Mental Health Review

1. A client with a history of opioid abuse is exhibiting manifestations of moderate withdrawal. Which of the following would the nurse expect to assess? A. Sweating B. Insomnia C. Dilated pupils D. Respiratory depression

A,B,C

1. A client is involuntarily committed without a court order. The nurse understands that the emergency, short-term hospitalization can occur for how long? A. A maximum of 24 hours B. 48 to 92 hours C. 3 to 5 days D. 1 week

B

1. The nurse is in the orientation phase of the nurse-client relationship with a client diagnosed with schizophrenia. When interviewing the client during this first encounter, which information about the client would be most important for the nurse to obtain? A. Previous medication trials B. History of psychiatric hospitalizations C. The client's perception of the problem D. Family history of schizophrenia

C

1. The nurse is reviewing the medical records of several clients receiving antipsychotic agents. Which factors, if noted, would the nurse identify as placing a client at greater risk for tardive dyskinesia? A. Male gender B. Age 30 to 45 years C. Previous extrapyramidal symptoms D. New treatment with antipsychotics

C

1. A nurse is caring for a client with schizoid personality trait. When developing a plan of care for the client, which would a nurse most likely include? A. Social skills training B. Anger management training C. Relaxation techniques D. Coping skills training

A

1. The nurse is assessing a client who has borderline personality disorder. Which would be the priority considering the comorbid conditions associated with this disorder? A. Nutrition patterns B. Personal hygiene practices C. Physical functioning D. Somatic complaints

A

1. The nurse is caring for an older adult client who has been taking an antipsychotic medication for 1 week. The nurse notifies the physician when he observes that the client has muscle rigidity that resembles Parkinson's disease. Which agent would the nurse expect the physician to prescribe? A. Anticholinergic. B. Anxiolytic C. Benzodiazepine D. Beta-blocker

A

1. The nurse is explaining advance care directives, or 'living wills,' to a client and the client's spouse. Which would the nurse include in the description? A. The document tells what treatments are preferred and/ or unwanted when the client is unable to make the decision. B. An advanced directive must be signed by the client with two witnesses and an attorney present. C. The client's physician must act as a witness when the client signs the document. D. An attorney draws up the papers to be given to the client and his or her family.

A

1. The nurse is interviewing a client with schizophrenia when the client begins to say, "Kite, night, right, height, fright." The nurse documents this as: A. Clang association. B. Stilted language. C. Verbigeration. D. Neologisms.

A

1. While providing care to a client with a mental disorder, the client asks the nurse, "Does mental illness run in your family?" Which statement, if made by the nurse, is least therapeutic? A. "Mental illnesses do run in families, and I've had a lot of experience caring for people with mental illness." B. "It sounds like you are concerned that there may be a family connection to your current problem?" C. "Yes, it does. I have a sister who was diagnosed several years ago with severe depression." D. "Mental illness can be family related. Let's focus the discussion on you and how you're doing today."

A

1. The nurse is preparing a client for electroconvulsive therapy. Which would the nurse include in the client's plan of care? Select all that apply. A. Ensuring that there is a signed informed consent form on the client's chart B. Informing the client they can have fluids but no food before the procedure C. Alerting the client to the possibility of confusion after the treatment D. Informing the client that their dentures can stay in place for the treatment E. Ensuring that the client is closely supervised for at least the first 12 hours afterward

A,C,E

1. A client with bipolar disorder has a lithium drug concentration of 1.2 mEq/L. Which finding would the nurse expect to assess? Select all that apply. A. Metallic taste B. Ataxia C. Mild diarrhea D. Slurred speech E. NystagmusS F. Fatigue

A,C,F

1. A 20-year-old client arrives at the emergency department by ambulance. The client is unconscious, with slow respirations and pinpoint pupils. There are "tracks" visible on the client's arms. The friend who came with the client reports that the client had just "shot up" heroin when the client became unconscious. Which medication would the nurse most likely expect to administer? A. Naloxone B. Naltrexone C. Buprenorphine D. Disulfiram

A

1. A client receiving lithium therapy has a plasma blood concentration of 2.2 mEq/L. Which would the nurse expect to assess? A. Slurred speech B. Fine hand tremor C. Firm stools D. Mild diarrhea

A

1. A client who has been diagnosed with panic disorder visits the clinic and experiences a panic attack. The client tells the nurse, "I'm so nervous. My hands are shaking, and I'm sweating. I feel as if I'm having a stroke right now." What would be the priority intervention at this time? A. Stay with the client while remaining calm. B. Go to the medroom to prepare their scheduled buspirone 5 mg PO. C. Tell the client that the attack will soon pass. D. Teach the client deep breathing techniques to calm the client.

A

1. A family member brings a client who has Alzheimer's disease to the clinic. The client has been taking a cholinesterase inhibitor medication for 1 month. When assessing the client, the nurse would be alert for the possibility of which side effect? A. Gastrointestinal distress B. Mild headache C. Muscle tics D. Blurred vision

A

1. A nurse is caring for a client diagnosed with delirium who has been brought for treatment by the client's adult child. While taking the client's history, which question would be most appropriate for the nurse to ask the client's adult child? A. "Has your parent taken any new medications recently?" B. "Are you aware of your parent falling or injuring the head in any way?" C. "Has your parent had a recent stroke?" D. "Has your parent experienced any major losses recently?"

A

1. A nurse is caring for a client in the outpatient setting who has been diagnosed with a depressive disorder. Before the client is given a prescription for a tricyclic antidepressant, assessment for which of the following would be most important? A. Suicidal ideations and attempt history B. Seizure disorder C. Cardiac dysrhythmias D. Body mass index

A

1. A client is to receive lithium therapy as part of the treatment plan for bipolar disorder. When reviewing the client's medication history, which agents would alert the nurse to the possibility that a decrease in the lithium dosage may be needed? Select all that apply. A. Lisinopril B. Hydrochlorothiazide C. Docusate D. Acetaminophen E. Ibuprofen

A,B,E

1. A psychiatric-mental health nurse is using motivational interviewing. Which communication strategies would the nurse most likely integrate when using this technique? Select all that apply. A. Eliciting and strengthening client change talk B. Negotiating change plans C. Firming up client commitment by making them sign a contract D. Trying to "stick to the plan" without too many adjustments E. Using reflective statements and offering affirmations

A,B,E

1. The nurse is completing the admission of a client who is seeking treatment for alcoholism. The client tells the nurse that the last time they had any alcohol to drink was at 10 a.m., before leaving for the hospital. The nurse closely monitors the client. Which of the following would lead the nurse to suspect that the client is experiencing mild alcohol withdrawal syndrome? Select all that apply. A. Slight diaphoresis B. Hand tremors C. Intermittent confusion D. Heart rate of 135 beats/min E. Normal blood pressure

A,B,E

1. The nurse is developing an education plan for a client who is prescribed escitalopram. Which side effect would the nurse include in this plan? Select all that apply. A. Weight gain B. Decreased sexual interest C. Sedation D. Blurred vision E. Urinary retention F. Nausea and stomach ache

A,B,F

1. The nurse is preparing a continuing education presentation about various psychopharmacologic agents for a group of psychiatric-mental health nurses. The nurse is planning to discuss selective serotonin reuptake inhibitors. Which agents would the nurse include in this group? Select all that apply. A. Fluoxetine B. Duloxetine C. Escitalopram D. Venlafaxine E. Bupropion

A,C

1. The nurse is working with a client diagnosed with chronic depression. Which statement(s) made by the nurse demonstrates compliance with the basic principles of therapeutic communication? Select all that apply. A. "Our talks are confidential unless what you share poses a danger to you or someone else." B. "I have been depressed before and I found medication to be most helpful." C. "Tell me more about what you mean when you call your partner abusive." D. "It is very hard to help you when you miss our sessions so often." E. "I understand what you are going through, my divorce was the most painful thing I have ever experienced."

A,C

1. The client with schizophrenia is being treated by a team in the in the emergency room. The team determines that a client is competent when the client is able to: (Select All That Apply) A. Communicate their choices B. Show no deficits in cognition C. Understand relevant treatment information D. Appreciate their situation and its consequences

A,C,D

1. As part of a follow-up home visit to a client age 80 years who has had surgery, a nurse discusses the client's risk for delirium with his family members. Which of the following would the nurse include as placing the client at increased risk? Select all that apply. A. Urinary tract infection B. Hypertension C. Acute infection D. Bone fractures E. Dehydration F. Chronic back pain

A,C,D,E

1. A client is diagnosed with posttraumatic stress disorder (PTSD). When assessing the client, which finding would the nurse identify as intrusive? Select all that apply. A. Client reports reexperiences a traumatic image B. Client relates no longer experiencing dreams C. Client states feelings that the event is reoccurring D. Client complains of excessive sleeping, usually 12 hours or more per day E. Client reports feelings of being suspended in outer space and unable to find a way home

A,C,E

1. The nurse is conducting a review class on borderline personality disorder. When describing the characteristics associated with this disorder, which would the nurse most likely include? Select all that apply. A. Difficulty regulating moods B. Overinflated self-identity C. Problems with interpersonal relationships D. Thinking that is based on delusions E. Impulsive behavior

A,C,E

1. The nurse is developing a plan of care for a client diagnosed with an antisocial personality disorder who has been admitted to the inpatient psychiatric unit. Which would the nurse likely include? Select all that apply. A. Developing a therapeutic relationship B. Allowing some flexibility with unit rules C. Holding the client responsible for behavior D. Discouraging client from discussing thoughts E. Closely observing interactions with other clients.

A,C,E

1. The parent of a child diagnosed with schizophrenia is engaging less time with their child and spends most of their time on the computer researching causes and treatments of the disorder. The nurse interprets this information as reflecting which defense mechanism? A. Denial. B. Intellectualization. C. Projection. D. Passive aggression.

B

1. A client comes to the emergency department because the client thinks the client is having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most appropriate for the nurse to ask? A. "Are you feeling much better now that you are lying down?" B. "What did you experience just before and during the attack?" C. "Do you think you will be able to drive home?" D. "What do you think caused you to feel this way?"

B

1. A client comes to the emergency department reporting a severe hypertension, pounding headache in the temples and a stiff neck. The client is flushed and diaphoretic, and the client's pulse is racing. The client states that the client is being treated for depression with selegiline. Which question by the nurse would be most important to ask at this time? A. "When did you last have blood drawn to check your drug level?" B. "What have you had to eat or drink today?" C. "Are you having any chest pain?" D. "Do you use any herbal remedies?"

B

1. A client is prescribed disulfiram to prevent relapse from their mental illness. The client asks the nurse, "How will this drug help me?" Which response by a nurse would be most appropriate? A. "It will help to cure your alcoholism." B. "It can help to prevent you from drinking." C. "It makes the withdrawal symptoms less troublesome." D. "It helps to clear the alcohol out of your body."

B

1. A client was admitted to the psychiatric unit 3 days ago because of suicidal ideation. The client's suicidal risk has lessened considerably, and the client currently denies having any desire to kill himself or herself. In addition, the client is able to identify reasons why the client wants to be alive. Which nursing intervention would be most appropriate at this time? A. Assigning nursing staff to stay with the client during the suicidal crisis B. Developing a personal plan for managing suicidal thoughts when they occur C. Advising the client to consider electroconvulsive therapy treatments D. Administering the client's scheduled sertraline 75 mg daily PO.

B

1. A client with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After educating the client and family about the drug, the nurse determines that the education was successful when they state: A. "The client needs to have an electrocardiogram periodically when taking this drug." B. "We'll need to make sure that the client has the client's blood count checked at least weekly." C. "The client might develop toxic levels of the drug if the client smokes cigarettes." "We need to watch to make sure that the client doesn't lose too much weight."

B

1. A client with schizophrenia tells the nurse, "I'm being watched constantly by the Federal Bureau of Investigation because of my job." Which response by the nurse would be most appropriate? A. "Tell me more about how you are being watched." B. "It must be frightening to feel like you're always being watched." C. "You're not being watched; it's all in your mind." D. "You are experiencing a delusion because of your illness."

B

1. A client with somatic symptom disorder is complaining of significant pain in the joints. When providing care to this client, which would be most important for a nurse to keep in mind? A. Opioid analgesics are the primary mode of therapy. B. The client's experience of pain is real. C. Complementary therapies are usually of little benefit. D. Outcomes need to reflect the biologic aspects of the pain.

B

1. The nurse is implementing a brief intervention with a client who is abusing alcohol. The nurse most likely would be involved with which action? A. Asking the client questions about alcohol use B. Negotiating a conversation with the client about the need to change C. Pointing out the inconsistencies in thoughts, feelings, and actions D. Helping the client change the way the client thinks about a situation

B

1. After educating a client who is receiving phenelzine, the nurse determines that the education was successful when the client states the need to avoid: A. Fresh oranges. B. Cooked sliced ham. C. Tap beers. D. T-bone steak

B,C

1. Assessment of a client indicates complicated grief. Which statement would the nurse identify as supporting this reaction? Select all that apply. A. "It's been 2 months, and I still want my son back." B. "I still wait for him to come right through the door every day." C. "I'm really struggling with trusting anybody anymore." D. "I wish I could go back to the days before he died." E. "Life seems so empty now that he's gone. What will I do?"

B,C,D,E

1. After assessing a client with schizophrenia, a nurse suspects that the client is experiencing an anticholinergic crisis. What would the nurse most likely have assessed? Select all that apply. A. Dilated, reactive pupils B. Blurred vision C. Ataxia D. Coherent speech E. Facial pallor Disorientation

B,C,F

1. A psychiatric-mental health nurse has developed a therapeutic relationship with a client. Which action would alert the nurse to the possibility that the relationship is moving outside professional boundaries? Select all that apply. A. The client brings the nurse a baked item for their lunch. B. The nurse is spending considerably more time with the client than the others in the group. C. The nurse objectively contributes to the team meeting about behaviors the client is displaying. D. The nurse tells a friend that the nurse is the only one who truly understands this client. E. The nurse does not inform the supervisor that the client asked the nurse to "keep a secret from the rest of the staff."

B,D,E

1. The nurse is engaged in a therapeutic nurse-client relationship. The relationship is in the working phase. The nurse recognizes the client should be involved with which actions? Select all that apply. A. Beginning to identify a need B. Testing new ways for problem solving C. Maintaining the boundaries of the relationship D. Discussing problems related to needs E. Examining personal issues

B,D,E

1. A client is hospitalized on a psychiatric unit secondary to a suicide attempt. The client has been diagnosed with depression and is consistently depressed. When assessing the client, which finding would alert the nurse that the client's suicidal risk has increased? A. The client tells the nurse that the client feels as depressed as ever. B. The client is lethargic, remaining isolated from other clients. C. The client says the client feels better, with more energy to interact with others D. The client's energy level and degree of depression remain the same.

C

1. A hospitalized client diagnosed with depression asks a nurse, "Should I go home this weekend?" Which response by the nurse uses the technique of reflection? A. "Should you go home for the weekend?" B. "Home means what to you?" C. "It sounds as if you don't want to go home this weekend." D. "I doubt that you really should go home this weekend."

C

1. A nurse is performing an assessment of a client with suicidal ideation. Which question would the nurse most likely ask to determine the degree of planning? A. "How seriously do you want to die?" B. "Have you attempted suicide before?" C. "Have you chosen a place where you would do this?" D. "How much do the thoughts distress you?"

C

1. The nurse observes an older adult client who has been taking antipsychotic medications for 8 months. The nurse sees the client's lips smacking and eyes blinking rapidly. The nurse also observes a protruding tongue. Which action by the nurse would be most appropriate? Ask whether the client has been experiencing side effects. Instruct the client to begin tapering the medication. Document the client's symptoms of tardive dyskinesia and contact the provider. Document that the client's medication has become less effective at controlling the client's symptoms.

C

1. When explaining kindling to a group of nursing students in their mental health rotation, which of the following would the nurse use as the best explanation of "kindling?" A. After combat exposure a client has little or no reaction when a car backfires on the road. B. The sensitized client will no longer react to later, milder stressors that are similar to their initial exposure. C. With repeated reexperiencing of the traumatic event, posttraumatic stress disorder symptoms become more easily triggered with time. D. The symptoms associated with the stressor will correlate to a decrease in dopamine activity.

C

1. Which question would be most helpful in beginning an initial assessment interview for a client who has just been admitted to a psychiatric inpatient unit? A. "Have you had any thoughts about trying to harm yourself?" B. "Have you had any previous psychiatric admissions?" C. "What brings you into the hospital today?" D. "What psychiatric medications have you tried in the past?"

C

1. Which client would the nurse determine to be the most likely candidate for involuntary commitment? A. The client with depression who reports suicidal ideation. B. The client with PTSD who is experiencing hypervigilance and refuses to participate in treatment. C. The client with anorexia nervosa with a BMI of 15 despite intensive treatment. D. The client with schizophrenia who is homeless and has auditory hallucinations.

C, NOT SUICIDE IDEATION

1. An adolescent is brought to the emergency department by her parents because they were concerned about their daughter's appearance. The client appears emaciated and pale. The parents tell the nurse that the client has been diagnosed with anorexia nervosa. A history, physical examination, and laboratory testing are completed. Which of the following would lead the nurse to suspect that the client will be admitted to the hospital? Select all that apply. A. Blood pressure of 100/60 mm Hg B. BMI 17 kg/m2 C. Potassium 3.0 mEq/L D. Heart rate of 40 beats/min E. Statements of being "hopeless"

C,D,E

1. A client has been diagnosed with memory dysfunction associated with Alzheimer's disease. The nurse determines that damage to the client's brain includes deterioration of temporal lobe structures and the nerves of which area? A. Insula B. Amygdala C. Pre-frontal cortex D. Hippocampus

D

1. A client hospitalized for treatment of schizophrenia has been receiving olanzapine for the past 2 months. The nurse should be especially alert for: A. Weight loss. B. Hypertension. C. Seizures D. Diabetes.

D

1. A client is brought to the emergency department by a family member who reports that the client became very agitated and "seems very confused." Further assessment reveals elevated temperature, tachycardia, muscle rigidity and twitching, vomiting, and diarrhea. The family member states that the client recently started taking a medication for depression. Which would the nurse most likely suspect? A. Neuroleptic malignant syndrome B. Acute dystonic reaction C. Discontinuation syndrome D. Serotonin syndrome

D

1. A hospitalized male client who has been taking an antipsychotic medication for 2 weeks begins pacing and walking throughout the unit. He tells the nurse that he "cannot sit still." The nurse documents this finding as: A. Tardive dyskinesia. B. Dystonia. C. Pseudo-parkinsonism. D. Akathisia.

D

1. After educating a class of nursing students about the rights of persons receiving mental health services, the instructor determines a need for additional instruction when the students identify which as a right? A. Freedom from restraints or seclusion B. Access to one's own mental health records upon request C. An individualized written treatment plan D. Refusal of treatment during an emergency situation

D

1. The nurse is assessing a client and suspects obsessive-compulsive disorder. The nurse understands that to rule a behavior as obsessive-compulsive disorder (OCD), the obsession or compulsion must meet which criteria? A. The client is convinced that the obsessive thoughts are true. B. The obsession is the client's primary thought process throughout the entire day. C. Cause considerable anguish if not performed first thing in the morning. D. Take up more than 1 hour/day and cause stress to the client.

D

1. The nurse is assessing the parents of a child age 6 years who has died from leukemia. The nurse is integrating the dual process model for the assessment. What would the nurse identify as reflecting the parents' loss-oriented coping? A. Engaging in new activities B. Denying the grief C. Developing new relationships D. Thinking about the lost child

D

1. The nurse is caring for a client who has a history of several re-admissions for non-adherence to medications. Which action by the nurse would best help the client with medication adherence? A. Gaining the client's trust before offering education about the medication's effectiveness rates. B. Asking why the client failed to adhere to the medication regimen. C. Including a support person to aid in medication administration in the home. D. Using a shared decision-making tool to discuss beliefs about medication.

D