chapt 34. All

14.The nurse is caring for a patient with a diagnosis of catatonic schizophrenia. What behavior is consistent with this diagnosis? a. Talks excitedly about going home b. Suspiciously watches the staff c. Stands on one foot for 15 minutes d. States he has a cat under his bed that talks to him

c.Stands on one foot for 15 minutes Maintaining a rigid pose for long periods of time is an example of behavior expected with catatonic schizophrenia.

22. The nurse reviews the nursing considerations related to the administration of lithium, which include: (Select all that apply.) a.drug should be taken on an empty stomach. b.fluids should be restricted to 1000 mL daily. c.ensure frequent blood levels are drawn. d.encourage contraception to avoid pregnancy while on drug. e.avoid caffeine.

c.ensure frequent blood levels are drawn. d.encourage contraception to avoid pregnancy while on drug. e.avoid caffeine.

10.The patient talks with his dead brother and arranges furniture so that his brother will have a place to sit. How should the nurse document this behavior? a. Disordered thinking b. Anhedonia c. Hallucination d. Alogia

c. Hallucination

21. What is the priority nursing intervention when working with the patient with a personality disorder? 1. Encouraging group activity participation 2. Reassuring the patient that he or she is a "good person" 3. Setting limits with the patient 4. Supporting the patient's decisions consistently

3. Setting limits with the patient

9. A 47-year-old patient is in the hospital for severe depression. She is unkempt and has lost 15 pounds in the past 2 months. Her family states that she always keeps a knife in her purse. The nurse will consider which intervention for this patient? 1. Suicide precautions to prevent self-injury 2. Occupational therapy to build self-esteem 3. Art psychotherapy to help her express feelings 4. Large-portioned meals to improve nutritional status

1. Suicide precautions to prevent self-injury

2. A patient with Alzheimer's disease continually wanders. Which snack will best meet the patient's nutritional needs? (Select all that apply.) 1. Candy bars and ice cream sundaes 2. Eggnog milk shakes and oatmeal-raisin cookies 3. Protein bars and juice 4. Root beer and potato chips 5. Cheese and crackers and milk

3. Protein bars and juice 5. Cheese and crackers and milk

4. A delusional patient becomes agitated while watching television and states, "If I don't buy Crest toothpaste right now, I will have cavities." What is the nurse's best response? 1. "The advertisement on the TV is saying its product will reduce tooth decay if you use their product regularly." 2. "If you feel that it is absolutely necessary we can go to the store now and purchase Crest toothpaste." 3. "You can't believe everything you hear or see on TV." 4. "Any toothpaste can be used to help prevent cavities; not just Crest toothpaste."

1. "The advertisement on the TV is saying its product will reduce tooth decay if you use their product regularly."

16. A 37-year-old patient is not responding to drug therapy for depression. The health care provider has recommended ECT treatments for 1 week as an outpatient. The nurse will stress which point in the pretreatment teaching? 1. "You will need someone to take you to and from the clinic." 2. "Eat a good breakfast because you will sleep through lunch." 3. "Scrub your forearms before coming to the clinic." 4. "Take a laxative the night before so you won't have an accident during the treatment."

1. "You will need someone to take you to and from the clinic."

6. Besides feelings of sadness or despair, which is also a sign or symptom of depression? 1. Extreme fatigue 2. Restlessness 3. Flight of ideas 4. Hallucinations

1. Extreme fatigue

28. The nurse takes into consideration that it is estimated that _____% of the population will have some form of anxiety disorder.

25%

18. A 17-year-old boy tells his mother he is writing a paper for class on all the rock stars who have killed themselves. In the past few months, he has let his hair grow long, bathes only once a week, and stays in his room when he is at home. He is tired and irritable. His mother asks a friend who is a nurse if this is normal teenage behavior. What is the best response? 1. "Yes; all teenagers go through a grunge stage." 2. "Yes; he is just tired from the rapid growth spurt during adolescence." 3. "No, and if he doesn't snap out of it, you might want to take him to a health care provider." 4. "No; he should see a health care provider or counselor right away."

4. "No; he should see a health care provider or counselor right away."

12. A 24-year-old woman was admitted for medication adjustment for bipolar disorder. The patient has not slept for 2 days and is unable to sit for more than a few minutes at a time. She has lost 11 pounds in the past week. Which factor will facilitate the best nutrition for the patient while she is in her manic phase?1. Have her take her meals in her room to reduce distracting stimuli.2. Have the kitchen double her meal portions, since she eats only half of the food served.3. Allow the patient to snack on candy bars between meals to gain back her lost weight.4. Keep sandwiches, granola bars, fruit, and noncaffeinated beverages available at the desk.

4. Keep sandwiches, granola bars, fruit, and noncaffeinated beverages available at the desk.

19. A 70-year-old patient is in the hospital for pneumonia and has been taking sertraline (Zoloft) for 1 year for depression. On the third day of her hospitalization, the patient has a pulse rate of 100, demonstrates trembling in her hands, has an oral temperature of 103° F, and is diaphoretic. What is the nursing assessment? 1. Anxiety, related to hospitalization 2. Increased cranial pressure 3. Impaired airway 4. Serotonin syndrome

4. Serotonin syndrome

16. Antidepressant therapy has been effective and the suicidal patient verbalizes that he feels better. The nurse is aware that at this time, the: a. risk of self-harm increases. b. patient gains insight to his previous desire for suicide. c. suicidal precautions can be relaxed. d. antidepressive medication doses can be reduced.

a. risk of self-harm increases. The risk of suicide is greater now that the patient has increased energy to plan and complete the suicide.

2. While the nurse is helping the dialysis patient dress to go to her dialysis treatment, the patient bursts into tears and says, I cant go! I cant stand another day in that awful place. I will die if I have to go! The nurses best intervention would be to: a. stop the dressing process, sit down, and calmly ask, Lets talk about how you are feeling. b. continue to dress the patient and say, Youll feel better after you have had your dialysis treatment. c. stop the dressing process and ask, Are you aware that you can get sicker if you dont go? d. continue dressing the patient and say, Well have to hurry if you are to eat breakfast before you go.

a. stop the dressing process, sit down, and calmly ask, Lets talk about how you are feeling.

5.A young man with malaria spikes a temperature of 105 F and begins to hallucinate. How should the nurse assess this? a. Delirium b. Psychotic break c. Possible stroke d. Anxiety disorder

a. Delirium

2.When the patient with a psychosis is thought to be a danger to self or others, by what method should the patient be admitted to the hospital? a. Probating b. Nurses request c. Physicians order d. Family request

a. Probating can be done if the individual is thought to be a danger to self or others.

12.The nurse cautions a patient to watch his step. What response indicates concrete thinking? a. The patient fixedly begins to watch his feet. b. The patient immediately examines his watch. c. The patient begins to watch the nurses feet. d. The patient stands rigidly in one place without moving.

a. The patient fixedly begins to watch his feet.

8. The sibling of a patient who was diagnosed with a serious mental illness asks why a case manager has been assigned. The nurses reply should cite the major advantage of the use of case management as: a. The case manager can modify traditional psychotherapy for homeless patients so that it is more flexible. b. Case managers coordinate services and help with accessing them, making sure the patients needs are met. c. The case manager can focus on social skills training and esteem building in the real world where the patient lives. d. Having a case manager has been shown to reduce hospitalizations, which prevents disruption and saves money.

b. Case managers coordinate services and help with accessing them, making sure the patients needs are met.

8. A resident in a long-term care facility who has generalized anxiety disorder (GAD) enters the dining room on her walker and discovers that her regular place has been taken by a visitor. The resident becomes agitated and says, I need my place so I can eat! I cant eat unless I am in my place! The nurses most effective intervention would be to say: a. Go sit with Mrs. Smith right now. There is no one else at her table now. b. Well eat over here for lunch and at your regular place for supper. c. Dont be silly! That chair is no different from any other chair in the room. d. If you dont eat, you will be hungry.

b. Well eat over here for lunch and at your regular place for supper.

21. For patients diagnosed with serious mental illness, what is the major advantage of case management? a. The case manager can modify traditional psychotherapy. b. With one coordinator of services, resources can be more efficiently used. c. The case manager can focus on social skills training and esteem building. d. Case managers bring groups of patients together to discuss common problems.

b. With one coordinator of services, resources can be more efficiently used.

15. Serious mental illness is characterized as: a. any mental illness of more than 2 weeks duration. b. a major long-term mental illness marked by significant functional impairments. c. a mental illness accompanied by physical impairment and severe social problems. d. a major mental illness that cannot be treated to prevent deterioration of cognitive and social abilities.

b. a major long-term mental illness marked by significant functional impairments.

11. A resident in the long-term care facility has been in a manic stage for 2 days. He has not slept and cannot focus long enough to eat a meal. The nurse can enhance his nutrition by: a. insisting he sit down and eat at the table at regular mealtimes. b. spoon-feeding him at the table at regular mealtimes. c. handing him small glasses of high-protein drinks every hour. d. making up a game about who can finish a meal first.

c. handing him small glasses of high-protein drinks every hour.

5. An outpatient diagnosed with schizophrenia attends programming at a community mental health center. The patient says, I threw away the pills because they keep me from hearing God. Which response by the nurse would most likely to benefit this patient? a. You need your medicine. Your schizophrenia will get worse without it. b. Do you want to be hospitalized again? You must take your medication. c. I would like you to come to the medication education group every Thursday. d. I noticed that when you take the medicine, you have been able to hold a job you wanted.

d. I noticed that when you take the medicine, you have been able to hold a job you wanted.

6. A homeless individual diagnosed with serious mental illness, anosognosia, and a history of persistent treatment nonadherence is persuaded to come to the day program at a community mental health center. Which intervention should be the teams initial focus? a. Teach appropriate health maintenance and prevention practices. b. Educate the patient about the importance of treatment adherence. c. Help the patient obtain employment in a local sheltered workshop. d. Interact regularly and supportively without trying to change the patient.

d. Interact regularly and supportively without trying to change the patient.

15.What is the term used for the beginning stage of schizophrenia, characterized by a lack of energy and complaints of multiple physical problems? a. Prepsychotic b. Residual c. Acute d. Prodromal

d. Prodromal The prodromal phase is the beginning stage of schizophrenia. Hallucinations and delusions sometimes occur in the prepsychotic stage. In the acute phase, individuals often lose touch with reality. The residual phase follows the acute phase and the symptoms of that phase are similar to those of the prodromal stage.

6.A patient admitted for delirium demonstrates increased disorientation and agitation only during the evening and nighttime. What is the term applied to this type of delirium? a. Disordered thinking b. Schizophrenia c. Dementia d. Sundowning syndrome

d. Sundowning syndrome

13.The nurse asks a patient with schizophrenia if he had any visitors on Sunday. Which response indicates loose association? a. No. b. Yes! I had 90 visitors who came from every state in the union. c. Sunday is the Sabbath. Do we have visitors on the Sabbath? d. We visited Yellowstone Park last summer.

d. We visited Yellowstone Park last summer. Loose association is a type of disordered thinking that occurs when the individual cannot interpret information and the conversation does not flow.

16.For the past 3 weeks, the nurse has observed a patient interacting with staff and other patients, helping decorate the dining room for a party, and leading the singing in the activity room. Today, the patient tearfully refuses to dress or get out of bed. The nurse recognizes these behaviors as evidence of which psychiatric disorder? a. Unipolar depression b. Dysthymic disorder c. Hypomanic episode d. Bipolar disorder

d.Bipolar disorder can cause the patient to experience a sudden shift in emotion from one extreme to the other.

18.A home health nurse has a patient who is taking lithium. What should be included in the teaching plan? a. Examine her skin closely for eruptions b. Take her blood pressure twice a day to check for hypertension c. Have her drug blood level checked every month d. Avoid aged cheese and red wine ANS: C

c. Have her drug blood level checked every month

4.When all five axes of the Diagnostic and Statistical Manual of Psychiatric Disorders, V, are used, it provides what type of assessment approach to comprehensive care? a. Personalized b. Individualized c. Holistic d. Organic

c. Holistic

3.The Diagnostic and Statistical Manual of Psychiatric Disorders, V (DSM-V), is used by most hospitals and is the current tool used to examine mental health and illness. What approach does the DSM-V use to classify mental disorders? a. Holistic system b. Hierarchical system c. Multiaxial system d. Evaluation system

c. Multiaxial system

1.The nurse is discussing the differences between a patient with a neurosis and one with a psychosis. What is true of the patient experiencing a neurosis? a. The patient experiences a flight from reality. b. The patient usually needs hospitalization. c. The patient has insight that there is an emotional problem. d. The patient has severe personality deterioration.

c. The patient has insight that there is an emotional problem.

21.The home health nurse assesses a patient who creates elaborate excuses for not leaving home. Further questioning reveals the patient had not left home for 6 months. How should this be documented? a. Mania b. Depression c. Agoraphobia d. Anxiety

c.Agoraphobia

20.The nurse is assessing a female patient who has become rapidly and exceedingly anxious because her fingernail polish is chipped. What type of anxiety should the nurse conclude that the patient is exhibiting? a. Signal anxiety b. General anxiety c. Anxiety traits d. Panic disorder

c.Anxiety traits

11. A patient says the anchorwoman on the television news talks to him and told him that there was a car bombing in Israel today. What is the nurse's best response? 1. "I don't think you understand how television projection works." 2. "She is reporting the world news to everyone in the room. It only appears she is looking at you but she is looking in a TV camera that sends a picture to the TV." 3. "If you look in the back of the TV console, you will see there is no person inside." 4. "You are delusional. That is only a projected image of a person reading the news to a camera far away."

2. "She is reporting the world news to everyone in the room. It only appears she is looking at you but she is looking in a TV camera that sends a picture to the TV."

7. What is the therapy of choice for bipolar, or manic-depressive, disorder? 1. Chlorpromazine (Thorazine) 2. Lithium carbonate 3. Electroconvulsive therapy 4. Fluoxetine (Prozac)

2. Lithium carbonate

14. A patient is a broker on Wall Street who smokes half a pack of cigarettes a day. He avoids caffeine because he has trouble sleeping. He also often complains of an aching lower back. His physician was not able to find anything wrong physically. What is a possible cause of his back pain? 1. Congenital anomaly 2. Psychophysiologic origins 3. Possible renal calculi forming 4. Dependent personality disorder

2. Psychophysiologic origins

5. The nurse is assessing a patient with a diagnosis of schizophrenia for negative, or absent, behavior patterns. Which symptoms would the nurse assess for? (Select all that apply.) 1. Delusions 2. Social withdrawal 3. Hallucinations 4. Disordered thinking 5. Apathy

2. Social withdrawal 5. Apathy

1. An 82-year-old man was admitted to the long-term care facility with moderate to severe heart failure and is unable to take care of himself at home. After dinner, the patient becomes agitated and confused. There are no significant changes in vital signs, and he has received the same medications he had been taking at home. What cause of acute confusion should the nurse consider? 1. Alzheimer's disease 2. Sundowning syndrome 3. Electrolyte imbalance 4. Acute renal failure

2. Sundowning syndrome

3. The psychiatrist makes a diagnosis with the use of which multiaxial system guide? 1. The Physicians' Desk Reference 2. The Diagnostic and Statistical Manual, Fifth Edition. 3. The hospital formulary 4. Freud's The Ego and the Id

2. The Diagnostic and Statistical Manual, Fifth Edition.

19.The nurse alters the care plan for a patient with depression to include what type of activity? a. Domino game with three other patients b. Ping-Pong game with one other patient c. Group outing to view wildflowers d. Magazine to read alone

c.Group outing to view wildflowers

13. A patient who was sexually abused as a child recently married but finds sexual intercourse painful. She confides in her friend who is a nurse. What is the appropriate response from her friend? 1. "You should see your gynecologist right away in case you have torn tissues." 2. "It is normal to have pain at first, but you will adjust to your husband over time." 3. "You should seek counseling and make sure to get a good physical examination." 4. "Did you report this abuse to the police?"

3. "You should seek counseling and make sure to get a good physical examination."

20. To effectively communicate with a patient demonstrating manic, elevated mood behaviors, the nurse will incorporate what technique into the plan of care? 1. Provide detailed explanations to the patient. 2. Joke and use puns with the patient. 3. Be brief and concrete with the patient. 4. Offer prn medications to the patient.

3. Be brief and concrete with the patient.

15. A 17-year-old patient is worried about her weight. When she is out with friends, she eats junk food until she vomits and then exercises the next day for 4 hours. If she does not have a daily bowel movement, she takes a laxative. Her dentist has noticed her front teeth have signs of erosion. Her family has noticed her hair falling out, and now they have decided to take her to the family health care provider. What diagnosis do these symptoms support? 1. Anorexia nervosa 2. Laxative addiction 3. Bulimia nervosa 4. Gastroenteritis

3. Bulimia nervosa

8. A patient admitted to the emergency department is complaining of an anxiety attack. What manifestations are consistent with an anxiety attack? 1. Hypotension and bradycardia 2. Lethargy and thready pulse 3. Hyperventilation and tachycardia 4. Hallucinations and apathy

3. Hyperventilation and tachycardia

17. The nurse is aware of the phases of schizophrenia. Arrange the following symptoms in the correct order according to the phases of schizophrenia. 1. Odd or eccentric behavior 2. Loss of contact with reality 3. Lack of energy and motivation 4. Some relief of symptoms

3. Lack of energy and motivation 1. Odd or eccentric behavior 2. Loss of contact with reality 4. Some relief of symptoms

22. When providing care for a depressed patient, what assessment data warrants immediate attention from the nurse? 1. Anorexia and weight loss 2. Lowered self-esteem 3. Inability to care for self effectively 4. Suicidal ideation

4. Suicidal ideation

10. Antipsychotic medications have a number of side effects that discourage compliance by the patient. Which effect has the potential to lead to a serious permanent problem? 1. Photosensitivity 2. Postural hypotension 3. Chronic constipation 4. Tardive dyskinesia

4. Tardive dyskinesia

17. A patient diagnosed with schizophrenia tells the community mental health nurse, I threw away my pills because they interfere with Gods voice. The nurse identifies the etiology of the patients ineffective management of the medication regime as: a. inadequate discharge planning. b. poor therapeutic alliance with clinicians. c. dislike of antipsychotic medication side effects. d. impaired reasoning secondary to the schizophrenia.

d. impaired reasoning secondary to the schizophrenia.

12. The nurse is aware that chlorpromazine (Thorazine) is given along with lithium carbonate because: a. lithium takes up to 2 weeks to reach therapeutic level. b. Thorazine reduces the threat of lithium toxicity. c. Thorazine lowers blood pressure. d. Thorazine synergizes the lithium.

a. lithium takes up to 2 weeks to reach therapeutic level.

3. The night nurse finds a patient who broke both legs in a car accident 2 weeks ago awake and crying at 2:00 AM. When the nurse asks if she wants a sedative to sleep, the patient confesses that she relives the accident in her dreams and is fearful to go to sleep. The nurse recognizes signs of: a. post-traumatic stress disorder (PTSD). b. phobic disorder. c. obsessive-compulsive disorder (OCD). d. panic level of anxiety.

a. post-traumatic stress disorder (PTSD).

4. An outpatient diagnosed with schizophrenia tells the nurse, I am here to save the world. I threw away the pills because they make God go away. The nurse identifies the patients reason for medication nonadherence as: a. poor alliance with clinicians. b. inadequate discharge planning. c. dislike of medication side effects. d. lack of insight associated with the illness.

d. lack of insight associated with the illness.

5. The nurse is aware that unless effective intervention occurs for demonstrated anxiety disorders, the anxiety will: a. be self-limiting. b. force the person to seek medical intervention. c. develop into a full-blown psychosis. d. return at a greater level of severity.

d. return at a greater level of severity.

13. Many persons brought before a criminal court have mental illness, have committed minor offenses, and are off medications. The judge consults the nurse at the local community mental health center for guidance about how to respond when handling such cases. Which advice from the nurse would be most appropriate? a. Sometimes a little time in jail makes a person rethink what theyve been doing and puts them back on the right track. b. Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses. c. Arresting these people helps them in the long run. Sometimes we cannot hospitalize them, but in jail they will get their medication. d. Research suggests that special mental health courts do not make much difference so far, but outpatient commitment does seem to help.

b. Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses.

4. A patient diagnosed with serious mental illness was living successfully in a group home but wanted an apartment. The prospective landlord said, People like you have trouble getting along and paying their rent. The patient and nurse meet for a problem-solving session. Which options should the nurse endorse? Select all that apply. a. Coach the patient in ways to control symptoms effectively. b. Seek out landlords less affected by the stigma associated with mental illness. c. Threaten the landlord with legal action because of the discriminatory actions. d. Encourage the patient to remain in the group home until the illness is less obvious. e. Suggest that the patient list a false current address in the rental application. f. Have the case manager meet with the landlord to provide education about mental illness.

a. Coach the patient in ways to control symptoms effectively. b. Seek out landlords less affected by the stigma associated with mental illness. f. Have the case manager meet with the landlord to provide education about mental illness.

23. A consumer at a rehabilitative psychosocial program says to the nurse, People are not cleaning up behind themselves in the bathrooms. The building is dirty and cluttered. How should the nurse respond? a. Encourage the consumer to discuss it at a meeting with everyone. b. Hire a professional cleaning service to clean the restrooms. c. Address the complaint at the next staff meeting. d. Tell the consumer, Thats not my problem.

a. Encourage the consumer to discuss it at a meeting with everyone.

18. A patient living independently had command hallucinations to shout warnings to neighbors. After a short hospitalization, the patient was prohibited from returning to the apartment. The landlord said, You cause too much trouble. What problem is the patient experiencing? a. Grief c. Homelessness b. Stigma d. Nonadherence

b. Stigma

10. A patient diagnosed with a serious mental illness lives independently and attends a psychosocial rehabilitation program. The patient presents at the emergency department seeking hospitalization. The patient has no acute symptoms but says, I have no money to pay my rent or refill my prescription. Select the nurses best action. a. Involve the patients case manager to provide crisis intervention. b. Send the patient to a homeless shelter until housing can be arranged. c. Arrange for a short in-patient admission and begin discharge planning. d. Explain that one must have active psychiatric symptoms to be admitted.

a. Involve the patients case manager to provide crisis intervention.

2. The nurse manager of a mental health center wants to improve medication adherence among the seriously mentally ill persons treated there. Which interventions are likely to help achieve this goal? Select all that apply. a. Maintain stable and consistent staff. b. Increase the length of medication education groups. c. Stress that without treatment, illnesses will worsen. d. Prescribe drugs in smaller but more frequent dosages. e. Make it easier to access prescribers and pay for drugs. f. Require adherence in order to participate in programming.

a. Maintain stable and consistent staff. e. Make it easier to access prescribers and pay for drugs.

5. An adult patient tells the case manager, I dont have bipolar disorder anymore, so I dont need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now Im bored and dont have any friends. Where should the nurse refer the patient? Select all that apply. a. Psychoeducational classes b. Vocational rehabilitation c. Social skills training d. A homeless shelter e. Crisis intervention

a. Psychoeducational classes b. Vocational rehabilitation c. Social skills training d.

14. A nurses neighbor says, My sister has been diagnosed with bipolar disorder but will not take her medication. I have tried to help her for over 20 years, but it seems like everything I do fails. Do you have any suggestions? Select the nurses best response. a. The National Alliance on Mental Illness offers a family education series that you might find helpful. b. Since your sister is noncompliant, perhaps its time for her to be changed to injectable medication. c. You have done all you can. Now its time to put yourself first and move on with your life. d. You cannot help her. Would it be better for you to discontinue your relationship? might not be on the test

a. The National Alliance on Mental Illness offers a family education series that you might find helpful.

6. Which statements most clearly indicate the speaker views mental illness with stigma? Select all that apply. a. We are all a little bit crazy. b. If people with mental illness would go to church, their problems would be solved. c. Many mental illnesses are genetically transmitted. Its no ones fault that the illness occurs. d. Anyone can have a mental illness. War or natural disasters can be too stressful for healthy people. e. People with mental illness are lazy. They get government disability checks instead of working.

a. We are all a little bit crazy. b. If people with mental illness would go to church, their problems would be solve e. People with mental illness are lazy. They get government disability checks instead of working.

10. After having refused lunch and dinner because her regular chair was occupied at breakfast, the resident in a long-term care facility asks for a snack. The nurse should take this opportunity to sit down with the resident and say: a. You are hungry now. Is there something else you could have done besides refuse to eat? b. Here is your snack. Maybe you wont be so quick to refuse meals the next time you dont get your way. c. Refusing meals is not the answer. You must eat. d. Why in the world did you leave the dining room without eating?

a. You are hungry now. Is there something else you could have done besides refuse to eat?

6. The nurse reminds the patient who has just been prescribed diazepam (Valium) to use it with caution as this drug can cause: a. dependency. b. urine retention. c. severe dehydration. d. hallucinations.

a. dependency.

20. The nurse lists the signs and symptoms of a general anxiety disorder (GAD), which include: (Select all that apply.) a.heart rate of over 100 beats/min. b.restlessness. c.urinary retention. d.fatigue. e.muscular tension.

a. heart rate of over 100 beats/min. b. restlessness. d. fatigue. e. muscular tension.

24. The nurse assesses data about a depressed patient that increase the probability of his being suicidal, which are: (Select all that apply.) a.owning a gun collection. b.living with wife and three children. c.being an active member of the local church. d.having a plan to shoot himself in a motel. e.having a brother that recently committed suicide.

a. owning a gun collection. d. having a plan to shoot himself in a motel. e. having a brother that recently committed suicide.

21. The nurse outlines the treatment for a person with anxiety disorders, which include: (Select all that apply.) a.anxiolytic medication. b.education about disorder. c.individual therapy. d.relaxation techniques. e.stress management.

a.anxiolytic medication. b.education about disorder. c.individual therapy. d.relaxation techniques. e.stress management.

18. The patient suspected of having bulimia should be assessed for the classic behavior of this disorder, which is: 18. The patient suspected of having bulimia should be assessed for the classic behavior of this disorder, which is: a. bingeing and purging. b. refusal to eat. c. excessive exercising. d. hiding food to make it appear it was eaten. b. refusal to eat. c. excessive exercising. d. hiding food to make it appear it was eaten.

a.bingeing and purging.

25. A patient is considering having electroconvulsive therapy to treat his severe depression. Which statements indicate the patient has an understanding of the procedure? (Select all that apply.) a. My treatment plan will include treatments once every other month. b. The shock will cause me to have a short seizure. c. This treatment is often more successful than medications. d. I will have to be hospitalized the day before and after the treatments for observation. e. The treatments will be performed in the early morning hours.

b. The shock will cause me to have a short seizure. c. This treatment is often more successful than medications. e. The treatments will be performed in the early morning hours.

19. A person diagnosed with a serious mental illness enters a shelter for the homeless. Which intervention should be the nurses initial priority? a. Find supported employment. b. Develop a trusting relationship. c. Administer prescribed medication. d. Teach appropriate health care practices.

b. Develop a trusting relationship.

3. A person diagnosed with serious mental illness has frequent relapses, usually precipitated by situational stressors such as running out of money or the absence of key staff at the mental health center. Which interventions would the nurse suggest to reduce the risk of stressors to cause relapse? Select all that apply. a. Discourage potentially stressful activities such as groups or volunteer work. b. Develop written plans that will help the patient remember what to do in a crisis. c. Help the patient identify and anticipate events that are likely to be overwhelming. d. Encourage health-promoting activities such as exercise and getting adequate rest. e. Accompany the patient to a National Alliance on Mental Illness support group.

b. Develop written plans that will help the patient remember what to do in a crisis. c. Help the patient identify and anticipate events that are likely to be overwhelming. d. Encourage health-promoting activities such as exercise and getting adequate rest. e. Accompany the patient to a National Alliance on Mental Illness support group.

20. A homeless patient diagnosed with a serious mental illness became suspicious and delusional. Depot antipsychotic medication began, and housing was obtained in a local shelter. One month later, which statement by the patient indicates significant improvement? a. They will not let me drink. They have many rules in the shelter. b. I feel comfortable here. Nobody bothers me. c. Those shots make my arm very sore. d. Those people watch me a lot.

b. I feel comfortable here. Nobody bothers me.

19. The nurse is caring for a patient admitted with a diagnosis of serotonin syndrome. Which will most likely be included in the plan of treatment? a. Antihypertensive medications b. Intravenous therapy c. Large doses of antianxiety medications d. Sedatives

b. Intravenous therapy Serotonin syndrome is a potential life-threatening condition that could start 30 minutes to 48 hours after taking the medication. Symptoms include change of mental status, increase in pulse and fluctuation in blood pressure, loss of muscular coordination, and hyperthermia. Treatment includes stopping medication, administering intravenous (IV) fluids, and decreasing temperature.

12. A patient diagnosed with a serious mental illness died suddenly at age 52. The patient lived in the community for 5 years without relapse and held supported employment the past 6 months. The distressed family asks, How could this happen? Which response by the nurse accurately reflects research and addresses the familys question? a. A certain number of people die young from undetected diseases, and its just one of those sad things that sometimes happen. b. Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, smoke more, or are overweight. c. We will have to wait for the autopsy to know what happened. There were some medical problems, but we were not expecting death. d. We are all surprised. The patient had been doing so well and saw the nurse every other week.

b. Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, smoke more, or are overweight.

7. The nurse encourages the patient with generalized anxiety disorder (GAD) that buspirone (BuSpar) has the benefit of: a. less time to reach therapeutic level. b. decreased risk of dependence. c. increased sedation. d. inhibiting serotonin reuptake.

b. decreased risk of dependence.

1. After 5 years in a state hospital, an adult diagnosed with schizophrenia was discharged to the community. This patient now requires persistent direction to accomplish activities of daily living and expects others to provide meals and do laundry. The nurse assesses this behavior as the probable result of: a. side effects of antipsychotic medications. b. dependency caused by institutionalization. c. cognitive deterioration from schizophrenia. d. stress associated with acclimation to the community.

b. dependency caused by institutionalization.

9. An older adult resident in a long-term care facility has come to the desk for the fourth time in an hour with various minor complaints. He continues to wander about aimlessly. The nurse examines the patients chart and finds the newly prescribed drug that may explain his anxious behavior, which would be: a. Tylenol 32 mg PO every 4 hours for pain. b. theophylline 100 mg bid for asthma. c. bisacodyl tabs 2 prn for constipation. d. lisinopril 10 mg bid for hypertension.

b. theophylline 100 mg bid for asthma. The drug theophylline makes patients feel anxious and restless. Tylenol, bisacodyl, and lisinopril do not typically have this effect.

13. A patient who has been on lithium for 5 days walks up the hall singing loudly and gaily greets everyone he sees. He is a little unsteady in his walker. He asks for more ice water saying he is very thirsty and complaining of insomnia. The nurse would report the observation of: a. manic behavior. b. unsteady gait. c. thirst. d. insomnia.

b. unsteady gait. The ataxic gait should be reported immediately as a sign of lithium toxicity. It is too soon in therapy for the mania to be controlled. Thirst and insomnia are expected side effects of lithium, but not toxic ones.

9.A patient believes himself to be the president of the United States and that terrorists are trying to kidnap him. The nurse records these observations as which type of behavior? a. Absent behavior b. Positive behavior c. Negative behavior d. False behavior ANS: B

b. Positive behavior

8.A profound, disabling mental illness is characterized by bizarre, nonreality thinking. What is the illness? a. Manic depressive b. Schizophrenia c. Paranoia d. Bipolar

b. Schizophrenia

23. The nurse assesses the patient for the signs and symptoms that characterize a major depressive disorder, which are: (Select all that apply.) a. euphoria. b. psychomotor retardation. c. indecisiveness. d. sleep disturbances. e. suicidal ideation.

b. psychomotor retardation. c. indecisiveness. d. sleep disturbances. e. suicidal ideation.

3. Which service would be expected to provide resources 24 hours a day, 7 days a week if needed for persons with serious mental illness? a. Clubhouse model b. Cognitive Behavioral Therapy (CBT) c. Assertive Community Treatment (ACT) d. Cognitive Enhancement Therapy (CET)

c. Assertive Community Treatment (ACT)

16. Which nursing diagnosis is likely to apply to an individual diagnosed with a serious mental illness who is homeless? a. Insomnia b. Substance abuse c. Chronic low self-esteem d. Impaired environmental interpretation syndrome

c. Chronic low self-esteem

11. The nurse wants to enroll a patient with poor social skills in a training program for patients diagnosed with schizophrenia. Which description accurately describes social skills training? a. Patients learn to improve their attention and concentration. b. Group leaders provide support without challenging patients to change. c. Complex interpersonal skills are taught by breaking them into simpler behaviors. d. Patients learn social skills by practicing them in a supported employment setting.

c. Complex interpersonal skills are taught by breaking them into simpler behaviors.

26. The nurse is reviewing the medical history of a patient who is being evaluated for anorexia nervosa. Which characteristic(s) would be consistent with the condition? (Select all that apply.) a. Loss of 2 to 3 pounds in the past month b. Binge eating c. Frequent mood changes d. Absence of three consecutive menstrual periods e. Body weight less than 85% of what is expected for height and weight

c. Frequent mood changes d. Absence of three consecutive menstrual periods e. Body weight less than 85% of what is expected for height and weight

2. An adult diagnosed with a serious mental illness says, I do not need help with money management. I have excellent ideas about investments. This patient usually does not have money to buy groceries by the middle of the month. The nurse assesses the patient as demonstrating: a. rationalization. c. anosognosia. b. identification. d. projection. this one was not in the book

c. anosognosia. he inability to recognize ones deficits due to ones illness. The patient is not projecting an undesirable thought or emotion from himself onto others. He is not justifying his behavior via rationalization and is not identifying with another.

14. The nurse takes into consideration that when a depressed person presents herself as sad the term takes on the meaning of being: a. fatigued and gloomy. b. physically unclean. c. hopeless and worthless. d. suicidal.

c. hopeless and worthless.

4. The nurse clarifies that anxiety disorders differ from normal anxiety in that anxiety disorders: a. develop into suicidal tendencies. b. are seldom controlled. c. interfere with effective functioning. d. make maintenance of relationships impossible.

c. interfere with effective functioning.

1. The nurse observes a coworker who is always behind because he checks and rechecks the accuracy of his medication dosages. Even after being reassured his dosages are correct, he checks them again. The nurse suspects her coworker to be suffering from: a. perfectionism. b. phobic disorder. c. obsessive-compulsive disorder (OCD). d. general anxiety disorder.

c. obsessive-compulsive disorder (OCD).

11.What is the prognosis for a schizophrenic patient who is exhibiting positive behaviors? a. Guarded b. Poor c. Good d. Repeatable

c. Good

1. A person diagnosed with a serious mental illness (SMI) living in the community was punched, pushed to the ground, and robbed of $7 during the day on a public street. Which statements about violence and serious mental illness in general are accurate? Select all that apply. a. Persons with SMI are more likely to be violent. b. SMI persons are more likely to commit crimes than to be the victims of crime. c. Impaired judgment and social skills can provoke hostile or assaultive behavior. d. Lower incomes force SMI persons to live in high-crime areas, increasing risk. e. SMI persons experience higher rates of sexual assault and victimization than others. f. Criminals may believe SMI persons are less likely to resist or testify against them.

c.Impaired judgment and social skills can provoke hostile or assaultive behavior. d.Lower incomes force SMI persons to live in high-crime areas, increasing risk. e.SMI persons experience higher rates of sexual assault and victimization than others. f.Criminals may believe SMI persons are less likely to resist or testify against them.

9. A family discusses the impact of a seriously mental ill member. Insurance partially covered treatment expenses, but the family spent much of their savings for care. The patients sibling says, My parents have no time for me. The parents are concerned that when they are older, there will be no one to care for the patient. Which response by the nurse would be most helpful? a. Acknowledge their concerns and consult with the treatment team about ways to bring the patients symptoms under better control. b. Give them names of financial advisors that could help them save or borrow sufficient funds to leave a trust fund to care for their loved one. c. Refer them to crisis intervention services to learn ways to manage caregiver stress and provide titles of some helpful books for families. d. Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the patient become more independent.

d. Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the patient become more independent.

. A patient diagnosed with schizophrenia has had multiple relapses. The patient usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply as the patient transitions from hospital to community? a. Administer a second-generation antipsychotic to help negative symptoms. b. Use a quick-dissolving medication formulation to reduce cheeking. c. Prescribe a long-acting intramuscular antipsychotic medication. d. Involve the patient in decisions about which medication is best.

d. Involve the patient in decisions about which medication is best.

22. The parent of a seriously mentally ill adult asks the nurse, Why are you making a referral to a vocational rehabilitation program? My child wont ever be able to hold a job. Which is the nurses best reply? a. We make this referral to continue eligibility for federal funding. b. Are you concerned that were trying to make your child too independent? c. If you think the program would be detrimental, we can postpone it for a time. d. Most patients are capable of employment at some level, competitive or supported.

d. Most patients are capable of employment at some level, competitive or supported.

15. The depressed patient who has been taking amitriptyline (Elavil) for the past 2 weeks complains of still feeling depressed and wants to abandon the drug. The nurses most helpful response would be: a. All drugs dont work for all people. I will talk to the physician about a new order for a different drug. b. You probably should quit taking Elavil if it is not helping you. c. Sometimes drinking a small glass of wine with meals helps. d. These drugs take several weeks to become effective.

d. These drugs take several weeks to become effective. It can take up to 4 weeks before symptoms are relieved by tricyclics.

17. The nurse is aware that the basic drive behind the patients anorexia nervosa is to: a. be sexually desirable by staying slender. b. be involved with preparation of food, but not eating it. c. punish self by denial of adequate nutrition. d. gain a sense of control by limiting food intake.

d. gain a sense of control by limiting food intake.

17.The nurse recognizes that researchers have identified that hereditary factors account for what percentage of mood disorders? a. 10% to 15% b. 20% to 30% c. 35% to 50% d. 60% to 80%

d. 60% to 80%

7.Dementia is an organic mental disease secondary to what problem? a. Chemical imbalance b. Emotional problems c. Circulatory impairment d. Cerebral disease

d. Cerebral disease

27. The nurse points out that a persistent irrational fear of a specific object or situation that causes anxiety that interferes with responsibilities is a(n) _________.

phobia A phobia is an irrational fear of a specific object or situation that renders the person unable to fulfill responsibilities.