mental health ch 7-12

When reviewing the nursing notes from the previous shift, the nurse notices notations indicating that the client was experiencing a somnolent level of consciousness. The clients behavior would be described as:

"Falling asleep easily and only awakening with strong verbal stimuli"

The nurse is attempting to develop trust with a newly admitted female client for the purpose of establishing a therapeutic relationship. The nurse is currently administering medications to all clients on the unit. The newly admitted client asks the nurse to sit and talk with her for a while. What is the nurse's best response?

"I have to finish giving all the clients their medications, but I will then come back so we can talk."

Which nurse response is the best example of the therapeutic principle of respect?

"I hear how worried you are about your future and can imagine how you feel."

The nursing student is assigned a client to interview and is asked to practice the therapeutic communication technique of sharing perceptions. Which statement made by the student nurse best describes this technique?

"I noticed that you pace the halls, and you have a tense look on your face. I sense that you are anxious about something."

A female client has been attending group therapy for support regarding an abusive relationship with her husband. The client voices concern about her 10-year-old daughter growing up in this environment but states that she just cant find the strength to leave her husband. The nurse responds by using the nontherapeutic technique of reassuring. Which statement is the best example of this nontherapeutic technique?

"I'm sure it won't be that bad to be out on your own. I know you can do it."

Which nurse responses could block effective communication with a client? (Select all that apply.)

"This is what I think you should say..." Don't stress over it. EveGryRthAinDgEwSiLllAtuBrn.oCuOt Mfine." Why did you do that?" Most people in your circumstance..."

A nurse is working with a male client in a mental health outpatient clinic. The client voices a desire to become more autonomous. Which goal will assist the client in becoming more autonomous?

. The client will check his calendar each night to plan for commitments scheduled on the following day.

Lithium levels are considered toxic when they become higher than __________ mEq/L.

1.5

During client teaching, the nurse must inform the client prescribed a tricyclic antidepressant (TCA) to not expect to see a difference in mood or anxiety level for up to:

2-3 weeks

A client complains to the nurse that he has been fired from his fourth job in 10 months because his bosses and co-workers didnt understand him. While he once had a few close friends, he no longer associates with them for the same reason. His level of functioning on the global assessment of functioning (GAF) scale would be:

41-50; serious symptoms

Upon entrance into a mental health care system, clients are thoroughly assessed, and this is followed by the development of a mental health treatment plan. Which of the following are purposes of the treatment plan? (Select all that apply.)

A means of monitoring the clients progress An instrument for communication and coordination of care A guide for planning and implementation of care Evaluating the effectiveness of interventions

_______ is how the client displays his or her emotions through facial, vocal, or gestural behavior.

Affect

While completing the history portion of an admission assessment of a client with schizophrenia, the nurse notices that the client is continually moving in the chair and frequently stands, then sits back down. The nurse knows that this client most likely is experiencing the side effect of:

Akathisia

One of the goals of therapy established with a client on a mental health unit who has been given a diagnosis of obsessive-compulsive disorder (OCD) is to improve his feelings of stability in his environment. Much of his OCD behavior manifests as cleanliness and control of germs. Which nursing intervention most likely would help this client to feel more stable in his environment?

Allowing him to wash his hands only for an agreed upon number of times daily

Following completion of a male clients series of group therapy sessions, the nurse periodically talks with the client to determine whether he has any signs of relapse of his previous problems. This action by the nurse is an example of:

Assessment

A nurse is trying to develop trust with a client on an inpatient mental health unit. Which action by the nurse is going to best promote development of a mutually trusting relationship?

At the beginning of the shift, the nurse promises to play a game of cards with the client at some point during that day and does so before the end of the shift.

During an interview with a 15-year-old female client admitted for depression, the nurse expresses her disappointment when she to learns that the client recently became pregnant and then had an abortion. The nurse is contradicting the effective interview guideline of:

Avoiding ones personal values that may cloud professional judgment

An important component of providing good care is for health caregivers to take care of, or nurture, themselves. Which of the following are ways that effectively assist health caregivers to nurture themselves? (Select all that apply.)

Be supportive of colleagues. Recognize and accept ones own limitations, and strive to improve. Take pride in oneself. Be responsible and accountable for ones own actions.

When practicing therapeutic communication with a client, the nurse demonstrates which of the following listening skills?

Changing the environment to decrease distractions

A male client with the diagnosis of depression has not attended his last two group meetings. The nurse provides a printed schedule of meeting dates and times to the client the next time she sees him. The nurses actions can be described as:

Client advocacy

The nurse suspects the client is experiencing a manic episode based on which of the following observations?

Clothing is very colorful and mismatched, and client cannot sit in chair during interview.

________ coping mechanisms are means of successfully solving a problem or reducing ones stress level.

Constructive

. A male client with schizophrenia has lost his job and home and has been living in a homeless shelter. He voluntarily admits himself into a mental health treatment facility. The client's current living situation and lack of a job at this time likely will contribute to his having difficulty with which dimension of hope?

Contextual

The nurse is reviewing information regarding a female client that was obtained with the psychiatric assessment tool. The clients ability to provide food and shelter for herself is included in which area of the assessment?

Coping responses, discharge planning needs

The nurse is talking with a male client regarding his recent relapse of alcohol addiction. The client alludes to the fact that he started to drink again after a fight with his wife. The nurse uses clarification to ensure an accurate understanding of the client. Which statement is the best example of clarification?

Could you tell me again when and what happened that you feel caused you to start drinking again?

Clients diagnosed with Type Ipositive schizophrenic symptoms respond better to antipsychotic medications. Manifestations of Type I schizophrenia include which of the following? (Select all that apply.)

Delusions Hallucinations Illusions

Short-term memory loss is seen in which of the following disorders? (Select all that apply.)

Depression Alzheimers disease Anxiety

The nurse is working with a health care team with that believes in the philosophy of reality therapy. The nurse is aware that the teams belief is centered around:

Describing clients as irresponsible rather than mentally ill

A male client with a diagnosis of schizophrenia begins to have hallucinations during a conversation with the nurse; this prevents him from receiving the message that the nurse is trying to communicate to him. According to Rueschs theory of communication, this unsuccessful interaction is called _____ communication.

Disturbed

A female client discusses her feelings of jealousy regarding the relationship between her mother and her daughter. The nurse responds in a nontherapeutic way by making a statement that is defensive and challenging. Which statement is the best example of a defensive and challenging nontherapeutic response?

Dont you think that you should be thankful that your daughter has a good relationship with her grandmother?

During the sociocultural assessment of a client who is entering a mental health program, the nurse focuses on which information related to the client? (Select all that apply.)

Education Income Ethnicity Age Gender Belief system

A female client calls the clinic for advice after forgetting to take her morning dose of twice-daily lithium 5 hours ago. Which instructions should the nurse give the client?

Eliminate the dose missed, and take the second dose at the normal time.

A male client with schizophrenia lives in an assisted-living complex for individuals with mental health disorders. He is tired of the Parkinson-like symptoms he experiences with his antipsychotic medication and therefore stops taking his medication after much discussion with his treatment team. He is progressively withdrawing from reality but is not a safety risk at this point to himself or others. What is the best response of the nurse and treatment team?

Ensure that the client and those around him are safe, and monitor for additional symptoms of his schizophrenia while maintaining trust with the client

During a session with a female client with a diagnosis of social phobia, she talks about how proud she is of herself because she was finally able to shop at the grocery store. The nurse documents the events and knows that this would be considered which phase of the nursing process?

Evaluation

__________ side effects can occur when antipsychotic medications are taken that manifest as abnormal movements such as akathisia and pseudo-Parkinson symptoms.

Extrapyramidal

Valium is administered to a client anxious about impending surgery. Which of the following side effects is the client at risk for?

Falls

Which elements must be present for communication to occur? (Select all that apply.)

Feedback Transmission Sender Receiver Context

Which is the best way that a nursing unit manager can assist his or her staff in maintaining a professional commitment to their job and profession?

Frequently offering and requiring a specific number of hours of in-service training on new care modalities within the facility

The nurse is working with a male client to instill a feeling of self-commitment to improve his self-esteem. From which of the following interventions would the client most benefit?

Having the client promise himself that he will do the best he can in a particular situation, knowing that failure is a possibility

An adolescent female client continually displays a negative attitude toward everyone she comes into contact with and toward life in general. Which action should the nurse implement first that will be helpful in assisting this client to develop a more positive attitude?

Helping the client recognize negative thoughts, emotions, and attitudes

A caregiver is said to be practicing __________ care not only when she takes into consideration the clients actual or potential problems but also when she considers the clients family, work responsibilities, and social aspects of life.

Holistic

Without assessment of six specific aspects of an individuals being, the mental health nurses scope of care is narrow and limited in effectiveness. These aspects include social, physical, cultural, intellectual, emotional, and spiritual areas of a persons life, known as a(n) __________ assessment.

Holistic

When educating the client being treated with lithium, which item in their diet should be monitored or avoided?

Hot dogs and ham

A score of 1 to 10 on the global assessment functioning (GAF) scale would indicate that a client was at risk for:

Hurting himself or others

A nurse and an adolescent female client develop a plan of care together that addresses the clients difficult relationship with her parents. The client says that her parents just dont understand her, and she is always getting privileges taken away for not doing things that she is supposed to do. What is the nurses best action?

Identify two priority responsibilities that are agreed upon between the client and her parents, and monitor her ability to comply with the plan for 1 week.

A client with a history of delusions demonstrates which of the following behaviors?

Insists the government is out to harm them

The assessment phase of the nursing process refers to the phase when data collection occurs. Which methods does the nurse use to collect data? (Select all that apply.)

Interviewing the client and significant others Observing client behavior Performing physical assessment Reviewing diagnostic testing results

Therapeutic communication techniques support effective communication between the client and the nurse. Which group of therapeutic techniques is most likely to be effective when one is conversing with a client?

Listening, silence, and reflection

When asking the adolescent client about the magazine she is reading, she responds, "It's an article about my favorite movie star. Did you see all the stars out last night? I used to be afraid of the dark at night." Which speech pattern is this an example of?

Loose association

Which of the following are basic responsibilities of nurses who administer psychotherapeutic drugs? (Select all that apply.)

Monitoring and evaluating the clients response to the medication Continually assessing the clients condition Assisting in the coordination of the clients care Teaching clients about their medications Administering prescribed medications

According to the DSM-IV-TR Axis guidelines, clinical disorders are described as:

Mood disorder, substance abuse, and schizophrenic disorders

__________ is a side effect that can occur while a client is taking an antipsychotic medication, causing muscle rigidity, high fever, unstable vital signs, confusion, and agitation.

Neuroleptic Malignant Syndrome (NMS)

The CMA is administering an antianxiety medication to a client. Monitoring side effects is the responsibility of which member of the health care team?

Nurse

A married woman, who is the mother of two children, has been in an abusive relationship for 4 years. She decides to leave her husband after suffering an episode of severe physical abuse. She and her children, ages 7 and 9, arrive at a crisis intervention center. What is the nurses priority intervention?

Offer immediate emotional support.

A client seen in the emergency department is noted to be stuporous. Which of the following assessment findings would be of most concern?

Painting furniture in a windowless room

Careful assessment for changes in attitude and suicidal gestures should be monitored in a client taking which medication?

Paxil (paroxetine)

A male client with a history of schizophrenia was admitted to the mental health facility after he was found on the street in a confused state and was uncooperative when approached by the police. One of the first assessments that should be performed on this client upon admission is a _____ assessment.

Physical

The treatment team meets with a client for the first time and determines, with the clients input, a nursing diagnosis, goal, and steps to reach this goal. In addition to a nursing diagnosis, the treatment team has completed which phase of the nursing process?

Planning

A female client is being discharged from an inpatient mental health unit after receiving treatment for bipolar disorder. She has responded well to treatment but voices concern about going home and maintaining balance in her life. The client would benefit most by a response from the nurse that conveyed the therapeutic communication principle of:

Protection

A recently widowed 74-year-old male is seen in the mental health clinic for sleep disorders and depression. Which of the following nursing actions demonstrate caring? (Select all that apply.)

Providing a private place to interview the client Delegating other tasks to a colleague while speaking to the client Asking about his daily activities and hobbies during the interview

A client with frequent re-admissions to the inpatient unit refuses to eat or participate in activities. The nurse functions as the client advocate by which of the following actions?

Providing consistent encouragement to attend activities and having food available

A busy community mental health center treats a client who is in crisis. The client is provided with instruction on relaxation exercises, but throws them away. Two weeks later the staff is dismayed when the client returns with her condition worsened. This lack of success after the previous visit is due to which of the following factors?

Pseudoresolution

Psychotropic medications can cause a parasympathetic and/or sympathetic response from the autonomic nervous system. Which of the following is considered a sympathetic response?

Pupil dilation

Identify the stages experienced by a person in a crisis. (Select all that apply.)

Recovery Disorganization Crisis Denial Reorganization Perception

The nurse is administering medications to a client with a diagnosis of paranoid schizophrenia. The nurse would expect to see which medication ordered for this client?

Risperdal

A female client is 3 days postoperative and has been receiving meperidine (Demerol) for pain control. The family mentions to the nurse that the client has been taking phenelzine (Nardil) for years for her depression. The client did not list this medication on admission. What signs and symptoms should the nurse look for in case of reaction between these two medications?

Sedation, disorientation, and hallucinations

In order to be therapeutic when communicating with a client living in a homeless shelter is important to apply which techniques? (Select all that apply.)

Show acceptance and respect. Consider the client's environment. Assess the client's pattern of verbal and nonverbal communication.

Which of the following are signs that indicate that the mental health nurse is becoming overly involved with a clients care? (Select all that apply.)

Showing greater levels of concern for one client over all other clients Feeling that the nurse is the only caregiver who understands the client

Selective serotonin reuptake inhibitors (SSRIs) are most health care providers drug of choice for the treatment of depression because:

Side effects are more manageable than with most antidepressants.

In preparing discharge planning for a client who has been prescribed lithium for the treatment of bipolar disorder, the nurse must be sure that the client demonstrates an understanding of the need to monitor his or her diet for intake of:

Sodium

A client has difficulty in communicating as a result of his illness. He displays a rapid, confusing delivery of speech patterns. Which term best describes this difficulty in communicating?

Speech cluttering

An adult female client is exhibiting behavior that the nurse interprets as anger toward another client. What is the nurses best action?

Talk with the client about the observations made, and ask whether she was displaying anger toward the other client.

The nurse is developing a teaching plan for a client who has been diagnosed recently with a mental health disorder and has been prescribed a psychotropic medication. Which interventions regarding the medication should the nurse include in the teaching plan? (Select all that apply.)

Teach signs and symptoms of side effects and what to do if these occur. Provide written information regarding the purpose, dosage, route, and dosing schedule. Ask the client and significant other to verbally explain when it is necessary to contact the physician should side effects occur.

A client is believed to have adapted to a situation when he or she exhibits which characteristic?

The client has shown improvement in behavior as evidenced by the ability to carry out activities normal to his or her life.

Which interventions assist the nurse to effectively communicate with clients from other cultures? (Select all that apply.)

The nurse adapts his or her behavior to accommodate the difference in communication styles. The nurse identifies and clarifies confusion during the interaction.

An adult female client becomes combative with the nurse during routine medication administration. What is the nurses primary responsibility in this situation?

To ensure that the client is kept safe while trying to protect staff safety and to reason with the client to try to de-escalate the combative behavior

While the nurse is talking with a female client, the client becomes silent for several seconds. Which is the nurses best response?

To remain silent and be attentive to the clients nonverbal communication

Place in proper chronological order the steps in the process of growing as a result of failure.

Understand that failure is a necessary part of change. Give oneself permission to fail. Consider ones failure as a learning experience. Discover opportunities that are created by failure.

The nurse is talking with a male client with a diagnosis of schizophrenia who often experiences auditory hallucinations. For this communication to be most effective, the nurse should:

Use simple, concrete language.

The client tells the nurse that she believes there is no improvement in her manic episodes. Her clothing matches and her makeup is more subdued. She sits quietly in the chair during the session. What does this indicate?

Verbal communication is not congruent with nonverbal communication.

The night before her final exam, the nursing student cannot sleep, and is convinced she will fail. Which of the following actions will help to promote a more positive outlook?

Visualize staying relaxed during the exam and successfully passing.

The nurse is caring for a female client with a diagnosis of severe bipolar disorder. Out of many treatment methods, the one treatment that the client and the team have found to be most effective is the medication lithium. The client voices concern about her future with this diagnosis. Which nurse response best represents the concept of hope?

You are doing very well since we found that lithium helps. You should do well as long as you continue your therapy and medication.

A client who usually is very active in her therapy group tells the nurse that she really does not feel well today and would rather not attend the group therapy session. Which is the nurses most appropriate response?

You don't feel like attending the group therapy today?"

A client is monopolizing a group session, not allowing other members to participate. What is the most appropriate way to address the client?

You need to stop this behavior. Let's see what others have to say.

The four classes of psychotherapeutic medications include antianxiety agents, antidepressants, antimanics, and __________.

antipsychotics

An important aspect of developing a therapeutic relationship with a mental health client is for the nurse to show that she cares about the client. The nurse who is working on an inpatient unit can show signs of caring by:

asking a client what his or her favorite movie is and then showing that movie during a movie night on the unit.

The nurse asks the client a series of questions upon entry into a mental health care system. This action is an example of which phase of the nursing process?

assessment

A male client with the diagnosis of depression is taking a monoamine oxidase inhibitor (MAOI). Which is the most important teaching point the nurse must include in his care plan?

avoid alcoholic beverages

The __________ constitute a class of drugs that are commonly prescribed for cardiac arrhythmias but also have been found to be effective treatment for social phobias.

beta blockers

The nurse asks a client how she is feeling, and the client provides a detailed description of everything she is experiencing. This is an example of:

circumstantiality.

______ mechanisms are thoughts or actions that are used to help individuals handle or reduce stress.

coping

During the mental status examination, the nurse observes that the client rapidly changes from one idea to another related thought. Which disordered thinking process is the client displaying?

flight of ideas

An adult female client has been diagnosed recently with mild depression but opts not to take the medication prescribed by her physician after talking with the physician about the benefits, risks, possible outcomes, and side effects. She decides to investigate alternative treatments. This client is making this decision based on the premise of:

informed consent

A nurse administers antidepressant medication to a client in an assisted-living facility. This is an example of which phase of the nursing process?

intervention

The nurse is aware that he or she may be administering the new antianxiety medication pregabalin (Lyrica) to clients without an anxiety disorder for the purpose of treating:

neuropathic pain

A female client who has had bipolar disorder for several years decides to stop all of her medications because she is tired of the side effects. She also cancels all appointments with her therapist, stating that it is just too difficult to plan the visits in her hectic schedule. This client is considered:

noncompliant

A nurse has just graduated from nursing school and has been hired on a mental health unit. The nurse wants to practice good communication skills with clients but knows that a mistake made by many new nurses in trying to communicate effectively involves:

parroting

The theorist Eric Berne theorized that an individuals three ego states of parent, child, and adult make up ones:

personality

During the mental status assessment, the nurse hands the client a piece of paper that reads Please raise your left hand. If the client follows the command, the nurse has just assessed which ability of the client?

reading

The nurse's ability to interpret communication effectively in the mental health setting depends mostly on:

the nurse's ability to listen to and observe the client's verbal and nonverbal messages.