Psych Final Question Study Guide

1. A newly admitted patient diagnosed with schizophrenia says, "The voices are bothering me. They yell and tell me I'm bad. I have got to get away from them." Select the nurse's most helpful reply.

"I will stay with you. Focus on what we are talking about, not the voices."

1. A client with the diagnosis of paranoid personality disorder is admitted to the psychiatric unit. As the nurse approaches the client with medication. The nurse's best strategy would be to tell him that

"You may decide if you want to take the medication by mouth or injection, but you must take it."

Which statement is mostly likely to be made by a patient diagnosed with agoraphobia? 1. "Being afraid to go out seems ridiculous, but I can't go out the door." 2. "I'm sure I'll get over not wanting to leave home soon. It takes time." 3. "When I have a good incentive to go out, I can do it." 4. "My family says they like it now that I stay home."

1. "Being afraid to go out seems ridiculous, but I can't go out the door."

2. Which statement shows a nurse has empathy for a patient who made a suicide attempt? 1. "You must have been very upset when you tried to hurt yourself." 2. "It makes me sad to see you going through such a difficult experience." 3. "If you tell me what is troubling you, I can help you solve your problems." 4. "Suicide is a drastic solution to a problem that may not be such a serious matter."

1. "You must have been very upset when you tried to hurt yourself."

A client diagnosed with schizophrenia receives fluphenazine decanoate (Prolixin Decanoate) from a home health nurse. The client refuses medication at one regularly scheduled home visit. Which nursing intervention is ethically appropriate? 1. Allow the client to decline the medication and document the decision. 2. Tell the client that if the medication is refused, hospitalization will occur. 3. Arrange with a relative to add the medication to the client's morning orange juice. Call for help to hold the client down while the injection is administered

1. Allow the client to decline the medication and document the decision.

. Risperidone (Risperdal) is to hallucinations as clonazepam (Klonopin) is to: 1. Anxiety. 2. Depression. 3. Mania. 4. Alcohol dependency.

1. Anxiety.

4. A 58-year-old client on a mental health unit has lost control, despite having been properly medicated, and is threatening to harm himself and others. He has been placed in four-point restraints. Which nursing measure should be taken next? 1. Release one restraint every 15 minutes. 2. Have a staff member stay with the client at all times. 3. Leave the client alone to reduce his sensory stimulation and allow him to regain control. 4. Restrict fluids until the restraint period is over.

1. Have a staff member stay with the client at all times.

A nurse is planning care for a child diagnosed with gender dysphoria. Which of the following nursing diagnoses could potentially document this client's problems? (Select all that apply.) 1. Low self-esteem R/T rejection by peers 2. Self-care deficit R/T isolative behaviors 3. Disturbed personal identity R/T parenting patterns 4. Impaired social interactions R/T socially unacceptable behaviors 5. Activity intolerance R/T fatigue

1. Low self-esteem R/T rejection by peers 3. Disturbed personal identity R/T parenting patterns 4. Impaired social interactions R/T socially unacceptable behaviors

A soldier returns to the United States from active duty in a combat zone. The soldier is diagnosed with posttraumatic stress disorder (PTSD). The nurse's highest priority is to screen this soldier for which problem? 1. Major depressive disorder 2. Bipolar disorder 3. Schizophrenia 4. Dementia

1. Major depressive disorder

A psychiatrist prescribes an MAOI for a client. When teaching the client about the effects of tyramine, which foods will the nurse caution the client to avoid? 1. Pepperoni pizza and red wine 2. Bagels with cream cheese and tea 3. Apple pie and coffee 4. Potato chips and diet cola

1. Pepperoni pizza and red wine

A patient performs ritualistic hand washing. What should the nurse do to help the patient develop more effective coping strategies? 1. Allow the patient to set a hand-washing schedule. 2. Encourage the patient to participate in social activities. 3. Encourage the patient to discuss hand-washing routines. Focus on the patient's symptoms rather than on the patient

2. Encourage the patient to participate in social activities.

The nurse expects to establish a supportive therapeutic relationship with a client diagnosed with schizotypal personality disorder. Which nursing intervention is most appropriate? 1.Set limits on acting-out behaviors and explain consequences. 2. Present reality when client is experiencing magical thinking. 3. Encourage client to gradually verbalize hostile feelings. 4. Remove all dangerous objects from the environment

2. Present reality when client is experiencing magical thinking.

A nurse is assessing a client diagnosed with pedophilic disorder. What would differentiate this sexual disorder from a sexual dysfunction? 1. Symptoms of sexual dysfunction include inappropriate sexual behaviors, whereas symptoms of a sexual disorder include impairment in normal sexual response. 2. Symptoms of a sexual disorder include inappropriate sexual behaviors, whereas symptoms of sexual dysfunction include impairment in normal sexual response. 3. Sexual dysfunction can be caused by increased levels of circulating androgens, whereas levels of circulating androgens do not affect sexual disorders. 4. Sexual disorders can be caused by decreased levels of circulating androgens, whereas levels of circulating androgens do not affect sexual dysfunction.

2. Symptoms of a sexual disorder include inappropriate sexual behaviors, whereas symptoms of sexual dysfunction include impairment in normal sexual response.

A client has been taking bupropion (Wellbutrin) for more than 1 year. The client has been in a car accident with loss of consciousness and is brought to the emergency department. For which reason would the nurse question the continued use of this medication? 1. The client may have a possible injury to the gastrointestinal system. 2. The client is at risk for seizures from a potential closed head injury. 3. The client is at increased risk of bleeding while taking bupropion. 4. The client may experience sedation from bupropion, making assessment difficult.

2. The client is at risk for seizures from a potential closed head injury.

Which situation exemplifies both assault and battery? 1. The nurse becomes angry, calls the client offensive names, and withholds treatment. 2. The nurse threatens to "tie down" the client and then does so, against the client's wishes. 3. The nurse hides the client's clothes and medicates the client to prevent elopement. 4. The nurse restrains the client without just cause and communicates this to family.

2. The nurse threatens to "tie down" the client and then does so, against the client's wishes.

A patient hospitalized with a mood disorder has aggression, agitation, talkativeness, and irritability. A nurse begins the care plan based on the expectation that the health care provider is most likely to prescribe a medication classified as a(n): 1. anticholinergic. 2. mood stabilizer 3. psychostimulant. tricyclic antidepressant

2. mood stabilizer

Which nursing intervention demonstrates false imprisonment? 1. A confused and combative patient says, "I'm getting out of here and no one can stop me." 2. The nurse restrains this patient without a health care provider's order and then promptly obtains an order. 3. A patient has been irritating, seeking the attention of nurses most of the day. Now a nurse escorts the patient down the hall, saying, "Stay in your room or you'll be put in seclusion." 4. An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. A nurse rushes after the patient and convinces the patient to return to the unit.

3. A patient has been irritating, seeking the attention of nurses most of the day. Now a nurse escorts the patient down the hall, saying, "Stay in your room or you'll be put in seclusion."

Which of these brain structures puts emotional meaning on a stimulus, forms emotional memories, and is involved with rage and fear? 1. Hippocampus 2. Temporal lobe 3. Amygdala 4. Midbrain

3. Amygdala

. Which medication is most likely to be prescribed for the extrapyramidal side effects of antipsychotic medications? 1. Diazepam (Valium) 2. Amitriptyline (Elavil) 3. Benztropine (Cogentin) 4. Methylphenidate (Ritalin)

3. Benztropine (Cogentin)

Irresponsible, guiltless behavior is to a client diagnosed with cluster B personality disorder as avoidant, dependent behavior is to a client diagnosed with a: 1. Cluster A personality disorder. 2. Cluster B personality disorder. 3. Cluster C personality disorder. 4. Cluster D personality disorder

3. Cluster C personality disorder

. During visiting hours, a client who is angry at her ex-husband's charges of child neglect expresses this anger by lashing out at her sister-in-law. The nurse understands that the client is demonstrating the use of which defense mechanism? 1. Denial. 2. Projection. 3. Displacement. 4. Rationalization.

3. Displacement.

Consider these three drugs: divalproex (Depakote), carbamazepine (Tegretol), and gabapentin (Neurontin). Which drug also belongs to this group? 1. Clonazepam (Klonopin) 2. Risperidone (Risperdal) 3. Lamotrigine (Lamictal) 4. Aripiprazole (Abilify)

3. Lamotrigine (Lamictal)

Which client diagnosis should the nurse associate with a decrease in GABA? 1. Alzheimer's disease 2. Schizophrenia 3. Panic disorder 4. Depression

3. Panic disorder

For a patient experiencing panic, which nursing intervention should be implemented first? 1. Teach relaxation techniques. 2. Administer an anxiolytic medication. 3. Provide calm, brief, directive communication. 4. Gather a show of force in preparation for gaining physical control.

3. Provide calm, brief, directive communication.

Which part of the nervous system should the nurse identify as playing a major role during stressful situations? 1. Peripheral nervous system 2. Somatic nervous system 3. Sympathetic nervous system 4. Parasympathetic nervous system

3. Sympathetic nervous system

When counseling patients diagnosed with major depressive disorder, an advanced practice nurse will address the negative thought patterns by using: 1. psychoanalytic therapy. 2. desensitization therapy. 3. cognitive behavioral therapy. 4. alternative and complementary therapies.

3. cognitive behavioral therapy.

A soldier returned home last year after deployment to a war zone. The soldier's spouse complains, "We were going to start a family but now he won't talk about it. He will not look at children. I wonder if we're going to make it as a couple." Select the nurse's best response. 1. "Posttraumatic stress disorder often changes a person's sexual functioning." 2. "I encourage you to continue to participate in social activities where children are present." 3. "Have you talked with your spouse about these reactions? Sometimes we just need to confront behavior." 4. "Posttraumatic stress disorder often strains relationships. I will suggest some community resources for help and support."

4. "Posttraumatic stress disorder often strains relationships. I will suggest some community resources for help and support."

The right to determine one's own destiny is to autonomy as the duty to benefit or promote the good of others is to: 1. Nonmaleficence. 2. Justice. 3. Veracity. 4. Beneficence.

4. Beneficence.

Which nursing action should occur first when preparing to work with a patient who has a problem of sexual functioning? 1. Acquire knowledge of the patient's sexual roles and preferences 2. Develop an understanding of human sexual responses 3. Assess the patient's sexual functioning 4. Clarify the nurse's own personal values

4. Clarify the nurse's own personal values

1. An inpatient psychiatric client suddenly becomes loud and visibly anxious. What is the best action for the nurse to take? 1. Summon help and escort the client to his room. 2. Face the client squarely and say, "You must be quiet." 3. Say, "Calm down; you're safe here." 4. Say, "Let's go talk in your room."

4. Say, "Let's go talk in your room."

3. A 65-year-old woman reports periods of palpitations, sweating, and slight shortness of breath. She feels like she's going to die. You speak with her daughter who reports that her father recently passed away and her mother lives alone. How would you respond? 1. Tell the daughter that her mother is likely experiencing panic attacks and will develop depressive disorder. 2. Tell the daughter that her mother is likely experiencing depressive disorder. 3. Tell the daughter that her mother is likely experiencing panic attacks. 4. Tell the daughter that her mother is likely experiencing panic attacks and that she should tell her primary practitioner about it so she can be treated soon.

4. Tell the daughter that her mother is likely experiencing panic attacks and that she should tell her primary practitioner about it so she can be treated soon.

1. The most appropriate short-term nursing goal for clients with schizophrenia is to

: Establish a trusting, nonthreatening relationship.

A victim of a violent rape has been in the emergency department for 3 hours. Evidence collection is complete. As discharge counseling begins, the victim says softly, "I will never be the same again. I can't face my friends. There is no sense of trying to go on." Select the nurse's most important response. A. "Are you thinking of suicide?" B. "It will take time, but you will feel the same as before." C. "Your friends will understand when you tell them." D. "You will be able to find meaning in this experience as time goes on."

A. "Are you thinking of suicide?"

1. A patient says, "I've done a lot of cheating and manipulating in my relationships." Select a nonjudgmental response by the nurse. A. "How do you feel about that?" B. "It's good that you realize this." C. "That's not a good way to behave." D. "Have you outgrown that type of behavior?"

A. "How do you feel about that?"

1. A patient says, "Please don't share information about me with the other people." How should the nurse respond? A. "I won't share information with others without your permission, but I will share information about you with other staff members." B. "A therapeutic relationship is just between the nurse and the patient. It's up to you to tell others what you want them to know." C. "It really depends on what you choose to tell me. I will be glad to disclose at the end of each session what I will report to others." D. "I cannot tell anyone about you. It will be as though I am talking about my own problems, and we can help each other by keeping it between us."

A. "I won't share information with others without your permission, but I will share information about you with other staff members."

1. Which client statement should alert a nurse that a client may be responding maladaptively to stress? A. "I've found that avoiding contact with others helps me cope." B. "I really enjoy journaling; it's my private time." C. "I signed up for a yoga class this week." D. "I made an appointment to meet with a therapist."

A. "I've found that avoiding contact with others helps me cope."

1. Which client should the nurse anticipate to be most receptive to psychiatric treatment? A. A Jewish, female social worker. B. A Baptist, homeless male. C. A Catholic, black male. D. A Protestant, Swedish business executive.

A. A Jewish, female social worker.

1. A client diagnosed with schizophrenia receives fluphenazine decanoate (Prolixin Decanoate) from a home health nurse. The client refuses medication at one regularly scheduled home visit. Which nursing intervention is ethically appropriate? A. Allow the client to decline the medication and document the decision. B. Tell the client that if the medication is refused, hospitalization will occur. C. Arrange with a relative to add the medication to the client's morning orange juice. D. Call for help to hold the client down while the injection is administered.

A. Allow the client to decline the medication and document the decision.

A client newly admitted to an inpatient psychiatric unit is diagnosed with obsessive-compulsive disorder. Which correctly stated nursing diagnosis takes priority? A. Anxiety R/T regression of ego development AEB ritualistic behaviors B. Powerlessness R/T ritualistic behaviors AEB statements of lack of control C. Fear R/T a traumatic event AEB stimulus avoidance D. Social isolation R/T increased levels of anxiety AEB not attending groups

A. Anxiety R/T regression of ego development AEB ritualistic behaviors

1. A patient has progressive memory deficit associated with dementia. Which nursing intervention would best help the individual function in the environment? A. Assist the patient to perform simple tasks by giving step-by-step directions. B. Reduce frustration by performing activities of daily living for the patient. C. Stimulate intellectual function by discussing new topics with the patient. D. Promote the use of the patient's sense of humor by telling jokes.

A. Assist the patient to perform simple tasks by giving step-by-step directions.

Others describe a worker as very shy and lacking in self-confidence. This worker stays in an office cubicle all day and never comes out for breaks or lunch. Which term best describes this behavior? A. Avoidant B. Dependent C. Histrionic D. Paranoid

A. Avoidant

1. Which finding would prompt the nurse to carefully assess an 8-year-old child for development of a psychiatric disorder? A. Being raised by a parent with chronic major depressive disorder B. Moving to three new homes over a 2-year period C. Not being promoted to the next grade D. Having an imaginary friend

A. Being raised by a parent with chronic major depressive disorder

Which medication would be a first line consideration in the treatment of anxiety? A. Buspirone (BuSpar) B. Alprazolam (Xanax) C. Chlordiazepoxide (Librium) D. Clonazepam (Klonopin)

A. Buspirone (BuSpar)

1. A child diagnosed with attention deficit hyperactivity disorder (ADHD) is going to begin medication therapy. The nurse should plan to teach the family about which classification of medications? A. Central nervous system stimulants and non-stimulants B. Monoamine oxidase inhibitors (MAOIs) C. Antipsychotic medications D. Anxiolytic medications

A. Central nervous system stimulants and non-stimulants

1. Psychobiological agents showing promise for the treatment of cognitive impairment associated with AD include: A. Cholinesterase inhibitors B. Herbals, including ginkgo biloba C. SSRIs and trazodone D. Benzodiazepines and buspirone

A. Cholinesterase inhibitors

1. Which of the following is least likely to contribute to building an effective therapeutic alliance between the nurse and a patient with anorexia? A. Establishing disciplined eating through the nurse's authoritarian approach with the patient B. Avoiding the stance of a parental role to foster a sense of empowerment C. Offering a highly structured approach in treating patients who are severely underweight D. Contracting with the outpatient person about treatment terms

A. Establishing disciplined eating through the nurse's authoritarian approach with the patient

Chloe is now being seen by the ED physician. Her husband, Chad, is quietly demanding to see his wife. As the triage nurse, what are your best actions? (Select all that apply.) *A. Have a staff member regularly touch base with Chad in the waiting room to reassure him that Chloe "is fine" but no room for visitors is provided. B. Immediately call hospital security. *C. Move Chloe to secluded area in the ED so that you can interview her in private and advise her of safe shelters and offer brochures. D. Insist that Chloe admit she is being abused by Chad and immediately report the abuse to the police department.

A. Have a staff member regularly touch base with Chad in the waiting room to reassure him that Chloe "is fine" but no room for visitors is provided. C. Move Chloe to secluded area in the ED so that you can interview her in private and advise her of safe shelters and offer brochures.

1. Which structure of the brain is involved in learning, processing information into memories, and assigning the time and the place to memories? A. Hippocampus B. Olfactory bulb C. Limbic system D. Occipital lobe

A. Hippocampus

1. An older adult diagnosed with moderate-stage Alzheimer disease forgets where the bathroom is and has episodes of incontinence. Which intervention should the nurse suggest to the patient's family? A. Label the bathroom door. B. Take the older adult to the bathroom hourly. C. Place the older adult in disposable adult diapers. Make sure the older adult does not eat nonfood items

A. Label the bathroom door.

1. While assessing your patient, Simon, a 63-year-old man in the psychiatric unit with a diagnosis of generalized anxiety disorder, he asks you, "Can you tell me why my family thinks that I am just acting sick to get attention?" Drawing from your knowledge of the impact of mental illness on families, which of the following would you include in your discussion to help Simon see his illness as a real illness? (Select all that apply.) A. Mental health is fundamental to health. B. Mental disorders are real health conditions that have an immense impact on individuals and families. C. The efficacy of mental health treatment is well documented. D. A range of treatments exists for most mental disorders.

A. Mental health is fundamental to health. B. Mental disorders are real health conditions that have an immense impact on individuals and families. C. The efficacy of mental health treatment is well documented. D. A range of treatments exists for most mental disorders.

1. If an older adult patient must be physically restrained, who is responsible for the patient's safety? A. Nurse assigned to care for the patient B. Nursing assistant who applies the restraint C. Health care provider who ordered the application of the restraint D. Family member who agrees to the application of the restraint

A. Nurse assigned to care for the patient

1. A nurse assessing a patient with suspected delirium will expect to find that the patient's symptoms developed: A. Over a period of hours to days B. Over a period of weeks to months C. With no relationship to another condition D. During middle age

A. Over a period of hours to days

1. A patient diagnosed with moderate to severe Alzheimer disease has a dressing and grooming self-care deficit. Designate the appropriate interventions to include in the patient's plan of care. (Select all that apply.) A. Provide clothing with elastic and hook-and-loop closures. B. Label clothing with the patient's name and name of the item. C. Administer antianxiety medication before bathing and dressing. D. Provide necessary items and direct the patient to proceed independently. E. If the patient resists, use distraction and then try again after a short interval.

A. Provide clothing with elastic and hook-and-loop closures. B. Label clothing with the patient's name and name of the item. E. If the patient resists, use distraction and then try again after a short interval.

1. A mental health technician asks the nurse, "How do psychiatrists determine which diagnosis to give a patient?" Which of these responses by the nurse would be most accurate? A. Psychiatrists use pre-established criteria from the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). B. Hospital policy dictates how psychiatrists diagnose mental disorders. C. Psychiatrists assess the patient and identify diagnoses based on the patient's unhealthy responses and contributing factors. D. The American Medical Association identifies 10 diagnostic labels that psychiatrists can choose from.

A. Psychiatrists use pre-established criteria from the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

What is the priority intervention for a nurse beginning a therapeutic relationship with a patient diagnosed with a schizotypal personality disorder? A. Respect the patient's need for periods of social isolation. B. Prevent the patient from violating the nurse's rights. C. Engage the patient in many community activities. D. Teach the patient how to match clothing.

A. Respect the patient's need for periods of social isolation.

In caring for a patient with late AD, which nursing diagnosis demands the nurse's highest priority? A. Risk for injury The patient is bed bound; therefore, a risk for falls is not so great. A risk for decubiti exists, but this is addressed as a need related to self-care deficit. B. Self-care deficitThe patient requires total patient care and is bed bound. C. Chronic low self-esteem D. Impaired verbal communication

A. Risk for injury The patient is bed bound; therefore, a risk for falls is not so great. A risk for decubiti exists, but this is addressed as a need related to self-care deficit.

1. An older adult, diagnosed with Alzheimer disease, lives with family and has multiple bruises. The home health nurse talks with the older adult's daughter, who becomes defensive and says, "My mother often wanders at night. Last night she fell down the stairs." Which nursing diagnosis has priority? A. Risk for injury, related to cognitive impairment and lack of caregiver supervision B. Noncompliance, related to confusion and disorientation as evidenced by lack of cooperation C. Impaired verbal communication, related to brain impairment as evidenced by the confusion D. Insomnia, related to cognitive impairment as evidenced by wandering at night

A. Risk for injury, related to cognitive impairment and lack of caregiver supervision

A patient diagnosed with borderline personality disorder has been hospitalized several times after self-inflicted lacerations. The patient remains impulsive. Dialectical behavior therapy starts on an outpatient basis. Which nursing diagnosis is the focus of this therapy? A. Risk for self-mutilation B. Impaired skin integrity C. Risk for injury D. Powerlessness

A. Risk for self-mutilation

A patient at the emergency department is diagnosed with a concussion. The patient is accompanied by a spouse who insists on staying in the room and answering all questions. The patient avoids eye contact and has a sad affect and slumped shoulders. Assessment of which additional problem has priority? A. Risk of intimate partner violence B. Phobia of crowded places C. Migraine headaches D. Depressive symptoms

A. Risk of intimate partner violence

1. A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness? A. Schizophrenia spectrum disorder B. Major depressive disorder C. Body dysmorphic disorder D. Parkinson's disease

A. Schizophrenia spectrum disorder

A nurse cares for a patient diagnosed with paraphilia. The nurse expects the health care provider may prescribe which type of medication to reduce paraphilic behaviors? A. Selective serotonin reuptake inhibitor (SSRI) B. Erectile dysfunction medication C. Atypical antipsychotic medication D. Mood stabilizer

A. Selective serotonin reuptake inhibitor (SSRI)

1. Nursing staff that care for patients who are cognitively impaired can develop burnout. Strategies to avoid the development of burnout include: A. Setting realistic patient goals. B. Insulating self from emotional involvement with patients. C. Sedating patients to promote rest and minimize catastrophic episodes. D. Encouraging the family to permit the use of restraints to promote patient safety.

A. Setting realistic patient goals.

1. A psychiatric nurse working on an inpatient unit receives a call asking if an individual has been a client in the facility. Which nursing response reflects appropriate legal and ethical obligations? A. The nurse refuses to give any information to the caller, citing rules of confidentiality. B. The nurse hangs up on the caller. C. The nurse confirms that the person has been at the facility but adds no additional information. D. The nurse suggests that the caller speak to the client's therapist.

A. The nurse refuses to give any information to the caller, citing rules of confidentiality.

The nurse states to a client on an in-patient unit, "Tell me what's been on your mind." Which describes the purpose of this therapeutic communication technique? A. To have the client initiate the conversation. B. To present new ideas for consideration. C. To convey interest in what the client is saying. D. To provide time for the nurse and client to gather thoughts and reflect.

A. To have the client initiate the conversation.

1. To whom can information be released without the client's consent? A. To public officials responsible for responding to child abuse B. To insurance companies C. To school personnel D. To public health agencies that track HIV status

A. To public officials responsible for responding to child abuse

1. At what point should the nurse determine that a client is at risk for developing a mental illness? A. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria. B. When maladaptive responses to stress are coupled with interference in daily functioning. C. When a client communicates significant distress. D. When a client uses defense mechanisms as ego protection.

A. When maladaptive responses to stress are coupled with interference in daily functioning.

The client refuses to take medication. What is the next decision? A. Withhold the medication. B. The client must accept the medication. C. The provider should consider whether the medication is appropriate. D. The court can order the medication to be administered.

A. Withhold the medication.

1. A patient being treated in an alcohol rehabilitation unit reveals to the nurse, "I feel terrible guilt for sexually abusing my 6-year-old child before I was admitted." Based on state and federal law, the best action for the nurse to take is to: A. anonymously report the abuse by telephone to the local child abuse hotline. B. reply, "I'm glad you feel comfortable talking to me about it." C. respect the nurse-patient relationship of confidentiality. D. file a written report on the agency letterhead.

A. anonymously report the abuse by telephone to the local child abuse hotline.

1. An older adult takes digoxin and hydrochlorothiazide daily, as well as lorazepam (Ativan) as needed for anxiety. Over 2 days, this adult developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. These findings are most characteristic of: A. delirium. B. dementia. C. amnestic syndrome D. Alzheimer disease

A. delirium.

1. A parent diagnosed with schizophrenia and her 13-year-old child live in a homeless shelter. The child has formed a trusting relationship with a shelter volunteer. The child says, "My three friends and I got an A on our school science project." The nurse can assess that the child: A. displays resiliency. B. has a difficult temperament. C. is at risk for posttraumatic stress disorder. D. uses intellectualization to deal with problems

A. displays resiliency.

1. A community mental health nurse plans an educational program for staff members at a home health agency that specializes in the care of older adults. A topic of high priority should be: A. identifying depression in older adults. B. providing cost-effective foot care for older adults. C. identifying nutritional deficiencies in older adults. D. psychosocial stimulation for those who live alone

A. identifying depression in older adults.

1. A nurse assesses an inpatient psychiatric unit, noting that exits are free from obstruction, no one is smoking, the janitor's closet is locked, and all sharp objects are being used under staff supervision. These observations relate to: A. management of milieu safety. B. coordinating care of patients. C. management of the interpersonal climate. D. use of therapeutic intervention strategies.

A. management of milieu safety.

1. A 78-year-old nursing home resident diagnosed with hypertension and cardiac disease is usually alert and oriented. This morning, however, the resident says, "My family visited during the night. They stood by the bed and talked to me." In reality, the patient's family lives 200 miles away. The nurse should first suspect that the resident: A. may be experiencing side effects associated with medications. B. may be developing Alzheimer disease associated with advanced age. C. had a transient ischemic attack and developed sensory perceptual alterations. D. has previously unidentified alcohol abuse and is beginning alcohol withdrawal delirium.

A. may be experiencing side effects associated with medications.

1. Planning for patients diagnosed with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for patients who: A. present a clear danger to self or others. B. are noncompliant with medications at home. C. have no support systems in the community. D. develop new symptoms during the course of an illness.

A. present a clear danger to self or others.

1. A tricyclic antidepressant is prescribed for an older adult patient diagnosed with major depressive disorder. Nursing assessment should include careful collection of information regarding: A. use of other prescribed medications and over-the-counter products. B. evidence of pseudoparkinsonism or tardive dyskinesia. C. history of psoriasis and any other skin disorders. D. current immunization status.

A. use of other prescribed medications and over-the-counter products.

1. A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, "I saw two doctors talking in the hall. They were plotting to kill me." The nurse may correctly assess this behavior as:

An idea of reference.

A patient says to the nurse, "My life does not have any happiness in it anymore. I once enjoyed holidays, but now they're just another day." How would the nurse document the complaint?

Anhedonia: Inability to feel joy or pleasure.

1. A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social functioning. The patient is also overweight and has hypertension. Which drug should the nurse advocate?

Aripiprazole (Abilify)

1. What is your best intervention when you assess that a patient is responding to an auditory hallucination?

Ask the patient, "Can you tell me what you are hearing?"

1. A patient diagnosed with schizophrenia says, "High heat. Last time here. Did you get a coat?" What type of verbalization is evident?

Associative Looseness: Lack of connection

1. A client was recently admitted to the inpatient unit after a suicide attempt and has not responded to SSRIs or tricyclic antidepressants. The client asks the nurse, "I heard about MAOIs (monoamine oxidase inhibitors). Why can't they be added to what I am on now? Wouldn't adding one help?" Which is the most appropriate nursing response? A. "Electroconvulsive therapy (ECT) is your best option at this point." B. "Combined use can lead to a life-threatening condition called a hypertensive crisis." C. "There is no reason why an MAOI couldn't be added to your therapy." D. "They can't be used together because their mechanisms of action are very different."

B. "Combined use can lead to a life-threatening condition called a hypertensive crisis."

1. An 80-year-old patient has difficulty walking because of arthritis and says, "It's awful to be old. Every day is a struggle. No one cares about old people." Which is the nurse's most therapeutic response? A. "Everyone here cares about old people. That's why we work here." B. "It sounds like you're having a difficult time. Tell me about it." C. "Let's not focus on the negative. Tell me something good." D. "You are still able to get around, and your mind is alert."

B. "It sounds like you're having a difficult time. Tell me about it."

1. Jessie had a blood alcohol level (BAL) of 0.11% upon arrival at the emergency department (ED). She is now your patient in the hospital psychiatric unit, day 4. She tells you, "I wasn't drunk. I just had a few beers." What is an appropriate response? A. "Jessie, of course you were drunk. You always are." B. "Jessie, your BAL was 0.11%. That clearly indicates that you had alcohol intoxication." C. "You are in denial, and that will impede your recovery from alcoholism." D. "Until you recognize your problem, you will never win over this addiction."

B. "Jessie, your BAL was 0.11%. That clearly indicates that you had alcohol intoxication."

1. A nurse is teaching a client who has an anxiety disorder and is scheduled to begin classical psychoanalysis. Which of the following client statements indicates an understanding of this form of therapy? A. "Even if my anxiety improves, I will need to continue this therapy for 6 weeks." B. "The therapist will focus on my past relationships during our sessions." C. "Psychoanalysis will help me reduce my anxiety by changing my behaviors." D. "This therapy will address my conscious feelings about stressful experiences."

B. "The therapist will focus on my past relationships during our sessions."

1. A patient with a diagnosis of major depression who has attempted suicide says to the nurse, "I should have died! I've always been a failure. Nothing ever goes right for me." Which response demonstrates therapeutic communication? A. "You have everything to live for." B. "Why do you see yourself as a failure?" C. "Feeling like this is all part of being depressed." D. "You've been feeling like a failure for a while?"

B. "Why do you see yourself as a failure?"

1. Your patient asks, "Will Antabuse really help me with my drinking problem?" What is your most appropriate response? A. "Yes, if you are motivated." B. "Yes, if you use it correctly." C. "That is totally up to you." D. "Antabuse works well for some."

B. "Yes, if you use it correctly.

1. According to Maslow's hierarchy of needs, which situation on an inpatient psychiatric unit would require priority intervention by a nurse? A. A client rudely complaining about limited visiting hours B. A client exhibiting aggressive behavior toward another client C. A client stating that no one cares D. A client verbalizing feelings of failure

B. A client exhibiting aggressive behavior toward another client

. Mrs. H, 87, is anxious. She tells you she must go home immediately, saying: "My twins need me. They're barely a year old!" Select the best response. A. Help reorient her by explaining patiently that she is too old now to still have babies. B. Ask her questions to describe her need to go home and sympathize with how hard it can be to be away from home. C. Implement withdrawal and promise to return in 10 minutes when she is calmer and more rational. D. Reward her with attention when she focuses on reality.

B. Ask her questions to describe her need to go home and sympathize with how hard it can be to be away from home.

1. A nurse is conducting education on anxiety and stress management. Which of the following should be identified as the most important initial step in learning how to manage anxiety? A. Diagnostic blood tests B. Awareness of factors creating stress C. Relaxation exercises D. Identifying support systems

B. Awareness of factors creating stress

A nurse plans the care for an individual diagnosed with antisocial personality disorder. Which characteristic behaviors will the nurse expect? (Select all that apply.) A. Reclusive behavior B. Callous attitude C. Perfectionism D. Aggression E. Clinginess F. Anxiety

B. Callous attitude D. Aggression

1. During morning care, a nursing assistant asks a patient diagnosed with dementia, "How was your night?" The patient replies, "It was lovely. I went out to dinner and a movie with my friend." Which term applies to the patient's response? A. Sundown syndrome B. Confabulation C. Perseveration D. Delirium

B. Confabulation

1. A nurse assesses a confused older adult. The nurse experiences sadness and reflects, "The patient is like one of my grandparents, so helpless." What feelings does the nurse describe? A. Transference B. Countertransference C. Catastrophic reaction D. Defensive coping reaction

B. Countertransference

1. An unconscious psychological mechanism that reduces anxiety arising from unacceptable or potentially harmful stimuli is called as? A. Homeostasis B. Defense mechanism C. Ego centralism D. Intrinsic mechanism

B. Defense mechanism

A nurse in the emergency department tells an adult, "Your mother had a serious stroke." The adult tearfully says, "Who will take care of me now? My mother always told me what to do, what to wear, and what to eat. I need someone to reassure me when I get anxious." Which term best describes this behavior? A. Histrionic B. Dependent C. Narcissistic D. Borderline

B. Dependent

1. A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client's neurotransmitters should a nurse expect to be elevated? A. Serotonin B. Dopamine C. Gamma-aminobutyric acid (GABA) D. Histamine

B. Dopamine

For the third time within a month, a client with borderline personality disorder took a handful of pills, called 911, and was admitted to the emergency department. The nurse overhears an unlicensed staff member say, "Here she comes again. If she was serious about committing suicide, she'd have done it by now." The nurse determines there is a need to teach the staff member which of the following? A. Clients with personality disorders rarely have completed suicides. B. Each suicidal attempt should be taken seriously. C. Exploration of suicidal ideation and intent should be avoided. D. The nurse should prepare the client for direct inpatient admission

B. Each suicidal attempt should be taken seriously.

A 58-year-old client on a mental health unit has lost control, despite having been properly medicated, and is threatening to harm himself and others. He has been placed in four-point restraints. Which nursing measure should be taken next? A. Release one restraint every 15 minutes. B. Have a staff member stay with the client at all times. C. Leave the client alone to reduce his sensory stimulation and allow him to regain control. D. Restrict fluids until the restraint period is over.

B. Have a staff member stay with the client at all times.

1. A child is diagnosed with Tourette's disorder and is withdrawn, refuses to participate in group therapy, and initiates little or no communication with peers. On the basis of the symptoms presented, which nursing diagnosis should the nurse assign to this child? A. Risk for self-directed or other-directive violence B. Impaired social interaction C. Low self-esteem D. Anxiety (severe)

B. Impaired social interaction

1. The health care provider prescribes medication for a child diagnosed with attention deficit hyperactivity disorder (ADHD). The desired behavior for which the nurse should monitor is: A. Increased expressiveness in communicating with others. B. Improved ability for cooperative play with other children. C. Ability to identify anxiety and implement self-control strategies. D. Improved socialization skills with other children and authority figures.

B. Improved ability for cooperative play with other children.

1. The role of a psychiatric nurse on an inpatient unit would include which one of the following? A. Prescribing medication B. Maintaining a therapeutic milieu C. Analyzing patient behavior D. Providing psychotherapy

B. Maintaining a therapeutic milieu

1. Because he works with young men in a treatment center for domestic abuse, Ernesto is always careful to be respectful of both patients and staff—‟especially women," he tells a coworker. Which educational tool is Ernesto demonstrating most clearly? A. Empathy B. Modeling (Presents a vivid example of values in action) C. Transference D. Value teaching

B. Modeling (Presents a vivid example of values in action)

1. A patient diagnosed with Alzheimer disease wanders at night. Which action should the nurse recommend for a family to use in the home to enhance safety? A. Place throw rugs on tile or wooden floors. B. Place locks at the tops of doors. C. Encourage daytime napping. D. Obtain a bed with side rails

B. Place locks at the tops of doors.

What is a nurse's legal responsibility if child abuse or neglect is suspected? A. Discuss the findings with the child's teacher, principal, and school psychologist. B. Report the suspected abuse or neglect according to state regulations. C. Document the observations and speculations in the medical record. D. Continue the assessment.

B. Report the suspected abuse or neglect according to state regulations.

1. What is the priority nursing diagnosis for a patient experiencing fluctuating levels of consciousness, disturbed orientation, and visual and tactile hallucinations? A. Bathing/hygiene self-care deficit related to altered cerebral function as evidenced by confusion and inability to perform personal hygiene tasks B. Risk for injury related to altered cerebral function, misperception of the environment, and unsteady gait C. Disturbed thought processes related to medication intoxication as evidenced by confusion, disorientation, and hallucinations D. Fear related to sensory perceptual alterations as evidenced by hiding from imagined ferocious dogs

B. Risk for injury related to altered cerebral function, misperception of the environment, and unsteady gait

1. The parent of a child who is newly diagnosed with autism disorder asks the psychiatric nurse how the parent should interact with the child. What is the psychiatric nurse's best response? A. Ask your pediatrician. B. Speak with the child face-to-face, maintain a safe environment, give rewards for good behaviors, and do not punish for bad behaviors, which may lead to self-injury by the child. C. Treat the child as you would treat other children. D. Send the parent to an autism disorder website.

B. Speak with the child face-to-face, maintain a safe environment, give rewards for good behaviors, and do not punish for bad behaviors, which may lead to self-injury by the child.

1. A 23-year-old mother asks the psychiatric nurse for the telephone number of a child psychiatrist because her 2-year-old daughter constantly refuses to do what she is told to do. She throws a tantrum in public when she does not get her way. The mother wants the psychiatrist to treat her daughter for oppositional defiant disorder (ODD). What is the best response by the psychiatric nurse? A. Give the mother names and telephone numbers of a few local psychiatrists. B. Tell the mother that the child is demonstrating normal behavior and her actions are consistent with a child struggling with emerging independence. C. Tell the mother that treatment for ODD does not begin until age 3. D. Tell the mother to take the child to her pediatrician to rule out underlying medical conditions that might be causing the problem.

B. Tell the mother that the child is demonstrating normal behavior and her actions are consistent with a child struggling with emerging independence.

1. Which cerebral structure should a nursing instructor describe to students as the "emotional brain"? A. The cerebellum B. The limbic system C. The cortex D. The left temporal lobe

B. The limbic system

1. Which statement about tricyclic antidepressant medications is accurate? A. Strong or aged cheese should not be eaten while taking them. B. Their full therapeutic potential may not be reached until 4 weeks. C. They may cause hypomania or recent memory impairment. D. They should not be given with antianxiety agents.

B. Their full therapeutic potential may not be reached until 4 weeks.

A voluntary client is asking for discharge. What is the nurse's first consideration? A. Notifying the physician. B. What is the required action? C. What are the needs of the nursing staff? D. Are there are enough staff to keep the client on the unit?

B. What is the required action?

1. A patient diagnosed with schizophrenia believes evil spirits are being summoned by a local minister and verbally threatens to bomb a local church. The psychiatrist notifies the minister. The psychiatrist has: A. released information without proper authorization. B. demonstrated the duty to warn and protect. C. violated the patient's confidentiality. D. avoided charges of malpractice.

B. demonstrated the duty to warn and protect.

A patient who has been diagnosed with schizoid personality disorder is newly admitted to the unit. The best initial nursing intervention is to: A. set firm limits. B. engage in trust building. C. involve in milieu and group activities. D. encourage identification and expression of feelings

B. engage in trust building.

1. When assessing a 2-year-old diagnosed with autism spectrum disorder, a nurse expects: A. hyperactivity and attention deficits. B. failure to develop interpersonal skills. C. history of disobedience and destructive acts. high levels of anxiety when separated from a parent

B. failure to develop interpersonal skills.

A nurse should introduce the matter of a contract during the first session with a new patient because contracts: A. specify what the nurse will do for the patient. B. spell out the participation and responsibilities of each party. C. indicate the feeling tone established between the participants. D. are binding and prevent either party from prematurely ending the relationship.

B. spell out the participation and responsibilities of each party.

A nurse set limits for a patient diagnosed with a borderline personality disorder. The patient tells the nurse, "You used to care about me. I thought you were wonderful. Now I can see I was mistaken. You're terrible." This outburst can be assessed as: A. denial. B. splitting. C. reaction formation. D. separation-individuation strategies

B. splitting.

1. An aging client with chronic schizophrenia takes an antipsychotic and propranolol, a beta-adrenergic blocking agent, for hypertension. Given the combined side effects of these drugs, which client teaching should the nurse provide? A. "Make sure you concentrate on taking slow, deep, cleansing breaths." B. "Watch your diet and try to engage in some regular physical activity." C. "Rise slowly when you change position from lying to sitting or sitting to standing." D. "Wear sunscreen and try to avoid midday sun exposure."

C. "Rise slowly when you change position from lying to sitting or sitting to standing."

1. A client began taking lithium for the treatment of bipolar disorder approximately 1 month ago and asks why he has gained 12 pounds since then. Which is the most appropriate nursing response? A. "I'm surprised you have gained; weight loss is the typical pattern when taking lithium." B. "Your weight gain is more likely related to food intake than medication." C. "Weight gain is a common, but troubling side effect. Let's talk about some strategies for safely improving your nutrition and exercise habits." D. "There's not much you can do about the weight gain. It's better than being emotionally unstable though."

C. "Weight gain is a common, but troubling side effect. Let's talk about some strategies for safely improving your nutrition and exercise habits."

1. A client diagnosed with schizophrenia refuses to take medication, citing the right of autonomy. Under which circumstance would a nurse have the right to medicate the client against the client's wishes? A. A client makes inappropriate sexual innuendos to a staff member. B. A client constantly demands attention from the nurse by begging, "Help me get better." C. A client physically attacks another client after being confronted in group therapy. D. A client refuses to bathe or perform hygienic activities.

C. A client physically attacks another client after being confronted in group therapy.

1. Which situation reflects violation of the ethical principle of veracity? A. A nurse discusses with a client another client's impending discharge. B. A nurse refuses to give information to a physician who is not responsible for the client's care. C. A nurse tricks a client into seclusion by asking the client to carry linen to the seclusion room. D. A nurse does not treat all of the clients equally, regardless of illness severity.

C. A nurse tricks a client into seclusion by asking the client to carry linen to the seclusion room.

1. What percentage of child molestations are perpetrated by family members? A. About 8% B. About 25% C. About 75% D. About 90%

C. About 75%

1. An older adult was stopped by police for driving through a red light. When asked for a driver's license, the adult hands the police officer a pair of sunglasses. What sign of dementia is evident? A. Aphasia B. Apraxia C. Agnosia D. Memory impairment

C. Agnosia

1. Which of these brain structures puts emotional meaning on a stimulus, forms emotional memories, and is involved with rage and fear? A. Hippocampus B. Temporal lobe C. Amygdala D. Midbrain

C. Amygdala

1. A patient has decreased circulating levels of GABA. Which health problem is this most likely to suggest? A. Alzheimer's disease B. Parkinson's disease C. Anxiety disorders D. Insomnia

C. Anxiety disorders

1. A client is angry, pacing, and muttering obscenities. A staff member is asking the nurse to consider restraints. What should the nurse consider first? A. If there are enough staff for a show of force B. Calling the physician for a PRN medication C. Assess reasons why the client is agitated before looking at any interventions D. The needs of the nursing staff

C. Assess reasons why the client is agitated before looking at any interventions

1. What is the priority nursing intervention for a patient diagnosed with delirium who has fluctuating levels of consciousness, disturbed orientation, and perceptual alterations? A. Avoidance of physical contact B. High level of sensory stimulation C. Careful observation and supervision D. Application of wrist and ankle restraints

C. Careful observation and supervision

Which of the following is necessary when considering a medication for a consenting client? A. Client must have input into medication choice. B. Client must agree to report side effects. C. Client must be competent. D. Client must be willing to accept the medication.

C. Client must be competent.

1. Eileen works with youth in a residential treatment center. When Amber, a new patient of hers, does not want her parents to visit, Eileen says, "I know how you feel. Did your dad molest you too?" Eileen's reaction is an example of which behavior? A. Empathy B. Verbal tracking C. Countertransference: Tendency of the nurse to displace feelings related to people in his or her past onto a patient D. Positive reinforcement

C. Countertransference

1. A client is diagnosed with anxiety disorder. Which medication is prescribed for anxiety? A. Chlorpromazine (Thorazine) B. Clozapine (Clozaril) C. Diazepam (Valium) D. Methylphenidate (Ritalin)

C. Diazepam (Valium)

Which nursing action is inappropriate during a crisis situation? A. Taking an active role in problem solving and making decisions for the client B. Guiding the client to appropriate resources C. Encouraging independent thinking to promote insight D. Creating a highly structured environment for the client

C. Encouraging independent thinking to promote insight

A patient diagnosed with a personality disorder has used manipulation to get his or her needs met. The staff decides to apply limit setting interventions. What is the correct rationale for this action? A. It provides an outlet for feelings of anger and frustration. B. It respects the patient's wishes so assertiveness will develop. C. External controls are necessary while internal controls are developed. D. Anxiety is reduced when staff members assume responsibility for the patient's behavior

C. External controls are necessary while internal controls are developed.

A client arrives for her mental health appointment wearing a cocktail dress and theatrical makeup. She announces loudly, dramatically, and in a flirtatious manner that she needs to be seen immediately because she is experiencing overwhelming psychological distress. The nurse should recognize behaviors suggestive of which personality disorder? A. Borderline B. Narcissistic C. Histrionic D. Antisocial

C. Histrionic

An adult tells the nurse, "My partner abuses me only when drinking. The drinking has increased lately, but I always get an apology afterward and a box of candy. I've considered leaving but haven't been able to bring myself to actually do it." Which phase in the cycle of violence prevents the patient from leaving? A. Tension building B. Acute battering C. Honeymoon D. Recovery

C. Honeymoon

1. A jilted college student is admitted to a hospital following a suicide attempt and states, "No one will ever love a loser like me." According to Erikson's theory of personality development, a nurse should recognize that this patient has a deficit in which developmental stage? A. Trust versus mistrust B. Initiative versus guilt C. Intimacy versus isolation D. Ego integrity versus despair

C. Intimacy versus isolation

1. When used for treatment of patients diagnosed with Alzheimer disease, which medication would be expected to antagonize N-methyl-D-aspartate (NMDA) channels rather than cholinesterase? A. Donepezil (Aricept) B. Rivastigmine (Exelon) C. Memantine (Namenda) D. Galantamine (Razadyne)

C. Memantine (Namenda)

Which is most true about elder abuse? A. Abusive caretakers are mentally ill. B. Most abused older adults were abusive themselves as parents. C. Often an abusive caretaker is financially dependent on the older adult in their care. D. It is against the law for a caretaker to have any access to an older adult's bank account

C. Often an abusive caretaker is financially dependent on the older adult in their care.

1. Which is most likely to be a precursor to developing agoraphobia? A. Social phobia B. Bipolar disorder C. Panic disorder D. Anxiety disorder

C. Panic disorder

1. A nurse is performing a mental health assessment on an adult client. According to Maslow's hierarchy of needs, which client action would demonstrate the highest achievement in terms of mental health? A. Maintaining a long-term, faithful, intimate relationship B. Achieving a sense of self-confidence C. Possessing a feeling of self-fulfillment and realizing full potential D. Developing a sense of purpose and the ability to direct activities

C. Possessing a feeling of self-fulfillment and realizing full potential

1. Which of the following matches the definition: the justification of behaviors using reason other than the real reason? A. Compensation B. Projection C. Rationalization D. Dysphoria

C. Rationalization

As a nurse prepares to administer an oral medication to a patient diagnosed with borderline personality disorder, the patient says, "just leave it on the tab. I'll take it when I finish combing my hair. What is the nurses best response? A. Reinforce this assertive action by the patient. Leave the medication on the table as requested. B. Respond to the patient, "I'm worried that you might not take it. I will come back later." C. Say to the patient, "I must watch you take the medication. Please take it now." D. Ask the patient, "Why don't you want to take your medication now?"

C. Say to the patient, "I must watch you take the medication. Please take it now."

When assessing a client for possible suicide, an important clue would be if the client A. Is hostile and sarcastic to the staff. B. Identifies with problems expressed by other clients. C. Seems satisfied and detached. D. Begins to talk about leaving the hospital.

C. Seems satisfied and detached.

A client presents in the mental health clinic saying, "I didn't expect it. They just told me this morning that I don't have a job anymore. I can't think straight. I feel like I'm going crazy." The nurse should conclude that the client is experiencing which type of crisis A. Adventitious B. Maturational C. Situational D. Personal

C. Situational

1. A patient experiencing fluctuating levels of awareness, confusion, and disturbed orientation shouts, "Bugs are crawling on my legs! Get them off!" Which problem is the patient experiencing? A. Aphasia B. Dystonia C. Tactile hallucinations D. Mnemonic disturbance

C. Tactile hallucinations

1. The nurse is assessing a client who has a diagnosis of Schizophrenia and takes an antipsychotic agent daily. Which finding requires further nursing assessment? A. Respirations of 22 beats/minute B. Weight gain of 8 pounds in 2 months C. Temperature of 101°F D. Excess salivation

C. Temperature of 101°F

. Several children are seen in the emergency department for treatment of illnesses and injuries. Which finding would create a high index of suspicion for child abuse? The child who has: A. repeated middle ear infections. B. severe colic. C. bite marks. D. Croup

C. bite marks.

Termination of a therapeutic nurse-patient relationship with a patient has been successful when the nurse: A. avoids upsetting the patient by shifting focus to other patients before the discharge. B. gives the patient a personal telephone number and permission to call after discharge. C. discusses with the patient changes that have happened during the relationship and evaluates the outcomes. D. offers to meet the patient for coffee and conversation three times a week after discharge.

C. discusses with the patient changes that have happened during the relationship and evaluates the outcomes.

The most challenging nursing intervention for patients diagnosed with personality disorders who use manipulation to get their needs met is: A. supporting behavioral change. B. monitoring suicide attempts. C. maintaining consistent limits. D. using aversive therapy.

C. maintaining consistent limits.

1. Which individual with a mental illness may need emergency or involuntary hospitalization for mental illness? The individual who: A. resumes using heroin while still taking methadone. B. reports hearing angels playing harps during thunderstorms. C. throws a heavy plate at a waiter at the direction of command hallucinations. D. does not show up for an outpatient appointment with the mental health nurse.

C. throws a heavy plate at a waiter at the direction of command hallucinations.

A patient diagnosed with bipolar disorder has rapid cycles. The health care provider prescribes and anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate with be prescribed?

Carbamazepine (Tegretol) Anticonvulsant

A priority nursing intervention for a patient diagnosed with major depressive disorder is:

Carefully and inconspicuously observing the patient around the clock

1. A patient experiencing fluctuating levels of consciousness, disturbed orientation, and perceptual alteration begs, "Someone get these bugs off me." What is the nurse's best response? A. "There are no bugs on your legs. Your imagination is playing tricks on you." B. "Try to relax. The crawling sensation will go away sooner if you can relax." C. "Don't worry. I will have someone stay here and brush off the bugs for you." D. "I don't see any bugs, but I know you are frightened so I will stay with you."

D. "I don't see any bugs, but I know you are frightened so I will stay with you."

A person's spouse filed charges of battery. The person has a long history of acting-out behaviors and several arrests. Which statement by the person suggests an antisocial personality disorder? A. "I have a quick temper, but I can usually keep it under control." B. "I've done some stupid things in my life, but I've learned a lesson." C. "I'm feeling terrible about the way my behavior has hurt my family." D. "I get tired of being nagged. My spouse deserved the beating."

D. "I get tired of being nagged. My spouse deserved the beating."

1. A nurse is providing teaching for a client who is scheduled to receive ECT for the treatment of major depressive disorder. Which of the following client statements indicates understanding of the teaching? A. "It is common to treat depression with ECT before trying medications." B. "I can have my depression cured if I receive a series of ECT treatments." C. "I should receive ECT once a week for 6 weeks." D. "I will receive a muscle relaxant to protect me from injury during ECT."

D. "I will receive a muscle relaxant to protect me from injury during ECT."

1. A charge nurse is discussing TMS with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "TMS is indicated for clients who have schizophrenia spectrum disorders." B. "I will provide post anesthesia care following TMS." C. "TMS treatments usually last 5 to 10 minutes." D. "I will schedule the client for TMS treatments 3 to 5 times a week for the first several weeks."

D. "I will schedule the client for TMS treatments 3 to 5 times a week for the first several weeks."

1. The nurse's lack of verbal communication for therapeutic reasons is to "silence" as the nurse's ability to process information and examine reactions to the messages received is to: A. "Focusing." B. "Offering self." C. "Restating." D. "Listening."

D. "Listening."

1. Jessie is attending AA meetings three times a week for the past 6 weeks. She has been sober during this time and visits bi-weekly the community mental health outpatient clinic. Jessie's nurse counselor wants to talk with her about the AA meetings. Which initial question or statement is most appropriate? A. "I am so excited that you are attending the AA sessions!" B. "Do you enjoy attending the AA meetings?" C. "Are the members of the group friendly and accepting?" D. "Tell me about the last AA meeting you attended."

D. "Tell me about the last AA meeting you attended."

1. As part of discharge teaching, which guideline regarding lithium therapy will the nurse plan to include? A. Avoid excessive use of beverages containing caffeine. B. Maintain a consistent sodium intake. C. Consume at least 2500 to 3000 mL of fluid per day. D. All of the above

D. All of the above

A client seeks assistance at a crisis center. The client describes being intensely anxious and having nightmares since assisting with cleanup activities at a school where a student fatally shot a classmate. To assist the client to cope effectively, what should be the first action by the nurse? A. Arrange for the client to visit with a member of clergy. B. Advise the client to avoid going near the school for at least six weeks. C. Send the client to the emergency department for further evaluation. D. Allow the client to express feelings and perceptions about the incident.

D. Allow the client to express feelings and perceptions about the incident.

1. Ms. S, 87, is physically disabled but otherwise healthy, except that she feels "tired. I need simplicity at this time in my life." Ms. S has no family but appoints her long-time live-in partner to act as her agent, even though she does not have a terminal illness and is not incompetent. "I'd rather have Estella make all decisions on my behalf," she says. This is most clearly an example of a(n): A. Advance directive B. Living will C. Directive to physician D. Durable power of attorney for health care

D. Durable power of attorney for health care

1. A 15-year-old adolescent is referred to a residential program after an arrest for theft and running away from home. At the program, the adolescent refuses to participate in scheduled activities and pushes a staff member, causing a fall. Which approach by the nursing staff would be most therapeutic? A. Neutrally permit refusals B. Coax to gain compliance C. Offer rewards in advance D. Establish firm limits

D. Establish firm limits

The most effective nursing intervention for a severely anxious client who is pacing vigorously would be to: A. Instruct her to sit down and quit pacing. B. Place her in bed to reduce stimuli and allow rest. C. Allow her to walk until she becomes physically tired. D. Give her prn medication and walk with her at a gradually slowing pace

D. Give her prn medication and walk with her at a gradually slowing pace

1. A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness? A. Bipolar disorder: mania B. Schizophrenia spectrum disorder C. Generalized anxiety disorder D. Major depressive episode

D. Major depressive episode

1. Which medication does not require periodic blood-level monitoring? A. Eskalith (lithium carbonate) B. Depakote (valproic acid) C. Clozaril (clozapine) D. Paxil (paroxetine)

D. Paxil (paroxetine)

1. Which statement should a nurse identify as correct regarding a client's right to refuse treatment? A. Clients can refuse pharmacological but not psychological treatment. B. Clients can refuse any treatment at any time. C. Clients can refuse only electroconvulsive therapy (ECT). D. Professionals can override treatment refusal by an actively suicidal or homicidal client.

D. Professionals can override treatment refusal by an actively suicidal or homicidal client.

A 37-year-old is involuntarily committed to outpatient treatment after sexually molesting a 12-year-old child. The patient says, "That girl looked like she was 19 years old." Which defense mechanism is this patient using? A. Denial B. Identification C. Displacement D. Rationalization

D. Rationalization

Of the following outcomes, which one is most appropriate for a patient with cognitive impairment related to delirium? The patient will: A. Participate fully in self-care from admission on. B. Have stable vital signs 6 hours after admission. C. Participate in simple activities that bring enjoyment. D. Return to the premorbid level of functioning.

D. Return to the premorbid level of functioning.

1. The nurse is caring for a severely depressed client who has just been admitted to the in-client psychiatric unit. Which of the following is a PRIORITY of care? A. Nutrition B. Elimination C. Rest D. Safety

D. Safety

An inpatient psychiatric client suddenly becomes loud and visibly anxious. What is the best action for the nurse to take? A. Summon help and escort the client to his room. B. Face the client squarely and say, "You must be quiet." C. Say, "Calm down; you're safe here." D. Say, "Let's go talk in your room."

D. Say, "Let's go talk in your room."

1. Jessie has missed three sessions at the mental health center and sporadically attends AA meetings. She is drinking heavily this weekend and has sustained a 2-inch gash in her forehead after swerving off the road into a shallow ditch. She is taken by rescue to the ED. You are her nurse. She tells you, "I hope I just go to sleep and never wake up." What is your best intervention? A. Tell Jessie, "You are just tired and have had too much alcohol in your system." B. Clear the area of any items that Jessie may use to inflict self-harm. C. Immediately activate the mental health protocol to have Jessie admitted to a psychiatric unit. D. Stay with Jessie, call the supervisor, and arrange for continuous monitoring.

D. Stay with Jessie, call the supervisor, and arrange for continuous monitoring.

A 5-year-old child diagnosed with attention deficit hyperactivity disorder (ADHD) bounces out of a chair in the waiting room, runs across the room, and begins to slap another child. What is the nurse's best action? A. Call for emergency assistance from another staff member. B. Instruct the parents to take the child home immediately. C. Direct this child to stop, and then comfort the other child. D. Take the child into another room with toys to act out feelings

D. Take the child into another room with toys to act out feelings

A 15-year-old client presents in the emergency department requesting voluntary admission to the psychiatric unit. What should the nurse consider? A. Whether a bed is available on the unit B. Whether the unit will accept adolescent clients C. Whether there is 1:1 staffing available D. The age of the individual

D. The age of the individual

1. A health-care team, an Asian American client, and several members of the client's family are meeting together to discuss the client's imminent discharge. During this time, the client does not speak and makes eye contact only with family members. From a cultural perspective, which nursing assessment accurately describes the client's behavior? A. The client has a lack of understanding of the disease process. B. The client is experiencing denial related to the client's condition. C. The client is experiencing paranoid thoughts toward authority figures. D. The client has respect for members of the health-care team.

D. The client has respect for members of the health-care team.

1. Eleanor is treated with a _____, which helps to slow the destruction of acetylcholine. A. 5-HT2A (serotonin) antagonist B. GABA C. D2 (dopamine) antagonist D. cholinesterase inhibitor

D. cholinesterase inhibitor

When preparing to interview a patient diagnosed with narcissistic personality disorder, a nurse can anticipate the assessment findings will include: A. preoccupation with minute details; perfectionism. B. charm, drama, seductiveness; seeking admiration. C. difficulty being alone; indecisiveness, submissiveness. D. grandiosity, attention seeking, and arrogance.

D. grandiosity, attention seeking, and arrogance.

1. A nurse cares for an older adult patient admitted for treatment of depression. The health care provider prescribes an antidepressant medication, but the dose is more than the usual adult dose. The nurse should: A. implement the order. B. consult a drug reference. C. give the usual geriatric dosage. D. hold the medication and consult the health care provider.

D. hold the medication and consult the health care provider.

1. The spouse of a patient who has delusions asks the nurse, "Are there any circumstances under which the treatment team is justified in violating the patient's right to confidentiality?" The nurse must reply that confidentiality may be breached: A. under no circumstances. B. at the discretion of the psychiatrist. C. when questions are asked by law enforcement. D. if the patient threatens the life of another person.

D. if the patient threatens the life of another person.

1. The following patients are seen in the emergency department. The psychiatric unit has one bed available. Which patient should the admitting officer recommend for admission to the hospital? The patient who: A. is experiencing dry mouth and tremor related to side effects of haloperidol (Haldol). B. is experiencing anxiety and a sad mood after a separation from a spouse of 10 years. C. self-inflicted a superficial cut on the forearm after a family argument. D. is a single parent and hears voices saying, "Smother your infant."

D. is a single parent and hears voices saying, "Smother your infant."

A nursing diagnosis applies to a patient experiencing mania: imbalanced nutrition: less than body requirements, related to insufficient caloric intake and hyperactivity as evidenced by 5-pound weight loss in 4 days. Select the most appropriate outcome. The patient will:

Drink six servings of a high-calorie, high-protein drink each day.

A person diagnosed with schizophrenia has had difficulty keeping a job because of arguing with coworkers and accusing them of conspiracy. Today the person shouts, "They're all plotting to destroy me." Select the nurse's most therapeutic response.

Feeling that people want to destroy you must be very frightening."

After the death of a spouse, and adult repeatedly says, "I should have made him go to the doctor when he said he didn't feel well." this individual is experiencing.

Guilt

1. A patient with bulimia nervosa has become dehydrated from self-induced vomiting. This is most likely to result in: Hyperchloremia. Hypokalemia. Tachycardia. D. Parotid gland atrophy.

Hypokalemia.

Consider these three drugs: divalproex (Depakote), carbamazepine (Tegretol), and gabapentin (Neurontin). Which drug also belongs to this group?

Lamotrigine (Lamictal), divalproex, carbamazepine, gabapentin CD LG

A nurse should recognize that a decrease in norepinephrine levels will play a significant role in which mental illness?

Major Depressive Episode

Which intervention takes priority when working with newly admitted clients experiencing suicidal ideations?

Monitor the clients at close, but irregular, intervals

A patient hospitalized with a mood disorder has aggression, agitation, talkativeness, and irritability. A nurse begins the care plan based on the expectation that the health care provider is most likely to prescribe a medication classified as an:

Mood Stabilizer

A patient diagnosed with schizophrenia begins to talk about "cracklomers" in the local shopping mall. The term "cracklomers" should be documented as:

Neologism: A made up word

1. A patient diagnosed with schizophrenia has catatonia. The patient has little spontaneous movement and waxy flexibility. Which patient needs are of priority importance?

Physiologic

A person is directing traffic on a busy street while shouting and making obscene gesture at passing cars. The person has not slept or eaten for three days. What features of mania are evident?

Poor judgment and hyperactivity

A patient diagnosed with major depressive disorder begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy period priority information given to the patient and family and should include a directive to

Report increased suicidal thoughts

Which principle takes priority for the psychiatric inpatient staff when addressing behavioral crises? A. Resolve behavioral crises using the least restrictive intervention possible. B. Rights of the majority of patients supersede the rights of individual patients. C. Swift intervention is justified to maintain the integrity of the therapeutic milieu. D. Allow patients opportunities to regain control without intervention if the safety of other patients is not compromised.

Resolve behavioral crises using the least restrictive intervention possible.

A newly admitted client has been diagnosed with major depressive disorder. Which nursing diagnosis takes priority?

Risk for self-directed violence R/T depressed mood

1. When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol (Haldol) was prescribed. The patient now says, "I stopped taking those pills. They made me feel like a robot." What likely side effects did the patient experience?

Sedation and muscle stiffness

A patient diagnosed with borderline personality disorder has a history of self-mutilation and suicide attempts. The patient reveals feelings of depression and anger with life. The psychiatrist suggests the use of a medication. Which type of medication should the nurse expect? A. Selective serotonin reuptake inhibitor (SSRI) B. Monoamine oxidase inhibitor (MAOI) C. Benzodiazepine D. Antipsychotic

Selective serotonin reuptake inhibitor (SSRI)

A 20-year-old male client is admitted to the psychiatric unit with a diagnosis of schizophrenia, acute episode. He is having auditory hallucinations and seems disoriented to time and place. The nurse knows that a hallucination can be explained as a(n)

Sensory experience without foundation in reality.

1. A patient has taken trifluoperazine (Stelazine) 30 mg/day orally for 3 years. The clinic nurse notes that the patient grimaces and constantly smacks both lips. The patient's neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect?

Tardive dyskinesia

.Which of the lobes of the brain is primarily involved in auditory hallucinations? 1. Occipital lobe 2. Parietal lobe 3. Frontal lobe 4. Temporal lobe

Temporal lobe

A patient diagnosed with major depressive disorder is receiving imipramine (Tofranil) 200 mg every night at bedtime. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effect of this drug?

Urinary Retention

A nurse works with a patient diagnosed with schizophrenia regarding the importance of medication management. The patient repeatedly says, "I don't like taking pills." Which treatment strategy should the nurse discuss with the patient and health care provider?

Use of long-acting antipsychotic injections

A nurse receives this laboratory result for a patient diagnosed with bipolar disorder: lithium level 1 mEq/L. This result is:

Within therapeutic limits: 0.8- 1.2 mEq/L

1. The parent of an adolescent recently diagnosed with schizophrenia says to the nurse, "This is entirely my fault. I should have spent more time with my child when he was a toddler." Which response by the nurse is correct? a. "Schizophrenia is genetically transmitted, so it was not in your control." b. "Your child's disorder is more likely the result of an undetected head injury." c. "Environmental toxins are directly implicated in the origins of schizophrenia." d. "Lack of prenatal care causes schizophrenia rather than early childhood events."

a. "Schizophrenia is genetically transmitted, so it was not in your control."

1. Which scenario presents the highest risk for a pregnancy resulting in offspring with an intellectual developmental disability (IDD)? a. 18-year-old mother who received no prenatal care b. 32-year-old woman diagnosed with anorexia nervosa c. 26-year-old father with a history of episodic alcohol abuse d. 38-year-old father diagnosed with generalized anxiety disorder

b. 32-year-old woman diagnosed with anorexia nervosa

1. A nurse plans to lead a group in a residential facility for kindergarten-age, abused children. Which strategy should the nurse incorporate? a. Building a house using blocks b. Telling a story about a child who felt sad c. Drawing pictures of fun activities at a park d. Reading and discussing a book about abused children

b. Telling a story about a child who felt sad

. A patient comes to the hospital for treatment of injuries sustained during a rape. The patient abruptly decides to decline treatment and return home. Before the patient leaves, the nurse should: a. tell the patient, "You may not leave until you receive prophylactic treatment for sexually transmitted diseases." b. provide written information concerning the physical and emotional reactions that may be experienced. c. explain the need for and importance of human immunodeficiency virus (HIV) testing. d. offer verbal information about legal resources.

b. provide written information concerning the physical and emotional reactions that may be experienced.

1. The nurse interviews the parent of a 7-year-old child diagnosed with moderate autism spectrum disorder. Which comment from the parent best describes autistic behavior? a. "My child occasionally has temper tantrums." b. "Sometimes my child wakes up with nightmares." c. "My child swings for hours on our backyard gym set." d. "Toilet training was more difficult for this child than my other children."

c. "My child swings for hours on our backyard gym set."

1. A community mental health nurse talks with a 6-year-old child whose divorced parents have shared custody. Which initial question will best help the nurse explore the child's perception of home life? a. "Is your life different from your friends' lives?" b. "Are you happiest at your mother's or your father's house?" c. "Do you find it hard to move back and forth between two homes?" d. "What are some of the good and bad things about living in two places?"

d. "What are some of the good and bad things about living in two places?"