Mental Health Moodle Quizzes (also includes the midterm questions)

The goal for a patient is to increase resiliency. Which outcome should a nurse add to the plan of care? Within 3 days, the patient will: a. identify healthy coping behaviors in response to stressful events. b. describe feelings associated with loss and stress c. allow others to assume responsibility for major areas of own life d. meet own needs without considering the rights of others

a. identify healthy coping behaviors in response to stressful events

An 11-year-old child is absent from school to care for siblings while the parents work. The family cannot afford a babysitter. When asked about the parents, the child reluctantly says, "My parents don't like me. They call me stupid and say I never do anything right." Which type of abuse is likely? a. Sexual b. Emotional c. Economic d. Physical

b. Emotional

A patient begins therapy with a phenothiazine medication. What teaching should a nurse provide related to the drug's strong dopaminergic effects? Select one: a. Chew sugarless gum. b. Arise slowly from bed. c. Report muscle stiffness. d. Increase dietary fiber.

c. Report muscle stiffness.

An aggressive client was placed in four-point restraints and given an intramuscular dose of anxiolytic medication. Systematic assessment to guide interventions during the period of restraint should include: (SELECT ALL THAT APPLY) a. Level of awareness b. Vital signs c. Nutritional needs d. ROM and comfort needs e. Elimination needs f. Hydration

ALL OF THEM!

A person who feels unattractive repeatedly says, "Although I'm not beautiful, I am smart." This is an example of: a. Compensation b. Repression c. Identification d. Devaluation

a. Compensation R: Compensation is an unconscious process that allows an individual to make up for deficits in one area by excelling in another area to raise self-esteem.

A client is admitted to the psychiatric unit with a diagnosis of bipolar affective disorder and mania. The nurse would prioritize that which of the following symptoms or behaviors requires immediate intervention? a. Constant physical activity and poor oral intake b. Constant, incessant talking, with sexual innuendoes c. Grandiose delusions of being a czar of Russia d. Outlandish behaviors and wearing odd and eccentric clothing

a. Constant physical activity and poor oral intake

The nurse is told that the result of a serum carbamazepine (Tegretol) level for a client who is receiving the medication for the control his mood swings is 10mcg/mL. Based on this laboratory result, the nurse anticipates that the physician will prescribe: a. Continuation of the presently prescribed dosage b. Discontinuation of the medication c. A decrease of the dosage of the medication d. An increase of the dosage of the medication

a. Continuation of the presently prescribed dosage

For the last year, a college student continually and unrealistically worries about academic performance and love life performance. The student is irritable and suffers from severe insomnia.This behavior is associated with which diagnosis? a. Generalized Anxiety Disorder (GAD) b. Agoraphobia c. Obsessive-Compulsive Disorder (OCD) d. Social Phobia Disorder

a. Generalized Anxiety Disorder (GAD)

The client admitted to the mental health unit with major depression 3 days ago could hardly get out of bed without coaxing and needed constant encouragement to get dressed and participate in unit activities. Today, the client appears in the dayroom dressed and well-groomed, without any guidance from the staff. The client appears to be calm and relaxed, yet more energetic than before. The nurse should take which initial action after noting this client's behavior? a. Speak to the client personally about the nurse's observations, and ask if the client is thinking about suicide b. Continue to monitor the client's behavior from a distance c. Document that the client is adapting to the unit and is feeling safe d. Notify the staff of these observations at the team meeting, which will begin in 3 hours.

a. Speak to the client personally about the nurse's observations, and ask if the client is thinking about suicide

A nurse uses the SAD PERSONS scale to interview a patient. This tool provides data relevant to: a. suicide potential b. level of anxiety c. mood disturbance d. current stress level

a. suicide potential

A violent patient is restrained. What is the nurse's first priority? a. Administer a sedating medication. b. Ensure the patient's safety. c. Debrief the patient. d. Obtain an order from the health care provider.

b. Ensure the patient's safety R: Once in restraints, a patient must be directly observed and formally assessed at frequent, regular intervals for level of awareness, level of activity, safety with the restraints, hydration, toileting needs, nutrition and comfort.

In preparing for the orientation phase of the therapeutic relationship, the nurse suggests addressing which of the following subjects? a. Facilitating behavioral change b. Establishing the parameters of the relationship c. Promoting self-esteem in the client d. Promoting problem solving skills in the client

b. Establishing the parameters of the relationship

The client says to the nurse "I am going to die, I wish my family would stop hoping for a cure! I get so angry when they carry on like this! After all, I'm the one who's dying." The most therapeutic response is: a. "Well, it sounds like you're being pessimistic. After all, years ago people died of pneumonia." b. Have you shared your feelings with your family?" c. "You're feeling angry that your family continues to hope for you to be cured." d. "I think we should talk more about your anger with your family."

b. Have you shared your feelings with your family?"

A patient who is on chlorpromazine (Thorazine) is preparing for discharge. In developing a health promotion plan for the patient, the nurse instructs the patient: a. To have the therapeutic blood levels drawn because there is a narrow range between the therapeutic and toxic levels of the medication. b. To avoid prolonged exposure to the sun. c. To adhere to a strict tyramine-restricted diet d. On the signs and symptoms of relapse for depression.

b. To avoid prolonged exposure to the sun. R: Chlorpromazine is an antipsychotic medication often used in the treatment of psychosis. Photosensitivity is sometimes a side effect of the phenothiazine class of antipsychotic medications to which chlorpromazine (Thorazine) belongs.

Which referral is most appropriate for a woman who is severely beaten by her husband, who has no relatives or friends in the community, is afraid to return home, and has limited financial resources? a. Support group b. Women's shelter c. Vocational counseling d. Law enforcement

b. Women's shelter

A nursing student is conducting a clinical conference and is describing the characteristics associated with milieu therapy. Which of the following statements, if made by the student, indicates an understanding of the focus of this form of therapy? a. "Milieu therapy provides a cognitive approach to changing behavior." b. "Milieu therapy provides a behavior modification approach type of therapy." c. "A living, learning, or working environment is the focus of milieu therapy." d. "A behavioral approach to changing behavior is the focus of milieu therapy."

c. "A living, learning, or working environment is the focus of milieu therapy."

The most therapeutic response a nurse could make to a student who begins to cry upon learning that a failing grade was received on a final exam is: a. "You'll make it next time." b. "It won't seem so important 5 years from now." c. "Failing an exam is an upsetting thing to happen." d. "How close were you to passing?"

c. "Failing an exam is an upsetting thing to happen."

A client hates her mother because of childhood neglect.T he nurse determines which client statement represents the use of the use of the defense mechanism of reaction formation? a. "My mother hates me." b. "My mom always loved my sister more than she loved me." c. "I have a very wonderful mother whom I love very much." d. "I don't like to talk about my relationship with my mother."

c. "I have a very wonderful mother whom I love very much."

Cognitive therapy was provided for a patient who frequently said, "I'm stupid." Which statement by the patient indicates the therapy was effective? Select one: a. "I always fail when I try new things." b. "Things always go wrong for me." c. "Sometimes I do stupid things." d. "I'm disappointed in my lack of ability."

c. "Sometimes I do stupid things."

A client who attempted suicide by hanging is brought to the emergency department by emergency medical services. The immediate nursing action is which of the following? a. Perform a focused assessment, paying particular attention to the client's neurological status. b. Call the mental health crisis team and notify them that a client who attempted suicide is being admitted to the hospital. c. Assess the client's respiratory status and for the presence of neck injuries. d. Take the client's vital signs.

c. Assess the client's respiratory status and for the presence of neck injuries.

When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented? a. Instruct the client regarding unit rules and regulations b. Leave the client alone to maintain privacy c. Sit with the client in the day room to provide comfort d. Communicate with simple words and brief message

c. Sit with the client in the day room to provide comfort? (apparently Chahine says this isn't the right answer but literally none of the others ones make sense and she doesn't give us the right answer for the midterm quiz so.....)

Psychotherapy involves all below except: a. neural plasticity b. positive expectancy c. appropriate medications d. a therapeutic relationship

c. appropriate medications

A home care nurse visits a client at home. Clonazepam (Klonopin) has been prescribed for the client, and the nurse teaches the client about the medication. Which statement by the client indicates that further teaching is necessary? a. "I should take my medication with food to decrease stomach problems." b. "My drowsiness will decrease over time with continued treatment." c. "I can take my medication at bedtime if it tends to make me feel drowsy." d. "If I experience slurred speech, it will disappear in about 8 weeks."

d. "If I experience slurred speech, it will disappear in about 8 weeks." R: Clients who are experiencing signs and symptoms of toxicity with the administration of clonazepam exhibit slurred speech, sedation, confusion, respiratory depression, hypotension, and eventually coma. Some drowsiness may occur but will decrease with continued use. The medication may be taken with food to decrease gastrointestinal irritation. The other options are correct and represent an accurate understanding of the medication.

A nurse is having a conversation with a depressed client on an inpatient psychiatric unit. The client says to the nurse, "Things would be so much better for everyone if I just weren't around." Which of the following responses by the nurse would be appropriate at this time? a. "Have you talked to anyone specifically about what is bothering you?" b. "Those feelings will go away when your medication really takes effect." c. "I know what you mean; everyone gets that way when they are depressed." d. "You sound very unhappy. Are you thinking of harming yourself?"

d. "You sound very unhappy. Are you thinking of harming yourself?"

The child with autism spectrum disorder (ASD) has difficulty with trust. With this in mind, which of the following nursing actions would be most appropriate? a. Encourage the staff to hold the child as often as possible, conveying trust through touch. b. Assign different staff member each day so the child learns that everyone can be trusted. c. Allow for flexibility in the daily schedule. d. Avoid direct eye contact.

d. Avoid direct eye contact R: Direct eye contact this is extremely uncomfortable for the child with autism, and may even discourage trust.

A patient is undergoing diagnostic tests. the patient says, "Nothing is wrong with me except a stubborn chest cold." the spouse reports that the patient smokes, coughs daily, and has lost 15 pounds and is easily fatigued. Which defense mechanism is the patient using? a. Displacement b. Projection c. Regression d. Denial

d. Denial R: Denial is an unconscious blocking of threatening or painful information or feelings

The nurse is preparing the client for the termination phase of the nurse-client relationship. The nurse prepares to implement which nursing task is most appropriate for this phase? a. Developing realistic solutions. b. Identifying expected outcomes. c. Planning short term goals. d. Making appropriate referrals.

d. Making appropriate referrals.

A 22-year old college student presented to the ER with hypertension (BP= 200/110), tachycardia, cramping, hyperreflexia, and myoclonus. He was taking phenelzine (Nardil) and had been out to a restaurant with friends. What is the most likely food/drink that could have interacted with the medication? a. Grapefruit juice b. Eggs c. Cucumbers d. Red wine

d. Red wine R: MAOIs inhibit the enzyme (MAO) that breaks down monoamine neurotransmitters (i.e., dopamine, norephinephrine, serotonin) once they have been pumped back into the presynaptic cell. While taking MAOIs, certain foods and alcohol that are high in the amino acid tyramine (aged, pickled, processed) can cause a severe hypertensive crisis and should be avoided. Alcohol (specifically beer and red wine) should be avoided or should be limited to only 4 ounces per day.

A nurse in the emergency department is preparing to care for a female client who has just been sexually assaulted. Which of the following client behaviors would demonstrate denial? a. The client is blaming her sister for the incident. b. The client is justifying unacceptable self-behaviors. c. The client is verbalizing generalizations about the incident. d. The client is calm and quiet.

d. The client is calm and quiet

A patient is started on a regimen of lamotrigine (Lamictal) 50 mg daily for bipolar depression. The client shows the nurse a red and purple rash on his arm that is blistering and peeling. What is the most likely explanation? a. The patient is experiencing a benign rash to the medication which can be treated with diphenhydramine (Benadryl). b. The medication increases the patient's sensitivity to sunlight resulting in a sunburn from not using protection. c. The rash is a common side effect which resolves after the medication reaches therapeutic range. d. The rash is a rare adverse effect which causes a toxic epidermal necrolysis.

d. The rash is a rare adverse effect which causes a toxic epidermal necrolysis. R: Stevens-Johnson syndrome is a serious rash requiring hospitalization and discontinuation of treatment. The incidence of this rash is approximately 0.08% in patients being prescribed Lamictal for mental health issues (higher for those being prescribed it for seizure disorders). The rash develops during in the first few months of the medication being titrated especially if the medication is increased too quickly. The potential to develop Steven-Johnson syndrome increase when Lamictal is used as adjunct therapy with Valproic Acid (Depakote).

Match the nursing approach for each of the continuum of emotional responses. 1) Anxious 2) Calm 3) Aggression 4) Agitated 5) Tension Reduction A) Nurse uses active listening; allows for ventilation; supportive, informing; addresses immediate concerns and sources of fear, pain, and frustration; offers alternatives B) Nurse is professional; helping; available C) Nurse is aware of physical distance; escape routes; physical intervention plan D) Nurse takes a directive stance and provides short concise instructions E) Nurse re-establishes therapeutic rapport; initiates debriefing

Anxious → Nurse uses active listening; allows for ventilation; supportive, informing; addresses immediate concerns and sources of fear, pain and frustration; offers alternatives Calm → Nurse is professional; helpful; available Aggression → Nurse is aware of physical distance; escape routes; physical intervention plan Agitated → Nurse takes a directive stance and provides short concise instructions Tension Reduction → Nurse re-establishes therapeutic rapport; initiates debriefing.

A client has been admitted to the inpatient psychiatric unit because the client has displayed violent behavior and is at risk for potentially harming others. Which of the following should the nurse avoid doing when caring for this client? a. Closing the door to the client's room when giving care to the client b. Admitting the client to a room near the nurses' station c. Arranging for a security officer to be available in the general area d. Facing the client while speaking and providing nursing care

a. Closing the door to the client's room when giving care to the client

A patient who is experiencing moderate anxiety says, "I feel undone." An appropriate response for the nurse would be: a. "I'm not sure I understand. Give me an example." b. "Why do you suppose you are feeling anxious?" c. "You must get your feelings under control before we can continue." d. What would you like me to do to help you?

a. "I'm not sure I understand. Give me an example." R: Increased anxiety results in scattered thoughts and an inability to articulate clearly. Clarification helps the patient identify his or her thoughts and feelings.

When assessing a patient who has ingested flunitrazepam (Rohypnol) also known as roofies, the nurse would expect: a. acrophobia b. anterograde amnesia c. hallucinations d. hypothermia

b. anterograde amnesia

The nurse has been caring for a client with a diagnosis of depression. The client says to the nurse, "I wish you would just be my friend." The appropriate response by the nurse is: a. "Our relationship is a therapeutic and helping one." b. "I can't be your friend. I'm the nurse, and you're the client." c. "You have plenty of friends. You don't need me to be your friend, too." d. "I am your friend."

a. "Our relationship is a therapeutic and helping one."

"Dry as a bone, red as a beat, hot as a hare, blind as a bat, and mad as a hatter" describes the symptoms of: a. Anticholinergic toxicity b. Neuroleptic malignant syndrome c. Lithium toxicity d. Serotonin Syndrome

a. Anticholinergic toxicity R: Anticholinergic toxicity is a potentially fatal condition characterized by skin that is hot, dry and flushed, blurred vision, and CNS effects (hallucinations and delirium). Death can result from respiratory depression caused by the blockage of muscarinic cholinergic receptors. Many of the psychiatric drugs have anticholinergic side effects, especially the tricyclic antidepressants and phenothiazine antipsychotics. These should be used cautiously in older adults and in patients taking multiple drugs with anticholinergic properties.

A client has, in the past, had a nursing diagnosis of ineffective coping related to impulsively acting out anger as evidenced by striking others. An appropriate plan for forestalling such incidents would be: a. Helping a client identify incidents that trigger impulsive acting out. b. Explaining that restrain and seclusion will be used if violence occurs. c. Request that the client receive lorazapam (Ativan) every 4 hours to reduce anxiety. d. Offer one-on-one supervision to help the client maintain control.

a. Helping a client identify incidents that trigger impulsive acting out. R: Identification of trigger incidents allows the client and nurse to plan interventions that reduce irritation and frustration, which lead to acting out anger, and eventually to put into practice more adaptive coping strategies.

Mrs. F. has remained close to the nurse all day. When the nurse talked with other clients during dinner, Mrs. F. tried to regain the nurse's attention and began to shout, "You're just like my mother. You pay attention to everyone but me!" The best interpretation of this behavior is that... a. Mrs. F. is demonstrating transference. b. Mrs. F. has been spoiled by her family. c. Mrs. F. is exhibiting resistance. d. The nurse has failed to meet Mrs. F's needs.

a. Mrs. F. is demonstrating transference.

Lorazepam (Ativan) is prescribed for a client to manage anxiety. Which of the following, if noted on the client's record, would indicate the need to consult with the physician before administering the medication? a. Positive pregnancy test b. History of coronary artery disease c. History of hypothyroidism d. History of diabetes millitus

a. Positive pregnancy test R: Lorazepam is contraindicated in clients who are pregnant or breastfeeding because this drug crosses the placenta and breast milk posing potential danger to the fetus or newborn infant in view of their pharmacologic effects, side effects, or complications. It is also not prescribed for clients who have a hypersensitivity or cross-sensitivity with other benzodiazepines. It is contraindicated in clients who are comatose, with preexisting central nervous system (CNS) depression, those with uncontrolled severe pain, and those with narrow-angle glaucoma.

A client who was brought into the emergency room by EMS intoxicated, suddenly removes a knife from his coat pocket and threatens to kill himself or anyone who tries to stop him from leaving the room. A psychiatric emergency code is called and the client is safely disarmed and placed in restraints. the rationale for use of restraints was that the client: a. Presented a clear and present danger to self and others. b. Clearly evidenced a thought disorder, rendering him incapable of rational decision c. Presented a clear escape risk d. Was psychotic.

a. Presented a clear and present danger to self and others. R: The client's threat to kill himself and others with the knife he possessed constituted a clear and present danger to self and other.

A client is admitted for psychiatric observation after being arrested for breaking windows in the home of his former girlfriend, who had refused to see him. His history reveals abuse as a child by a punitive father, torturing family pets, and one arrest for disorderly conduct. The nursing diagnosis that should be considered for development is: a. Risk for other-directed violence b. Disturbed thought processes c. Risk for injury d. Post-traumatic syndrome

a. Risk for other-directed violence R: The defining characteristics for risk for violence directed at others include a history of being abused as a child, having committed other violent acts, and demonstrating poor impulse control.

Which rationale best explains why a nurse should be aware of personal feelings while working with a family experiencing family violence? a. Strong negative feelings interfere with assessment and judgment. b. Strong positive feelings lead to underinvolvement with the victim. c. Positive feelings promote the development of sympathy for patients. d. Self-awareness protects one's own mental health.

a. Strong negative feelings interfere with assessment and judgement

A client receiving long-term therapy with lithium carbonate (Lithobid) exhibits muscle tremors, confusion, vomiting, and diarrhea. The nurse anticipates that the results of the latest test of the serum lithium level will be between: Select one: a. 1.0 and 1.3 mEq/L b. 1.5 and 2.0 mEq/L c. 0.6 and 1.0 mEq/L d. 0 and 0.5 mEq/L

b. 1.5 and 2.0 mEq/L

What is the team intervention techniques used in nonviolent crisis intervention? a. TIP: Team, Isolate, Plan b. ARD: Assess, Restrain, Debrief c. APT: Assess, Plan, Treat d. CARE: combine, assign, redirect, explain

a. TIP: Team, Isolate, Plan R: The TIP technique focuses on having a team of two to three staff members with one being the team leader who approaches the client and maintains one-to-one communication. Isolation of the individual and situation helps decrease stimuli, provides for a more therapeutic environment and confidentiality, as well as maintaining a safe and therapeutic milieu. . A plan should be reviewed with the team on how best to to balance or offset the person's behavior with therapeutic responses by the staff. Taking physical control of a person when he has lost complete control is the most therapeutic process possible, if the action by staff is carried out in an nonharmful, nonviolent manner.

With conventional (typical) antipsychotics, the higher the potency, a. The higher the risk of EPS b. The lower the risk for EPS c. The lower the risk for dystonia d. the higher the risk for sedation

a. The higher the risk of EPS R: Conventional (first generation) antipsychotics with high potency have a stronger D2 receptor blockade than those with low potency, thereby decreasing dopamine levels in the nigrostriatal pathway. This can result in drug-induced extrapyramidal side-effects involving movement, including parkinsonism (tremor, bradykinesia, rigidity), dyskinesias, and akathesia.

A nurse is caring for a hospitalized patient who has been taking clozapine (Clozaril) for the treatment of a schizophrenic disorder, and the nurse reviews the laboratory studies that have been prescribed for the patient. Which laboratory study will the nurse specifically review to monitor for an adverse effect associated with the use of this medication? a. White blood cell count b. Blood urea nitrogen c. Cholesterol level d. Hemoglobin level

a. WBC count R: Hematological reactions can occur in the patient taking clozapine and include agranulocytosis and mild leukopenia. The white blood cell count should be assessed before initiating treatment and should be monitored closely during the use of this medication. The client should also be monitored for signs indicating anranulocytosis, which may include sore throat, malaise, and fever.

The nurse is talking with a male client who is actively hallucinating. The client is fearful that the voices he hears will direct him to kill himself or will hurt him directly. Which of the following nursing statements would be therapeutic at this time? a. "I know you believe they are going to cause you harm, but it's not true." b. "I don't hear them, but it must be frightening to hear voices that others can't hear." c. "I know whose voices you are hearing and told them not to hurt you." d. "I can hear the voices too, but they are telling you to go to bed now."

b. "I don't hear them, but it must be frightening to hear voices that others can't hear."

A client admitted to the inpatient unit is being considered for electroconvulsive therapy (ECT). The client is calm, but the client's daughter is hypervigilant and anxious. The daughter says to the nurse, "My mother's brain will be shocked with electricity. How can the doctor even think about doing this to her?" Which of the following responses by the nurse would be therapeutic? Select one: a. "I think you need to speak directly to the psychiatrist." b. "It sounds as though you are very concerned about the procedure. Let's discuss the procedure." c. "Maybe you'll feel better if you see the ECT room and speak to the staff." d. "Your mother has decided to have this treatment. You should support her."

b. "It sounds as though you are very concerned about the procedure. Let's discuss the procedure."

The nurse is developing a care plan that will include goals that will help the client achieve an optimal level of functioning and appropriate resource utilization. When the nurse enters the client's room, the client asks the nurse, "Could you ask the physician to let me have a pass for the weekend?" The nursing response that assists the client in achieving these goals is: Select one: a. "I will call the doctor and find out if you can have a pass so that you can make your arrangements." b. "When the physician arrives on the unit, I will let him or her know that you have a question." c. "When your doctor comes in, I will ask for a pass for the weekend." d. "You can't have a pass for the weekend. You are not ready, and I'm sure that your doctor will say no."

b. "When the physician arrives on the unit, I will let him or her know that you have a question."

Two hours after a client lost control and required restraints and PRN medication, she is out of restraints, calm, and sitting in her room reading. The post-intervention debriefing process is initiated by the nurse and includes: (SELECT ALL THAT APPLY) a. Avoiding mentioning the incident. b. Helping the client identify the precipitating event. c. Reestablishing therapeutic communication and rapport with client. d. Suggesting that the client may wish to apologize. e. Reviewing possible alternative coping strategies.

b. Helping the client identify the precipitating event c. Reestablishing therapeutic communication and rapport with the client e. Reviewing possible alternative coping strategies

The nurse is meeting a new client on the unit. Which action, by the nurse, is most effective in initiating the nurse-client relationship? a. Describe the nurse's family and ask the client to describe his/her family. b. Introduce self and explain the purpose and the plan for the relationship. c. Wait until the client indicates a readiness to establish a relationship. d. Ask the client why he/she was brought to the hospital.

b. Introduce self and explain the purpose and the plan for the relationship.

During the termination phase of the nurse-client relationship, the clinic nurse observes that the client continuously demonstrates bursts of anger. The most appropriate interpretation of the behavior is that the client... a. Requires further treatment and is not ready to be discharged. b. Is displaying typical behaviors that can occur during termination. c. Needs to be referred to the psychiatrist as soon as possible. d. Needs to be admitted to the hospital.

b. Is displaying typical behaviors that can occur during termination.

The nurse is preparing for the arrival of a new client at a drug abusers' residential treatment center and prepares to explain to the client that the emphasis of the center is on group and social interaction, and that rules and expectations are mediated by peer pressure. The most likely focus of therapy of this residential center is: a. Systematic desensitization b. Milieu therapy c. aversion conditioning d. cognitive-behavioral therapy

b. Milieu therapy

A supervisor assigns a worker a new project. The worker initially agrees but feels resentful. The next day when asked about the project, the worker says, "I've been working on other things." When asked 4 hours later, the worker says, "Someone else was using the copier, so I couldn't finish it." The worker's behavior demonstrates: a. Rationalization b. Passive aggression c. Acting out d. Projection

b. Passive aggression R: A passive-aggressive person deals with emotional conflict by indirectly expressing aggression towards others. Compliance on the surface masks covert resistance. Resistance is expressed through procrastination, inefficiency, and stubbornness in response to assigned tasks.

The nurse directs the intervention team who must take an aggressive client to seclusion. Other clients have been removed from the area. Before approaching the client, the nurse should ensure that staff: (SELECT ALL THAT APPLY) a. Quickly approach the client and take hold of the closest arm or leg. b. Remove jewelry, glasses, and harmful items from their persons. c. Appoint a person to clear a pat and open, close or lock doors. d. Select the person who will communicate with the client. e. Move behind the client to use the element of surprise.

b. Remove jewelry, glasses, and harmful items from their persons. c. Appoint a person to clear a pat and open, close or lock doors. d. Select the person who will communicate with the client.

An acutely depressed client is receiving cognitive-behavioral therapy. The nurse is developing a plan of care for the client and includes interventions that focus on this type of therapy. Which of the following interventions would the nurse include? Select all that apply: a. Assisting the client with the administration of antidepressant medications b. assisting the client to develop alternative thinking patterns c. assisting the client to identify and test negative cognition d. Assisting the client to rehearse new cognitive and behavioral responses e. Assisting the client to participate in the treatment process f. Assisting the client to participate in group therapy on a regular basis.

b. assisting the client to develop alternative thinking patterns c. assisting the client to identify and test negative cognition d. Assisting the client to rehearse new cognitive and behavioral responses e. Assisting the client to participate in the treatment process

A nurse is providing medication instructions to a patient who is taking doxepin (Sinequan) daily. Which statement by the patient indicates a need for further instructions? a. "If I miss a dose, I need to take it as soon as possible unless it is almost time for the next dose." b. "I need to avoid alcohol while taking the medication." c. "I need to take the medication in the morning before breakfast." d. "The effects of the medication may not be noticed for at least two weeks."

c. "I need to take the medication in the morning before breakfast." R: The patient should be instructed to take the medication (a single dose) at bedtime and not in the morning because it causes fatigue and drowsiness. The patient is instructed to take the medication as directed, and if a dose is missed to take it as soon as possible unless it is almost time for the next dose. The patient is told that medication effects may not be noticed for at least 2 weeks, and to avoid alcohol or other central nervous system depressants during therapy.

The nurse is caring for a Native American client who says, "I don't want you to touch me. I'll take care of myself." Which nursing response is most therapeutic? a. "If you don't want our care, why did you come here?" b. "Why are you being so difficult? I only want to help you." c. "It sounds as though you want to take care of yourself. Let's work together so you can do things for yourself." d. "Okay, if that's what you want. I'll just leave this cup for you to collect your urine."

c. "It sounds as though you want to take care of yourself. Let's work together so you can do things for yourself."

Two students fail their introductory nursing course. One student plans to seek tutoring and retake the course next fall. The second student attempts suicide. Which of the following factors would have been influential in the development of the second student's crisis? a. The presence of support systems b. The time of year in which the event occurred c. A lack of adequate coping mechanisms d. The individual's family birth order

c. A lack of adequate coping mechanisms

A mental health nurse who has been meeting with a client with a diagnosis of post-traumatic stress disorder is in the termination phase of the nurse-client relationship. The nurse notes that the client has been quiet and withdrawn and interprets the client's behavior as: a. An indication of the need for additional therapy sessions b. An indication of the need for antidepressants c. A normal behavior that can occur during termination d. An inability of the client to terminate from the nurse

c. A normal behavior that can occur during termination

Two staff nurses applied for promotion to nurse manager. The nurse not promoted initially had feelings of loss but then became supportive of the new manager by helping make the transition smooth and encouraging others. Which term best describes this nurse's response? a. Sublimation b. Passive aggression c. Altruism d. Suppression

c. Altruism R: Altruism is the mechanism by which an individual deals with emotional conflict by meeting the needs of others and vicariously receiving gratification from the responses of others.

The nurse notes that a client receiving lithium therapy is drowsy, has slurred speech, and is experiencing muscle twitching and impaired coordination. The nurse takes which of the following actions? a. Holds one dose of lithium b. Increase fluids to 2000 ml per day c. Calls the physician d. Doubles the next lithium dose

c. Calls the physician R: Signs and symptoms of lithium toxicity include vomiting and diarrhea, and nervous system changes such as slurred speech, incoordination, drowsiness, muscle weakness, or twitching. Before administering any further doses, the nurse should notify the physician. As long as there are no contraindications, the client should routinely take in between 2000 to 3000 ml of fluid per day while taking this medication.

The first task in assessing violent behavior should be: a. Establishing a treatment plan b. obtaining information from observers c. Determination of the cause d. ascertaining degree of injuries e. Admission to the hospital

c. Determination of the cause

A client has recently been diagnosed with mild to moderate NCD due to Alzheimer's disease. Which medication would the nurse expect the physician to order for the client's cognitive impairment? a. Zaleplon (Sonata) b. Quetiapine (Seroquel) c. Donepezil (Aricept) d. Nortriptyline (Pamelor)

c. Donepezil (Aricept)

The medication protocol the nurse should use to provide immediate intervention for an angry psychotic client whose aggressive behavior continues to escalate despite verbal intervention is: a. Trazodone b. Valproic Acid c. Haloperidol d. Lithium

c. Haloperidol (Haldol) R: Haloperidol is a short-acting antipsychotic that is useful in calming angry, aggressive clients regardless of their diagnosis.

A voluntarily hospitalized patient tells the nurse, "Get me the forms for discharge against medical advice so I can leave now." What is the nurse's best initial response? a. "Since you signed your consent for treatment, you may leave if you desire." b. "I'll get the forms for you right now and bring them to your room." c. I will get them for you, but let's talk about your decision to leave treatment." d. "I can't give you those forms without your health care provider's knowledge."

c. I will get them for you, but let's talk about your decision to leave treatment."

Which nursing diagnosis is written correctly? a. Conduct disorder related to childhood sexual abuse evidenced by hostile and aggressive behaviors. b. Risk for social isolation related to low self-esteem evidenced by staying in room during the day. c. Imbalanced nutrition: less than body requirements related to suspiciousness evidenced by 20 lbs. weight loss. d. Low self-esteem related to major depressive disorder evidenced by childhood abuse.

c. Imbalanced nutrition: less than body requirements related to suspiciousness evidenced by 20 lbs. weight loss.

Two staff nurses applied for a charge nurse position. After the promotion was announced, the nurse who was not promoted said, "The nurse manager had a headache the day I was interviewed." Which defense mechanism is evident? a. Splitting b. Introjection c. Projection d. Conversion

c. Projection R: projection is the hallmark of blaming, scapegoating, thinking prejudicially, and stigmatizing others.

A mental health nurse is assigned to care for a client with a diagnosis of undifferentiated schizophrenia with acute exacerbation. The nurse uses which of the following approaches when planning care for this client? a. Allow the client to set the goals for the plan of care. b. Repeatedly point out inconsistencies in the client's communication during initial treatment. c. Provide assistance with grooming and nutrition until the client's thinking has cleared. d. Let the client act out initially, and use the quiet room and restraints as needed.

c. Provide assistance with grooming and nutrition until the client's thinking has cleared.

A person who is speaking about a rival for a significant other's affection says in a gushy, syrupy voice, "What a lovely person. That's someone I simply adore." The individual is demonstrating: a. Repression b. Projection c. Reaction formation d. Denial

c. Reaction formation R: Reaction formation is an unconscious mechanism that keeps unacceptable feelings out of awareness by using the opposite behavior.

The client who is diagnosed with a borderline personality is admitted to the psychiatric unit. Based on a thorough understanding of personality disorders, the nurse would select which nursing diagnosis as the priority? a. Social isolation b. Ineffective coping c. Risk for self-mutilation d. chronic low self-esteem

c. Risk for self-mutilation

The assumption most useful to a nurse planning crisis intervention for any patient is that the patient: a. poses a threat of violence to others b. is experiencing a type of mental illness c. is experiencing a state of disequilibrium d. has a high potential for self-injury.

c. is experiencing a state of disequilibrium

Which statement about aggression would serve as the rational for care planning using behavioral techniques? Aggression... a. runs in families and is manifested as early as infancy. b. results from abnormalities in the temporal lobe of the brain. c. is motivated by rewards received for previous aggression. d. results from low levels of the neurotransmitter serotonin.

c. is motivated by rewards received for previous aggression R: Behavioral therapy does not accept aggressive drives as being instinctual or biological. It views aggressive behavior as a learned response that tends to be repeated if reinforced.

The nurse is preparing a client for discharge who was hospitalized following a suicide attempt. The nurse evaluates that the client could benefit from further development of coping strategies if the client was overheard making which of the following statements prior to discharge? a. "It is important for me to take my medications just as prescribed." b. "It's been good to learn better ways to deal with the stresses in my life." c. "I know now that I can't be all the things to all people all the time." d. "I know that I won't become depressed again after the treatment I received here."

d. "I know that I won't become depressed again after the treatment I received here."

In the shift-change report, an off-going nurse criticizes a patient who wars heavy makeup. Which comment by the nurse who receives the report best demonstrates advocacy? a. "Let's all show acceptance of this patient by wearing lots of makeup too." b. "This is a psychiatric hospital. Craziness is what we are all about." c. "Your comments are inconsiderate and inappropriate. Keep the report objective." d. "Our patients need our help to learn behaviors that will help them get along in society."

d. "Our patients need our help to learn behaviors that will help them get along in society."

A client looks at a mirror and cries out, "I look like a bird. This is not my face." The nurse responds therapeutically by saying: a. "Maybe the light is playing tricks on you." b. "Why do you think that you look like a bird?" c. "What kind of a bird do you think you are?" d. "That must be very distressing to you, your face does not look different to me."

d. "That must be very distressing to you, your face does not look different to me."

A client with a potential for violence is exhibiting aggressive gestures, making belligerent comments to the other clients, and is continuously pacing in the hallway. Which of the following comments by the nurse would be therapeutic at this time? a. "You are going to be restrained if you do not change your behavior." b. "Please stop so I don't have to put you in seclusion." c. "Why are you intent on upsetting the other clients?" d. "What is causing you to become agitated?"

d. "What is causing you to become agitated?"

A client is pacing the hall near the nurses' station, swearing loudly. An appropriate initial intervention for the nurse would be to address the client by name and say... a. "Hey, what's up?" b. "Please quiet down" c. "You need to go to your room to get control of yourself." d. "You seem upset. Tell me about it."

d. "You seem upset. Tell me about it." R: Intervention should begin with analysis of the client and the situation. With this response the nurse is attempting to hear the client's feelings and concerns. This leads to the next step of planning an intervention.

A client relates angrily to the nurse that his wife says he is selfish. Which response by the nurse would be most helpful? a. "That's just her opinion." b. "Everyone is a little bit selfish." c. "I don't think that you are selfish." d. "You sound angry - tell me more about what went on."

d. "You sound angry - tell me more about what went on."

A nurse is caring for a patient in acute mania who is being treated with carbamazepine (Tegretol).The nurse reviews the laboratory report for the results of the drug plasma level and determines that the plasma level is in a therapeutic range if which of the following is noted? a. 20 mcg/ml b. 1 mcg/ml c. 18 mcg/ml d. 10 mcg/ml

d. 10 mcg/mL R: When carbamazepine is administered, plasma levels of the medication need to be monitored periodically to check for absorption of the medication. The amount of the medication prescribed is based on the results of this laboratory test. The therapeutic plasma level of carbamazepine is 3 to 14 mcg/ml.

Which patient behavior is a criterion for mechanical restraint? a. Screaming profanities. b. Spitting at a family member during visiting hours. c. Throwing a pillow at another patient. d. Assaulting a staff person. e. Refusing a medication dose.

d. Assaulting a staff person. R: Indications for the use of mechanical restraint include protecting the patient form self-harm and preventing the patient from assaulting others.

A patient who has been diagnosed with Schizoaffective Disorder, Bipolar Type has an order to receive valproic acid (Depakene) 500mg once daily. To maximize the patient's safety, the nurse schedules administration of the medication: a. Before breakfast b. With breakfast c. With lunch d. At bedtime

d. At bedtime R: Valproic acid is a mood stabilizer and anticonvulsant that causes central nervous system (CNS) depression. For this reason, the side effects include sedation, dizziness, ataxia, and confusion. When the patient is taking this medication as a single daily dose, administering it at bedtime negates the risk of injury from sedation and enhances patient safety. Otherwise, it may be given after meals to avoid gastrointestinal upset.

The nurse in the pediatric unit is admitting a 2-year-old child. The nurse plans care, knowing that the child is in which stage of Erikson's psychosocial stages of development? Industry versus inferiority b. Initiative versus guilt c. Trust versus mistrust d. Autonomy versus shame and doubt

d. Autonomy versus shame and doubt

The principle on which nursing intervention should be predicated when a client's aggression quickly escalates is: a. Staff should match client's affective level, tone of voice, and so forth. b. Ask the client what will be most helpful to him or her. c. Immediately use physical containment measures. d. Begin with the least restrictive measure possible.

d. Begin with the least restrictive measure possible. R: Legal constraints require that staff use the least restrictive measure possible. This becomes the principle for intervention.

The nurse is describing medication side effects to a client who is taking a benzodiazepine. The nurse tells the client to take the medication only as prescribed because of the most common serious risk of a. Headache b. GI side effects c. Skin rashes d. Dependence

d. Dependence

The nurse is working with a client who shows signs of benzodiazepine withdrawal. The nurse suspects that the client has suddenly discontinued taking which of the following prescribed medications? a. Haloperidol (Haldol) b. Fluoxetine (Prozac) c. Sertraline (Zoloft) d. Diazepam (Valium)

d. Diazepam (Valium)

A client is taking a monoamine oxidase inhibitor (MAOI). The nurse assesses the client closely because: a. These medications increase the amount of MAOI in the liver. b. Hypotensive crisis may be precipitated by foods rich in tyramine and typtophan. c. Hypotension may indicate toxicity d. Headache, hypertension, and nausea and vomiting may indicate toxicity.

d. Headache, hypertension, and nausea and vomiting may indicate toxicity. R: Headache, hypertension, tachycardia, nausea, and vomiting are precursors to hypertensive crisis brought about by the ingestion of foods rich in tyramine and tryptophan while the client is taking an MAOI. These medications act by decreasing the amount of MAOI in the liver, which is necessary for the breakdown and utilization of tyramine, and tryptophan. Hypertensive crisis may lead to circulatory collapse, intracranial hemorrhage, and death.

A patient tells the nurse, "My husband is abusive most often when he drinks too much. His family was like that when he was growing up. He always apologizes and regrets hurting me." What risk factor was most predictive for the husband to become abusive? a. Loss of employment b. Poverty c. Abuse of alcohol d. History of family violence

d. History of violence (remember it's a LEARNED behavior!)

A patient tells a nurse, "My new friend is the most perfect person one could imagine; kind, considerate, and good looking. I can't find a single flaw." This patient is demonstrating: a. Denial b. Projection c. Compensation d. Idealization

d. Idealization R: idealization is an unconscious process that occurs when an individual attributes exaggerated positive qualities to another.

A client who has sustained severe injuries in a motorcycle accident was diagnosed with intensive care unit (ICU) psychosis. The nurse would be most likely to conclude that the client's status is improving if the client: a. Appears to be delirious but has stopped trying to pull out the nasogastric tube b. Tells his wife, "I feel better, but the doctors want to give me a lethal injection." c. Keeps his eyes fixed on the nurses while they are working in the room but has stable vital signs d. Increases the number of hours slept at one time and is increasingly alert

d. Increases the number of hours slept at one time and is increasingly alert

A patient on tranylcypromine (Parnate) requests information on foods that are acceptable to eat while taking the medication.The nurse tells the patient that it is safe to eat: a. Raisins b. Smoked fish c. Cheddar cheese d. Oranges

d. Oranges R: Tranylcypromine is classified as a monoamine oxidase inhibitor (MAOI) and, as such, tyramine-containing food should be avoided. Types of food to be avoided include, but are not limited to, those items identified except for oranges which are permissible. Additionally, beer, wine, caffeinated beverages, picked meats, yeast preparations, avocados, bananas, and plums are to be avoided. Ingesting Tyramine while taking MAOIs can result in HYPOTENSIVE CRISIS!

The nurse is assigned to a client who is psychotic, pacing, agitated, and using aggressive gestures and rapid speech. The nurse determines that the priority of care at this time is which of the following? a. Providing the other clients on the unit with a sense of comfort and safety by isolating the client b. Offering the client a less stimulated area in which to calm down and gain control c. Assisting in caring for the client in a controlled environment, such as a quiet room d. Providing safety for the client and other clients on the unit

d. Providing safety for the client and other clients on the unit

An individual experiences sexual dysfunction and blames it on a partner by calling the person unattractive and unromantic. Which defense mechanism is evident? a. Introjection b. Regression c. Compensation d. Rationalization

d. Rationalization R: Rationalization involves unconsciously making excuses for one's behavior, inadequacies, or feelings.

A nurse is caring for a client in active alcohol withdrawals on a med-surg unit. The client is observed speaking in a loud voice, using profanity with clenched fists. Which of the following actions should the nurse take? a. Walk away form the client. b. Move as close to the client as possible. c. Insist that the client stop yelling. d. Request that other staff members remain close by.

d. Request that other staff members remain close by. R: Use the team approach in crisis situations. do not intervene alone. The nurse should request that other staff members remain close by to assist if necessary.

The client on the mental health unit who should be assess as being at highest risk for directing violent behavior towards others is: a. The client who has completed alcohol withdrawal and is beginning a rehabilitation program. b. The client who has severe depression with delusions of worthlessness c. The client who has obsessive-compulsive disorder and performs many rituals d. The client who has paranoid delusions that she is being followed by members of the mafia.

d. The client who has paranoid delusions that she is being followed by members of the mafia. R: The client has the greatest disruption of ability to perceive reality accurately. People who feel persecuted may strike out against those believed to be persecutors.

The nurse is assisting in developing a plan of care for a client with a psychotic disorder who is experiencing altered thought processes that include the belief that the food is being poisoned. The nurse develops strategies that will encourage the client to discuss feelings and plans to: a. Focus on the fact that the client's beliefs are untrue. b. Focus on the components of adequate nutrition. c. Instruct the client about the need for adequate nutrition. d. Use open-ended questions and silence.

d. Use open-ended questions and silence.

An effective nursing intervention for helping angry clients learn to manage anger without violence would be: a. Administering anti-anxiety medications. b. Administering antipsychotic medications c. Providing negative reinforcement such as restraint or seclusion in response to angry outbursts, whether or not violence is present. d. Using cognitive strategies to identify a thought that increases anger, find proof for or against the belief, and substitute reality-based thinking.

d. Using cognitive strategies to identify a thought that increases anger, find proof for or against the belief, and substitute reality-based thinking. R: Anger has a strong cognitive component, so using cognition to manage anger is logical.

A Nurse is developing a teaching plan for a client who will be receiving phenelzine sulfate (Nardil). The nurse plans to tell the client to avoid: a. Vasodilators b. Cherries and blueberries c. Digitalis preparations d. Aged cheeses

d. aged cheeses R: Phenelzine sulfate is in the monoamine oxidase inhibitor (MAOI) class of antidepressant medications. An individual on an MAOI must avoid aged cheeses, alcoholic beverages, avocados, bananas, and caffeine drinks. There are also other food items to avoid, including chocolate, meat tenderizers, picked herring, raisins, sour cream, yogurt, and soy sauce. Medications that should be avoided include amphetamines, antiasthmatics, and certain antidepressants. The client should also avoid antihistamines, antihypertensive medications, levodopa (L-Dopa), and meperidine (Demerol).

A patient has a history of physical violence against family members when frustrated and then experiences periods or remorse after each outburst. Which finding indicates success in the plan of care? The patient: a. explains the rationale for behaviors to the victim. b. agrees to seek counseling. c. identifies three personal strengths. d. expresses frustration verbally instead of physically

d. expresses frustration verbally instead of physically

The following patients are seen in the emergency department. Which of the following patients meets the severity of illness and intensity of care required for the admitting officer to recommend admission to the psychiatric unit? The patient who: Select one: a. who self inflicted a superficial cut on the forearm after a family argument. b. experiencing dry mouth and tremor related to side effects of haloperidol (Haldol) c. experiencing anxiety and a sad mood after a separation from a spouse of 10 years. d. who is a single parent and hears voices saying, "Smother your infant."

d. who is a single parent and hears voices saying, "Smother your infant."