MH Chapter Review Questions

While weighing patients on an eating disorders unit, the nurse overhears a psychiatric technician say, "I wish I had an eating disorder; maybe I'd lose a little weight." What is the nurse's best action? a) Report the clinical observation to the nursing supervisor. b) Ask the psychiatric technician, "What did you mean by that comment?" c) Privately discuss the importance of sensitivity with the psychiatric technician. d) Immediately interrupt the interaction between the patient and the psychiatric technician.

Answer: c. The comment by the psychiatric technician trivializes the patients' problems. Low self-esteem and self-doubts about personal worth are characteristic features of persons who have eating disorders. The comment contributes to these aspects of self-perception.

Which scenario presents the most risk factors for suicide? a) 64-year-old black female whose husband died 3 months ago b) 72-year-old white female scheduled for hip replacement in 2 weeks c) 82-year-old widowed white male recently diagnosed with pancreatic cancer d) 92-year-old black male who recently moved into the home of his adult children

Answer: c. The highest suicide rate is among white males age 65 and older. Depression can be dangerous when the older person is also experiencing illness, loneliness, or other life losses.

A 28-year-old second-grade teacher is diagnosed with major depressive disorder. She grew up in Texas but moved to Alaska 10 years ago to separate from an abusive mother. Her father died by suicide when she was 12 years old. Which combination of factors in this scenario best demonstrates the stress-diathesis model? a) Cold climate coupled with history of abuse b) Current age of 28 coupled with family history of depression c) Family history of mental illness coupled with history of abuse d) Female gender coupled with the stressful profession of teaching

Answer: c. The stress-diathesis model explains depression from an environmental, interpersonal, and life-events perspective combined with biological vulnerability or predisposition (diathesis). Psychosocial stressors and interpersonal events, such as abuse, trigger certain neurophysical and neurochemical changes in the brain. Early life trauma is a significant component in the stress reaction.

A nurse assesses four adolescents diagnosed with various eating disorders. Which comment would the nurse expect from the adolescent diagnosed with anorexia nervosa? a) "I look good because whenever I overeat, I purge myself." b) "I love sweets. I make myself throw up so I can eat more." c) "I've lost 60 pounds, but I'm still a size 2. I want to be a size 0." d) "I've hidden my eating disorder from everyone, even my parents."

Answer: c. Thought processes that accompany anorexia nervosa include a terror of gaining weight, viewing oneself as fat even when emaciated, and judging one's self-worth by one's weight or size.

A nurse plans a psychoeducational group about physical health in an outpatient program for patients diagnosed with serious mental illness. Which topic has priority? a) Heart-healthy living b) Living with diabetes c) ABCDEs of skin cancer d) Breast and testicular self-examination

Answer: a. Although all of the topics are important, heart-healthy living encompasses diet, exercise, lifestyle or behavior changes, and management of hypertension. Persons who take antipsychotic medications are particularly at risk for heart disease and metabolic syndrome as a result of weight gain and hyperlipidemia.

A university football coach invites the campus nurse to talk to the team about healthy relationships in the community. Which topic has priority for the nurse to include? a) Appropriate behavior with intimate partners b) University resources for counseling and support c) The importance of role modeling for children and teens d) Public recognition of children with life-threatening illnesses

Answer: a. Although the nurse may include any of the topics, the topic of appropriate behaviors with intimate partners has priority. The characteristics of the game of football, the physical power required to be a player, and the risk for drug or alcohol misuse among this age group are factors that increase the risk for intimate partner violence.

A community mental health nurse counsels a group of patients about the upcoming flu season. What instruction does the nurse provide for patients who are prescribed lithium? a) "Call the clinic if you have nausea, vomiting, and/or diarrhea or are unable to stay well hydrated." b) "Remember that lithium reduces your immunity, so you are more vulnerable to catching the flu." c) "The flu is contagious. Isolate yourself if you get the flu so that you avoid exposing others to it." d) "Because you take lithium, you may have flu symptoms that are not typically experienced by others."

Answer: a. Patients should stop taking lithium if excessive diarrhea, vomiting, or sweating occurs. These problems can lead to dehydration, which can raise serum lithium to toxic levels.

A distraught 8-year-old girl tells the nurse, "I had a horrible nightmare and was so scared. I tried to get in bed with my parents, but they said, 'No.' I think I could have gone back to sleep if I had been with them." Which family dynamic is likely the basis of this child's comment? a) Boundaries in the family are rigid. b) The family has poor differentiation of roles. c) The girl is enmeshed in part of a family triangle. d) Generational boundaries in the family are diffuse.

Answer: a. Rigid or disengaged boundaries are those in which the rules and roles are followed despite the consequences.

A patient diagnosed with schizophrenia says, "I hear the voices every day. They always say bad things about me." Which action by the nurse has the highest priority? a) Assess the patient for suicidal thinking and plans. b) Review the patient's medication regimen and adherence. c) Educate the patient about symptoms associated with schizophrenia. d) Suggest distracters for the patient to use when auditory hallucinations occur.

Answer: a. The daily experience of negativity creates a scenario in which the risk for suicide is high. Depressive symptoms occur frequently in schizophrenia. Suicide is the leading cause of premature death in this population.

A nurse plans a group meeting for adult patients in a therapeutic milieu. Which topic should the nurse include? a) Coping with grief and loss b) The importance of hand washing c) Strategies for money management d) Staffing shortages expected over the next 3 days

Answer: b. A therapeutic milieu provides a healthy social structure within an inpatient setting or structured outpatient clinic. Groups aim to help increase patients' self-esteem, decrease social isolation, encourage appropriate social behaviors, and educate patients in basic living skills, such as good hand washing. Coping with grief and loss (Option a) would be more appropriately provided by a therapist or advanced practice nurse.

A nurse assesses a 78-year-old patient who lives alone at home and is beginning three new prescriptions. Which question by the nurse will best provide for the patient's safety? a) "How do you store your medications at home?" b) "What is your usual bowel elimination pattern?" c) "Who usually helps you with your medications?" d) "How much alcohol do you drink on a normal day?"

Answer: d. The interaction of drugs and alcohol in the older adult can have serious consequences. Alcohol may prolong, potentiate, or accelerate the metabolism of various drugs.

A patient is hospitalized with a diagnosis of anorexia nervosa. The nurse reviews the patient's laboratory results, as follows: - Sodium 143 mEq/L - Potassium 3.1 mEq/L - Chloride 102 mEq/L - Magnesium 2.2 mEq/L - Calcium 8.4 mg/dL - Phosphate 3.0 mg/dL The nurse should take which action next? a) Measure the patient's body temperature. b) Inspect the patient's skin and sclera for jaundice. c) Assess the patient's mucous membranes for erosion. d) Auscultate the patient's heart rate, rhythm, and sounds.

Answer: d. The laboratory results show hypokalemia and hypocalcemia, which are likely to affect cardiac function, producing bradycardia, arrhythmias, and/or murmurs.

An adult required a heart transplant 5 years ago. Multiple medical complications followed, resulting in persistent irritability, depression, and insomnia. The adult's spouse says, "I've walked on eggshells for 5 years, never knowing when something else will go wrong." What is the nurse's priority intervention regarding the spouse? a) Explore the spouse's feelings, showing care and compassion. b) Encourage the spouse to attend a community support group. c) Teach stress reduction and relaxation techniques to the spouse. d) Refer the spouse to the primary care provider for health assessment.

Answer: d. The scenario suggests that the spouse has experienced the effects of long-term stress. When stress is prolonged, the body stays alert. Chemicals produced by the stress response can have damaging effects on the body, causing physical diseases. Although all of the actions may be indicated, obtaining a health assessment from the primary care provider has the first priority.

A patient diagnosed with major depressive disorder was hospitalized for 2 weeks on an acute psychiatric unit. One day after discharge, the patient completed suicide. Recognizing likely reactions among staff, which action should the nursing supervisor implement first? a) Assess each staff member individually for suicidal intent and/or plans. b) Provide a private setting for staff members to talk about feelings associated with the event. c) Remind staff members that suicide is a risk for the patient population and that they are not at fault. d) Invite a guest speaker to conduct an educational session for staff members about suicide risk factors.

Answer: b. All health care members who provided care for a suicide victim, including medical staff, nursing staff, and ancillary staff, are at risk of being traumatized by suicide. Staff also may experience symptoms of posttraumatic stress disorder with guilt, shock, anger, shame, and decreased self-esteem. To reduce the trauma associated with the sudden loss, posttrauma loss debriefing can help to initiate an adaptive grief process and prevent self-defeating behaviors.

A 92-year-old lives alone, but family members assist with transportation and home maintenance. This adult tells the nurse, "They mean well, but sometimes my family treats me like a child." What is the nurse's best action? a) Encourage the adult to overlook these behaviors from family members. b) Role-play with the adult ways to share these feelings with family members. c) Contact family members privately and educate them about the harmful effects of ageism. d) Reinforce family members' good intentions and say, "It's fortunate your family is so helpful."

Answer: b. As an advocate, the nurse can help to empower the patient to address the problem. Role-playing provides an opportunity to safely practice different responses.

A mature, professional couple plans a large wedding in a city that is 100 miles from their home. Which response is most likely to be associated with this experience? a) Distress b) Eustress c) Acute stress d) Depersonalization

Answer: b. Eustress is beneficial stress that will help the couple to focus, problem solve, and successfully plan their wedding.

Which scenario presents the highest risk for a pregnancy resulting in offspring with an intellectual developmental disability (IDD)? a) 18-year-old mother who received no prenatal care b) 32-year-old woman diagnosed with anorexia nervosa c) 26-year-old father with a history of episodic alcohol abuse d) 38-year-old father diagnosed with generalized anxiety disorder

Answer: b. IDD may be a result of hereditary factors, alterations in early embryonic development, pregnancy and perinatal problems, and other factors such as trauma and poisoning.

A nurse leads a milieu meeting in an outpatient program for adults diagnosed with serious mental illness. Four patients complain that another patient is "always begging us for money." Which comment by the nurse is therapeutic? a) "If you can afford to help each other, it is reasonable to do so." b) "Let's review what we have learned about being assertive with others." c) "No one needs to bring money to our program. Lunch is provided at no charge." d) "Let's show understanding of each other. Money management is a problem for everyone."

Answer: b. Individuals with severe mental illness (SMI) usually have difficulties in multiple areas, including finances and budgeting. Psychoeducational programming builds interpersonal skills, including assertiveness.

A person diagnosed with serious mental illness has been homeless for 8 years and says, "I don't have any money because I've never had a job. I can't afford a place to live." Which intervention should the outpatient mental health nurse add to the plan of care? a) Requisition the patient's legal record of arrests and convictions. b) Help the patient to apply for Supplemental Security Income (SSI). c) Assist the patient to apply for Social Security Disability Income (SSDI). d) Seek to have the patient adjudicated non compos mentis (incompetent).

Answer: b. Issues for those with severe mental illness (SMI) include poverty, stigma, isolation, unemployment, poorer health outcomes, law enforcement encounters, victimization, and inadequate housing or homelessness. Supplemental Security Income (SSI) provides a modest income for indigent persons ineligible for Social Security Disability Income (SSDI).

An outpatient nurse has lunch with a group of patients diagnosed with serious mental illness. The nurse observes an obese adult ask a malnourished adult, "If you aren't going to eat your apple, will you give it to me?" What is the nurse's best action? a) Remind both adults that sharing food with each other is not permitted. b) Remind the malnourished adult of treatment goals related to weight gain. c) Reseat the patients at two separate tables for the remainder of the meal. d) Overlook the remark. Both adults are permitted to make their own decisions.

Answer: b. The consumer has an active role in treatment and quality of life. Poverty and lack of access to quality foods can cause poor nutrition. The recovery model stresses a partnership between care providers and the patient, both working together to plan and direct treatment. Empowering the patient and focusing on strengths rather than limitations helps the patient to use his or her strengths to achieve the highest quality of life possible.

An 85-year-old woman says to the nurse, "I raised three children, but now two of them barely speak to me. I did not do a good job of instilling a family spirit." Which response should the nurse provide? a) "Do you think this situation is likely to change?" b) "If you could relive those earlier years, what would you do differently?" c) "There's no guidebook for parenting. Your children have made their own choices." d) "Your children are likely to regret their behavior. I hope you can find it in your heart to forgive them."

Answer: b. The developmental task of late life is integrity versus despair. The patient's comment shows feelings of hopelessness and loss, which contribute to despair. The correct response assists the patient to find meaning in life.

The nurse asks an 87-year-old, "How are you doing?" The patient replies, "I have good days and bad days." Select the nurse's therapeutic response. a) "How is your sleep?" b) "Tell me more about that." c) "Are you feeling depressed?" d) "We expect that from people your age."

Answer: b. The patient's comment may relate to physical or mental concerns. The nurse should first clarify and explore the meaning of the comment.

A young adult tells the nurse, "I have a new prescription for medical marijuana. I use it several times a day for my frequent muscle spasms." What information should the nurse provide first to this patient? a) Guidance that the prescription should not be shared with peers b) Directions to weigh self once a week and maintain a log of the results c) Instructions about safety issues associated with driving or operating machinery d) Information about the potential for amotivational syndrome and memory problems

Answer: c. All of the options are correct, but safety is the nurse's first concern. Marijuana is a psychoactive substance. Effects include euphoria, sedation, perceptual distortions, and hallucinations; therefore, driving or operating machinery may be hazardous.

Select the best example of altruism. a) After recovering from a gunshot wound, a police officer attends a local support group. b) After recovering from open-heart surgery, an individual plays tennis three times a week. c) An individual who received a liver transplant volunteers at a local organ procurement agency. d) An individual with a long-standing fear of animals volunteers at a community animal shelter.

Answer: c. Altruism is a health defense mechanism in which emotional conflicts and stressors are addressed by meeting the needs of others. With altruism, the person receives gratification either vicariously or from the response of others.

A family member asks the nurse, "I know my uncle's Alzheimer's disease has progressed, but is there any medication that can help him now?" Which response by the nurse is correct? a) "I'm sorry, but there are no medications that help with severe Alzheimer's disease." b) "Alzheimer's disease sometimes stabilizes. Let's hope that happens in this situation." c) "There are a few medications that may help. Let's discuss it with the health care provider." d) "It sounds like you're having difficulty accepting that your uncle's disease is irreversible. Would you like to talk about those feelings?"

Answer: c. Memantine (Namenda), an N-methyl-D-aspartate (NMDA) antagonist, and some cholinesterase inhibitors may be prescribed to treat symptoms of moderate to severe Alzheimer's disease.

A nurse working in the county jail assesses four new inmates. The nurse should direct officers to place which inmate under suicide watch? a) An inmate charged with breaking and entering b) An inmate charged with criminal solicitation (prostitution) c) An inmate charged with a lewd and lascivious act perpetrated on a minor d) An inmate charged with assault and battery of an elderly person

Answer: c. Pedophilia involves lewd or lascivious (sexual) acts perpetrated on a minor. Perpetrators are at especially high risk of suicide, especially in the first 24 to 48 hours after incarceration.

After a power outage, a facility must serve a dinner of sandwiches and fruit to patients. Which comment is most likely from a patient diagnosed with a narcissistic personality disorder? a) "These sandwiches are probably contaminated with bacteria." b) "I suppose it's the best we can hope for under these circumstances." c) "You should have ordered a to-go meal from a local restaurant for me." d) "I would rather wait to eat until the dietary department can prepare a meal."

Answer: c. People diagnosed with narcissistic personality disorder consider themselves special and expect special treatment. Their demeanor is arrogant and haughty. They have a sense of entitlement.

While interacting with a 62-year-old adult diagnosed with a progressive neurocognitive disorder, the nurse observes that the adult has slow responses and difficulty finding the right words. What is the nurse's best initial action? a) Suggest words that the adult may be trying to remember. b) Ask the adult, "Are you having problems saying what you mean?" c) Use silence to allow the adult an opportunity to compose responses. d) Discontinue the interaction to prevent further frustration for the adult.

Answer: c. Silence is a therapeutic communication technique. It is respectful and provides an opportunity for the adult to compose responses.

An emergency department nurse talks with a newly admitted victim of reported rape. Which communication should the nurse offer to comfort this patient? a) "You are safe now. I will stay with you in this private room." b) "Would you like your friend to stay with you during your examination?" c) "You made a good decision to come to the hospital after you were raped." d) "What questions do you have about your examination by the sexual assault nurse examiner?"

Answer: a. A sexual assault victim who arrives at the emergency department needs compassionate, supportive care and should not be left alone.

Which scenario best demonstrates empathic caring? a) A nurse provides comfort to a colleague after an error of medication administration. b) A nurse works a fourth extra shift in 1 week to maintain adequate unit staffing. c) A nurse identifies a violation of confidentiality and makes a report to an agency's privacy officer. d) A nurse conscientiously reads current literature to stay aware of new evidence-based practices.

Answer: a. Caring is evidenced by empathic understanding, actions, and patience on another's behalf; actions, words, and presence that lead to happiness and touch the heart; and giving of self while preserving the importance of self. Comforting is a part of caring, which includes social, emotional, physical, and spiritual support.

A nursing assistant says to the nurse, "The schizophrenic in room 226 has been rambling all day." When considering the nurse's responsibility to manage the ancillary staff, which response should the nurse provide? a) "It is more respectful to refer to the patient by name than by diagnosis." b) "Thank you for informing me about that. I will document the behavior." c) "It is not unusual for schizophrenics to do that. It's just part of their illness." d) "You have a difficult job. I'm glad you are so accepting of our patients' behaviors."

Answer: a. Diagnoses classify disorders that people have, not the person. For this reason, it is important to avoid use of expressions such as "a schizophrenic" or "an alcoholic." The nurse has a responsibility to educate the coworker.

A day-shift nurse contacts a nurse scheduled for the night shift at home and says, "Our unit is full, and there are eight patients in the emergency department waiting for a bed." The night-shift nurse replies, "Thanks for telling me. I am calling in sick." Which type of problem is evident by the night-shift nurse's reply? a) Ethical problem of fidelity b) Legal problem of negligence c) Legal problem of an intentional tort d) Violation of the patients' right to treatment

Answer: a. Fidelity is the ethical principle of maintaining loyalty and commitment to the patient. The nurse in this situation is not maintaining commitment to patients by refusing to work the shift. It is not, however, illegal for a nurse to call off for personal reasons, making this an ethical decision.

A person shoplifts merchandise from a community cancer thrift shop. When confronted, the person replies, "All this stuff was donated, so I can take it." This comment suggests features of which personality disorder? a) Antisocial b) Histrionic c) Borderline d) Schizotypal

Answer: a. The persons exhibits callousness, entitlement, lack of remorse, and disregard for the rights of others. These characteristics are common in persons diagnosed with antisocial personality disorder.

The parent of an adolescent recently diagnosed with schizophrenia says to the nurse, "This is entirely my fault. I should have spent more time with my child when he was a toddler." Which response by the nurse is correct? a) "Schizophrenia is genetically transmitted, so it was not in your control." b) "Your child's disorder is more likely the result of an undetected head injury." c) "Environmental toxins are directly implicated in the origins of schizophrenia." d) "Lack of prenatal care causes schizophrenia rather than early childhood events."

Answer: a. Genetic factors have been implicated in a number of childhood mental disorders, including autism, bipolar disorder, schizophrenia, attention-deficit hyperactivity disorder (ADHD), intellectual developmental disorders, and some others.

As Election Day nears, a psychiatric nurse studies the position statements of various candidates for federal offices. Which candidate's commentary would the nurse interpret as supportive of services for persons diagnosed with mental illness? a) Full-parity insurance coverage for mental illness b) Coverage for biologically based mental illnesses c) Reimbursement for initial treatment of addictions d) Managed care oversight for mental illness services

Answer: a. Mental health parity refers to third-party (insurance) coverage of care for mental illness and addictions similar to the coverage of the care for physical illness. Federal and state legislation apply, but coverage varies by state. Some states offer full parity for mental illness insurance coverage.

A nurse plans care for a patient diagnosed with borderline personality disorder. Which patient problem is most likely to apply to this patient? a) Ineffective relationships related to frequent splitting b) Social isolation related to fear of embarrassment or rejection c) Ineffective impulse control related to violence as evidenced by cruelty to animals d) Disturbed thought processes related to recurrent suspiciousness of people and situations

Answer: a. People diagnosed with borderline personality disorder frequently use the defense of splitting, which strains personal relationships. Splitting is the inability to integrate both the positive and the negative qualities of an individual into one person.

A patient diagnosed with bipolar disorder lives in the community and is showing early signs of mania. The patient says, "I need to go visit my daughter, but she lives across the country. I put some requests on the Internet to get a ride. I'm sure someone will take me." What is the nurse's most therapeutic response? a) "I'm concerned about your safety when meeting or riding with strangers." b) "Have you asked friends and family to donate money for your airfare?" c) "You are not likely to get a ride. Let's consider some other strategies." d) "Have you asked your daughter if she wants you to come for a visit?"

Answer: a. Safety is a priority. Mania impairs the person's judgment and impulse control, which may result in harm to self. The correct response identifies potential dangers and shows care for the patient.

A patient at a general medical clinic tells the nurse, "I have so many ailments that I need to see six different doctors. None of them has discovered what is really wrong with me." Which comment should the nurse offer next? a) "Let's review all the medications you currently take." b) "Tell me about allergic reactions you've had to medication." c) "Selecting one primary care provider would be better for you." d) "I'm not sure I understand how you can afford these expenses."

Answer: a. Safety is the nurse's first concern. One serious risk associated with doctor-shopping is medication interactions and duplicate medications.

A patient tells the nurse, "I was raped 8 years ago but never told anyone. Nevertheless, the memories haunt me every day. I should be over it by now." Which comment should the nurse offer next? a) "It sounds like you're judging yourself for continuing to struggle with your reaction." b) "Rape is criminal behavior. You should have reported the incident to law enforcement." c) "Are you now ready to engage in counseling to deal with your reactions to this experience?" d) "Although it's important to learn from such life events, it's more important to put things in the past."

Answer: a. The correct response demonstrates the use of reflection, a therapeutic communication technique. The consequences of rape can cause serious, long-term psychological trauma. Rape-trauma syndrome is a common sequela. Later in this interaction, the nurse should encourage the patient to consider professional counseling.

On the sixth anniversary of her spouse's death, a widow says, "Sometimes life does not seem worth living anymore. I wish I could go to sleep and never wake up." Which response by the nurse has priority? a) "Are you considering suicide?" b) "You still have so much to live for." c) "Grief can sometimes last for many years." d) "Why do you continue to grieve something from long ago?"

Answer: a. The nurse should always take an individual very seriously if he or she mentions some form of suicidal ideation and ask directly about suicide.

A patient who had a stroke 3 days ago tearfully tells the nurse, "What's the use in living? I'm no good to anybody like this." Which action should the nurse employ first when caring for a patient demonstrating hopelessness? a) Implement the institutional protocol for suicide risk. b) Support the patient to clarify and express feelings of grief. c) Educate the patient about the success of stroke rehabilitation. d) Offer the patient an opportunity to confer with the pastoral counselor.

Answer: a. The patient's comment suggests hopelessness, helplessness, and worthlessness. Physical illnesses play a role in increasing suicide risk. Suicide precautions should be initiated.

A patient diagnosed with major depressive disorder tells the community mental health nurse, "I usually spend all day watching television. If there's nothing good to watch, I just sleep or think about my problems." What is the nurse's best action? a) Refer the patient for counseling with a recreational therapist. b) Ask the patient, "What kinds of program do you like to watch?" c) Suggest to the patient, "Are there some friends you could call instead?" d) Advise the patient, "Watching television and thinking about problems makes depression worse."

Answer: a. The patient's comments indicate problems with the use of leisure time. Recreational activities improve emotional, physical, cognitive, and social well-being. A recreational therapist is the best member of the treatment team to provide these services. Asking the patient about program preferences (Option b) may give the nurse more information but does not provide any action to improve well-being.

A veteran of the war in Afghanistan tells the nurse, "Every day, something happens that makes me feel like I'm still there. My family has grown impatient with me. They say it's time for me to move on from that time in my life, but I can't." What is the nurse's first priority? a) Assess the veteran for suicide risk. b) Refer the veteran for specialized mental health services. c) Assess the veteran for evidence of traumatic brain injury. d) Refer the veteran's family to a posttraumatic stress disorder group.

Answer: a. The veteran has high risk for posttraumatic stress disorder (PTSD). When PTSD is untreated or undertreated, painful repercussions often occur, particularly marital problems, unemployment, heavy substance abuse, and suicide. The highest priority is an assessment of suicide risk.

Which newly hospitalized patient should the nurse monitor closely for the development of delirium? a) A 48-year-old who usually drinks a six-pack of beer daily b) A 68-year-old who takes aspirin 650 mg twice daily for arthritic pain c) A 72-year-old who says, "I have a glass of wine every evening to stimulate my appetite." d) A 78-year-old diabetic whose blood glucose levels are consistently greater than 250 mg/dL

Answer: a. Withdrawal from alcohol, anxiolytics, opioids, and central nervous system stimulants presents a significant risk for the development of delirium. The correct response identifies a patient who is likely to have tolerance to alcohol and is thus at risk for alcohol withdrawal delirium.

A college student has been experiencing significant stress associated with academic demands. Last month, the student began attending yoga sessions three times a week. Which outcome indicates this activity has been successful? a) The student reports improved feelings of well-being. b) The student increases the use of caffeine to enhance concentration. c) The student reports, "Now I am sleeping about 10 hours every day." d) The student says, "I withdrew from two courses to reduce my academic load."

Answer: a. Yoga and other physical activities can be effective ways to manage stress. These activities deepen breathing, relieve muscle tension, and can elevate levels of the body's own endorphins, which induces a sense of well-being.

A patient in the emergency department was seen for the third time in a month with complaints of tremors and paresthesia in the lower extremities. Neurological functional disorder was diagnosed. While preparing for discharge, the patient says, "Now I'm having chest pain, but it's probably nothing." How should the nurse respond? a) Assess the patient's most current laboratory values. b) Interrupt the discharge and arrange additional medical evaluation of the patient. c) Remind the patient, "The diagnostic tests showed you did not have a medical problem." d) Tell the patient, "Being in the emergency department for a long time can be very distressing."

Answer: b. A paresthesia is a tingling or pricking sensation. Conversion disorder (functional neurobiological symptom disorder) usually involves weakness or paralysis, abnormal movement, swallowing or speech difficulties, seizures or attacks, and sensory problems. Patients may be distressed or show la belle indifference (a lack of emotional concern). Despite the diagnosis, the patient's complaints must be taken seriously. Further evaluation is needed.

A mental health nurse assesses a patient diagnosed with an antisocial personality disorder. Which comorbid problem is most important for the nurse to include in the assessment? a) Generalized anxiety b) Alcohol or substance use disorder c) Compulsions and phobias d) Dysfunctional sleep patterns

Answer: b. Alcohol abuse is a commonly occurring problem in persons diagnosed with antisocial personality disorder.

In what scenario is it most urgent for the nurse to act as a patient advocate? a) an adult cries and experiences anxiety after a near-miss automobile accident on the way to work b) a homeless adult diagnosed with schizophrenia lives in a community expecting a category 5 hurricane c) a 14-year-old girl's grades decline because she consistently focuses on her appearance and social networking d) the parents allow the prescription to lapse for 1 day for their 8-year-old child's medication for attention-deficit/hyperactivity disorder

Answer: b. Although all of the scenarios present opportunities for a nurse to intervene, the correct response presents an imminent danger to the patient's safety and well-being.

Four adult patients describe frightening events that resulted in panic levels of anxiety/fear. Which patient's report most clearly indicates a reasonable fear response? a) "I saw a large spider crawling along my kitchen wall." b) "I was at the mall when a gunman began firing an assault weapon." c) "I was at home when a storm with heavy thunder and lightning lasted over an hour." d) "I was trapped in an elevator that stopped between floors when the power went out."

Answer: b. Although all of these situations may produce some level of fear or anxiety, the correct response presents a scenario of imminent, specific danger.

A patient smiles broadly at the nurse and says, "Look at my clean teeth. I brushed them with scouring powder because the label said, 'It brightens and whitens everything.'" Which term should the nurse include when documenting this encounter? a) Circumstantiality b) Concrete thinking c) Poverty of speech d) Associative looseness

Answer: b. Concrete thinking refers to literal interpretations, with an inability to comprehend abstract concepts.

An 84-year-old tells the nurse, "I do four or five number puzzles every day to keep my brain healthy and sharp." When considering a holistic approach to maintaining mental health, the nurse should respond: a) "It is more important for you to have physical activity every day." b) "Let's think of some other activities we can add to your daily routine." c) "Repetition of the same activity is not helpful for keeping your brain healthy." d) "There are some herbal preparations that will also help keep your brain sharp."

Answer: b. Important considerations for promoting mental health in the older adult include the need for older adults to continue to include social, intellectual, and physical activities in their routines. Older adults can continue to learn and contribute even when physiological changes occur.

A female nurse is appointed to a committee with seven men. At the beginning of the meeting, the chairman asks the nurse to be the secretary. The nurse responds, "No. You're just asking me to be secretary because I'm the only woman here." Which response would have been more effective? a) "There are others more qualified than I am to be secretary." b) "I would be glad to perform another role for our committee." c) "I'm probably overreacting, but I find your request offensive." d) "Thank you for asking, but your request is sexually discriminatory."

Answer: b. In the original response, the nurse personalized the request and responded in an aggressive manner. The correct answer demonstrates an assertive response, which would have been more effective.

A nurse in an outpatient medical clinic talks to a patient with a long history of malingering and doctor-shopping. The patient continues to express complaints of multiple problems. Select the nurse's best comment to the patient. a) "The treatment team believes you would benefit more from seeing a mental health professional." b) "The treatment team discussed your case and wants to begin a special case management program for you." c) "Because you take a number of medications, it would be safer to have them all filled at the same pharmacy." d) "Diagnostic testing has shown no medical problems, and you are using more than your fair share of health care services."

Answer: b. It's important for the nurse to convey compassion and support to the patient but without reinforcing the symptoms. Case management can help to limit health care costs. Seeing the patient at regular intervals can instill security and avoid frantic and frequent demands. The patient who establishes a relationship with the case manager often feels less anxiety because he or she has an advocate and feels that someone is managing and aware of his or her care.

Considering Maslow's pyramid, which comment indicates that an individual is motivated by one of the higher levels of need? a) "Even though I'm 40 years old, I have returned to college so that I can get a better job." b) "I help my community by volunteering at a thrift shop that raises money for the poor." c) "I recently applied for public assistance in order to feed my family, but I hope it's not forever." d) "My children tell me I'm a good parent. I feel happy being part of a family that appreciates me."

Answer: b. Maslow's hierarchy of needs is placed conceptually on a pyramid, with the most basic and important needs on the lower level. The higher levels, the more distinctly human needs, occupy the top sections of the pyramid. When lower-level needs are met, higher-level needs are able to emerge. Self-actualization and esthetics are the highest-level needs.

Which comment by a patient diagnosed with bipolar disorder best indicates the patient is experiencing mania? a) "I have been sleeping about 6 hours each night." b) "Yesterday I made 487 posts on my social network page." c) "I am having dreams about my father's death 8 years ago." d) "My appetite is so robust that I've gained 4 pounds in the past 2 weeks."

Answer: b. Numerous posts on a social network page indicate hyperactivity, which is a hallmark of mania.

A patient has been identified as having a somatoform disorder. Which of the following should the nurse do when interacting with the patient? a) Ignore feelings to avoid promoting progression of symptoms. b) Redirect conversation away from feelings but show interest toward the patient. c) Encourage the use of benzodiazepines on a consistent basis to reduce anxiety. d) Suggest the patient direct all questions to the nurse and not the medical provider.

Answer: b. Nurses should avoid emphasizing feelings but should continue to show interest in the patient. Ignoring feelings or symptoms completely could result in missing a serious medical issue. Frequent use of benzodiazepines is not recommended, but patients may benefit from other anxiolytic medications. When somatic symptom disorders are suspected, a nurse may be assigned as a main contact point, but the patient should still be encouraged to discuss care his or her providers.

The school nurse assesses four adolescents who appear to have a healthy weight. Which comment would lead the nurse to explore further for an eating disorder? a) "I usually try to exercise 30 minutes a day." b) "I know everything in my life will be better once I lose 15 more pounds." c) "I forgot my lunch today, so I will only be eating an apple." d) "I know I shouldn't eat potato chips, but I just love them."

Answer: b. People with eating disorders may perceive themselves as overweight and place unrealistic value on being thin. Losing 15 pounds is not likely to alter all aspects of someone's life.

Friends invite an adult diagnosed with type 2 diabetes to go on a mountain hike. The adult replies, "I can't go because I don't have any hiking shoes." Unconsciously, this person is concerned about difficulty with blood glucose management during strenuous activity. Which defense mechanism is evident? a) Displacement b) Rationalization c) Passive aggression d) Reaction formation

Answer: b. Rationalization refers to justifying an action to satisfy the listener.

A woman experienced a double mastectomy yesterday. Now she cheerfully says to the nurse, "I didn't need those things anyway. No more wet T-shirt contests for me!" How should the nurse interpret this comment? a) The patient is realistically accepting her loss. b) The comment is sarcastic, which may reflect anger. c) The patient is experiencing a distorted body image. d) The comment suggests guilt regarding prior behavior.

Answer: b. Sarcasm is a veiled form of anger.

An emergency department nurse assesses a child with a fractured ulna. The nurse also observes yellow and purple bruises across the child's back and shoulders. Which comment by the parents should prompt the nurse to consider making a report to Child Protective Services? a) "We do not believe in immunization of our children." b) "This child is always creating problems for the family." c) "Our child would rather play alone than with other children." d) "We homeschool our children in order to include religious education."

Answer: b. The acute injury, coupled with bruises of different ages, suggest that the child may be abused. Abusive parents may perceive the child as bad or evil or project blame. The nurse is required to report suspicions of abuse to child protective services.

A parent tells the nurse about the death of a child 2 years ago. Which comment by this parent warrants the nurse's priority attention? a) "I still have some of my child's toys and clothes." b) "A parent should never live longer than their child." c) "I never returned to church again after the death of my child." d) "My child has been dead a long time, but it seems like only yesterday."

Answer: b. The correct response represents a covert message and suggests possible suicidal thinking by the parent. The nurse should further assess the meaning of the comment.

A woman in a relationship characterized by a long history of battering and abuse tells the nurse, "We've had a rough time lately. I admit it: He beat me last night but then said he was sorry." Which event would the nurse expect to occur next in this relationship? a) Another beating by the abusive partner b) Love, gifts, and praise from the abusive partner c) A brief period during which the partners ignore each other d) The abusive partner leaving the relationship for a short time

Answer: b. The cycle of violence consists of three phases: (1) tension-building phase, (2) acute battering phase, and (3) honeymoon phase. The question scenario shows acute battering, so a period of loving calm is likely to follow.

An emergency department nurse assesses a woman suspected of being abused by an intimate partner. Which assessment finding most clearly confirms the suspicion? a) Leathery facial tone b) Injuries in a bikini pattern c) Reluctance to be examined d) Lack of eye contact with the nurse

Answer: b. The majority of the victims of reported intimate partner violence are women. Intimate partner violence is the number one cause of emergency department visits by women. Patterns of damage are often in locations that cannot be noticed easily, such as the torso, back, upper arms, upper legs, inside body orifices, and under the hair.

A patient tells the nurse, "After many years, I finally quit smoking. Now I use e-cigarettes only." Which is an appropriate response? a) "Using e-cigarettes is now more socially acceptable than using traditional cigarettes." b) "Congratulations on quitting, but e-cigarettes contain nicotine and other hazardous chemicals." c) "Nicotine is a powerful addiction. Quitting smoking is a big step toward adopting a healthier lifestyle." d) "I am glad you have quit smoking. Your loved ones will no longer be exposed to the hazards of secondhand smoke."

Answer: b. The nurse should educate the patient. E-cigarettes are advertised as safe; however, they contain nicotine as well as other hazardous chemicals.

In a hostile voice, a patient experiencing mania yells at the nurse: "You will listen to me and not interrupt. I have some really important stuff to say. I'm tired of you nurses and doctors acting like you have all the answers." To facilitate effective communication, which initial response should the nurse provide? a) "You are our patient, so we always listen to you." b) "I can talk with you better if you use a calm voice." c) "It's our job to help you get through this manic episode." d) "Patients have an important role in treatment planning."

Answer: b. The patient's behavior is aggressive. Aggressive behaviors reflect rage, hostility, and the potential for physical assault or verbal destructiveness and can be directed at others or oneself. Aggression is a hostile reaction that occurs when control over anger is lost. It is used in an attempt to regain control over the stressor or flee the situation. By suggesting an appropriate behavior, the nurse offers an opportunity for the patient to regain control.

A patient diagnosed with schizophrenia complains to the nurse about persistent feelings of restlessness and says, "I feel like I need to move all the time." What is the nurse's next action? a) Add an activity group to the patient's plan of care. b) Assess the patient for other extrapyramidal symptoms. c) Perform a full mental status evaluation of the patient. d) Educate the patient about the psychomotor agitation associated with schizophrenia.

Answer: b. The patient's comments suggest that akathisia, which is an extrapyramidal symptom, is occurring. The nurse should assess the patient for other indicators of this side effect of antipsychotic medication.

A patient has been disruptive to the therapeutic milieu for 2 days. A certified nursing assistant says to the nurse, "We need to seclude this patient because this behavior is upsetting everyone on the unit." Considering patients' rights, how should the nurse respond? a) "Seclusion is not part of this patient's plan of care." b) "Let's think of some new ways to help this patient be less disruptive." c) "Thank you for that suggestion. I will discuss it with the health care provider." d) "Disruptive behavior is expected with mental illness. We must respond therapeutically."

Answer: b. The scenario offers no indication that the patient is dangerous or out of control; therefore, less restrictive interventions should be employed. The nurse has a responsibility to provide guidance to the certified nursing assistant.

A nurse plans to lead a group in a residential facility for kindergarten-age, abused children. Which strategy should the nurse incorporate? a) Building a house using blocks b) Telling a story about a child who felt sad c) Drawing pictures of fun activities at a park d) Reading and discussing a book about abused children

Answer: b. Therapeutic interventions should be matched to the developmental level of the child. Abused children are likely to have problems with anxiety or depression. Storytelling is a form of bibliotherapy likely to appeal to kindergarten-age children. Children unconsciously identify with the characters in the story, allowing self-expression in a safe environment to occur. Reading and discussing a book about abused children may be too charged and would likely increase anxiety.

A patient diagnosed with dissociative identity disorder is hospitalized on an acute care psychiatric unit after a suicide attempt. During a team meeting, which staff nurse's comment should prompt the nursing supervisor to intervene? a) "I have never taken care of a patient diagnosed with this disorder." b) "I think this patient was misdiagnosed and probably has schizophrenia." c) "I find myself more fascinated and engaged with this patient than others." d) "I recently read an autobiographical book about someone with this problem."

Answer: c. Although dissociative identity disorder can be a very interesting diagnosis, the nurse should avoid focusing more on one patient at the expense of others.

An 8-year-old tells a parent, "I like to scare kids at school by showing them pictures of clowns. Some kids are terrified." How should the nurse counsel the parents regarding this behavior? a) Recommend family therapy for the child, siblings, and parents. b) Suggest the parents enroll the child in an anger management program. c) Educate both parents about bullying, including possible origins and long-term effects. d) Teach the parents about the developmental phase and tasks for an 8-year-old child.

Answer: c. Bullying is an intentional display and use of violence, although it may appear mild in some instances. Bullying can be defined as an offensive, intimidating, malicious, condescending behavior designed to humiliate. The scenario identifies an instance of lateral bullying. All kinds of bullying behaviors create a toxic environment. Those who are bullied are prone to negative feelings about self, humiliation, poor self-concept, and great emotional pain, and many can suffer severe, long-term reactions. After educating the parents about bullying, the nurse should assist them in setting limits with the child.

A nurse begins a therapeutic relationship with a patient diagnosed with schizophrenia. The patient has severe paranoia. Which comment by the nurse is most appropriate? a) "Let's begin by talking about the goals you have for yourself." b) "I understand that you have problems with fear and suspiciousness of others." c) "As you get to know me better, I hope you will feel comfortable talking to me." d) "I am part of your treatment team. Our goal is to help stabilize your symptoms."

Answer: c. Paranoia causes an inability to trust the actions of others. Therapeutic strategies should focus on lowering the patient's anxiety and decreasing defensive patterns. The application of principles for dealing with paranoia is helpful for establishing trust and rapport.

Shortly after hospitalization, an adolescent diagnosed with anorexia nervosa says to the nurse, "Being fat is the worst thing in the world. I hope it never happens to me." Which response by the nurse is appropriate? a) "You need to gain weight to become healthier." b) "Your world would not change if you gained a few pounds." c) "Tell me how your world would be different if you were fat." d) "Your attractiveness is not defined by a number on the scale."

Answer: c. Cognitive distortions with underlying emotions of anxiety, dysphoria, low self-esteem, and feelings of lack of control are often present in persons with eating disorders. In this instance, the adolescent is catastrophizing. The nurse should first help the patient to identify the fears. Cognitive distortions are consistently confronted by all members of the interdisciplinary team in preparation for carefully planned challenges to the patient later in treatment.

The nurse assesses a new patient suspected of having a schizotypal personality disorder. Which assessment question is this patient most likely to answer affirmatively? a) "Do some types of situations frighten you?" b) "Do you often have episodes of prolonged crying?" c) "Has anyone in your family ever been diagnosed with a mental illness?" d) "Is it ever very important for you to do everything correctly?"

Answer: c. Genetics seems to play a significant role in the development of schizotypal personality disorder, which is more common in families with a history of schizophrenia.

A patient experiencing depression says to the nurse, "My health care provider said I need 'talk' therapy, but I think I need a prescription for an antidepressant medication. What should I do?" Select the nurse's best response. a) "Which antidepressant medication do you think would be helpful?" b) "There are different types of talk therapy. Most patients find it beneficial." c) "Let's consider some ways to address your concerns with your health care provider." d) "Are you willing to give 'talk therapy' a try before starting an antidepressant medication?"

Answer: c. Helplessness is sometimes a finding in major depressive disorder. The nurse has a responsibility for patient advocacy. Helping the patient to advocate for self is empowering.

The nurse presents a class about mental health and mental illness to a group of fourth graders. One student asks, "Why do people get mentally ill?" Select the nurse's best response. a) "There are many reasons why mental illness occurs." b) "The cause of mental illness is complicated and very hard to understand." c) "Sometimes a person's brain does not work correctly because something bad happens or he or she inherits a brain problem." d) "Most mental illnesses result from genetically transmitted abnormalities in cerebral structure; however, some are a consequence of traumatic life experiences."

Answer: c. In the correct response, the nurse answers rather than evades the question, provides accurate information, and uses terminology a 9- or 10-year-old child can understand. Many of the most prevalent and disabling mental disorders have been found to have strong biological influences, including genetic transmission.

The nurse at a local clinic reviews phoned-in requests from patients for prescription refills. As the nurse confers with the health care provider about which prescription refill requests should be authorized, which refill request should be considered first? a) Codeine 10 mg PO q4h PRN for an adult with a persistent cough b) Hydroxyzine (Vistaril) 25 mg PO TID PRN for an adult who experiences uncomfortable muscle spasms c) Lorazepam (Ativan) 1 mg PO BID for an adult who has taken it daily for 3 years for episodes of anxiety d) Lomotil 2 mg PO q6h PRN for an adult experiencing severe diarrhea

Answer: c. Lorazepam is a benzodiazepine. Sudden withdrawal from this class of medications has medical complications, including the possibility of death; hence this refill request has priority.

Which scenario meets the criteria for "normal" behavior? a) An 8-year-old child's only verbalization is "No, no, no." b) A 16-year-old girl usually sleeps for 3 or 4 hours per night. c) A 43-year-old man cries privately for 1 month after the death of his wife. d) A 64-year-old woman has difficulty remembering the names of her grandchildren.

Answer: c. Many biological, cultural, and environmental factors influence mental health. Persons who are normal also may experience dysfunction during their lives. The death of a spouse is a difficult experience, so crying is expected.

A nurse teaches a patient with alcohol use disorder about a new prescription for naltrexone (ReVia, Vivitrol). Which comment by the patient indicates the teaching was effective? a) "This medicine will stop my cravings for alcohol." b) "I should take this medication only when I feel cravings to drink alcohol." c) "This medicine is one part of a bigger treatment plan to help me stay sober." d) "I should not use products that contain alcohol, such as cough medicine and aftershave lotion."

Answer: c. Naltrexone (ReVia, Vivitrol) reduces the desired pleasant feelings related to alcohol or opioid intake and helps to reduce drug cravings. It is part of a total program for maintaining sobriety.

Three days after beginning a new regime of haloperidol (Haldol), the nurse observes that a hospitalized patient is drooling, has stiff and extended extremities, and has skin that is damp and hot to the touch. The patient has difficulty responding verbally to the nurse. What is the nurse's correct analysis and action in this situation? a) A seizure is occurring; place the patient in a lateral recumbent position and monitor. b) Serotonin syndrome has developed; place an intravenous line and rapidly infuse D5½ normal saline (NS). c) Neuroleptic malignant syndrome has developed; prepare the patient for immediate transfer to a medical unit. d) An acute dystonic reaction is occurring; promptly administer an intramuscular injection of diphenhydramine (Benadryl).

Answer: c. Neuroleptic malignant syndrome (NMS) occurs in persons who have taken antipsychotic agents and usually begins early in the course of therapy. It is characterized by a decreased level of consciousness; greatly increased muscle tone; and autonomic dysfunction, including hyperpyrexia, labile hypertension, tachycardia, tachypnea, diaphoresis, and drooling. Treatment consists of early detection, discontinuation of the antipsychotic agent, management of fluid balance, reduction of temperature, and monitoring for complications. Treatment of this problem should occur in a medical unit.

Which disorder would the nurse suspect when a person takes their child from doctor to doctor and from hospital to hospital with a variety of intentionally induced symptoms? a) Illness anxiety disorder b) Functional neurological disorder c) Factitious disorder imposed by another d) Rumination disorder

Answer: c. People with factitious disorder imposed by another may do things to cause symptoms or illness in another person. They will often go from provider to provider or hospital to hospital. The motivation is for the attention, caring, and sympathy they receive as the caregiver of the victim.

An emergency department nurse prepares to discharge a victim of reported rape. Which comment by the victim indicates that the nurse's teaching was effective? a) "I should bathe frequently over the next week." b) "I am required to follow up with law enforcement." c) "It's important for me to follow up with counseling." d) "I should delay any sexual activity for at least 3 months."

Answer: c. Prior to leaving the emergency department, the patient should have a scheduled follow-up appointment with a rape counselor or crisis counselor.

The nurse interviews the parent of a 7-year-old child diagnosed with moderate autism spectrum disorder. Which comment from the parent best describes autistic behavior? a) "My child occasionally has temper tantrums." b) "Sometimes my child wakes up with nightmares." c) "My child swings for hours on our backyard gym set." d) "Toilet training was more difficult for this child than my other children."

Answer: c. Prominent behavioral characteristics of ASD include motions repeated over and over (flaps hands, rocks body, spins self in circles, repeatedly turns light on and off), playing with toys the same way every time, getting upset by minor changes (furniture rearranged, changed route to someplace familiar), and obsessive interests.

An adult plans to attend an upcoming 10-year high school reunion. This person says to the nurse, "I am embarrassed to go. I will not look as good as my classmates. I haven't been successful in my career." Which comment by the nurse addresses this cognitive distortion? a) "You look fine to me. Do you think you will have fun at your reunion?" b) "Everyone ages. Other classmates have had more problems than you." c) "Do you think you are the only person who has aged and faced difficulties in life?" d) "I think you are doing well in the face of the numerous problems you have endured."

Answer: c. Rapid, unthinking responses are known as automatic thoughts. Often these automatic thoughts, or cognitive distortions, are irrational because people make false assumptions and misinterpretations. Once the negative patterns of thought that lead to negative emotions are identified, they can be replaced with rational thoughts.

A mentally ill gunman opens fire in a crowded movie theater, killing six people and injuring others. Which comment about this event by a member of the community most clearly shows the stigma of mental illness? a) "Gun control laws are inadequate in our country." b) "It's frightening to feel that it is not safe to go to a movie theater." c) "All these people with mental illness are violent and should be locked up." d) "These events happen because American families no longer go to church together."

Answer: c. Stigma refers to the array of negative attitudes and beliefs regarding mental illness. Bias, prejudice, fear, and misinformation contribute to stigma.

Select the completion of the following sentence that demonstrates that an adult is coping in a healthy way: "I am feeling so angry right now ... a) I'm afraid I'm going to cry." b) I would like to punch something." c) I want to talk to someone about it." d) I want to curl up and sleep for a long time."

Answer: c. Talking about one's feelings is healthier than violence or avoidance.

Which patient is likely to achieve maximum benefit from cognitive-behavioral therapy (CBT)? a) Older adult diagnosed with stage 3 Alzheimer's disease b) Adult diagnosed with schizophrenia and experiencing delusions c) Adult experiencing feelings of failure after losing the fourth job in 2 years d) School-age child diagnosed with attention-deficit/hyperactivity disorder (ADHD)

Answer: c. The goal of CBT is to identify the negative patterns of thought that lead to negative emotions. Once the maladaptive patterns are identified, they can be replaced with rational thoughts. A person must be able to engage in meaningful dialogue to benefit from CBT.

A patient has a long history of bipolar disorder with frequent episodes of mania secondary to stopping prescribed medications. The patient says, "I will use my whole check next month to buy lottery tickets. Winning will solve my money problems." Select the nurse's best action. a) Educate the patient about the low odds of winning the lottery. b) Present reality by saying to the patient, "That is not a good use of your money." c) Confer with the treatment team about appointing a legal guardian for the patient. d) Tell the patient, "If you buy lottery tickets, your money will run out before the end of the month."

Answer: c. The nurse has responsibility for advocacy. In view of the patient's long history of problems, a legal guardian should be considered.

An experienced nurse in a major medical center requests a transfer from a general medical unit to an acute care psychiatric unit. Which organizational feature would best support this nurse's successful transition? a) Assignment to medication administration for the first 6 months b) Working with a seasoned mental health technician for the first month c) Co-assignment with a knowledgeable psychiatric nurse for an extended orientation d) Staff development activities focused on developing therapeutic communication skills

Answer: c. The nurse's skills from the medical unit will be valuable, but this nurse will need to expand his or her skill set to effectively care for a psychiatric population. Working with an experienced psychiatric nurse will provide opportunities for learning.

The nurse admits a patient experiencing hallucinations and delusional thinking to an inpatient mental health unit. The plan of care will require that which service occurs first? a) Social history b) Psychiatric history c) Medical assessment d) Psychological evaluation

Answer: c. The plan of care begins with a medical assessment to rule out or consider co-occurring/comorbid conditions.

An elderly widow tells the nurse, "Since my sister-in-law's death, her husband has been making advances toward me. He tried to come into my home with a bottle of wine. Even though he's family, I'm afraid of what might happen if I let him in." Which action should the nurse take first? a) Support the widow to clarify her thoughts and feelings about the situation. b) Explain to the widow how to obtain an order of protection (restraining order). c) Positively reinforce the widow for addressing the problem with a caring professional. d) Educate the widow about sexual assault and violence, including the importance of prevention.

Answer: c. The scenario presents a risk for sexual assault. Many people are sensitive about sexual matters, so the nurse should first give recognition to the widow for her willingness to share the problem. The most common drug used to facilitate the crime of rape is alcohol. Sexual violence occurs across all ages and is perpetrated against men, women, and children. Cultural and societal factors play a part in forming attitudes about sexual violence.

The nurse interacts with a veteran of World War II. The veteran says, "Veterans of modern wars whine and complain all the time. Back when I was in service, you kept your feelings to yourself." Select the nurse's best response. a) "American society in the 1940s expected World War II soldiers to be strong." b) "World War II was fought in a traditional way, but the enemy is more difficult to identify in today's wars." c) "We now have a better understanding of how trauma affects people and the importance of research-based, compassionate care." d) "Intermittent explosive devices (IEDs), which were not in use during World War II, produce traumatic brain injuries that must be treated."

Answer: c. Trauma occurs in many forms, including physical, sexual, and emotional abuse; war; natural disasters; and other harmful experiences. Trauma-informed care provides guidelines for integrating an understanding of how trauma affects patients into clinical programming.

A victim of reported sexual assault tells the nurse, "This was entirely my fault. I should never have gone to that party alone." Which response by the nurse is most therapeutic? a) "This was a frightening experience for you." b) "What do you think you should have done differently?" c) "Would you like to tell me more about what happened?" d) "It sounds like you're blaming yourself for the assailant's behavior."

Answer: d. Common emotional reactions after a sexual assault include anger, fear, anxiety, guilt, humiliation, embarrassment, self-blame, and mood swings. Compassionate care involves approaching the person who has been sexually assaulted in a nonjudgmental and empathic manner. Patients need to hear and understand that the rape is not their fault. It is important to help survivors separate the issues of vulnerability from blame.

A nurse's sibling happily says, "I want to introduce you to my fiancé. We're getting married in 6 months." The nurse has encountered the fiancé in a clinical setting and is aware of the fiancé's diagnosis of schizophrenia. What is the nurse's best response? a) In private, tell the sibling about the fiancé's diagnosis. b) Encourage the sibling to postpone the wedding for at least a year. c) Ask the fiancé, "Have you told my sibling about your mental illness?" d) Say to the sibling and fiancé, "I hope you will be very happy together."

Answer: d. Despite personal misgivings, the nurse must maintain the fiancé's confidentiality.

A community mental health nurse talks with a 6-year-old child whose divorced parents have shared custody. Which initial question will best help the nurse explore the child's perception of home life? a) "Is your life different from your friends' lives?" b) "Are you happiest at your mother's or your father's house?" c) "Do you find it hard to move back and forth between two homes?" d) "What are some of the good and bad things about living in two places?"

Answer: d. Developmental level is an important part of the assessment with children, so the nurse should select terms the child will understand. A semistructured interview provides an opportunity for the child to express perceptions about life at home and life at school with teachers and peers. Severe marital discord is a factor that may contribute to mental illness in children.

Over the past 2 months a patient made eight suicide attempts, with increasing lethality. The health care provider informs the patient and family that electroconvulsive therapy (ECT) is needed. The family whispers to the nurse, "Isn't this a dangerous treatment?" How should the nurse reply? a) "Our facility has an excellent record of safety associated with use of electroconvulsive therapy." b) "Your family member will eventually be successful with suicide if aggressive measures are not promptly taken." c) "Yes, there are hazards with electroconvulsive therapy. You should discuss these concerns with the health care provider." d) "Electroconvulsive therapy is very effective when urgent help is needed. Your family member was carefully evaluated for possible risks."

Answer: d. ECT is safe and effective and can achieve a 70% to 90% remission rate in depressed patients within 1 to 2 weeks. ECT is especially indicated when there is a need for a rapid, definitive response when a patient is suicidal or homicidal as well as in selected other circumstances.

In a staff meeting at an inpatient mental health facility for individuals, the administrator announces that psychiatric technicians will now be supervised by the milieu director rather than by nurses. What is the nurse's best action? a) Confer with colleagues about their opinions regarding the proposed change. b) Volunteer to participate on a committee charged with defining the job responsibilities of unlicensed assistive personnel. c) Ask the administrator to delay implementation of this change until the decision can be reviewed by an interdisciplinary team. d) Advise the administrator of regulations in the state nurse practice act regarding supervision of unlicensed assistive personnel.

Answer: d. Institutional policies and practices do not absolve an individual nurse of responsibility to practice on the basis of professional standards of nursing care. State nurse practice acts specify that assistive personnel must work under a nurse's supervision.

The nurse assessed an elderly person who was abused by the caregiver. Afterward, which internal dialogue should prompt the nurse to seek guidance? a) "Sometimes I get so discouraged and frustrated with my job." b) "It's incredible that anyone could hurt a child or elderly person." c) "The abuser was probably a victim of abuse at some point in life." d) "I hope the abuser gets victimized so they know what it feels like."

Answer: d. Nurses must be self-aware, particularly in highly charged situations. Wishing harm on an abuser may be understandable, but it is an indicator of the nurse's need for guidance.

A disaster relief nurse has just arrived to help efforts after a tornado that destroys a town. Which approach would be most appropriate when talking with survivors? a) Provide active listening. b) Help the survivors generate possible solutions. c) Help the survivors develop self-awareness to understand their stress response. d) Offer firm, short, simple statements and instructions.

Answer: d. People who have just experienced a disaster such as a tornado will most likely be experiencing severe or panic levels of anxiety. People at this level would benefit most from short, clear instructions. The other options are more appropriate for someone with mild to moderate anxiety.

A single adult says to the nurse, "Both of my parents died several years ago, and my only sibling committed suicide 2 weeks ago. I feel so alone." After determining that the adult has no suicidal ideation, the nurse should: a) Explore the adult's feelings of survivor's guilt. b) Assess the adult's cultural beliefs and spirituality. c) Refer the adult for cognitive-behavioral therapy (CBT). d) Refer the adult to a self-help group for suicide survivors.

Answer: d. Referrals need to be made available to family members and friends to assist them in dealing with and addressing the many emotional reactions and problems that easily may develop after the suicide of a family member or friend. Self-help groups are extremely beneficial for survivors.

An adult experienced a spinal cord injury resulting in quadriplegia 3 years ago and now lives permanently in a skilled care facility. Which comment by this person best demonstrates resiliency? a) "I often pray for a miracle that will heal my paralysis so I will be whole again." b) "I don't know what I did to deserve this fate or whether I am tough enough to endure it." c) "My accident was a twist of fate. I suppose there are worse things than being paralyzed." d) "Being paralyzed has taken things from me, but it hasn't kept me from being mentally involved in life."

Answer: d. Resiliency is the ability to recover from or adjust successfully to trauma or change. A successful transition through a crisis builds resiliency for the next difficult trial. In the correct response, the person demonstrates acceptance of the paralysis and a focus on his or her abilities and assets.

A nurse working in an acute care unit for adolescents diagnosed with mental illness says, "Our patients have so much energy. We need some physical activities for them." In recognition of needs for safety and exercise, which activity could the treatment team approve? a) Badminton tournament b) Competitive soccer matches c) Intramural basketball games d) Line dancing to popular music

Answer: d. Safety is a key consideration in the selection of activities. The correct response identifies an activity likely to appeal to the population but without physical contact between patients or equipment, which may be associated with injury.

An adult diagnosed with stage 2 Alzheimer's disease begins a new prescription for rivastigmine (Exelon). Which nursing diagnosis has the highest priority to add to the plan of care? a) Risk for constipation b) Impaired perception c) Impaired oral mucous membrane d) Risk for impaired nutritional status

Answer: d. Side effects of rivastigmine (Exelon) include nausea, vomiting, diarrhea, weight loss, loss of appetite, and muscle weakness.

A colleague tells the nurse, "I have not been able to sleep for the past 3 days. I feel like a robot." What is the nurse's best action? a) Direct the colleague to leave the facility immediately. b) Observe the colleague closely for evidence of impaired practice. c) Offer to administer medications to patients assigned to the colleague. d) Confer with the supervisor about the nurse's ability to safely deliver care.

Answer: d. Sleep deprivation causes impaired practice, which jeopardizes patient safety. The colleague's comments indicate that impairment is likely. The nurse should confer with the supervisor to determine the appropriate action.

A patient tells the nurse, "No matter what I do, I feel like there's always a dark cloud following me." Select the nurse's initial action. a) Assess the patient's current sleep and eating patterns. b) Explain to the patient, "Everyone feels down from time to time." c) Suggest alternative activities for times when the patient feels depressed. d) Say to the patient, "Tell me more about what you mean by 'a dark cloud.'"

Answer: d. The correct response accomplishes two results: the nurse can further assess the patient's complaint, and the nurse uses clarification, a therapeutic communication technique.

A young adult has reported heavy use of alcohol and prescription drugs since mid-adolescence. This individual now has an ataxic gait and uses a cane. Which comment by the nurse presents reality while demonstrating compassion? a) "I know you must feel self-conscious about using a cane at your age, but it will help prevent falls." b) "Addiction is a fatal disease. If you continue to drink like you have done in past, you will not live another 10 years." c) "It's time to face your addiction. You are disappointing your family and must stop drinking for the sake of the people who love you." d) "Addiction is powerful. You are young yet cannot walk without a cane. Your health has been significantly affected by your long-term use of drugs and alcohol."

Answer: d. The correct response recognizes the power of addiction but presents the reality of the consequences of continued use.

The nurse prepares outcomes to the plan of care for an adult diagnosed with mental illness. Which strategy recognizes the current focus of treatment services for this population? a) The patient's diagnoses are confirmed using advanced neuroimaging techniques. b) The nurse confers with the treatment team to verify the patient's most significant disability. c) The nurse prioritizes the patient's problems in accordance with Maslow's hierarchy of needs. d) The patient and family participate actively in establishing priorities and selecting interventions.

Answer: d. The correct response recognizes the recovery model, which has the following tenets: Mental health care is consumer and family driven, with patients being partners in all aspects of care; care must focus on increasing the consumer's success in coping with life's challenges and building resilience; and an individualized care plan is at the core of consumer-centered recovery.

A patient was diagnosed with bipolar disorder many years ago. The patient tells the nurse, "When I have a manic episode, there's always a feeling of gloom behind it, and I know I will soon be totally depressed." What is the nurse's best response? a) "Most patients diagnosed with bipolar disorder report the same types of feelings." b) "Feelings of gloom associated with depression result from serotonin dysregulation." c) "If you take your medication as it is prescribed, you will not have those experiences." d) "Your comment indicates you have an understanding of and insight about your disorder."

Answer: d. The correct response shows use of the therapeutic communication technique of verbalizing the implied. Gaining insight contributes to relapse prevention.

A patient reports sleeplessness, fatigue, and sadness to the primary care provider. In our current health care climate, what is the most likely treatment approach that will be offered to the patient? a) Group therapy b) Individual psychotherapy c) Complementary therapy d) Psychopharmacological treatment

Answer: d. The patient's report suggests that depression is occurring. With the increased understanding of the biology of psychiatric illnesses, treatment approaches have evolved rapidly into more scientifically grounded methods, particularly psychopharmacology.

A nursing student arrives late for a clinical experience and is not wearing the correct attire. When the instructor privately criticizes the behavior, the student responds, "I'm always the one who gets caught. You're going to cause me to fail." Select the instructor's best response. a) "Other students get caught as well." b) "I am not trying to cause you to fail. I am here to help you." c) "I am sorry you feel that way. I try to treat all my students equally." d) "The requirements for this experience were discussed during our orientation."

Answer: d. The student is demonstrating projection, as evidenced by not taking responsibility for his or her own behavior and blaming the instructor for a perception of failing. In the correct answer, the instructor avoids a defensive response and reinforces that the responsibility belongs to the student.

The nurse cares for a hospitalized adolescent diagnosed with major depressive disorder. The health care provider prescribes a low-dose antidepressant. In consideration of published warnings about the use of antidepressant medications in younger patients, which action(s) should the nurse employ? (Select all that apply.) a) Notify the facility's patient advocate about the new prescription. b) Teach the adolescent about Black Box warnings associated with antidepressant medications. c) Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior. d) Remind the health care provider about warnings associated with the use of antidepressants in children and adolescents.

Answers: b, c. The possibility that antidepressant medication might contribute to suicidal behavior, especially in children and adolescents, has been a long-time concern, and all antidepressants include a Black Box warning. The use of selective serotonin reuptake inhibitors shows a strong association with a reduction in suicide. All treatments have potential risks; each patient should be considered individually when antidepressants are prescribed. All consumers of antidepressants should be observed carefully for worsening of depression and suicidal thoughts.