Chap 4, Chapter 2: Biological Implications, exam 1 practice questions, ch.3 Mental Health, Mental Health Exam Quiz Question, Mental Health Exam #1, ch 1 Concepts of Personality Development, Chapter 1: Mental Health and Mental Illness, Psychiatric-Men...

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An instructor is teaching nursing students about neurotransmitters. Which term best explains the process by which neurotransmitters released into the synaptic cleft return to the presynaptic neuron? A. Regeneration B. Reuptake C. Recycling D. Retransmission

B. Reuptake

Which mental illness should a nurse identify as being associated with a decrease in prolactin hormone level? A. Major depressive disorder B. Schizophrenia C. Anorexia nervosa D. Alzheimer's disease

B. Schizophrenia

The nurse understands that abnormal levels of growth hormone may play a role in which disorder? A. Acute mania B. Schizophrenia C. Anorexia nervosa D. Alzheimer's disease

C. Anorexia nervosa

Which client diagnosis should the nurse associate with a decrease in GABA? A. Alzheimer's disease B. Schizophrenia C. Panic disorder D. Depression

C. Panic disorder

A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defense mechanism? A. Displacement B. Projection C. Reaction formation D. Sublimation

C. Reaction formation

A nurse is assessing a client's response to stress. The nurse concludes that the client is performing a secondary appraisal of a stressful event when the client determines: A. The event is benign. B. The event is irrelevant. C. Resources are available. D. The event is pleasurable.

C. Resources are available.

Which part of the nervous system should the nurse identify as playing a major role during stressful situations? A. Peripheral nervous system B. Somatic nervous system C. Sympathetic nervous system D. Parasympathetic nervous system

C. Sympathetic nervous system

Social Security Disability Insurance (SSDI) benefits typically cover needs based on which one of the following? A. Disability B. Economic need C. Unemployment Mental illness

*A. Disability

The nurse informs a client that his/her spouse was killed in an automobile accident. The client begins to scream "No, no, that's a lie!" while covering her ears and rocking back and forth. Which stage of grief would the nurse anticipate next? 1. Denial 2. Anger 3. Bargaining 4. Depression

2. Anger

A client is admitted to the psychiatric unit for the fourth time in a month after being found face down in parking lot with an extremely high blood alcohol level. While speaking with the nurse, the client explains he drinks alcohol to ease the pain of losing his family. What ego defense mechanism is the client exemplifying? 1. Compensation 2. Denial 3. Displacement 4. Projection

2. Denial

As part of discharge teaching, which guideline regarding lithium therapy will the nurse plan to include? 1. Avoid excessive use of beverages containing caffeine. 2. Maintain a consistent sodium intake. 3. Consume at least 2,500 to 3,000 mL of fluid per day. 4. All of the above

Childhood

A nurse is caring for a hospitalized client who is quarrelsome, opinionated, and has little regard for others. According to Sullivan's interpersonal theory, the nurse should associate the client's behaviors with a previous deficit in which stage of development?

Computed tomography (CT)

A series of x-ray images is taken of the brain and a computer analysis produces slices providing precise 3d-like reconstruction of each segment. Can detect lesions, abrasions areas of infarct, and aneurysms.

Which of the following statements should a nurse recognize as true about defense mechanisms? Select all that apply. A. They are employed when there is a threat to biological or psychological integrity. B. They are controlled by the id and deal with primal urges. C. They are used in an effort to relieve mild to moderate anxiety. D. They are protective devices for the superego. E. They are mechanisms that are characteristically self-deceptive.

A, C, E

Which client statement alerts the nurse that the client may be responding maladaptively to stress? A. "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. "Avoiding contact with others helps me cope."

Which neuroimaging technique would reveal problems in the anatomical structure of the brain but not problems in function? A. CT B. PET C. SPECT D. None of the above.

A. CT

"I don't ever cheat on tests; it is wrong."

According to Freud, which statement should a nurse associate with predominance of the superego?

neurophysiological activity

All aspects of conscious mental activity and sense of self originate from the _________________________ of the brain.

Identify special dietary + drug restrictions in a teaching plan for a pt taking a monoamine oxidase inhibitor (MAOI).

Avoid: -Doxepin -Use of other CNS depressants drugs -Sedating histamines - aged cheese, picked, smoked fish and wine

A client tells the nurse, "I experience stress on a regular basis. Why do I feel this way?" Which is the nurse's most appropriate response? A. "Genetics has nothing to do with your tem- perament or feelings." B. "Your reactions to past experiences influence your current feelings." C. "Your stress level is lower when you are in good physical health." D. "You'll experience less stress if you use appropriate coping skills."

B. "Your reactions to past experiences influence your current feelings."

A lucid client diagnosed with schizophrenia regularly 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. Tell the client that if the medication is refused, hospitalization will occur. B. Allow the client to decline the medication and document. C. Arrange with a relative to add medication to the client's morning orange juice. D. Call for help to hold the client down while the injection is administered.

B. Allow the client to decline the medication and document.

Which of the following medications would be an appropriate prn medication for an individual with anxiety symptoms? A. Buspirone B. Alprazolam C. Fluoxetine D. Sertraline

B. Alprazolam

A nurse gave a client 5mg of haloperidol for agitation. The client's chart was clearly stamped "Allergic haloperidol." The client suffered anaphylactic shock and died. How would the nurse's actions be labeled? A. Intentional tort B. Negligence C. Battery D. Assault

B. Negligence

Dopamine

Involved in fine muscle movement, integration of emotions and thoughts, decision making, and stimulates hypothalamus to release hormones.

Norepinephrine (NE)

Level in brain affects mood, attention and arousal, and stimulates sympathetic branch of autonomic nervous system for fight or flight in response to stress. Decrease in this youll see depression if there is too much youll see anxiety and schizophrenia.

Acetylcholine

Plays a role in memory and learning, regulates mood, affects sexual and aggressive behavior, and stimulates parasympathetic nervous system. Decrease in this causes dementia.

NIC

Research-based, standardized listing of interventions reflective of current clinical practices the nurse can use to plan care; an evidence-based approach

Neurotransmitters

a chemical messenger

Grassroots groups

•Confront stigma, influence policies, and support the rights of those who are mentally ill. •Have successfully joined together to shape the delivery of mental health care.

The nurse is preparing to assess a client before the physician prescribes a regimen of psychopharmacological therapy. Which components will the nurse assess? (Select all that apply.) 1. Medical history 2. Physical examination findings 3. Ethnocultural characteristics 4. Current medication

1, 2, 3, 4

Which biological responses occur at the sustained stage of stress during the "fight or flight" syndrome? Select all that apply. 1. Decreased fluid retention 2. Decreased immune response 3. Decreased retention of sodium 4. Decreased inflammatory response 5. Decreased basal metabolic rate (BMR)

2. Decreased immune response 4. Decreased inflammatory response

A client is diagnosed with anxiety disorder. Which medication is prescribed for anxiety? 1. Chlorpromazine (Thorazine) 2. Clozapine (Clozaril) 3. Diazepam (Valium) 4. Methylphenidate (Ritalin)

The nurse is assessing a client who has a diagnosis of schizophrenia and takes an antipsychotic agent daily. Which finding requires further nursing assessment? 1. Respirations of 22 beats/minute 2. Weight gain of 8 lbs. in 2 months 3. Temperature of 101oF 4. Excess salivation

A client has been diagnosed with major depression and is prescribed imipramine (Tofranil). What information specifically related to this class of antidepressants will the nurse plan to include in client and family education? 1. The medication may cause dry mouth. 2. The medication may cause nausea. 3. The medication should not be discontinued abruptly. 4. The medication may cause photosensitivity.

Which basic need is at the top of Maslow's hierarchy of needs? 1. Protection 2. Affection 3. Self-respect 4. Self-fulfillment

4. Self-fulfillment

Phallic

A 6-year-old boy uses his father's flashlight to explore his 3-year-old sister's genitalia. According to Freud, in which stage of psychosocial development should a nurse identify this behavior as normal?

A 25 year old man barely avoids a motor vehicle accident. His heart is pounding, his palms are sweaty and his respirations are increased. This is an example of which stage of the general adaptation syndrome? A. Alarm reaction stage B. Stage of resistance C. Stage of exhaustion D. Stage of biological stress

A. Alarm reaction stage

Which concepts are included in Hobfoll's Conservation of Resources theory? Select all that apply. A. Availability of resources B. Disequilibrium C. Genetics D. Past experiences E. Resilience

A. Availability of resources C. Genetics D. Past experiences

Which psychoneurotic responses to severe anxiety are identified in the DSM-5? A. Somatic symptom disorders B. Grief reactions C. Psychosis D. Bipolar disorder

A. Somatic symptom disorders

Which step in SOAPIE involves interpretation of two kinds of data in identifying a problem or a nursing diagnosis? A."S" B."A" C."P" D. "I"

A: Assessment (nurse interprets S and O and describes either a problem or a nursing diagnosis)

An employee uses the defense mechanism of displacement when the boss openly disagrees with suggestions. What behavior would be expected from this employee? 1. The employee assertively confronts the boss. 2. The employee leaves the staff meeting to work out in the gym. 3. The employee criticizes a coworker. 4. The employee takes the boss out to lunch.

Ans: 3. The nurse should expect that the client using the defense mechanism displacement would criticize a coworker after being confronted by the boss. 1. Confronting others is not a behavior consistent with displacement. 2.Leaving the staff meeting is not a behavior consistent with displacement. 4.Taking the boss out to lunch is not a behavior consistent with displacement.

Positron emission tomography (PET)

Are useful in identifying physiological and biochemical changes as they occur in living tissue. Can detect: oxygen utilization, glucose metabolism, blood flow, and neurotransmitter-receptor interaction.

The nurse identifies which symptom as typical of the fight-or-flight response? A. Decreased heart rate B. Increased peristalsis C. Increased salivation D. Pupil constriction

B. Increased peristalsis

After your first conversation, Becky withdraws from you again before you've even really begun. Which statement will contribute most to establishing Becky's trust? A. "Weren't you complying with your medication regimen?" B."It must be discouraging to be readmitted to the hospital so soon." C."Everyone with bipolar disorder ends up in the hospital occasionally." D."You must take your drugs as prescribed or you will be rehospitalized."

B."It must be discouraging to be readmitted to the hospital so soon."

Lorazepam (Ativan)

Is a Benzodiazepines (These decrease anxiety). They cause sedation at higher therapeutic doses. These are extremely addictive.

Brainstem

Processing center for sensory information

AMA

Released against medical advice

Data gathering for nursing assessment

Review of systems Laboratory data MSE Psychosocial assessment Spiritual/religious assessment Cultural and social assessment Validating the assessment Using rating scales

Cerebellum

This regulates skeletal muscle, Coordination and contraction, and Maintains equilibrium

The structure and dynamics of the personality

When assessing clients, a psychiatric nurse should understand that psychoanalytic theory is based on which underlying concept?

Which neuroimaging technique would reveal problems in the anatomical structure of the brain but not problems in function? a. CT b. PET c. SPECT

As election day nears, a mental health nurse studies the position statements of various candidates for federal offices. Which candidate's commentary would the nurse interpret as supportive of services for persons diagnosed with mental illness? a. "full parity insurance coverage for mental illness" b. "coverage for biologically based mental illnesses" c. "reimbursement for initial treatment of addictions" d. "managed care oversight for mental illness services"

a. "full parity insurance coverage for mental illness"

As Becky is preparing for discharge, she presents you with a handmade card of appreciation for the care you provided. Should you accept the card? A.Yes B.No C.Depends on state laws D.Depends on her illness

a. yes

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 The neurotransmitter γ-aminobutyric acid (GABA) seems to play a role in modulating neuronal excitability + anxiety. Decreased levels are associated with anxiety.

A nurse working in an acute care unit for adolescents diagnosed with mental illness says, "Our patients have so much energy. We need some physical activities for them." In recognition of needs for safety and exercise, which activity could the treatment team approve? a. badminton tournament b. competitive soccer matches c. intramural basketball d. line dancing to popular music

d. line dancing to popular music

Answer - c. Pages 5-6. Trauma occurs in many forms, including physical, sexual, and emotional abuse; war; natural disasters; and other harmful experiences. Trauma-informed care provides guidelines for integrating an understanding of how trauma affects patients into clinical programming.

he nurse interacts with a veteran of World War II. The veteran says, "Veterans of modern wars whine and complain all the time. Back when I was in service, you kept your feelings to yourself." Select the nurse's best response. a. "American society in the 1940s expected World War II soldiers to be strong." b. "World War II was fought in a traditional way but the enemy is more difficult to identify in today's wars." c. "We now have a better understanding of how trauma affects people and the importance of research-based, compassionate care." d. "Intermittent explosive devices (IEDs), which were not in use during World War II, produce traumatic brain injuries that must be treated."

Lithium

is a mood stabilizer in pts with bipolar disorder. is your go to drug for people who have Mania! Must look at fluid and electrolyte status of our patients.

Glutamate

is excitatory and may play a role in learning and memory.

milieu therapy

taking care of pt and environmental therapy

Different setting of psych care

•24-hour nursing care •Locked units (for safety) •Crisis care •Residential treatment programs •State acute care systems •General hospital psychiatric units •Private psychiatric hospital acute care •Primary care providers •Patient-centered medical homes •Primary care medical homes •Community mental health centers •Psychiatric home care •Intensive outpatient programs

Which of the following identifies the titles that registered nurses will use and what they are legally allowed to do? A.State Boards of Nursing B.Professional Organizations C.Custom as a Standard of Care D.Institutional Policies and Procedures

A.State Boards of Nursing????

Bandi lives in a cemetery under a tarp. He scavenges for food around the local supermarket. Today, the manager of the supermarket calls the police. Upon arrival, they find Bandi pushing multiple grocery carts, agitated, his fingers bleeding. He tells the police, "I have to scrub all the rust off these carts and all the carts in the world. Then I can be saved and go to heaven." The police bring Bandi to the community mental health center. Which one of the following applies to Bandi's rights as a citizen? A. His rights were violated. B. His rights were upheld. C. His rights were not considered. His rights were misinterpreted.

*B. His rights were upheld. He was deemed at risk for harm to self.

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)

Place the selected steps of the problem-solving process in the correct order. 1. Determine risks and benefits of each option. 2. Formulate goals to resolve the stressful situation. 3. Implement a second alternative. 4. Study the alternatives for dealing with the situation.

2, 4, 1, 3

The nurse is caring for a client who is having difficulty achieving satisfactory interpersonal relationships. Which level of Maslow's Hierarchy of needs would the nurse conclude the client is attempting to achieve? 1. Self-actualization 2. Self-esteem 3. Love and belonging 4. Safety and security

3. Love and belonging

A client is experiencing a psychotic episode. He is in good physical health but has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Which antipsychotic medication would be contraindicated for the client? 1. Haloperidol, because it is used only in elderly patients 2. Clozapine, because it is incompatible with desipramine 3. Risperidone, because it exacerbates symptoms of depression 4. Thioridazine, because of cross-sensitivity among phenothiazines

The nurse in the intensive care unit (ICU) is giving report to the nurse on the cardiac step-down unit. The nurse states, "The patient is a 48-year-old woman admitted 3 days ago for chest pain and a stent placement. Vital signs are stable, but I am worried about her stress level. She said she just moved here due to a job transfer and her husband stayed behind to sell the house. She told me they have a high insurance deductible and she is worried about the hospital bill." Which factor has the most significant influence on the client's health? A. Coping skills B. Existing conditions C. Individual vulnerability D. Perceived threat

B. Existing conditions

A patient presents in the emergency department immediately following a shooting incident in a school where she has been teaching. There is no evidence of physical injury, but she appears very hyperactive and talkative. Which are common initial biological responses to stress? Select all that apply. A. Constricted pupils B. Watery eyes C. Unusual food cravings D. Increased heart rate E. Increased respirations

B. Watery eyes D. Increased heart rate E. Increased respirations

Which part of the brain is most responsible for Eleanor's difficulty with delivering her lectures and remembering whether she has eaten? A.Brainstem B.Cerebrum C.Cerebellum D. Hypothalamus

B.Cerebrum

The nurse plans care for a newly hospitalized patient experiencing panic level anxiety after an automobile accident. The patient has no physical injuries. When selecting goals from the Nursing Outcomes Classification (NOC), the nurse will a. Select outcomes related to patient learning. b. Focus first on the long-term goals for the patient. c. Individualize outcomes based on the patient's needs. d. Confer with the patient about which outcomes the patient wants to achieve.

C Outcomes, as well as interventions, must always be individualized to the patient and should reflect the patient's multidimensional needs. While it is important to confer with the patient about which outcomes are desirable, a patient experiencing panic is unable to engage in decision making or learning activities.

EBP for nurses

Combination of clinical skill and use of clinically relevant research in the delivery of effective patient-centered care

Quality and Safety Education for Nurses (QSEN)

Provide patient-centered care Work in multidisciplinary teams Employ evidence-based practice (EBP) Apply quality improvement Utilize informatics

You discover that part of Mr. R's lack of appetite has been due to a urinary tract infection he has been unable to articulate. You ask his sister for more information about the home environment, ADLs, and medications. What type of information source is his sister? Primary Secondary Private Informed

Secondary

Which term on an assessment form is broader? Spirituality Religion Church/mosque/temple/synagogue None of the above.

Spirituality

Answer - b. Page 48. Olanzapine (Zyprexa) has metabolic side effects, particularly weight gain. Metabolic monitoring for all patients receiving atypicals is recommended, although risperidone (Risperdal) and quetiapine (Seroquel) have a lower weight gain. Ziprasidone (Geodon) and aripiprazole (Abilify) are considered weight neutral. Metabolic monitoring usually includes measurements of body weight, body mass index (BMI), waist circumference, fasting plasma glucose level, and fasting lipid profile.

Systematic measurement of body weight, body mass index (BMI), waist circumference, and glucose levels would be most important for a patient beginning a new prescription for which medication? a. Aripiprazole (Abilify) b. Olanzapine (Zyprexa) c. Ziprasidone (Geodon) d. Quetiapine (Seroquel)

Cerebrum

What part of the brain does this: Mental activities, Conscious sense of being, Emotional status, Memory, Control of skeletal muscles - movement, Language and communication

The effects of social processes on personality development

Which underlying concept should a nurse associate with interpersonal theory when assessing a client?

MAOI's

are a group of antidepressant drugs that illustrate the principle that drugs can have a desired and beneficial effect in the brain while at the same time having possible danger effects elsewhere in the body. These prevent the destruction of monamines by inhibiting the action of MAO.

The nurse admits a patient experiencing hallucinations and delusional thinking to an inpatient mental health unit. The plan of care will require which service occurs first? a. social history b. psychiatric history c. medical assessment d. psychological evaluation

c. medical assessment

Functional imaging techniques ( Positron emission tomography (PET) and Single photon emission computed tomography (SPECT) )

revela physiological activity in the brain.

Guidelines of involuntary admission

•Judicial determination •Administrative determination •Agency determination In addition, a specified number of physicians must certify that the person's mental health status justifies detention and treatment.

Use of seclusion and restraint is permitted only under the following circumstances

•Written order of a physician •Confined to specific, time-limited periods (e.g., 2 to 4 hours)

superego

"It is never right to take something that doesn't belong to you." According to Sigmund Freud, this statement reflects the predominance of the _______________ structure of the personality.

When Bandi was apprehended by the police, he was handcuffed and placed in the police car. Care was taken to ensure that he was not injured during the process. The officers told Bandi that he was being taken to a safe place. Upon arrival at the facility, Bandi was escorted to the emergency services area where he was assessed and admitted to the crisis stabilization unit. He was frightened, paranoid, and physically struggling with the mental health technicians, yelling, "I ain't finished my mission. The grocery carts are still covered in rust! I'm gonna die!" Upon entry to the crisis stabilization unit, Bandi was taken to the seclusion room and chemically restrained. What does this mean? A. He was medicated against his will. B. He was forced to swallow drugs. C. He was a victim of assault and battery. D. He was a victim of false imprisonment.

*A. He was medicated against his will.

Private insurance typically covers which one of the following? A. All illnesses regardless of duration B. All illnesses except mental illness C. All mental illnesses over a lifetime Mental illness with a lifetime cap

*D. Mental illness with a lifetime cap

Identify specific cautions you might incorporate into your medication teaching plan with regard to herbal treatments.

- Potential long-term effects •Nerve damage •Kidney damage •Liver damage - Possibility of adverse chemical reactions •With other substances •With conventional medications

planning for nursing care

-Principles to consider when planning care . Safe . Compatible and appropriate . Realistic and individualized . Evidence-based

three components of nursing diagnosis

-Problem (unmet need) -Etiology (probable cause) -Supporting data (signs and symptoms) Ex. Hopelessness(problem) related to abandonment(etiology/related factor). lack of involvement with family and friends, and inattention to self-care for self (support datas).

A client with depression and substance abuse has an interrupted sleep pattern. She demands that her psychiatrist prescribe her a sedative. What teaching would the nurse provide about the rationale for the use of nonpharmacological interventions instead? 1. "Sedative-hypnotics are potentially addictive and gradually lose their effectiveness as one builds up tolerance to them." 2. "Sedative-hypnotics work best in combination with other techniques." 3. "Sedative-hypnotics are not permitted for use in patients with substance abuse disorders." 4. "Sedative-hypnotics are not as effective as the antidepressant medications for treating sleep disturbances."

A client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which potentially fatal side effect will the nurse teach the client about? 1. Agranulocytosis 2. Akathisia 3. Dystonia 4. Akinesia

A psychiatrist prescribes a 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 Coke

In the treatment of anxiety disorders, benzodiazepines (such as Ativan and Xanax) are indicated for_________ use and have__________ abuse potential. 1. short-term; high 2. long-term; high 3. short-term; low 4. long-term; low

Joey, age 8 years, takes methylphenidate (Ritalin) for attention deficit/hyperactivity disorder. His mother complains to the nurse that Joey has a very poor appetite, and she struggles to help him gain weight. What teaching will the nurse provide? 1. Administer Joey's medication immediately after meals. 2. Administer Joey's medication at bedtime. 3. Skip a dose of the medication when Joey does not eat anything. 4. Assure Joey's mother that Joey will eat when he is hungry.

Which information suggests that caution is necessary in prescribing a benzodiazepine to an anxious client? 1. The client has a history of alcohol dependence. 2. The client has a history of diabetes mellitus. 3. The client has a history of schizophrenia. 4. The client has a history of hypertension.

Which client behavior noted by the nurse is indicative of using projection? 1. A client blaming his or her boss after getting fired from his or her job 2. A client who refuses to admit he or she has a problem with alcohol 3. A client yelling at a family member because of the traffic 4. A client making excuses for not being able to stop taking drugs

1. A client blaming his or her boss after getting fired from his or her job

Which are common responses that can be observed in a client with general adaptation syndrome? Select all that apply. 1. Alarm 2. Resistance 3. Exhaustion 4. Reflex pain response 5. Inflammatory response

1. Alarm 2. Resistance 3. Exhaustion

A client who developed an alcohol problem after the death of her baby tells the nurse, "No I do not have a drinking problem. I do not drink in excess; I can stop before I get to that point. That open container in the car was the only reason I got a DUI in the a couple of months ago." Which defense mechanism does the nurse suspect from the client's statement? 1. Denial 2. Projection 3. Introjection 4. Rationalization

1. Denial

The nurse is preparing a care plan for a client who is experiencing the second Kubler-Ross stage of grief. Which intervention in the care plan will help to reduce these symptoms in the client? 1. Secluding the client for some time 2. Enhancing the self-esteem of the client 3. Providing health education to the client 4. Teaching the client proper decision-making

1. Secluding the client for some time

The registered nurse is teaching a group of student nurses about the effects of psychotropic medications on neurotransmitters. Which statement made by the registered nurse needs correction? 1. "Increased sweating, insomnia, and tremors are the side effects associated with selective serotonin reuptake inhibitors." 2. "Chlorpromazine is useful in the treatment of intractable hiccoughs." 3. "Depression, decreased libido, and stress intolerance are the side effects associated with antipsychotic medications." 4. "Moclobemide interacts with tyramine and causes hypertensive crisis."

1. "Increased sweating, insomnia, and tremors are the side effects associated with selective serotonin reuptake inhibitors." Option 1: Selective serotonin reuptake inhibitors (SSRIs) are the potent inhibitors of serotonin reuptake. Sweating, insomnia, and tremors are the side effects associated with the blockade of norepinephrine reuptake. Therefore, these side effects are not associated with SSRIs as they do not block norepinephrine reuptake. Option 2: Chlorpromazine is an antipsychotic useful in the treatment of psychosis and intractable hiccoughs. Option 3: Prolactin hypersecretion is a side effect associated with antipsychotics. The behavioral symptoms associated with prolactin hypersecretion are depression, decreased libido, and stress intolerance. Option 4: Moclobemide is a monoamine oxidase (MAO) inhibitor. The reason for the hypertensive crisis with the MAO inhibitors is interaction of medication with tyramine.

Which neurotransmitter is decreased in clients with schizophrenia? 1. Glutamate 2. Norepinephrine 3. Dopamine 4. Serotonin

1. Glutamate Option 1: Glutamate and aspartate are decreased in clients with schizophrenia. Option 2: Norepinephrine is increased in clients with mania, anxiety states, and schizophrenia. Option 3: Dopamine is decreased in clients with Parkinson's disease and depression. Option 4: Serotonin is decreased in clients with depression.

Which neurotransmitter(s) might show decreased levels in a client with a diagnosis of schizophrenia? 1. Glutamate and aspartate 2. Norephinephrine 3. Dopamine 4. Serotonin

1. Glutamate and aspartate Option 1: Glutamate and aspartate exist in decreased levels in clients with schizophrenia. Option 2: Norepinephrine levels are increased in mania, anxiety states, and schizophrenia. Option 3: Dopamine levels are decreased in clients with Parkinson disease and also in clients with depression. Option 4: Serotonin levels are decreased in clients with depression.

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 monoamine oxidase inhibitors (MAOIs). Why can't they be added to what I am on now? Wouldn't adding one help?" Which is the appropriate nursing response? 1. "Electroconvulsive therapy is your best option at this point." 2. "Combined use can lead to a life-threatening condition called hypertensive crisis." 3. "There is no reason why an MAOI couldn't be added to your therapy." 4. "They can't be used together because their mechanisms of action are very different."

A client was recently admitted to the inpatient unit after a suicide attempt. He has been placed on a tricyclic antidepressant. In terms of medication, what steps should be taken to maintain the client's safety when he is discharged? 1. Provide a 6-month supply to ensure long-term compliance. 2. Provide a 1-week supply of medication, with refills authorized only after he visits his provider. 3. Encourage him to increase fluid intake to counteract the common side effect of diarrhea. 4. Educate him not to eat foods that contain tyramine.

A client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which signs and symptoms of a potentially fatal side effect will the nurse teach the client about? 1. Blurring vision and muscular weakness 2. Sore throat, fever, and malaise 3. Tremor, shuffling gait, and rigidity 4. Fine tremor, tinnitus, and nausea

A physician prescribes an additional medication for a client taking an antipsychotic agent. The medication is to be administered "prn for EPS." When will the nurse plan to give this medication? 1. When the client's white blood cell count falls below 3,000/mm3 2. When the client exhibits tremors and a shuffling gait 3. When the client complains of dry mouth 4. When the client experiences a seizure

When used in combination with anxiolytic medication, alcohol leads to _____________ effects, and caffeine leads to _______________ effects. 1. increased; increased 2. increased; decreased 3. decreased; decreased 4. decreased; increased

Which statement about the tricyclic group of antidepressant medications is accurate? 1. Strong or aged cheese should not be eaten while taking them. 2. Their full therapeutic potential may not be reached until 4 weeks. 3. They may cause hypomania or recent memory impairment. 4. They should not be given with antianxiety agents.

The RN is educating a nursing student about dopamine. Which statement made by the nursing student indicates a need for further education? 1. "People with Parkinson's disease experience a decrease in dopamine." 2. "Dopamine is a neurotransmitter that is released by the pituitary." 3. "Increased dopamine levels have been found in people with schizophrenia." 4. "Decreased dopamine levels are noted in people with depression."

2. "Dopamine is a neurotransmitter that is released by the pituitary." Option 1: People with Parkinson's disease present with a decrease in dopamine levels. Option 2: Dopamine is released by the hypothalamus. This statement indicates a need for further education. Option 3: People with schizophrenia are found to have increased dopamine levels. Option 4: People with depression do have a decrease in dopamine levels.

The hypothalamus is located just above the pituitary gland. Which of the following would be considered major functions of this region of the forebrain? 1. Integration of sensory input 2. Regulation of the pituitary gland 3. Regulation of visual interpretation 4. Blocking of minor sensations

2. Regulation of the pituitary gland Option 1: The thalamus integrates all sensory input. Option 2: The hypothalamus regulates the pituitary gland. Option 3: The thalamus regulates visual interpretation. Option 4: The thalamus is also involved in temporarily blocking minor sensations so that an individual can concentrate on one important event.

A client began taking lithium for the treatment of bipolar disorder approximately 1 month ago and asks why he has gained 12 lbs. since then. Which is the appropriate nursing response? 1. "I'm surprised you have gained; weight loss is the typical pattern when taking lithium." 2. "Your weight gain is more likely related to food intake than medication." 3. "Weight gain is a common, but troubling side effect. Let's talk about some strategies for safely improving your nutrition and exercise habits." 4. "There's not much you can do about the weight gain. It's better than being emotionally unstable, though."

An aging client with chronic schizophrenia takes a beta-adrenergic blocking agent (propranolol) for hypertension and an antipsychotic. Given the combined side effects of these drugs, what teaching should the nurse provide? 1. "Make sure you concentrate on taking slow, deep, cleansing breaths." 2. "Watch your diet and try to engage in some regular physical activity." 3. "Rise slowly when you change position from lying to sitting or sitting to standing." 4. "Wear sunscreen and try to avoid midday sun exposure."

Place Kubler-Ross' stages of feelings related to loss in the correct order. 1. Anger 2. Bargaining 3. Denial 4. Depression 5. Acceptance

3, 1, 2, 4, 5

Which task would a client with moderate anxiety need assistance from the nurse to complete? 1. Brushing his or her teeth 2. Feeding him- or herself 3. Putting together a puzzle 4. Folding the laundry

3. Putting together a puzzle Option 1: The client with moderate anxiety levels will be able to perform his or her own oral hygiene. Option 2: The client with severe anxiety may have difficulty completing simple tasks like feeding him- or herself. Option 3: The client with moderate anxiety will need assistance with problem solving, so the nurse may need to help with putting together a puzzle. Option 4: Folding laundry does not require problem solving so a client with moderate anxiety will be able to complete the task.

The nurse is caring for a client who has been raped. The client says, "I don't remember anything after I entered my apartment building." Which ego defense mechanism should the nurse conclude the client is exhibiting? 1. Intellectualization 2. Introjection 3. Repression 4. Sublimation

3. Repression

The hypothalamus is located just above the pituitary gland. Which is a major function of this region of the forebrain? 1. Integrates all sensory input 2. Responsible for emotional experience 3. Regulates the appetite 4. Temporarily blocks minor sensations

3. Regulates the appetite Option 1: The thalamus integrates all sensory input. Option 2: The limbic system is responsible for the experience of emotions. Option 3: The hypothalamus regulates the appetite. Option 4: The thalamus is involved in temporarily blocking minor sensations so that an individual can concentrate on one important event.

The physician orders a computed tomography scan for a client that is having problems with short-term memory loss. On which lobe of the cerebrum will the study focus? 1. Occipital 2. Frontal 3. Temporal 4. Parietal

3. Temporal Option 1: The primary functions of the occipital lobe are visual reception and interpretation. Option 2: The primary functions of the frontal lobe are voluntary body movement, including movements that permit speaking, as well as thinking, judgment formation, and expression of feelings. Option 3: The primary functions of the temporal lobe are hearing, short-term memory, sense of smell, and expression of emotions through connection with limbic system. Option 4: The primary functions of the parietal lobe are perception and interpretation of most sensory information (including touch, pain, taste, and body position).

The nurse is caring for a client who experienced a cerebral vascular accident (CVA) in the occipital lobe of the brain. Which deficit will the nurse find when doing an assessment? 1. Taste 2. Speech 3. Vision 4. Smell

3. Vision Option 1: Damage to the parietal lobe will lead to problems with taste. Option 2: Damage to the frontal lobe will lead to problems with speech. Option 3: Damage to the occipital lobe will lead to problems with vision. Option 4: Damage to the temporal lobe will lead to problems with smell.

A client takes a maintenance dosage of lithium carbonate for a bipolar disorder. She has come to the community health clinic, stating that she "has had the flu for over a week." She describes her symptoms as coughing, runny nose, chest congestion, fever, and gastrointestinal upset. Her temperature is 100.9°F. What situation does the nurse anticipate? 1. She has consumed some foods high in tyramine. 2. She has stopped taking her lithium carbonate. 3. She has probably developed a tolerance to the lithium carbonate. 4. The lithium carbonate may be producing symptoms of toxicity.

A client was admitted with major depression that was a single episode and moderate. During her stay, she was started on Prozac (fluoxetine) at 40 mg orally every day. The nurse's discharge teaching should include all of the following except: 1. Continue taking Prozac as prescribed. You will continue to see improvement over the next few weeks. 2. Make sure that you follow up with outpatient psychotherapy as you and the social worker have arranged. 3. You may be able to discontinue the medication within 6 months to 1 year, but only under a doctor's supervision. However, there is a chance of recurring episodes. 4. You should avoid foods with tyramine, including beer, beans, processed meats, and red wine.

A client was recently admitted to the inpatient unit after a suicide attempt and is prescribed a selective serotonin reuptake inhibitor (SSRI). The nurse teaches the client about serotonin syndrome. Which of the following is a symptom of serotonin syndrome? 1. Change in mental status 2. Myoclonus 3. Blood pressure lability 4. Priapism

A client with schizophrenia has recently begun a new medication, clozapine (Clozaril). Which blood cell counts would reveal a potentially fatal side effect of this medication? 1. WBCs, >3,000/mm3; granulocytes, >2,000/mm3 2. WBCs, <3,000/mm3; granulocytes, >2,000/mm3 3. WBCs, >3,000/mm3; granulocytes, <2,000/mm3 4. WBCs, <3,000/mm3; granulocytes, <2,000/mm3

Which medication does not require periodic blood-level monitoring? 1. Eskalith (lithium carbonate) 2. Depakote (valproic acid) 3. Clozaril (clozapine) 4. Paxil (paroxetine)

The nurse is managing a support group for clients who have lost spouses. Which client is demonstrating behaviors of acceptance? 1. A client who is very quiet and appears sad and depressed 2. A client who pleads with a higher power for help to get through the tough time 3. A client who is angry at friends who go out on dates with their spouses 4. A client who has found hobbies and interests with others

4. A client who has found hobbies and interests with others

Which biological response occurs at the initial stage of stress during "fight or flight" syndrome? 1. Lipogenesis 2. Constriction of pupils 3. Increase in intestinal motility 4. Increase in lacrimal secretions

4. Increase in lacrimal secretions

Which physiological activity occurs at sustained stress during the "fight or flight" syndrome? 1. Increased libido 2. Decreased metabolic rate 3. Decreased fluid retention 4. Increased gluconeogenesis

4. Increased gluconeogenesis

While assessing a client, the nurse learns that client has been diagnosed with anxiety in the past. The client also he or she is afraid of "going crazy." Which level of anxiety will the nurse expect to see when reviewing the client's previous history? 1. Mild 2. Moderate 3. Severe 4. Panic

4. Panic

A day shift nurse contacts a nurse scheduled for night shift at home and says, "Our unit is full and there are eight patients in the emergency department waiting for a bed." The night shift nurse replies, "Thanks for telling me. I am calling in sick." Which type of problem is evident by the night shift nurse's reply? a. Ethical problem of fidelity b. Legal problem of negligence c. Legal problem of an intentional tort d. Violation of the patients' right to treatment

A Fidelity is an ethical principle that involves maintaining loyalty and commitment to patients

The autistic phase

A 1-month-old infant is left alone for extended periods, has little physical stimulation, and is malnourished. Based on this infant's situation, in which phase of development, according to Mahler's theory, should a nurse expect to see a potential deficit?

Industry versus inferiority

A 10-year-old child wins the science fair competition and is chosen as a cheerleader for the basketball team. A nurse should recognize that this child is in the process of successfully accomplishing which stage of Erikson's developmental theory?

The symbiotic phase

A 9-month-old child screams every time his mother leaves and will not tolerate anyone else changing his diaper. The nurse should determine that, according to Mahler's developmental theory, this child's development was arrested at which phase?

The not me

A client has flashbacks of sexual abuse by her uncle. She did not have these memories until recently, when she became sexually active with her boyfriend. A nurse should identify this experience as which part of Sullivan's concept of the self-system?

Answer - a. Page 31 (Box 3-2). Rigid or disengaged boundaries are those in which the rules and roles are followed despite the consequences.

A distraught 8-year-old girl tells the nurse, "I had a horrible nightmare and was so scared. I tried to get in bed with my parents but they said, 'No.' I think I could have gone back to sleep if I had been with them." Which family dynamic is likely the basis of this child's comment? a. Boundaries in the family are rigid. b. The family has poor differentiation of roles. c. The girl is enmeshed in part of a family triangle. d. Generational boundaries in the family are diffuse.

Identifying oneself

A father of a 5-year-old demeans and curses his child for disobedience. In turn, when upset, the child uses swear words at kindergarten. A school nurse recognizes this behavior as unsuccessful completion of which stage of development, according to Peplau?

The id

A female complains that her husband only satisfies his sexual needs and never her needs. According to Freud, which personality structure should a nurse identify as predominantly driving the husband's actions?

Intimacy versus isolation

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?

Intimacy versus isolation

A married, 26-year-old client works as a schoolteacher. She and her husband have just had their first child. A nurse should recognize that this client is successfully accomplishing which stage of Erikson's developmental theory?

Answer - c. Pages 8-9. Stigma refers to the array of negative attitudes and beliefs regarding mental illness. Bias, prejudice, fear, and misinformation contribute to stigma.

A mentally ill gunman opens fire in a crowded movie theater, killing six people and injuring others. Which comment about this event by a member of the community most clearly shows the stigma of mental illness? a. "Gun control laws are inadequate in our country." b. "It's frightening to feel that it is not safe to go to a movie theater." c. "All these people with mental illness are violent and should be locked up." d. "These events happen because American families no longer go to church together."

Learning to delay satisfaction

A nurse observes a 3-year-old client willingly sharing candy with a sibling. According to Peplau, which psychological stage of development should the nurse determine that this child has completed?

Answer - b. Page 31. A therapeutic milieu provides a healthy social structure within an inpatient setting or structured outpatient clinic. Groups aim to help increase patients' self-esteem, decrease social isolation, encourage appropriate social behaviors, and educate patients in basic living skills, such as good hand washing.

A nurse plans a group meeting for adult patients in a therapeutic milieu. Which topic should the nurse include? a. Coping with grief and loss b. The importance of hand washing c. Strategies for money management d. Staffing shortages expected over the next 3 days

Answer - a. Page 14. Diagnoses classify disorders that people have, not the person. For this reason, it is important to avoid use of expressions such as "a schizophrenic" or "an alcoholic." The nurse has a responsibility to educate the coworker.

A nursing assistant says to the nurse, "The schizophrenic in room 226 has been rambling all day." When considering the nurse's responsibility to manage the ancillary staff, which response should the nurse provide? a. "It is more respectful to refer to the patient by name than by diagnosis." b. "Thank you for informing me about that. I will document the behavior." c. "It is not unusual for schizophrenics to do that. It's just part of their illness." d. "You have a difficult job. I'm glad you are so accepting of our patients' behaviors."

Answer - c. Page 48. Risperidone blocks α1- and H1 receptors. It can cause orthostatic hypotension and sedation, which can lead to falls.

A patient begins a new prescription for risperidone (Risperdal). Which intervention should the nurse include in the plan of care? a. Monitor intake and output daily. b. Educate patient about foods that contain tyramines. c. Assess sitting, standing, and lying blood pressure daily. d. Administer with food to reduce gastrointestinal irritation.

Answer - a. Page 37 (Figure 4-2). The cerebellum is critical in both motor and cognitive functions. Alterations in cerebello-thalamo-cortical circuits may manifest as disturbances of coordination, balance, and gait. Safety is the nurse's first concern.

A patient is diagnosed with an abscess in the cerebellum. Which nursing diagnosis has priority for the plan of care? a. Risk for falls related to loss of balance and equilibrium b. Unilateral neglect related to impairments to perception c. Impaired physical mobility related to spasticity and changes in muscle tone d. Risk for impaired cerebral tissue perfusion related to obstruction secondary to infection

Answer - d. Page 4. The patient's report suggests that depression is occurring. With the increased understanding of the biology of psychiatric illnesses, treatment approaches have evolved rapidly into more scientifically grounded methods, particularly psychopharmacology.

A patient reports to a primary care provider about sleeplessness, constant fatigue, and sadness. In our current health care climate, what is the most likely treatment approach that will be offered to the patient? a. Group therapy b. Individual psychotherapy c. Complementary therapy d. Psychopharmacological treatment

Answer - c. Page 45. At lower doses, trazodone loses its antidepressant action while retaining hypnotic effects through histamine receptor antagonism; therefore it is useful for insomnia. Fifty milligrams is a low dose. High doses of trazodone are required for the serotonergic action to relieve depression.

A patient tells the community mental health nurse, "I told my health care provider I was having trouble sleeping and he prescribed trazodone 50 mg every night. I read on the internet that drug is an antidepressant, but I'm not depressed. What should I do?" Which response by the nurse is correct? a. "I will help you contact your health care provider for clarification regarding this new prescription." b. "Insomnia and depression usually go hand-in-hand. If your depression is relieved, your sleep will improve." c. "In low doses, trazodone helps relieve insomnia. Higher doses are needed for antidepressant effects to occur." d. "Information on the internet is often misleading and incorrect. It's more important to trust the judgment of your health care provider."

Establishing a career, personal relationships, and societal connections

A physically healthy, 35-year-old, single client lives with his parents, who provide total financial support. According to Erikson's theory, which developmental task should a nurse assist the client to accomplish?

Which of the following were attributed to mental illness prior to the influence of Middle Eastern countries? Select all that apply. A. Supernatural Forces B. Medical conditions C. Disequilibrium of humors D. Personality E. Demons

A, C, E

A patient has been out of work 3 weeks with a major illness and anticipates another month of recovery. The patient tells the nurse, "I'm trying to keep up with my work email from home. They hired a new person in my department but the person has no experience." Select the nurse's therapeutic response. a. "It sounds like you're saying you are worried about your job security." b. "No one expects you to keep pace with your job while you're recovering." c. "Your employer is required to hold your job for you while you're on sick leave. "d. "Don't worry about your job right now. It's more important for you to recover."

A- "It sounds like you're saying you are worried about your job security." The correct response demonstrates the therapeutic technique of reflection.

A nurse prepares a patient in a rural community for an initial telehealth visit with the health care provider. Select the nurse's priority action. a. Ensure that the patient's rights to privacy are respected. b. Ask the patient, "How much do you know about the Internet?" c. Inform the patient, "This experience will be like appearing on television." d. Advise the patient, "You will be able to hear, but not see, your health care provider."

A- Ensure that the patient's rights to privacy are respected. Telehealth is a live interactive mechanism used to track clinical progress and provide access to people who otherwise might not receive good medical or psychosocial help. The nurse should accurately provide education about this mechanism as well as ensure the patient's rights to privacy.

An adult experiencing a recent exacerbation of ulcerative colitis tells the nurse, "I had an accident while I was at the grocery store. It was so embarrassing." Select the nurse's therapeutic response. a. "Most grocery stores have public restrooms available." b. "Tell me more about how you felt when that happened." c. "People usually have compassion about those types of events." d. "Your disease is now in remission so that is not likely to happen again."

A-" Most grocery stores have public restrooms available." The correct response encourages description and helps the patient to express feelings related to this experience.

A nurse is working with a client who has recently been under a great deal of stress. Which nursing recommendations would be most helpful to assist the client to cope with stress? Select all that apply. A. "Enjoy a pet." B. "Spend time with a loved one." C. "Listen to music." D. "Focus on the stressors." E. "Journal your feelings."

A. "Enjoy a pet." B. "Spend time with a loved one." C. "Listen to music." D. "Focus on the stressors."

A depressed client states, "I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again." Which response by the nurse is best? A. "Medications are one way to address chemical imbalances. Environmental and interpersonal factors can also have an impact on biological factors." B. "Biological factors are the sole cause of depression, so medications will improve your mood." C. "Environmental factors have been shown to exert the most influence in the development of depression." D. "Researchers have been unable to demonstrate a link between biology and genetics."

A. "Medications are one way to address chemical imbalances. Environmental and interpersonal factors can also have an impact on biological factors."

A mental health technician asks the nurse, "How do psychiatrists determine which diagnosis to give a patient?" Which is the nurse's best response? A. "Psychiatrists use criteria from the APA's Diagnostic and Statistical Manual of Mental Disorders." B. "Psychiatrists are required to follow hospital policy to diagnose mental disorders." C. "Psychiatrists make diagnoses based on the patient's behavior and other factors." D. "Psychiatrists use on of the 10 diagnostic labels from the American Medical Association."

A. "Psychiatrists use criteria from the APA's Diagnostic and Statistical Manual of Mental Disorders."

A nursing student is learning about the human limbic system. Which student statement demonstrates that teaching about the function of the limbic system has been effective? A. "The limbic system helps stabilize emotional behavior." B. "The limbic system functions to assist with symbolic thinking." C. "The limbic system aids in analytical thinking." "The limbic system helps modulate motor coordination."

A. "The limbic system helps stabilize emotional behavior."

A nurse is interviewing a distressed client who reports being fired after 15 years of loyal employment. Which of the following questions best assists the nurse to determine the client's appraisal of the situation? Select all that apply. A. "What resources have you used previously in stressful situations?" B. "Have you ever experienced a similar stressful situation?" C. "Who do you think is to blame for this situa- tion?" D. "Why do you think you were fired from your job?" E. "What skills do you possess that might lead to gainful employment?"

A. "What resources have you used previously in stressful situations?" B. "Have you ever experienced a similar stressful situation?" E. "What skills do you possess that might lead to gainful employment?"

Which situation contradicts the ethical principle of veracity? A. A nurse tricks a client into seclusion by asking the client to carry linen to the seclusion room. B. A nurse provides a client with outpatient resources to benefit recovery. C. A nurse treats all of the clients equally regardless of illness severity. D. A nurse refuses to give information to a physician who is not responsible for the client's care.

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

Meditation has been shown to be an effective stress management technique. Which nursing assessment indicates meditation has been effective? A. An achieved state of relaxation B. An achieved insight into one's feelings C. A demonstration of appropriate role behav- iors D. An enhanced ability to problem-solve

A. An achieved state of relaxation

The nurse is caring for a client admitted to the palliative care unit. The client's spouse has been at the client's bedside since the client was admitted. One week ago, the spouse began to visit 2 or 3 hours a day. The nurse understands the spouse is experiencing which of the following? A. Anticipatory grief B. Bereavement C. Depression D. Resolution

A. Anticipatory grief

When an individual's stress response is sustained over a long period, the nurse anticipates which physiological effect? A. Decreased resistance to disease B. Increased libido C. Decreased blood pressure D. Increased inflammatory response

A. Decreased resistance to disease

A new psychiatric nurse states, "This client's use of defense mechanisms should be eliminated." Which is a correct evaluation of the nurse's statement? A. Defense mechanisms are self-protective responses to stress and do not need to be eliminated B. Defense mechanisms are maladaptive attempts of the ego to manage anxiety and should always be eliminated C. Defense mechanisms are used by individuals with weak ego integrity and should not be eliminated D. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged

A. Defense mechanisms are self-protective responses to stress and do not need to be eliminated

A nurse is assessing a client who appears to be experiencing moderate anxiety during questioning. Which symptoms might the client demonstrate? Select all that apply. A. Fidgeting B. Laughing inappropriately C. Palpitations D. Nail biting E. Extremely limited attention span

A. Fidgeting B. Laughing inappropriately D. Nail biting

A. He was medicated against his will.

Most cultures label behavior as mental illness on the basis of which of the following criteria? A. Incomprehensibility and cultural relativity B. Strength of character and ethics C. Goal directedness and high energy D. Creativity and good coping skills

A. Incomprehensibility and cultural relativity

How is the DSM-5 useful in the practice of psychiatric nursing? Select all that apply. A. It informs the nurse of accurate and reliable medical diagnosis. B. It represents progress toward a more holistic view of mind-body. C. It provides a framework for interdisciplinary communication. D. It provides a template for nursing care plans. E. It provides a framework for communication with the client.

A. It informs the nurse of accurate and reliable medical diagnosis. B. It represents progress toward a more holistic view of mind-body. C. It provides a framework for interdisciplinary communication.

An operating room nurse asks a psychiatric nurse "How can you work with the mentally ill day in and day out?" The psychiatric nurse replies "It's just the right thing to do." The psychiatric nurse is operating from which ethical framework? A. Kantianism B. Christian Ethics C. Ethical Egoism D. Utilitarianism

A. Kantianism

When Bandi was apprehended by the police, he was handcuffed and placed in the police car. Care was taken to ensure that he was not injured during the process. The officers told Bandi that he was being taken to a safe place. Upon arrival at the facility, Bandi was escorted to the emergency services area where he was assessed and admitted to the crisis stabilization unit. He was frightened, paranoid, and physically struggling with the mental health technicians, yelling, "I ain't finished my mission. The grocery carts are still covered in rust! I'm gonna die!" Which one of the following applies to Bandi's treatment by the nurse manager? A. Legal protocol was followed. B. Ethical boundaries were crossed. C. The patient will probably file a lawsuit. D. Informed consent was not obtained.

A. Legal protocol was followed. (Typically, medication is considered if verbal interventions fail. Chemical interventions are usually considered less restrictive than mechanical.)

Which of the following are cultural aspects of mental illness? Select all that apply. A. Local or cultural norms define pathological behavior. B. The higher the social class the greater the recognition of mental illness behaviors. C. Psychiatrists typically see patients when the family can no longer deny the illness. D. The greater the cultural distance from the mainstream of society, the greater the likelihood that the illness will be treated with sensitivity and compassion.

A. Local or cultural norms define pathological behavior. B. The higher the social class the greater the recognition of mental illness behaviors. C. Psychiatrists typically see patients when the family can no longer deny the illness.

Which one of the following most correctly defines a psychiatrist? A. Medical physician B. Psychologist C. Mental health counselor Psychiatric practitioner

A. Medical physician

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 on 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

A client plans to have electroconvulsive therapy (ECT). Which member of the team is responsible for obtaining the client's informed consent? A. Physician B. Psychologist C. Case manager D. Registered nurse

A. Physician

A mental health nurse is speaking with parents who are concerned about their 15-year-old identical twins' responses to stress. One twin becomes anxious and irritable, while the other withdraws and cries. Which is the nurse's best response? A. Reactions to stress are relative rather than absolute. Individual responses to stress vary. B. It is abnormal for identical twins to react differently to similar stressors. C. Identical twins should share the same temperament and respond similarly to stress. D. Environmental influences to stress weigh more heavily than genetic influences.

A. Reactions to stress are relative rather than absolute. Individual responses to stress vary.

As a last resort, an agitated physically aggressive client placed in four point restraints. The client yells "I'll sue you for assault and battery." The unit manger determines that the nurses are protected under which condition? A. The client is voluntarily committed and poses a danger to others on the unit. B. The client is voluntarily committed and has a history of being a danger to others C. The client is involuntarily committed because of a history of violent behavior. D. The client is involuntarily committed and is refusing treatment.

A. The client is voluntarily committed and poses a danger to others on the unit.

Which is a responsibility that only an APRN-PMH can perform? A.Conducting psychotherapy B.Administering prescription medications C.Integrating biological and complementary therapies D.Adapting health instruction to a patient's specific needs

A.Conducting psychotherapy "Thconducts individual, couples, group, and family psychotherapy using evidence-based psychotherapeutic frameworks and nurse-patient e psychiatric nurse advanced practice registered nurse (APRN-PMH) therapeutic relationships."

As a nurse assesses a new client, the nurse makes sure the door remains open. Which type of communication factor is this action? A.Environmental B.Relationship C.Personal

A.Environmental

A nurse spends extra time with a client who has personality features similar to the nurse's estranged spouse. Which aspect of countertransference is most likely to result? A.Over-involvement B.Misuse of honesty C.Indifference D.Rescue

A.Over-involvement

20. _______________________ is the study of the biological foundations of cognitive, emotional, and behavioral processes.

ANS: Psychobiology Page: 15 Feedback: Psychobiology is the study of the biological foundations of cognitive, emotional, and behavioral processes. In recent years, a greater emphasis has been placed on the study of the organic basis for psychiatric illness.

1. A depressed client states, "I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again." Which nursing response is appropriate? 1. "Medications only address biological factors. Environmental and interpersonal factors must also be considered." 2. "Because biological factors are the sole cause of depression, medications will improve your mood." 3. "Environmental factors have been shown to exert the most influence in the development of depression." 4. "Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment)."

ANS: 1 Page: 15-19 Feedback 1 The nurse should advise the client that medications address biological factors, but there are other factors that affect mood. The nurse should educate the client on environmental and interpersonal factors that can lead to depression. 2 The statement is false because biological factors are not the sole cause of depression. 3 It is false that environmental factors have been shown to exert the most influence in the development of depression. 4 Researchers have demonstrated a link between nature and nurture.

17. A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness? 1. Schizophrenia spectrum disorder 2. Major depressive disorder 3. Body dysmorphic disorder 4. Parkinson's disease

ANS: 1 Page: 21, 24 Feedback 1 The nurse should expect that an increase in dopamine activity might play a significant role in the development of schizophrenia spectrum disorder. Functions of dopamine include regulation of emotions, coordination, and voluntary decision-making ability. Increased dopamine activity is also associated with mania. 2 Increased dopamine activity is not associated with major depressive disorder. 3 Increased dopamine activity is not associated with body dysmorphic disorder. 4 Increased dopamine activity is not associated with Parkinson's disease.

19. Which of the following symptoms should a nurse associate with the development of decreased levels of thyroid-stimulating hormone (TSH) in a newly admitted client? (Select all that apply.) 1. Depression 2. Fatigue 3. Increased libido 4. Mania 5. Hyperexcitability

ANS: 1, 2 Page: 28 Feedback 1. The nurse should associate depression with decreased levels of TSH. 2. The nurse should associate fatigue with decreased levels of TSH. 3. Decreased libido is associated with decreased levels of TSH. 4. Mania is not associated with decreased levels of TSH. 5. Hyperexcitability is not associated with decreased levels of TSH.

18. Which of the following information should a nurse include when explaining causes of anorexia nervosa to a client? (Select all that apply.) 1. There is a possible correlation between abnormal secretion of growth hormone and anorexia nervosa. 2. There is a possible correlation between antidiuretic hormone levels and anorexia nervosa. 3. There is a possible correlation between low levels of gonadotropin and anorexia nervosa. 4. There is a possible correlation between increased levels of prolactin and anorexia nervosa. 5. There is a possible correlation between altered levels of oxytocin and anorexia nervosa.

ANS: 1, 3 Page: 29 Feedback 1. The nurse should explain to the client that there is a possible correlation between anorexia nervosa and decreased levels of growth hormones. 2. There is no correlation between anorexia nervosa and antidiuretic hormone levels. 3. Research shows that there is possible correlation between low levels of gonadotropin and anorexia nervosa. 4. There is no correlation between anorexia nervosa and increased prolactin levels. 5. There is no correlation between anorexia nervosa and altered levels of oxytocin.

13. Which cerebral structure should a nursing instructor describe to students as the "emotional brain"? 1. The cerebellum 2. The limbic system 3. The cortex 4. The left temporal lobe

ANS: 2 Page: 19 Feedback 1 The cerebellum is concerned with involuntary movement, posture, and equilibrium. 2 The limbic system is often referred to as the "emotional brain." The limbic system is largely responsible for one's emotional state and is associated with feelings, sexuality, and social behavior. 3 The cortex is identified by numerous folds called gyri and sulci. 4 The left temporal lobe is concerned with auditory functions.

8. An instructor is teaching nursing students about neurotransmitters. Which best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron? 1. Regeneration 2. Reuptake 3. Recycling 4. Retransmission

ANS: 2 Page: 21 Feedback 1 Regeneration is incorrect wording to describe this process. 2 The nursing instructor should explain that the process by which neurotransmitters are released into the synaptic cleft and returned to the presynaptic neuron is termed reuptake. Reuptake is the process by which neurotransmitters are stored for reuse. 3 Recycling is incorrect wording to describe this process. 4 Retransmission is incorrect wording to describe this process.

10. 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? 1. Serotonin 2. Dopamine 3. Gamma-aminobutyric acid (GABA) 4. Histamine

ANS: 2 Page: 21 Feedback 1 Serotonin plays a role in sleep, libido, and appetite. 2 The nurse should expect that elevated dopamine levels might be an attributing factor to the client's current level of functioning. Dopamine functions include regulation of movements and coordination, emotions, and voluntary decision-making ability. 3 GABA prevents postsynaptic excitation. 4 Histamine mediates allergic and inflammatory reactions.

12. Which mental illness should a nurse identify as being associated with an increase in prolactin hormone level? 1. Major depressive episode 2. Schizophrenia 3. Anorexia nervosa 4. Alzheimer's disease

ANS: 2 Page: 29 Feedback 1 There is no known correlation between increased levels of prolactin and major depressive disorder. 2 Although the exact mechanism is unknown, there may be some correlation between increased levels of the hormone prolactin and schizophrenia. 3 There is no known correlation between increased levels of prolactin and anorexia nervosa. 4 There is no known correlation between increased levels of prolactin and Alzheimer's disease.

6. Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective? 1. Neuroendocrinology 2. Psychoneuroimmunology 3. Diagnostic technology 4. Neurophysiology

ANS: 2 Page: 31 Feedback 1 Neuroendocrinology is the study of the interaction between the nervous system and the endocrine system. 2 Psychoneuroimmunology is the branch of medicine that studies the effects of social and psychological factors on the functioning of the immune system. Studies of the biological response to stress hypothesize that individuals become more susceptible to physical illness following exposure to stressful stimuli. 3 Diagnostic testing assists in diagnosing. 4 Neurophysiology is the physiology of the nervous system.

7. A withdrawn client, diagnosed with schizophrenia, expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being responsible for this behavior? 1. Dendrites 2. Axons 3. Neurotransmitters 4. Synapses

ANS: 3 Page: 21 Feedback 1 Dendrites are processes that transmit impulses toward the cell body. 2 Axons transmit impulses away from the cell body. A junction between two neurons is a synapse. 3 The nurse should recognize that neurotransmitters play an essential function in the role of human emotion and behavior. Neurotransmitters are targeted and affected by many psychotropic medications. 4 A junction between two neurons is a synapse.

3. Which part of the nervous system should a 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

ANS: 3 Page: 21 Feedback 1 The peripheral nervous system does not play a major role during stressful situations. 2 The somatic nervous system is part of the peripheral nervous system. 3 The nurse should identify that the sympathetic nervous system plays a major role during stressful situations. The sympathetic nervous system prepares the body for the fight-or-flight response. 4 The parasympathetic nervous system is dominant when an individual is in a nonstressful state.

4. Which client statement reflects an understanding of circadian rhythms in psychopathology? 1. "When I dream about my mother's horrible train accident, I become hysterical." 2. "I get really irritable during my menstrual cycle." 3. "I'm a morning person. I get my best work done before noon." 4. "Every February, I tend to experience periods of sadness."

ANS: 3 Page: 29-30 Feedback 1 This statement does not indicate understanding of circadian rhythms. 2 The menstrual cycle is not affected by the circadian rhythm. 3 By stating, "I am a morning person," the client demonstrates an understanding that circadian rhythms may influence a variety of regulatory functions, including the sleep-wake cycle, regulation of body temperature, and patterns of activity. Most humans follow a 24-hour cycle that is largely affected by lightness and darkness. 4 Experiencing periods of sadness is not indicative of the circadian rhythm.

14. A nurse understands that the abnormal secretion of growth hormone may play a role in which illness? 1. Acute mania 2. Schizophrenia 3. Anorexia nervosa 4. Alzheimer's disease

ANS: 3 Page: 31 Feedback 1 There is no correlation between abnormal levels of growth hormone and acute mania. 2 There is no correlation between abnormal levels of growth hormone and schizophrenia. 3 The nurse should understand that research has found a correlation between abnormal levels of growth hormone and anorexia nervosa. The growth hormone is responsible for growth in children, as well as continued protein synthesis throughout life. 4 There is no correlation between abnormal levels of growth hormone and Alzheimer's Disease.

2. A client diagnosed with major depressive disorder asks, "What part of my brain controls my emotions?" Which nursing response is appropriate? 1. "The occipital lobe governs perceptions, judging them as positive or negative." 2. "The parietal lobe has been linked to depression." 3. "The medulla regulates key biological and psychological activities." 4. "The limbic system is largely responsible for one's emotional state."

ANS: 4 Page: 16 Feedback 1 The occipital lobes are the area of visual reception and interpretation. 2 Somatosensory input (touch, taste, temperature, etc.) occurs in the parietal lobes. 3 The medulla contains vital centers that regulate heart rate and reflexes. 4 The nurse should explain to the client that the limbic system is largely responsible for one's emotional state. This system is often called the "emotional brain" and is associated with feelings, sexuality, and social behavior.

16. A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness? 1. Bipolar disorder: mania 2. Schizophrenia spectrum disorder 3. Generalized anxiety disorder 4. Major depressive episode

ANS: 4 Page: 21 Feedback 1 A decrease in norepinephrine would not lead to mania. 2 A decrease in norepinephrine would not lead to schizophrenia. 3 A decrease in norepinephrine would not lead to generalized anxiety disorder. 4 The nurse should recognize that a decrease in norepinephrine level would play a significant role in the development of major depressive disorder. The functions of norepinephrine include the regulation of mood, cognition, perception, locomotion, cardiovascular functioning, and sleep and arousal.

9. A nurse concludes that a restless, agitated client is manifesting a fight-or-flight response. The nurse should associate this response with which neurotransmitter? 1. Acetylcholine 2. Dopamine 3. Serotonin 4. Norepinephrine

ANS: 4 Page: 21 Feedback 1 Acetylcholine functions include pain, arousal, and pain perception. 2 Dopamine functions include regulation of movement and coordination. 3 Serotonin plays a role in sleep, libido, and appetite. 4 The nurse should associate the neurotransmitter norepinephrine with the fight-or-flight response. Norepinephrine produces activity in the sympathetic postsynaptic nerve terminal and is associated with the regulation of mood, cognition, perception, locomotion, and sleep and arousal.

15. A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the production of these symptoms? 1. Abnormal levels of serotonin 2. Decreased levels of dopamine 3. Increased levels of norepinephrine 4. Decreased levels of acetylcholine

ANS: 4 Page: 31 Feedback 1 Abnormal levels of serotonin do not cause memory deficits and decreased motor functions. 2 Abnormal levels of dopamine do not cause memory deficits and decreased motor functions. 3 Abnormal levels of norepinephrine do not cause memory deficits and decreased motor functions. 4 The nurse should correlate memory deficits and decreased motor function with decreased levels of acetylcholine. Acetylcholine is a major chemical effector of the autonomic nervous system. Functions of acetylcholine include sleep regulation, pain perception, the modulation and coordination of movement, and memory.

11. A client's wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client's therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapist's recommendations? 1. The therapist is using an interpersonal approach. 2. The client has an alteration in neurotransmitters. 3. It is routine practice to remind clients about nutrition, exercise, and rest. 4. The client is susceptible to illness because of effects of stress on the immune system.

ANS: 4 Page: 31 Feedback 1 This approach is not proven by evidence-based research. 2 This rationale is not proven by evidence-based research. 3 Reminding clients about nutrition, exercise and rest is routine but is not proven by evidence-based research. 4 The therapist's recommendations should be based on the knowledge that the client has been exposed to stressful stimuli and is at an increased risk to develop illness because of the effects of stress on the immune system. The study of this branch of medicine is called psychoneuroimmunology.

5. Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community? 1. Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy 2. Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill 3. Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents 4. Studies in which monozygotic twins were raised together by mentally ill biological parents 5. All of the above

ANS: 5 Page: 31 Feedback 1 This type of adoption study can provide information on children with mentally ill biological parents who are raised by adoptive parents who are mentally healthy parents. 2 This type of adoption study can provide information on children with mentally healthy biological parents who are raised by adoptive parents who are mentally ill. 3 This type of adoption study provides important information on monozygotic twins from mentally ill parents who were raised separately by different adoptive parents. 4 This type of adoption study provides important information on monozygotic twins who were raised together by mentally ill biological parents. 5 The nurse should determine that all of the studies could possibly benefit the psychiatric community. The studies may reveal research findings relating genetic links to mental illness. Adoption studies allow comparisons to be made of the influences of the environment versus genetics.

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

ANS: D Cholinesterase inhibitors show some efficacy in slowing the rate of memory loss + even improving memory by inactivating the enzyme that breaks down acetylcholine, cholinesterase, leading to less destruction of acetylcholine and, therefore, a higher concentration at the synapse. The neurotransmitter γ-aminobutyric acid (GABA) (B) seems to play a role in modulating neuronal excitability + anxiety. Decreased levels are associated with anxiety. D2 (dopamine) + 5-HT2A (serotonin) antagonists (blockers) (C + D) are both antidepressants.

Surrogate

According to Peplau, a nurse who provides an abandoned child with parental guidance and praise following small accomplishments is serving which therapeutic role?

Answer - d. Page 12. Resiliency is the ability to recover from or adjust successfully to trauma or change. A successful transition through a crisis builds resiliency for the next difficult trial. In the correct response, the person demonstrates acceptance of the paralysis and a focus on his or her abilities and assets.

An adult experienced a spinal cord injury resulting in quadriplegia 3 years ago and now lives permanently in a skilled care facility. Which comment by this person best demonstrates resiliency? a. "I often pray for a miracle that will heal my paralysis so I will be whole again." b. "I don't know what I did to deserve this fate or whether I am tough enough to endure it." c. "My accident was a twist of fate. I suppose there are worse things than being paralyzed." d. "Being paralyzed has taken things from me but it hasn't kept me from being mentally involved in life."

Answer - c. Page 25 (Table 3-3). Rapid, unthinking responses are known as automatic thoughts. Often these automatic thoughts, or cognitive distortions, are irrational because people make false assumptions and misinterpretations. Once the negative patterns of thought that lead to negative emotions are identified, they can be replaced with rational thoughts.

An adult plans to attend an upcoming tenth high school reunion. This person says to the nurse, "I am embarrassed to go. I will not look as good as my classmates. I haven't been successful in my career." Which comment by the nurse addresses this cognitive distortion? a. "You look fine to me. Do think you will have fun at your reunion?" b. "Everyone ages. Other classmates have had more problems than you." c. "Do you think you are the only person who has aged and faced difficulties in life?" d. "I think you are doing well in the face of the numerous problems you have endured."

Which client should the nurse anticipate to be most receptive to psychiatric treatment? 1. A Jewish, female social worker. 2. A Baptist, homeless male. 3. A Catholic, black male. 4. A Protestant, Swedish business executive.

Ans: 1 Rationale: The nurse should anticipate that the client of Jewish culture would place a high importance on preventative health care and would consider mental health as equally important to physical health. 2. The homeless client may have difficulty accessing health care and may not place a high emphasis on mental health treatment. 3.Women are more likely to seek treatment for mental health problems than men. 4.This client is not typically as receptive to psychiatric treatment as the client of Jewish culture.

A psychiatric nurse intern states, "This client's use of defense mechanisms should be eliminated." Which is a correct evaluation of this nurse's statement? 1. Defense mechanisms can be appropriate responses to stress and need not be eliminated. 2. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated. 3. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not eliminated. 4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.

Ans: 1 Rationale: The nurse should determine that defense mechanisms can be appropriate during times of stress. 2. Defense mechanisms are not maladaptive attempts of the ego to manage anxiety. 3. Defense mechanisms are a normal part of coping with stress. They are not used by individuals with weak ego integrity. They should not be discouraged and eliminated. 4.Defense mechanisms are normal and are used by all individuals in some way during times of stress; they do not cause disintegration of the ego.

A nurse is assessing a set of 15-year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, and the other withdraws and cries. How should the nurse explain these different stress responses to the parents? 1. Reactions to stress are relative rather than absolute; individual responses to stress vary. 2. It is abnormal for identical twins to react differently to similar stressors. 3. Identical twins should share the same temperament and respond similarly to stress. 4. Environmental influences to stress weigh more heavily than genetic influences.

Ans: 1 Rationale: The nurse should explain to the parents that, although the twins have identical DNA, there are several other factors that affect reactions to stress.

A nurse is assessing a client who appears to be experiencing some anxiety during questioning. Which symptoms might the client demonstrate that would indicate anxiety? (Select all that apply.) 1. Fidgeting 2. Laughing inappropriately 3. Palpitations 4. Nail biting 5. Limited attention span

Ans: 1,2,4. Fidgeting, Laughing inappropriately, Nail biting indicates anxiety

At what point should the nurse determine that a client is at risk for developing a mental illness? 1. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria. 2. When maladaptive responses to stress are coupled with interference in daily functioning. 3. When a client communicates significant distress. 4. When a client uses defense mechanisms as ego protection.

Ans: 2 Rationale: The nurse should determine that the client is at risk for mental illness when responses to stress are maladaptive and interfere with daily functioning. The DSM-5 indicates that in order to be diagnosed with a mental illness, daily functioning must be significantly impaired.

Which nursing statement regarding the concept of psychosis is most accurate? 1. Individuals experiencing psychoses are aware that their behaviors are maladaptive. 2. Individuals experiencing psychoses experience little distress. 3. Individuals experiencing psychoses are aware of experiencing psychological problems. 4. Individuals experiencing psychoses are based in reality.

Ans: 2 The nurse should understand that the client with psychosis experiences little distress owing to his or her lack of awareness of reality.

Which nursing statement about the concept of neurosis is most accurate? 1. An individual experiencing neurosis is unaware that he or she is experiencing distress. 2. An individual experiencing neurosis feels helpless to change his or her situation. 3. An individual experiencing neurosis is aware of the psychological causes of his or her behavior. 4. An individual experiencing neurosis has a loss of contact with reality.

Ans: 2. The client feels helpless to change his or her situation. Rationale: 1. The client is aware that he or she is experiencing distress. 3. The client is unaware of the psychological causes of the distress. 4. The client experiences no loss of contact with reality.

According to Maslow's hierarchy of needs, which situation on an inpatient psychiatric unit would require priority intervention by a nurse? 1. A client rudely complaining about limited visiting hours 2. A client exhibiting aggressive behavior toward another client 3. A client stating that no one cares 4. A client verbalizing feelings of failure

Ans: 2. The nurse should immediately intervene when a client exhibits aggressive behavior toward another client. Safety and security are considered lower-level needs according to Maslow's hierarchy of needs and must be fulfilled before other higher-level needs can be met.

During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, "I'm here for my heart, not my head problems." Which is the nurse's best response? 1. "It is just a routine part of our assessment. All clients are asked these same questions." 2. "Why are you concerned about these types of questions?" 3. "Psychological factors, like excessive stress, have been found to affect medical conditions." 4. "We can skip these questions, if you like. It isn't imperative that we complete this section."

Ans: 3 Rationale: The nurse should attempt to educate the client on the negative effects of excessive stress on medical conditions.

How would a nurse best complete the new DSM-5 definition of a mental disorder? "A health condition characterized by significant dysfunction in an individual's cognitions, or behaviors that reflect a disturbance in ..." which of the following? 1. Psychosocial, biological, or developmental process underlying mental functioning 2. Psychological, cognitive, or developmental process underlying mental functioning 3. Psychological, biological, or developmental process underlying mental functioning 4. Psychological, biological, or psychosocial process underlying mental functioning

Ans: 3. The new DSM-5 definition of a mental disorder is "A health condition characterized by significant dysfunction in an individual's cognitions, or behaviors that reflect a disturbance in the psychological, biological, or developmental process underlying mental functioning."

Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife should indicate to a nurse that the client is in the acceptance stage of grief? 1. "If only we could have tried again, things might have worked out." 2. "I am so mad that the children and I had to put up with him as long as we did." 3. "Yes, it was a difficult relationship, but I think I have learned from the experience." 4. "I still don't have any appetite and continue to lose weight."

Ans: 3. The nurse should evaluate that the client is in the acceptance stage of grief because during this stage of the grief process, the client would be able to focus on the reality of the loss and its meaning in relation to life. Rationale: 1. This statement indicates denial. 2. This statement indicates anger. 4. This statement indicates prolonged grieving.

A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defense mechanism? 1. Displacement 2. Projection 3. Reaction formation 4. Sublimation

Ans: 3. The nurse should identify that the boy is using reaction formation as a defense mechanism. Reaction formation is the attempt to prevent undesirable thoughts from being expressed by expressing opposite thoughts or behaviors. 1. Displacement refers to transferring feelings from one target to another. 2.Projection refers to the attribution of unacceptable feelings or behaviors to another person. 4.Sublimation refers to channeling unacceptable drives or impulses into more constructive, acceptable activities.

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? 1. Maintaining a long-term, faithful, intimate relationship 2. Achieving a sense of self-confidence 3. Possessing a feeling of self-fulfillment and realizing full potential 4. Developing a sense of purpose and the ability to direct activities

Ans: 3. The nurse should identify that the client who possesses a feeling of self-fulfillment and realizes his or her full potential has achieved self-actualization, the highest level on Maslow's hierarchy of needs.

A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client's behaviors? 1. The client's behaviors demonstrate mental illness in the form of depression. 2. The client's behaviors are extensive, which indicates the presence of mental illness. 3. The client's behaviors are not congruent with cultural norms. 4. The client's behaviors demonstrate no functional impairment, indicating no mental illness.

Ans: 4 Rationale: The nurse should assess that the client's daily functioning is not impaired. The client who experiences feelings of sadness after the loss of a pet is responding within normal expectations.

When under stress, a client routinely uses alcohol to excess. Finding her drunk, her husband yells at the client about her chronic alcohol abuse. Which action alerts the nurse to the client's use of the defense mechanism of denial? 1. The client hides liquor bottles in a closet. 2. The client yells at her son for slouching in his chair. 3. The client burns dinner on purpose. 4. The client says to the spouse, "I don't drink too much!"

Ans: 4. The client's statement "I don't drink too much!" alerts the nurse to the use of the defense mechanism of denial. The client is refusing to acknowledge the existence of a real situation and the feelings associated with it.

A patient asks the psychiatric mental health registered nurse, "I'm having so much anxiety. I think hypnosis would help me. Will you do that for me?" When determining a response, which factor should the nurse consider?a. The patient's current medication regime b. State regulations regarding scope of practice c. The patient's level of participation within the therapeutic milieu d. The plan of care the multidisciplinary team has developed for the patient

B Hypnosis is not within the scope of practice of a staff level registered nurse. The state nurse practice act details regulations regarding scope of practice. Hypnosis is an advanced practice intervention.

On an inpatient unit, one patient assaults another patient resulting in a small laceration. Considering the patients' right to confidentiality, how will the nurse effectively document this event?a. Ensure unit safety by documenting the hostile and combative characteristics of the assaulting patient. b. Document in each patient's medical record the events and actions taken, using initials of other patients involved. c. Document in both patients' medical records that an occurrence (incident) report was prepared according to agency policy. d. Verbally report the events to other team members and minimize written documentation in order to reduce potential legal consequences.

B It is important to document the events and actions taken in both patients' records; however, confidentiality must be maintained. Using the initials of patients involved is one way to ensure that confidentiality is maintained.

A neighbor telephones the nurse daily, giving lengthy details about multiple somatic complaints and relationship problems. Which limit-setting strategy should the nurse employ? a. Suggest the neighbor call other people in the community. b. Say to the neighbor, "I can talk to you for 15 minutes twice a week." c. Use the telephone's caller identification to screen calls from the neighbor. d. Tell the neighbor, "You should discuss these concerns with your personal physician rather than me."

B- Say to the neighbor, "I can talk to you for 15 minutes twice a week." The nurse has a responsibility for self-care and must set limits on the neighbor's intrusive calls. Specifying the frequency and time allotment for calls shows compassion for the neighbor while preventing infringement on the nurse's personal life.

The nurse recognizes which principle underlies effective patient teaching? A. Moderate to severe anxiety increases patient learning B. Mild anxiety enhances patient learning C. Panic-level anxiety improves nurses' teaching D. Severe anxiety intensifies concentration and enhances attention

B. Mild anxiety enhances patient learning

Which nursing statement about the concept of neuroses is most accurate? A. "An individual experiencing neurosis is unaware that he or she is experiencing distress." B. "An individual experiencing neurosis feels helpless to change his or her situation." C. "An individual experiencing neurosis is aware of psychological causes of his or her behavior." D. "An individual experiencing neurosis has a loss of contact with reality."

B. "An individual experiencing neurosis feels helpless to change his or her situation."

Teaching regarding the concepts of mental health and mental illness is effective when the student nurse states which of the following? A. "The concepts are rigid and based in religious beliefs" B. "The concepts are multidimensional and culturally defined" C. "The concepts are universal and unchanging" D. "The concepts are fixed and unidimensional"

B. "The concepts are multidimensional and culturally defined"

Which statement reflects a student nurse's accurate understanding of the concepts of mental health and mental illness? A. "The concepts are unidimensional and fixed." B. "The concepts are multidimensional and culturally defined." C. "The concepts are rigid and religiously based." D. "The concepts are universal and unchanging."

B. "The concepts are multidimensional and culturally defined."

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

A nurse is providing 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. Identification of support systems

B. Awareness of factors creating stress

Which indicates to the nurse a client is at risk for developing a mental disorder? A. Expresses thoughts, feelings, and behaviors included amond Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria B. Demonstrates impaired daily functioning and maladaptive responses to stress C. Communicates significant distress that has not interfered with important activities D. Employs various defense mechanisms to protect the ego from anxiety

B. Demonstrates impaired daily functioning and maladaptive responses to stress

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

B. Dopamine

Extrapyramidal side effects are the result of which one of the following? A. Too much serotonin B. Dopamine blocking C. Too little serotonin D. Too few receptors

B. Dopamine blocking

Which of the following believed mental illness was curable? A. Benjamin Rush B. Dorothea Dix C. Florence Nightingale D. Linda Richards

B. Dorothea Dix

JS continues to argue with staff. He is not aggressive, but refuses all treatment. Legal and clients' rights are suspended when a client is hospitalized involuntarily. A.True B.False C.Depends on the state D.Depends on the physician assessment

B. False Involuntary admission requires that the client retain freedom from unreasonable bodily restraints, the right to informed consent, and the right to refuse medications, including psychotropic or antipsychotic medications. Other rights are preserved as well.

Which disorder does the nurse recognize as a disorder in the DSM-5? A. Morbid obesity B. Generalized anxiety disorder C. Essential hypertension D. Bereavement

B. Generalized anxiety disorder

B. His rights were upheld. He was deemed at risk for harm to self.

The nursing instructor described cerebral structures and the "emotional brain" to students. Teaching is effective if the students identify which brain structure? A. Cerebellum B. Limbic system C. Cortex D. Left temporal lobe

B. Limbic system

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 Providing psychotherapy

B. Maintaining a therapeutic milieu

A 32-year-old woman is speaking to the office nurse at an initial visit. The nurse asked, "What brings you in today?" The woman replied, "I have been having headaches three to four times a week for the past month or so. I'm not sleeping well and feel tired most of the time. I work 60 hours per week and am going through a divorce." The nurse determines the client's symptoms represent which of the following? A. Adaptive coping B. Maladaptive coping C. Problem-solving D. Self-awareness

B. Maladaptive coping

A nurse is educating a patient about the difference between mental health and mental illness. Which statement indicates teaching was effective? A. Mental health is the absence of any stressors. B. Mental health is successful adaptation to stressors in the internal and external environment. C. Mental health is incongruence between thoughts, feelings, and behavior D. Mental health is a diagnostic category in the DSM-5.

B. Mental health is successful adaptation to stressors in the internal and external environment.

A nurse was the case manager for a client with serious mental illness for 6 years. The client died by suicide 1 week ago. Today, the client's spouse asks, "I always wondered if my spouse was a victim of sexual abuse in childhood. What can you tell me about that?"Can the nurse disclose information to the surviving spouse? A.Yes B.No C.It depends on state law D.It depends on how damaging the physician feels this would be to all concerned.

B. No A person's reputation can be damaged even after death. Therefore, it is important that nurses not divulge information after a person's death that could not be legally shared before the death.

The school nurse is assessing a female high school student who is distraught because her parents can't afford horseback riding lessons. The nurse recognizes the student's perception is that the problem is: A. Endangering her well-being. B. Personally relevant. C. Based on immaturity. D. Exceeds her capacity to cope.

B. Personally relevant.

A student confides in the school nurse that he is "stressed out" about deciding whether to go to college or work to provide income the family needs. Which coping strategy is the nurse's best recommendation? A. Meditation B. Problem-solving training C. Relaxation D. Journaling

B. Problem-solving training

A teenage boy is attracted to a female teacher. Without objective evidence, a school nurse overhears the boy state, "I know she wants me." This statement reflects which defense mechanism? A. Displacement B. Projection C. Rationalization D. Sublimation

B. Projection

Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective? A. Neuroendocrinology B. Psychoneuroimmunology C. Diagnostic technology D. Neurophysiology

B. Psychoneuroimmunology

The nurse is interviewing a client with a history of excessive drinking and multiple arrests for impaired driving. The client states, "I work hard to provide for my family. I don't see why I can't drink to relax." The nurse recognizes the client is using which defense mechanism? A. Projection B. Rationalization C. Regression D. Sublimation

B. Rationalization

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. Refusing to give any information to the caller by hanging up B. Refusing to give any information to the caller, citing rules of confidentiality C. Affirming that the person has been seen at the facility but providing no further information D. Suggesting that the caller speak to the client's therapist

B. Refusing to give any information to the caller, citing rules of confidentiality

A client is brought to the emergency department and diagnosed with a panic level of anxiety. What biological system domination would be responsible for this diagnosis? A. Parasympathetic division of the autonomic nervous system B. Sympathetic division of the autonomic nervous system C. The cerebral cortex D. The cerebellum

B. Sympathetic division of the autonomic nervous system

Without authorization, a nurse administers an extra dose of narcotic tranquilizer to an agitated client. The nurse's coworker observes this action but does nothing for fear of repercussion. What is the ethical interpretation of the coworker's lack of involvement? A. Taking no action is acceptable, because the coworker is only a bystander. B. Taking no action is still considered an action by the coworker. C. Taking no action releases the coworker from ethical responsibility. D. Taking no action is advised when potential adverse consequences are foreseen.

B. Taking no action is still considered an action by the coworker.

Becky tells you,"I have something secret to tell you, but you can't tell anyone else." The nurse agrees. What is the likely consequence of the nurse's action? A.Healthy feelings of sympathy by the nurse toward the client. B.Blurred boundaries in the nurse-client relationship. C.Improved rapport between the nurse and client. D.Enhanced trust between the nurse and client.

B.Blurred boundaries in the nurse-client relationship.

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 C.Transference Value teaching

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

Fundamental goal od psych nursing

Balancing the rights of the individual and the rights of society at large

Hypothalamus

Basic drives and link between thought and emotion and function of internal organs

implementation for nursing care

Basic interventions -Coordination of care -Health teaching and health promotion -Milieu therapy -Pharmacological, biological, and integrative therapies Advanced practice interventions -Prescriptive authority and treatment -Psychotherapy -Consultation

A nurse assesses a new patient whose chief concern is "daily crying spells." Which comment from the patient would prompt the nurse to suspect a medical reason is causing the problem rather than depression? a. "I usually drink two or three cups of coffee in the morning. "b. "I often have headaches, especially when the pollen count is high." c. "Years ago I had thyroid problems but they cleared up and I stopped the medicine." d. "I recently had three moles removed because my doctor thought they were suspicious."

C The patient's thyroid problems may have reemerged and can mimic depression.

In which nurse-patient interaction would it be appropriate for the nurse to consider using touch? a. Comforting a tearful patient of Japanese heritage b. Counseling a child who was physically abused by a parent c. Welcoming a person of Hispanic heritage to a new group session d. Interacting with a Native American who has a hearing impairment

C Welcoming a person of Hispanic heritage to a new group session Therapeutic use of touch is a basic aspect of the nurse-patient relationship and often perceived as a gesture of warmth and friendship, but the response to touch is culturally defined. Many Hispanic Americans are accustomed to frequent physical contact and perceive it in a positive way.

A nurse participating in a community health fair interviews an adult who has had no interaction with a health care professional for more than 10 years. The adult says, "I like to keep to myself. Crowds make me nervous." Which action should the nurse employ? a. Refer the adult for a full health assessment. b. Explore the adult's family and social relationships. c. Ask the adult, "How do you feel about the quality of your life? "d. Explain to the adult, "We can help you feel better about yourself."

C- Ask the adult, "How do you feel about the quality of your life?" It's important for the nurse to continue to assess the adult, respect the adult's individuality, and delay judgment regarding whether the person is experiencing illness. Avoiding crowds may be an effective coping technique for this patient.

A group of nurses privately discuss patients under their care. Which nurse's comment indicates the need for clinical supervision regarding countertransference? a. "My patient is always asking my permission to do something, just like a child." b. "When our unit is understaffed, it seems like we have more incidents of disruptive behavior. "c. "My patient tries to tell me what to do all the time. I got a divorce because my spouse used to do that." d. "Our patients have had so many traumatic life experiences. I find myself feeling sympathetic sometimes."

C- "My patient tries to tell me what to do all the time. I got a divorce because my spouse used to do that." Countertransference refers to the tendency of the nurse to displace onto the patient feelings related to people in his or her past. Frequently, the patient's transference to the nurse evokes countertransference feelings in the nurse.

Which behavior from Noah would be considered a double- bind message? A.He winks at you and says, "Do you date 15-year-old guys?" B.He puts his head in his hands, shakes it, and snaps, "I don't want to do this. Just get me out of here!" C.He sneers at you and almost purrs as he says, "Oh yes. I will tell you anything you want to know. Of course. Of course I will." D.He cries and shakes, jiggling one leg, as he says softly, "Please. Let's just not talk about Dad, okay? God, please?"

C. He sneers at you and almost purrs as he says, "Oh yes. I will tell you anything you want to know. Of course. Of course I will."

A client hates her mother because of childhood neglect. The nurse determines which client statement represents the use of the defense mechanism of reaction formation? A. "I don't like to talk about my relationship with my mother." B. "My mother hates me." C. "I have a very wonderful mother whom I love very much." D. "My mom always loved my sister more than she loved me."

C. "I have a very wonderful mother whom I love very much."

Which client statement indicates the nurse's teaching about the effect of circadian rhythms is effective? A. "When I dream about my mother's horrible train accident, I become hysterical." B. "I get really irritable during my menstrual cycle." C. "I'm a morning person, so I get my best work done in the a.m." D. "Every February, I tend to experience periods of sadness."

C. "I'm a morning person, so I get my best work done in the a.m."

During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, "I'm here for my heart, not my head problems." Which is the nurse's best response? A. "It's just a routine part of our assessment. All clients are asked these same questions." B. "Why are you concerned about these types of questions?" C. "Psychological factors, like excessive stress, have been found to affect medical conditions." D. "We can skip these questions, if you like. It isn't imperative that we complete this section."

C. "Psychological factors, like excessive stress, have been found to affect medical conditions."

Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife should indicate to a nurse that the client is in the acceptance stage of grief? A. "If only we could have tried again, things might have worked out." B. "I am so mad that the children and I had to put up with him as long as we did." C. "Yes, it was a difficult relationship, but I think I have learned from the experience." D. "I still don't have any appetite and continue to lose weight."

C. "Yes, it was a difficult relationship, but I think I have learned from the experience."

The nursing staff is discussing the concept of competency. Which information about competency should a nurse recognize as true? A. Competency is determined with a client's compliance with treatment. B. Competency is a medical determination made by the client's physician. C. A competent client has the ability to make reasonable judgments and decisions. D. Refusal of medication can initiate an incompetency hearing leading to forced medications.

C. A competent client has the ability to make reasonable judgments and decisions.

The mental health nurse is conducting an intake interview with a couple seeking marital counseling. The nurse recognizes the husband is using the ego defense mechanism of projection when he exhibits which of the following? A. Stamps his feet and demands his wife honor her vows B. Ignores his wife's continues absence from the home C. Accuses his wife of infidelity and betrayal D. Takes out his frustration by verbally abusing his coworkers

C. Accuses his wife of infidelity and betrayal

Which individual with mental illness may need involuntary hospitalization? A. A person with alcoholism who has been sober for 6 months but begins drinking again B. An individual with schizophrenia who stops taking prescribed antipsychotic drugs C. An individual with bipolar disorder, manic phase, who has not eaten in 4 days D. Someone who repeatedly phones a national TV broadcasting service with news tips

C. An individual with bipolar disorder, manic phase, who has not eaten in 4 days

A supervisor openly disagrees with an employee's suggestions during a staff meeting. The employee's behavior represents the defense mechanism of displacement when he does which of the following actions? A. Assertively confronts the supervisor B. Abruptly leaves the staff meeting C. Angrily criticizes a coworker D. Takes the supervisor to lunch

C. Angrily criticizes a coworker

An unemployed college graduate confides in the clinic nurse that she is experiencing severe anxiety over not finding a teaching position and that she is having difficulty with independent problem-solving. Which nursing intervention is best? A. Encourage her to use other coping mecha- nisms. B. Complete the problem-solving process for her. C. Assist her with the problem-solving process. D. Encourage her to keep a daily journal of feelings.

C. Assist her with the problem-solving process.

Which of the following are included in Jaboda's indicators of mental health? Select all that apply. A. Acceptance B. Creativity C. Environmental mastery D. Fulfillment E. Integration

C. Environmental mastery E. Integration

A nursing student comes down with a sinus infection toward the end of every semester. Which stage of stress is the student most likely experiencing when this occurs? A. Alarm reaction B. Resistance C. Exhaustion D. Fight or flight

C. Exhaustion

A client has experienced the death of a close family member and at the same time becomes unemployed. The client's 6-month score on the Recent Life Changes Questionnaire is 110. The nurse: A. Understands the client is at risk for significant stress-related illness. B. Determines the client is not at risk for significant stress-related illness. C. Needs further assessment of the client's coping skills to determine susceptibility to stress-related illness. D. Recognizes the client may view the losses as challenges and perceive them as opportunities.

C. Needs further assessment of the client's coping skills to determine susceptibility to stress-related illness.

A client diagnosed with schizophrenia expresses little emotion and refuses to attend group therapy. The nurse recognizes the client's behavior is influenced by which component of the nervous system? A. Dendrites B. Axons C. Neurotransmitters D. Synapses

C. Neurotransmitters

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

A geriatric client is confused and wandering in and out of every door. Which scenario reflects the least restrictive alternative for this client? A. The client is placed in seclusion. B. The client is placed in soft Posey restraints. C. The client is monitored by an ankle bracelet. D. The client is placed in a geriatric chair with tray.

C. The client is monitored by an ankle bracelet.

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 D.Positive reinforcement

C.Countertransference: Tendency of the nurse to displace feelings related to people in his or her past onto a patient

You are about to initiate your first contact with Becky. Which is the most suitable goal in establishing the therapeutic relationship? A.Establish friendship and a sense of fun B.Ensure that mutual needs will be met C.Establish clear boundaries while identifying patient needs D.Ensure two-way communication to give or ask for help

C.Establish clear boundaries while identifying patient needs

A patient has been disruptive to the therapeutic milieu for two days. A certified nursing assistant says to the nurse, "We need to seclude this patient because this behavior is upsetting everyone on the unit." Considering patients' rights, the nurse should respond, a. "Seclusion is not part of this patient's plan of care." b. "Let's think of some new ways to help this patient be less disruptive." c. "Thank you for that suggestion. I will discuss it with the health care provider." d. "Disruptive behavior is expected with mental illness. We must respond therapeutically."

C.Pages 65-66. The scenario offers no indication that the patient is dangerous or out of control; therefore less restrictive interventions should be employed. The nurse has a responsibility to provide guidance to the certified nursing assistant (CNA).

We know that Eleanor has come to the clinic for help with sleep. Which function of the brain controls this? Homeostasis ANS regulation Circadian rhythm Impulse conduction

Circadian rhythm

Answer - b. Page 24 (Figure 3-2). Maslow's hierarchy of needs are placed conceptually on a pyramid, with the most basic and important needs on the lower level. The higher levels, the more distinctly human needs, occupy the top sections of the pyramid. When lower-level needs are met, higher-level needs are able to emerge. Self-actualization and esthetics are the highest-level needs.

Considering Maslow's pyramid, which comment indicates an individual is motivated by the highest level of need? a. "Even though I'm 40 years old, I have returned to college so I can get a better job." b. "I help my community by volunteering at a thrift shop that raises money for the poor." c. "I recently applied for public assistance in order to feed my family, but I hope it's not forever." d. "My children tell me I'm a good parent. I feel happy being part of a family that

A nurse's sibling happily says, "I want to introduce you to my fiancé. We're getting married in six months." The nurse has encountered the fiancé in a clinical setting and is aware of the fiancé's diagnosis of schizophrenia. What is the nurse's best response? a. In private, tell the sibling about the fiancé's diagnosis. b. Encourage the sibling to postpone the wedding for at least a year. c. Ask the fiancé, "Have you told my sibling about your mental illness?" d. Say to the sibling and fiancé, "I hope you will be very happy together."

D Page 66. Despite personal misgivings, the nurse must maintain the fiancé's confidentiality.

In a staff meeting at an inpatient mental health facility for persons, the administrator announces that psychiatric technicians will now be supervised by the milieu director rather than by nurses. What is the nurse's best action? a. Confer with colleagues about their opinions regarding the proposed change. b. Volunteer to participate on a committee charged with defining job responsibilities of unlicensed assistive personnel. c. Ask the administrator to delay implementation of this change until the decision can be reviewed by an interdisciplinary team. d. Advise the administrator of regulations in the state nurse practice act regarding supervision of unlicensed assistive personnel.

D Institutional policies and practices do not absolve an individual nurse of responsibility to practice on the basis of professional standards of nursing care. State nurse practice acts specify that unlicensed assistive personnel (UAP) work under a nurse's supervision.

A colleague tells the nurse, "I have not been able to sleep for the past three days. I feel like a robot." What is the nurse's best action? a. Direct the colleague to leave the facility immediately. b. Observe the colleague closely for evidence of impaired practice. c. Offer to administer medications to patients assigned to the colleague. d. Confer with the supervisor about the nurse's ability to safely deliver care.

D Sleep deprivation causes impaired practice, which jeopardizes patient safety. The colleague's comments indicate that impairment is likely. The nurse should confer with the supervisor to determine the appropriate action.

A 55-year-old lives 100 miles from her parents and mother-in-law. In the past year, her father had back surgery, her mother broke her hip, and her mother-in-law had a cardiac event. Which nursing diagnosis is most applicable to the 55-year-old? a. Risk for complicated grieving related to impending deaths of parents b. Risk for injury related to frequent long drives to care for aging parents c. Risk for chronic low self-esteem related to overwhelming responsibilities d. Risk for caregiver role strain related to responsibilities for care of aging parents

D The focus of the question is the caregiver. Demands associated with the care of three elderly persons who live at a distance have the potential of overwhelming the caregiver. Because there is no evidence of role strain, a risk diagnosis is formulated.

Which comment by the nurse would be appropriate to begin a new nurse-patient relationship? a. "Which of your problems is most serious?" b. "I want you to tell me about your problems." c. "I'm an experienced nurse. You can trust me." d. "What would you like to tell me about yourself?"

D- "What would you like to tell me about yourself?" The correct response is respectful and recognizes that trust between the nurse and patient needs to be developed. The correct response is also open ended, which is an appropriate communication technique to begin a new relationship.

A nurse counsels a widow whose husband died 5 years ago. The widow says, "If I'd done more, he would still be alive." Select the nurse's therapeutic response. a. "I understand how you feel after such a terrible loss." b. "That was a long time ago. Now it's time to move on with your life." c. "You did a very good job of caring for him, especially since he was sick so long." d. "Your husband was 82 years old with severe chronic obstructive pulmonary disease."

D- "Your husband was 82 years old with severe chronic obstructive pulmonary disease." The correct response demonstrates the therapeutic technique of presenting reality. Giving advice, disagreeing, and changing the subject are nontherapeutic communication techniques.

A patient has been oppositional, demanding, and resistant to working on goals. A mental health nurse tells the nursing supervisor, "We finally had a serious talk. I let that patient know it's time to get right with God and stop this behavior." Recognizing the nurse's actions were not acceptable, select the supervisor's responding action. a. Review the facility policies regarding patient's rights with the nurse. b. Ask the nurse about documentation related to this patient interaction. c. Schedule the nurse for a staff development activity on cultural sensitivity. d. Work with the nurse to prepare and analyze a process recording of the interaction.

D- Work with the nurse to prepare and analyze a process recording of the interaction. Preparing and analyzing a process recording provides an opportunity for clinical supervision of the experienced nurse. The nurse and the supervisor examine the nurse's feelings and reactions to the patient and the way in which they affect the relationship.

A school nurse is assessing a female high-school student who is overly concerned about her appearance. The client's mother states, "That's not something to be stressed about!" Which response by the nurse is best? A. "Teenagers! They don't know a thing about real stress." B. "Psychological or physical stress occur only when there is a loss." C. "Poor physical condition can interfere with psychological well-being." D. "A threat to self-esteem can result in psy- chological stress."

D. "A threat to self-esteem can result in psy- chological stress."

Which nursing statement about the concept of psychoses is most accurate? A. "Individuals experiencing psychoses are aware of experiencing psychological problems." B. "Individuals experiencing psychoses are aware that their behaviors are maladaptive." C. "Individuals experiencing psychoses are based in reality." D. "Individuals experiencing psychoses experience little distress."

D. "Individuals experiencing psychoses experience little distress."

A client diagnosed with major depressive disorder asks, "What part of my brain controls my emotions?" Which nursing response is best? A. "The occipital lobe judges perceptions as positive or negative." B. "The parietal lobe has been linked to depression." C. "The medulla regulates key biological and psychological activities." D. "The limbic system is largely responsible for one's emotional state."

D. "The limbic system is largely responsible for one's emotional state."

A nursing instructor asks students when diseases of adaptation are likely to occur. Which student response indicates that teaching is effective? A. "When an individual has limited experience dealing with stress." B. "When an individual inherits maladaptive genes." C. "When an individual experiences existing conditions that exacerbate stress." D. "When an individual's physiological and psychological resources are depleted."

D. "When an individual's physiological and psychological resources are depleted."

Devastated by a divorce from an abusive husband, a wife completes grief counseling. Which statement by the wife should indicate to a nurse that the client is in the acceptance stage of grief? A. "I still don't have any appetite and continue to lose weight." B. "If only we could have tried again, things might have worked out." C. "I am so mad that the children and I had to put up with him as long as we did." D. "Yes, it was a difficult relationship, but I think I have learned from the experience."

D. "Yes, it was a difficult relationship, but I think I have learned from the experience."

The emergency department nurse is providing discharge instructions to a 23- year-old man who was injured in a motor vehicle crash. The client stated, "My heart was racing when I saw the car coming through the red light was going to hit me. I didn't know my heart could go that fast!" Which is the nurse's best response? A. "Don't worry, your heart is strong because you are young and in good health." B. "Everyone gets scared when they realize another car is going to hit them." C. "You had a panic attack when you saw the car that hit you was not going to stop." D. "Your body responded to the stress of knowing the car was going to hit you."

D. "Your body responded to the stress of knowing the car was going to hit you."

A physically and emotionally healthy client has just been fired. During a routine office visit, he tells the nurse, "Perhaps this was the best thing to happen. Maybe I'll consider pursuing an art degree." The nurse determines the client perceives the stressor of his job loss as: A. Irrelevant. B. Harm/loss. C. A threat. D. A challenge.

D. A challenge.

Which patient is a least likely candidate for telehealth/teletherapy? A. A depressed mother in an underserved area B. A soldier in Afghanistan C. An adolescent in a rural family D. A violent man who is threatening to harm his family

D. A violent man who is threatening to harm his family

Which should the nurse recognize as an example of the defense mechanism of repression? A. A student aware of the need to study for tomorrow's test goes to a movie instead. B. A woman whose son was killed in Iraq does not believe the military report. C. A man who is unhappily married goes to school to become a marriage counselor. D. A woman was raped when she was 12 and no longer remembers the incident.

D. A woman was raped when she was 12 and no longer remembers the incident.

Which of the following is determined by the degree to which thoughts, feelings, and behaviors interfere with an individual's functioning? A. Anxiety B. Defense mechanisms C. Mental health D. Adaptation

D. Adaptation

Which is an example of the ego defense mechanism of regression? A. A mother blames the teacher for her child's failure in school. B. A teenager becomes hysterical after seeing a friend killed in a car accident. C. A woman wants to marry a man exactly like her beloved father. D. An adult throws a temper tantrum when he does not get his own way.

D. An adult throws a temper tantrum when he does not get his own way.

Miller and Rahe (1997) identified a correlation between the effects of life change and illness. This research led to the development of the Recent Life Changes Question- naire (RLCQ). Which principle most limits the effectiveness of this tool? A. Specific physical and psychological illnesses are not identified. B. Numerical values associated with specific life events are randomly assigned. C. Stress is viewed as a solely physiological response. D. An individual's personal perception of the event is excluded.

D. An individual's personal perception of the event is excluded.

A first-time mother is crying and asks the nurse, "How can I go to work if I can't afford child care?" Which is the nurse's initial action to assist the client with problem- solving? A. Determine the risks and benefits for each alternative B. Formulate goals for resolution of the prob- lem C. Evaluate the outcome of the implemented alternative D. Assess the facts of the situation

D. Assess the facts of the situation

A client is admitted to the emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should the nurse correlate with the presentation of these symptoms? A. Abnormal levels of serotonin B. Decreased levels of dopamine C. Increased levels of norepinephrine D. Decreased levels of acetylcholine

D. Decreased levels of acetylcholine

A child is taking guanfacine for ADHD. Which of the following would be part of the client education associated with administration of this medication? A. Do not take with foods that contain tyramine B. Always use sunblock when spending time outdoors C. Report for blood tests once a month D. Do not discontinue the medication abruptly

D. Do not discontinue the medication abruptly

A husband attending family therapy tells his wife, "I'm listening. I want to support you in this," but he glares out the window and taps his foot when she starts to cry and explain her feelings. Which is the best description of his response? A.Active listening B.Reflective listening C.Use of a patient filter D.Double-bind message

D. Double-bind message. (He is sending a mixed message, which creates confusion by being a mix of content—what is said—and process—what is transmitted nonverbally—usually a hurtful or negative message)

Supplemental Security Income (SSI) benefits typically cover needs based on which one of the following? A. Mental illness B. Unemployment C. Homelessness Economic need

D. Economic need

The nurse recognizes that a decrease in norepinephrine levels plays a significant role in which disorder? A. Mania B. Schizophrenia C. Anxiety D. Major depressive disorder

D. Major depressive disorder

Social stigma related to mental illness refers to which one of the following statements? A.Mental illness is a disease process. B. Mental illness is inherited. C. Mental illness is a complex problem. D. Mental illness is due to wrong thinking.

D. Mental illness is due to wrong thinking

A nurse concludes that a restless, agitated client is manifesting a fight-or-flight response. The nurse understands the client's response is associated with which neurotransmitter? A. Acetylcholine B. Dopamine C. Serotonin D. Norepinephrine

D. Norepinephrine

Bandi has been observed in the seclusion room for the past 2 hours. His hygiene is very poor. He is drowsy with slurred speech, vital signs are stable, and he states that he is hungry. What is the nurse manager's best intervention(s) at this time? A.Ask the mental health technician (MHT) to bring Bandi to the day room, seat him at a table, and offer him a snack. B.Offer Bandi a snack, and ask the MHT to offer fluids and toileting; then medicate the patient again as a precaution against his aggression. C.Ask the MHT to assist Bandi with a shower. Return him to the seclusion room, and then offer him a snack. D.Offer Bandi a snack, and then assist the MHT in taking Bandi to his assigned room to lie down. Document the interventions and outcomes.

D. Offer Bandi a snack, and then assist the MHT in taking Bandi to his assigned room to lie down. Document the interventions and outcomes.

Which is the most significant consequence of the excessive use of defense mechanisms? A. The superego will be suppressed. B. Emotions will be experienced intensely. C. Learning and the ability to grow will be enhanced. D. Problem-solving will be limited.

D. Problem-solving will be limited.

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. The American Medical Association identifies 10 diagnostic labels that psychiatrists can choose from. 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. Psychiatrists use pre-established criteria from the APA's Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

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

When under stress, a client routinely uses an excessive amount of alcohol. Finding her drunk, her husband yells at her about the chronic alcohol abuse. Which reaction should the nurse recognize as the use of the defense mechanism of denial? A. Hiding liquor bottles in a closet B. Yelling at their son for slouching in his chair C. Burning dinner on purpose D. Saying to the spouse, "I don't drink too much!"

D. Saying to the spouse, "I don't drink too much!"

A client's spouse of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The client's therapist stresses the importance of proper sleep, nutrition, and exercise. What is the best rationale for the therapist's advice? A. An interpersonal approach is indicated for depressed clients. B. Sleep, nutrition, and exercise affect imbalances in neurotransmitters. C. Sleep, nutrition, and exercise will alleviate symptoms of depression. D. The client is susceptible to illness due to effects of stress on the immune system.

D. The client is susceptible to illness due to effects of stress on the immune system.

A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client's behaviors? A. The client's behaviors demonstrate mental illness in the form of depression. B. The client's behaviors are extensive, which indicates the presence of mental illness. C. The client's behaviors are not congruent with cultural norms. D. The client's behaviors demonstrate no functional impairment, indicating no mental illness.

D. The client's behaviors demonstrate no functional impairment, indicating no mental illness.

Noah has made it clear he doesn't want to talk about his dad. But the truth is, as the interview proceeds, he becomes anxious and tries to evade all questions about why he is here. Which type of communication might be most appropriate right now? A.Stop questioning so much and just give him some good advice so he'll trust you. B.Express honest disapproval of his resistance to help. C.Ask him pointblank why he is evading you. D.Ask a miracle question.

D.Ask a miracle question.

Noah's whispered statement of "Yeah, well. It's just gonna keep on happening" does not involve which of the following? A.Channel B.Stimulus C.Message D.Feedback

D.Feedback

You teach Mr. R's sister about important precautions associated with a new prescription. Afterward, she accurately summarizes major self-management strategies associated with this drug. Which step of the nursing process applies to her summarization?

Evaluation

C. Anxiety disorders

If a person has decreased circulating levels of GABA, which health problem would be expected? A. Alzheimers disease B. Parkinsons disease C. Anxiety disorders D. Insomnia

Answer - b. Pages 6-7. While all of the scenarios present opportunities for a nurse to intervene, the correct response presents an imminent danger to the patient's safety and well-being.

In which scenario is it most urgent for the nurse to act as a patient advocate? a. An adult cries and experiences anxiety after a near-miss automobile accident on the way to work. b. A homeless adult diagnosed with schizophrenia lives in a community expecting a category 5 hurricane. c. A 14-year-old girl's grades decline because she consistently focuses on her appearance and social networking. d. A parent allows the prescription to lapse for 1 day for their 8-year-old child's medication for attention-deficit/hyperactivity disorder.

DocumentationAs Mr. R's sister has suspected, Mr. S sometimes forgets to eat. In which part of the nursing care plan would the nurse expect to find this statement: "Offer snacks and finger foods frequently." Assessment Diagnosis Planning and outcomes identification Intervention Evaluation

Intervention

Amitriptyline (Elavil)

Is an Antidepressant Drug. If taken in large doses they cause cardio toxicity (overdose these are usually used). They have a lot of anitcholinergic reactions to it (dry mouth for example)

Neurons

Nerve cells that conduct electrical impulses. respond to stimuli, conduct electrical impulses, and release chemicals called neurotransmitters.

outcome criteria

Outcomes that reflect the maximal level of patient health that can realistically be achieved through nursing interventions

Core

Regulates internal organs and vital functions

Answer - d. Page 5. The correct response recognizes the recovery model, which has the following tenets: Mental health care is consumer and family driven, with patients being partners in all aspects of care; care must focus on increasing the consumer's success in coping with life's challenges and building resilience; and an individualized care plan is at the core of consumer-centered recovery.

The nurse prepares outcomes to the plan of care for an adult diagnosed with mental illness. Which strategy recognizes the current focus of treatment services for this population? a. The patient's diagnoses are confirmed using advanced neuroimaging techniques. b. The nurse confers with the treatment team to verify the patient's most significant disability. c. The nurse prioritizes the patient's problems in accordance with Maslow's hierarchy of needs. d. The patient and family participate actively in establishing priorities and selecting interventions.

Answer - c. Pages 13-14. In the correct response, the nurse answers rather than evades the question, provides accurate information, and uses terminology a 9- or 10-year-old child can understand. Many of the most prevalent and disabling mental disorders have been found to have strong biological influences, including genetic transmission.

The nurse presents a class about mental health and mental illness to a group of fourth graders. One student asks, "Why do people get mentally ill?" Select the nurse's best response. a. "There are many reasons why mental illness occurs." b. "The cause of mental illness is complicated and very hard to understand." c. "Sometimes a person's brain does not work correctly because something bad happens or they inherit a brain problem." d. "Most mental illnesses result from genetically transmitted abnormalities in cerebral structure; however, some are a consequence of traumatic life experiences."

Answer - c. Page 25. The goal of cognitive behavioral therapy (CBT) is to identify the negative patterns of thought that lead to negative emotions. Once the maladaptive patterns are identified, they can be replaced with rational thoughts. A person must be able to engage in meaningful dialogue to benefit from CBT.

Which patient is likely to achieve maximum benefit from cognitive behavioral therapy (CBT)? a. Older adult diagnosed with stage 3 Alzheimer's disease b. Adult diagnosed with schizophrenia and experiencing delusions c. Adult experiencing feelings of failure after losing the fourth job in 2 years d. School-age child diagnosed with attention-deficit/hyperactivity disorder (ADHD)

Answer - d. Page 35. Executive functions occur in the cerebrum. Loss of cortical tissue has been associated with schizophrenia as 470well as with treatment involving haloperidol and other typical antipsychotics. In contrast, newer atypical antipsychotics and antidepressants have been found to increase brain volume and structural synaptic/neuronal plasticity.

Which patient would the nurse expect to have the most difficulty with problem solving and decision making? a. An 18-year-old diagnosed with bulimia nervosa at age 14; has taken oral doses of fluoxetine (Prozac) daily for 3 years b. A 46-year-old diagnosed with schizophrenia at age 24; has taken oral doses of clozapine (Clozaril) daily for 18 years c. A 62-year-old diagnosed with bipolar disorder at age 28; has taken oral divalproex sodium (Depakote) daily for 16 years d. A 52-year-old diagnosed with schizophrenia at age 21; has taken monthly injections of haloperidol (haldol decanoate) for 12 years

Answer - a. Page 6. Caring is evidenced by empathic understanding, actions, and patience on another's behalf; actions, words, and presence that lead to happiness and touch the heart; and giving of self while preserving the importance of self. Comforting is a part of caring, which includes social, emotional, physical, and spiritual support.

Which scenario best demonstrates empathetic caring? a. A nurse provides comfort to a colleague after an error of medication administration. b. A nurse works a fourth extra shift in 1 week to maintain adequate unit staffing. c. A nurse identifies a violation of confidentiality and makes a report to an agency's privacy officer. d. A nurse conscientiously reads current literature to stay aware of new evidence-based practices.

Answer - c. Page 10. Many biological, cultural, and environmental factors influence mental health. Persons who are normal also may experience dysfunction during their lives. The death of a spouse is a difficult experience, so crying is expected.

Which scenario meets the criteria for "normal" behavior? a. An 8-year-old child's only verbalization is "No no no." b. A 16-year-old girl usually sleeps for 3 or 4 hours per night. c. A 43-year-old man cries privately for 1 month after the death of his wife. d. A 64-year-old woman has difficulty remembering the names of her grandchildren.

A patient diagnosed with major depressive disorder tells the community mental health nurse, "I usually spend all day watching television. If there's nothing good to watch, I just sleep or think about my problems." What is the nurse's best action? a. refer the patient for counseling with a recreational therapist b. ask the patient, "what kinds of program fo you like to watch?" c. suggest to the patient, "are there some friends you could call instead?" d. advise the patient, "watching television and thinking about problems makes depression worse"

a. refer the patient for counseling with a recreational therapist

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

An experienced nurse in a major medical center requests a transfer from a general medical unit to an acute care psychiatric unit. Which organizational feature would best support this nurse's successful transition? a. assignment to medication administration for the first 6 months b. working with a seasoned mental health technician for the first month c. co-assignment with a knowledgeable psychiatric nurse for an extended orientation d. staff development activities focused on developing therapeutic communication skills

c. co-assignment with a knowledgeable psychiatric nurse for an extended orientation

You notice that you look forward to talking to Becky because her dark sense of humor reminds you of your best friend in high school. You also begin to make little cynical jokes, hoping to have a good laugh together. What is this relationship showing early signs of? A.Accountability B.Self-reflection C.Transference D.Countertransference

countertransference

Social stigma related to mental illness refers to which of the following statements? a. mental illness is a disease process b. mental illness is inherited c. mental illness is a complex problem d. mental illness is due to wrong thinking

d. mental illness is due to wrong thinking

Structured imaging techniques (Computed tomography (CT) and Magnetic resonance imaging (MRI) )

provide over all images of the brain and the layers of the brain.

hypothalamus

secretes hormones called releasing factors which act on the pituitary gland to stimulate or inhibit the synthesis and release of pituitary hormones and these influence various internal activities once in circulation.

true or false: evaluation is ongoing

true

Tarasoff Doctrine

•Duty to warn third parties is applied to advanced practice registered nurses (APRNs) and psychiatric mental health nurses. •Staff nurses and members of the mental health team should report threats of harm.

Specialty psychiatric settings

•Pediatric psychiatric care •Geriatric psychiatric care •Forensic psychiatric care •Veterans Administration centers •Alcohol and drug abuse treatment •Self-help options

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