NUR448 Exam 2 Practice Questions

Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder? A. "I'm so restless. I can't seem to sit still." B. "I spend most of my time studying. I have to get into a good college." C. "I'm not trying to diet, but I've lost about 5 pounds in the past 5 months." D. "I go to sleep around 11 pm but I'm always up by 3 am and can't go back to sleep."

D. "I go to sleep around 11 pm but I'm always up by 3 am and can't go back to sleep."

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

A. 10 to 34 year olds B. Males E. Native American

When assessing an adolescent patient for depression, it is most important for the nurse to recognize that depression in adolescents is often: A. Similar in presentation to depression in adults B. Masked by aggressive behaviors C. Situational and not as serious as depression in adults D. An indication of family dysfunction

B. Masked by aggressive behaviors

The main goal of crisis intervention therapy is to: A. Assist the patient in returning to the level of pre-crisis functioning. B. Introduce new, effective coping methods to the patient. C. Assess the patient in order to identify the causative stressors. D. Establish a sustainable therapeutic nurse-patient relationship.

A. Assist the patient in returning to the level of pre-crisis functioning. Rationale: The main goal of crisis intervention therapy is directed toward solving the immediate problem, with the goal of returning the patient to a level of functioning that is equal to or better than that experienced precrisis. This goal is reached through strategies that include the introduction of new coping methods directed toward the stressors that contributed to the crisis. The establishment of a therapeutic nurse-patient relationship is a general goal for all nursing relationships.

The activity of gamma-aminobutyric acid (GABA) contributes to a slowing of neural activity. Which of the following drugs facilitates the action of GABA? A. Benzodiazepines B. Antihistamines C. Anticonvulsants D. Noradrenergic

A. Benzodiazepines

Which med doesn't belong in the following group? A. Buspirone B. Doxepin C. Imipramine D. Nortriptyline

A. Buspirone (serotonin partial agonist) A, C, and D are TCAs

Anxiety problems in older adults can manifest as a fear of falling, greatly influencing an older adult's personal freedom. A home health nurse checking on a patient with mild dementia and anxiety related to falling should question which new order? A.Yoga and tai-chi B. Xanax C. Relaxation techniques D. Electric wheelchair

B. Xanax

In pediatric mental health there is a lack of sufficient numbers of community based resources and providers, and there are long waiting lists for services. This has resulted in... Select all that apply. A. Children of color and poor economic conditions being underserved B. Increased stress in the family unit C. Markedly increased funding D. Premature termination of services

A. Children of color and poor economic conditions being underserved B. Increased stress in the family unit D. Premature termination of services

Which of the following meds is not in the benzodiazepine family? A. Chlorpromazine B. Diazepam C. Alprazolam D. Clonazepam

A. Chlorpromazine (FGA)

The nurse is performing an assessment on a client with dementia. Which of the following, if found to be present, would be a manifestation associated with dementia? A. Confabulation B. Improvement in sleeping C. Absence of sundown syndrome D. Presence of personal hygienic care

A. Confabulation Rationale: For the client to use confabulation or fabrication of events or experiences to fill in memory gaps is common. Often, lack of inhibition on the part of the client constitutes the first indication to the client's significant others that something is "wrong." As the dementia progresses, the client will have episodes of wandering or sundowning.

A patient who has just been sexually assaulted is calm and quiet. A nurse analyzes this behavior as indicating which defense mechanism? A. Denial B. Projection C. Rationalization D. Intellectualization

A. Denial Rationale: Denial is refusal to admit to a painful reality and may be a response by a victim of sexual abuse. Projection is transferring one's internal feelings, thoughts, and unacceptable ideas and traits to someone else. Rationalization is justifying the unacceptable attributes about oneself. Intellectualization is the excessive use of abstract thinking or generalizations to decrease painful thinking.

A community nurse is visiting an 80 year-old client. The client tells the nurse, "My children never visit me." The nurse is aware that the client's children visited on the previous day. What additional assessments will the nurse expect to find if the client is experiencing dementia? (Select all that apply) A. Disoriented B. Affective distressed C. Struggles to perform tasks D. Impaired concentration E. Diminished appetite F. Symptoms become better as the day progresses.

A. Disoriented C. Struggles to perform tasks D. Impaired concentration

Which patient has an increased risk for the development of anxiety and will require frequent assessment by the nurse? Select all that apply. A. Exacerbation of asthma signs and symptoms B. History of peanut and strawberry allergies C. History of chronic obstructive pulmonary disease D. Current treatment for unstable angina pectoris E. History of a TBI

A. Exacerbation of asthma signs and symptoms C. History of chronic obstructive pulmonary disease D. Current treatment for unstable angina pectoris E. History of a TBI

Tammy, a 28-year-old with major depressive disorder and bulimia nervosa, is ready for discharge from the count hospital after 2 weeks of inpatient therapy. Tammy is taking citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervosa, what is an alternative antidepressant to consider? A. Fluoxetine (Prozac) B. Isocarboxazid (Marplan) C. Amitriptyline D. Duloxetine (Cymbalta)

A. Fluoxetine (Prozac)

What assessment question should the nurse ask when attempting to determine a teenager's mental health resilience? Select all that apply. A. How did you cope when your father deployed with the Army for a year in Iraq? B. Who did you go to for advice while your father was away in Iraq? C. How do you feel about talking to a mental health counselor? D. Where do you see yourself in 10 years? E. Do you like the school you go to?

A. How did you cope when your father deployed with the Army for a year in Iraq? B. Who did you go to for advice while your father was away in Iraq? D. Where do you see yourself in 10 years?

Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply. A. I have to keep reminding myself to consistently drink six 12 ounces glasses of fluid everyday B. I discussed the diuretic my cardiologist prescribed with my psychiatric care provider C. Lithium may help me lose the few extra pounds I tend to carry around D. I take my lithium on an empty stomach to help with absorption E. I've already made arrangements for my monthly lab work

A. I have to keep reminding myself to consistently drink six 12 ounces glasses of fluid everyday B. I discussed the diuretic my cardiologist prescribed with my psychiatric care provider E. I've already made arrangements for my monthly lab work

What is the rationale for providing a patient diagnosed with dementia easily accessible finger foods throughout the day? A. Increases input throughout the day B. The person may be anorexic C. Assists with monitoring food intake D. Helps prevent constipation

A. Increases input throughout the day

What side effects should the nurse monitor for when caring for a patient prescribed donepezil (Aricept)? Select all that apply. A. Insomnia B. Constipation C. Bradycardia D. Signs of dizziness E. Reports of headache

A. Insomnia C. Bradycardia D. Signs of dizziness E. Reports of headache

What are the nursing responsibilities to a patient expressing suicidal thoughts? Select all that apply. A. Instituting one-to-one observation B. Documenting the patient's whereabouts and mood every 15 to 30 minutes C. Ensuring that the patient has no contact with glass or metal utensils D. Ensuring that patient has swallowed each individual dose of medication E. Discussing triggers of depression

A. Instituting one-to-one observation B. Documenting the patient's whereabouts and mood every 15 to 30 minutes C. Ensuring that the patient has no contact with glass or metal utensils D. Ensuring that patient has swallowed each individual dose of medication

The nurse is planning nursing interventions to improve self-esteem for a group of clients diagnosed with Alzheimer disease. Which of the following therapeutic strategies will the nurse include in the treatment plan? (Select all that apply.) A. Life review or reminiscence therapy B. Music therapy C. Pet therapy D. Puzzles, board games E. Watching TV

A. Life review or reminiscence therapy B. Music therapy C. Pet therapy

Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply. A. Limited language skills B. Level of cognitive development C. Level of emotional development D. Parental denial that a problem exists E. Severity of the type of mental illness observed in young children

A. Limited language skills B. Level of cognitive development C. Level of emotional development

Which interventions should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply. A. Monitor the patient's vital signs frequently B. Keep the patient distracted with group oriented activities C. Provide the patient with frequent milkshakes and protein drinks D. Reduce the volume on the television and dim bright lights in the environment E. Use a firm but calm voice to give specific concise directions for the patient

A. Monitor the patient's vital signs frequently C. Provide the patient with frequent milkshakes and protein drinks D. Reduce the volume on the television and dim bright lights in the environment E. Use a firm but calm voice to give specific concise directions for the patient

A homebound patient diagnosed with agoraphobia has been receiving therap in the home. The nurse evaluates patient teaching is effective when the patient states: A. I may never leave the house again B. Having groceries delivered is very convenient C. My risk for agoraphobia is increased by my family history D. I will go out again someday, just not today

C. My risk for agoraphobia is increased by my family history

A woman comes into the emergency room in a severe state of anxiety after a car accident. Which of the following is the appropriate nursing intervention? A. Remain with the patient. B. Put the patient in a quiet room. C. Teach the patient deep breathing techniques. D. Encourage the patient to talk about her feelings and concerns.

A. Remain with the patient. Rationale: If a patient with severe anxiety is left alone, the patient may feel abandoned and become overwhelmed. Placing the patient in a quiet room is also important, but the nurse must stay with the patient. Teaching the patient deep breathing or relaxation is not possible until the anxiety decreases. Encouraging the patient to discuss concerns and feelings would not take place until the anxiety has decreased.

All of the following are in the SSRI family except: A. Paroxetine B. Fluoxetine C. Phenelzine D. Duloxetine

C. Phenelzine (MAOi)

A monoamine oxidase inhibitor (MAOI) is prescribed for a patient. The nurse instructs the patient that signs and symptoms of toxicity related to the use of this medication may include: A. Restlessness B. Feelings of fatigue C. Lack of energy D. Lethargy

A. Restlessness Rationale: Acute toxicity of MAOIs is manifested by restlessness, anxiety, and insomnia. Dizziness and hypertension also can occur in acute toxicity. Options 2, 3 and 4 are not signs of toxicity related to MAOIS.

The nurse develops a nursing diagnosis of self-care deficit for an older client with dementia. Which of the following is an appropriate goal for this client? A. The client will function at the highest level of independence possible. B. The client will complete all activities of daily living (ADL) independently within a 1-hour time frame. C. The client will be admitted to a long-term care facility to have ADL needs met. D.The nursing staff will attend to all the client's ADL needs during the hospital stay.

A. The client will function at the highest level of independence possible. Rationale: All clients, regardless of age, need to be encouraged to perform at the highest level of independence possible. Independence contributes to the client's sense of control and sense of well-being. Option 3 is incorrect because what the self-care deficit entails is not known. To assume that the client requires long-term care based on so little information would be erroneous. Options 2 and 4 are close-ended statements.

Which behavior observed by a nurse indicates a suspicion that a depressed adolescent patient may be suicidal? A. The patient gives away a prized CD and a cherished autographed picture of a performer. B. The patient becomes angry while speaking on the telephone and slams down the receiver. C. The patient gets angry with her roommate when the roommate borrows the patient's clothes without asking. D. The patient sits sullenly in the open area of the unit.

A. The patient gives away a prized CD and a cherished autographed picture of a performer. Rationale: A depressed suicidal patient often gives away that which is of value as a way of saying goodbye and wanting to be remembered. Options 1, 3 and 4 deal with anger and acting-out behaviors that are often typical of any adolescent.

Pam, the nurse educator, is teaching a new nurse about seclusion and restraint. Order the following interventions from least (1) to most (5) restrictive. A. With the patient identify the behaviors that are unacceptable and consequences associated with harmful behaviors B. Placing the patient in physical restraints C. Allowing the patient to take a time out and sit in his or her room D. Offering a PRN medication by mouth E. Placing the patient in a locked seclusion room

A. With the patient identify the behaviors that are unacceptable and consequences associated with harmful behaviors D. Offering a PRN medication by mouth C. Allowing the patient to take a time out and sit in his or her room E. Placing the patient in a locked seclusion room B. Placing the patient in physical restraints

A nurse is providing care to a patient admitted to the hospital with a diagnosis of acute anxiety disorder. The patient says to the nurse, "I have a secret that I want to tell you. You won't tell anyone about it, will you?" The appropriate nursing response would be which of the following? A. "No, I won't tell anyone." B. "I cannot promise to keep a secret." C. "If you tell me a secret, I will tell it to your doctor." D. "If you tell me the secret, I will need to document it in your record."

B. "I cannot promise to keep a secret." Rationale: The nurse should never promise to keep a secret. Secrets are appropriate in a social relationship, but not in a therapeutic one. The nurse needs to be honest with the patient and tell the patient that a promise cannot be made to keep the secret. Options 1, 3, and 4 are inappropriate responses.

Conversion disorder is described as an absence of a neurological diagnosis that manifests in neurological symptoms. Channeling of emotions, conflicts, and stressors into physical symptoms is thought to be the cause in conversion disorder. Which statement is true? A. People with conversion disorder are extremely upset about often dramatic symptoms B. Abnormal patterns of cerebral activation have been found in individuals with conversion disorder C. An organic cause is usually found in most cases of conversion disorder D. Symptoms can be turned off and on depending on the patient's choice

B. Abnormal patterns of cerebral activation have been found in individuals with conversion disorder

A nurse is performing an assessment on a patient admitted to the mental health unit. The nurse notes that the patient's diagnosis is documented as obsessive-compulsive disorder. The nurse plans care knowing that the patient is most likely to experience which type of compulsive behavior? A. Thoughts B. Actions C. Fears D. Illusions

B. Actions Rationale: A compulsion is a repetitive act, and an obsession is a repetitive thought. The patient with a phobia is likely to experience repetitive fears. Illusions are characteristic of schizophrenia.

A nurse is caring for a client with Alzheimer's disease who is having difficulty recognizing objects that are well known, including people. The nurse documents that the client is experiencing: A. Aphasia B. Agnosia C. Apraxia D. Ataxia

B. Agnosia

What is the shortest acting anxiolytic here? A. Lorazepam B. Alprazolam C. Fluroazepam D. Diazepam

B. Alprazolam Alprazolam and Clonazepam are the short acting anxiolytics

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

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

A patient with a history of panic disorder comes to the emergency department and states to the nurse: "Please help me- I think I'm having a heart attack." What is the priority nursing action? A. Identify the patient's activity during the pain. B. Assess the signs related to the panic disorder. C. Assess the patient's vital signs. D. Determine the patient's use of relaxation techniques.

B. Assess the patient's vital signs Rationale: Patients with panic disorders experience acute physical symptoms, such as chest pain and palpitations. The priority is to assess the patient's physical condition to rule out a physiological disorder.

Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to... A. Limited executive functioning B. Cerebellum maturation C. Cerebral stasis and hormonal changes D. A slight reduction in brain volume

B. Cerebellum maturation

An adolescent client presents in the emergency room with right arm paralysis. A complete diagnostic workup is completed, but no organic cause for the paralysis can be determined. The client tells the nurse, "I guess I will have to miss my piano recital today." The nurse suspects the client may be experiencing: A. Malingering B. Conversion disorder C. Undifferentiated somatoform disorder D. Body dysmorphic disorder (BDD)

B. Conversion disorder

Which is the highest priority intervention for the nurse who is working with a child with anxiety? A. Have the child face his or her fear B. Decrease fear and anxiety C. Protect the child from fears D. Allow the child to express fears

B. Decrease fear and anxiety

Which medication is best for mixed episodes of rapid cycling in bipolar disorder? A. Carbamazepine B. Divalproex sodium C. Lamotrigine D. Lithium carbonate

B. Divalproex sodium

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

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

When planning discharge of a patient with chronic anxiety, a nurse directs the goals at promoting a safe environment at home. The appropriate maintenance goal should focus on which of the following? A. Ignoring the feelings of anxiety. B. Identifying anxiety-producing situations. C. Continuing contact with a crisis counselor. D. Eliminating all anxiety from daily situations.

B. Identifying anxiety-producing situations. Rationale: Recognizing situations that produce anxiety allows the patient to prepare to cope with anxiety and avoid a specific stimulus. Counselors will not be available for all anxiety-producing situations, and this option does not encourage the development of internal strengths. Ignoring feelings will not resolve anxiety. Elimination of all anxiety from life is impossible.

A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially? A. Reinforce that the level is therapeutic B. Instruct the patient to hold the next dose of medication and contact the prescriber C. Have the patient go to the hospital emergency room immediately D. Alert the patient to the possibility of seizures and appropriate precautions

B. Instruct the patient to hold the next dose of medication and contact the prescriber

What is the drawback of buspirone? A. It has addictive tendencies B. It takes ~2 weeks to be effective C. It is a CNS depressant D. It causes restlessness as a side effect

B. It takes ~2 weeks to be effective

Which statement(s) made by the nurse demonstrates an understanding of the effective use of relaxation therapy for anxiety management? Select all that apply. A. Relaxation therapy main goal is to prevent exhaustion by removing muscle tension B. Muscle relaxation promotes the relaxation response C. Show me how you learned to deep breathe in yesterday's therapy session D. You've said that going to group makes you nervous so let's start relaxing now E. I've given you written descriptions of the various relaxation exercise for you to review

B. Muscle relaxation promotes the relaxation response C. Show me how you learned to deep breathe in yesterday's therapy session D. You've said that going to group makes you nervous so let's start relaxing now E. I've given you written descriptions of the various relaxation exercise for you to review

A nurse assesses a patient with the admitting diagnosis of bipolar affective disorder, mania. The symptom presented by the patient that requires the nurse's immediate intervention is the patient's: A. Outlandish behaviors and inappropriate dress. B. Nonstop physical activity and poor nutritional intake. C. Grandiose delusions of being a royal descendant of King Arthur. D. Constant, incessant talking that includes sexual innuendos and teasing the staff.

B. Nonstop physical activity and poor nutritional intake. Rationale: Mania is a mood characterized by excitement, euphoria, hyperactivity, excessive energy, decreased need for sleep and impaired ability to concentrate or complete a single train of thought. Mania is a period when the mood is predominantly elevated, expansive or irritable. All options reflect a patient's possible symptoms. Option 2 clearly presents a problem, however, that compromises physiological integrity and needs to be addressed immediately. [Maslow's hierarchy]

A nurse is reviewing the record of a patient admitted to the mental health unit. The nurse notes documentation that the patient experiences flashbacks. The nurse would expect that this patient has been diagnosed with: A. Agoraphobia B. PTSD C. Anxiety D. Schizophrenia

B. PTSD Rationale: The major clinical manifestation associated with PTSD is patient experience of flashbacks. Flashbacks are not specifically associated with agoraphobia, anxiety or schizophrenia.

Ling works as a registered nurse in an Alzheimer care home. She has specialized a rapport building technique she uses called reminiscence. She uses this technique by... A. Telling the residents stories about her grandparents lives B. Playing music from the residents formative years C. Reviewing movies the residents enjoy D. Encouraging the residents to talk about pleasurable past experiences

D. Encouraging the residents to talk about pleasurable past experiences

Lucas is a nurse on a medical floor caring for Kelly, a 48 year old patient with newly diagnosed type 2 diabetes. He realizes that depression is a complicating factor in the patient's adjustment to her new diagnosis. What problem has the most potential to arise? A. Development of agoraphobia B. Treatment nonadherence C. Frequent hypoglycemic reactions D. Sleeping rather than checking blood sugar

B. Treatment non-adherence

A client with a diagnosis of hypochondriasis tells the nurse in excessive detail about his current physical complaint. The most appropriate response from the nurse would be: A. "Tell me more about your physical symptoms." B. "Do you really expect me to believe what you just said? That's absurd." C. "I will make a note of what you said." D. "Don't worry. The doctors here know what they are doing."

C. "I will make a note of what you said."

A client who developed delirium following surgery asks if having delirium is the beginning of Alzheimer disease. The nurse explains the differences between delirium and dementia. Which of the following statements by the client requires further teaching? A. "If I have dementia I will slowly get worse." B. "So I developed delirium because I had surgery." C. "In dementia there are quick changes in the levels of consciousness too." D. "I might have developed permanent brain damage."

C. "In dementia there are quick changes in the levels of consciousness too."

Which of the following people is at highest risk for committing suicide? A. A 24-year-old patient who just had an argument with her roommate. B. A 71-year-old patient with a cardiac disorder. C. A 75-year-old patient with metastatic cancer. D. A 30-year-old newly divorced patient who states she has custody of the children.

C. A 75-year-old patient with metastatic cancer. Rationale: The person is at highest risk for suicide is the patient with terminal illness. Other high-risk groups include adolescents, drug abusers, persons who have experienced recent losses, those who have few or no social supports, and those with a history of suicide attempts and a suicide plan.

Nancy is a nurse. After talking with her mother, she became concerned enough to drive over and check on her. Her mother's appearance is disheveled, words are nonsensical, smells strongly of urine, and there is a stain on her dress. Nancy recognizes that her mother's conditions is likely temporary due to: A. Early onset dementia B. A mild cognitive disorder C. A urinary tract infection D. Skipping breakfast

C. A urinary tract infection

The nurse employs play therapy with a small group of 6 year olds. The primary expected outcome for these children is? A. Learn to talk openly about themselves B. Learn how to give and receive feedback C. Act out feelings in a constructive manner D. Learn problem-solving skills

C. Act out feelings in a constructive manner Rationale: This choice is most consistent & appropriate with 6 year olds' developmental growth

A patient is admitted to the mental health unit after an attempt of suicide by hanging. A nurse's most important aspect of care is to maintain client safety. This is accomplished best by: A. Requesting that a peer remain with the patient at all times. B. Removing the patient's clothing and placing the patient in a hospital gown. C. Assigning a staff member to the patient who will remain with the patient at all times. D. Admitting the patient to a seclusion room where all potentially dangerous articles are removed.

C. Assigning a staff member to the patient who will remain with the patient at all times. Rationale: Hanging is a serious suicide attempt. The plan of care must reflect action that ensure the patient's safety. Constant observation (one-to-one) with a staff member who is never less than an arm's length away is the best choice. Seclusion should not be the initial intervention, and the least restrictive measure should be used. Placing the patient in a hospital gown and requesting that a peer remain with the patient would not ensure a safe environment.

A patient who is on lithium carbonate (Lithobid) will be discharged at the end of the week. In formulating a discharge teaching plan, the nurse will include which of the following precautions? A. Avoid soy sauce, wine and aged cheese. B. Take the medication only as prescribed because it can become addicting C. Check with the psychiatrist before using any over-the counter medications. D. Have the blood lithium level checked every 2 weeks.

C. Check with the psychiatrist before using any over-the counter medications. Rationale: Lithium competes with sodium in the cell. Many over the counter medications contain sodium, and often prescription medications (diuretics) change the sodium-potassium ratios of the cell, thereby affected lithium concentrations so that it is more difficult to achieve therapeutic levels of the medication. Lithium blood levels are recommended every 3-4 months.

A home care nurse making an initial home visit notes that a client is taking donepezil hydrochloride (Aricept). The nurse questions the client's spouse about a history of which of the following disorders as indicated by the use of this medication? A. Seizure disorder B. Schizophrenia C. Dementia D. Obsessive-compulsive disorder

C. Dementia Rationale: Donepezil hydrochloride is a cholinergic agent that is used in the treatment of mild to moderate dementia of the Alzheimer's type. It increases the concentration of acetylcholine, which slows the progression of Alzheimer's disease. The other options are incorrect.

A patient recently admitted to the hospital in the manic phase of bipolar disorder is dehydrated, unkempt, taking antipsychotic medications and complaining of abdominal fullness and discomfort. The nurse determines that which of the following is an appropriate intervention for these complaints? A. Teach self-grooming skills. B. Reward cleanliness with unit privileges. C. Encourage frequent fluid intake and a high-fiber diet. D. Monitor the adequacy of the antipsychotic dosage.

C. Encourage frequent fluid intake and a high-fiber diet. Rationale: Constipation is a common elimination problem with patient in a manic phase of bipolar disorder. Constipation may occur as the result of a combination of factors, including taking antipsychotic medications, suppressing the urge to defecate, and a decreased fluid intake as a result of the manic activity level. The symptoms listed in the question, dehydrated, unkempt, and abdominal fullness and discomfort, in combination with antipsychotic medications, are indicators of constipation. A high-fiber diet and increased fluids can reduce constipation.

A manic patient announces to everyone in the dayroom that a stripper is coming to perform this evening. When a nurse firmly states that this is inappropriate and will not happen, the patient becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, the nurse determines that the appropriate action would be to: A. Orient the patient to time, person, and place B. Tell the patient that the behavior is inappropriate C. Escort the patient to her room, with assistance D. Tell the patient that smoking privileges are revoked for 24 hours

C. Escort the patient to her room, with assistance Rationale: The patient is at risk for injury to self and others and should be escorted out of the dayroom. Option 4 may increase agitation that already exists in this patient. Orientation will not halt the behavior. Telling the patient that the behavior is inappropriate has already been attempted by the nurse.

When considering stress, what is the primary goal of making daily entries into a personal journal? A. Providing a distraction from the daily stress B. Expressing emotions to manage stress C. Identifying stress triggers D. Focusing on one's stress

C. Identifying stress triggers

Chose the medicine that doesn't belong with the others: A. Amitriptyline B. Nortriptyline C. Lamotrigine D. Immipramine

C. Lamotrigine (anti-convulsant) A, B, and D are TCAs

Phenelzine, tranylcypromine, and selegiline belong to which antidepressant family? A. TCAs B. SSRIs C. MAOis D. Atypicals

C. MAOis

A client with dementia has a disturbed sleep pattern. Which of the following interventions should the nurse utilize for the client? A. Encourage TV watching during the day. B. Awaken the client when napping. C. Promote mild exercise. D. Give sleep medication.

C. Promote mild exercise.

A nurse assists a male patient with a diagnosis of OCD in his preparations for bedtime. One hour later the patient calls the nurse and says that he is feeling anxious; he asks the nurse to sit and talk for a while. The appropriate initial nursing action is which of the following? A. Administer the prescribed as-needed antianxiety medication. B. Tell the patient it is time for sleep and that you will talk with him tomorrow. C. Sit and talk with the patient. D. Ask the nursing assistant to sit with the patient.

C. Sit and talk with the patient. Rationale: The appropriate initial nursing action is to sit and talk with the patient if he is expressing anxiety. Anti-anxiety medication may be necessary, but this would not be the initial appropriate nursing action. A nursing assistant may not be able to alleviate the client's anxiety. Option 2 is an inappropriate action and places the patient's feelings on hold.

A patient arrives in the ED in a crisis state. The patient shows signs of profound anxiety and is unable to focus on anything but the object of the crisis and the impact on self. The initial nursing assessment would focus on: A. The object of the crisis. B. The presence of support systems. C. The physical condition of the patient. D. The patient's coping mechanisms.

C. The physical condition of the patient. Rationale: The initial nursing assessment of a patient in a crisis state is to evaluate the physical condition of the patient, the potential for self-harm, and the potential for harm to others. After this has been determined and appropriate interventions have been initiated, the nurse proceeds with the mental health interview.

A patient with a diagnosis of depression has been meeting with the mental health nurse for therapy sessions for the past 6 weeks. During the session the patient says to the nurse, "I lost my job this week, and I'm going to be evicted from my apartment if I can't pay my bill. The only person that I have is my daughter, but I don't want to burden her with my problems." Which response by the nurse would be most therapeutic? A. "If you get evicted from your apartment, we will commit you to the hospital so you will have a place to eat and sleep." B. "Why did you lose your job?" C. "There are homeless shelters available, and we will get you into one if you are evicted from your apartment." D. "Let's talk about contacting your daughter. Wouldn't you want to know if your daughter was having difficulty and try to help her if you could?"

D. "Let's talk about contacting your daughter. Wouldn't you want to know if your daughter was having difficulty and try to help her if you could?" Rationale: The therapeutic communication technique is clarification that attempts to put vague ideas into words. It helps the patient to view the explicit correlation between the patient's feelings and actions. Asking why a patient lost a job is not directly related to the client's feelings and concerns. Offering to provide a homeless shelter or to commit the patient to the hospital does not address the issue at hand and places the patient's concerns and does not address the patient's feelings directly.

The parent of a child with Attention-deficit/ hyperactivity disorder (ADHD) tells the nurse that the child doesn't follow instructions well. Which strategy should the nurse recommend to the parent? A. "Teach your child to be less aggressive and more assertive." B. "Consider developing a predictable daily routine." C. "It could be helpful to assign time out if instructions aren't followed." D. "Try having your child repeat what you say before starting the task."

D. "Try having your child repeat what you say before starting the task.

A patient with a diagnosis of major depression who has attempted suicide says to a nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." The most therapeutic response to the patient is: A. "I don't see you as a failure." B. "You have everything to live for." C. "Feeling like this is all part of being ill." D. "You've been feeling like things haven't been going well for you..?"

D. "You've been feeling like things haven't been going well for you..?" Rationale: Responding to the feelings expressed by a patient is an effective therapeutic communication technique. The correct option is an example of the use of restating. Options 1, 2, and 3 block communication because they minimize the patient's experience and do not facilitate exploration of the patient's expressed feelings.

Which patient is at greatest risk for developing a stress-induced MI? A. A patient who lost a child in an accidental shooting 24 hours ago B. A woman who has begun experiencing early signs of menopause C. A patient who has spent years trying to sustain a successful business D. A patient who was diagnosed with chronic depression 10 years ago

D. A patient who was diagnosed with chronic depression 10 years ago

A patient is admitted to the mental health unit with a diagnosis of depression. A nurse develops a plan of care for the patient and includes which appropriate activity in the plan? A. Reading and writing most of the day B. Several activities from which the client may choose C. Nothing, until the client asks to participate in milieu D. A structured program in which the client can participate

D. A structured program in which the client can participate Rationale: A patient with depression often has a depressed mood and is withdrawn. The patient also may experience difficulty concentrating, loss of interest or pleasure, low energy, fatigue, and feelings of worthlessness and poor self-esteem. The plan of care needs to provide successful experiences in a stimulating yet structured environment.

A nurse is admitting a patient with a diagnosis of PTSD to a mental health unit. The patient is confused and disoriented. During the assessment, the nurse's primary goal for this patient is to: A. Stabilize the patient's psychiatric needs. B.. Orient the patient to the unit. C. Explain the unit rules. D. Accept the patient and make the patient feel safe.

D. Accept the patient and make the patient feel safe. Rationale: It is important to make a confused patient feel safe. Stabilizing psychiatric needs is a long-term goal. Orientation and explaining the unit rules are part of any admission process.

The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply. A. Increased attentiveness B. Getting up at night to urinate C. Improved vision D. An upset stomach for no apparent reason E. Shaky hands that make holding a cup difficult

D. An upset stomach for no apparent reason E. Shaky hands that make holding a cup difficult

All of the following are mood stabilizers, EXCEPT A. Lithium carbonate B. Valproic acid C. Carbamazepine D. Buspirone

D. Buspirone

To maximize the therapeutic effect, which lifestyle practice should the nurse discourage for a patient who has been recently prescribed an anti anxiety medication? A. Eating high protein food B. Using acetaminophen without first discussing it with a healthcare provider C. Taking medications after eating dinner or while having a bedtime snack D. Buying a large coffee with sugar and extra cream each morning on the way to work

D. Buying a large coffee with sugar and extra cream each morning on the way to work

What precipitating emotional factor has been associated with an increased incidence of cancers? Select all that apply. A. Anxiety B. Job-related stress C. Acute grief D. Feelings of hopelessness and despair from depression E. Prolonged, intense stress

D. Feelings of hopelessness and despair from depression E. Prolonged, intense stress

Living comfortable and materialistic lives in Western societies seems to have altered the original hierarchy proposed by Maslow in that: A. Once lower level needs are satisfied, no further growth feels necessary B. Self-actualization is easier to achieve with financial stability C. Esteem is more highly valued than safety D. Focusing on materialism reduces interests in love, belonging, and family

D. Focusing on materialism reduces interests in love, belonging, and family

A patient with depression who is taking tranylcypromine sulfate (Parnate) has been instructed on appropriate diet. The nurse determines that the patient understands the diet if the patient selects which foods from the dietary menu? A. Pepperoni pizza, salad and a cola drink B. Roasted chicken, roasted potatoes, and beer C. Pickled herring, French fries, and milk D. Fried haddock, baked potato and a cola drink

D. Fried haddock, baked potato and a cola drink Rationale: Tranylcypromine sulfate (Parnate) is an MAOI that is used to treat depression. A tyramine-restricted diet is required while on this medication to avoid hypertensive crisis, a life-threatening side effect of the medication. Foods to be avoided are aged and processed food such as meats prepared with tenderizer, smoked or pickled fish, beef or chicken liver, and dry sausage (salami, pepperoni, bologna). In addition, figs; bananas; aged cheese; yogurt and sour cream; beer, red wine and other alcoholic beverages.

A patient who is on lithium carbonate (Lithobid) complains of nausea. Later that day the patient complains of drowsiness, muscle weakness, and lack of coordination. It is time for the patient's 4:00 PM dose of lithium. The best nursing action is: A. Give the 4:00 PM dose as scheduled and re-educate the patient that these are normal side effects of the medication. B. Give the 4:00 PM dose and document the patient's complaints. C. Give the 4:00 PM dose and notify the physician of the patient's complaints. D. Hold the 4:00 PM dose and notify the physician of the patient's complaints.

D. Hold the 4:00 PM dose and notify the physician of the patient's complaints. Rationale: The side effects of lithium include fine hand tremors, polyuria, mild thirst and mild nausea. Diarrhea, vomiting, nausea, drowsiness, muscle weakness, and lack of coordination may be early signs of toxicity. The medication is withheld and the physician notified so that the patient can be further evaluated to determine the presence of toxicity.

A nurse is planning care for a patient with bipolar disorder who is experiencing psychomotor agitation. Which of the following activities should the nurse plan for this patient? A. Reading letters and books in a quiet environment. B. Involving the patient in a card game with other patients on the unit. C. Providing an activity such as checkers for the patient. D. Including the patient in a clay-molding class that is scheduled for today.

D. Including the patient in a clay-molding class that is scheduled for today. Rationale: When a patient is experiencing psychomotor agitation, it is best to provide activities that involve the use of hands and gross motor movements. Such activities can include ping-pong, volleyball, finger-painting, drawing, and working with clay. These activities will provide an appropriate way for the patient to discharge motor tension. Simple card games and reading are sedentary activities. Playing checkers requires concentration and more intensive use of thought processes.

A nurse is developing a plan of care for a patient experiencing anxiety after the loss of a job. The patient is verbalizing concerns regarding the ability to meet role expectations and financial obligations. The appropriate nursing diagnosis for this patient is: A. Dysfunctional family process B. Disturbed thought process C. Risk for anxiety D. Ineffective coping

D. Ineffective coping Rationale: Ineffective coping may be evidenced by inability to meet basic needs, inability to meet role expectations, alteration in social participation, use of inappropriate defense mechanisms, or impairment of usual patterns of communication. Disturbed thought processes are evidenced by altered attention span; distractibility; and disorientation to time, place, person and events. A dysfunctional family process may exist when the family has difficulty adapting or responding to the changes or traumatic experience of the member in crisis.

Cabot has multiple symptoms of depression including mood reactivity, social phobia, anxiety, and overeating. With a history of hypertension, which classification of antidepressants dispensed as a transdermal patch would be a safe medication? A. Tricyclic antidepressant B. SSRIs C. SNRIs D. MAOIs

D. MAOIs

Which SSRI family medication has the most anticholinergic side effects? A. Citalopram B. Sertraline C. Fluoxetine D. Paroxetine

D. Paroxetine

A nurse is conducting a group therapy session. During the session, a patient with mania constantly talks and dominates the group session, and this behavior is disrupting group interactions. The nurse would initially: A. Ask the patient to leave the group session. B. Ask another nurse to escort the patient out of the group session. C. Tell the patient that she will not be able to attend any future group sessions. D. Tell the patient that she needs to allow other patients in the group time to talk.

D. Tell the patient that she needs to allow other patients in the group time to talk. Manic patients may be talkative and can dominate group meetings or therapy sessions by their excessive talking. If this occurs, the nurse would initially set limits on the patient's behavior. Initially, asking the patient to leave the session or asking another person to escort the patient out of the session is inappropriate. This may agitate the patient and escalate the patient's behavior further. Option 3 is also an inappropriate initial action because it violates the patient's right to receive treatment and is a threatening action.

A nurse is planning activities for a patient who has bipolar disorder with aggressive social behavior. Which of the following activities would be most appropriate for this patient? A. Chess B. Ping pong C. Basketball D. Writing

D. Writing Solitary activities that require a short attention span with mild physical exertion are the most appropriate activities for a patient who is exhibiting aggressive behavior. Writing (journaling), walks with staff, and finger painting are activities that minimize stimuli and provide constructive release for tension. Competitive games should be avoided because they can stimulate aggression and increase psychomotor activity.

T or F: Anxiolytics = Antianxiety

True