NURSG 534 - Evolve Psychiatry Practice Questions (Level Intermediate)

A nursing home resident with dementia of the Alzheimer type, stage 2, who has been receiving donepezil is engaging in numerous acting-out behaviors. On what should the nurse base the initial plan of care? -Assessing the client's level of consciousness -Identifying the stressors that precipitate the client's behavior -Observing the client's performance of activities of daily living -Monitoring the side effects associated with the client's medications

Identifying the stressors that precipitate the client's behavior

A client comes to a trauma center reporting that she has been raped. She is disheveled, pale, and staring blankly. The nurse asks the client to describe what happened. What is the nurse's rationale for doing this? -It will help the nursing staff give legal advice and provide counseling. -Talking about the assault will help the client see how her behavior may have led to the event. -It will let the victim put the event in better perspective and help begin the resolution process. -Discussing the details will keep the victim from concealing the intimate happenings during the assault.

It will let the victim put the event in better perspective and help begin the resolution process.

During a nursing team conference, a mental health worker suggests that a client with schizophrenia, paranoid type, be assigned to group therapy. What should the nurse manager explain about this type of therapy for this client? -Individuals with this disorder respond well to small therapeutic groups. -Therapeutic group work tends to be threatening to individuals who are suspicious. -Compliance with unit rules and medication regimens increases as therapeutic group involvement increases. -Involvement in small therapeutic groups may decrease the regression and dependency associated with institutionalization.

Therapeutic group work tends to be threatening to individuals who are suspicious.

How can the nurse best minimize psychologic stress in an anxious client who has been admitted to the psychiatric unit? -Explain in detail the therapies being used. -Learn what is of particular importance to the client. -Advise the client that the nurse is in charge of the client's situation. -Avoid the discussion of any areas that may be emotionally charged.

Learn what is of particular importance to the client.

A depressed client arrives at the mental health unit with mild suicidal ideation but no plan of action. Assessment data reveal that the client has many family responsibilities and adequate family support and attends church regularly. What does the nurse determine about this client? Should be at no risk for suicide Warrants one-on-one observation Warrants placement in a seclusion room Should be reassessed at intervals regarding suicidal intent

Should be reassessed at intervals regarding suicidal intent

What is the nurse's primary outcome goal when managing the care of a client diagnosed with generalized anxiety disorder (GAD)? -Creating an anxiety-free environment for the client -Assisting the client with the development of healthy, adaptive coping mechanisms -Identifying the triggers that produce anxiety in the client -Providing reinforcement that the client's anxiety issues can be eliminated

Assisting the client with the development of healthy, adaptive coping mechanisms

During a group discussion it is learned that a group member hid suicidal urges and committed suicide several days ago. What should the nurse leading the group be prepared to manage? -Guilt of the co-leaders for failing to anticipate and prevent the suicide -Guilt of group members because they could not prevent another's suicide -Lack of concern over the suicide expressed by several of the members in the group -Fear by some members that their own suicidal urges may go unnoticed and that they may go unprotected

Fear by some members that their own suicidal urges may go unnoticed and that they may go unprotected

The nurse at the mental health clinic is counseling a client with obsessive-compulsive disorder who spends a lot of time each day engaged in handwashing and has trouble keeping appointments on time as a result. What is the most therapeutic initial intervention by the nurse? -Discouraging the frequent handwashing to prevent skin breakdown -Encouraging the client to hasten the ritual so appointments can be kept on time -Telling the client how angry others become when activities are delayed for handwashing -Accepting the ritualistic behavior with a matter-of-fact attitude without displaying criticism

Accepting the ritualistic behavior with a matter-of-fact attitude without displaying criticism

When working with a client who has a phobia of black cats, what problem does the nurse anticipates for this client? -Denying that the phobia exists -Anger toward the feared object -Anxiety when discussing the phobia -Distortion of reality when completing daily routines

Anxiety when discussing the phobia

A nurse is using cognitive therapy to help a client who experiences panic attacks. What is the goal of this therapy? Preventing future panic attacks Helping the client hide the panic attacks Stopping the panic attacks once they begin Decreasing the fear of having panic attacks

Decreasing the fear of having panic attacks

A client has a diagnosis of schizoid personality disorder. During the assessment what should the nurse expect of the client's behavior? -Rigid and controlling -Dependent and submissive -Detached and socially distant -Superstitious and socially anxious

Detached and socially distant

A 6-year-old child recently started school but has been refusing to go for the past 3 weeks. What would be an appropriate nursing intervention for this child? -Explain that school is a place to have fun. -Delay the return to school for several months. -Enroll the child in a special education program. -Develop a behavior modification program with the child

Develop a behavior modification program with the child

At times a client's anxiety level is so high that it blocks attempts at communication and the nurse is unsure of what is being said. To clarify understanding, the nurse says, "Let's see whether we mean the same thing." What communication technique is being used by the nurse? -Reflecting feelings -Making observations -Seeking consensual validation -Attempting to place events in sequence

Seeking consensual validation

When interacting with an adolescent client with the diagnosis of anorexia nervosa, what is most important for the nurse to do? -Show empathy. -Maintain control. -Set and maintain limits. -Focus on food and nutrition

Set and maintain limits.

A mother calls the emergency department and speaks to a nurse. Her 16-year-old daughter has just been found in her bedroom cutting her wrists. The mother says, "They're just superficial cuts; the old ones have healed just fine." The mother states that the daughter has had three previous psychiatric admissions for suicide attempts and says that "this situation is pretty much like the other times. I'm not sure whether I should bring her in tonight or tell her primary healthcare provider about what happened at her next appointment, later this week." What is the best reply by the nurse? -"You should call 911 now and let them know that your daughter has made a suicide attempt and needs help." -"You should let your daughter's primary healthcare provider know about this occurrence in the morning and see whether the provider wants you to make an appointment for her tomorrow." -"It sounds like you're very experienced with this situation. You can probably talk to her at home and see whether she'll tell you why she decided to cut herself." -"Call her primary healthcare provider in the morning and let the provider know what has happened. Don't have any further conversations about suicide, because you don't want to give her any more ideas about hurting herself."

"You should call 911 now and let them know that your daughter has made a suicide attempt and needs help."

When caring for a newly admitted depressed client, a nurse arranges for a staff member to remain with the client continuously. What information supports the nurse's decision to institute this precaution? Select all that apply. Refusal to eat any food Inability to concentrate Agitated pacing in the hall History of suicide attempts Statements that life is not worth living

Agitated pacing in the hall History of suicide attempts Statements that life is not worth living

An older adult resident of a nursing home who has the diagnosis of dementia of the Alzheimer type frequently talks about the good old days at the ranch. What is the most appropriate action by the nurse? -Allowing the resident to reminisce about the past and listening with interest -Involving the resident in interesting diversional activities with a small group -Reminding the resident that those "good old days" are past and that the client should focus on the present -Introducing the resident to other residents with the same diagnosis so that they can share their past experiences

Allowing the resident to reminisce about the past and listening with interest

When assessing the mental status of a 7- or 8-year-old child, what is most important for the nurse to do? -Listen to the parents' description of the child's behavior. -Compare the child's function from one occasion to another. -Engage the parents in a discussion about the child's feelings. -Determine the child's mental status with the use of direct questions.

Compare the child's function from one occasion to another.

What should a nurse include in the initial plan of care for a client with the long-standing obsessive-compulsive behavior of handwashing? -Determining the purpose of the ritualistic behavior -Limiting the time allowed for the ritualistic behavior -Suggesting a symptom-substitution technique to refocus the ritualistic behavior -Developing a routine schedule of activities to reduce the need for the ritualistic behavior

Developing a routine schedule of activities to reduce the need for the ritualistic behavior

A nurse is assigned to care for an adolescent who has been admitted to the psychiatric hospital with a diagnosis of anorexia nervosa. What should the nurse's initial intervention be? -Scheduling an endocrinology consult because of amenorrhea -Confronting those behaviors that reflect an inflated self-importance -Arranging for psychotherapy sessions to help develop a desire to accommodate others -Developing a contract to achieve a weekly weight gain, with consequences for nonachievement

Developing a contract to achieve a weekly weight gain, with consequences for nonachievement

A client with the diagnosis of obsessive-compulsive disorder attends a day treatment program. The client feels that her hands are dirty and has a need to wash them 70 to 80 times a day, and, as a result, the client's hands are red and raw, with some bleeding. An immediate nursing intervention for this client is to get the client to do what? -Understand that the hands are not dirty. -Gain insight into the emotional problems. -Stop washing the hands so the skin will heal. -Limit the number of times handwashing occurs

Limit the number of times handwashing occurs

What should the nurse do when planning continuing care for a moderately depressed client? -Encourage the client to determine leisure time activities. -Offer the client the opportunity to make some decisions. -Relieve the client of the responsibility of making any decisions. -Allow the client time to be alone to decide in which activities to engage

Offer the client the opportunity to make some decisions.

A nurse is caring for a moderately depressed client. What activity is most appropriate for this client? -Assembling a leather wallet -Putting together a jigsaw puzzle -Participating in aerobic exercise -Stuffing envelopes for a local charity

Participating in aerobic exercise

An adolescent who has had the diagnosis of conduct disorder since the age of 9 years is placed in a residential facility. The adolescent has a history of fighting, stealing, vandalizing property, and running away from home. The adolescent is aggressive, has no friends, and has been suspended from school repeatedly. What is the nurse's priority when developing a plan of care? -Preventing violence -Encouraging insight -Supporting self-esteem -Promoting social interaction

Preventing violence

The nurse admits an adolescent to the psychiatric unit with the diagnosis of anorexia nervosa. What is the primary gain a client with anorexia achieves from this disorder? -Reduction of anxiety through control over food -Separation from parents secondary to hospitalization -Release from school responsibilities because of illness -Increased parental attentiveness related to massive weight loss

Reduction of anxiety through control over food

A 12-year-old child who has a history of poor grades and oppositional defiant disorder (ODD) is admitted to a child psychiatric unit with the diagnosis of conduct disorder. The youngest of three children, this child is identified by both the parents and the siblings as the family problem. The nurse recognizes the family's pattern of relating to the child as what? -Enabling -Patronizing -Scapegoating -Avoidance

Scapegoating

The nurse is caring for a 30-year-old client who was admitted yesterday with borderline personality disorder (BPD). What is the most important intervention for the nurse caring for a client with BPD? -Setting limits -Offering advice -Being an attentive listener -Encouraging group activities

Setting limits

A nurse is counseling a client with the diagnosis of bulimia nervosa. The client admits to at times feeling helpless in regard to the eating disorder. What is the most appropriate short-term outcome for this client? -Practicing effective socialization skills -Perceiving the body shape as acceptable -Decreasing preoccupation with delusional thoughts -Verbalizing the desire to increase control over stressful situations

Verbalizing the desire to increase control over stressful situations

A child has been hospitalized repeatedly for illnesses of unknown origin. Finally the primary healthcare provider makes the diagnosis of Munchausen syndrome by proxy. What is the most therapeutic approach by the nurse to the involved parent? -Confrontation -Open communication -Health teaching about child-rearing -Validation of the child's physical status

open communication

The nurse is caring for a client who self-identifies as having a strong Hispanic heritage. According to transcultural nursing researchers, what should the nurse ask when assessing a woman with depression for the risk of self-harm who also identifies as having Hispanic ethnicity? -"When did you last spend time with friends?" -"How do you express yourself when you're angry?" -"What made you first notice that you were depressed?" -"Do you have many interests outside your work and home?"

"How do you express yourself when you're angry?"

A nurse is assessing a client with bulimia nervosa. What should the nurse ask to obtain information about the client's intake habits and patterns? -"Are you trying to control other people through the use of food?" -"When you socialize, do you find that you eat more than when you eat by yourself?" -"Do you find yourself eating more right before the beginning of your menstrual cycle?" -"How frequently are you eating in response to your feelings rather than because you're hungry?

"How frequently are you eating in response to your feelings rather than because you're hungry?

A client with an antisocial personality disorder is remanded to the inpatient psychiatric unit for approximately 1 week. The client refuses to discuss any problems with the nursing staff, and so the team decides to use a confrontational approach. One morning the nurse asks the client how things went the day before. The client says, "I didn't do much. I watched TV and read a little." What is the most appropriate confrontational response by the nurse? -"It seems that you're expecting us to wave a magic wand that will cure you." -"That's not much for someone who wants to get out of the hospital so badly." -"Please tell me why you seem to be having difficulty facing up to your part in your problems." -"It doesn't sound to me like you've been doing much work on the problems that brought you into the hospital."

"It doesn't sound to me like you've been doing much work on the problems that brought you into the hospital."

Lunch is being served, and the clients must walk to the dining room. The nurse finds one client sitting alone with the head slightly tilted as if listening to something. How should the nurse respond? -"I know you're busy, but it's lunchtime." -"Are the voices bothering you again?" -"Get going; you don't want to miss lunchtime." -"It's lunchtime; I'll walk with you to the dining room."

"It's lunchtime; I'll walk with you to the dining room."

One day while shaving, a male client with the diagnosis of bipolar disorder tells the nurse, "I've hidden a razor blade, and tonight I'm going to kill myself." What is the best reply by the nurse? -"You're going to kill yourself?" -"Things really can't be that bad." -"Are you sure you really mean that?" -"Killing yourself is not going to solve your problems."

"You're going to kill yourself?"

A client on a psychiatric unit who has been acting out for several weeks approaches the nurse and says, "I'm really sorry about how I've acted. I'll bet everyone thinks I'm an idiot." What is the best initial response by the nurse? "You're wondering how others will react to you now." "Some clients are concerned that you might lose control again." "Everyone feels foolish sometimes; you didn't deliberately act that way." "Nobody thinks you're a fool; everyone recognized that you were really struggling to keep control."

"You're wondering how others will react to you now."

The nurse is developing a plan of care for a client who is using ritualistic behavior. Initially the nurse must understand what about the ritual? -That it is under conscious control -That it is used primarily for secondary gains -That it helps the client focus on the inability to cope with reality -That it helps the client control the level of anxiety the client is experiencing

That it helps the client control the level of anxiety the client is experiencing

A client is found to have a conversion disorder. What is the typical reaction by the client to the physical symptom? -Anger -Apathy -Anxiety -Agitation

Apathy

A client with the diagnosis of personality disorder with antisocial behavior is hospitalized. The client is openly discussing interpersonal difficulties with family members and the boss at work from whom the client has stolen money. The client is facing criminal charges. Which behavior indicates that the client is meeting treatment outcomes? -Expression of feelings of resentment toward the employer -Discussion of plans for each of the possible outcomes of a trial -Expression of resignation about difficult relationships with the spouse and children -Discussion of the decision to file a grievance against the employer after discharge from the hospital

Discussion of plans for each of the possible outcomes of a trial

A school nurse is asked to present an educational program on attention deficit-hyperactivity disorder (ADHD) to the staff of an elementary school. What should the nurse emphasize about this disorder? -It becomes evident before 4 years of age. -Its major clinical manifestation is easy distractibility. -It occurs more frequently in lower socioeconomic groups. -It causes affected children to sleep more than unaffected children.

Its major clinical manifestation is easy distractibility.

The nurse determines that the plan for bolstering an overweight adolescent's self-esteem has been effective when, 3 months later, the adolescent's mother reports that the adolescent is doing what? -Seems to be doing average work in school -Has asked her how to bake bread and cookies -Imitates a sibling's manner of speech and dress -Joined a dirt bike group that meets at the school

Joined a dirt bike group that meets at the school

A child is found to have attention deficit-hyperactivity disorder (ADHD). What strategy should the nurse teach the parents to help them cope with this disorder? -Orient the child to reality. -Reward appropriate conduct. -Suppress feelings of frustration. -Use restraints when behavior is out of control

Reward appropriate conduct.

A client is admitted to the psychiatric unit with the diagnosis of obsessive-compulsive disorder. The client washes her hands more than 20 times a day, and they are raw and bloody. What defense mechanism does the nurse conclude that the client is using to ease anxiety? -Undoing -Projection -Introjection -Displacement

undoing

A male client with the diagnosis of antisocial personality disorder takes a female nurse by the shoulders, kisses her, and shouts, "I like you." What is the most appropriate response by the nurse? -Thank you. I like you, too." -"I wish you wouldn't do that." -"Don't ever touch me like that again. I don't like it " -"Your behavior is inappropriate. Don't do that again."

"Your behavior is inappropriate. Don't do that again."

What should the nurse include when planning activities for an older nursing home resident with a diagnosis of dementia? -Varied activities that will keep the resident occupied -Familiar activities that the resident can complete successfully -Challenging activities to maintain the resident's contact with reality -Ways to ensure that the resident actively participates in the unit's daily activities

Familiar activities that the resident can complete successfully

A client is admitted to the psychiatric service with a diagnosis of severe depression. When approached by the nurse, the client says, "You know I'm a sorry, lazy person. I don't deserve a job. I'm just stupid and no good." What does the nurse conclude that the client is experiencing? -Nihilistic delusions -Delusions of persecution -Feelings of self-deprecation -Experiences of depersonalization

Feelings of self-deprecation

One morning a male client whose thought processes are marked by ideas of reference and persecutory ideation appears very upset. The client tells the nurse that a reporter on television told everyone that the client is "a queer." What is the most therapeutic response by the nurse? -It sounds to me like you're having some frightening feelings." -"I'll call the station to ask why the reporter said that about you." -"You seem upset by this. Why do you think the reporter said that about you?" -"Sometimes we're unsure of ourselves. Could you be projecting feelings onto others?"

It sounds to me like you're having some frightening feelings."

During the admission process, a client with symptoms of manic behavior has pressured speech punctuated with profanity. What is the most therapeutic approach for the nurse to use to manage this client's behavior? Explaining in detail the type of behavior allowed in the facility Stating that the use of profanity should stop, because it is inappropriate Interrupting the interview until the client refrains from using profanity Encouraging the client to keep talking while using a nonjudgmental attitude

Stating that the use of profanity should stop, because it is inappropriate

What should the nurse do when an adolescent with the diagnosis of anorexia nervosa starts to discuss food and eating? Listen to the client's list of favorite foods and secure these foods for the client. Tell the client gently but firmly to direct the discussion of food to the nutritionist. Use the client's current interest in food to encourage an increase in food intake. Let the client talk about food as long as the client wants and limit discussion about eating.

Tell the client gently but firmly to direct the discussion of food to the nutritionist.