NP3 - Mental Health
The TWO most critical things to assess in a manic patient.
"Are they a danger to themselves or to others."
Serving this type of food to a manic patient may help increase food intake.
"Finger Foods" or foods that can be eaten "on the go."
In evaluating the effectiveness of medication teaching for a patient on MAOIs, the nurse would expect to hear this, if teaching was effective.
"I must have a low or tyramine-free diet."
This long-term goal regarding medication addresses the most common problem with Bipolar patients and medication.
"The patient will adhere to medication regimen." (include time frame)
The outcome or goal for a patient will always begin with these three words.
"The patient will..."
The beginning of mood lifting, once antidepressant therapy has begun, is still a dangerous time for the suicidal patient because of this.
"They may now have the energy to act on a suicide plan."
This would be the time frame you'd plan for a patient to express improved mood if on SSRI therapy.
"Within 2 weeks"
A lithium lab result of 1.0 mEq/L would be evaluated as this, in terms of blood level range.
"Within Therapeutic Range"
This outcome (in any measure of time) would be most critical, in terms of safety, for the patient with a mood disorder.
, "The patient will not harm self and/or others." (include time frame of course)
The nurse in the mental health unit plans to use which therapeutic communication techniques when communicating with a client? Select all that apply. 1. Restating 2. Active listening 3. Asking the client "Why?" 4. Maintaining neutral responses 5. Providing acknowledgment and feedback 6. Giving advice and approval or disapproval
1,2,4,5
Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? Select all that apply. 1. Communicate expected behaviors to the client. 2. Ensure that the client knows that they are not in charge of the nursing unit. 3. Assist the client in identifying ways of setting limits on personal behaviors. 4. Follow through about the consequences of behavior in a nonpunitive manner. 5. Enforce rules by informing the client that he/she will not be allowed to attend therapy groups. 6. Have the client state the consequences for behaving in ways that are viewed as unacceptable.
1,3,4,6
The nurse should plan which goals of the termination stage of group development? Select all that apply. 1. The group evaluates the experience. 2. The real work of the group is accomplished. 3. Group interaction involves superficial conversation. 4. Group members become acquainted with one another. 5. Some structuring of group norms, roles, and responsibilities takes place. 6. The group explores members' feelings about the group and the impending separation.
1,6
The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbor 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? 1. "I cannot discuss any client situation with you." 2. "If you want to know about Carol, you need to ask her yourself." 3. "Only because you're worried about a friend, I'll tell you that she is improving." 4. "Being her friend, you know she is having a difficult time and deserves her privacy."
1. "I cannot discuss any client situation with you."
A client is preparing to attend a Gamblers Anonymous meeting for the first time. The nurse should tell the client that which is the first step in this 12-step program? 1. Admitting to having a problem 2. Substituting other activities for gambling 3. Stating that the gambling will be stopped 4. Discontinuing relationships with people who gamble
1. Admitting to having a problem
A client is unwilling to go to his church because his ex-girlfriend goes there and he feels that she will laugh at him if she sees him. Because of this hypersensitivity to a reaction from her, the client remains homebound. The home care nurse develops a plan of care that addresses which personality disorder? 1. Avoidant 2. Borderline 3. Schizotypal 4. Obsessive-compulsive
1. Avoidant
A client admitted voluntarily for treatment of an anxiety problem demands to be released from the hospital. Which action should the nurse take initially? 1. Contact the client's health care provider (HCP). 2. Call the client's family to arrange for transportation. 3. Attempt to persuade the client to stay "for only a few more days." 4. Tell the client that leaving would likely result in an involuntary commitment.
1. Contact the client's health care provider (HCP).
A client is participating in a therapy group and focuses on viewing all team members as equally important in helping the clients meet their goals. The nurse is implementing which therapeutic approach? 1. Milieu therapy 2. Interpersonal therapy 3. Behavior modification 4. Support group therapy
1. Milieu therapy
When reviewing the admission assessment, the nurse notes that a client was admitted to the mental health unit involuntarily. Based on this type of admission, the nurse should provide which intervention for this client? 1. Monitor closely for harm to self or others. 2. Assist in completing an application for admission. 3. Supply the client with written information about her or his mental health problem. 4. Provide an opportunity for the family to discuss why they felt the admission was needed.
1. Monitor closely for harm to self or others.
The nurse observes that a client is pacing, agitated, and presenting aggressive gestures. The client's speech pattern is rapid, and affect is belligerent. Based on these observations, which is the nurse's immediate priority of care? 1. Provide safety for the client and other clients on the unit. 2. Provide the clients on the unit with a sense of comfort and safety. 3. Assist the staff in caring for the client in a controlled environment. 4. Offer the client a less stimulating area in which to calm down and gain control.
1. Provide safety for the client and other clients on the unit.
The nurse is conducting a group therapy session. During the session, a client diagnosed with mania consistently disrupts the group's interactions. Which intervention should the nurse initially implement? 1. Setting limits on the client's behavior 2. Asking the client to leave the group session 3. Asking another nurse to escort the client out of the group session 4. Telling the client that they will not be able to attend any future group sessions
1. Setting limits on the client's behavior
A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat? 1. Using open-ended questions and silence 2. Sharing personal preference regarding food choices 3. Documenting reasons why the client does not want to eat 4. Offering opinions about the necessity of adequate nutrition
1. Using open-ended questions and silence
Patients on Lithium therapy must have at least this much H2O intake per day.
1500 mL (1500- 3000 mL recommended)
This type of monitoring is necessary for the patient actively contemplating suicide.
1:1 or one-to-one monitoring
The nurse would evaluate the probable effectiveness of SNRI therapy at this time interval.
2 Weeks
The nurse calls security and has physical restraints applied to a client who was admitted voluntarily when the client becomes verbally abusive, demanding to be discharged from the hospital. Which represents the possible legal ramifications for the nurse associated with these interventions? Select all that apply. 1. Libel 2. Battery 3. Assault 4. Slander 5. False imprisonment
2,3,5
The nurse is caring for a client diagnosed with paranoid personality disorder who is experiencing disturbed thought processes. In formulating a nursing plan of care, which best intervention should the nurse include? 1. Increase socialization of the client with peers. 2. Avoid using a whisper voice in front of the client. 3. Begin to educate the client about social supports in the community. 4. Have the client sign a release of information to appropriate parties for assessment purposes.
2. Avoid using a whisper voice in front of the client.
When planning the discharge of a client with chronic anxiety, which is the most appropriate maintenance goal? 1. Suppressing feelings of anxiety 2. Identifying anxiety-producing situations 3. Continuing contact with a crisis counselor 4. Eliminating all anxiety from daily situations
2. Identifying anxiety-producing situations
A client diagnosed with delirium becomes disoriented and confused at night. Which intervention should the nurse implement initially? 1. Move the client next to the nurses' station. 2. Use an indirect light source and turn off the television. 3. Keep the television and a soft light on during the night. 4. Play soft music during the night, and maintain a well-lit room.
2. Use an indirect light source and turn off the television.
The nurse is planning activities for a client diagnosed with bipolar disorder with aggressive social behavior. Which activity would be most appropriate for this client? 1. Chess 2. Writing 3. Board games 4. Group exercise
2. Writing
A client says to the nurse, "The federal guards were sent to kill me." Which is the best response by the nurse to the client's concern? 1. "I don't believe this is true." 2. "The guards are not out to kill you." 3. "Do you feel afraid that people are trying to hurt you?" 4. "What makes you think the guards were sent to hurt you?"
3. "Do you feel afraid that people are trying to hurt you?"
The nurse is preparing a client with schizophrenia a history of command hallucinations for discharge by providing instructions on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggests to the nurse that the client has a need for additional information? 1. "My medications will help my anxious feelings." 2. "I'll go to support group and talk about what I am feeling." 3. "When I have command hallucinations, I'll call a friend for help." 4. "I need to get enough sleep and eat well to help prevent feeling anxious."
3. "When I have command hallucinations, I'll call a friend for help."
A client 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? 1. "Have you shared your feelings with your family?" 2. "I think we should talk more about your anger with your family." 3. "You're feeling angry that your family continues to hope for you to be cured?" 4. "You are probably very depressed, which is understandable with such a diagnosis."
3. "You're feeling angry that your family continues to hope for you to be cured?"
The nurse visits a client at home. The client states, "I haven't slept at all the last couple of nights." Which response by the nurse demonstrates therapeutic communication? 1. "I see." 2. "Really?" 3. "You're having difficulty sleeping?" 4. "Sometimes I have trouble sleeping too."
3. "You're having difficulty sleeping?"
A client is admitted to a medical nursing unit with a diagnosis of acute blindness after being involved in a hit-and-run accident. When diagnostic testing cannot identify any organic reason why this client cannot see, a mental health consult is prescribed. The nurse plans care based on which mental health condition? 1. Psychosis 2. Repression 3. Conversion disorder 4. Dissociative disorder
3. Conversion disorder
A manic client begins to make sexual advances toward visitors in the dayroom. When the nurse firmly states that this is inappropriate and will not be allowed, the client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, which intervention should the nurse implement? 1. Place the client in seclusion for 30 minutes. 2. Tell the client that the behavior is inappropriate. 3. Escort the client to their room, with the assistance of other staff. 4. Tell the client that their telephone privileges are revoked for 24 hours.
3. Escort the client to their room, with the assistance of other staff.
The nurse is caring for a client just admitted to the mental health unit and diagnosed with catatonic stupor. The client is lying on the bed in a fetal position. Which is the most appropriate nursing intervention? 1. Ask direct questions to encourage talking. 2. Leave the client alone so as to minimize external stimuli. 3. Sit beside the client in silence with simple open-ended questions. 4. Take the client into the dayroom with other clients to provide stimulation.
3. Sit beside the client in silence with simple open-ended questions.
The nurse would evaluate the probable effectiveness of MAO or Tricyclic antidepressant therapy at this time interval.
4-6 weeks.
A client with a diagnosis of depression who has attempted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response by the nurse demonstrates therapeutic communication? 1. "You have everything to live for." 2. "Why do you see yourself as a failure?" 3. "Feeling like this is all part of being depressed." 4. "You've been feeling like a failure for a while?"
4. "You've been feeling like a failure for a while?"
A client is admitted to the mental health unit with a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention? 1. Encouraging quiet reading and writing for the first few days 2. Identification of physical activities that will provide exercise 3. No socializing activities until the client asks to participate in milieu 4. A structured program of activities in which the client can participate
4. A structured program of activities in which the client can participate
On review of the client's record, the nurse notes that the admission was voluntary. Based on this information, the nurse plans care anticipating which client behavior? 1. Fearfulness regarding treatment measures 2. Anger and aggressiveness directed toward others 3. An understanding of the pathology and symptoms of the diagnosis 4. A willingness to participate in the planning of the care and treatment plan
4. A willingness to participate in the planning of the care and treatment plan
When a client is admitted to an inpatient mental health unit with the diagnosis of anorexia nervosa, a cognitive behavioral approach is used as part of the treatment plan. The nurse plans care based on which purpose of this approach? 1. Providing a supportive environment 2. Examining intrapsychic conflicts and past issues 3. Emphasizing social interaction with clients who withdraw 4. Helping the client to examine dysfunctional thoughts and beliefs
4. Helping the client to examine dysfunctional thoughts and beliefs
The nurse is working with a client who, despite making a heroic effort, was unable to rescue a neighbor trapped in a house fire. Which client-focused action should the nurse engage in during the working phase of the nurse-client relationship? 1. Exploring the client's ability to function 2. Exploring the client's potential for self-harm 3. Inquiring about the client's perception or appraisal of why the rescue was unsuccessful 4. Inquiring about and examining the client's feelings for any that may block adaptive coping
4. Inquiring about and examining the client's feelings for any that may block adaptive coping
What is the most appropriate nursing action to help manage a manic client who is monopolizing a group therapy session? 1. Ask the client to leave the group for this session only. 2. Refer the client to another group that includes other manic clients. 3. Tell the client to stop monopolizing in a firm but compassionate manner. 4. Thank the client for the input, but inform the client that others now need a chance to contribute.
4. Thank the client for the input, but inform the client that others now need a chance to contribute.
STICKY NOTE: Physiologic >Psychologic
A client whose physiologic issues are of greater concern than psychological issues is NOT appropriate for inpatient mental health care. For example, IV and Oxygen delivery systems typically cannot be accommodated on most inpatient psych units.
An experienced nurse says to a new graduate, "When you've practiced as long as I have, you'll instantly know how to take care of psychotic patients." What is the new graduate's best analysis of this comment? Select all that apply. a. The experienced nurse may have lost sight of patients' individuality, which may compromise the integrity of practice. b. New research findings must be continually integrated into a nurse's practice to provide the most effective care. c. Experience provides mental health nurses with the tools and skills needed for effective professional practice. d. Experienced psychiatric nurses have learned the best ways to care for psychotic patients through trial and error. e. Effective psychiatric nurses should be continually guided by an intuitive sense of patients' needs.
A, B
On assessment of a person with complicated grief, which of the following may you expect to find? Select all that apply. A.Morbid preoccupation with feelings of worthlessness. B.Marked psychomotor retardation .C.Prolonged and marked functional impairment. D.Transient feelings of thinking the deceased person's voice has been heard. E.Guilt about things they wish they'd done differently with the deceased
A, B, C
Which patient statements identify qualities of nursing practice with high therapeutic value? (Select all that apply.) "The nurse: a. talks in language I can understand." b .helps me keep track of my medications." c.is willing to go to social activities with me." d. lets me do whatever I choose without interfering." e. looks at me as a whole person with different needs."
A, B, E
Which findings are signs of a person who is mentally healthy? (Select all that apply.) a. Says, "I have some weaknesses, but I feel I'm important to my family and friends." b. Adheres strictly to religious beliefs of parents and family of origin. c. Spends all holidays alone watching old movies on television. d. Considers past experiences when deciding about the future. e. Experiences feelings of conflict related to changing jobs.
A, D, E
A client is experiencing severe EPS effects. In addition to administering a lower dose of the antipsychotic agents, the nurse would anticipate administering a medication in which of the following categories? A.Anticholinergics B.Cholinergics C.Dopamine agonists D.Antidepressants
A. Anticholinergics
A patient is on maintenance lithium therapy for bipolar disorder and enters the emergency room confused. A serum lithium level is drawn and is 2 mEq/L. The nurse would anticipate: A.holding the next dose of lithium. B.administering the next dose of lithium at the next scheduled time. C.administering the next dose of lithium STAT. D.holding one half of the next dose of lithium.
A. holding the next dose of lithium.
The nurse notes that the client has very tense body posture. What is the best statement for the nurse to make? A."I notice your fists are clenched; what's happening?" B."I will not allow you to hurt yourself or others." C."I need you to calm down; would you like some medication?" D."There is no acting out behavior allowed on this unit."
A."I notice your fists are clenched; what's happening?"
Your patient is being discharged on lithium. Which statement should you include in your teaching? A."Make sure you maintain a normal salt and water intake." B."Make sure you limit your intake of table salt." C."Make sure you have 3000mL of fluid intake each day." D."Make sure you increase table salt and fluid intake."
A."Make sure you maintain a normal salt and water intake."
A client is withdrawing from alcohol and has been placed on a chlordiazepoxide (Librium) tapering regimen. The client was medicated per orders with 50 mg. Librium PO one hour ago. The client now presents with coarse hand tremors, is diaphoretic, and complains of nausea. In evaluating this response to the Librium dose, which of the following should the nurse do first? A.Check vital signs. B.Encourage fluids. C.Administer thiamine. D.Medicate for nausea.
A.Check vital signs.
The patient has recently been prescribed haloperidol (Haldol). The patient has just complained of stiff muscles and restlessness. The nurse notifies the physician and anticipates an order for A.Cogentin (benztropine). B.Levodopa (methyldopa). C.Thorazine (chlorpromazine). D.Librium (chlordiazepoxide)
A.Cogentin (benztropine).
A patient is taking a benzodiazepine agent secondary to grief related anxiety. The patient questions the nurse about discontinuing this medication. The nurse's most appropriate response is: A.The dosage needs to be tapered in order to avoid withdrawal. B.There may be increased seizure activity for 1 month after discontinuation. C.Short-term amnesia may be experienced if weaning does not occur. D.Abrupt discontinuation will require buspirone administration.
A.The dosage needs to be tapered in order to avoid withdrawal.
This is the term for decreased energy that accompanies depression.
Anergia
This is the term for one of the two most classic symptoms of major depression, and means loss of joy or pleasure.
Anhedonia
This class of drugs is commonly used to treat mood regulation, and includes Depakote, Tegretol, Neurontin, and Lamictal.
Anti-Eleptics aka Anti-Seizure or Anti-Convulsants
These TWO thought patterns are believed to contribute to chronic depression, and are treated with cognitive therapy.
Automatic Negative Thoughts and Learned Helplessness
A patient in the emergency department says, "Voices say someone is stalking me. They want to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a threat." Which aspects of the patient's mental health have the greatest and most immediate concern to the nurse? (Select all that apply.) a. Happiness b. Appraisal of reality c. Control over behavior d. Effectiveness in work e. Healthy self-concept
B, C, E
A nurse is scheduling a client's medications. The client is ordered to receive a daily dose of fluoxetine. Due to the major side effects of this medication, the nurse correctly scheduled this medication at: A.1700 B.0800 C.1200 D.2200
B. 0800
As a nurse for elderly clients in Erickson's final psychosocial stage, you understand that placing family photographs in the client's room and encouraging reminiscence promotes which of the following? A.Coherent sense of self and actualization of one's abilities. B.Acceptance of the worth and uniqueness of one's life. C.Realization of competence and perseverance. D.Capacity for love and commitment to work and relationships
B. Acceptance of the worth and uniqueness of one's life.
The police bring a client, found wandering a neighborhood, to the emergency room. The client is a 68 year-old male and is carrying no identification. The client is agitated and when asked his name, replies: "You people leave me alone!". He has a rapid pulse and very dry mucous membranes, with periods of clouded fluctuating consciousness. You anticipate a diagnosis of: A.Dementia with Lewy Bodies B.Delirium C.Dementia, Alzheimer's Type D.Schizophrenia
B. Delirium
Which of the following interventions is highest priority for the care plan for a client on lithium therapy? A.Drink alcohol in moderation. B.Drink 1.5 L of water per day. C.Monitor daily weights and urine output D.Limit caffeinated beverages and table salt
B. Drink 1.5 L of water per day.
The nurse is intervening with a group of children who experienced a shooting at school. As the nurse carries out crisis incident debriefing, she sets the following as the priority expected outcome: A.Individually provide opportunity for treatment. B.Share thoughts and feelings in a safe, controlled environment. C.Assess for the need of further therapy and possibly medication. D.Provide psychoeducational information in an age-appropriate manner.
B. Share thoughts and feelings in a safe, controlled environment.
A patient acknowledges currently having thoughts of harming herself. What is the nurse's priority assessment at this time?A.Reasons the patient feels like harming herself. B.The presence of a suicide plan. C.The maximum length of time the patient can be committed. D.Adherence to the antidepressant regimen.
B. The presence of a suicide plan.
Which patient with schizophrenia would be expected to have the lowest score in global assessment of functioning? A.39 years old; paranoid ideation since age 35 years B.40 years old; has had disorganized schizophrenia since age 18 C.Diagnosed as catatonic at age 24 years; stable for 3 years D.19 years old; diagnosed with undifferentiated schizophrenia at age 17
B.40 years old; has had disorganized schizophrenia since age 18
Which client statement indicates to the nurse that teaching about tricyclic antidepressants (TCAs) has been effective? A.I will stay out of the sun while taking this medication. B.I may feel drowsy for a few weeks after starting this medication. C.Since diarrhea is common with this medication, I will increase my fiber intake. D.To control the common side effects of nausea and vomiting, I will eat smaller meals.
B.I may feel drowsy for a few weeks after starting this medication.
A client who has been on an antipsychotic medication for several years begins to exhibit lip smacking, tongue protrusion, and facial grimaces. Which effect should the nurse suspect? A.Parkinsonism B.Tardive dyskinesia C.Antiadrenergic effects D.Anticholinergic effects
B.Tardive dyskinesia
A nurse uses cognitive therapy strategies with a patient with an anxiety disorder. The patient's homework is to keep a diary of symptoms of anxiety and events that transpired just before the onset of symptoms. What is the rationale for this strategy?A.To learn to intellectualize rather than emotionalize responses. B.To link symptoms with precipitating events. C.To learn what events should be avoided in the future. D.To log habitual behaviors and emotional responses.
B.To link symptoms with precipitating events.
This is the most commonly used scale to measure symptoms of depression.
Beck Depression Inventory
This is the most extreme form of Bipolar Disorder.
Bipolar 1
This disorder includes periods of hypomania.
Bipolar 2
The elevation of this vital sign is a danger with MAO Inhibitors.
Blood Pressure
You are assessing a depressed patient in order to formulate a nursing diagnosis. Which of the following data is most important in planning daily activities? A.Family history B.History of childhood disorders C.Changes in psychomotor activity D.Presence of minor physical aches and pains
C. Changes in psychomotor activity
A chronic psychotic disorder, schizophrenia, has symptoms divided into two groups; those with positive symptoms and those with negative symptoms. Patients with negative symptoms may display which of the following set of symptoms upon assessment? A.Hallucinations and delusions B.Paranoia and perceived persecution C.Decrease of function and motivation D.Agitation and incoherent speech
C. Decrease of function and motivation
A 50 year-old client hasn't eaten for 2 days, is unkempt, and is experiencing uncontrolled crying spells. She refuses to leave her bedroom and has not returned to work since her spouse passed away 3 months ago. Which of the following nursing diagnoses is most appropriate at this time? A.Grieving RT recent loss of spouse AEB refusing to leave bedroom B.Disenfranchised Grieving RT husband's death AEB feels no longer belongs in society C.Dysfunctional Grieving RT death of spouse AEB regression and isolation D.Grieving RT loss of husband AEB uncontrolled crying spells
C. Dysfunctional Grieving RT death of spouse AEB regression and isolation
Which client statement indicates to the nurse that teaching about taking antipsychotic medication has been effective? A.I will be able to stop taking this medication as soon as I feel better. B.If I feel sleepy while taking this medication, I will stop taking it and call the physician. C.My symptoms will come back if I don't take this medication exactly as prescribed. D.These medications are highly addictive and must be discontinued slowly.
C. My symptoms will come back if I don't take this medication exactly as prescribed.
A client newly diagnosed with major depression is being treated with medication. For which of the following medications/drug classes would you most likely plan to provide teaching? A.tricyclic antidepressant B.MAO inhibitor C.SSRI D.lithium
C. SSRI
During assessment the nurse notes that a patient is experiencing a panic level of anxiety. What is the most appropriate intervention? A.Leave the patient alone in a quiet room. B.Don't ask any questions at this time. C.Use closed-ended questions. D.Ask questions to determine the precipitating factor
C. Use closed-ended questions.
A patient tells the nurse, "I wanted my physician to prescribe Valium [diazepam] for my anxiety but BuSpar [buspirone] was prescribed instead. Why?" The nurse's reply should be based on the knowledge that buspirone A.can be administered asneeded. B.does not produce blood dyscrasias. C.does not cause dependence. D.is faster acting
C. does not cause dependence.
A patient diagnosed with schizophrenia is to begin antipsychotic therapy and is ordered to receive a phenothiazine (Thorazine). The nurse would teach the patient's family to monitor vital signs because it can cause: A.bradycardia. B.hypertension. C.hypotension. D.tachypnea.
C. hypotension.
The client expresses a concern that the information between the client and the nurse remain confidential. What is the best response for the nurse to make? A."We can keep the information between us if you prefer." B."I will share the information with staff members only with your approval." C."If the information is important to your care, I will need to share it with staff." D."We can make the decision whether your psychiatrist needs this information for your care."
C."If the information is important to your care, I will need to share it with staff."
When alprazolam is prescribed for acute anxiety, what should be included in the teaching plan? A.Taper off the drug when buspirone has been prescribed B.Alprazolam may interact with tyramine-rich foods. C.Avoid alcohol intake when taking alprazolam. D.Do not take if buspirone has been taken within 4 hours
C.Avoid alcohol intake when taking alprazolam.
A client continually talks about the role of spirituality in curing depression. What is the most therapeutic approach by the nurse? A.Educate the client that spirituality alone will not cure depression. B.Shift the client's focus on spirituality to combine therapies. C.Listen to the client in a supportive manner regarding spirituality. D.Encourage the client to explore alternatives to spirituality.
C.Listen to the client in a supportive manner regarding spirituality.
When planning care for a patient with a mood disorder, what is the priority expected outcome? The patient A.has increased energy and thought processing. B.exhibits improved mood within two weeks of medication therapy. C.remains safe in the environment. D.utilizes the cognitive-behavioral therapy process.
C.remains safe in the environment.
This disorder has no periods of "rest" in between mood poles.
Cyclothymia
A client admitted through the ER after staging an automobile accident would be assessed at what level of suicide risk if not admitted to the hospital? A.Mild risk of imminent suicide. B.Low risk of imminent suicide. C.Moderate risk of imminent suicide. D.High risk of imminent suicide.
D. High risk of imminent suicide.
An ER client is restrained and is screaming, "You're all out to get me!" An IV of normal saline has been initiated at "keep vein open" rate. Pupils are dilated, respirations are 24 per minute, blood pressure is 158/98, pulse is 120 beats per minute. Paramedics report the client's sister called 911. The client's airway is patent. What is the next action the nurse should take? A.Undo restraints to calm client and reassess vital signs. B.Call the intensive care unit to ensure a bed is prepared. C.Run the IV at a fast rate and call the physician STAT. D.Initiate continuous 12-lead ECG monitoring
D. Initiate continuous 12-lead ECG monitoring
The phenothiazines, such as chlorpromazine (Thorazine) are effective for treating positive symptoms of psychotic behavior. A side effect for which the nurse must monitor is: A.hypertension. B.renal failure. C.increased white blood cells. D.extra-pyramidal symptoms
D. extra-pyramidal symptoms
In assessing an adult patient in a manic state, you would expect to find: A.rapid mood-cycling and altered thought processes. B.racing thoughts and decreased task completion times. C.poor impulse control and suicidal tendencies. D.high energy level and unpredictability.
D. high energy level and unpredictability.
A nurse is preparing an educational plan for a depressed patient with a personality disorder. The nurse notes the patient will most likely be prescribed which of the following medications? A.tricyclic antidepressant. B.serotonin-norepinephrine reuptake inhibitor. C.an atypical antidepressant D.monoamine oxidase inhibitor.
D. monoamine oxidase inhibitor.
You are working with an anxious patient who states she is experiencing terror, feeling a loss of controls, and you find that her thoughts are disorganized as reflected in her speech. Your assessment is that this patient is at which one of the following levels of anxiety? A.mild B.moderate C.severe D.panic
D. panic
Which of the following is most appropriate for the nurse to express to the client during the orientation phase of the nurse-client relationship? A."I am your nurse, but whatever you tell me I may have to tell other people." B."I am your nurse. The treatment team will set your goals and I'll inform you." C."I am going to be your nurse and together, we'll get your goals all completed." D."I am your nurse; my purpose in working with you is to help you achieve your goals."
D."I am your nurse; my purpose in working with you is to help you achieve your goals."
A patient states, "I hear little bugs that are eating holes in my brain." Which documentation of this patient's symptoms is most accurate? A."The patient is expressing delusions of grandeur." B."The patient is describing tactile hallucinations." C."The patient is exhibiting signs of delirium tremens." D."The patient is describing auditory hallucinations."
D."The patient is describing auditory hallucinations."
The nurse is attempting to communicate with a patient who is staring into space, his/her head cocked in a listening manner. What is the nurse's best response? A."You seem inattentive to what is happening around you; can you tell me why?" B."You seem to be daydreaming. Can we begin our session?" C."You seem as if you don't want to communicate; can you re-shift your focus?" D."You seem to be daydreaming; can you tell me what you are thinking?"
D."You seem to be daydreaming; can you tell me what you are thinking?"
A patient is ordered to receive diazepam (Valium). The nurse is teaching the patient about her medication. Which of the following would be included in the teaching plan? A.The medication may cause high levels of energy and activity. B.The medication is effective in decreasing suicidal ideations. C.The medication is safe to take with occasional alcohol use. D.The patient may develop tolerance after prolonged use
D.The patient may develop tolerance after prolonged use
When early symptoms of mania begin, the person may use this coping mechanism by insisting, "Nothing is wrong."
Denial
In this disorder, the patient has a persistent low mood without fully reaching classic symptoms of major depression.
Dysthymia
The term for seizure-inducing therapy for most resistant forms of depression.
Electro-Convulsive Therapy
The dehydrated manic patient would have a goal specifically related to this.
Fluid Intake
These three medical conditions are most closely associated with the development of a major depressive episode.
Heart Attack, Stroke, and Cancer
The term in this nursing diagnosis signifies the patient has "given up" on believing his or her condition will improve.
Hopelessness
This is hallmark symptom of mania.
Hyperactivity (excessive energy)
These TWO terms refer to sleep disorders that may accompany depression.
Hypersomnia and Insomnia
STICKY NOTE: Recovery
In mental health, "recovery" does not mean cured, or that the individual no longer has a diagnosis, or no longer needs medications, or no longer needs periodic access to therapy.
One of the three symptoms of manic behavior that begins with an "I."
Irritable, Impulsive, or Intrusive
This naturally-occurring salt is the first-line treatment for Bipolar Disorders
Lithium
It is a necessity for MAOI (monoamine oxidase inhibitor) therapy that the patient make this diet alteration.
Low Tyramine Diet
The nurse may collaborate with a nutritionist for patient teaching if the patient is on this class of antidepressant.
MAO Inhibitors.
This nursing diagnosis may be given related to either over-eating or anorexia secondary to a mood disorder.
Nutrition: Imbalanced (either deficit or excess)
The term for dangerous manic delusional belief that "I can do anything!"
Omnipotence
This depressive disorder is associated with recovery after childbirth.
Postpartum depression
This is the term for general "slowing down" of both physiological processes and thought processes in the depressed patient.
Psycho-Motor Retardation
This feature may accompany the severest forms of depression or mania in Bipolar I
Psychotic Feature
This is the term used for quick polar shifts in mood.
Rapid-Cycling
This nursing diagnosis receives priority in the depressed patient
Risk for Suicide (or Risk for Violence-Self-Directed)
This disorder is associated with lack of light.
Seasonal Affective disorder
In the absence of a physician, an RN may initiate this intervention if the patient is actively attempting to harm self or others.
Seclusion and/or Restraint
This nursing diagnosis may be given due to lack of energy or interest in bathing or other personal hygiene issues
Self-Care Deficit
This deadly syndrome can result when multiple antidepressant classes are taken, or an antidepressant is taken along with St. John's Wort.
Serotonin Syndrome
These TWO neurotransmitters are believed to be primary in mood regulation.
Serotonin and Norepinephrine
This is the newest class of antidepressants and affects both primary neurotransmitters in mood regulation.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRI)
The nurse would expect to find this memory issue on evaluation of a patient undergoing ECT.
Short-Term Memory Loss
STICKY NOTE: Ethical Issues in MH nursing
Stigma of psychiatric diagnosis Controlling individual freedom (violence, suicide, psychosurgery, psychotropics, restraint/seclusion) Involuntary admission/treatment Client privacy and confidentiality Clients' Rights
This is the most dangerous symptom of Major Depression.
Suicidal Ideations
According to the DSM-IV, this is the length of time symptoms must occur before diagnosing as Major Depressive Disorder.
Two Weeks
This medication is an atypical antidepressant, is as old as tricyclic antidepressants, is contraindicated in patients with seizure history, and is also marketed for smoking cessation.
Wellbutrin
The symptoms of Bipolar Disorder have commonly been referred to as these two terms.
What are "Manic" and "Depressive"
This is the therapeutic index range for Lithium, expressed in mEq/L.
What is 0.4 - 1.3 mEq/L
This document may be helpful in decreasing the likelihood of a suicide attempt.
a No-Self Harm Contract
A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Select the nurse's most caring comment. a. "Let's discuss some means of coping other than suicide when you have these feelings." b. "I understand why you're so depressed. When I got divorced, I was devastated too." c. "You should forget about your marriage and move on with your life." d. "How did you get so depressed that hospitalization was necessary?"
a. "Let's discuss some means of coping other than suicide when you have these feelings."
A bill introduced in Congress would reduce funding for the care of people with mental illnesses. A group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Advocacy b. Attending c. Recovery d. Evidence-based practice
a. Advocacy
A patient who immigrated to the United States from Honduras was diagnosed with schizophrenia. The patient took an antipsychotic medication for 3 weeks but showed no improvement. Which resource should the treatment team consult for information on more effective medications for this patient? a. Clinical algorithm b. Clinical pathway c. Clinical practice guideline d. International Statistical Classification of Diseases and Related Health Problems(ICD)
a. Clinical algorithm
A nurse says, "When I was in school I learned to call upset patients by name to get their attention, but I read a descriptive research study that says that this approach doesn't work. I'm going stop calling patients by name." Which statement is the best appraisal of this nurse's comment? a. One descriptive research study rarely provides enough evidence to change practice. b. Staff nurses apply new research findings only with the help from clinical nurse specialists. c. New research findings should be incorporated into clinical algorithms before using them in practice. d. The nurse misinterpreted the results of the study. Classic tenets of practice do not change
a. One descriptive research study rarely provides enough evidence to change practice.
Which finding best indicates that the goal "Demonstrate mentally healthy behavior" was achieved for an adult patient? The patient a. sees self as capable of achieving ideals and meeting demands. b. behaves without considering the consequences of personal actions. c. aggressively meets own needs without considering the rights of others. d. seeks help from others when assuming responsibility for major areas of own life
a. sees self as capable of achieving ideals and meeting demands.
A nursing student expresses concerns that mental health nurses "lose all their clinical nursing skills." Select the best response by the mental health nurse. a. "Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of the patients' problems." b. "Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations." c. "That's a misconception. Psychiatric nurses frequently use high technology monitoring equipment and manage complex intravenous therapies." d. "Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That appeals to me."
b. "Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations."
A patient shows the nurse an article from the Internet about a health problem. Which characteristic of the web site's address most alerts the nurse that the site may have biased and prejudiced information? a. Address ends in ".org." b. Address ends in ".com." c. Address ends in ".gov." d. Address ends in ".net."
b. Address ends in ".com."
Which historical nursing leader helped focus practice to recognize the importance of science in psychiatric nursing? a. Abraham Maslow b. Hildegard Peplau c. Kris Martinsen d. Harriet Bailey
b. Hildegard Peplau
A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional intervention? a. Conduct mental health assessments. b. Prescribe psychotropic medication. c. Establish therapeutic relationships. d. Individualize nursing care plans
b. Prescribe psychotropic medication.
Which research evidence would most influence a group of nurses to change their practice? a. Expert committee report of recommendations for practice b. Systematic review of randomized controlled trials c. Nonexperimental descriptive study d. Critical pathway
b. Systematic review of randomized controlled trials
A nurse consistently strives to demonstrate caring behaviors during interactions with patients. Which reaction by a patient indicates this nurse is effective? A patient reports feeling: a. distrustful of others. b. connected with others. c. uneasy about the future. d. discouraged with efforts to improve.
b. connected with others.
Complete this analogy. NANDA: clinical judgment:NIC: a. patient outcomes. b. nursing actions. c. diagnosis. d. symptoms.
b. nursing actions.
Which outcome, focused on recovery, would be expected in the plan of care for a patient living in the community with serious and persistent mental illness? Within 3 months, the patient will: a. deny suicidal ideation b. report a sense of well-being c. take medications as prescribed d. attend clinic appointments on time
b. report a sense of well-being
Which assessment finding most clearly indicates that a patient may be experiencing a mental illness? The patient a. reports occasional sleeplessness and anxiety. b. reports a consistently sad, discouraged, and hopeless mood. c.is able to describe the difference between "as if" and "for real." d. perceives difficulty making a decision about whether to change jobs.
b. reports a consistently sad, discouraged, and hopeless mood.
Two nursing students discuss career plans after graduation. One student wants to enter psychiatric nursing. The other student asks, "Why would you want to be a psychiatric nurse? All they do is talk. You'll lose your skills." Select the best response by the student interested in psychiatric nursing. a."Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of patients' problems." b."Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensional problems. I'm challenged by those situations." c."I think I'll be good in the mental health field. I do not like clinical rotations in school, so I don't want to continue them after I graduate." d."Psychiatric nurses don't have to deal with as much pain and suffering as medical surgical nurses. That appeals tome."
b."Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensional problems. I'm challenged by those situations."
A family has a long history of conflicted relationships among the members. Which family member's comment best reflects a mentally healthy perspective? a. "I've made mistakes but everyone else in this family has also." b. "I remember joy and mutual respect from our early years together." c. "I will make some changes in my behavior for the good of the family." d. "It's best for me to move away from my family. Things will never change."
c. "I will make some changes in my behavior for the good of the family."
When a new bill introduced in Congress reduces funding for care of persons diagnosed with mental illness, a group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Recovery b. Attending c. Advocacy d. Evidence-based practice
c. Advocacy
A nurse encounters an unfamiliar psychiatric disorder on a new patient's admission form. Which resource should the nurse consult to determine criteria used to establish this diagnosis? a. International Statistical Classification of Diseases and Related Health Problems (ICD-10) b. The ANA's Psychiatric-Mental Health Nursing Scope and Standards of Practice c. Diagnostic and Statistical Manual of Mental Disorders (DSM-V) d. A behavioral health reference manual
c. Diagnostic and Statistical Manual of Mental Disorders (DSM-V)
A nurse assesses a newly admitted patient with depression. Which statement is an example of "attending"? a. "We all have stress in life. Being in a psychiatric hospital isn't the end of the world." b. "Tell me why you felt you had to be hospitalized to receive treatment for your depression." c. "You will feel better after we get some antidepressant medication started for you." d. "I'd like to sit with you a while so you may feel more comfortable talking with me."
d. "I'd like to sit with you a while so you may feel more comfortable talking with me."
An informal group of patients discuss their perceptions of nursing care. Which comment best indicates a patient's perception that his or her nurse is caring? a. "My nurse always asks me which type of juice I want to help me swallow my medication." b. "My nurse explained my treatment plan to me and asked for my ideas about how to make it better." c. "My nurse told me that if I take all the medicines the doctor prescribes I will get discharged soon." d. "My nurse spends time listening to me talk about my problems. That helps me feel like I'm not alone."
d. "My nurse spends time listening to me talk about my problems. That helps me feel like I'm not alone."
In the shift-change report, an off-going nurse criticizes a patient who wearsheavymakeup.Whichcommentbythenursewhoreceivesthereportbestdemonstrates advocacy? a. "This is a psychiatric hospital. Craziness is what we are all about." b. "Let's all show acceptance of this patient by wearing lots of makeup too." c. "Your comments are inconsiderate and inappropriate. Keep the report objective." d. "Our patients need our help to learn behaviors that will help them get along in society."
d. "Our patients need our help to learn behaviors that will help them get along in society."
Which belief will best support a nurse's efforts to provide patient advocacy during a multidisciplinary patient care planning session? a. All mental illnesses are culturally determined. b. Schizophrenia and bipolar disorder are cross-cultural disorders. c. Symptoms of mental disorders are unchanged from culture to culture. d. Assessment findings in mental illness reflect a person's cultural patterns
d. Assessment findings in mental illness reflect a person's cultural patterns
A patient's relationships are intense and unstable. The patient initially idealizes the significant other and then devalues him or her, resulting in frequent feelings of emptiness. This patient will benefit from interventions to develop which aspect of mental health? a. Effectiveness in work b. Communication skills c. Productive activities d. Fulfilling relationships
d. Fulfilling relationships
The DSM-V classifies: a. deviant behaviors. b. present disability or distress. c. people with mental disorders. d. mental disorders people have
d. mental disorders people have
Which individual is demonstrating the highest level of resilience? One who a.is able to repress stressors. b. becomes depressed after the death of a spouse. c. lives in a shelter for 2 years after the home is destroyed by fire. d. takes a temporary job to maintain financial stability after loss of a permanent job
d. takes a temporary job to maintain financial stability after loss of a permanent job
Two nutrition-related deficits you might see due to manic behavior.
decreased food intake (weight loss) and decreased fluid intake (dehydration).
This gustatory side-effect is common when first beginning Lithium therapy.
metallic taste
This class of medications (non- antidepressants) when taken with antidepressants, may lead to serotonin syndrome.
migraine medications (such as Imitrex).
The most critical think to assess for in a depressed patient.
suicidal ideations.
The most important thing to assess in a suicidal patient who has a plan.
the means and ability to act on a suicidal plan.
The most critical thing to assess for in a suicidal patient.
the presence of a suicide plan