MH Qs

10. The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbors says to the nurse, "How is Carol doing? She is my best friend and is seen at your clinic every week." Which is the MOST APPROPRIATE nursing response? a. "I can not discuss any patient situation with you." b. "If you want to know about Carol, you need t ask her yourself." c. "Only because you're worried about a friend, I'll tell you that she is improving." d. "Being her friend, you know she is having a difficult time and deserves her privacy."

(A) "I cannot discuss any patient situation with you." RATIONALE: The nurse is required to maintain confidentiality regarding the patient and the patient's care. Confidentiality is basic to the therapeutic relationship and is a patient's right. The most appropriate response to the neighbor is the statement of that responsibility in a direct, but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal patient information may be taken as disrespectful and uncaring. The remaining options identify statements that do not maintain patient confidentiality.

7. A patient admitted voluntarily for treatment of an anxiety disorder demands to be released from the hospital. Which action should the nurse take INITIALLY? a. Contact the patients health care provider (HCP) b. Call the patients family to arrange for transportations. c. Attempt to persuade the pt to stay "for only a few more days" d. Tell the patient that leaving would likely result in an involuntary commitment

(A) Contact the patients health care provider (HCP) RATIONALE: In general, patients seek, voluntary admission. Voluntary patients have the right to demand and obtain release. The nurse needs ot be familiar with the state and facility policies and procedures. The best nursing action is to contact the HCP, who has the authority to discuss discharge with the patient. While arranging for safe transportation is appropriate it is premature in this situation and should be done only with the patients' permission. While it is appropriate to discuss why the patient feels the need to leave and the possible outcomes of leaving against medical advice, attempting to get the patient to agree to staying "a few more days" has little value and will not likely be successful. Many states require that the patient submit a written release notice to the facility staff members, who reevaluate the patient's condition for possible conversion to involuntary status if necessary, according to criteria established by law. While this is a possibility, it should not be used as a threat to the patient.

8. When reviewing the admission assessment, the nurse notes that a patient was admitted to the mental health unity involuntarily. Based on this type of admission, the nurse should provide which intervention for this patient? a. Monitor closely for harm to self or others b. Assist in completing an applicantion for admission c. Supply the patient with written information about their mental illness d. Provide an opportunity for the family to discuss why they felt the admission was needed

(A) Monitor closely for harm to self or others RATIONALE: Involuntary admission is necessary when a person is a danger to self or others or is in need of psychiatric treatment regardless of the patient's willingness to consent to the hospitalization. A written request is a component of a voluntary admission. Providing written information regarding the illness is likely premature initially. The family may have had no role to play in the patients' admission.

3. A patient experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the use to encourage the patient to eat? a. Using open-ended questions and silence b. Sharing personal prefernce regarding food choices c. Documenting reasons why the patient does not wat to eat d. Offering opinions about the necessity of adequate nutrition

(A) Using open-ended questions and silence RATIONALE: Open-ended questions and silence are strategies use to encourage patients to discuss their problems. Sharing personal food preferences is not a patient-centered intervention. The remaining options are not helpful to the patient because they do not encourage the patient to express feelings. The nurse should not offer opinions and should encourage the patient to identify the reasons for the behavior.

12. The nurse in the mental health unit recognizes ______ as being therapeutic communication techniques? SELECT ALL THAT APPLY a. Restating b. Listening c. Asking the patient "Why?" d. Maintaining neutral responses e. Providing acknowledgment and feedback f. Giving advice and approval or disapproval

(A, B, D, E) Restating, Listening, Maintaining neutral responses, Providing acknowledgment and feedback RATIONALE: Therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings and open-ended questions, focusing nd refocusing, restating, clarifying and validating, sharing perceptions, reflecting, providing acknowledgment and feedback, giving information, presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, and summarizing Asking why is often interpreted as being accusatory by the patient and should also be avoided. Providing advice or giving approval or disapproval are barriers to communication.

17. The nurse is providing care to a client admitted to the hospital with a diagnosis of acute anxiety disorder. The patient say s to the nurse "I have a secret that I want to tell you. You won't tell anyone about it, will you?" What is the MOST APPROPRIATE nursing response? a. "No, I won't tell anyone." b. "I cannot promise to keep a secret." c. "It depends on what the secret is about." d. "If you tell me the secret, I may need to document it."

(B) "I cannot promise to keep a secret." RATIONALE: The nurse should never promise to keep a secret. Secret are never appropriate in a therapeutic relationship. The nurse needs to be honest and tell the patient that a promise cannot be made to keep the secret. The remaining options are inappropriate responses since they either promise to keep the secret or provide the criteria for when a secret may be appropriately kept.

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

(B) Making appropriate referrals RATIONALE: Tasks of the termination phase include evaluating patient performance, evaluating achievement of expected out-comes, evaluating future needs, making appropriate referrals and dealing with the common behaviors associated with termination. The remaining options identify tasks appropriate for the working phase of the relationship.

16. Which statement demonstrates the BEST understanding of the nurse's role regarding ensuring taht each client's rights are respected? a. "Autonomy is the fundamental right of each and every client." b. "A patient's rights are guaranteed by both state and federal laws." c. "Being respectful and concerned will ensure that I'm attentive to my patient's rights." d. "Regardless of the patient's conditions, all nurses have the duty to respect patient rights."

(C) "Being respectful and concerned will ensure that I'm attentive to my patients' rights." RATIONALE: The nurse needs to respect and have concern for the patient; this is vital to protecting the patient's rights. While it is true the autonomy is a basic client right, there are other rights that must also be both respected and facilitated. State and federal laws do protect a patient's rights, but it is sensitivity to those rights that will ensure that the nurse secures these rights for the patient. It is a fact that safeguarding a patient's rights are a nursing responsibility, but stating that fact does not show understanding or respect for the concept.

5. A patient diagnosed with terminal cancer says to the nurse "I'm going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's dying." Which response by the nurse is therapeutic? a. "Have you shared your feelings with your family?" b. "I think we should talk more about your anger with your family." c. "You're feeling angry that your family continues to hope for you to be cured?" d. "You are probably very depressed, which is understanble with such a diagnosis"

(C) "You're feeling angry that your family continues to hope for you to be cured?" RATIONALE: Restating is a therapeutic communication technique in which the nurse repeats what the patient says to show understanding and to review what was said. While it is appropriate for the nurse to attempt to assess the patient's ability to discuss feelings openly with family members, it does not help the patient discuss the feelings causing the anger. The nurse's attempt to focus on the central issue of anger is premature. The nurse would never make a judgment regarding the reason for the patient's feeing, this is non-therapeutic in the one-to-one relationship.

2. When the community health nurse visits a patient at home, the patitent states, "I haven't slept at all the last cople of nights. Which response by the nurse illustrates a therapeutic communication response to this patient." a. "I see." b. "Really?" c. "You're having difficulty sleeping?" d. "Sometimes, I have trouble sleeping too."

(C) "You're having difficulty sleeping?" RATIONALE: The correct option uses the therapeutic communication technique of restatement. Although restatement is a technique that has a prompting component to it, it repeats the patients major theme, which assists the nurse to obtain a more specific perception of the problem from the patient. The remaining options are not therapeutic responses since none encourage the patient to expand on the problem. Offering personal experiences moves the focus away from the patient and onto the nurse.

1. A patient with a diagnosis of major depression who has attenpted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response demonstrates therapeutic communication? a. "You have everything to live for" b. "Why do you see yourself as a failiure?" c. "Feeling like this is all part of being depressed." d. "You've been feeling like a failure for a while?"

(D) "You've been feeling like a failure for a while?" RATIONALE: Responding to the feelings expressed by a patient is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the patient's experience and do not facilitate exploration of the patient's expressed feelings. In additions, use of the word "why" is nontherapeutic.

6. On review of the patients record, the nurse notes the admission was voluntary. Based on this information, the nurse anticipates which patient behavior? a. Fearfulness regarding treatment measures. b. Anger and agressiveness directed toward others. c. An understanding of the pathology and syptoms of the diagnosis d. A willingness to participte in the planning of the care and treatment plan

(D) A willingness to participate in the planning of the care and treatment plan RATIONALE: In general, patients seek voluntary admission. If a patient seeks voluntary admission, the most likely expectations is the patient will participate in the treatment program since they are actively seeking help. The remaining options are not characteristics of this type of admission. Fearfulness, anger, and aggressiveness are more characteristic of an involuntary admission. Voluntary admission does not guarantee a patients understanding of their illness, only of their desire for help.

14. A patient's unresolved feelings related to loss would be MOST LIKELY observed during which phase of the therapeutic nurse-patient relationship? a. Trusting b. Working c. Orientation d. Termination

(D) Termination RATIONALE: In the termination phase, the relationship comes to a close. Ending treatment sometimes may be traumatic for patients who have come to value the relationship and the help. Because loss is an issue, any unresolved feelings related to loss may resurface during this phase. The remaining options are not specifically associated with this issue of unresolved feelings.

The risk of experiencing serotonin syndrome when SSRI's are given with monoamine oxidase inhibitors such as phenelzine (Nardil). Serotonin syndrome is best characterized in which of the following? A Hypotension and urinary retention. B Muscle rigidity and high fever. C A productive cough and vomiting. D Tea-colored urine and constipation.

B Muscle rigidity and high fever

A client taking lithium carbonate (Lithobid) started complaining of nausea, vomiting, diarrhea, drowsiness, muscle weakness, tremor, blurred vision and ringing in the ears. The lithium level is 2 mEq/L. The nurse interprets this value as: A Normal level. B Toxic level. C Below normal level. D Above normal leve

B Toxic level.

A nurse notes that a client with schizophrenia and receiving an antipsychotic medication is having uncontrolled movement of the lips and tongue. The nurse determines that the client is experiencing? A Hypertensive crisis. B Parkinsonism. C Tardive dyskinesia. D Neuroleptic malignant syndrome

C Tardive dyskinesia.

Nurse Krina knows that the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD): A benztropine (Cogentin) and diphenhydramine (Benadryl). B chlordiazepoxide (Librium) and diazepam (Valium) C fluvoxamine (Luvox) and clomipramine (Anafranil) D divalproex (Depakote) and lithium (Lithobid)

C) fluvoxamine (Luvox) and clomipramine (Anafranil)

Which of the following symptoms is classified as a mild lithium toxicity: A) Confusion and ataxia. B) Muscle fasciculations and oliguria. C) Tinnitus and blurred vision. D) Apathy and Lethargy

D) Apathy and Lethargy

A client with schizophrenia has been started on medication therapy with clozapine (Clozaril). A nurse assesses the results of which laboratory study to monitor for adverse effect related to this medication? White blood cell. Platelet count. Liver function studies. Random blood sugar

White blood cell.