Subtopic Treatment of Mental Health Disorders
Which suicide method is the least lethal? 1 Hanging 2 Ingesting pills 3 Jumping from a tall bridge 4 Poisoning with carbon monoxide
2 Ingesting pills Ingesting pills is considered the least lethal of these suicide methods, because it is considered slower. Hanging, jumping, and carbon monoxide poisoning are all quicker and therefore more lethal methods.
A 20-year-old college student reports to the nurse at the college health clinic increasing anxious feelings, inability to sleep, and a loss of appetite. The client also reports an inability to concentrate and a drop in grades. What question should the nurse ask? 1 "With whom have you shared your feelings of anxiety?" 2 "What have you identified as the cause of your anxiety?" 3 "It must be difficult for you. How long has this been going on?" 4 "Sounds like you're having problems adjusting. Shall we talk about it?"
3 "It must be difficult for you. How long has this been going on?" Expressing sympathy and asking how long the problem has persisted shows recognition of the client's feelings and attempts to collect data. Whom the client has shared the problem with is irrelevant and will not elicit data about the extent of the anxiety. The client may not be able to identify the cause of the anxiety. Anxiety is most often a response to a vague, nonspecific threat. It is too early to identify the cause of the anxiety; crisis intervention with anxious clients requires a more structured approach than "Shall we talk?"
The husband of a young mother who has attempted suicide tells the nurse that he told his wife he would bring their 26-month-old daughter to visit his wife and asks if that would be possible. What is the best response by the nurse? 1 "Probably so, but you'd better check with her primary healthcare provider first." 2 "Of course! Children of all ages are welcome to visit relatives." 3 "It could be very upsetting for your child to see her mother so depressed." 4 "Tell me what your wife said when you offered to bring your child for a visit."
4 "Tell me what your wife said when you offered to bring your child for a visit." The nurse should determine whether the spouse has discussed the child visiting with the client before commenting further. The responses "Probably so, but you'd better check with her primary healthcare provider first" and "Of course! Children of all ages are welcome to visit relatives" assume that the client has consented to the visit; this assumption may be incorrect. The response "It may be very upsetting for your child to see her mother so depressed" makes an assumption that requires more data and discussion to validate.
What is the priority when a nurse is formulating a plan of care for a client with a diagnosis of dementia of the Alzheimer type? 1 Implementing remotivational therapy 2 Structuring the environment for safety 3 Arranging for long-term custodial care 4 Stimulating thinking with new experiences
2 Structuring the environment for safety Structuring the environment for safety supports the client's ability to function in a protected, safe milieu. Attempting to remotivate the client is not the priority; also, it is not always possible to remotivate a client with organic brain damage. There are no data to indicate the client needs long-term care at this time. Structure and routines will decrease anxiety and increase performance of activities of daily living. Cognitive maintenance should be part of the focus of care.
What treatment should a nurse anticipate will be prescribed for a client with severe, persistent, intractable depression and suicidal ideation? 1 Electroconvulsive therapy 2 Short-term psychoanalysis 3 Nondirective psychotherapy 4 High doses of anxiolytic drugs
1 Electroconvulsive therapy Electroconvulsive therapy, which interrupts established patterns of behavior, helps relieve symptoms and limits suicide attempts in clients with severe, intractable depression that does not respond to antidepressant medication. The client's depressed mood limits participation in psychotherapy; feelings precipitated by therapy may lead to suicidal acting out. Psychotherapy is directed toward helping the person learn new coping mechanisms and better ways of coping with problems; the depressed client needs direction to accomplish this. Antianxiety medications are usually not prescribed for clients with depression.
What is the most appropriate nursing intervention for clients who exhibit mild cognitive impairment? 1 Reality orientation 2 Behavioral confrontation 3 Reflective communication 4 Reminiscence group therapy
1 Reality orientation Reality orientation is generally helpful for clients exhibiting mild cognitive impairment; these clients are aware of their impairment, and orientation then reduces anxiety. Behavioral confrontation is not therapeutic because it may cause frustration and increase psychomotor agitation in a client with cognitive impairment. Reflective communication is a technique in which the nurse restates or repeats the client's statements; it can be used to clarify thoughts but may also lead to frustration when the approach is overdone. Reminiscence group therapy is helpful with severely confused, disorganized clients because it reinforces identity, acknowledges what was significant, and often compensates for the dullness of the present.
A client recently admitted to the psychiatric unit after an attempted suicide is placed in a private room with the curtains, telephone, and call light removed. A student nurse caring for this client identifies that the client has become withdrawn and tends to sleep most of the time. What is the most appropriate nursing intervention? 1 Asking whether the client wants to rest or prefers to talk 2 Leaving the room quietly and allowing the client to sleep 3 Asking an open-ended question and sitting quietly by the client 4 Focusing on the client's behavior and requesting an explanation
3 Asking an open-ended question and sitting quietly by the client Open-ended questions encourage the client to talk about topics of interest or concern without the nurse's imposing specific topics to be discussed. Sitting quietly shows concern and acceptance. Direct statements such as asking whether the client wants to rest or prefers to talk make it too easy for the client to say no and remain withdrawn. Prolonged sleeping is a sign of withdrawal and depression; the client should be encouraged to interact with the nurse. Focusing on the client's behavior and requesting an explanation is too confrontational at this time; the client may not be able to provide an explanation.
A nurse is caring for a client with a diagnosis of conversion disorder manifesting as paralysis of the legs. Which is the most therapeutic nursing intervention? 1 Encouraging the client to try to walk 2 Explaining to the client that there is nothing wrong 3 Avoiding focusing on the client's physical symptoms 4 Helping the client follow through with the physical therapy plan
3 Avoiding focusing on the client's physical symptoms The physical symptoms are not the client's major problem and therefore should not be the focus of care. This is a psychological problem, and the focus should be in this domain. Encouraging the client to try to walk is focusing on the physical symptom of the conflict; the client is not ready to give up the symptom. The disorder operates on an unconscious level but is very real to the client; saying there is nothing wrong denies feelings. Psychotherapy, not physical therapy, is needed at this time.
A nurse is counseling a client who is experiencing substance abuse delirium. What communication strategies should be used by the nurse when working with this client? 1 Encouraging the client to practice self-control 2 Using humor when communicating with the client 3 Offering an introduction to the client at each meeting 4 Approaching the client from the side rather than the front
3 Offering an introduction to the client at each meeting Clients with delirium have short-term memory loss; therefore it is necessary to reinforce information. A client experiencing delirium is unable to participate in a discussion about self-control. Humor is inappropriate and may cause the client to feel uncomfortable. Approaching the client from the side rather than the front may initiate a startle response, causing the client to become fearful.
While walking to the examination room with the nurse, a toddler with autism suddenly runs to the wall and starts banging the head on it. What should the nurse's initial action be? 1 Allowing the toddler to act out feelings 2 Asking the toddler to stop this behavior 3 Restraining the toddler to prevent head injury 4 Telling the toddler that the behavior is unacceptable
3 Restraining the toddler to prevent head injury The child with autism needs protection from self-injury. Permitting the child to act out is possible only if the acting out does not place the child in jeopardy. The child with autism has difficulty following directions, especially when out of control. The child with autism cannot separate self from behavior; a punitive approach will decrease the child's self-esteem.
A client who experiences auditory hallucinations agrees to discuss alternative coping strategies with a nurse. For the next 3 days when the nurse attempts to focus on alternative strategies, the client gets up and leaves the interaction. What is the most therapeutic response by the nurse? 1 "Come back; you agreed that you would discuss other ways to cope." 2 "You seem very uncomfortable every time I bring up a new way to cope." 3 "Did you agree to talk about other ways to cope because you thought that was what I wanted?" 4 "You walk out each time I start to discuss the hallucinations; does that mean you've changed your mind?"
2 "You seem very uncomfortable every time I bring up a new way to cope." "You seem very uncomfortable every time I bring up a new way to cope" focuses on a feeling that the client may be experiencing and provides an opportunity to validate the nurse's statement. "Come back; you agreed that you would discuss other ways to cope" demands that the client stay in an uncomfortable situation without offering any support. "Did you agree to talk about other ways to cope because you thought that was what I wanted?" fails to recognize the part anxiety plays in changing behavior. "You walk out each time I start to discuss the hallucinations; does that mean you've changed your mind?" seems like an attack on the client; also, although it offers an explanation for the behavior, it fails to convey an understanding that changing behavior is anxiety-producing.
A depressed client cries when the family does not visit. What is the most therapeutic response by the nurse? 1 "It's difficult to realize that no one cares about you." 2 "Your family didn't visit, and now you're feeling rejected." 3 "It's terrible to have such negative thoughts about yourself." 4 "Your family members work—that's why they don't visit you."
2 "Your family didn't visit, and now you're feeling rejected." The statement "Your family didn't visit, and now you're feeling rejected" accurately reflects the client's emotions and may encourage exploration of feelings. The nurse does not know that no one cares about the client, and the statement may increase the client's unhappiness. The client is upset about the lack of visitors; discussing negative self-thoughts changes the subject. The defensive statement "Your family members work—that's why they don't visit you" may worsen the client's self-derogatory feelings.
A nurse is caring for a female client during the manic phase of bipolar disorder. What should the nurse do to help the client with personal hygiene? 1 Suggest that she wear hospital clothing. 2 Guide her to dress appropriately in her own clothing. 3 Allow her to apply makeup in whatever manner she chooses. 4 Keep makeup away from her because she will apply it too freely.
2 Guide her to dress appropriately in her own clothing. Having clients who are experiencing the manic phase of bipolar disorder wear personal clothing helps keep them more in touch with reality. The client may need direction to dress appropriately. Suggesting that she wear hospital clothing does not help the client learn new ways to cope with problem situations. Allowing her to apply makeup in whatever manner she chooses may set up the client as a target of ridicule by other clients. The client may use makeup but with supervision.
A delusional client verbalizes the belief that others are out to cause the client harm. A nurse notes the client's worsening pacing and agitation. What is the best nursing intervention? 1 Advising the client to use a punching bag 2 Moving the client to a quiet place on the unit 3 Encouraging the client to sit down for a while 4 Allowing the client to continue pacing with supervision
2 Moving the client to a quiet place on the unit A client losing control feels frightened and threatened; this client needs external controls and a reduction in external stimuli. Advising the client to use a punching bag is helpful if the client is holding back aggressive behavior but is not useful in easing agitation associated with delusions. The client is unable, at this time, to sit in one place; the agitation is building. The client may get completely out of control if the pacing is allowed to continue.
A client who complains of memory loss, nervousness, insomnia, and fear of leaving the house is admitted to the hospital after several days of increasing incapacitation. What nursing action is the priority in light of this client's history? 1 Evaluating the client's adjustment to the unit 2 Providing the client with a sense of security and safety 3 Exploring the client's memory loss and fear of going out 4 Assessing the client's perception of reasons for the hospitalization
2 Providing the client with a sense of security and safety The client is anxious and afraid of leaving home; the priority is the client's safety and security needs. Unless the client is provided with a sense of security, adjustment probably will be unsatisfactory, because the anxiety will most likely escalate. Exploring the client's memory loss and fear of going out cannot be done until anxiety is reduced. The client is experiencing memory loss and may not be able to remember what precipitated admission to the hospital; some memory loss may be a result of high anxiety and thought blocking.
A nurse is conducting the Mini-Mental Status examination on an older client. What should the nurse ask the client to do when testing short-term memory? 1 Subtract serial sevens from 100. 2 Copy one simple geometric figure. 3 State three random words mentioned earlier in the exam. 4 Name two common objects when the nurse points to them.
3 State three random words mentioned earlier in the exam. Stating three random words mentioned earlier in the examination is a test of the client's ability to recall from short-term memory. Subtracting serial sevens from 100 is a test of the ability to calculate and pay attention. Copying one simple geometric figure is a test of visual comprehension. Naming two common objects when the nurse points to them is a test of verbal skills to identify aphasia.
A school nurse knows that school-aged children often use defense mechanisms to cope with situations that might negatively affect their self-esteem. The nurse hears a child who was not invited to a sleepover say, "I don't have time to go to that sleepover. I have better things to do." The nurse concludes that the student is using which defense mechanism? 1 Denial 2 Projection 3 Regression 4 Rationalization
4 Rationalization Rationalization is the offering of an explanation to one's self or others to allay anxiety. Denial involves avoiding the reality of a situation. Projection is blaming others for one's shortcomings. Regression is returning to an earlier more familiar mode of behavior.
The nurse notes that a young client with anorexia nervosa telephones home just before each mealtime. The client ignores reminders to eat and continues talking until the other clients are finished eating. The client then refuses to eat food that has gotten cold. What should the nurse do initially? 1 Insist that the client eat the food. 2 Revoke the client's telephone privileges. 3 Hang up the telephone when meals are served. 4 Schedule a family meeting to discuss the problem.
4 Schedule a family meeting to discuss the problem. By talking to the client on the telephone at mealtimes, the family is enabling the client to continue the self-destructive behavior; the client and family must be included in discussion of and possible solutions to the problem. Insisting that the client eat the food is a punitive approach that does not address the underlying problem. Revoking the client's telephone privileges is a behavior modification approach that may be used if talking to the family does not produce needed change. Hanging up the telephone when meals are served is a punitive approach that does not address the underlying problem.
A client with an obsessive-compulsive disorder continually walks up and down the hall, touching every other chair. When unable to do this, the client becomes upset. What should the nurse do? 1 Distract the client, which will help the client forget about touching the chairs 2 Encourage the client to continue touching the chairs as long as the client wants until fatigue sets in 3 Remove chairs from the hall, thereby relieving the client of the necessity of touching every other one 4 Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed
4 Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed It is important to set limits on the behavior, but it is also important to involve the client in the decision-making. Distracting the client, which will help the client forget about touching the chairs, is nontherapeutic; rarely can a client be distracted from a ritual when anxiety is high. Encouraging the client to continue touching the chairs for as long he desires until fatigue sets in is a nontherapeutic approach; some limits must be set by the client and nurse together. Removing chairs from the hall, thereby relieving the client of the necessity of touching every other one, will increase the client's anxiety because the client uses the ritual as a defense against anxiety.
The parents of a young adult client visit regularly. After one visit the client becomes very agitated. What should the nurse do to relieve the client's distress? 1 Take the client to the coffee shop for a treat. 2 Distract the client by providing a unit activity. 3 Limit the client's future contact with the parents. 4 Explore the client's response to the parents' behavior.
4 Explore the client's response to the parents' behavior. Helping the client understand the meaning of a family member's behavior and responses to it reduces the family member's emotional control over the client. Taking the client to the coffee shop for a treat ignores the necessity of clarifying the family member's behavior. Distraction is not a therapeutic way to deal with realistic feelings. Limiting the client's future contact with the parents is a temporary measure and does not reduce the emotional conflict with the family member.
A client has just been admitted to the psychiatric unit on involuntary admission status. During the admission assessment the client tells the nurse, "I am the second son of God and need to say a prayer." What is the best response by the nurse? 1 Interrupting the client and continuing the assessment 2 Joining the client in the prayer and then refocusing on the assessment 3 Quietly leaving the client and coming back later to complete the assessment 4 Waiting until the client finishes the prayer and then completing the assessment
4 Waiting until the client finishes the prayer and then completing the assessment During the initial assessment it is important for the nurse to learn as much as possible about a client and to establish baseline data; therefore both direct and indirect assessment data are important. Interrupting the client may interfere with the nurse-client relationship and increase the client's anxiety; also, it may interfere with obtaining valuable information about the client. Joining the client in the prayer and then refocusing on the assessment is not therapeutic and may reinforce the client's delusional thinking. Quietly leaving the client and returning later to complete the assessment is not therapeutic and will not meet standards of care; it may precipitate feelings of abandonment.
