Mental Health Exam 2 Study Guide

A voluntarily hospitalized patient tells the nurse, Get me the forms for discharge. I want to leave now. Select the nurses best response

I will get them for you, but lets talk about your decision to leave treatment.

A patient says, Please dont share information about me with the other people. How should the nurse respond?

I will not share information with your family or friends without your permission, but I share information about you with other staff.

An adolescent hospitalized after a violent physical outburst tells the nurse, Im going to kill my father, but you cant tell anyone. Select the nurses best response.

I am obligated to share that information with the treatment team.

A patient tells the nurse, I will never be happy until Im as successful as my older sister. The nurse asks the patient to reassess this statement and reframe it. Which reframed statement by the patient is most likely to promote coping?

I can find contentment in succeeding at my own job level.

A patient cries as the nurse explores the patients feelings about the death of a close friend. The patient sobs, I shouldnt be crying like this. It happened a long time ago. Which responses by the nurse facilitate communication?Select all that apply.

I can see that you feel sad about this situation. The loss of a close friend is very painful for you. Crying is a way of expressing the hurt you are experiencing.

According to the Recent Life Changes Questionnaire, which situation would most necessitate a complete assessment of a persons stress status and coping abilities?

A person returning to college after an employer ceased operations

A nurse is concerned that an agencys policies are inadequate. Which understanding about the relationship between substandard institutional policies and individual nursing practice should guide nursing practice?

Agency policies do not exempt an individual nurse of responsibility to practice according to professional standards of nursing care.

A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?

Am I correct in understanding that . .

A patient in alcohol rehabilitation reveals to the nurse, I feel terrible guilt for sexually abusing my 6-year-old before I was admitted. Select the nurses most important action.

Anonymously report the abuse by phone to the local child protection agency.

A community mental health nurse has worked with a patient for 3 years but is moving out of the city and terminates the relationship. When a novice nurse begins work with this patient, what is the starting point for the relationship?

Begin at the orientation phase.

Which documentation of a patients behavior best demonstrates a nurses observations?

Wore four layers of clothing. States, I need protection from evil bacteria trying to pierce my skin.

A nurse wants to demonstrate genuineness with a patient diagnosed with schizophrenia. The nurse should:

use congruent communication strategies.

Two hospitalized patients fight whenever they are together. During a team meeting, a nurse asserts that safety is of paramount importance, so treatment plans should call for both patients to be secluded to keep them from injuring each other. This assertion

violates the civil rights of both patient

A patient experiencing psychosis asks a psychiatric technician, Whats the matter with me? The technician replies, Nothing is wrong with you. You just need to use some self-control. The nurse who overheard the exchange should take action based on:

violation of the patients right to be treated with dignity and respect.

Which individual diagnosed with a mental illness may need involuntary hospitalization? An individual:

who takes 38 acetaminophen tablets after the persons stock portfolio becomes worthless

A new antidepressant is prescribed for an elderly patient with major depression, but the dose is more than the usual geriatric dose. The nurse should:

withhold the medication and confer with the health care provider.

A patient says, Ive done a lot of cheating and manipulating in my relationships. Select a nonjudgmental response by the nurse.

How do you feel about that?

At what point in the nurse-patient relationship should a nurse plan to first address termination?

During the orientation phase

A patient diagnosed with emphysema has severe shortness of breath and needs portable oxygen when leaving home. Recently the patient has reduced activity because of fear that breathing difficulty will occur. A nurse suggests using guided imagery. Which image should the patient be encouraged to visualize?

Feeling relaxed and taking regular deep breaths when leaving home

A nurse ends a relationship with a patient. Which actions by the nurse should be included in the termination phase? Select all that apply.

Focus dialogues with the patient on problems that may occur in the future. Help the patient express feelings about the relationship with the nurse.

Which descriptors exemplify consistency regarding nurse-patient relationships? Select all that apply.

Having the same nurse care for a patient on a daily basis Providing a schedule of daily activities to a patient Setting a time for regular sessions with a patient

During a one-on-one interaction with the nurse, a patient frequently looks nervously at the door. Select the best comment by the nurse regarding this nonverbal communication.

I notice you keep looking toward the door.

Which remark by a patient indicates passage from orientation to the working phase of a nurse-patient relationship?

I want to find a way to deal with my anger without becoming violent.

A nurse interacts with a newly hospitalized patient. Select the nurses comment that applies the communication technique of offering self.

Id like to sit with you for a while to help you get comfortable talking to me.

As a nurse escorts a patient being discharged after treatment for major depression, the patient gives the nurse a necklace with a heart pendant and says, Thank you for helping mend my broken heart. Which is the nurses best response?

Im glad I could help you, but I cant accept the gift. My reward is seeing you with a renewed sense of hope.

Which comments by a nurse demonstrate use of therapeutic communication techniques? Select all that apply.

Im glad you were able to tell me how you felt about your loss. I noticed your hands trembling when you told me about your accident.

A novice nurse tells a mentor, I want to convey to my patients that I am interested in them and that I want to listen to what they have to say. Which behaviors will be helpful in meeting the nurses goal? Select all that apply.

-Introducing self to a patient and identifying own role -Using facial expressions to convey interest and encouragement -Assuming an open body posture and sometimes mirror imaging

In which situations would a nurse have the duty to intervene and report? Select all that apply.

A peer tries to provide patient care in an alcohol-impaired state. A team member violates relationship boundaries with a patient.

Select the example of a tort.

A nurse gives a PRN dose of an antipsychotic drug to an agitated patient because the unit is short-staffed.

Which nursing intervention demonstrates false imprisonment?

A patient has been irritating and attention-seeking much of the day. A nurse escorts the patient down the hall saying, Stay in your room, or youll be put in seclusion.

Insurance will not pay for continued private hospitalization of a mentally ill patient. The family considers transferring the patient to a public hospital but expresses concern that the patient will not get any treatment if transferred. Select the nurses most helpful reply.

By law, treatment must be provided. Hospitalization without treatment violates patients rights.

A patient says to the nurse, I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadnt rested well. Which response should the nurse use to clarify the patients comment?

Can you give me an example of what you mean by stoned?

Which benefits are most associated with use of telehealth technologies? Select all that apply.

Cost savings for patients Maximize care management Access to services for patients in rural areas

A nurse assesses a confused older adult. The nurse experiences sadness and reflects, The patient is like one of my grandparentsso helpless. Which response is the nurse demonstrating?

Countertransference

A patient says, People should be allowed to commit suicide without interference from others. A nurse replies, Youre wrong. Nothing is bad enough to justify death. What is the best analysis of this interchange?

Differing values are reflected in the two statements.

A patient nervously says, Financial problems are stressing my marriage. Ive heard rumors about cutbacks at work; I am afraid I might get laid off. The patients pulse is 112/minute; respirations are 26/minute; and blood pressure is 166/88. Which nursing intervention will the nurse implement?

Direct the patient in slow and deep breathing via use of a positive, repeated word.

When a nurse asks a newly admitted patient to describe social supports, the patient says, My parents died last year and I have no family. I am newly divorced, and my former in-laws blame me. I dont have many friends because most people my age just want to go out drinking. Which action will the nurse apply?

Discuss how divorce support groups could increase coping and social support.

A patient diagnosed with schizophrenia tells the nurse, The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say. Which response by the nurse would be most therapeutic?

It sounds like youre concerned about your privacy

In a team meeting a nurse says, Im concerned about whether we are behaving ethically by using restraint to prevent one patient from self-mutilation, while the care plan for another self-mutilating patient requires one-on-one supervision. Which ethical principle most clearly applies to this situation?

Justice

A person in the community asks, Why arent people with mental illness kept in state institutions anymore? Select the nurses best response.

Less restrictive settings are available now to care for individuals with mental illness.

. A patient tells the nurse, I know that I should reduce the stress in my life, but I have no idea where to start. What would be the best initial nursing response?

Lets talk about what is going on in your life and then look at possible options.

An advanced practice nurse observes a novice nurse expressing irritability regarding a patient with a long history of alcoholism and suspects the new nurse is experiencing countertransference. Which comment by the new nurse confirms this suspicion?

My parents were alcoholics and often neglected our family.

The adult child of a patient diagnosed with major depression asks, Do you think depression and physical illness are connected? Since my fathers death, my mother has had shingles and the flu, but shes usually not one who gets sick. Which answer by the nurse best reflects current knowledge about psychoneuroimmunology?

Negative emotions and stress may interfere with the bodys ability to protect itself and can increase the likelihood of infection.

While talking with a patient diagnosed with major depression, a nurse notices the patient is unable to maintain eye contact. The patients chin lowers to the chest, while the patient looks at the floor. Which aspect of communication has the nurse assessed?

Nonverbal communication

A patient is brought to the Emergency Department after a motorcycle accident. The patient is alert, responsive, and diagnosed with a broken leg. The patients vital signs are pulse (P) 72 and respiration (R) 16. After being informed surgery is required for the broken leg, which vital sign readings would be expected?

P 80, R 20

A newly admitted acutely psychotic patient is a private patient of the medical director and a private-pay patient. To whom does the psychiatric nurse assigned to the patient owe the duty of care?

Patient

A patient with psychosis became aggressive, struck another patient, and required seclusion. Select the best documentation.

Patient pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At 1415 patient yelled, Ill punch anyone who gets near me, and struck another patient with fist. Physically placed in seclusion at 1420. Seclusion order obtained from MD at 1430.

A patient says, One result of my chronic stress is that I feel so tired. I usually sleep from 11:00 PM to 6:30 AM. I started setting my alarm to give me an extra 30 minutes of sleep each morning, but I dont feel any better and Im rushed for work. Which nursing response would best address the patients concerns?

Perhaps going to bed a half-hour earlier would work better than sleeping later.

As a nurse discharges a patient, the patient gives the nurse a card of appreciation made in an arts and crafts group. What is the nurses best action?

Recognize the effectiveness of the relationship and patients thoughtfulness. Accept the card.

Which issues should a nurse address during the first interview with a patient with a psychiatric disorder?

Relationship parameters, the contract, confidentiality, and terminatio

Which action by a nurse constitutes a breach of a patients right to privacy?

Releasing information to the patients employer without consent

When a female Mexican American patient and a female nurse sit together, the patient often holds the nurses hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behavior. Which analysis is most accurate?

The patient is accustomed to touch during conversation, as are members of many Hispanic subcultures.

Which technique will best communicate to a patient that the nurse is interested in listening?

Restating a feeling or thought the patient has expressed.

A novice psychiatric nurse has a parent with bipolar disorder. This nurse angrily recalls feelings of embarrassment about the parents behavior in the community. Select the best ways for this nurse to cope with these feelings.Select all that apply.

Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses. Recognize that the feelings may add sensitivity to the nurses practice, but supervision is important.

Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions?

Silence can provide meaningful moments for reflection.

A recent immigrant from Honduras comes to the clinic with a family member who has been a U.S. resident for 10 years. The family member says, The immigration to America has been very difficult. Considering cultural background, which expression of stress by this patient would the nurse expect?

Somatic complaints

A nurse prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot) to an outpatient with schizophrenia. As the nurse swabs the site, the patient shouts, Stop! I dont want to take that medicine anymore. I hate the side effects. Select the nurses best action.

Stop the medication administration procedure and say to the patient, Tell me more about the side effects youve been having.

A patient newly diagnosed as HIV-positive seeks the nurses advice on how to reduce the risk of infections. The patient says, I used to go to church and I was in my best health then. Maybe I should start going to church again. Which response will the nurse offer?

Studies show that spiritual practices can enhance immune system function and coping abilities.

A patient tells the nurse, My doctor thinks my problems with stress relate to the negative way I think about things and suggested I learn new ways of thinking. Which response by the nurse would support the recommendation?

Teach the patient to recognize, reconsider, and reframe irrational thoughts.

A patient reports, I am overwhelmed by stress. Which question by the nurse would be most important to use in the initial assessment of this the patient?

Tell me about the kinds of things you do to reduce or cope with your stress.

A school age child tells the school nurse, Other kids call me mean names and will not sit with me at lunch. Nobody likes me. Select the nurses most therapeutic response.

Tell me more about how you feel.

A nurse is interacting with patients in a psychiatric unit. Which statements reflect use of therapeutic communication? Select all that apply.

Tell me more about that situation. I notice you are pacing a lot. Ill stay with you a while.

An aide in a psychiatric hospital says to the nurse, We dont have time every day to help each patient complete a menu selection. Lets tell dietary to prepare popular choices and send them to our unit. Select the nurses best response.

Thanks for the idea, but its important to treat patients as individuals. Giving choices is one way we can respect patients individuality.

A patient says, Im still on restriction, but I want to attend some off-unit activities. Would you ask the doctor to change my privileges? What is the nurses best response?

Thats a good topic for you to discuss with your doctor.

A nurse explains to the family of a mentally ill patient how a nurse-patient relationship differs from social relationships. Which is the best explanation?

The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient.

During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patients hand. Select the correct analysis of the nurses behavior.

The gesture is premature. The patients cultural and individual interpretation of touch is unknown.

After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference?

The nurse feels unusually happy when the patients mood begins to lift.

A Filipino American patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were used to raise the patients self-esteem, but after 3 weeks, the patients eye contact did not improve. What is the most accurate analysis of this scenario?

The nurse should have assessed the patients culture before making this diagnosis and plan.

As a patient diagnosed with a mental illness is being discharged from a facility, a nurse invites the patient to the annual staff picnic. What is the best analysis of this scenario?

The nurses action blurs the boundaries of the therapeutic relationship.

A patient who had been experiencing significant stress learned to use progressive muscle relaxation and deep breathing exercises. When the patient returns to the clinic 2 weeks later, which finding most clearly shows the patient is coping more effectively with stress?

The patients systolic blood pressure has changed from the 140s to the 120s mm Hg

Documentation in a patients chart shows, Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, I enjoy spending time with you. Which analysis is most accurate?

The patients verbal and nonverbal messages are incongruent.

During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. The nurse should respond by saying:

The time we spend together is to discuss your concerns.

During which phase of the nurse-patient relationship can the nurse anticipate that identified patient issues will be explored and resolved?

Working

A patient tells the nurse, I dont think Ill ever get out of here. Select the nurses most therapeutic response.

You dont think youre making progress?

A patient experiencing significant stress associated with a disturbing new medical diagnosis asks the nurse, Do you think saying a prayer would help? Select the nurses best answer.

You may find prayer gives comfort and lowers your stress.

Which statement shows a nurse has empathy for a patient who made a suicide attempt?

You must have been very upset when you tried to hurt yourself.

A patient with acute depression states, God is punishing me for my past sins. What is the nurses most therapeutic response?

You sound very upset about this.

In order to release information to another health care facility or third party regarding a patient diagnosed with a mental illness, the nurse must obtain:

a signed consent by the patient for release of information stating specific information to be released.

A Puerto Rican American patient uses dramatic body language when describing emotional discomfort. Which analysis most likely explains the patients behavior? The patient:

belongs to a culture in which dramatic body language is the norm.

A nurse says, I am the only one who truly understands this patient. Other staff members are too critical. The nurses statement indicates:

boundary blurring.

What is the legal significance of a nurses action when a patient verbally refuses medication and the nurse gives the medication over the patients objection? The nurse:

can be charged with battery.

The patient says, My marriage is just great. My spouse and I always agree. The nurse observes the patients foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patients communication is:

mixed.

A patient diagnosed with schizophrenia believes a local minister stirred evil spirits. The patient threatens to bomb a local church. The psychiatrist notifies the minister. Select the answer with the correct rationale. The psychiatrist:

demonstrated the duty to warn and protect.

A nurse caring for a withdrawn, suspicious patient recognizes development of feelings of anger toward the patient. The nurse should:

discuss the anger with a clinician during a supervisory session.

Which behavior shows that a nurse values autonomy? The nurse:

discusses options and helps the patient weigh the consequences.

Termination of a therapeutic nurse-patient relationship has been successful when the nurse:

discusses with the patient changes that happened during the relationship and evaluates outcomes.

A nurse finds a psychiatric advance directive in the medical record of a patient experiencing psychosis. The directive was executed during a period when the patient was stable and competent. The nurse should:

ensure that the directive is respected in treatment planning.

1. A psychiatric nurse best applies the ethical principle of autonomy by:

exploring alternative solutions with a patient, who then makes a choice

Which actions violate the civil rights of a psychiatric patient? The nurse: (select all that apply)

opens and reads a letter a patient left at the nurses station to be mailed. restrains a patient who uses profanity when speaking to the nurse.

A nurse leads a psychoeducational group for depressed patients. The nurse plans to implement an exercise regime for each patient. The rationale to use when presenting this plan to the treatment team is that exercise:

has an antidepressant effect comparable to selective serotonin reuptake inhibitors

A family member of a patient with delusions of persecution asks the nurse, Are there any circumstances under which the treatment team is justified in violating a patients right to confidentiality? The nurse should reply that confidentiality may be breached

if the patient threatens the life of another person.

A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies? Giving advice:

is rarely helpful.

What is the desirable outcome for the orientation stage of a nurse-patient relationship? The patient will demonstrate behaviors that indicate:

rapport and trust with the nurse.

After leaving work, a nurse realizes documentation of administration of a PRN medication was omitted. This off-duty nurse phones the nurse on duty and says, Please document administration of the medication for me. My password is alpha1. The nurse receiving the call should:

refer the matter to the charge nurse to resolve.

A black patient says to a white nurse, Theres no sense talking. You wouldnt understand because you live in a white world. The nurses best action would be to:

say, Please give an example of something you think I wouldnt understand.

A nurse introduces the matter of a contract during the first session with a new patient because contracts:

spell out the participation and responsibilities of each party.

A nurse wants to enhance growth of a patient by showing positive regard. The nurses action most likely to achieve this goal is:

staying with a tearful patient.

A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, I really need to talk to you. The nurse should:

tell the interrupting patient, This session is 5 more minutes; then I will talk with you.

Which patient meets criteria for involuntary hospitalization for psychiatric treatment? The patient who:

threatens to harm self and others.

Which individual with mental illness may need emergency or involuntary admission? The individual who:

throws a heavy plate at a waiter at the direction of command hallucinations.