conducting meetings based on personality attributes are not keys to being a good leader.

A psychiatric-mental health nurse is integrating Piaget's theory of cognitive development into care of adolescents coming to the clinic for care. When planning for this population's learning needs, the nurse would identify this age group as in which stage? a. Sensorimotor b. Concrete operations c. Preoperational d. Formal operations

d. Formal operations Adolescents are in the formal operations stage of development. School-age children are in the concrete operations stage. Children between the ages of 2 and 7 years are in the preoperational stage of cognitive development. Infants and toddlers to age 2 years are in the sensorimotor stage

Benzodiazepines increase which neurotransmitter function? a. Serotonin b. Norepinephrine c. Acetylcholine d. GABA

d. GABA Benzodiazepines enhance the action of the neurotransmitter gamma-aminobutyric acid (GABA), which slows down the central nervous system. This produces the calming, sedative effect that helps with anxiety.

Which is an advantage of group therapy over individual therapy for a client with a borderline personality disorder? a. Group theory provides such clients with the personal attention they crave b. Individual therapy is too easily manipulated by such clients c. Individual theory makes countertransference an extremely likely outcome when such a client is involved d. Group therapy provides the client with relationship opportunities upon which to test behavior modifications

d. Group therapy provides the client with relationship opportunities upon which to test behavior modifications Group therapy differs from individual therapy in that it is more effective for treating problems with interpersonal relationships, such as for the client with a borderline personality disorder. It offers multiple relationships to assist the individual in growth and problem solving and allows psychiatric clients a greater opportunity for reality testing and experiencing mutual concern and support.

Who was the first to introduce the concept of interpersonal relations and the therapeutic relationship? a. Linda Richards b. Mary Nutting c. Florence Nightingale d. Hildegard Peplau

d. Hildegard Peplau Hildegard Peplau wrote a publication introducing the concepts of interpersonal relations and the therapeutic relationship within psychiatric-mental health nursing practice.

Assertive Community Treatment (ACT) reduces the use of which type of service? a. Detoxification b. Community based c. Crisis intervention d. In-patient Hospital

d. In-patient Hospital ACT, a community based service, reduces the use of hospital and emergency room services, which in turn reduces the cost of mental health treatment for clients with serious mental illnesses. ACT does not reduce the use of crisis intervention, or detoxification.

Which is an inaccurate depiction of self-awareness? a. It involves self-reflection. b. There is an understanding that a nurse's belief may conflict with the client's. c. The nurse gains recognition of his or her feelings and beliefs. d. It involves changing one's values or beliefs.

d. It involves changing one's values or beliefs. The goal of self-awareness is to know oneself so that one's values, attitudes, and beliefs are not projected to the client, interfering with nursing care. Self-awareness does not mean having to change one's values or beliefs, unless one desires to do so. Therefore, this is the inaccurate depiction of self-awareness the question asks for.

A client receives the first dose of fluphenazine. The next day, during the follow-up appointment, the nurse finds the client is confused and mute, and the client's temperature is 103°F. The client also presents with rigidity and diaphoresis. The nurse should investigate further for which condition? a. Parkinsonism b. Serotonin syndrome c. Heatstroke d. Neuroleptic malignant syndrome

d. Neuroleptic malignant syndrome d. The most serious and potentially fatal side effect of the typical antipsychotics is neuroleptic malignant syndrome, characterized by severe muscular rigidity, altered consciousness, disorientation, dysphagia, elevated creatinine phosphokinase, stupor, catatonia, hyperpyrexia, and labile pulse and blood pressure. This life-threatening condition can occur after a single dose of a neuroleptic; however, it is more common in the first 2 weeks of administration or with an increase in dose. It can continue for up to 2 weeks after discontinuation of the medication. Serotonin syndrome has some overlapping signs and symptoms, but it is characterized by hyperreflexia rather than rigidity and is usually the result of taking an MAOI and an SSRI.

Which intervention is appropriate for a psychiatric-mental health nurse at the basic level of practice? a. Prescribing psychotropic medications b. Interpreting laboratory tests c. Conducting family therapy d. Promoting symptom management

d. Promoting symptom management Basic psychiatric-mental health nurses promote and encourage the maintenance of health and prevention of disorders, assess biopsychosocial functioning, serve as case managers, design therapeutic environments, and promote self-care activities, including medication and symptom management. At the advanced level, psychiatric-mental health nurses deliver comprehensive primary mental health services. Functions include delivering psychotherapy, prescribing medications (in many states), teaching and screening, performing preventive interventions, and evaluating and managing care for people with mental illness.

The forensic nurse is assessing a client with new onset of hallucinations and agitation in a police station. Which finding is most consistent with mentally ill clients in the criminal justice system? a. Danger of self-harm b. Re-offense with incarceration c. Increased number of crimes d. Risk of violence

d. Risk of violence There is a higher risk of serious violence (homicide) for those with a first-episode psychosis who have not yet been treated than for those who have previously received treatment. Offenders with mental illnesses are less likely to reoffend than someone who has been in prison who does not have a mental illness. People with mental illnesses are more likely to harm themselves than someone else. Despite the large number of people with mental illnesses who commit crimes, the majority of their encounters with the justice system occur when individuals with mental illness are victims of crime.

After educating a client who is receiving phenelzine, the nurse determines that the education was successful when the client states the need to avoid consuming which food or beverage? a. Soy Milk b. Fresh cottage cheese c. Cooked sliced ham d. Tap beers

d. Tap beers Phenelzine is a monoamine oxidase inhibitor. The client needs to avoid foods high in tyramine, such as tap beers, matured and aged cheeses, dried aged and fermented meats, broad bean pods, concentrated yeast extract, sauerkraut, and soy sauce.

A client is seen in an outpatient mental health clinic for complaints of involuntary tongue movement, blinking, and facial grimacing. This syndrome would be identified correctly as what? a. Akathisia b. Dystonia c. Neuroleptic malignant syndrome d. Tardive dyskinesia

d. Tardive dyskinesia The symptoms of tardive dyskinesia include involuntary movements of the tongue, facial and neck muscles, upper and lower extremities, and truncal musculature. Neuroleptic malignant syndrome is a potentially fatal reaction manifested by rigidity, high fever, and autonomic instability. Acute dystonia includes acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties. Akathisia is reported by the client as an intense need to move about.

A client is using cognitive therapy as an adjunct treatment for bipolar disorder. Which would be an overall goal for this client related to the use of cognitive therapy for this condition? a. The client will no longer have to take medication. b. The client will continue to have sessions with the therapist once a week for life. c. The client will relinquish all control. d. The client will engage in self-care independent of professional assistance.

d. The client will engage in self-care independent of professional assistance. Cognitive therapy assumes that individuals have an innate ability to solve their own problems; thus, the overarching treatment goal is for the patient to engage in self-care independent of professional assistance.

The nurse is discussing deinstitutionalization of mentally ill persons at a community forum. What is a consequence of the trend towards deinstitutionalization? a. Male offenders receive more treatment than do female offenders. b. One million people in correctional facilities have mental illness. c. The justice and correctional systems work together to improve care. d. The number of persons with mental illness in prison has increased.

d. The number of persons with mental illness in prison has increased. As the number of state hospitals was dramatically reduced beginning in the 1960s, the number of persons with mental illness incarcerated in jails and prisons increased. Based on the total number of inmates, this means that there are approximately 356,000 inmates with serious mental illness in jails and state prisons. A large number of persons with mental illness are confined to U.S. prisons and jails. Individuals with mental illnesses are at higher risk for arrest than the general population. They are more likely to have encounters with the criminal justice system and be convicted of a crime than those without a mental illness. After they enter the corrections system, female offenders are more likely than male offenders to receive mental health services, and black offenders receive significantly less mental health treatment than similar non-black Americans.

A client is receiving clozapine. For which life-threatening disorder should the nurse be alert when assessing this client? a. hypotension b. hypertension c. diabetes d. agranulocytosis

d. agranulocytosis Agranulocytosis is an acute reaction that causes the individual's white blood cell count to drop to very low levels and concurrent neutropenia, a reduction in neutrophils in the blood, to develop. While the remaining options are potential side effects of antipsychotics, agranulocytosis is both life-threatening and specific to clozapine.

In which way do neurons communicate through the use of synapses? a. excitatorily b. inhibitorily c. indirectly d. electrochemically

d. electrochemically Norepinephrine, a neurotransmitter, belongs to a group of structurally related chemicals called catecholamines that also includes dopamine, serotonin, and epinephrine. Neurons do not communicate indirectly, excitatorily, or inhibitorily.

A client with a history of a traumatic brain injury is admitted for personality changes and labile mood. Upon assessment, the client has difficulty with problem solving and impaired working memory. The nurse identifies that which part of the brain was affected by the previous injury? a. occipital lobe b. temporal lobe c. parietal lobe d. frontal lobe

d. frontal lobe Each hemisphere of the brain is divided by four lobes including the frontal, parietal, occipital, and temporal. The lobes work in coordinated ways, but each lobe is responsible for specific functions. The frontal lobes are responsible for working memory, insight, judgment, reasoning, self-evaluation, problem-solving, concept formation, and mood and personality. The parietal lobes are responsible for sensory function and spatial relationships. The temporal lobes are responsible for auditory and olfactory areas. The occipital lobes are responsible for vision. The client experiencing labile mood and personality changes likely has had damage to their frontal lobe(s).