Psychiatric Nursing

Which statement from a female client experiencing severe anxiety after being raped would indicate the possibility of post-traumatic stress disorder?

"I keep reliving the rape."

One of the goals for Melissa is to help her replace compulsive eating by recognizing following interventions that would operationalize this goal?

Teach stress reduction techniques such as relaxation and imagery

When assessing the suicidal client's plan for suicide, the most important area to be evaluated is

The availability of the means and the lethality of the method

A confused elderly nursing home client is in bed sleeping. When the nursing staff make rounds, they enter the room quietly, reach under the top sheet to feel the bottom sheet to see if it's wet. The client awakens and strikes out, hitting the psychiatric technician in the face. Which statement best explains the client's action?

The client misinterpreted the health care worker's behavior as potentially harmful

In the first interview with Mrs. Dolan the psychiatric technician should explore

What Mrs. Dolan has in mind when she states that she can't take it anymore and it has to stop

Mrs. Jacobson points to the man in the painting on the wall and screams that a man is watching her. She is experiencing

an illusion

A new client is admitted to the psychiatric unit. He appears to be very negative, restless, sits in unusual postures and refuses to speak. The psychiatric technician reads this client's chart and sees the diagnosis of schizophrenia, catatonic type. The psychiatric technician knows that another symptom of this mental disorder is

catalepsy

What assessment can be made about the way Mr. Baker perceives his environment?

dangerous

The most therapeutic approach for the psychiatric technician to take when working with an alcoholic client who is entering treatment is to be

firmly directive and supportive

Crisis intervention is likely to be successful for Mrs. Dolan because she

is experiencing disequilibrium that she finds uncomfortable

The most important factors in successfully using physical management techniques to intervene with an assaultive client are

practice and team work

Mrs. Jacobson decides she will take Antabuse (disulfiram) to help her avoid impulsively responding to drinking cues. Discharge teaching for Mrs. Jacobson should include the need to

read labels of all liquid medications

The psychiatric technician can best communicate to the client that he/she has been listening by

restating the main feeling or thought the client has expressed

The psychiatric technician and Mrs. Jacobson talk about AA. Mrs. Jacobson asks, "What's AA all about?" Which reply best describes it?

"It's a self-group where the norm is sobriety."

Which of the following statements indicates that the nurse is reacting to Ashley's severe anxiety rather than her needs?

"There is nothing physically wrong with you, you need to stop breathing so rapidly"

Helen, a 60-year-old retiree, was awakened early one morning by a police officer informing her that her husband died while jogging. The next three days Mrs. Price went through the funeral ritual in a state of numbness. Several of Mrs. Price's friends tried repeatedly to get her to vent her feelings by crying; they were unsuccessful. Two weeks later, Mrs. Price went to visit her late husband's doctor. While waiting to see the doctor, the clinic nurse sat down beside Mrs. Price. What would be an appropriate statement for the nurse to make?

"Your husband's loss must be very painful for you."

Mrs. Jacobson was admitted to the psychiatric unit last night. She was transferred from the emergency room where she had an x-ray taken of her leg. She had fallen down while intoxicated. The x-ray revealed no injury. The psychiatric technician had cared for this client on previous admissions for similar problems and is feeling angry and frustrated to see her again in this condition. What action by the psychiatric technician would be most beneficial for Mrs. Jacobson?

Acknowledge her feelings to herself and the client by asking how she can help Mrs. Jacobson

One of Mr. Donaldson's nursing diagnoses is self-care deficit: dressing and grooming. Choose the intervention that would be inappropriate to include in his nursing care plan

Administer antianxiety medication prior to bathing and dressing

Based on the data gathered for Mr. Baker's perceived environment as dangerous and ideas of reference, at this point what two nursing diagnoses should the staff consider?

Altered thought process and high risk of violence

Which statement provides the rationale for the nursing intervention: Monitor the severely depressed hospitalized client closely during antidepressant therapy?

As depression lifts, the client has the physical energy to carry out a plan for suicide

Mrs. Jacobson was brought to the hospital at 0200. She had been drinking at the time she fell. If she is going to experience withdrawal symptoms the psychiatric technician should be alert for them to begin

Between 0800 and 1000 today

An appropriate short term goal for an antisocial client with ineffective individual coping related to manipulation of others would be

Client will acknowledge manipulative behavior when called to his/her attention

Stephanie is a 22-year-old client who is dealing anorexia nervosa. She complains to the medication nurse that she is constipated. The medication nurse would first

Encourage Stephanie to drink fluids

A cognitive approach to helping an excessively dependent client would require having the client

Examine thoughts about being independent

In order to assist a client with conversion blindness to eat, the psychiatric technician should

Expect the client to feed themselves after explaining the arrangement of the food on the tray

Ms. Littleton is concerned that she may have serious heart disease. She seeks help at the mental health center, after referral by the internist who has told her she has no physical illness. Ms. Littleton reports she has experienced tightness in her chest and the sensation of her heart missing a beat. Because of her concern over her symptoms she has missed much time from work over the past two years. Her social life has also been severely restricted because she believes she must rest each evening. Ms. Littleton's problem can best be identified as

Hypochondriasis

Paul, a 32 year old salesman, has had difficulty holding a job because he accuses co-workers of conspiring to take his sales. Today, when he argued with several office mates psychiatric unit for evaluation, he has had previous admissions to the unit. When the psychiatric technician meets Mr. Baker, he states loudly, as he points to the two doctors talking in the hallway, "They're plotting to kill me!" The psychiatric technician may correctly assess this behavior as an

Idea of reference

What is the priority nursing diagnosis for Mrs. Dolan?

Ineffective individual coping related to situational crisis

As staff members continue to work with the client diagnosed with antisocial personality disorder, what would be the most challenging nursing intervention?

Maintain consistent limits

The client shakes his fist at the female psychiatric technician and states, "Back off, you witch!" and goes into the dayroom. The psychiatric technician should

Make sure there is physical space between herself and the client

The psychiatric technician says to the client, "I noticed the anger in your voice when you spoke of your father. Tell me about that." What communication techniques is the psychiatric technician using?

Making observations and exploring

The phenomenon of scapegoating within a family group involves

Projection of inadequacies of family members on a victim within the family

Patricia tells the psychiatric technician, "I'm really popular here in the hospital. Lots of doctors and nurses stop by to check on my blindness and the other patients are really interested in it too. Too bad people outside the hospital don't find me so interesting." Based on this statement the psychiatric technician will want to continue to gather assessment data to support a nursing diagnosis of

Self-esteem disturbance

Mr. Bradley and Mr. Gander both have alzheimer's disease (late stage). Mr. Bradley walks up behind Mr. Gander in the hall and shouts, "Move along, you're blocking the road. I'll take a stick to you." Mr. Gander turns around shakes his fist and shouts, "I know what you're up to, you're trying to steal my car." The best nursing action for the psychiatric technician to take would be to

Separate and distract them by directing one to go to the dayroom, and taking the other one to the activities area

James is a 40 year old Native American. In order to obtain admission data what communication style should the psychiatric technician adopt?

Soft-spoken, breaking eye contact occasionally using general leads and reflective techniques

Which of the following sets of characteristics describes the pedophile?

Tends to be sexually and socially immature and feels less threatened by children than by adults

Which statement best describes a therapeutic relationship?

The focus is on the client; problems are discussed by the psychiatric technician and the client; solutions are implemented by the client

Which of the following statements are true about clients who have somatoform disorders?

These clients are difficult to convince to seek psychiatric help

A young male client in a psychoanalytically oriented group related to the therapist as one might to a parent. The client asks permission to attend activities, to socialize with others, etc. This phenomenon is known as

Transference

The staff that work with Mr. Baker and his family try to help them understand the importance of the client taking medication regularly. Mr. Baker continues to say he doesn't like taking pills, and his family stated that they feel helpless to foster his compliance. What treatment strategy should the staff discuss with Mr. Baker's physician?

Use of fluphenazine (Prolixin) decanoate

Clients who voluntarily admit themselves to a mental health facility are

able to refuse antipsychotic medications

The psychiatric technician places a penny in the hand of Mr. Donaldson, a client with alzheimer's disease, and asks the client to name the the object. The psychiatric technician is assessing for

agnosia

The psychiatric technician attempts to give the client her medication. The client adamantly refuses the medication. The psychiatric technician gives the medication anyway. Legally, what can the psychiatric technician be charged with?

battery

Which intervention would be appropriate for an antisocial client with a nursing diagnosis of ineffective individual coping related to manipulation of others?

channel all requests and questions related to care to the primary nurse

When Mr. Baker was discharged from the hospital six months ago, the plan was for him to take chlorpromazine, 100mg PO QID. He told the nurse he stopped taking his pills after a couple months because he hated the way they made him feel. To what common side effects is Mr. Baker most likely referring?

dry mouth, stiffness, shuffling walk

Melissa was recently admitted to the eating disorders unit of the psychiatric hospital with a diagnosis of obesity related to compulsive eating. Her friend told the psychiatric technician, "I can't believe Melissa is so heavy. When we're together, I never see her eat." This alerts the psychiatric technician to the possibility that Melissa engages in behavior involving

eating in secret

Mrs. Jacobson's condition remains relatively stable. She is shaky, irritable and anxious, and she talks about having vivid nightmares for two nights. The next day when the psychiatric technician returns from lunch, she finds Mrs. Jacobson restless and perspiring. Her pulse is 130; she cries, "There are bugs crawling on my bed. I've got to get out of here." She begins to trash about. The most accurate assessment of the situation would be that she

is experiencing symptoms consistent with withdrawal delirium

The head nurse tells the psychiatric technician, "We anticipate Mrs. Swan will experience symptoms of withdrawal from sedative/hypnotics. Watch her closely." For which symptoms should the psychiatric technician assess Mrs. Swan?

nausea, vomiting, diaphoresis, anxiety, tremors

Paula is a depressed client on the acute psychiatric unit. The psychiatric technician notices as she talks with Paula that she is unable to maintain eye contact; She drops her chin to her chest and looks down. The nurse has made an assessment of Paula's

nonverbal communication

Mrs. Jacobson's hourly blood pressure and pulse are recorded as the following: Admission: 122/80 and 72 0400: 126/78 and 80 0600: 124/80 and 72 0800: 148/88 and 96 The priority action for the psychiatric technician is to

notify the physician

An angry elderly client grabs the psychiatric technician's har. The psychiatric technician should initially

press the attacker's hands against her head

A client tells the psychiatric technician she had psychotherapy weekly for three years. The therapist used the techniques of free association, dream analysis, and facilitating awareness of transference feelings to help the client understand unconscious process and foster personality change. The psychiatric technician can identify this type of therapy as

psychoanalysis

The husband who is sexually inadequate and blames it on his partner, saying that she is unattractive and that her manner is too blasé, may be using defense mechanism of

rationalization

Melissa has been under a great deal of stress at work. She worked long hours to make up for a staff shortage. When she went home, she propped her feet up in front of the TV and ate until she went to bed. She felt too exhausted to exercise. She gained 20 pounds in a month. At five feet tall, she weighs 175 pounds. What is the possible etiology of Melissa's obesity?

reactive obesity

A client tells the members of the inpatient therapy group that he hears voices telling him that his doctor is going to poison him. He continues, "I look around to see who's talking to me, and I can't see anybody." Another client replies, "I used to hear voices too. I found out they were my imagination. The voices you hear aren't real either." Which concept, basic to group process, is demonstrated in this interchange?

reality testing

Mrs. Price tells the doctor she is experiencing a great deal of discomfort in the epigastric region. She adds, "I wonder if I have an ulcer." The diagnostic tests are negative. What normal phenomena of mourning does this exemplify?

sensations of somatic distress

Ashley, a 19-year-old, accompanied her boyfriend, Chris, to the emergency room. They had been in a motorcycle accident. Chris was badly hurt, but apparently, Ashley was not injured. However, she appeared confused and had trouble focusing on what was going on around her. She complained of dizziness and nausea although physically she was unharmed. She was hyperventilating as the nurse was doing the assessment. The nurse should assess Ashley's level of anxiety as

severe

Mrs. Dolan, age 42, is admitted to a psychiatric unit after an outpatient session with her psychotherapist. She tells the psychiatric technician, "I can't take it anymore! It has to stop. Last year my husband had an affair with our next-door-neighbor. We don't communicate anymore. Three months ago, I found a lump in my breast that the doctor is watching closely because I may need a mastectomy. Yesterday, my 20-year-old-daughter told me she is quitting college and moving to another state with her boyfriend." What type of crisis is Mrs. Dolan experiencing?

situational

Each of the following interventions is appropriate for the psychiatric technician in the keeping space between herself and the client except

speaking in a loud, urgent tone of voice

Which of Mrs. Dolan's problems should be the focus for secondary crisis intervention?

strategies to cope with the daughter's leaving home

For the client whose nursing diagnosis is Powerlessness related to inability to control compulsive cleaning, the psychiatric technician recognizes that the primary gain associated with the cleaning rituals is

temporary anxiety reduction

When group members use concepts such as ego states, scripts and games, the type of group therapy in which they're involved can be identified as

transactional analysis

The psychiatric technician reports to the interdisciplinary team that an antisocial client lies to other clients, verbally abuses a client with alzheimer's disease, flatters his primary nurse, and is detached and superficial with the psychiatrist. Which behavior most clearly warrants limit setting?

verbal abuse of another client