Nursing 4530 - Mental Health - Exam 1

A newly admitted client asks, "Why do we need a unit schedule? I'm not going to these groups. I'm here to get some rest." Which is the most appropriate nursing reply? A. group therapy is optional, you can go if you find the topic helpful and interesting B. group therapy provides the opportunity to learn and practice new coping skills C. group therapy is mandatory, all clients must attend D. group therapy is an economical way of providing therapy to many clients concurrently

"Group therapy provides the opportunity to learn and practice new coping skills"

The nurse knows that the client understands the rationale for dietary restrictions when taking a monoamine oxidase inhibitor (MAOI) when the client makes which statement? A. "foods that are high in tyramine will reduce the medications effectiveness" B. "i should avoid foods that are high in amino acid tyramine such as aged cheese, meats, and chocolate because this drug causes the level of tyramine to go up to dangerous levels" C. i am now allergic to foods that are high in the amino acid tyramine such as aged cheese, organ meats, wines, and chocolate" D. "certain foods will cause me to have sexual dysfunction when I take this medication"

"I should avoid foods that are high in the amino acid tyramine such as aged cheese, meats and chocolate because the drug causes the level of tyramine to go up to dangerous levels"

A nurse is interviewing a newly admitted psychiatric patient. Which nursing statement is an example of offering a "general lead"? A. "are you feeling depressed or anxious?" B. "do you know why you are here?" C. "can you chronologically order the events that led to your admission?" D. "i'd like to hear more"

"I'd like to hear more"

A client who has been taking buspirone as prescribed for 2 days is close to discharge. Which statement indicates to the nurse that the client has an understanding of important discharge teaching? A. this drug causes physical dependence, and i need to strictly follow doctor's orders B. i can drink any alcohol with this medication C. i cant take this medication with food, it needs to be taken on an empty stomach D. it is going to take 2-4 weeks in order for me to begin to feel better

"It is going to take 2-4 weeks in order for me to begin to feel better"

A nurse is planning care for a client diagnosed with bipolar disorder; manic episode. In which order should the nurse prioritize the listed client outcomes? 1. maintain nutritional status 2. interacts appropriately with peers 3. remains free from injury 4. sleep 6-8 hrs a night

3,1,4,2 remains free from injury maintain nutritional status sleep 6-8hrs a night interacts appropriately with peers

A client is admitted to the psychiatric unit with a diagnosis of major depressive disorder. The client is unable to concentrate, has no appetitive, and is experiencing insomnia. Which should be included in this client's plan of care? A. a schedule that includes mandatory activities to decreased social isolation B. a flexible schedule that allows the client opportunities for decision making C. a daily schedule filled with activities to promote socialization D. a simple, structured daily schedule with limited choices of activities

A single, structured daily schedule with limited choices of activities

A nurse and client are engaged in a discussion. The client says, "I feel really close to you. You are the only true friend I have." Which response by the nurse would be most therapeutic? A. "since ours is a professional relationship, let's explore other opportunities in your life for friendship" B. "i am sure there are other people in your life who are your friends; besides, we just met" C. "it makes me feel good that you trust me so much ; it is important for the work we are doing together" D. "we are definitely not friends, this is strictly professional"

A. "Since ours is a professional relationship, let's explore other opportunities in your life for friendship"

A client is currently experiencing a panic attack. Which is the most appropriate response by the nurse? A. "you are safe, take a deep breath" B. "what are you feeling right now?" C. "there is nothing here to harm you" D. "just try to relax"

A. "You are safe. Take a deep breath"

A nurse begins the intake assessment of a client diagnosed with bipolar 1 disorder. The client shouts, "You can't do this to me. Do you know who I am?". which is the priority nursing action in this situation? A. to provide self and client with a safe environment B. to provide high calorie finger foods to meet nutritional needs C. to redirect the client to the needed assessment information D. to reorient the client to person, place, time and situation

A. To provide self and client with a safe environment

A client suffers from frequent panic attacks and often described feeling disconnected from the self during these attacks. Which condition should the nurse note in the chart? A. depersonalization B. denial C. derealization D. hallucinations

A. depersonalization

A client cheats on their spouse and then brings the spouse of a dozen roses. Which ego defense mechanism does this represent? A. undoing B. repression C. denial D. suppression

A. undoing

An 88 yr old client on an in-patient psychiatric unit states, "My children are refusing to visit me. I feel like giving up." The client has a deficit in which of Erikson's stages of development? A. integrity vs role confusion B. initiative vs guilt C. industry vs inferiority D. integrity vs despair

D. integrity vs despair

An isolative client was admitted 4 days ago with a diagnosis of major depressive disorder. Which nursing statement would best motivate this client to attend a therapeutic group being held in the milieu? A. "It must be difficult for you to attend group therapy when you feel so bad" B. "I'll walk with you to the day room. Group is about to start" C. "We'll go to the day room when you are ready for group" D. "Let me tell you about the benefits of attending the group"

B. "I'll walk with you to the day room. Group is about to start."

At what point should the nurse determine that a client is at risk for developing a mental disorder? A. when the client uses defense mechanisms as ego protection B. when maladaptive responses to stress are coupled with interference in daily functioning C. when thoughts, feelings, and behaviors are not reflective of DSM-5 criteria D. when the client communicates significant distress

B. When maladaptive responses to stress are coupled with interference in daily functioning

A college student recently experienced a relationship break-up. The college student is admitted to a hospital following a suicide attempt and states "No one will ever love a loser like me." According to Erikson's theory of personality development, a nurse should recognize a deficit in which developmental stage? A. initiative versus guilt B. intimacy versus isolation C. trust versus mistrust D. ego integrity versus despair

B. intimacy versus isolation

A provocatively dressed client diagnosed with bipolar I disorder is observed laughing loudly with peers in the milieu. Which nursing action is a priority in this situation? A. redirect clients in the milieu to structured social activities, such as cards B. privately discuss with the client the inappropriate provocative dress C. administer pm anti-anxiety med to calm the pt D. join the milieu to assess the appropriateness of the laughter

B. privately discuss with the client inappropriate provocative dress

A nurse is assessing the factors contributing to the well-being of a newly admitted client. Which would the nurse identify as having a positive impact on the individual's mental health? A. striving for total self-reliance B. The ability to affectively manage stress C. a family history of mental illness D. Not needing others for companionship

B. the ability to effectively manage stress

According to Erikson's developmental theory, when planning care for a 47 yr old client, which developmental task should a nurse identify as appropriate for this client? A. to achieve a sense of self-confidence and recognition from others B. to develop basic trust in others C. to achieve established life goals and consider the welfare of future generations D. to reflect back on life events to derive pleasure and meaning

C. To achieve life goals and consider the welfare of future generations

The nurse is providing counseling to clients diagnosed with MDD. The nurse chooses to help the clients alter their mood by learning how to change the way they think. The nurse is functioning under which theoretical framework? A. interpersonal theory B. behavioral theory C. cognitive theory D. psychoanalytic theory

C. cognitive theory

Which is true regarding mental health and mental illness? A. persons who engage in fantasies are mentally ill B. behavior that may be viewed as acceptable in one culture is always unacceptable to other cultures C. in most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self concept, and emotional stability D. it is easy to determine if a person is mentally healthy or mentally ill

C. in most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self concept, and emotional stability

A client puts when their partner does not give them the attention they are seeking. The client is suing which defense mechanism? A. projection B. minimization C. regression D. rationalization

C. regression

Which expected client outcome should a nurse identify as being correctly formulated? A. client will feel happier by discharge B. client will demonstrate 2 relaxation techniques C. client will verbalize triggers to anger by end of session D. client will initiate interaction with 1 peer during free time within 2 days

Client will initiate interaction with one peer during free time within 2 days *measurable, realistic, client focused, time frame

A 75 yr old client with a long history of depression is currently on doxepin 100 mg daily. The client takes a daily diuretic for hypertension and is recovering from the flu. Which nursing diagnosis should the nurse assign the highest priority? A. risk for constipation R/T excessive fluid loss B. risk for infection R/T suppressed WBC count C. risk for ineffective thermoregulation R/T anhidrosis D. risk for injury R/T orthostatic hypotension

D. risk for injury R/T orthostatic hypotension

A client diagnosed with panic disorder states, "When an attack happens, I feel like I am going to die." Which is the most appropriate nursing reply? A. "Most people who experience panic attacks have feeling of impending doom" B. "Tell me why you think you are going to die every time you have a panic attack" C. "Death from a panic attack happens so infrequently that there is no need to worry" D. "I know it's frightening, so I will stay with you"

D. "I know it's frightening, so I will stay with you."

All of the following are interventions appropriate for client who is having suicidal thoughts and has stated they have a plan for suicide EXCEPT: A. search the clients belongings for harmful objects with the client present B. initiate one on one supervision C. do not assign a private room and keep door open at all times D. allow the client to use only their metal spoon when eating

D. allow the client to use only their metal spoon when eating

A client diagnosed with bipolar I disorder is distraught over insomnia over the last 3 nights and a 12 pound weight loss over the past 2 weeks. Which should be the client's priority nursing diagnosis? A. knowledge deficit R/T bipolar disorder AEB concern about symptoms B. altered nutrition less than body requirements R/T hyperactivity AEB weight loss C. risk for suicide R/T powerlessness AEB insomnia and anorexia D. altered sleep patterns R/T mania AEB insomnia for past 3 nights

D. altered nutrition: less than body requirements R/T hyperactivity AEB weight loss

An angry client on an inpatient unit approaches a nurse stating, "Someone took my lunch! People need to respect others, and you need to do something about this now!" The nurse's response should be guided by which basic assumption of milieu therapy? A. conflict should be resolved by the nursing staff B. conflict should be avoided at all costs on inpatient psychiatric units C. conflict resolution should be addressed only during group therapy D. every interaction is an opportunity for therapeutic intervention

Every interaction is an opportunity for therapeutic intervention

Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I am anxious, the only thing that calms me down is alcohol." Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" A. making observations B. reflecting C. formulating a plan of action D. giving recognition

Formulating a plan of action

Which therapeutic communication technique is being used in this nurse-client interaction? Client: "My father spanked me often" Nurse: "Your father was a harsh disciplinarian" A. focusing B. accepting C. offering general leads D. restatement

Restatement

The nurse enters a client's room and finds the patient anxiously pacing. The client begins shouting at the nurse "Get out of my room!". What is the most appropriate intervention by the nurse? A. call for help and say "calm down" B. turn and walk out of the room without saying anything C. approach the client and ask "what's wrong?" D. stand at the doorway and say "you seem agitated"

Stand at the doorway and say "You seem upset"

A client has been depressed and suicidal. The client started taking a tricyclic antidepressant 2 weeks ago. The nurse is preparing the client for discharge. Which is the concern of the nurse at discharge? A. the nurse will evaluate for risk of suicide by overdose of the tricyclic antidepressant B. the client will need regular laboratory work to monitor therapeutic drug levels C. the client may need a prescription for diphenhydramine (Benadryl) to use for side effects D. The nurse will need to teach the client about signs and symptoms of neuroleptic malignant syndrome

The nurse will evaluate risk for suicide by overdose of the antidepressant

Which symptoms would the nurse expect to assess in a client experiencing serotonin syndrome? A. agitation, sweating, fever, tachycardia, and hyperreflexia B. delirium, pallor, rigidity, and autonomic instability C. psychosis, fever, flaccidity, and hypothermia D. fever, seizures, constipation, bradycardia, and hypotension

agitation, sweating, fever, tachycardia, hyperreflexia

A nurse is caring for a client who begins yelling at other clients in the day room. Which of the following actions should the nurse take? A. express empathy about the client's feelings of anger B. place the client in restraints C. stand in front of the client to show him who is in control D. tell the client he will lose television privileges if he does not calm down

express empathy about the client's feelings of anger

Which statement is most accurate regarding the assessment of clients daignosed with psychiatric problems? A. assessment provides a holistic view of the client, including biopsychosocial aspects B. medical history is of little significance and can be eliminated from the nursing assessment C. comprehensive assessments can be performed only by advanced practice nurses D. psychosocial evaluations are gained by subjective reports rather than objective observations

assessment provides a holistic view of the client, including biopsychosocial aspects

An advanced practice nurse recommends that a client participates in cognitive therapy. The client asks, "What's cognitive therapy and how can it help me"? Which is the nurse's most appropriate reply? A. cognitive therapy relates to changing behavior through external or environmental conditions/stimuli B. cognitive therapy relates to exposure to a least anxiety provoking situation and progresses up to the most anxiety provoking situation C. cognitive therapy relates to providing positive reinforcement such as positive verbal feedback D. cognitive therapy relates to your thoughts and how these thoughts can lead to your reaction

cognitive therapy relates to your thoughts and how these thoughts can lead to your reaction

A client comes to day treatment intoxicated but says he is not. The nurse identifies that the client is exhibiting symptoms of A. reaction formation B. denial C. projection D. transference

denial

To promote self-reliance, how should a psychiatric nurse best conduct medication administration? A. take medications to the clients bedside at the appropriate times B. encourage clients to request their medications at the appropriate times C. allow the clients to determine appropriate medication times D. refuse to administer medications unless clients request them at appropriate times

encourage clients to request their medications at the appropriate time

A client is admitted with ETOH and Major Depression. During the admission process, the nurse notices the client's speech is slurred and asks if they've been drinking. The client states they drink daily and lost their job lately. Which interventions will be important?

encourage the client to identify behaviors that have causes problems in their life ask the client when they last had an alcoholic drink validate the client's frustration or anger in dealing with dual problems monitor the patient for alcohol withdrawal using the CIWA

Which of the following characteristics are typically related to the manic phase of bipolar 1?

grandiose view of self and abilities labile mood with euphoria poor judgement

The nurse is evaluating lab test results for a client prescribed lithium carbonate (Lithium). The client's lithium level is 1.9mEq/L. Which nursing intervention takes priority? A. give the next dose because the lithium level is normal for acute mania B. immediately notify the physician and hold the dose until instructed further C. give the next dose after assessing for signs and symptoms of lithium toxicity D. hold the next dose and continue the medication as prescribed the following day

immediately notify the physician and hold the dose unitl instructed further

Which of the following is an example of a cognitive response to mild levels of anxiety? A. increased respirations B. feeling of horror or dread C. pacing the hall D. increased learning ability

increased learning ability

Wide perceptual field, sharpened senses, increased motivation, effective problem solving Perceptual field narrowed to immediate task, selectively attentive, cannot connect thoughts Perceptual field reduced to one detail or scattered details, cannot complete tasks, feels awe, dread, and terror Perceptual fields reduced to focus on self, distorted perceptions, loss of rational self, may be suicidal

mild anxiety moderate anxiety severe anxiety panic anxiety

A nurse concludes that a restless, agitated client is manifesting a "fight-or-flight" response. The nurse should associate this response with which neurotransmitter? A. dopamine B. serotonin C. norepinephrine D. acetylcholine

norepinephrine

Which mental health client intervention is a example of mileu therapy? A. assist family in dealing with life stressors caused by interactions with the client B. engage in one on one interactions to discuss family dynamics C. practice interpersonal relationship skills D. discuss side effect of an anxiolytic with the nurse

practice interpersonal relationship skills *group and social interaction emphasis

A nurse at a college campus mental health counseling center is caring for a student who just failed an examination. The student spends the session berating the teacher and the course. The nurse should recognize this behavior as which of the following defense mechanisms? A. undoing B. conversion C. projection D. regression

projection

A nurse is caring for a client who requires a crisis intervention for acute anxiety. Which of the following actions is the highest priority? A. protect the client from injury B. ensure the clients safe C. identify the client's coping skills D. determine the cause of the client's anxiety

protect the client from injury

A nurse is caring for a client who is having difficulty sleeping and is pacing the floor. The client's head is down and he is wringing his hands. Which of the following actions should the nurse take? A. encourage the client to go back to bed B. remain with the client C. explore alternatives D. give the client a PRN sleeping med

remain with the client

Which is the overall priority goal of in-patient psychiatric treatment? A. medication adherence B. maintenance of stability in the community C. better communication skills D. stabilization and return to the community

stabilization and return to the community

Somatization is defined by 3 central features. Which below are these 3 central features? Select all that apply.

symptoms are not under the client's conscious control psychological factors/conflicts are key in initiating, exacerbating, and maintaining the symptoms physical complaints suggest major medical issues but have diagnosis tests do not support an organic basis

A nurse is assessing a client who is experiencing chronic stress. Which of the following findings should the nurse expect? A. increased energy B. hypotension C. increased cognitive awareness D. viral infection

viral infection