Mental Health Final

Parents of a 3-year-old have noticed an improvement in behavior because of using a time out behavioral approach. What aspect of time out therapy may be responsible for this childs improved behavior?

Positive reinforcement is removed.

After the electroconvulsive therapy, most clients will awaken within _______ minutes and will be confused and disoriented.

10 to 15

During a course of 12 electroconvulsive therapy (ECT) procedures, an anxious client diagnosed with major depression refuses to bathe or attend group therapy. He reports some memory problems and says he has trouble figuring out what time of day it is. At this time, which of the following nursing diagnoses should be assigned to this client? Select all that apply. A. Anxiety R/T post-ECT confusion and memory loss B. Risk for injury R/T post-ECT confusion and memory loss C. Risk for activity intolerance R/T post-ECT confusion and memory loss D. Altered sensory perception R/T post-ECT confusion and memory loss E. Social isolation R/T post-ECT confusion and memory loss

A, B, C, E

Which of the following conditions would place a client at risk for injury during electroconvulsive therapy (ECT)? Select all that apply. A. Severe osteoporosis B. Acute and chronic pulmonary disorders C. Hypothyroidism D. Recent cardiovascular accident E. Prostatic hypertrophy

A, B, D

Which assessment results should a nurse evaluate and report in the process of clearing a client for electroconvulsive therapy (ECT)? Select all that apply. A. Electrocardiographic records B. Pulmonary function study results C. Electroencephalogram analysis D. Complete blood count values E. Urinalysis results

A. Electrocardiographic records B. Pulmonary function study results D. Complete blood count values E. Urinalysis results

Which of the following client statements would indicate that teaching about benzodiazepines has been successful? Select all that apply. A. I cant drink alcohol when taking lorazepam (Ativan). B. If I abruptly stop taking buspirone (BuSpar), I may have a seizure. C. Valium can make me drowsy, so I shouldnt drive for awhile. D. My new diet cannot include aged cheese or pickled herring. E. When the fluoxetine (Prozac) begins working, I can stop the alprazolam (Xanax).

A. I cant drink alcohol when taking lorazepam (Ativan). C. Valium can make me drowsy, so I shouldnt drive for awhile.

A nurse should recognize that electroconvulsive therapy (ECT) would potentially improve the symptoms of clients with which of the following diagnoses? Select all that apply.

A. Major depressive disorder B. Bipolar I disorder: manic episode C. Schizoaffective disorder

A nurse practitioner uses cognitive therapy with depressed clients. The nurse asks clients to keep a daily record of dysfunctional thoughts. Which of the following are appropriate nursing replies to a client questioning the purpose of this exercise? Select all that apply. A. The purpose of this exercise is to identify automatic thoughts. B. The purpose of this exercise is to identify rational alternatives. C. The purpose of this exercise is to modify cognitive errors. D. The purpose of this exercise is to eliminate irrational beliefs. E. The purpose of this exercise is to monitor thoughts related to self-esteem.

A. The purpose of this exercise is to identify automatic thoughts. B. The purpose of this exercise is to identify rational alternatives. C. The purpose of this exercise is to modify cognitive errors.

A nurse administers pure oxygen to a client during and after electroconvulsive therapy. What is the nurses rationale for this procedure?

To prevent anoxia due to medication-induced paralysis of respiratory muscles

A client is in therapy with a nurse practitioner for the treatment of arachnophobia. The nurse practitioner decides to use the technique of flooding. Which intervention best exemplifies this technique?

Accompanying the client to a 1-hour visit to the local zoos spider room

Immediately after an initial electroconvulsive therapy (ECT) procedure, a client states, Im not hungry and just want to stay in bed and sleep. On the basis of this information, which is the most appropriate nursing intervention?

Allow the client to remain in bed

The director of nursing (DON) sets up a meeting with the newly appointed nurse manager, who, to this point, has done an excellent job. The nurse manager anticipates job termination. What is the best description of the cognitive error being employed by the nurse manager?

Always thinking the worst will occur without considering positive outcomes

Using a cognitive approach, a nurse would choose which intervention for assisting clients to manage their anger without the use of violence?

Assist the client to identify thoughts that trigger anger and substitute reality-based thinking.

During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both of the clients from the group. The nurse has demonstrated which leadership style?

Autocratic

A client states, My doctor has told me I am a candidate for electroconvulsive therapy (ECT). Where will the treatment take place, and how much time would this entail? Which is the most accurate nursing reply?

Clients typically undergo 6 to 12 ECT procedures, 3 times a week in an outpatient setting.

A client is diagnosed with an anxiety disorder. The nurse counselor recommends intervention with the behavioral technique of reciprocal inhibition. The client asks, Whats that? Which is the most appropriate nursing reply?

By introducing an adaptive behavior that is mutually exclusive to your maladaptive behavior, we will expect subsequent behavior to improve.

A welder has been selected as employee of the year. The welder wants to ask for a promotion but is hampered by poor self-esteem. The employee health nurse provides assistance. Which technique should the nurse use to help the employee request the promotion?

Cognitive rehearsal

A nursing instructor is lecturing about cognitive therapy. Which of the following are objectives when implementing this therapy? Select all that apply. A. To modify automatic thoughts to promote minimization of negative cognitions B. To apply a variety of methods to create change in an individuals thinking C. To apply cognitive principles in order to change an individuals basic schema D. To modify belief systems in an effort to bring about emotional change E. To modify belief systems in an effort to bring about behavioral change

B. To apply a variety of methods to create change in an individuals thinking D. To modify belief systems in an effort to bring about emotional change E. To modify belief systems in an effort to bring about behavioral change

Which of the following are accurate descriptors of a therapeutic community? Select all that apply. A. The unit schedule includes unlimited free time for personal reflection. B. Unit responsibilities are assigned according to client capabilities. C. A flexible schedule is determined by client needs. D. The individual is the sole focus of therapy. E. A democratic form of government exists.

B. Unit responsibilities are assigned according to client capabilities. E. A democratic form of government exists.

A client with cognitive deficits is extremely suicidal. The client has not responded to antidepressants and the treatment team is considering electroconvulsive therapy (ECT). What client information would impact the feasibility of this treatment option?

Because informed consent is required for ECT, cognitive deficits could preclude this option.

A client recovering from alcohol toxicity is using minimization. Which statement reflects this cognitive distortion?

I may have a minor problem, but I can handle it.

A client states, I keep having horrible nightmares about the car accident that killed my daughter. I shouldnt have taken her with me to the store. Using a cognitive approach, which nursing reply would be best?

Can anyone predict when a car accident will happen?

A client diagnosed with borderline personality disorder states, Get out of here. No one cares about me or my situation! Which nursing reply is an example of a cognitive intervention?

Can you explain further your thinking about your situation?

During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development?

I think Joes Antabuse suggestion is a good one and might work for me.

A nursing instructor is teaching about dichotomous thinking. Which student statement indicates that learning has occurred?

Dichotomous thinking is when an individual views situations as being good or bad or black or white.

A child always chooses to ask mother over father when seeking special privileges. The father is more apt to disagree than agree with the childs requests, whereas the mother usually consents. The childs choice is the result of which component of operant conditioning?

Discriminative stimuli

Immediately after electroconvulsive therapy, in which position should a nurse place the client?

On his or her side to prevent aspiration

A nursing instructor is teaching about electroconvulsive therapy (ECT). Which student statement indicates that learning has occurred?

ECT induces a grand mal seizure.

When a clients husband comes home late from work, the wife immediately fears infidelity. The advanced practice nurse therapist encourages the wife to consider other explanations for her husbands tardiness. What technique is the nurse using?

Generating alternatives

An advanced practice nurse recommends that a client participate in cognitive therapy. The client asks, Whats cognitive therapy and how can it help me? Which is the nurses most appropriate reply?

It is a type of psychotherapy that focuses treatment on the modification of distorted thinking and maladaptive behaviors.

After undergoing two of nine electroconvulsive therapy (ECT) procedures, a client states, I cant even remember eating breakfast, so I want to stop the ECT. Which is the most appropriate nursing reply?

It is within your right to discontinue the treatments, but lets talk about your concerns.

A high school basketball player sustains a serious knee injury and states to the school nurse, I will never get to college if I dont receive a basketball scholarship. Which nursing reply would assist the student to see a broader range of possibilities?

Lets look at the alternatives for funding your college education.

A nursing student evaluates her group project partner as irresponsible because of minimal participation in planning. When told of this situation, the nursing instructor plans to use the cognitive technique of examining the evidence. Which response exemplifies this technique?

Lets look at the potential reasons why your partner has not participated.

A nursing student states, The instructor gave me a failing grade on my research paper. I know its because the instructor doesnt like me. Which cognitive error does a nurse recognize in this students statement?

Magnification

A successful business executive continually thinks that job accomplishments are not adequate. A nurse recognizes that the clients thinking is reflective of which cognitive error?

Minimization

An adolescent comes from a dysfunctional family where physical and verbal abuse prevails. At school this adolescent bullies and fights with classmates. According to principles of behavior therapy, what is the probable source of this behavior?

Modeling

A labor and delivery nurse listens to a new mother relate thoughts regarding her healthy, 8-pound baby girl. Which statement by the mother indicates to the nurse the use of the cognitive error, selective abstraction?

My baby is wonderful, but Im depressed because I wanted twins.

A kindergarten rule states that if unacceptable behavior occurs, a childs personalized fish will be moved to the sea grass. Children who behave keep their fish out of the sea grass. The school nurse should identify this intervention as based on which principle of behavior therapy?

Negative reinforcement

When using a cognitive approach, a nurse would include which point in teaching a client about panic disorder?

Remind yourself that symptoms of a panic attack are time limited and will end.

A client is experiencing auditory hallucinations. Using a cognitive strategy, the nurse would encourage the client to do which of these?

Remind yourself that the voices are symptoms of your disease.

Which client statement would exemplify the level of cognitive function that you would expect to see in mild anxiety?

Right now I feel as sharp as a tack.

A nurse administers ordered preoperative glycopyrrolate (Robinul) 30 minutes prior to a clients ECT procedure. What is the rationale for administering this medication?

Robinul decreases SECRETIONS to prevent aspiration during the ECT procedure

In the role of milieu manager, which activity should the nurse prioritize?

Searching newly admitted clients for hazardous objects

A mother states, You are old enough to clean your own bedroom. Later inspection finds the floor clear, but with everything stacked in a chair. The mother praises the child for clearing the floor. This is consistent with which technique of behavior modification?

Shaping

A client admitted to a Veterans Administration (VA) hospital with a diagnosis of major depressive disorder tells the nurse, I failed my battalion by giving the wrong order. Fortunately, no one was injured. Which nursing diagnosis should the nurse assign to this client?

Situational low self-esteem

A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment?

Structured programming

A chronically depressed and suicidal client is admitted to a psychiatric unit. The client is scheduled for electroconvulsive therapy (ECT). During the course of ECT, a nurse should recognize the continued need for which critical intervention?

Suicide assessment must continue throughout the ECT course.

The nurse should utilize which group function to help an extremely withdrawn, paranoid client increase feelings of security?

Support

A client reports, My friend panicked at the site of spiders. Her therapist used gradual exposure to spiders that initially made her increasingly more anxious. Which technique was the friends therapist most likely using?

Systematic desensitization

Parents decide to try the nurse practitioners suggestion of time out when their child misbehaves. What teaching should the nurse practitioner provide the parents?

Temporarily move your child to an area where behavior is not being reinforced.

A client experienced bradycardia during electroconvulsive therapy (ECT). A nurse assigns a nursing diagnosis of decreased cardiac output R/T vagal stimulation occurring during ECT. Which outcome would the nurse expect the client to achieve?

The client will continue adequate tissue perfusion 1 hour after treatment.

A nursing student is observing an electroconvulsive therapy (ECT) procedure. The student notices a blood pressure cuff on the clients lower leg. The student questions the instructor about the cuff placement. Which is the most accurate instructor reply?

The cuff functions to prevent succinylcholine from reaching the foot.

Which group leader activity should a nurse identify as being most important in the final, or termination, phase of group development?

The group leader helps the members to process feelings of loss.

A nurse believes that the members of a parenting group are in the initial, or orientation, phase of group development. Which group behaviors would support this assumption?

The group members compliment the leader and compete for the role of recorder.

A client scheduled for electroconvulsive therapy (ECT) at 9:00 a.m. is discovered eating breakfast at 8:00 a.m. On the basis of this observation, which is the most appropriate nursing action?

The nurse notifies the clients physician of the situation and cancels the ECT.

A nursing instructor is teaching about the didactic aspects of cognitive therapy. Which student statement indicates a deficit in meeting the learning objectives of this content?

The therapist uses guided imagery in an effort to elicit automatic thoughts.

According to behavioral theory, the treatment of phobic symptoms should involve which action?

The use of desensitization

A client who is learning about electroconvulsive therapy (ECT) asks a nurse, Isnt this treatment dangerous? Which is the most appropriate nursing reply?

There are some risks, but a thorough examination will determine your candidacy for ECT.

A nursing instructor is teaching about the medications given prior to and during ECT. Which student statement indicates that learning has occurred?

Thiopental sodium (Pentothal) is a short-acting anesthesia to render the client unconscious.

What is the best rationale for including the clients family in therapy within the inpatient milieu?

To facilitate discharge from the hospital

An advanced practice nurse is counseling a client diagnosed with generalized anxiety disorder. The nurse plans to use activity scheduling to address this clients concerns. What is the purpose of this nursing intervention?

To identify important areas needing concentration during therapy

During a smoking cessation group, the community health nurse explains that in their effort to quit smoking, a reciprocal inhibition approach will be used. The nurse should give the group which example of this technique?

When you have the urge to smoke, hold your breath and then rhythmically breathe.

A 2-year-old engages in frequent temper tantrums that usually result in the parents giving in to demands. During family therapy, how should a nurse counsel the parents?

You are positively reinforcing your childs behavior.

Which information should a nurse include when teaching about the potential side effects of ECT?

You may experience some memory deficit surrounding the ECT.

A third-grader feigns illness in order to avoid doing homework. The teacher recommends an educational program that uses a token economy. How should a school nurse explain a token economy to this childs parent?

Your child will receive green tokens for completing homework that can be cashed in for desired rewards.

electroconvulsive therapy (ECT)

a biomedical therapy for severely depressed patients in which a brief electric current is sent through the brain of an anesthetized patient

During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating?

democratic

Systematic desensitization

is a treatment for phobias in which a phobic individual is gradually exposed to increasing amounts of the phobic stimulus while practicing relaxation techniques. Eventually, the phobic stimulus causes little or no anxiety.

minimization

is the undervaluing of the positive significance of an event.

Immediately after electroconvulsive therapy a nurse should:

monitor pulse, respirations, and blood pressure every 15 minutes for the first hour, during which time the client should remain in bed

A nursing assistant has failed a prerequisite course toward admission to nursing school and states, I will always be only a nursing assistant and never an RN. Her nursing advisor understands this is an example of:

overgeneralization

The most common side effect of ECT is:

temporary amnesia

A psychiatric nurse is counseling a client who has thought patterns consisting of rapid responses to a situation without rational analysis. What assessment data will the nurse document on this client?

thought patterns include a predominance of automatic thoughts