Mental Health Exam 1
When a new bill introduced in Congress reduces funding for care of persons with mental illness, a group of nurses writes letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Recovery c. Advocacy b. Attending d. Evidence-based practice
C
The nurse should assess a patient taking a drug with anticholinergic properties for inhibited function of the: a. parasympathetic nervous system. c. reticular activating system. b. sympathetic nervous system. d. medulla oblongata.
a
A patients sibling says, My brother has a mental illness, but the doctor ordered a functional magnetic resonance image (fMRI) test. That test is too expensive and will just increase the hospital bill. Select the nurses best responses. Select all that apply. a. Sometimes there are physical causes for psychiatric symptoms. This test will help us understand whether that is the situation. b. Some mental illnesses are evident on fMRIs. This test will give information to help us plan the best care for your brother. c. Tell me more about what kinds of tests your brothers health insurance plan covers. d. It sounds like you do not truly believe your brother had a mental illness. e. It would be better for you to discuss your concerns with the doctor.
A,b
An individual is experiencing problems with memory. Which of these structures are most likely to be involved in this deficit? Select all that apply. a. Amygdala b. Hippocampus c. Occipital lobe d. Temporal lobe e. Basal ganglia
A,b,d
A nurse prepares to administer a second-generation antipsychotic medication to a patient diagnosed with schizophrenia. Additional monitoring for adverse effects will be most important if the patient has which co-morbid health problems? Select all that apply. a. Parkinsons disease b. Graves disease c. Hyperlipidemia d. Osteoarthritis e. Diabetes
A,c,e
Which comment best indicates that a patient perceived the nurse was caring? My nurse: a. always asks me which type of juice I want to help me swallow my medication. b. explained my treatment plan to me and asked for my ideas about how to make it better. c. spends time listening to me talk about my problems. That helps me feel like I am not alone. d. told me that if I take all the medicines the doctor prescribes, then I will get discharged sooner.
C
In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill? One who: a. describes hearing Gods voice speaking. b. is usually pessimistic but strives to meet personal goals. c. is wealthy and gives away $20 bills to needy individuals. d. always has an optimistic viewpoint about life and having own needs met.
a
The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3. Select the nurses best action. a. Report the results to the health care provider immediately. b. Administer the next dose as prescribed. c. Give aspirin and force fluids. d. Repeat the laboratory test.
a
A drug causes muscarinic receptor blockade. The nurse will assess the patient for: a. dry mouth. c. pseudoparkinsonism. b. gynecomastia. d. orthostatic hypotension.
a
A nurse cares for four patients who are receiving clozapine, lithium, fluoxetine, and venlafaxine, respectively. With which patient should the nurse be most alert for problems associated with fluid and electrolyte imbalance? The patient receiving: a. lithium (Lithobid). c. fluoxetine (Prozac). b. clozapine (Clozaril). d. venlafaxine (Effexor).
a
An obese patient has a diagnosis of schizophrenia. Medications that block which receptors would contribute to further weight gain? a. H1 c. Acetylcholine b. 5 HT2 d. Gamma-aminobutyric acid (GABA)
a
The nurse administers a medication that potentiates the action of gamma-aminobutyric acid (GABA). Which effect would be expected? a. Reduced anxiety c. More organized thinking b. Improved memory d. Fewer sensory perceptual alterations
a
Which finding best indicates that the goal Demonstrate mentally healthy behavior was achieved? A patient: a. sees self as capable of achieving ideals and meeting demands. b. behaves without considering the consequences of personal actions. c. aggressively meets own needs without considering the rights of others. d. seeks help from others when assuming responsibility for major areas of own life.
a
An experienced nurse says to a new graduate, When youve practiced as long as I have, you instantly know how to take care of psychotic patients. What information should the new graduate consider when analyzing this comment? Select all that apply. a. The experienced nurse may have lost sight of patients individuality, which may compromise the integrity of practice. b. New research findings should be integrated continuously into a nurses practice to provide the most effective care. c. Experience provides mental health nurses with the essential tools and skills needed for effective professional practice. d. Experienced psychiatric nurses have learned the best ways to care for mentally ill patients through trial and error. e. An intuitive sense of patients needs guides effective psychiatric nurses.
a,b
Which findings are signs of a person who is mentally healthy? Select all that apply. a. Says, I have some weaknesses, but I feel Im important to my family and friends. b. Adheres strictly to religious beliefs of parents and family of origin. c. Spends all holidays alone watching old movies on television. d. Considers past experiences when deciding about the future. e. Experiences feelings of conflict related to changing jobs.
a,d,e
10. Complete this analogy. NANDA: clinical judgment: NIC: _________________ a. patient outcomes c. diagnosis b. nursing actions d. symptoms
b
A drug blocks the attachment of norepinephrine to a1 receptors. The patient may experience: a. hypertensive crisis. c. severe appetite disturbance. b. orthostatic hypotension. d. an increase in psychotic symptoms.
b
A nurse caring for a patient taking a selective serotonin reuptake inhibitor (SSRI) will develop outcome criteria related to: a. coherent thought processes. c. reduced levels of motor activity. b. improvement in depression. d. decreased extrapyramidal symptoms.
b
A nurse encounters an unfamiliar psychiatric disorder on a new patients admission form. Which resource should the nurse consult to determine criteria used to establish this diagnosis? a. International Statistical Classification of Diseases and Related Health Problems (ICD-10) b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) c. A behavioral health reference manual d. Wikipedia
b
A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information? a. Nursing Outcomes Classification (NOC) b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) c. The ANAs Psychiatric-Mental Health Nursing Scope and Standards of Practice d. International Statistical Classification of Diseases and Related Health Problems (ICD-10)
b
A nurse would anticipate that treatment for a patient with memory difficulties might include medications designed to: a. inhibit gamma-aminobutyric acid (GABA). b. prevent destruction of acetylcholine. c. reduce serotonin metabolism. d. increase dopamine activity.
b
A patient diagnosed with bipolar disorder has an unstable mood, aggressiveness, agitation, talkativeness, and irritability. The nurse expects the health care provider to prescribe a medication from which group? a. Psychostimulants c. Anticholinergics b. Mood stabilizers d. Antidepressants
b
A patient has disorganized thinking associated with schizophrenia. Neuroimaging would likely show dysfunction in which part of the brain? a. Hippocampus c. Cerebellum b. Frontal lobe d. Brainstem
b
A patient has fear as well as increased heart rate and blood pressure. The nurse suspects increased activity of which neurotransmitter? a. Gamma-aminobutyric acid (GABA) c. Acetylcholine b. Norepinephrine d. Histamine
b
A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. Which drug action causes these symptoms to develop? a. Anticholinergic effects c. Endocrine-stimulating effects b. Dopamine-blocking effects d. Ability to stimulate spinal nerves
b
A patient with a long history of hypertension and diabetes now develops confusion. The health care provider wants to make a differential diagnosis between Alzheimers disease and multiple infarcts. Which diagnostic procedure should the nurse expect to prepare the patient for first? a. Skull x-rays b. Computed tomography (CT) scan c. Positron-emission tomography (PET) d. Single-photon emission computed tomography (SPECT)
b
A professional football player is seen in the emergency department after losing consciousness from an illegal block. Prior to discharge, the nurse assists the patient to schedule an outpatient computed tomography (CT) scan for the next day. Which strategy should the nurse use to ensure the patient remembers the appointment? a. Write the appointment day, time, and location on a piece of paper and give it to the player. b. Log the appointment day, time, and location into the players cell phone calendar feature. c. Ask the health care provider to admit the patient to the hospital overnight. d. Verbally inform the patient of the appointment day, time, and location.
b
A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional intervention? a. Conduct mental health assessments. c. Establish therapeutic relationships. b. Prescribe psychotropic medication. d. Individualize nursing care plans.
b
By which mechanism do selective serotonin reuptake inhibitors (SSRI) improve depression? a. Destroying increased amounts of serotonin b. Making more serotonin available at the synaptic gap c. Increasing production of acetylcholine and dopamine d. Blocking muscarinic and a1 norepinephrine receptors
b
Consider these medications: carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin). Which medication below also belongs with this group? a. Galantamine (Reminyl) c. Buspirone (BuSpar) b. Valproate (Depakote) d. Tacrine (Cognex)
b
The nurse prepares to assess a patient diagnosed with major depression for disturbances in circadian rhythms. Which question should the nurse ask this patient? a. Have you ever seen or heard things that others do not? b. What are your worst and best times of the day? c. How would you describe your thinking? d. Do you think your memory is failing?
b
The parent of an adolescent diagnosed with schizophrenia asks the nurse, My childs doctor ordered a PET. What kind of test is that? Select the nurses best reply. a. This test uses a magnetic field and gamma waves to identify problem areas in the brain. Does your teenager have any metal implants? b. PET means positron-emission tomography. It is a special type of scan that shows blood flow and activity in the brain. c. A PET scan passes an electrical current through the brain and shows brain-wave activity. It can help diagnose seizures. d. Its a special x-ray that shows structures of the brain and whether there has ever been a brain injury.
b
The therapeutic action of neurotransmitter inhibitors that block reuptake cause: a. decreased concentration of the blocked neurotransmitter in the central nervous system. b. increased concentration of the blocked neurotransmitter in the synaptic gap. c. destruction of receptor sites specific to the blocked neurotransmitter. d. limbic system stimulation.
b
When a nursing student expresses concerns about how mental health nurses lose all their nursing skills, the best response by the mental health nurse is: a. Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of the patients problems. b. Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations. c. Thats a misconception. Psychiatric nurses frequently use high technology monitoring equipment and manage complex intravenous therapies. d. Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That appeals to me.
b
Which assessment finding most clearly indicates that a patient may be experiencing a mental illness? The patient: a. reports occasional sleeplessness and anxiety. b. reports a consistently sad, discouraged, and hopeless mood. c. is able to describe the difference between as if and for real. d. perceives difficulty making a decision about whether to change jobs.
b
Which component of treatment of mental illness is specifically recognized by Quality and Safety Education for Nurses (QSEN)? a. All genomes are unique. b. Care is centered on the patient. c. Healthy development is vital to mental health. d. Recovery occurs on a continuum from illness to health.
b
Which instruction has priority when teaching a patient about clozapine (Clozaril)? a. Avoid unprotected sex. b. Report sore throat and fever immediately. c. Reduce foods high in polyunsaturated fats. d. Use over-the-counter preparations for rashes.
b
Questions the nurse could ask that would be nonjudgmental when obtaining information about patient use of herbal remedies include: (select all that apply) a. You dont regularly take herbal remedies, do you? b. What herbal medicines have you used to relieve your symptoms? c. What over-the-counter medicines and nutritional supplements do you use? d. What differences in your symptoms do you notice when you take herbal supplements? e. Have you experienced problems from using herbal and prescription drugs at the same time?
b,c,d,e
A patient in the emergency department says, Voices say someone is stalking me. They want to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a threat. Which aspects of the patients mental health have the greatest and most immediate concern to the nurse? Select all that apply. a. Happiness b. Appraisal of reality c. Control over behavior d. Effectiveness in work e. Healthy self-concept
b,c,e
A category 5 tornado occurred in a community of 400 people resulting in destruction of many homes and businesses. In the 2 years after this disaster, 140 individuals were diagnosed with posttraumatic stress disorder (PTSD). Which term best applies to these newly diagnosed cases? a. Prevalence c. Incidence b. Co-morbidity d. Parity
c
A nurse can anticipate anticholinergic side effects are likely when a patient takes: a. lithium (Lithobid). c. imipramine (Tofranil). b. buspirone (BuSpar). d. risperidone (Risperdal).
c
A nurse cares for a group of patients receiving various medications, including haloperidol (Haldol), carbamazepine (Tegretol), trazodone (Desyrel), and phenelzine (Nardil). The nurse will order a special diet for the patient who takes: a. carbamazepine. c. phenelzine. b. haloperidol. d. trazodone.
c
A nurse instructs a patient taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of: a. cardiac dysrhythmia. c. hypertensive crisis. b. hypotensive shock. d. hypoglycemia.
c
A patient is hospitalized for severe depression. Of the medications listed below, the nurse can expect to provide the patient with teaching about: a. chlordiazepoxide (Librium). c. sertraline (Zoloft). b. clozapine (Clozaril). d. tacrine (Cognex).
c
The spouse of a patient diagnosed with schizophrenia says, I dont understand how events from childhood have anything to do with this disabling illness. Which response by the nurse will best help the spouse understand the cause of this disorder? a. Psychological stress is the basis of most mental disorders. b. This illness results from developmental factors rather than stress. c. Research shows that this condition more likely has a biological basis. d. It must be frustrating for you that your spouse is sick so much of the time.
c
Which disorder is a culture-bound syndrome? a. Epilepsy c. Running amok b. Schizophrenia d. Major depression
c
18. A nurse is part of a multidisciplinary team working with groups of depressed patients. Half the patients receive supportive interventions and antidepressant medication. The other half receives only medication. The team measures outcomes for each group. Which type of study is evident? a. Incidence c. Co-morbidity b. Prevalence d. Clinical epidemiology
d
A citizen at a community health fair asks the nurse, What is the most prevalent mental disorder in the United States? Select the nurses best response. a. Schizophrenia c. Dissociative fugue b. Bipolar disorder d. Alzheimers disease
d
A patient asks, What are neurotransmitters? The doctor said mine are imbalanced. Select the nurses best response. a. How do you feel about having imbalanced neurotransmitters? b. Neurotransmitters protect us from harmful effects of free radicals. c. Neurotransmitters are substances we consume that influence memory and mood. d. Neurotransmitters are natural chemicals that pass messages between brain cells.
d
A patient begins therapy with a phenothiazine medication. What teaching should the nurse provide related to the drugs strong dopaminergic effect? a. Chew sugarless gum. c. Arise slowly from bed. b. Increase dietary fiber. d. Report changes in muscle movement.
d
A patient has acute anxiety related to an automobile accident 2 hours ago. The nurse should teach the patient about medication from which group? a. Tricyclic antidepressants c. Antimanic drugs b. Antipsychotic drugs d. Benzodiazepines
d
A patient tells the nurse, My doctor prescribed Paxil (paroxetine) for my depression. I assume Ill have side effects like I had when I was taking Tofranil (imipramine). The nurses reply should be based on the knowledge that paroxetine is a(n): a. selective norepinephrine reuptake inhibitor. b. tricyclic antidepressant. c. MAO inhibitor. d. SSRI.
d
A patients history shows drinking 4 to 6 liters of fluid and eating more than 6,000 calories per day. Which part of the central nervous system is most likely dysfunctional for this patient? a. Amydala c. Hippocampus b. Parietal lobe d. Hypothalamus
d
A patients relationships are intense and unstable. The patient initially idealizes the significant other and then devalues him or her, resulting in frequent feelings of emptiness. This patient will benefit from interventions to develop which aspect of mental health? a. Effectiveness in work c. Productive activities b. Communication skills d. Fulfilling relationships
d
An individual hiking in the forest encounters a large poisonous snake on the path. Which change in this individuals vital signs is most likely? a. Pulse rate changes from 90 to 72. b. Respiratory rate changes from 22 to 18. c. Complaints of intestinal cramping begin. d. Blood pressure changes from 114/62 to 136/78.
d
Select the best response for the nurse who receives a question from another health professional seeking to understand the difference between a Diagnostic and Statistical Manual of Mental Disorders (DSM-5) diagnosis and a nursing diagnosis. a. There is no functional difference between the two. Both identify human disorders. b. The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis takes culture into account. c. The DSM-5 diagnosis describes causes of disorders whereas a nursing diagnosis does not explore etiology. d. The DSM-5 diagnosis guides medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for issues a patient is experiencing.
d
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies: a. deviant behaviors. c. people with mental disorders. b. present disability or distress. d. mental disorders people have.
d
Which belief will best support a nurses efforts to provide patient advocacy during a multidisciplinary patient care planning session? a. All mental illnesses are culturally determined. b. Schizophrenia and bipolar disorder are cross-cultural disorders. c. Symptoms of mental disorders are unchanged from culture to culture. d. Assessment findings in mental disorders reflect a persons cultural patterns.
d
Which individual is demonstrating the highest level of resilience? One who: a. is able to repress stressors. b. becomes depressed after the death of a spouse. c. lives in a shelter for two years after the home is destroyed by fire. d. takes a temporary job to maintain financial stability after loss of a permanent job.
d
Which nursing intervention below is part of the scope of an advanced practice psychiatric/mental health nurse only? a. Coordination of care c. Milieu therapy b. Health teaching d. Psychotherapy
d
. A college student said, Most of the time Im happy and feel good about myself. I have learned that what I get out of something is proportional to the effort I put into it. Which number on this mental health continuum should the nurse select? Mental Illness Mental Health 1 2 3 4 5 a. 1 b. 2 c. 3 d. 4 e. 5
e