PMHN Original

Ego defense mechanism: Introjection

Taking on the beliefs and values of someone else.

Mini-Mental State Exam (MMSE)

Tests for delirium and dementia. score 24-30 normal, 18-23 mild impairment, 0-7 severe impairment

Recovery model - characteristics

- Self-determination and self-advocacy - Hope and empowerment - Viewing relapse as a temporary setback, with continued expectations of personal success - Resiliency drawn from personal strengths, personalized support systems, and ongoing education about each person's clinical picture - The person with a mental illness as the teacher; the nurse as the student - Hope is the fundamental message

Anorexia nervosa Physical consequences

- cardiac arrhythmias - bradycardia or tachycardia - hypotension - skin dryness with possible lanugo (a soft, fine, downy fair on the arms and other body parts) - edema - amenorrhea (at least two consecutive cycles) - cachexia (loss of fat, muscle mass, reduced thyroid metabolism, cold intolerance, difficulty maintaining temperature) - leukopenia - osteoporosis

Bulimia nervosa Physical consequences

- metabolic disturbances and electrolyte abnormalities (hypokalemia, hypochloremic alkalosis, hypomagnesemia) - loss of dental enamel -esophageal tears

Erickson's 8 stages of psychosocial development: Autonomy vs shame and doubt

1 to 3 years of age Successful achievement: developing an internal locus of control; feels adequate; expresses some self-control without loss of self-esteem; good will and pride; sense of justice. Non-achievement: develops external locus of control; feels inadequate; low self-esteem; secretiveness; feelings of persecution

Erickson's 8 stages of psychosocial development: Identity vs role confusion

12 to 18 years of age Successful achievement: incorporates beliefs and values taught earlier; variety of roles well established; idealistic; integrative (integrates identity with libido; aptitudes with opportunity); confident. Non-achievement: has problems with many roles (social, vocational, interpersonal); delinquency problems; psychotic episodes; doubt; over-identification with heroes; cliques and crowds important.

Erickson's 8 stages of psychosocial development: Initiative vs guilt

3 to 6 years of age Successful achievement: purposeful, positive behaviors; feeling guilty appropriately; loving; relaxed; bright in judgment; energetic; task-oriented. Non-achievement: sees own behavior as bad; experiences a high level of guilt; hysterical denial; paralysis; inhibition; psychosomatic disease; self-righteousness; moralistic surveillance; overcompensatory showing off.

Erickson's 8 stages of psychosocial development: Industry vs inferiority

6 to 12 years of age Successful achievement: feels competent; enjoys work or school; able to problem-solve; productive; task completion skills; steady attention; perseverance; manipulation of tools. Non-achievement: feels inferior; may withdraw or act out; mediocrity; self-restriction; conformity.

Ego defense mechanism: Compensation

A counterbalancing technique. When told you cannot cook, you counter with "But I can dance."

Erickson's 8 stages of psychosocial development: Trust vs mistrust

Birth to 1 year Successful achievement: developing trust in relationships, ease in feeding, depth of sleep, relaxation and movement of bowels, allows primary caregiver out of sight without undue anxiety or rage. Non-achievement: unable to trust others, suspicious, withdrawn into schizoid and depressive states.

Ego defense mechanism: Denying that your an alcoholic despite its negative impact on your marital relationship.

Denial: Acting as though a painful circumstance, situation, feeling, or thought doesn't exist.

Ego defense mechanism: Being angry at your boss but not verbalizing or expressing it, coming home and getting angry at your wife for the way she handles the house.

Displacement: Directing unacceptable feelings, impulses, or thoughts onto a safer, less threatening target.

Ego defense mechanism: Acting out

Engaging in extreme behaviors instead of language to express oneself.

Ego defense mechanism: Identification

Looking up to someone so much that you don their style or dress, manner of speaking, and other visible attributes.

Ego defense mechanism: Dissociation

Loss of track of time or sense of self.

Erickson's 8 stages of psychosocial development: Generativity vs stagnation

Middle adulthood Successful achievement: develops family; guides next generation; productivity and creativity. Non-achievement: feels useless and unneeded; egocentric focus; regression to an obsessive need for pseudo-intimacy; personal impoverishment; self-love; lack of faith.

Ego defense mechanism: Intellectualization

Often used to distance oneself from entering into emotional responses or impulses. Instead of focusing on something that causes sadness, one focuses on minute details.

Erickson's 8 stages of psychosocial development: Ego integrity vs despair

Older adulthood Successful achievement: acceptance of "good" and "bad" aspects of life; positive self-concept; assurance of order and meaning; new and different love for one's parents; emotional integration; fellowship with others; acceptance of leadership. Non-achievement: sees past life as a failure; negative self-concept; fear of death; sense time as too short; disgust.

Prochaska and Velicer's Transtheoretical Model of Behavior Change (5 stages): 1. Precontemplation

Patient: not seeing there is a problem or considering change. Nurse: Raise doubt, give information to raise awareness of health risk.

Prochaska and Velicer's Transtheoretical Model of Behavior Change (5 stages): 5. Maintenance

Patient: perseveres with consolidated actions to sustain positive behavior change. Nurse: Continue support to sustain progress, accept relapses as temporary, use steps in preparation stage to resume progress.

Prochaska and Velicer's Transtheoretical Model of Behavior Change (5 stages): 2. Contemplation

Patient: sees there is a problem, is thinking about not not committed to changing behavior. Nurse: Promote discussion of pros and cons of change, give detailed information about possible actions and solutions.

Prochaska and Velicer's Transtheoretical Model of Behavior Change (5 stages): 3. Preparation

Patient: sees there is a problem, is willing to make a change within the next 30 days. Nurse: Help patient choose a realistic course of action.

Prochaska and Velicer's Transtheoretical Model of Behavior Change (5 stages): 4. Action

Patient: takes concrete actions to make needed changes. Nurse: Support active steps to change behavior, give feedback, review progress.

Ego defense mechanism: An angry person who accuses her partner of being hostile.

Projection: Attributing one's shameful or undesired impulses, thoughts, or feelings onto another.

Prochaska and Velicer's Transtheoretical Model of Behavior Change (5 stages)

Provides a framework for assessing a person's readiness to change or learn.

Ego defense mechanism: Forgetting being sexually abused as a child.

Repression: An unconscious forgetting, usually of a traumatic event or feeling.

Ego defense mechanism: Contending that the only reason you have two martinis for lunch every day is because your are a salesperson, and drinking at lunch is expected.

Rationalization: Supplying a logical reason for a behavior to justify it.

Ego defense mechanism: A kidnap victim "falls in love" with the feared and hated person who has complete control over him or her.

Reaction formation: Taking on a position opposite to what one actually believes or perceives to be unacceptable.

Bulimia nervosa

Recurrent episodes of binge eating followed by inappropriate compensatory mechanisms Compensatory behaviors at least two times a week for 3 months

Anorexia nervosa

Refusal to maintain body weight at or above 85% of the expected based on age and height.

Ego defense mechanism: Toddler who goes back to wanting a bottle or pacifier and soils his pants when his baby brother is born.

Regression: Reversion to an earlier stage of development.

Ego defense mechanism: Splitting

Seeing everything as all good or all bad with nothing in between.

Ego defense mechanism: A person with very aggressive tendencies becomes a butcher.

Sublimation: One of the healthy defense mechanisms; the channeling of unacceptable impulses into more acceptable outcomes.

Ego defense mechanism: A person is thinking about the possibility or a promotion so much that it is compromising his work. He decides not to think about it and just go with the flow of his present job in the best way possible.

Suppression: The conscious dismissing from the mind of an unacceptable idea, desire, painful memory, and so on. Can be a positive defense mechanism, used to eliminate negative or thinking.

Ego defense mechanism

Unconscious methods that people use to protect themselves from consciousness of a threat to self. By distorting the meaning of the original threat, the defense mechanism makes it less anxiety-provoking to the person.

Ego defense mechanism: When asked for a recommendation, a person makes derogatory remarks about a friend to her employer, but praises the good work her friend is doing for the company in the same interaction.

Undoing: Trying to take back behavior, feelings, or thoughts that are unacceptable to a person by partially negating a previous communication or action.

Erickson's 8 stages of psychosocial development: Intimacy vs isolation

Young adulthood Successful achievement: establishes mature and intimate relationships; makes commitments; sacrifices; compromises; work productivity; satisfactory sexual relationships. Non-achievement: tends towards isolation; fearful of intimacy; self-absorbed; distancing behaviors; character problems.

A patient is upset that he hasn't been able to complete a task successfully. Which of the following is an example of a non-therapeutic communication response? a. "I don't think you need to worry about that" b. "you're feeling frustrated" c. "perhaps we can work on this together" d. "let's talk about how you are feeling"

a. "I don't think you need to worry about that"

A patient with depression has been very withdrawn and is avoiding any socialization with others, but the PMHN notes that the patient sat with two other patients during a concert, occasionally speaking to them. The most appropriate feedback to the patient is: a. "I noticed you were sitting with other patients during the concert" b. "I was so happy to see you interacting with other patients at the concert!" c. "why did you decide to sit with other patients?" d. "sitting with the other patients is a good sign that you are improving"

a. "I noticed you were sitting with other patients during the concert" avoid being judgmental and questioning the patient regarding this behavior.

In group therapy, a patient called another patient "stupid and ugly", causing the second patient to begin crying. The PMHN meets with the first patient to discuss the behavior. The feedback that is most descriptive and focused on behavior is: a. "Mary was upset and sad when you called her 'stupid and ugly'" b. "you were mean and rude when you called Mary 'stupid and ugly'" c. "you should apologize for hurting Mary" d. "how would you feel if Mary had called you 'stupid and ugly'?"

a. "Mary was upset and sad when you called her 'stupid and ugly'"

A patient at risk for self-directed violence tells the PMHN that she wants to die and has nothing to live for. The most appropriate response is: a. "do you have a suicide plan?" b. "your family loves you very much" c. "you will feel better when the medication starts to work" d. "I'm so sorry to hear that, but I can help you"

a. "do you have a suicide plan?"

When utilizing psychodrama as a psychosocial therapy, the role of the protagonist is assumed by the: a. patient b. nurse c. therapist d. family member

a. patient Individual group members can explore, through enacted scenarios, conflictual relationships with significant others.

Which of the following tools is frequently utilized for drug-evaluation at the beginning of treatment with anti-anxiety drugs, as well as during treatment to adjust dosage and determine outcomes? a. Hamilton Anxiety Rating Scale b. Psychological Screening Inventory c. Milton Clinical Multiaxial Inventory d. Beck Anxiety Inventory

a. Hamilton Anxiety Rating Scale PSI: adults/adolescents; screens need for psychological treatment MCMI: used to assess personality and psychopathology BAI: used to assess anxiety as low/moderate/high

The legislative act that provides access to community services for older adults and Native Americans, including meals, legal assistance, adult day care, and transportation is the: a. Older Americans Act (OAA) b. Americans with Disabilities Act (ADA) c. Omnibus Budget Reconciliation Act (OBRA) d. Affordable Care Act (ACA)

a. Older Americans Act (OAA)

According to the International Society of Psychiatric-Mental Health Nurses (ISPN) position paper "Emergency Care Psychiatric Clinical Framework", clinical assessment of the patient in the emergency department should begin with: a. a focused medical assessment b. a mental status exam c. a review of current medications d. safety concerns

a. a focused medical assessment ...in order to determine if a medical condition may be responsible for the patient's presentation or if there is a medical issue in addition to mental health concerns. This assessment should be followed by a mental status exam.

A patient has been classified as having a mild intellectual disability (IQ 60). Based on this, the PMHN expects that the patient is capable of: a. achieving academic skills to a sixth-grade level b. achieving academic skills to a second-grade level c. learning through systemic habit-forming d. responding to minimal training in self-help

a. achieving academic skills to a sixth-grade level Mild (60-70) 6th grade, can learn some vocational skills Moderate (35-49) 2nd grade, may be able to work in a sheltered workshop, supervised living Severe (20-34) systematic habit-forming, cannot benefit from vocational training or work/live independently Profound (<20) responds to minimal training in self-help, needs constant care and supervision

A patient who has not responded well to other antipsychotics is started on quetiapine. In the initial period when the patient's medication dosage is being adjusted, the patient should be assisted with: a. ambulation b. toileting c. dressing d. eating

a. ambulation due to hypotensive effect of medication

A patient becomes confused during the night and falls when getting out of bed. The most appropriate solution to prevent further falls is: a. apply a pressure-sensitive movement pad with an alarm b. place physical restraints on the patient c. provide a sitter in the room with the patient d. move the patient's bed to a room next to the nursing desk

a. apply a pressure-sensitive movement pad with an alarm

When using Keller's (1987) attention-relevance-confidence-satisfaction (ARCS) model as a motivational strategy for learners, which term refers to the use of variable instructional methods? a. attention b. relevance c. confidence d. satisfaction

a. attention Attention: uses variable instructional methods, opposing positions, participatory discussions Relevance: utilizes knowledge, choices, and experiences the learner brings to the process Confidence: considers requirements of learning, difficulty level, goals, attributions, personal sense of accomplishment Satisfaction: includes reward systems, praise, learner use of new skill and personal evaluation

On the psychiatric unit, patients are rewarded for desired behaviors by receiving tokens that can be exchanged for privileges. This is a technique that is used in: a. behavioral therapy b. psychoanalytic therapy c. cognitive therapy d. Gestalt therapy

a. behavioral therapy

When admitting a new patient and reconciling medications, the PMHN finds one list of medications on a previous hospital record, another on the physician's notes, and a third provided by the patient. The first step is to: a. compare all three lists b. ask the patient which list is correct c. ask the patient to prepare a new list d. utilize the latest list

a. compare all three lists

Which of the following is the best approach when obtaining a history of an adolescent? a. conduct the interview without the parents/caregivers present b. ask the adolescent if the parents/caregivers should remain during the interview c. ask the parents/caregivers if they want to be present for the interview d. conduct the interview with the parents/caregivers present

a. conduct the interview without the parents/caregivers present

A patient with intermittent explosive disorder is exhibiting the prodromal syndrome of escalation-of-anger. The most appropriate first step in preventing an act of violence is to: a. ensure adequate staff is available b. utilize seclusion or restraints c. attempt to talk the patient down d. offer medication to the patient

a. ensure adequate staff is available then, attempt to talk-down offer PRN medication seclusion/restraint

When assessing the learning needs of a patient to promote self-care, the need that should have priority is: a. pain control b. anxiety reduction c. dietary instruction d. disease pathology

a. pain control

The PMHN should recommend that adults with a history of illicit injection drug use get the following vaccination(s): a. hep A and hep B b. pneumococcal polysaccharide (PPSV23) c. meningococcal d. human papillomavirus

a. hep A and hep B

Which physiological response is common when patients are undergoing acute withdrawal? a. hypertension b. hypotension c. somnolence d. constipation

a. hypertension hypertension and tachycardia, piloerection, diaphoresis, rhinorrhea, diarrhea, muscle cramps, arthralgia, nausea, vomiting, anxiety, and lethargy.

A patient with anxiety disorder wants to utilize complementary therapy as an adjunct to anti-anxiety medications. The complementary therapy that is likely to be the most effective in providing relief from anxiety is: a. imagery/self-relaxation b. acupuncture c. massage d. aromatherapy

a. imagery/self-relaxation

A patient with cognitive decline associated with dementia is undergoing sensory stimulation therapy, which is based on the concept of: a. neural plasticity b. health promotion c. behaviorism d. recovery model

a. neural plasticity

Which characteristic is typical of a patient presenting with a suspected conversion disorder, such as a sudden sensory motor deficit? a. patient exhibits lack of concern about the impairment b. patient exhibits very typical symptoms and pathology c. the more the patient knows, the more bizarre the symptoms d. patient is typically very well educated and knowledgeable

a. patient exhibits lack of concern about the impairment patient mimics neurological impairment, displayed symptoms may be inappropriate to condition

When conducting a community assessment for preventive measures as part of community-based care, the three primary factors to consider are: a. people, environment, and social systems b. people, costs, and time c. time, environment, and costs d. social systems, needs, and costs

a. people, environment, and social systems

A patient who had been treated as an inpatient for bulimia nervosa has been discharged and states on follow-up that she has not had any distorted eating or purging. Which of the following findings suggests that the patient has resumed purging? a. potassium: 3.2 mEq/L b. potassium: 3.7 mEq/L c. serum amylase: 45 U/L d. chloride: 102 mEq/L

a. potassium: 3.2 mEq/L

During which stage of the therapeutic relationship does the nurse examine personal feelings about working with a patient? a. pre-interaction b. orientation c. working d. termination

a. pre-interaction Pre-interaction: obtains information about patient from various sources and examines personal feelings about working with patient Orientation: get to know each other, establish rapport, develop plan of action Working: helps patient engage in problem-solving activities, overcome resistant behaviors, and evaluate progress toward goals Termination: explore feelings about termination and plan for continuing care

The purpose of the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Opening Doors program is to: a. prevent and end homelessness b. promote mental health care for veterans c. provide residential care for the mentally ill d. prevent prescription drug misuse and abuse

a. prevent and end homelessness

A "state of optimum anxiety" refers to: a. readiness for learning b. psychological well-being c. readiness for therapy d. response to treatment

a. readiness for learning

Piaget's Theory of Cognitive Development in children applies to adults in relation to concepts about: a. readiness to learn b. self-efficacy c. self-determination d. intelligence

a. readiness to learn

When developing a plan of care for a patient with obsessive-compulsive disorder who compulsively washes his hands, the first goal in assisting the patient to reduce this ritualistic behavior and to increase coping skills is to assist the patient to: a. recognize precipitating factors b. control the urge to carry out ritualistic behavior c. analyze the underlying cause of the ritualistic behavior d. view the ritualistic behavior rationally

a. recognize precipitating factors

A patient's plan of care calls for the patient to attend an outpatient therapy group for preventing drug abuse relapse, but the patient's insurance will not reimburse the costs of participation. Which of the following is likely the most appropriate alternative when modifying the plan of care? a. refer the patient to Narcotics Anonymous b. provide literature about preventive measures c. refer the patient to online resources d. provide the patient with staff contact information

a. refer the patient to Narcotics Anonymous

A patient becomes extremely agitated during an activity and begins yelling and banging his head against the wall. The first step in de-escalation is to: a. remove other patients from the environment b. have a team of staff members exhibit a show-of-force c. utilize a third-person "negotiator" to calm the patient d. call for physical restraints to be applied

a. remove other patients from the environment

A patient with bipolar disorder is extremely manipulative and often behaves in a sexually provocative and inappropriate manner with staff members and other patients. The most appropriate method(s) of dealing with this inappropriate behavior is to: a. utilize positive reinforcement and negative consequences b. use chemical restraints to control inappropriate behavior c. refer the matter to the patient's psychiatrist for guidance d. isolate the patient from other patients until behavior improves

a. utilize positive reinforcement and negative consequences

A 68-year-old Medicare patient who is to be discharged from a mental health facility wants to be followed by home health care rather than to return to the clinic for outpatient treatment. Which of the following may make the patient eligible for home health care? a. the patient has a debilitating physical condition that makes travel difficult b. the patient doesn't want to waste time traveling to and from the clinic c. the patient does not have a care and must depend on public transportation d. the patient is over 65 years old

a. the patient has a debilitating physical condition that makes travel difficult

The PMHN is providing education about coping mechanisms to a group of patients, one of whom has recently developed profound hearing loss but is unable to utilize sign language. Much of the prepared material is in video format. The most appropriate accommodation for the patient with hearing loss is: a. to provide closed-captioning for the video b. to print out a script of the video c. to provide illustrations and written explanations d. to separate this patient from the group and instruct privately

a. to provide closed-captioning for the video

Which of the following is a developmental milestone that usually occurs during adolescence (12-to-18 years)? a. understanding abstract concepts b. comprehending and carrying-out multiple directions in sequence c. understanding concepts of size and time d. enjoying doing things without assistance

a. understanding abstract concepts

A female patient with a methadone overdose is undergoing Q-T monitoring. The normal range for the Q-T interval is: a. 0.33 to 0.35 seconds b. 0.36 to 0.44 seconds c. 0.45 to 0.50 seconds d. 0.51 to 0.53 seconds

b. 0.36 to 0.44 seconds gender norms: <0.43 for male and <.045 female critical measure is >0.50 seconds

In the cycle of battering, during the phase of tension-building, a battered woman typically: a. tries to hide b. acts compliant c. feels guilty d. provokes abuse

b. acts compliant Phase I: tension-building, becomes very compliant, trying to defuse the abuser's anger Phase II: acute battering, tries to hide or get away, may provoke beating to get it over with Phase III: respite/loving, feels guilty that abuser was forced to act and wants to believe that abuser will remain loving and kind

Which of the following statements or questions by a PMHN about a patient who identifies as transgender (male-to-female) suggests the nurse's attitude may negatively impact delivery of care to the patient? a. "I don't really understand what transgender means" b. "I believe that someone born a man is always a man" c. "should I refer to the patient as he or she"? d. "I try to treat everyone the same"

b. "I believe that someone born a man is always a man"

A rape victim with multiple injuries has been brought to the ED for evaluation and treatment. The first thing that the PMHN should communicate is: a. "I'm so sorry this happened to you" b. "You are safe here. No one can hurt you" c. "This was not your fault" d. "I'm thankful you survived this attack"

b. "You are safe here. No one can hurt you"

A new patient on the unit has a speech impediment. During group therapy, some of the other participants made fun of her and mimicked her impediment, causing the patient to become very upset. Which of the following is an empathic response to the patient? a. "I know how you feel. I get so angry when people make fun of my ears" b. "you feel angry and sad about the other patients making fun of you" c. "just ignore what the others say" d. "the other patients made fun of you because they are insecure"

b. "you feel angry and sad about the other patients making fun of you"

A 16-year-old patient with anorexia nervosa weighs 76 pounds, is severely emaciated and malnourished, and has developed cardiac dysrhythmias. Nutrition is critical, but the patient refuses to eat any food. The most appropriate response for the PMHN is: a. "you will die if you don't eat" b. "you will be fed by nasogastric tube if you don't eat c. "we can't help you if you don't help yourself d. "I can't force you to eat"

b. "you will be fed by nasogastric tube if you don't eat

The nursing organization that is the most active politically, lobbying to promote the interests of the nursing profession and policies regarding health care reform is the: a. American Nurses Credentialing Center (ANCC) b. American Nurses Association (ANA) c. American Psychiatric Nurses Association (APNA) d. American Association of Colleges of Nursing (AANC)

b. American Nurses Association (ANA)

A patient has undergone electroconvulsive therapy (ECT) and is awakening from the anesthesia. The initial patient response that is most expected is: a. sedation b. memory impairment c. agitation d. anger

b. memory impairment

A patient has been started on disulfiram before discharge from a treatment facility for alcoholism. A friend comes to visit the patient, and within about 5 minutes of the friend's leaving, the patient becomes hypotensive, complains of severe chest pain, headache, and vertigo and begins vomiting copiously. The most likely reason is: a. an adverse reaction to disulfiram b. acetaldehyde syndrome c. delirium tremens d. serotonin syndrome

b. acetaldehyde syndrome occurs if a patient who is taking disulfiram ingests even 7ml of ETOH. Symptoms begin within 5-10 minutes, begin to diminish within about 30 minutes and may persist for several hours.

Which of the following drug types is most indicated for treatment of generalized anxiety disorder? a. SSRI b. tricyclic antidepressant c. benzodiazepine d. MAO inhibitor

c. benzodiazepine HPA activation is elicited when anxious, which leads to alteration of NE, GABA. NE or glutamate: too much arousal leads to anxiety symptoms GABA: can be modulated by CNS depressants such as alcohol and benzodiazepines

When conducting the brief mental status evaluation as part of the clinical interview, which of the following is an appropriate activity to evaluate the patient's ability to concentrate? a. list 3 objects and ask the patient to repeat the list immediately and again in a few minutes b. ask the patient to spell the word 'world' in reverse c. ask the patient to carry out a two-to-three-step task d. ask the patient what 'a stitch in time saves nine' means

b. ask the patient to spell the word 'world' in reverse a. ability for registration c. ability for language

As part of milieu therapy, the PMHN should expect to: a. provide weekly patient feedback b. attend regular community meetings c. direct patient participation d. establish rules of patient behavior

b. attend regular community meetings

A patient frequently responds in rhymes, such as "the food is hot. I am hot and shot. The pot has been bought". This is an example of: a. word salad b. clang associations c. neologisms d. associative looseness

b. clang associations Word salad: random words Neologisms: patient-created words with meaning Loose associations: phrases with nothing in common

The three primary components of panic control treatment (PCT) include: a. imagery, progressive relaxation exercises, and cognitive restructuring b. cognitive restructuring, in vivo exposure, and interoceptive exposure c. assessment, in vivo exposure, and evaluation d. progressive relaxation, cognitive restructuring, and in vivo exposure

b. cognitive restructuring, in vivo exposure, and interoceptive exposure CR: patient is helped to explore physical response realistically in order to recognize that physical damage is not occurring IVE: patient is systematically exposed to the thing that causes the panic attack to reduce the response IE: patient induces panic-like responses, such as through hyperventilation, to begin desensitization

A patient who has been homeless is to be discharged. When developing a discharge plan with the patient, the PMHN should: a. provide a list of local shelters to the patient b. contact local shelters to secure a place for the patient c. ask the patient where he plans to stay after discharge d. tell the patient to contact shelters before discharge

b. contact local shelters to secure a place for the patient

Which of the following medications is most likely to trigger a psychotic or manic response? a. anticonvulsants b. corticosteroids c. antidepressants d. opioids

b. corticosteroids Particularly, high-doses (40mg +) of steroid drugs are responsible for hypomanic, psychotic, and manic responses.

When a PMHN has difficulty setting limits on a patient's behavior because of an emotional response to the patient, this is an example of: a. transference b. counter-transference c. magnification d. codependency

b. counter-transference whenever the nurse unknowingly transfers their unresolved thoughts, feelings, and emotions onto a client.

A patient hospitalized with depression has a long history of alcoholism. Five days after admission, the patient exhibits increasing agitation, tremors, and confusion. The patient is disoriented and having hallucinations. Temperature, pulse, and blood pressure levels are elevated, and the patient is diaphoretic. The treatment that is most indicated is: a. phenobarbital b. diazepam c. phenytoin d. clonidine

b. diazepam

With the four-phase crisis intervention (Aguilera, 1998) method that corresponds to the nursing process, which of the following actions should be completed during Phase IV (evaluation/anticipatory planning)? a. identify external support systems (family, friends, social agencies) b. discuss how the patient will deal with triggering events in the future c. assess the patient's personal perception of strengths d. identify the precipitating event that caused the crisis

b. discuss how the patient will deal with triggering events in the future Assessment: gather information about precipitating factors, events, coping methods, support systems, substance abuse, suicide/homicide potential, and the patient's perceptions of strengths. Develop nursing diagnoses Planning intervention: select actions for nursing diagnoses Intervention: carry-out actions, including establishing rapport, setting behavioral limits, clarifying problems, acknowledging feelings, guiding the patient through problem-solving, and helping the patient identify new coping mechanisms Evaluation/Anticipatory planning: evaluate resolution of crisis and discuss how the patient will deal with triggering events in the future

Which of the following is considered a "positive" symptom of schizophrenia? a. flat affect b. disorganized speech c. poor eye contact d. impaired hygiene

b. disorganized speech Positive: disorganized speech, hallucination, delusion Negative: flat affect, poor eye contact, impaired hygiene, social isolation, alogia, apathy, and anhedonia

A male patient who acts very polite and considerate in the presence of other patients and staff makes threatening and vulgar comments to the PMHN when no one else can hear. The most appropriate method of reporting this behavior is to: a. file an incident report b. document exactly what the patient said and the circumstances in the nursing notes c. document that the patient was "behaving inappropriately" in the nursing notes d. report the situation to the administrator

b. document exactly what the patient said and the circumstances in the nursing notes

The psychiatric facility is using the recovery model for treatment, but one of the patients has indicated that she does not plan to continue taking lithium for her bipolar disorder. The most appropriate response for the PMHN is to: a. insist that the patient continue taking the medication b. educate the patient about the need for medication c. warn the patient that she will suffer relapse without medication d. transition the patient to a different model for treatment

b. educate the patient about the need for medication

The American Psychiatric Nurses Association (APNA) position statement on the use of seclusion and restraint states that: a. seclusion and restraint should be routinely used to control aggressive behavior b. efforts should be made to reduce or eliminate the use of seclusion and restraint c. seclusion and restraint is generally under-utilized in psychiatric care d. restraints should be applied to minimize patient movement

b. efforts should be made to reduce or eliminate the use of seclusion and restraint

When interacting with a patient who is vision-impaired, the PMHN should: a. introduce others who are present by giving their names and roles b. explain and describe actions as they are being carried out c. hold the patient's hand when addressing the patient d. always stand in front of the patient when addressing the patient

b. explain and describe actions as they are being carried out

The International Society of Psychiatric Mental Health Nurses (ISPN) contains how many divisions representing different nursing specialty areas? a. two b. four c. six d. eight

b. four Association of Child and Adolescent Psychiatric Nurses (ACAPN) International Society of Psychiatric Consultation Liaison Nurses (ISPCLN) Society of Education and Research in Psychiatric Mental Health Nursing (SERPN) Adult and Geropsychiatric Mental Health Nurses (AGPN)

A patient taking clozapine for treatment should be regularly monitored for: a. liver function b. leukopenia c. renal function d. hypoglycemia

b. leukopenia and agranulocytosis with regular WBC counts

A patient with schizophrenia has delusions and believes that his family members cannot be trusted. According to Maslow's hierarchy of needs, the patient's delusions are interfering with development at the level of: a. physiological needs b. love/belonging needs c. safety needs d. self-esteem needs

b. love/belonging needs Physiological: basic needs such as air, food, water, shelter Safety and security: freedom from fear, physical comfort, safety Love and belonging: companionship, love, group ID, satisfying interpersonal relationships Self-esteem: working for success, desiring respect and prestige, seeking self-respect Self-actualization: feeling of self-fulfillment, satisfaction with achievements

A patient tends to walk and sit in a slumped-over position, keeping the head and eyes down, and rarely making eye contact or initiating conversation. The patient responds with a low tone of voice. These behaviors most likely represent: a. dislike b. low self-esteem c. fear d. anxiety

b. low self-esteem

Which of the following would fit the National Quality Forum's definition of a "serious reportable event"? a. patient commits suicide two weeks after discharge from the hospital b. patient elopes from the hospital and is killed when running into traffic c. patient attempts suicide in the hospital but has only minor injuries d. patient falls in the hospital resulting in a small abrasion on the hip

b. patient elopes from the hospital and is killed when running into traffic

Following a hurricane that leveled a woman's home, the woman goes to an emergency shelter and exhibits severe anxiety when interviewed by the PMHN, who is part of the emergency response team. The most appropriate intervention is: a. provide anti-anxiety medication to reduce the woman's symptoms b. provide reassurance and discussion of the stages of grief c. ask family or friends to stay with the woman d. tell the woman that she is safe and everything will be all right

b. provide reassurance and discussion of the stages of grief

A patient who is fearful about interacting with others attempts to change her perception by imagining that the others are afraid to interact with her. The strategy that the patient is utilizing is: a. assertiveness b. reframing c. repressive coping d. intellectualism

b. reframing

Under the American Nurses Association (ANA) Code of Ethics, if the PMHN feels that a research project is morally objectionable, the nurse has the right to: a. lodge a criminal complaint b. refuse to participate c. stop the research project d. ask the ANA to evaluate to project

b. refuse to participate

A patient who suffered severe brain damage as a result of a suicide attempt had written an advance directive stating that "no heroic measures" be used to keep her alive; however, the patient is being maintained on life support at the family's insistence. As an advocate for the patient, the most appropriate response for the PMHN is to: a. file a complaint with the district attorney b. remain supportive and provide education to the family c. tell the physician that he is violating the patient's rights d. file a complaint with the hospital administration

b. remain supportive and provide education to the family

A patient who uses problem-solving skills and coping strategies with stressful situations, such as illness, is exhibiting: a. resilience b. resourcefulness c. self-efficacy d. hardiness

b. resourcefulness Resourcefulness: using problem-solving skills such as health-seeking strategies and coping strategies to deal with stressful situations, such as illness, without developing stress Resilience: having the ability to cope with stress and not be overwhelmed Self-efficacy: having the belief that the events in life are affected by behavior and having high motivation and setting high personal goals Hardiness: having the ability to deal with stress without developing illness and to grow from the experience of stress

The PMHN has noted a number of nursing diagnoses in the plan of care for a patient with antisocial personality disorder admitted to the psychiatric unit under court order. The nursing diagnosis that should have priority is: a. ineffective coping b. risk for other-directed violence c. low self-esteem d. impaired social interaction

b. risk for other-directed violence address safety first

When utilizing the HEEADSSS method to interview an adolescent, the three S's refer to: a. sexuality/support/secrets b. sexuality/suicide/safety c. suicide/socialization/shelter d. sexuality/support/suicide

b. sexuality/suicide/safety HEEADSSS: a tool for gaining information regarding particular issues of concern when working with adolescents. Home and environment, Education and employment, Eating, Activities, Drugs, Suicide, Sexuality, and safety.

The PMHN had developed a good relationship with a patient with borderline personality disorder, but the nurse took time off to deal with a family matter and when returning found the patient angry and resentful and blaming the nurse for her problems. This is an example of: a. manipulation b. splitting c. clinging/distancing d. self-destructiveness

b. splitting Views people and events in all or nothing term.

When planning a group discussion with patients about alcohol prevention, an important consideration when forming the group is that: a. the group members be diverse in levels of health literacy and conditions b. the group members have similar levels of health literacy and conditions c. the group members be chosen at random d. the group members are all the same gender

b. the group members have similar levels of health literacy and conditions

A suicidal patient refuses to stay beyond the 72-hour hold in the inpatient unit because of lack of insurance and is to be followed on an outpatient basis. When developing the interdisciplinary plan for discharge, the most important consideration is: a. the patient will sign a no-suicide contract b. the patient will not be left alone c. the family will check the patient's apartment to remove dangerous items d. follow-up appointments will be scheduled

b. the patient will not be left alone

A 60-year-old female patient has been treated for depression with an SSRI for four months but reports no improvement in feelings of depression. The patient reports weight-gain, lethargy, and feeling constantly "chilled". The patient probably needs: a. an increased dosage of medication b. thyroid function tests c. a change to a different medication d. renal function tests

b. thyroid function tests

Which of the following is the key ingredient in developing a learning contract with a patient? a. cognitive ability b. trust c. motivation d. developmental stage

b. trust

When a patient thinks, "if I stop drinking, I can repair my marriage", this type of "self-talk" is referred to as: a. uncertainty maintenance b. uncertainty reduction c. realistic goal-setting d. learner readiness

b. uncertainty reduction thought process to reduce uncertainty about a decision

During a meeting between a patient and the nurse, the patient paces back and forth and appears agitated and upset. Which of the following is the most appropriate response? a. "why are you so upset?" b. "take a moment and calm down before we proceed" c. "I notice you are pacing and seem upset" d. "your pacing is making me uncomfortable"

c. "I notice you are pacing and seem upset"

A patient exhibits disturbed thought processes and delusional thinking, insisting his room is "bugged by the CIA". The most appropriate response to the patient is: a. "that's not true. The CIA has no access to this facility" b. "OK, let's see if we can find the bug and remove it" c. "I understand you believe your room is bugged, but I don't believe it's possible" d. :Remember what you learned about hallucinations and delusions not being real"

c. "I understand you believe your room is bugged, but I don't believe it's possible"

Relapse prevention is part of the patient's individualized education plan on discharge. The statement that suggests the patient has made a realistic plan to prevent relapse is: a. "I know I have to stop taking drugs" b. "don't worry. I've learned my lesson" c. "I will call my sponsor if I feel like using again" d. "my family will make sure I don't relapse"

c. "I will call my sponsor if I feel like using again"

When using the reflective method during an interview, the best response (therapeutic communication) to a patient's statement that his pain 'moves around' is: a. "what do you mean"? b. "where does it move around"? c. "moves around"? d. "could you be more specific"?

c. "moves around"? Reflecting: the focus is on the feeling, rather than the content.

A patient tells the PMHN that she is using aromatherapy to relieve anxiety and that she finds it more effective than medication. The most appropriate response is: a. "there's no evidence that aromatherapy works" b. "you should not stop taking the medications" c. "the aromatherapy may help you relax" d. "if aromatherapy cures your anxiety, that's great!"

c. "the aromatherapy may help you relax"

A patient became very angry with the group leader in a therapy session and threw a glass of water at the leader. Which of the following statements by the patient suggests that the patient is using the ego defense mechanism of rationalization to explain the actions? a. "I didn't throw the glass. It slipped out of my hand" b. "I lost my temper and threw the glass" c. "the leader repeatedly egged me on, forcing me to act" d. "I'm very sorry about throwing the glass of water"

c. "the leader repeatedly egged me on, forcing me to act"

A patient being treated for depression has started an exercise program to help alleviate symptoms and plans to do muscle-building exercises at a gym twice weekly and to walk daily. How many total minutes of walking per week is the minimum recommendation? a. 60 b. 100 c. 150 d. 200

c. 150

The most common co-morbid condition in adolescents with bipolar disorder is: a. juvenile arthritis b. lupus erythematosus c. ADHD d. dyslexia

c. ADHD

A patient with a long history of schizophrenia and alcohol and drug addiction with repeated institutionalizations is stabilized after the current hospitalization and is ready for discharge. Which of the following community resource referrals is most likely to be effective? a. Community Mental Health Center b. psychiatric home care c. Assertive Community Treatment (ACT) d. Partial Hospitalization Program (PHP)

c. Assertive Community Treatment (ACT) Multidisciplinary and comprehensive team-based approach to mental health and psychiatric care provides initial and ongoing assessments, CM, employment and housing assistance, medication management, family support and education, substance abuse counseling, and other supports that promote successful residency in the community.

Which of the following National Alliance on Mental Illness (NAMI) programs is especially designed to provide strategies for caregiving for patents/caregivers of children or adolescents with mental illness? a. Peer-to-Peer b. Homefront c. Basics d. Family-to-Family

c. Basics Basics: for parents/caregivers of children or adolescents with mental illness Peer-to-Peer: adults with mental illness to provide education and skills needed to prevent relapse, make decisions, interact with healthcare providers, and reduce stress Family-to-Family: family/caregivers of people with mental illness to provide education and strategies for caregiving Homefront: family/caregivers of military service members/veterans with mental illness

Which of the following gives patients the right to access their medical records and to have corrections made? a. OSHA b. ADA c. HIPAA d. NAMI

c. HIPAA

A patient who is morbidly obese (>400 pounds) has frequently binged on food, eating until she vomits. Which community resource or support group is likely to be most helpful? a. Weight Watchers b. Home meal delivery (Meals-on-Wheels) c. Overeaters Anonymous d. Recovery International

c. Overeaters Anonymous

Which of the following is an example of a secondary health prevention measure? a. a public service campaign to educate the population about depression b. a program to treat depression and prevent suicide c. a screening event for all patients over age 55 with the Geriatric Depression Scale d. A support group for patients with depression

c. a screening event for all patients over age 55 with the Geriatric Depression Scale Primary: parenting classes for expectant families, stress management skill training. Secondary: BP screening, screening for cognitive impairment among older adults, screening for depression or substance use. Tertiary: support group, treatment program

A patient is scheduled for electroconvulsive therapy for severe depression unresponsive to antidepressants. The pre-procedure medication that the nurse anticipates giving is a(n): a. sedative b. analgesic c. cholinergic blocking agent d. muscle relaxant

c. cholinergic blocking agent such as atropine or glycopyrrolate to decrease secretions and increase heart rate due to vagal stimulation caused by procedure anesthetic (methohexital) and muscle relaxant (succinylcholine) given during procedure

To reduce anxiety, the patient's plan of care calls for the patient to practice mindfulness meditation in order to detect symptoms before they become problematic. This is a technique used in: a. behavioral therapy b. psychoanalytic therapy c. cognitive therapy d. cognitive behavioral therapy

c. cognitive therapy

When utilizing Focus Charting for documentation of the nursing process, the focus may be on: a. medical diagnosis b. routine daily therapy c. current patient behavior d. the patient's history

c. current patient behavior date and time focus problem progress note: Data regarding the stated focus, Action to address the focus, and Response to action

A patient who is undergoing motivational Enhancement Therapy (MET) for treatment of substance abuse has made a decision to change behavior and stop using, indicating the patient is at the stage of: a. pre-contemplation b. contemplation c. determination d. action

c. determination

The patient's coping mechanism is a factor in which type of readiness to learn? a. emotional b. physical c. experiential d. knowledge

c. experiential Experiential: coping mechanisms, orientation, degree of aspirations, and cultural background Emotional: level of anxiety, support systems, motivation, frame of mind, developmental stage, and risk-taking behavior Physical: ability, task complexity, health, age, gender, and effects of the environment Knowledge: current knowledge base, cognitive ability, learning style, and learning disabilities

Which of the following actions is most likely to be effective in establishing a relationship of trust with a newly admitted patient? a. administering patient medications b. providing the patient a list of unit rules c. explaining the reason for unit procedures d. giving the patient a tour of the facility

c. explaining the reason for unit procedures

A patient has a severe phobia about heights and is unwilling to fly in an airplane or to ascend beyond the ground floor of a building. The most effective treatment approach is likely: a. cognitive restructuring b. mindfulness meditation c. exposure therapy d. self-help group

c. exposure therapy

When taking a history of a 65-year-old patient, the PMHN notes that the patient does not always seem to understand the questions, asks frequently for clarification, and speaks in an inappropriately loud tone of voice. Based on these observations, the PMHN recommends: a. cognitive assessment b. alcohol screening c. hearing assessment d. drug screening

c. hearing assessment

When completing the physical examination of a patient complaining of chest pain, the PMHN asks the patient where the chest pain is and the patient runs an index finger up-and-down the sternum (neck to epigastrium). This suggests that the pain is related to: a. angina b. gastritis c. heartburn d. pleurisy

c. heartburn

The PMHN is assigning nursing diagnoses to a patient with OCD. Which nursing diagnosis is appropriate to account for the patient's ritualistic behavior and obsessive thoughts? a. ineffective role performance b. social isolation c. ineffective coping d. powerlessness

c. ineffective coping

A patient deals with traumatic stress by accepting the stressful even, exposing herself to the stress by thinking about and describing the event, and working to understand the meaning of the event. This patient is engaged in: a. repressive coping b. reframing c. rational coping d. stress inoculation training

c. rational coping comprised of: acceptance, exposure, and understanding

A patient who believes that other people are constantly talking about him or laughing at him is likely experiencing delusions of: a. persecution b. grandeur c. reference d. control

c. reference

A patient was able to slowly read aloud an information sheet but when asked to state what she had read in her own words was unable to do so. The most likely reason is: a. low self-esteem b. poor hearing c. low health-literacy d. anxiety

c. low health-literacy

Which of the following is an appropriate task for the PMHN to delegate to unlicensed assistive personnel (UAP)? a. take vital signs for the initial admission physical examination b. apply physical restraints to a patient as per physician's orders c. monitor a patient's intake of food during a meal d. administer a laxative to a patient

c. monitor a patient's intake of food during a meal

A patient in treatment for substance abuse has a nursing diagnosis of chronic low self-esteem. An appropriate outcome criterion for this nursing diagnosis is: a. patient exhibits no signs of substance intoxication or withdrawal b. patient can verbalize names of support people willing to help c. patient can verbalize positive self-characteristics d. patient can verbalize coping strategies to avoid substance abuse

c. patient can verbalize positive self-characteristics

Data show that patients discharged during the day shift, 8am to 4pm, have better compliance with follow-up than patients discharged after 4pm, suggesting a quality variance in discharge procedures. Which of the following is most likely to result in variance reduction? a. notifying the afternoon staff that discharge procedures are deficient b. rewarding the day staff for quality discharge procedures c. providing a discharge checklist that is to be utilized with all patients d. rewarding all staff for meeting goals of variance reduction

c. providing a discharge checklist that is to be utilized with all patients

A patient taking an SSRI has become quite agitated and exhibits myoclonus, hyperreflexia, coarse tremors, diaphoresis, tachycardia, confusion, dilated pupils, fever, and diarrhea. Based on these symptoms, the PMHN suspects: a. delirium b. meningitis c. serotonin syndrome d. tardive dyskinesia

c. serotonin syndrome more severe symptoms include: hyperthermia, seizures, rhabdomyolysis, kidney failure, cardiac dysrhythmias, and DIC.

A patient who is being admitted to an outpatient program for recovering cocaine abusers states that he has a history of gonorrhea and chlamydia, has multiple sex partners, and uses condoms erratically, especially if he has been drinking. The most appropriate initial screening for the patient is for: a. sexual addiction b. hepatitis c. sexually-transmitted diseases d. alcohol abuse

c. sexually-transmitted diseases

The most effective position for active listening is: a. sitting beside the patient, touching the patient's arm b. standing near the patient with arms uncrossed c. sitting directly in front of the patient with arms uncrossed d. position is irrelevant

c. sitting directly in front of the patient with arms uncrossed

A patient experiences a sudden and severe panic attack and is almost paralyzed with fear, believing her life is in danger. In addition to providing and anti-anxiety medication, the most appropriate response for the PMHN is to: a. leave the patient alone in a quiet space to recover b. ask the patient what would help relieve the anxiety c. stay with the patient and offer reassurance of safety d. remind the patient that her fears are not real

c. stay with the patient and offer reassurance of safety

When serving as a mentor to a newly hired nurse, the PMHN noted that the new nurse became intimidated by an aggressive patient and was ineffectual in dealing with the patient's behavior. The PMHN's most appropriate response to the nurse is: a. "you didn't handle that situation with the patient very well" b. "what do you think you did wrong in that situation?" c. "always call for help if you don't know what to do with a patient" d. "how do you think you might have handled that differently?"

d. "how do you think you might have handled that differently?" avoid criticism, negative questioning, and offering solutions.

Which of the following ethnic groups may require lower dosages of benzodiazepines and tricyclic antidepressants because of enzyme (CYP450) deficiencies that decrease the rate of metabolism? a. Caucasians b. Hispanics c. African Americans d. Asians

d. Asians Most psych meds are metabolized by the cytochrome P450 (CYP450) enzymes as the drugs pass through the liver.

A patient with antisocial personality disorder has very poor social skills and resents authority. Which of the following therapeutic approaches may be most effective? a. cognitive behavioral therapy b. psychoanalytic therapy c. psychopharmacology d. Milieu therapy

d. Milieu therapy

A 78-year-old female patient has been alert and oriented but has sudden onset of confusion. She has no physical complaints but the PMHN finds a low-grade elevation of temperature on examination, leading the PMHN to suspect: a. a respiratory tract infection b. onset of influenza c. dehydration and malnutrition d. a urinary tract infection

d. a urinary tract infection

When educating a patient who has bee prescribed an MAOI, the PMHN advises the patient to avoid: a. oranges b. low-fat milk c. chicken (white meat) d. aged cheese (such as Swiss)

d. aged cheese (such as Swiss) aged products are high in tyramine as are: buttermilk, yogurt, sour cream, bananas, overripe fruits, chocolate, canned meats, dried meats, salami, ETOH, soy sauce, MSG, yeast concentrates, and packaged soups. Can result in hypertensive crisis, s/s: hypertension, palpitations, tachycardia, headache, nuchal rigidity, nausea, and vomiting.

A patient experienced a severe emotional crisis after her only child left home for college. This type of crisis is classified as: a. maturational/developmental b. dispositional c. traumatic stress d. an anticipated life transition

d. an anticipated life transition

When using cognitive behavioral therapy for treatment of mood disorders, the focus is on: a. rewarding positive behavior b. learning self-control c. making decisions about care d. changing automatic thoughts

d. changing automatic thoughts

The PMHN has accepted a position in an area with a large Native American population. The PMHN expects that Native Americans are: a. comfortable being touched by healthcare providers b. comfortable with small personal space c. comfortable with direct eye contact d. comfortable with silence during conversation

d. comfortable with silence during conversation

A male patient who is very short in stature has abused steroids in an attempt to build muscle mass. He excels in martial arts and he is very aggressive with other males. This behavior most likely reflects the ego defense mechanism of: a. identification b. repression c. introjection d. compensation

d. compensation Identification: characteristics of another Repression: blocking from awareness Introjection: integrating beliefs of another

The PMHN needs to complete a history and physical examination on a patient who is extremely depressed and suicidal. The best approach is to: a. delay the history and physical exam until the patient is stabilized b. conduct the baseline physical examination but delay the history-taking c. obtain the history from a family member and conduct the physical exam d. conduct the history and physical in a supportive manner

d. conduct the history and physical in a supportive manner

A patient with psychotic behavior is transferred from a board and care facility to the psychiatric unit for treatment. The transfer form has nothing listed under "current medications". Based on this finding, the PMHN should: a. ask the patient if he has been taking medications b. assume the patient has been taking no medications c. ask the psychiatrist if the patient has been taking medications d. contact the board and care facility to verify the information

d. contact the board and care facility to verify the information

A patient with PTSD is employed but has not disclosed his condition to his employer. He feels overwhelmed by the work schedule and wants accommodations, but when he requested a more flexible schedule, he was denied. His most appropriate course of action is to: a. get a different job b. file a suit against the employer c. seek further treatment to reduce anxiety d. disclose that he has a disability

d. disclose that he has a disability

When teaching, the PMHN tries to relate new information to knowledge that patients already have in memory to improve memory retention. This type of encoding is: a. visual b. organizational c. spontaneous/automatic d. elaborative

d. elaborative

Patients being discharged from the psychiatric unit are referred to the outpatient Wellness Recovery Action Plan (WRAP) for group interventions. The primary focus of this program is to help patients to: a.avoid relapses and re-hospitalization b. avoid substance abuse c. identify needs for services d. identify personal wellness tools

d. identify personal wellness tools Key elements of a WRAP - Developing a wellness tool box - Creating a daily maintenance plan - Identifying triggers and an action plan - Identifying early warning signs and an action plan - Planning for a crisis, and the time after a crisis

When videotaping patients in a secure unit for safety reasons, which areas may be videotaped without patient permission in most states? a. any areas within the unit b. patient's bedrooms only c. all areas except for the patient's bathroom d. public areas within the unit

d. public areas within the unit

One of the most important goals of family-focused psychoeducational (FFP) treatment for bipolar disorder is for family members to learn: a. use positive reinforcement b. manage the patient's medication c. set behavioral limits d. recognize early warning signs of relapse

d. recognize early warning signs of relapse

A patient states that, on the advice of a friend, he has been treating his anxiety with large doses of kava in addition to the amitriptyline that was prescribed for depression, but he has been feeling excessively fatigued and has noted dark urine. Which diagnostic test or tests are indicated? a. renal function tests b. CBC c. urinalysis d. liver function tests

d. liver function tests kava can result in liver damage and amitriptyline is processed through the liver

A 30-year-old patient with a 6-year-old child is treated in an outpatient clinic. The patient often has little money for food and purchases inexpensive non-nutritious fast food. The most appropriate recommendation is: a. home delivery of meals (Meals-on-Wheels) b. nutritional counseling c. WIC d. local food bank

d. local food bank

A 15-year-old patient with autism spectrum disorder and obsessive-compulsive disorder rarely verbalizes except for occasional words that seem random, and the patient often becomes very agitated when the PMHN attempts to interact or communicate with him. The most appropriate method to improve communication is to: a. keep interactions to a minimum to avoid agitating the patient b. have the patient evaluated by a speech therapist c. observe the patient carefully to note any communication strategies d. meet with parents/caregivers to discuss the patient's communication

d. meet with parents/caregivers to discuss the patient's communication

A patient with bipolar disorder has been maintained on lithium with no problem for three years but develops sudden onset of nausea, vomiting, diarrhea, and generalized myopathy. The patient's lithium level is 1.8 mEq/L, which suggests: a. non-lithium-related symptoms b. severe lithium toxicity c. moderate lithium toxicity d. mild lithium toxicity

d. mild lithium toxicity therapeutic range: 0.8-1.4 mEq/L (acute episodes); 0.4-1.0 (maintenance level) mild: 1.5-2.5 moderate: muscle tremor, ataxia, tinnitus, blurred vision, vertigo severe: over 2.5 and include elevated temp, renal failure, hypotension, cardiac dysrhythmias, altered consciousness, coma, or death

A patient has signed the consent for for ECT under pressure from her spouse but confides in the PMHN that she does not want the treatment and is terrified but afraid to stand-up to her spouse. The PMHN should: a. ask the patient if she wants to rescind the consent form b. tell the patient that she must tell her spouse she does not want the treatment c. tell the patient she must go through with the treatment because she signed the consent d. notify the physician of the patient's feelings about the treatment

d. notify the physician of the patient's feelings about the treatment

Which of the following is most likely an example of normal cognitive changes associated with aging in an 85-year-old patient? a. patient has forgotten how to use the stove to cook b. patient has forgotten attending a birthday party c. patient has forgotten which bank holds his savings d. patient has forgotten to keep an appointment with the doctor

d. patient has forgotten to keep an appointment with the doctor

According to the ANA, which of the following is a core principle of peer review? a. peer review should be done anonymously b. peer review expectations are the same regardless of the nurse's developmental age c. peer review should be done by a nurse's immediate supervisor d. peer review should focus on nursing practice

d. peer review should focus on nursing practice

A patient flirts with her male nurse and then complains to the administrative staff that the nurse is "coming on" to her. This is an example of: a. sublimation b. suppression c. displacement d. projection

d. projection Sublimation: refocus unacceptable drives/feelings/impulses onto something acceptable Suppression: voluntary blocking of unpleasant feelings/memories from awareness Displacement: transfer feelings from one person/thing to a less-threatening alternative

A patient who smoked two-to-three packs of cigarettes daily for over 20 years has been admitted to a no-smoking facility, so the PMHN is concerned about withdrawal symptoms. The most appropriate approach is: a. providing smoking cessation classes b. allowing scheduled smoking c. providing emotional support d. providing nicotine patches

d. providing nicotine patches

A patient in the emergency department with multiple injuries (bruises, split lip, facial laceration, head contusion) reports that her boyfriend got high on amphetamines and alcohol and beat her, so she drove herself to the hospital for treatment. The priority intervention is: a. asking the patient if she wants to call the police b. providing information about a women's shelter c. providing information about domestic abuse services d. providing wound care to the injuries

d. providing wound care to the injuries ask about police notification after attending to patient's wounds

A caregiver states that she is exhausted and angry about the quality of her life because of having to constantly care for her mother, who has severe Alzheimer's disease. The most appropriate initial recommendation is: a. family/friend assistance b. a long-term care facility c. a support group d. respite care

d. respite care

When utilizing Agency for Healthcare Research Quality (AHRQ)'s 'You Can Quit Smoking' guide to help a patient quit smoking, the first step of 'Getting Ready' includes: a. talking with the physician about nicotine medication b. telling friends and family members about quitting c. getting group counseling d. setting a date to quit, cold turkey

d. setting a date to quit, cold turkey

A patient who had a spontaneous abortion resulting from drug abuse becomes very upset when talking about it with the PMHN and begins to cry. The most appropriate response is to: a. tell the patient she is obviously upset that she caused the abortion b. suggest the patient focus on the future and changing her behavior c. hug the patient to provide comfort while she is crying d. sit quietly with the patient, allowing her to express feelings

d. sit quietly with the patient, allowing her to express feelings

A patient admitted to the psychiatric unit is withdrawn and fearful of others, staying in his room and remaining preoccupied with his own thoughts. The patient states he feels rejected by others. The most appropriate nursing diagnosis is: a. powerlessness b. low self-esteem c. disturbed thought process d. social isolation

d. social isolation

When the PMHN is serving as a preceptor for a student, the primary responsibility is: a. providing supervision to the student b. preventing errors in nursing care c. evaluating and assigning grades d. teaching and promoting learning

d. teaching and promoting learning

Which of the following is a boundary violation on the part of the PMHN? a. accepting a box of candy to be shared by the staff b. finding a patient attractive c. holding the hand of a frightened patient d. telling a patient about breaking-up with a fiancé

d. telling a patient about breaking-up with a fiancé

A patient with severe anxiety has persistent negative thoughts , believing that others think she is ugly and stupid. The patient's interdisciplinary plan of care calls for use of Acceptance Commitment Therapy (ACT). Which of the following actions by the patient indicates that the patient is successfully carrying out 'cognitive defusion' during an anxiety attack? a. the patient uses distraction to stop thinking negative thoughts b. the patient uses imagery to relax and to control negative thoughts c. the patient states that she understands she shouldn't react to thoughts d. the patient makes a list of evidence regarding the truth of negative thoughts

d. the patient makes a list of evidence regarding the truth of negative thoughts

A 15-year-old patient with anorexia nervosa has responded well to therapy and has gained about 2 pounds per week. As part of the plan of care, the patient will begin to participate in an eating disorder support group. One of the disadvantages of the patient's attending a support group is: a. most patients in support groups are older b. the patient may be too immature to benefit from a support group c. the patient no longer needs support because of weight gain d. the patient may be exposed to other patients with more severe symptoms

d. the patient may be exposed to other patients with more severe symptoms

A patient is undergoing habit reversal therapy (HRT) as part of the interdisciplinary plan of care for trichotillomania (repeated urge to pull out body hair). Which of the following actions by the patient indicates the patient is carrying out the 'competitive response' step to control urges? a. the patient identifies and creates a list of triggers b. the patient keeps a detailed list of all urge behaviors c. the patient states she knows she doesn't need to give in to urges d. the patient taps her wrist with an index finger when she has an urge

d. the patient taps her wrist with an index finger when she has an urge Awareness Trigger identification Assessment Competitive response Assessment of rationalizations Mindfulness

An Asian American adolescent is to be discharged from a psychiatric unit after a psychotic episode, but the parents, who are immigrants from China, are adamant that the patient cannot receive any outpatient treatment or follow-up care, stating that his illness was caused by an "infection". The probable reason for this is: a. they are unfamiliar with Western treatment for mental illness b. they have poor language skills and misunderstand the diagnosis c. they have very low health literacy d. they are ashamed their child has a psychiatric condition

d. they are ashamed their child has a psychiatric condition

A patient with severe treatment-resistant depression has had a device implanted in the chest wall for vagus nerve stimulation (VNS). When educating the patient about the treatment, the PMHN tells the patient to expect improvement in symptoms: a. almost immediately b. within a few days c. within a few weeks d. within a few months

d. within a few months