PSYCH EXAM 1
Ian makes the following statements to you while admitting him. Which statement indicates an increased likelihood of violent behavior? a. "When I get mad, I want to be left alone." b. "Last time I was in here I ended up in seclusion for punching my roommate." c. "My old man was meek and mild, and I've always said I'm not going to be like him." d. "My girlfriend says I yell way too much, and she's threatened to leave me."
B
Resilience is characteristic of mental health that allows people to adapt to tragedies, trauma, and loss. Which client behavior demonstrates this characteristic? A. "My mother made decisions about my husband's funeral when I just couldn't do that." B. "Losing my job was hard but my skills will help me get another one." C. "In spite of all the treatment, I know I'll never be really healthy." D. "My kids, happiness is worth any sacrifice I have to make."
B
You are assessing a 6-year-old patient. When assessing a child's perception of a difficult issue, which methods of assessment are appropriate? Select all that apply. a. Engage the child in a specific therapeutic game. b. Ask the child to draw a picture. c. Provide the child with an anatomically correct doll to act out a story. d. Allow the child to tell a story.
A, B, C, D
According to the DSM-V, which statement made by an adult client supports the criteria for generalized anxiety disorder? Select all that apply. A. I've been really anxious for at least 2 years now. B. My anxiety has to be genetic; my mom was a terrible worrier too. C. My marriage is in trouble because I'm always so irritable. D. I've had a good physical and my health care provider says I'm in good health. E. Its hard falling asleep and even harder staying asleep; I'm restless all night.
A, C, D, E
Which are the purposes of a thorough mental health nursing assessment? Select all that apply. a. Establish a rapport between the nurse and patient. b. Assess for risk factors affecting the safety of the patient or others. c. Allow the nurse the chance to provide counseling to the patient. d. Identify the nurse's goals for treatment. e. Formulate a plan of care.
A, B, D, E
Based on the current understanding of brain physiology, which neurotransmitter would be the expected target of medication prescribed to manage depression? Select all that apply. A. Dopamine B. γ-aminobutyric acid (GABA) C. Serotonin D. Norepinephrine E. Acetylcholine
A, C, D
Which of the following statements are true regarding the differences between a social relationship and a therapeutic relationship? Select all that apply. A. In a social relationship, both parties' needs are met; in a therapeutic relationship, only the patient's needs are to be considered. B. A social relationship is instituted for the main purpose of exploring one member's feelings and issues; a therapeutic relationship is instituted for the purpose of friendship. C. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. D. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship, solutions are discussed but are only implemented by the patient. E. In a social relationship, communication is usually deep and evaluated; in a therapeutic relationship, communication remains on a more superficial level, allowing patients to feel comfortable.
A, C, D
Emily is a 28-year-old nurse on the psychiatric unit. She has been working with Jenna, a 27-year-old who was admitted with depression. Emily and Jenna find they have much in common, including each having a 2-year-old daughter and each having graduated from the same high school. Emily and Jenna discuss getting together for lunch with their daughters after Jenna is discharged. This situation reflects: a. Successful termination b. Promoting interdependence c. Boundary blurring d. A strong therapeutic relationship
C
James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, "Last night demons came to my room and tried to rape me." Which response would be most therapeutic? a. "There are no such things as demons; what you saw were hallucinations." b. "It is not possible for anyone to enter your room at night; you are safe here." c. "You seem very upset; please tell me more about what you experienced last night." d. "That must have been very frightening, but we'll check on you at night and you'll be safe."
C
The premise that an individual's behavior and affect are largely determined by his or her attitudes and assumptions about the world underlies: a. modeling. b. milieu therapy. c. cognitive-behavioral therapy. d. psychoanalytic psychotherapy.
C
The theory of interpersonal relationships developed by Hildegard Peplau is based on the foundation provided by which early theorist? a. Freud b. Piaget c. Sullivan d. Maslow
C
Which statement about nonverbal behavior is accurate? a. A calm expression means that the patient is experiencing low levels of anxiety. b. Patients respond more consistently to therapeutic touch than to verbal interventions. c. The meaning of nonverbal behaviors varies with cultural and individual differences. d. Eye contact is a reliable measure of the patient's degree of attentiveness and engagement.
C
Epidemiological studies contribute to improvements in care for individuals with mental disorders by: a. Providing information about effective nursing techniques. b. Identifying risk factors that contribute to the development of a disorder. c. Identifying who in the general population will develop a specific disorder. d. Identifying which individuals will respond favorably to a specific treatment.
C. Identifying who in the general population will develop a specific disorder.
When preparing to hold an admission interview with a client, the nurse pulls up a chair and sits facing the client with his or her knees almost touching. When the nurse leans in close to speak, the client becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for client's behavior? A. The nurse violated the client's personal space by physically being too close. B. The client has issues with sharing personal information. C. The nurse failed to explain the purpose of the admission interview. D. The client is responding to the voices by ending the conversation.
A
Which contribution to modern psychiatric mental health nursing practice was made by Freud? a. The theory of personality structure and levels of awareness b. The concept of a "self-actualized personality" c. The thesis that culture and society exert significant influence on personality d. Provision of a developmental model that includes the entire life span
A
Which nursing intervention demonstrates the theory behind operant conditioning? A. Rewarding the client with a token for avoiding an argument with another client B. Showing the client how to be assertive without being aggressive C. Demonstrating deep breathing techniques to a group of clients D. Explaining to the client the consequences of not following unit rules
A
A 55-year-old patient recently came to the United States from England on a work visa. The patient was admitted for severe depression following the death of a life partner weeks ago. While discussing the death and its effects the patient shows little emotion. Which of the following explanations is most plausible for this lack of emotion? A. The patient in denial. B. The response may reflect cultural norms. C. The response may reflect personal guilt. D. The patient may have an antisocial personality.
B
A client has been admitted to your inpatient psychiatric unit with suicidal ideation. In a one-to-one session with the nurse, he shares the terrible guilt he feels over sexually abusing his stepdaughter and wanting to die because of it. Which of the following responses you could make reflects a helpful trait in a therapeutic relationship? A. "It's good that you feel guilty. That means you still have a chance of being helped." B. "Of course you feel guilty. You did a horrendous thing. You shouldn't even forget what you did." C. "The biggest question is, will you do it again? You will end up having even worse guilt feelings because you hurt someone again." D. "You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."
D
A student nurse exhibits the following behaviors or actions while interacting with her patient. Which of these are appropriate as part of a therapeutic relationship? a. Sitting attentively in silence with a withdrawn patient until the patient chooses to speak. b. Offering the patient advice on how he could cope more effectively with stress. c. Controlling the pace of the relationship by selecting topics for each interaction. d. Limiting the discussion of termination issues so as not to sadden the patient unduly.
A
A 38-year-old patient diagnosed with major depression states, "my provider said something about the medicine I've been prescribed will affect my neurotransmitters. What exactly are neurotransmitters?" What is the nurse's best response to the patient's question? A. "Neurotransmitters are chemical messengers in the brain that help regulate specific functions such as depression." B. "Neurotransmitters are too complicated to explain easily. Just know that the medication will help your mood and make you less depressed." C. "Neurotransmitters are chemicals in the brain that are the reason you are depressed." D. "I will ask your provider to give you a more in-depth explanation about why this medication will help your depression."
A
A 29-year-old patient has been admitted following a suicide attempt. Which nursing statement illustrates the concept of patient advocacy? A. "Dr. Raye, I notice you ordered fluoxetine for this patient. During the admission interview, the client stated they will refuse the medication because of adverse effects they experienced previously." B. "Dr. Raye, during the admissions interview the patient stated that there is a family history of three other suicide attempts in the past." C. "I'd like you tell me more about your depression and your suicide attempt?" D. "I will take you on a tour of the unit and orient you to the rules so you can get adjusted here."
A
A nurse administering a benzodiazepine should understand that the therapeutic effect of benzodiazepines results from potentiating the neurotransmitter: a. GABA b. dopamine c. serotonin d. acetylcholine e. a and c
A
Amanda was raised by a rejecting and abusive father and had a difficult childhood. As an inpatient, she frequently comments on how hard her nurse, Jane, works and on how other staff members do not seem to care as much about their patients as Jane does. Jane finds herself agreeing with Amanda. Jane appreciates her insightfulness, and realizes that the other staff members do not appreciate how hard she works and take her for granted. Jane enjoys the time she spends with Amanda and seeks out opportunities to interact with her. What phenomenon is occurring here, and which response by Jane would most benefit her and the patient? a. Amanda is experiencing transference; Jane should help Amanda to understand that she is emphasizing in Jane those qualities that were missing in her father. b. Jane is idealizing Amanda, seeing in her strengths and abilities that Amanda does not possess; Jane should temporarily distance herself somewhat from Amanda. c. Amanda is overidentifying with Jane, seeing similarities that do not in reality exist; Jane should label and explore this phenomenon in her interactions with Amanda. d. Jane is experiencing countertransference in response to Amanda's meeting Jane's needs for greater appreciation; Jane should seek clinical supervision to explore these dynamics.
A
Providing a safe environment for patients with impaired cognition, planning unit activities to stimulate thinking, and including patients and staff in unit meetings are all part of: a. milieu therapy. b. cognitive-behavioral therapy. c. behavior therapy. d interpersonal psychotherapy.
A
A 43-year-old client being seen in the mental health clinic states, "I have always been a practicing Jew, but in the past few months I am questioning everything. I just don't know if I believe in it anymore." Which of the following nursing diagnoses best describes the client's comment? A. Ineffective coping B. Spiritual distress C. Risk for self-harm D. Hopelessness
B
A client states, "I will always be alone because nobody could ever love me." The nurse recognizes that the client is expressing what cognitive-behavioral concept? A. Emotional consequence B. Schema C. Actualization D. Aversion
B
You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic? a. "A new psychiatrist is a chance to start fresh; I'm sure it will go well for you." b. "You say you look forward to the meeting, but you appear anxious or unhappy." c. "I notice that you frowned and avoided eye contact just now; don't you feel well?" d. "I get the impression you don't really want to see your psychiatrist—can you tell me why?"
B
A 17-year-old patient confides to the nurse that they have been thinking of ways to kill a peer. What response should the nurse give when the patient states, "you have to keep it a secret because its confidential information"? A. "I will keep it a secret, but you and I need to discuss ways to deal with this situation appropriately without committing a crime." B. "Yes, I will keep it confidential. We have laws to protect patients' confidentiality." C. "Issues of this kind have to be shared with the treatment team and your parents." D. "I will have to share this with the treatment team, but we will not share it with your parents."
C
A new nurse has accepted a position as staff nurse on a psychiatric unit. Which statement made by the new nurse requires additional instructions regarding the therapies provided on the unit? A. "You will participate in unit activities and groups daily." B. "You will be given a schedule daily of the groups we would like you to attend." C. "You will attend a psychotherapy group that I lead that will help you care for yourself." D. "You will see your provider daily in a one-to-one session."
C
A nurse expresses an exclusive belief in the biological model for mental illness when stating "it's the only one I really believe." What conclusion should be drawn from this statement? A. The biological model is the oldest and most reliable model for explaining mental illness. B. The biological model has been proven to be successful in finding the cause of most symptoms of mental illness. C. The biological model is the most popular theory among leading psychiatrists and therefore the one that should be fully embraced. D. In believing only in the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account.
D
A nurse stops in to interview a patient on a medical unit and finds the patient lying supine in her bed with the head elevated at 10 degrees. Which initial response(s) would most enhance the chances of achieving a therapeutic interaction? Select all that apply. a. Apologize for the differential in height and proceed while standing to avoid delay. b. If permitted, raise the head of the bed and, with the patient's permission, sit on the bed. c. If permitted, raise the head of the bed to approximate the nurse's height while standing. d. Sit in whatever chair is available in the room to convey informality and increase comfort. e. Locate a chair or stool that would place the nurse at approximately the level of the patient. f. Remain standing and proceed so as not to create distraction by altering the arrangements.
E
Venlafaxine (Effexor) exerts its antidepressant effect by selectively blocking the reuptake of: a. GABA. b. dopamine c. serotonin d. norepinephrine e. c and d
E
The intervention that can be practiced by an advanced practice registered nurse in psychiatric mental health but cannot be practiced by a basic level registered nurse is: a. Advocacy b. Psychotherapy c. Coordination of care d. Community-based care
b. Psychotherapy
Which statement about mental illness is true? a. Mental illness is a matter of individual nonconformity with societal norms. b. Mental illness is present when individual irrational and illogical behavior occurs. c. Mental illness changes with culture, time in history, political systems, and the groups defining it. d. Mental illness is evaluated solely by considering individual control over behavior and appraisal of reality.
c. Mental illness changes with culture, time in history, political systems, and the groups defining it.
Which statement best describes a major difference between a DSM-5 diagnosis and a nursing diagnosis? a. There is no functional difference between the two; both serve to identify a human deviance. b. The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis takes culture into account. c. The DSM-5 is associated with present symptoms, whereas a nursing diagnosis considers past, present, and potential responses to actual mental health problems. d. The DSM-5 diagnosis impacts the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying multidisciplinary interventions.
c. The DSM-5 is associated with present symptoms, whereas a nursing diagnosis considers past, present, and potential responses to actual mental health problems.
Andie is a patient anxiously waiting her turn to speak with you. As you are very busy, you ask Andie if she can wait a few minutes so that you can finish your task. Unfortunately the task takes longer than anticipated and you are delayed getting back to Andie. On seeing you approach her, Andie accuses you of lying and refuses to speak with you. Which response is most likely to be therapeutic at this time? a. "You are angry that I didn't speak with you when I promised I would." b. "I'm sorry for being late, but screaming at me is not the best way to handle it." c. "You are too angry to talk right now. I'll come back in 20 minutes, and we can try again." d. "Why are you angry? I told you that I was busy and would get to you as soon as I could."
A
The concepts at the heart of Sullivan's theory of personality are: a. needs and anxiety. b. basic needs and meta-needs. c. schemas, assimilation, and accommodation. d. developmental tasks and psychosocial crises.
A
The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving: a. lithium b. clozapine c. diazepam d. amitriptyline
A
Which of the following actions best represents the basis or foundation of all other psychiatric nursing care? a. The nurse assesses the patient at regular intervals. b. The nurse administers psychotropic medications. c. The nurse spends time sitting with a withdrawn patient. d. The nurse participates in team meetings with other professionals.
A
You are working on an adolescent psychiatric unit. A 16 year old being treated on an adolescent psychiatric unit has become angry and is in the hallway yelling, "It's not fair! You all hate me! I hate this place!" When the client begins pounding his/her fists on the wall the nurse should attempt to de-escalate the situation by providing which response? A. "I will help you calm down. Do you want to go to your room and talk or go to the quiet room?" B. "You may yell and bang your fists but you must do it in your own room so you don't upset the other patients." C. "Stop that right now! I will not allow you to behave like that!" D. "You will have to go into seclusion and restraints right now in order to be safe."
A
Which of the following statements represent a nontherapeutic communication technique? Select all that apply. A. "Why didn't you attend group this morning?" B. "From what you have said, you have great difficulty sleeping at night." C. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" D. "If I were you, I would quit the stressful job and find something else." E. "I'm really proud of you for the way you stood up to your brother when he visited today." F. "You mentioned that you have never had friends. Tell me more about that." G. "It sounds like you have been having a very hard time at home lately."
A, C, D, E
You respond to a loud, angry voice coming from the day room, where you find that Alex is pacing and shouting that he isn't "going to take this (expletive) anymore." Which of the following responses is likely to be helpful in de-escalating Alex? Select all that apply. a. Remain calm, quiet, and in control. b. Tell Alex that his actions are unacceptable and that he must go to his room. c. Match Alex's volume level so that he is able to hear over his own shouting. d. Ask Alex if he can tell you what is upsetting him so you may be able to help. e. Stand close to Alex so you can intervene physically if needed to protect others. f. Tell Alex that he could be placed in seclusion if he cannot control himself so that the patient is aware of negative consequences.
A, D
Consider both Sullivan's term security operations and Freud's term defense mechanisms. Which statement suggests that the client's specialized treatment goal has been successfully met? A. "I really think I can succeed in school now." B. "I'm experiencing much less anxiety about school now." C. "Going back to school is hard and I'll need support." D. "I know that I'm not the only person who has a difficult time in school."
B
A 43-year-old female patient is brought to the emergency department with complaints of bizarre speech, visual hallucinations, and changes in behavior. She has no psychiatric history. Before ordering a psychiatric consultation, the emergency room physician orders a battery of blood tests as well as an MRI of the brain. The rationale for this is: a. To avoid a lawsuit. b. Medical conditions and physical illnesses may mimic psychiatric illnesses; therefore, physical causes of symptoms must be ruled out c. Emergency room physicians are required to order a certain number of tests for the emergency room visit to be reimbursed. d. To comply with hospital standards of care.
B
A 49-year-old patient diagnosed with schizophrenia at 22 years old is prescribed risperidone. Which nursing assessment is the priority for this patient? A. Monitoring blood levels to avoid toxicity B. Monitoring for abnormal involuntary movements C. Observing for secondary mania D. Observing for memory changes
B
A male patient frequently inquires about the female student nurse's boyfriend, social activities, and school experiences. Which of the following initial responses by the student best addresses the issue raised by this behavior? a. The student requests assignment to a patient of the same gender as the student. b. She limits sharing personal information and stresses the patient-centered focus of the conversation. c. She tells him that she will not talk about her personal life. d. She explains that if he persists in focusing on her, she cannot work with him.
B
A nurse on the psychiatric unit has a past history of alcoholism and has regular meetings with a mentor. Which statement made to the nurse's mentor would indicate the presence of countertransference? A. "My patient is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again." B . "My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" C. "My patient started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA (Alcoholics Anonymous) meetings five times a week after discharge." D. "My patient, is an elderly woman with depression. She calls me by her daughter's name because she says I remind her of her daughter."
B
A nurse, active in local consumer mental health groups and in local and state mental health associations, keeps aware of state and national legislation affecting mental illness treatment. How can this nurse positively affect the climate for effective, mental health treatment? A. "By becoming active in politics leading to a potential political career." B. "By educating the public on the effects that stigmatizing has on mental health clients." C. "Advocating for laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons." D. "Advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions."
B
Blockage of dopamine transmission can lead to increased pituitary secretions of prolactin. In women, this hyperprolactinemia can result in: a. dry mouth b. amenorrhea c. increased production of testosterone d. blurred vision
B
The nurse is conducting an admission interview with a client who was raped 2 weeks ago. When asked about the rape, the client becomes very anxious and upset and begins to sob. What should be the nurse's response to the client's reaction? A. Push gently for more information about the rape because the information needs to be documented. B. Acknowledge that the topic of the rape is upsetting and reassure the client that it can be discussed at another time when she feels more comfortable. C. Use silence as a therapeutic tool and wait until the client is done sobbing to continue discussing the rape. D. Reassure the client that anything she says to you will remain confidential.
B
What older concept of care is being used currently to help in violence reduction in disruptive clients? A. Aired grievances B. Trauma-informed care C. Shared governance D. Learned helplessness
B
When approaching a client who is acting out aggressively, what interventions should the nurse implement to assure personal safety? A. Stand close to the client for reassurance and to convey caring. B. Have other staff as backup, and stay out of the client's personal space. C. Take the client to his/her room so that his/her privacy will be protected. D. Call security and wait until they arrive before approaching the client.
B
Which assessment should the nurse perform to evaluate the pharmacokinetic affect of a monoamine oxidase inhibitors (MAOIs) antidepressant medication? A. The status of the client's appetite B. The results of the liver function test C. The level of depression exhibited by the client D. The client's current sleeping patterns
B
Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages? a. SSRIs b. Antipsychotics c. Benzodiazepines d. Tricyclic antidepressants
B
Which student behavior is consistent with therapeutic communication? a. Offering your opinion when asked in order to convey support. b. Summarizing the essence of the patient's comments in your own words. c. Interrupting periods of silence before they become awkward for the patient. d. Telling the patient he did well when you approve of his statements or actions.
B
You are performing a spiritual assessment on a patient. Which patient statement would indicate that there is an experiential concern in the patient's spiritual life? a. "I really believe that my spouse loves me." b. "My sister will never forgive me for what I did." c. "I try to find time every day to pray, even though it's not easy." d. "I am happy with my life choices, even if my mother is not."
B
A 21-year-old client asks the nurse, "What's wrong with my brain causing me to be so angry and aggressive?" The nurse's response should be grounded on what research-supported basis? A. The diminishment of stress hormones causes anger and aggression. B. No abnormalities of the brain have been identified that correlate with anger and aggression. C. The limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression. D. Personality type plays a much greater part in anger and aggression than physical factors.
C
A 26-year-old patient is brought to the emergency room by a friend. The patient is unable to give any coherent history. Which response should the nurse provide when the patient's friend offers to provide information regarding the patient? A. "I'm sorry, but I cannot take any information from you as it would violate confidentiality laws." B. "There is no need for that as I will call his primary care provider to obtain the information we need." C. "Yes, I will be happy to get any information and history that you can provide." D. "Yes, however, we will have to get a release signed from the patient for you to be able to talk with me."
C
A nurse is providing care to a 28-year-old patient diagnosed with bipolar disorder who was admitted in a manic state. According to Maslow's Hierarchy of Needs theory, the nurse should identify which patient symptom as having priority? A. Rapid, pressured speech B. Grandiose thoughts C. Lack of sleep D. Hyperactive behavior
C
A patient is sitting with arms crossed over his or her chest, his or her left leg is rapidly moving up and down, and there is an angry expression on his or her face. When approached by the nurse, the patient states harshly, "I'm fine! Everything's great." Which statement related to communication should the nurse focus on when working with this patient? A. Verbal communication is always more accurate than nonverbal communication. B. Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. C. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. D. Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.
C
A patient who recently loss a parent begins crying during a one-to-one session with the nurse. Which of the following responses by the nurse illustrates empathy? A. "I'm so sorry. My father died 2 years ago, so I know how you are feeling." B. "You need to focus on yourself right now. You deserve to take time just for you." C. "That must have been such a hard situation for you to deal with." D. "I know that you will get over this. It just takes time."
C
A prescription for which medication would require the nurse to monitor the client for potential development of the side effect of hypothyroidism? A. Fluoxetine B. Bupropion C. Lithium D. Imipramine
C
Which statement about violence and nursing is accurate? a. Unless working in psychiatric mental health settings, nurses are unlikely to experience patient violence. b. To date, no legislation exists that addresses workplace violence against nurses. c. Emergency, psychiatric, and step-down units have the highest rates of violence toward staff. d. Violence primarily affects inexperienced or unskilled staff who cannot calm their patients.
C
You are caring for Malcolm, an 83-year-old African American patient with Alzheimer's disease. Malcolm exhibits agitated behavior at times, especially when he feels he is missing work, and he sometimes attempts to leave the unit to "get to the school where I teach." Which of the following interventions is appropriate for de-escalating Malcolm's agitation? a. Medicate Malcolm with prn medication at regular intervals to prevent agitation. b. Repeatedly explain to Malcolm that he is retired and no longer teaches as the repetition will reinforce the patient's orientation. c. Use validation therapy and ask Malcolm about the school and his job. d. Reduce stimulation in the environment by having Malcolm sit by himself in his room until the agitation passes.
C
A patient states he has "given up on life." His wife left him, he was fired from his job, and he is four payments behind on his mortgage, meaning he will soon lose his house. Which nursing diagnosis is appropriate? a. Anxiety related to multiple losses b. Defensive coping related to multiple losses c. Ineffective denial related to multiple losses d. Hopelessness related to multiple losses
D
A patient is presenting with behaviors that indicate anger. When approached, the patient states harshly, "I'm fine! Everything's great." Which response should the nurse provide to the patient? A. "Okay, but we are all here to help you, so come get one of the staff if you need to talk." B. "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." C. "I don't believe you. You are not being truthful with me." D. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"
D
Consider the nurse-patient relationship on an inpatient psychiatric unit. Which of the following statements made by the nurse reflects an accurate understanding of when the issue of termination should first be discussed? A. "You are being discharged today, so I'd like to bring up the subject of termination—discussing your time here and summarizing what coping skills you have attained." B. "I haven't met my new patient yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself." C. "Now that we are working on your problem-solving skills and behaviors you'd like to change, I'd like to bring up the issue of termination." D. "Now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge."
D
The nurse in an emergency department notices a patient's husband, pacing in the hallway, muttering to himself, and looking angrily around the emergency department. Which statement should the nurse make to the spouse to help prevent escalation and/or violence? A. "You need to stay with your wife. She needs you." B. "Hey, what's up? You look out of control." C. "I am calling security to deal with your behavior." D. "You appear upset. Can I help you with anything?"
D
Which response should the nurse provide a client who asks, "Why you need to conduct an assessment interview"? A. "I need to find out more about you and the way you think in order to best help you." B. "The assessment interview lets you have an opportunity to express your feelings." C. "You are able to tell me in detail about your past so that we can determine why you are experiencing mental health alterations." D. "We will be able to form a relationship together where we can discuss the current problems and come up with goals and a plan for treatment."
D
A nursing student new to psychiatric mental health nursing asks a peer what resources he can use to figure out which symptoms are present in a specific psychiatric disorder. The best answer would be: a. Nursing Interventions Classification (NIC) b. Nursing Outcomes Classification (NOC) c. NANDA-I nursing diagnoses d. DSM-5
d. DSM-5
