Psych Exam 2 Multiple Choice

The nurse is working with a client who shows signs of benzodiazepine withdrawal. The nurse should suspect that the client has suddenly discontinued taking which prescribed medication? a. Sertraline b. Diazepam c. Fluoxetine d. Haloperidol

b. Diazepam

The client diagnosed with schizophrenia says, "Everyone here is part of the secret police and wants to torture me," and refuses to be weighed by a member of the nursing staff. What is the most appropriate response by the nurse. a. "That is a strange idea. We aren't secret police persons." b. "That must be a frightening thought. We are nurses who work at this hospital." c. "Being suspicious isn't easy, is it? You won't be tortured here." d. "There is no need to b frightened. We will keep you safe from torture."

b. "That must be a frightening thought. We are nurses who work at this hospital."

Which activity should the nurse include in the plan of care for a client who is experiencing psychomotor agitation? a. Playing checkers with members of the staff b. Reading in a quiet, low-stimulus environment c. Engaging in a card game with other clients on the unit d. Attending a clay-molding class that is scheduled for today

d. Attending a clay-molding class that is scheduled for today

A client has a history of schizophrenia, controlled by haloperidol (Haldol). During an assessment, the nurse notes continuous restlessness. Which medication would the nurse expect the physician to prescribe for this client? a. Haloperidol (Haldol) b. Fluphenazine decanoate (Prolixin Decanoate) c. Clozapine (Clozaril) d. Benzotropine mesylate (Cogentin)

d. Benzotropine mesylate (Cogentin)

For the past year, a client has received haloperidol (Haldol). The nurse administering the client's next dose notes a twitch on the right side of the client's face and tongue movements. Which nursing intervention takes priority? a. Administer haloperidol (Haldol) along with benztropine (Cogentin) 1 mg IM PRN per order. b. Assess for other signs of hyperglycemia resulting from the use of the haloperidol (Haldol). c. Check the client's temperature, and assess mental status. d. Hold the haloperidol (Haldol), and call the physician.

d. Hold the haloperidol (Haldol), and call the physician.

Social Security Disability Insurance (SSDI) benefits typically cover needs based on which one of the following? a. Disability b. Economic need c. Unemployment d. Mental illness

a. Disability

What is the priority nursing action when admitting a client who has just attempted suicide? a. Ensure constant observation of the client at all times. b. Conduct a thorough mental health assessment of the client. c. Determine whether the client has ever attempted suicide previously. d. Remove all potentially dangerous articles from among the client's belongings.

a. Ensure constant observation of the client at all times.

A mature, professional couple plans a large wedding in a city 100 miles from their home. Which response is most likely to be associated with this experience? a. Distress b. Eustress c. Acute stress d. Depersonalization

b. Eustress

A client is in the active phase of paranoid schizophrenia. Which nursing intervention would aid in facilitating other interventions? a. Assign consistent staff members b. Convey acceptance of the delusional belief c. Help the client understand that anxiety causes hallucinations d. Encourage participation in group activities

a. Assign consistent staff members

A nurse is caring for a client who is experiencing a crisis. Which of the following medications might the provider prescribe? (select all that apply) a. lithium carbonate b. paroxetine c. risperidone d. haloperidol e. lorazepam

b. paroxetine e. lorazepam

A client who is exhibiting psychotic behaviors is admitted to the psychiatric unit. In developing a plan of care, the nurse should identify which as the priority client problem? a. Disturbed thought processes b. Lack of knowledge about the behavior c. Inability to care for self with bathing procedures d. Altered nutrition: inadequate consumption of food

a. Disturbed thought processes

A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? (select all that apply) a. Auditory hallucination b. Lack of motivation c. Use of clang associations d. Delusions of persecution e. Constantly waving arms f. Flat affect

a. Auditory hallucination c. Use of clang associations d. Delusions of persecution e. Constantly waving arms

Which one of the following most correctly defines a psychiatrist? a. Medical physician b. Psychologist c. Mental health counselor d. Psychiatric practitioner

a. Medical physician

When planning care for a client with a history of violent behavior toward others, the nurse should include which interventions? (Select all that apply.) a. Providing complete privacy when caring for the client b. Admitting the client to a room near the nurses' station c. Avoiding eye contact with the client while providing nursing care d. Arranging for a security officer to be nearby and available but out of the client's sight e. Closing the door to the client's room to ensure privacy when providing direct client care

b. Admitting the client to a room near the nurses' station d. Arranging for a security officer to be nearby and available but out of the client's sight

A client with the diagnosis of bipolar disorder, manic episode, is extremely active, talks constantly, and tends to badger the other clients, some of whome are now becoming agitated. What is the best strategy for the nurse to use with this client? a. Humor b. Sympathy c. Distraction d. Confrontation

c. Distraction

A nurse is caring for a client who has substance-induced psychotic disorder and is experiencing auditory hallucinations. The client states, "The voices won't leave me alone!" Which of the following statements should the nurse make? (select all that apply) a. "When did you start hearing the voices?" b. "The voices are not real, or else we would both hear them." c. "It must be scary to hear voices." d. "Are the voices telling you to hurt yourself?" e. "Why are the voices talking to only you?"

a. "When did you start hearing the voices?" c. "It must be scary to hear voices." d. "Are the voices telling you to hurt yourself?"

Select the completion of this sentence that demonstrates an adult is coping in a healthy way: "I am feeling so angry right now... a. I'm afraid I'm going to cry." b. I would like to punch something." c. I want to talk to someone about it." d. I want to curl up and sleep for a long time."

c. I want to talk to someone about it."

A moderately depressed client who was hospitalized 2 days ago suddenly begins smiling and reporting that the crisis is over. The client says to the nurse, "I'm finally cured." How should the nurse interpret this behavior as a cue to modify the treatment plan? a. Suggesting a reduction of medication b. Allowing increased "in-room" activities c. Increasing the level of suicide precautions d. Allowing the client off-unit privileges as needed

c. Increasing the level of suicide precautions

A client recently admitted to the hospital in the manic phase of bipolar disorder is unkempt, taking antipsychotic medications, and complaining of abdominal fullness and discomfort. Which intervention addresses the priority sign/symptom? a. Teach self-grooming skills. b. Reward cleanliness with unit privileges. c. Monitor the adequacy of the antipsychotic dosage. d. Encourage frequent fluid intake and a high-fiber diet.

d. Encourage frequent fluid intake and a high-fiber diet.

Which information provided by the nurse accurately describes electroconvulsive therapy? (Select all that apply.) a. The average series involves 8 to 12 treatments. b. Some confusion may be noted after the procedure. c. Memory loss will occur but will resolve with time. d. This treatment is a permanent cure to the condition. e. This treatment is tried before the use of medications.

a. The average series involves 8 to 12 treatments. b. Some confusion may be noted after the procedure. c. Memory loss will occur but will resolve with time.

A supervisor reprimands the charge nurse for not adhering to the unit budget. What behavior by the charge nurse is an example of displacement? a. The charge nurse blames staff for wasting supplies. b. The charge nurse claims that administration wasn't critical. c. The charge nurse refuses to believe the supervisor's criticisms. d. The charge nurse smiles and nods in agreement when reprimanded.

a. The charge nurse blames staff for wasting supplies.

A nurse working in an acute mental health facility is caring for a 35-year-old female clint who has manifestations of depression. The client lives at home with her partner and two young children. She currently smokes and has a history of chronic asthma. Which of the following factors put the client at risk for depression? (select all that apply) a. age b. gender c. history of chronic asthma d. smoking e. being married

a. age b. gender c. history of chronic asthma d. smoking

A nurse working on an acute mental health unit is caring for a client who has PTSD. Which of the following findings should the nurse expect? (select all that apply) a. difficulty concentrating on tasks b. obsessive need to talk about the traumatic event c. negative self-image d. recurring nightmares e. diminished relfexes

a. difficulty concentrating on tasks c. negative self-image d. recurring nightmares

A client is admitted to the psychiatric unit with a diagnosis of bipolar affective disorder and mania. The nurse should prioritize which assessment finding as requiring immediate intervention? a. Grandiose delusions of being a czar of Russia b. Constant physical activity and poor oral intake c. Constant, incessant talking, with sexual innuendoes d. Outlandish behaviors and wearing odd, eccentric clothing

b. Constant physical activity and poor oral intake

A client with depression verbalizes feelings of low self-esteem and self-worth typified by statements such as, "I'm such a failure. I can't do anything right." Which is the best nursing response? a. Tell the client that this is not true, that we all have a purpose in life. b. Identify recent behaviors or accomplishments that demonstrate the client's skills. c. Reassure the client that you know how the client is feeling and that things will get better. d. Remain with the client and sit in silence. This will encourage the client to verbalize feelings.

b. Identify recent behaviors or accomplishments that demonstrate the client's skills.

A patient diagnosed with major depressive disorder was hospitalized for 2 weeks on an acute psychiatric unit. One day after discharge, the patient completed suicide. Recognizing likely reactions among staff, which action should the nursing supervisor implement first? a. Assess each staff member individually for suicidal intent and/or plans. b. Provide a private setting for staff members to talk about feelings associated with the event. c. Remind staff members that suicide is a risk for the patient population and they are not at fault. d. Invite a guest speaker to conduct an educational session for staff members about suicide risk factors.

b. Provide a private setting for staff members to talk about feelings associated with the event.

A nurse is caring for a client in an inpatient mental health facility who gets up from a chair and throws it across the day room. Which of the following is the priority nursing action? a. Encourage the client to express her feelings. b. Maintain eye contact with the client. c. Move the client away from others. d. Tell the client that the behavior is not acceptable.

c. Move the client away from others.

The nurse caring for a client with a diagnosis of acute schizophrenia should use which approach when planning care? a. Allow the client to set the goals for the plan of care. b. Let the client act out initially, and use the quiet room and restraints as needed. c. Provide assistance with grooming and nutrition until the client's thinking has cleared. d. Repeatedly point out inconsistencies in the client's communication during initial treatment.

c. Provide assistance with grooming and nutrition until the client's thinking has cleared.

A nurse is caring for a client who is on suicide precautions. Which of the following interventions should the nurse include in the plan of care? a. Assign the client to a private room b. Document the client's behavior every hour c. Allow the client to keep perfume in her room d. Ensure that the client swallows medication

d. Ensure that the client swallows medication

A community mental health nurse counsels a group of patients about the upcoming flu season. What instruction does the nurse provide for patients who are prescribed lithium? a. "Stop taking your medicine and contact me if you have nausea, vomiting, and/or diarrhea." b. "Remember that lithium reduces your immunity, so you are more vulnerable to catching the flu." c. "The flu is contagious. Isolate yourself if you get the flu so that you avoid exposing others to it." d. "Because you take lithium, you may have flu symptoms that are not typically experienced by others."

a. "Stop taking your medicine and contact me if you have nausea, vomiting, and/or diarrhea."

A nurse is discussing routine follow-up needs with a client who has a new prescription fro valproate. The nurse should inform the client of the need for routine monitoring of which of the following? a. AST/ALT and LDH b. Creatinine and BUN c. WBC and granulocyte counts d. Serum sodium and potassium

a. AST/ALT and LDH

What is likely to occur when a patient taking lithium carbonate has low sodium levels? a. Lithium toxicity b. Low serum lithium levels c. Increase in mania d. Decrease in mania

a. Lithium toxicity

Sixteen years ago a toddler died in a tragic accident. Once a year, the parents place flowers at the accident site. How would the nurse characterize the parents' behavior? a. Mourning b. Bereavement c. Complicated grief d. Disenfranchised grief

a. Mourning

Jon, an emergency department (ED) nurse, has just worked an 8-hour shift in the ED. After a five-car wreck during his midshift, five patients have been transported to the hospital with multiple injuries and one fatality. Jon looks exhausted, and his hands are tremulous. He insists that he is scheduled to work another 6 hours. As the nurse manager, what is your best action? a. Tell him that he needs to end his shift right away. b. Tell him he needs to nap for 30 minutes and then return to work. c. Tell him to go to the cafeteria, relax, and drink strong coffee. d. Tell him to eat a high carbohydrate snack, take a 30-minute break, and then return to work.

a. Tell him that he needs to end his shift right away.

What is the appropriate nursing intervention for a client diagnosed with posttraumatic stress disorder and paranoid tendencies who begins to pace and fidget? a. Escort the client to a private, low-stimulus room. b. Engage the client in a nonthreatening conversation. c. Allow the client to pace unless the behavior becomes aggressive. d. Share the observation with the client so the behavior can be recognized.

d. Share the observation with the client so the behavior can be recognized.

The nurse should include which information in the medication teaching plan for a client diagnosed with schizophrenia? a. Coffee, tea, and soda consumption should be limited. b. If the client is compliant, the relapse of symptoms will never occur. c. Psychotropic medications may cause mild cardiovascular symptoms. d. Most schizophrenic clients are able to taper off their medications eventually.

a. Coffee, tea, and soda consumption should be limited.

The nurse is preparing a client for electroconvulsive therapy, which is scheduled for the next morning. Which interventions would be included in the preprocedural plan? (Select all that apply.) a. Have the client void. b. Obtain an informed consent. c. Administer tap water enemas. d. Avoid discussing the procedure. e. Remove dentures and contact lenses. f. Withhold food and fluids for 6 hours.

a. Have the client void. b. Obtain an informed consent. e. Remove dentures and contact lenses. f. Withhold food and fluids for 6 hours.

A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following actions is the nurse's priority? a. placing the client on one-to-one observation b. assisting the client to perform ADLs c. encouraging the client to participate in counseling d. teaching the client about medication adverse effects

a. placing the client on one-to-one observation

A nurse is caring for a client who has schizoaffective disorder. Which of the following statements indicates the client is experiencing depersonalization? a. "I am a superhero and am immortal." b. "I am no one, and everyone is me." c. "I feel monsters pinching me all over." d. "I know that you are stealing my thouhts."

b. "I am no one, and everyone is me."

Which characteristics would the nurse expect to note for a client with seasonal affective disorder? (Select all that apply.) a. Affects males more often than females b. Is related to abnormal melatonin metabolism c. Usually results in debilitating symptomatology d. Improves during the spring and summer months e. Is a result of alterations in the available amounts of sunlight f. A craving for carbohydrates lessens during sunnier and spring months

b. Is related to abnormal melatonin metabolism d. Improves during the spring and summer months e. Is a result of alterations in the available amounts of sunlight f. A craving for carbohydrates lessens during sunnier and spring months

The role of a psychiatric nurse on an inpatient unit would include which one of the following? a. Prescribing medication b. Maintaining a therapeutic milieu c. Analyzing patient behavior d. Providing psychotherapy

b. Maintaining a therapeutic milieu

A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse include in the plan or care? (select all that apply) a. Provide flexible client behavior expectations. b. Offer concise explanations. c. Establish consistent limits. d. Disregard client complaints e. Use a firm approach with communication.

b. Offer concise explanations. c. Establish consistent limits. e. Use a firm approach with communication.

The nurse is developing a plan of care for a client who is scheduled to have electroconvulsive therapy. Which problem is a priority for this client? a. Fear b. Anxiety c. Risk for aspiration d. Distorted body image

c. Risk for aspiration

The nurse is planning a stress management seminar for clients in an ambulatory care setting. Which concept should the nurse plan to include in the content of the seminar? a. Biofeedback has the advantage of using no equipment at all. b. Guided imagery is a helpful technique but requires video equipment for its use. c. Confrontation is a useful method for solving potentially stressful conflicts with others. d. Progressive muscle relaxation techniques are useful for easing tension from many causes.

d. Progressive muscle relaxation techniques are useful for easing tension from many causes.

A nurse in an acute mental health facility is caring for client who has bipolar disorder. Which of the following is the priority nursing action? a. Set consistent limits for expected client behavior. b. Administer prescribed medications as scheduled. c. Provide the client with step-by-step instructions during hygiene activities. d. Monitor the client for escalating behavior.

d. Monitor the client for escalating behavior.

As Election Day nears, a mental health nurse studies the position statements of various candidates for federal offices. Which candidate's commentary would the nurse interpret as supportive of services for persons diagnosed with mental illness? a. "Full parity insurance coverage for mental illness" b. "Coverage for biologically based mental illnesses" c. "Reimbursement for initial treatment of addictions" d. "Managed care oversight for mental illness services"

a. "Full parity insurance coverage for mental illness"

The nurse is working with a client who is demonstrating delusional thinking. The client says to the nurse, "The leaders of a religious cult are being sent to assassinate me." Which is the best response by the nurse? a. "I don't believe that what you are telling me is true." b. "There are no religious cults in this area that are going to kill you." c. "What makes you think that cult members are being sent to hurt you?" d. "I don't know about a religious cult. Are you afraid that people are trying to hurt you?"

d. "I don't know about a religious cult. Are you afraid that people are trying to hurt you?"

The nurse is planning activities for a client diagnosed with bipolar disorder with aggressive social behavior. Which activity would be most appropriate for this client? a. Chess b. Writing c. Ping pong d. Basketball

b. Writing

Grief is best described as a: a. Normal response to a significant loss. b. Mild to moderately severe mood disorder. c. Display of feelings associated with death. d. Denial of the reality of the loss of a significant person, object, or state of being.

a. Normal response to a significant loss.

T/F: Teenage boys are more vulnerable to depression than teenage girls.

False

In addition to experiencing paranoid delusions, a client is withdrawn, unkempt, and unmotivated to get out of bed. Which of the following medications would the nurse expect to be most beneficial for the client's symptoms? a. Haloperidol (Haldol) b. Chlorpromaine (Thorazine) c. Olanzapine (Zyprexa) d. Trihexyphenidyl (Artane)

c. Olanzapine (Zyprexa)

Which is the best therapeutic approach for the nurse to use in crisis counseling? a. Reassuring b. Passive listening c. Exploration of early life experiences d. Active, with focus on the current situation

d. Active, with focus on the current situation

A nurse is caring for a client on an acute mental health unit. The client reports hearing voices that are telling her to "kill your doctor." Which of the following actions should the nurse take first? a. Use therapeutic communication to discuss te hallucination with the client. b. Initiate one-to-one observation of the client. c. Focus the client on reality. d. Notify the provider of the client's statement.

b. Initiate one-to-one observation of the client.

The nurse is interviewing a client in crisis to assess the risk for self-harm. The nurse interprets that the client is most at risk for suicide when which factor is identified? a. Client exhibits impulsive behavior. b. Client exhibits disorganized behavior. c. Client has a history of suicide attempts. d. Client has an immediate plan for a suicide attempt.

d. Client has an immediate plan for a suicide attempt.

A homeless client, diagnosed with schizophrenia, is seen in the mental health clinic complaining of insects infesting arms and legs. Which intervention should the nurse implement first? a. Check the client for body lice. b. Present reality regarding somatic delusions. c. Explain the origin of persecutory delusions. d. Refer for in-patient hospitalization because of substance-induced psychosis.

a. Check the client for body lice.

A nurse is caring for a client who is screaming at staff members and other clients. Which of the following is a therapeutic response by the nurse to the client? a. "Stop screaming, and walk with me outside." b. "Why are you so angry and screaming at everyone?" c. "You will not get your way by screaming." d. "What was going through your mind when you started screaming?"

a. "Stop screaming, and walk with me outside."

Which client is at greatest risk for committing suicide? a. A client with metastatic cancer b. A client with a newly diagnosed cardiac disorder c. A client who just had an argument with her fiancé d. A newly divorced client who states she has custody of the children

a. A client with metastatic cancer

A nurse is assessing a client in an inpatient mental health unit. Which of the following findings should the nurse expect if the client is in the preassaultive stage of violence? (select all that apply.) a. lethargy b. defensive responses to questions c. disorientation d. facial grimacing e. agitation

b. defensive responses to questions d. facial grimacing e. agitation

To create a safe environment for the client diagnosed with major depression with psychotic features, the nurse most importantly devises a plan of care that deals specifically with which problem? a. Nutrition b. Self-care needs c. Disturbed thinking d. Medication compliance

c. Disturbed thinking

A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should anticipate a prescription of which of the following medications? a. Chlorpromazine b. Thiothixene c. Risperidone d. Haloperidol

c. Risperidone

A nurse is reviewing the medical record of a client who has a new prescription for bupropion for depression. Which of the following findings is the priority for the nurse to report to the provider? a. The client has a family history of seasonal pattern depression b. The client currently smokes 1.5 packs of cigarettes per day. c. The client had a motor vehicle crash last year and sustained a head injury. d. The client has a BMI of 25 and has gained 10lb over the last year.

c. The client had a motor vehicle crash last year and sustained a head injury.

A recently widowed adult says, "I've been calling my neighbors often but they act like they don't want to talk to me. I just need to talk about it, you know?" What is the nurse's best action? a. Say to the person, "You may call me anytime you need to talk." b. Ask the person, "What do you mean by 'I just need to talk about it'?" c. Educate the person about the importance of finding alternative activities. d. Tell the person the location and time of a local bereavement support group.

d. Tell the person the location and time of a local bereavement support group.

A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the teaching? a. constipation b. polyuria c. rash d. muscle weakness e. tinnitus

b. polyuria d. muscle weakness

Which statement made by a severely depressed client requires the nurse's immediate attention? a. "Feeling better really isn't important to me anymore." b. "No one can really understand what I've had to deal with." c. "I really don't like the way that new depression pill makes me feel." d. "I've not been the least bit interested in socializing since my divorce."

a. "Feeling better really isn't important to me anymore."

A client is admitted to the mental health unit after an attempted suicide by hanging. The nurse can best ensure client safety by which action? a. Requesting that a peer remain with the client at all times b. Removing the client's clothing and placing the client in a hospital gown c. Assigning to the client a staff member who will remain with the client at all times d. Admitting the client to a seclusion room where all potentially dangerous articles are removed

c. Assigning to the client a staff member who will remain with the client at all times

Which is the primary goal of crisis intervention therapy? a. Introduce new, effective coping methods to the client. b. Assess the client to identify the causative stressors. c. Establish a sustainable therapeutic nurse-client relationship. d. Assist the client in returning to the level of precrisis functioning.

d. Assist the client in returning to the level of precrisis functioning.

Which interventions should the nurse include in the plan of care for an acutely depressed client involved in cognitive-behavioral therapy? (Select all that apply.) a. Assisting the client to identify and test negative cognition b. Assisting the client to participate in the treatment process c. Assisting the client to develop alternative thinking patterns d. Assisting the client to rehearse new cognitive and behavioral responses e. Assisting the client with the administration of antidepressant medications f. Assisting the client's family to participate in group therapy on a regular basis

a. Assisting the client to identify and test negative cognition b. Assisting the client to participate in the treatment process c. Assisting the client to develop alternative thinking patterns d. Assisting the client to rehearse new cognitive and behavioral responses

A nurse is caring for a client who states, "I plan to commit suicide." Which of the following assessments should the nurse identify as the priority? a. Client's educational and economic background b. Lethality of the method and availability of means c. Quality of the client's social support d. Client's insight into the reasons for the decision

b. Lethality of the method and availability of means

The nurse cares for a hospitalized adolescent diagnosed with major depressive disorder. The health care provider prescribes a low-dose antidepressant. In consideration of published warnings about use of antidepressant medications in younger patients, which action should the nurse employ? a. Notify the facility's patient advocate about the new prescription. b. Teach the adolescent about Black Box warnings associated with antidepressant medications. c. Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior. d. Remind the health care provider about warnings associated with the use of antidepressants in children and adolescents.

c. Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior.

A client admitted 72 hours ago with a diagnosis of major depression presents for breakfast today appropriately dressed and well groomed, and appears to be calm and relaxed, yet more energetic than before. Which initial action should the nurse take after noting this client's behavior? a. Institute the unit's suicide precaution protocol. b. Notify the staff of these observations at today's team meeting. c. Alert the client's health care provider of these changes immediately. d. Ask the client directly about the presence of any suicide-related thoughts.

d. Ask the client directly about the presence of any suicide-related thoughts.

A nurse working in an acute care unit for adolescents diagnosed with mental illness says, "Our patients have so much energy. We need some physical activities for them." In recognition of needs for safety and exercise, which activity could the treatment team approve? a. Badminton tournament b. Competitive soccer matches c. Intramural basketball games d. Line dancing to popular music

d. Line dancing to popular music

A patient tells the nurse, "No matter what I do, I feel like there's always a dark cloud following me." Select the nurse's initial action. a. Assess the patient's current sleep and eating patterns. b. Explain to the patient, "Everyone feels down from time to time." c. Suggest alternative activities for times when the patient feels depressed. d. Say to the patient, "Tell me more about what you mean by 'a dark cloud'."

d. Say to the patient, "Tell me more about what you mean by 'a dark cloud'."

Which symptoms would the nurse expect to asses in a client experiencing serotonin syndrome? a. Confusion, restlessness, tachycardia, labile blood pressure, and diaphoresis b. Hypomania, akathisia, cardiac arrhythmias, panic attacks c. Dizziness, lethargy, headache, and nausea d. Orthostatic hypotension, urinary retention, constipation, blurred vision

a. Confusion, restlessness, tachycardia, labile blood pressure, and diaphoresis

During a mental status examination, the client states, "Glass breaks if you throw stones or shoot at it with a gun. My cousin shoots guns at the police all the time at target practice. People who live in glass houses shouldn't throw stones." How will the nurse appropriately document the client's speech? a. Speech is incoherent and tangential. b. Speech is illogical and loosely associated. c. Speech is distractible and contains flight of ideas. d. Speech is pressured and contains clang associations.

b. Speech is illogical and loosely associated.

A nurse is caring for a client who is taking phenelzine. For which of the following adverse effects should the nurse monitor? (select all that apply) a. elevated blood glucose level b. orthostatic hypotension c. priapism d. headache e. bruxism

b. orthostatic hypotension d. headache

A nurse is involved in a serious and prolonged mass casualy incident in the emergency department. Which of the following strategies should the nurse use to help prevent developing a trauma-related disorder? (select all that apply) a. avoid talking about the incident when it is over b. take a break during the incident for food and water c. debrief with others following the incident d. hold emotions in check in the days following the incident e. take advantage of offered counseling

b. take a break during the incident for food and water c. debrief with others following the incident e. take advantage of offered counseling

A patient experiencing depression says to the nurse, "My health care provider said I need 'talk' therapy but I think I need a prescription for an antidepressant medication. What should I do?" Select the nurse's best response. a. "Which antidepressant medication do you think would be helpful?" b. "There are different types of talk therapy. Most patients find it beneficial." c. "Let's consider some ways to address your concerns with your health care provider." d. "Are you willing to give 'talk therapy' a try before starting an antidepressant medication?"

c. "Let's consider some ways to address your concerns with your health care provider."

A client diagnosed with schizophrenia says to the nurse, "Will you protect me from the Grand Duchess?" and points to an older client who is sitting reading a book. Which statement is the therapeutic response by the nurse? a. "Where is she? I'll talk to her." b. "I can see no Grand Duchess. You will need to trust me on that." c. "You will be safe here. Your thinking will be clearer after your medication starts to work." d. "The Grand Duchess, huh? Well, I'm the Queen, and I will order her to stay away from you."

c. "You will be safe here. Your thinking will be clearer after your medication starts to work."

A community mental health nurse is planning care to address the issue of depression among older adult clients in the community. Which of the following interventions should the nurse plan as a method of tertiary prevention? a. Educating clients on health promotion techniques to reduce the risk of depression. b. Performing screenings for depression at community health programs. c. Establishing rehabilitation programs to decrease the effects of depression. d. Providing support groups for clients at risk for depression.

c. Establishing rehabilitation programs to decrease the effects of depression.

Laboratory work is prescribed for a client who has been experiencing delusions. When the nurse approaches the client to obtain a specimen of blood, the client begins to shout, "You're all vampires. Let me out of here!" Which nursing response addresses the client's anxiety? a. "What makes you think that I am a vampire?" b. "I'll leave and come back later for the specimen." c. "Do you remember discussing the lab work earlier?" d. "It must be frightening to think that others want to hurt you."

d. "It must be frightening to think that others want to hurt you."

A nurse leads a bereavement group. Which participant's comment best demonstrates that the work of grief has been successfully completed? a. "Our time together was too short. I only wish we had done more things together." b. "I know our life together was a blessing that I did not deserve. I wish I had said 'I love you' more often." c. "Other people knew my loved one as a good and helpful person. I hope people see me in the same way." d. "Our best vacations always involved water. When I see pictures of the ocean, those memories come flooding in."

d. "Our best vacations always involved water. When I see pictures of the ocean, those memories come flooding in."

For a nurse working in crisis intervention, which belief would be least helpful? a. A person in crisis is incapable of making his or her own decisions. b. The crisis counseling relationship is one between partners. c. Crisis counseling helps the patient refocus to gain new perspectives on the situation. d. Anxiety reduction techniques are used to enable the patient's inner resources to be accessed.

a. A person in crisis is incapable of making his or her own decisions.

A client with diabetes mellitus is told that amputation of the leg is necessary to sustain life. The client is very upset and tells the nurse, "This is all my health care provider's fault. I have done everything I've been asked to do!" Which nursing interpretation is best for this situation? a. An expected coping mechanism b. An ineffective defense mechanism c. A need to notify the hospital lawyer d. An expression of guilt on the part of the client

a. An expected coping mechanism

The nurse is creating a plan of care for a client diagnosed with depression whose food intake is poor. The nurse should include which interventions in the plan of care? (Select all that apply.) a. Assist the client in selecting foods from the food menu. b. Offer high-calorie fluids throughout the day and evening. c. Allow the client to eat alone in the room if the client requests to do so. d. Offer small high-calorie, high-protein snacks during the day and evening. e. Select the foods for the client to be sure that the client eats a balanced diet.

a. Assist the client in selecting foods from the food menu. b. Offer high-calorie fluids throughout the day and evening. d. Offer small high-calorie, high-protein snacks during the day and evening.

A patient who had a stroke 3 days ago tearfully tells the nurse, "What's the use in living? I'm no good to anybody like this." Which action should the nurse employ first when caring for a patient demonstrating hopelessness? a. Implement the institutional protocol for suicide risk. b. Support the patient to clarify and express feelings of grief. c. Educate the patient about the success of stroke rehabilitation. d. Offer the patient an opportunity to confer with the pastoral counselor.

a. Implement the institutional protocol for suicide risk.

The nurse is planning relapse prevention information for a client diagnosed with schizophrenia. The nurse understands that it is important to ensure which primary intervention? a. Including the client's support system in the teaching b. Facilitating weekly maintenance therapy for the client c. Having the client restate discharge goals and strategies d. Stressing the importance of client compliance with the medication plan

a. Including the client's support system in the teaching

The nurse is conducting a group therapy session. During the session, a client diagnosed with mania consistently disrupts the group's interactions. Which intervention should the nurse initially implement? a. Setting limits on the client's behavior b. Asking the client to leave the group session c. Asking another nurse to escort the client out of the group session d. Telling the client that they will not be able to attend any future group sessions

a. Setting limits on the client's behavior

A nurse is caring for a client who is prescribed lithium therapy. The client states that he wants to take ibuprofen for osteoarthritis pain relief. Which of the following statements should the nurse make? a. "That is a good choice. Ibuprofen does not interact with lithium." b. "Regular aspirin would be a better choice than ibuprofen." c. "Lithium decreases the effectiveness of ibuprofen." d. "The ibuprofen will make your lithium level fall too low."

b. "Regular aspirin would be a better choice than ibuprofen."

Statistically speaking, which two patients do you predict are at greatest risk for suicide? A. Ms. R, a 22-year-old grad student who is engaged B. Mr. M, a 34-year-old male with multiple sclerosis C. Mr. A, a 68-year-old Vietnam veteran with TBI D. Ms. G, a 25-year-old single Navajo mother who struggles with alcohol

C. Mr. A, a 68-year-old Vietnam veteran with TBI D. Ms. G, a 25-year-old single Navajo mother who struggles with alcohol

A patient diagnosed with bipolar disorder lives in the community and is showing early signs of mania. The patient says, "I need to go visit my daughter but she lives across the country. I put some requests on the Internet to get a ride. I'm sure someone will take me." What is the nurse's most therapeutic response? a. "I'm concerned about your safety when meeting or riding with strangers." b. "Have you asked friends and family to donate money for your airfare?" c. "You are not likely to get a ride. Let's consider some other strategies." d. "Have you asked your daughter if she wants you to come for a visit?"

a. "I'm concerned about your safety when meeting or riding with strangers."

A college student has been experiencing significant stress associated with academic demands. Last month, the student began attending yoga sessions three times a week. Which outcome indicates this activity has been successful? a. The student reports improved feelings of well-being. b. The student increases use of caffeine to enhance concentration. c. The student reports, "Now I am sleeping about 10 hours every day." d. The student says, "I withdrew from two courses to reduce my academic load."

a. The student reports improved feelings of well-being.

The nurse is performing an assessment on a client being admitted to the mental health unit. During the interview, the nurse discovers that the client suffered a severe emotional trauma 1 month earlier and is now experiencing paralysis of the right arm. Which is the initial nursing action? a. Refer the client to a psychiatrist. b. Encourage the client to move and use the arm. c. Assess the client for organic causes of the paralysis. d. Encourage the client to talk about his or her feelings.

c. Assess the client for organic causes of the paralysis.

A client admitted to the inpatient unit is being considered for electroconvulsive therapy (ECT). While the client is calm, the daughter anxiously tells the nurse, "My mother's brain will be shocked with electricity. How can the doctor even think about doing this to her?" Which response by the nurse will best address the daughter's concerns? a. "I think you need to speak directly to the psychiatrist." b. "Maybe you'll feel better if you see the ECT room and speak to the staff." c. "Your mother has decided to have this treatment. You should support her." d. "It sounds as though you are very concerned. Let's discuss the procedure."

d. "It sounds as though you are very concerned. Let's discuss the procedure."

The nurse in a high school meets with small groups of students the day after a school bus accident resulted in the death of five students. Which comment should the nurse use to begin the session? a. "Sometimes life is not fair. Yesterday's tragedy is an example of just how unfair it can be." b. "We're grateful that you are safe. Our discussion is to talk about feelings associated with yesterday's tragedy." c. "We've had a terrible loss. I also feel your pain. You need to talk about your feelings associated with the event." d. "Thank you for coming today. As school leaders, we know it is very important to respond to yesterday's tragedy."

b. "We're grateful that you are safe. Our discussion is to talk about feelings associated with yesterday's tragedy."

A nurse is speaking with a client who has schizophrenia when he suddenly seems to stop focusing on the nurse's questions and begins looking at the ceiling and talking to himself. Which of the following actions should the nurse take? a. Stop the interview at this point, and resume later when the client is better able to concentrate. b. Ask the client, "Are you seeing something on the ceiling?" c. Tell the client, "You seem to be looking at something on the ceiling. I see something there, too." d. Continue the interview without comment on the client's behavior.

b. Ask the client, "Are you seeing something on the ceiling?"

The nurse is monitoring a client diagnosed with schizophrenia who demonstrates a dysfunctional affect. Which situation is congruent with inappropriate affect? a. When told that a beloved pet has died, the client responds, "OK." b. The client giggled while describing being physically abused as a child. c. The client's facial expressions are unchanged during the entire admission process. d. When staff members attempt to engage the client in conversation, the client only mumbles.

b. The client giggled while describing being physically abused as a child.

The nurse has been closely observing a client who has been displaying aggressive behaviors. The nurse observes that the behavior displayed by the client is escalating. Which nursing intervention is most helpful to this client at this time? (Select all that apply.) a. Initiate confinement measures. b. Acknowledge the client's behavior. c. Assist the client to an area that is quiet. d. Maintain a safe distance from the client. e. Allow the client to take control of the situation.

b. Acknowledge the client's behavior. c. Assist the client to an area that is quiet. d. Maintain a safe distance from the client.

The nurse is planning care for a client who has a history of violent behavior and is at risk for harming others. Which intervention presents a need for follow-up because it could potentially present a danger to the client, health care providers, and others on the nursing unit? a. Facing the client when providing care b. Assigning the client to a room at the end of the hall c. Ensuring that a security officer is available at all times if needed d. Keeping the door to the client's room open when providing care to the client

b. Assigning the client to a room at the end of the hall

A nurse who has worked for a community hospice organization for 8 years says, "My patients and their families experience overwhelming suffering. No matter how much I do, it's never enough." Which problem should the nursing supervisor suspect? a. The nurse is experiencing spiritual distress. b. The nurse is at risk for burnout and compassion fatigue. c. The nurse is not receiving adequate recognition from others. d. The nurse is at risk for overhelping, which creates dependency.

b. The nurse is at risk for burnout and compassion fatigue.

The history assessment of a client diagnosed with schizophrenia confirms a routine that includes smoking two packs of cigarettes and drinking 10 cups of coffee daily. Considering the assessment data, the nurse recognizes which as placing the client at most risk for injury? a. Developing lung cancer and/or other respiratory disorders b. Withdrawal symptoms triggering a stress-induced relapse c. Diminishing the effectiveness of psychotropic medication d. Developing gastrointestinal disorders, including bleeding ulcers

c. Diminishing the effectiveness of psychotropic medication

A manic client begins to make sexual advances toward visitors in the dayroom. When the nurse firmly states that this is inappropriate and will not be allowed, the client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, which intervention should the nurse implement? a. Place the client in seclusion for 30 minutes. b. Tell the client that the behavior is inappropriate. c. Escort the client to their room, with the assistance of other staff. d. Tell the client that their telephone privileges are revoked for 24 hours.

c. Escort the client to their room, with the assistance of other staff.

A nurse is interviewing a 25-year-old client who has a new diagnosis of dysthymic disorder. Which of the following findings should the nurse expect? a. Wide fluctuations in mood b. Report of a minimum of five clinical findings of depression c. Presence of manifestations for at least 2 years d. Inflated sense of self-esteem

c. Presence of manifestations for at least 2 years

On the sixth anniversary of her spouse's death a widow says, "Sometimes life does not seem worth living anymore. I wish I could go to sleep and never wake up." Which response by the nurse has priority? a. "Are you considering suicide?" b. "You still have so much to live for." c. "Grief can sometimes last for many years." d. "Why do you continue to grieve something from long ago?"

a. "Are you considering suicide?"

The nurse is caring for a client who is at risk for suicide. What is the priority nursing action for this client? a. Provide authority, action, and participation. b. Display an attitude of detachment, confrontation, and efficiency. c. Demonstrate confidence in the client's ability to deal with stressors. d. Provide hope and reassurance that the problems will resolve themselves.

a. Provide authority, action, and participation.

The client who has schizoaffective disorder takes both haloperidol (Haldol) and Valproic Acid (Depakote). When the client asks the nurse to explain what this particular combination of drugs is expected to do, what would be the best response by the nurse? a. "Haloperidol (Haldol) makes your moods calmer and Valproic Acid (Depakote) prevents tight muscles." b. "This combination is good for people who have problems like yours." c. "Haloperidol improves your thinking and Valproic Acid stabilizes your moods." d. "This is an old combination of drugs that helps people keep thinking and feelings in balance."

c. "Haloperidol improves your thinking and Valproic Acid stabilizes your moods."

Supplemental Security Income (SSI) benefits typically cover needs based on which one of the following? a. Mental illness b. Unemployment c. Homelessness d. Economic need

d. Economic need

A nurse is caring for a client following the loss of her partner due to a terminal illness. Identify the sequence of Engel's five stages of grief that the nurse should expect the client to experience. (Arrange the stages of grief in order of occurence. All steps must be used.) a. Developing awareness b. Recovery c. Restitution d. Shock and disbelief e. Resolution of the loss

d. Shock and disbelief a. Developing awareness c. Restitution e. Resolution of the loss b. Recovery

During the assessment, what is the nurse's primary goal for a confused and disoriented client diagnosed with posttraumatic stress disorder? a. Explaining the unit rules b. Making the client feel safe c. Orienting the client to the unit d. Stabilizing the client's psychiatric needs

b. Making the client feel safe

The nurse is reviewing the record of a client scheduled for electroconvulsive therapy (ECT). Which medical diagnosis, if noted on the client's record, would indicate a need to contact the health care provider scheduled to perform the ECT? a. Type 2 diabetes mellitus b. Peripheral vascular disease c. Recent myocardial infarction d. Newly diagnosed hyperthyroidism

c. Recent myocardial infarction

A client diagnosed with depression is not eating adequately and at times even refuses to eat at all. What should the nurse plan to do to meet the client's nutritional needs? a. Force foods and fluids. b. Restrict social activities until food intake is increased. c. Promptly provide snacks and meals when the client requests them. d. Provide small, frequent meals that include the client's food preferences.

d. Provide small, frequent meals that include the client's food preferences.

What is the most appropriate nursing action to help manage a manic client who is monopolizing a group therapy session? a. Ask the client to leave the group for this session only. b. Refer the client to another group that includes other manic clients. c. Tell the client to stop monopolizing in a firm but compassionate manner. d. Thank the client for the input, but inform the client that others now need a chance to contribute.

d. Thank the client for the input, but inform the client that others now need a chance to contribute.

Andrew, a hospice nurse for 5 years and a member of your nursing team, is demonstrating a blunted affect and is not completing patient care documentation in the required time frame. As a peer, what is your best action? A. Avoid mentioning these observations because you are only a peer. B. Ask Andrew what he feels is causing him to fall behind in his work. C. Immediately report your concerns to the nurse manager in charge of your team. D. Take Andrew to lunch and keep the conversation light and humorous.

B. Ask Andrew what he feels is causing him to fall behind in his work.

Which statement made by an unlicensed assistive personnel (UAP) indicates to the registered nurse that the UAP understands the concepts related to suicide? a. "Discussing suicide with a client is not harmful." b. "Those clients who talk about suicide never do it." c. "Depressed clients are the only persons who commit suicide." d. "A suicide threat is a cry for attention from family and friends."

a. "Discussing suicide with a client is not harmful."

Which comment by a patient diagnosed with bipolar disorder best indicates the patient is experiencing mania? a. "I have been sleeping about 6 hours each night." b. "Yesterday I made 487 posts on my social network page." c. "I am having dreams about my father's death 8 years ago." d. "My appetite is so robust that I've gained 4 pounds in the past 2 weeks."

b. "Yesterday I made 487 posts on my social network page."

Mihn is taken to the emergency department by her parents. She has not showered in 4 days, refuses food, stating that it is "poisoned," and sits in her darkened room with music blaring. The psychiatrist tells Mihn's parents that she needs to be observed over several days. She is admitted to the psychiatric unit. Which phase of schizophrenia is Mihn most likely experiencing? a. Predromal b. Acute c. Stabilization d. Maintenance

b. Acute

A nurse is planning an intervention for a client in crisis who witnessed a violent crime. What key component of crisis intervention should the nurse plan to use at this time? a. Identify the client's maladaptive coping mechanisms b. Identify and support the client's coping patterns c. Assist the client in forgetting the crisis situation d. Teach the client to handle future crises

b. Identify and support the client's coping patterns

A nurse working in an outpatient clinic is providing teaching to a client who has a new diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following statements by the client indicates understanding of the teaching? a. "I can expect my problems with PMDD to be worst when I'm menstruating." b. "I will use light therapy 30 minutes a day to prevent further recurrences of PMDD." c. "I am aware that my PMDD causes me to have rapid mood swings." d. "I should increase my caloric intake with a nutritional supplement when my PMDD is active."

c. "I am aware that my PMDD causes me to have rapid mood swings."

In a hostile voice, a patient experiencing mania yells at the nurse: "You WILL listen to me and not interrupt. I have some really important stuff to say. I'm tired of you nurses and doctors acting like you have all the answers." To facilitate effective communication, which initial response should the nurse provide? a. "You are our patient, so we always listen to you." b. "I can talk with you better if you use a calm voice." c. "It's our job to help you get through this manic episode." d. "Patients have an important role in treatment planning."

c. "It's our job to help you get through this manic episode."

A charge nurse is discussing the care of a client who has major depressive disorder (MDD) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of th teaching? a. "Care during the continuation phase focuses on treating continued manifestations of MDD." b. "The treatment of MDD during the maintenance phase lasts for 6 to 12 weeks." c. "The client is at greatest risk for suicide during the first weeks of an MDD episode." d. "Medication and psychotherapy are most effective during the acute phase of MDD."

c. "The client is at greatest risk for suicide during the first weeks of an MDD episode."

Which assessment data would indicate that a client is most at risk for suicide? a. The client demonstrates impulsiveness. b. The client is disorganized in actions and thoughts. c. The client has an immediate plan for a suicide attempt. d. The client has a history of unsuccessful suicide attempts.

c. The client has an immediate plan for a suicide attempt.

A nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. When collecting a medical history from the client's adult daughter, which of the following statements is the priority to report to the provider? a. "My mother has diabetes that is controlled by her diet." b. "My mother recently completed a course of prednisone for acute bronchitis." c. "My mother received her flu vaccine last month." d. "My mother is currently on furosemide for her congestive heart failure."

d. "My mother is currently on furosemide for her congestive heart failure."

Social stigma related to mental illness refers to which one of the following statements? a. Mental illness is a disease process. b. Mental illness is inherited. c. Mental illness is a complex problem. d. Mental illness is due to wrong thinking.

d. Mental illness is due to wrong thinking.

Private insurance typically covers which one of the following? a. All illnesses regardless of duration b. All illnesses except mental illness c. All mental illnesses over a lifetime d. Mental illness with a lifetime cap

d. Mental illness with a lifetime cap

What statement should the nurse make to a client diagnosed with posttraumatic stress disorder who appears to be experiencing anxiety? a. "Try not to worry so much." b. "I can see that you are becoming upset." c. "Everything is going to be all right; just relax." d. "Why are you having trouble controlling your anxiety?"

b. "I can see that you are becoming upset."

Which activity is most appropriate for the nurse to introduce to a depressed client during the early part of hospitalization? a. Game of Trival Pursuit b. Project involving drawing c. Small aerobic exercise group d. Card game with three other clients

b. Project involving drawing

A depressed client on an inpatient unit says to the nurse, "My family would be better off without me." Which is the nurse's best response? a. "Have you talked to your family about this?" b. "Everyone feels this way when they are depressed." c. "You will feel better once your medication begins to work." d. "You sound very upset. Are you thinking of hurting yourself?"

d. "You sound very upset. Are you thinking of hurting yourself?"

A nurse is collecting an admission history for a client who has acute stress disorder (ASD). Which of the following information should the nurse expect to collect? a. the client remembers man details about the traumatic incident b. the client expresses heightened elation about what is happening c. the client states he first noticed manifestations of the disorder 6 weeks after the traumatic incident occurred d. the client expresses a sense of unreality about the traumatic incident

d. the client expresses a sense of unreality about the traumatic incident

A client arrives in the emergency department in a crisis state demonstrating signs of profound anxiety. What should the initial nursing assessment focus on? a. The object of the crisis b. The client's physical condition c. The client's coping mechanisms d. The presence of support systems

b. The client's physical condition

A client receiving Lithium Carbonate (Eskalith) complains of loose watery stools and difficulty walking. The nurse would expect the serum Lithium level to be which of the following? a. 0.7 mEq/L b. 1 mEq/L c. 1.3 mEq/L d. 1.8 mEw/L

d. 1.8 mEw/L

A client who is watching television in the dayroom shares with the nurse that he has begun seeing his mother being assaulted on the television screen. Which is the nurse's initial intervention? a. Turn off the television. b. Walk with the client around the unit. c. Discuss the possible hallucinatory triggers. d. Help him call his mother so he can speak with her.

a. Turn off the television.

A client diagnosed with schizophrenia takes Clozapine (Clozaril) 25 mg qd. Lab results reveal: RBC 4.7 million/mcL, WBC 2000/mcL, and TSH 1.3 mc-IU. Which would the nurse expect the physician to order? a. Levothyroxin Sodium (Synthroid) 150 mcg qd b. Ferrous Sulfate (Feosol) 100 mg tid c. Discontinue Clozapine d. Discontinue Clozapine and start Levothyroxine Sodium (Synthoid) 150 mcg qd

c. Discontinue Clozapine

Which pre-electroconvulsive therapy intervention will the nurse implement for a hospitalized client? a. Restrict the client smoking for 12 hours. b. Enforce nothing by mouth (NPO) status for 16 hours. c. Limit the client's participation in unit activities for 24 hours. d. Assure that an electrocardiogram is performed within 24 hours.

d. Assure that an electrocardiogram is performed within 24 hours.

The nurse notes documentation that a newly admitted client experiences flashbacks. What diagnosis would this notation support? a. Anxiety b. Agoraphobia c. Schizophrenia d. Posttraumatic stress disorder

d. Posttraumatic stress disorder

The nurse admits a patient experiencing hallucinations and delusional thinking to an inpatient mental health unit. The plan of care will require which service occurs first? a. Social history b. Psychiatric history c. Medical assessment d. Psychological evaluation

c. Medical assessment

The nurse suspects that the client hospitalized with a diagnosis of acute depression could benefit from further development of coping strategies. Which client statement supports this suspicion? a. "I know now that I can't be all things to all people all the time." b. "It is important for me to take my medications just as prescribed." c. "It's been good to learn better ways to deal with the stresses in my life." d. "I know that I won't become depressed again as long as I reduce my stressors."

d. "I know that I won't become depressed again as long as I reduce my stressors."

A client reports that men in blue clothes keep looking in her window and talking about her. Which of the following responses by the nurse is most appropriate? a. "Those men are groundskeepers. They're talking about their work, not you." b. "Don't take things so personally. Not everyone who is talking is talking about you." c. "Let's not pay attention to the men. Let's play cards instead." d. "I'll close the drapes so you can't see the men."

a. "Those men are groundskeepers. They're talking about their work, not you."

A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the charge nurse identify as being effectively treated by first-generation antipsychotics? (Select all that apply) a. Auditory hallucinations b. Withdrawal from social situations c. Delusions of grandeur d. Severe agitation e. Anhedonia

a. Auditory hallucinations c. Delusions of grandeur d. Severe agitation

The mental health nurse notes that a client diagnosed with schizophrenia is exhibiting flat affect. Which situation supports this documentation? a. During the entire family visit, the client presented with an expressionless, blank look. b. The client demonstrated minimal response to the news that his discharge had been postponed. c. The client grimaced during the entire therapy session that focused on finding one's personal joy. d. During grief therapy, the client was observed laughing while another client described the death of a parent.

a. During the entire family visit, the client presented with an expressionless, blank look.

The nurse is developing a daily care program for a depressed client who was just admitted to the mental health unit. Which is the best approach when planning activities for this client? a. Delay such planning until the client asks to participate in milieu. b. Encourage the client to play solitaire while providing a deck of cards. c. Provide a structured daily program of activities, and encourage the client to participate. d. Offer the client a menu of daily activities and insist that the client participate in all of them.

c. Provide a structured daily program of activities, and encourage the client to participate.

A nurse is working in a community mental health facility. Which of the following services does this type of program provide? (select all that apply) a. Educational groups b. Medication dispensing programs c. Individual counseling programs d. Detoxification programs e. Family therapy

a. Educational groups b. Medication dispensing programs c. Individual counseling programs e. Family therapy

The nurse is assigned to care for a chemically dependent client who has the potential for violent episodes. In planning care for the client, which action by the nurse should receive priority? a. Speaks slowly to the client b. Projects an attitude of calmness c. Bargains to prevent the violent episodes d. Moves quietly when approaching the client

b. Projects an attitude of calmness

The nurse is conducting an initial assessment of a client in crisis. When assessing the client's perception of the precipitating event that led to the crisis, which is the most appropriate question? a. "With whom do you live?" b. "Who is available to help you?" c. "What leads you to seek help now?" d. "What do you usually do to feel better?"

c. "What leads you to seek help now?"

A nurse begins a therapeutic relationship with a patient diagnosed with schizophrenia. The patient has severe paranoia. Which comment by the nurse is most appropriate? a. "Let's begin by talking about the goals you have for yourself." b. "I understand that you have problems with fear and suspiciousness of others." c. "As you get to know me better, I hope you will feel comfortable talking to me." d. "I am part of your treatment team. Our goal is to help stabilize your symptoms."

c. "As you get to know me better, I hope you will feel comfortable talking to me."

Mrs. Chauncey, 80 years old, is taking a selective serotonin reuptake inhibitor (SSRI) and Tylenol PM daily plus other medications. She has multiple, vague somatic complaints. This morning she complains of a "stomach ache" and "gas." What is your best initial nursing response? a. Tell her to increase her water intake. b. Perform a digital rectal examination for impaction. c. Document the complaint of abdominal pain. d. Assess bowel sounds in all four quadrants.

d. Assess bowel sounds in all four quadrants.

In formulating a discharge teaching plan, the nurse should include which precaution for a client who is prescribed lithium carbonate therapy? a. Avoid soy sauce, wine, and aged cheese. b. Have the blood lithium level checked every 2 weeks. c. Take the medication only as prescribed to avoid becoming addicted. d. Check with the psychiatrist before using any over-the-counter medications.

d. Check with the psychiatrist before using any over-the-counter medications.

A nurse is discussing normal grief with a client who recently lost a child. Which of the following statements made by the clint inicates understanding? (Select all that apply.) a. "I may experience feelings of resentment." b. "I will probably withdraw from others." c. "I can expect to experience changes in sleep." d. "It is possible that I will experience suicidal thoughts." e. "It is expected that I will have a loss of self-esteem."

a. "I may experience feelings of resentment." b. "I will probably withdraw from others." c. "I can expect to experience changes in sleep."

A parent tells the nurse about the death of a child 2 years ago. Which comment by this parent warrants the nurse's priority attention? a. "I still have some of my child's toys and clothes." b. "A parent should never live longer than their child." c. "I never returned to church again after the death of my child." d. "My child has been dead a long time, but it seems like only yesterday."

b. "A parent should never live longer than their child."

A woman experienced a double mastectomy yesterday. Now she cheerfully says to the nurse, "I didn't need those things anyway. No more wet T-shirt contests for me!" How should the nurse interpret this comment? a. The patient is realistically accepting her loss. b. The comment is sarcastic, which may reflect anger. c. The patient is experiencing a distorted body image. d. The comment suggests guilt regarding prior behavior.

b. The comment is sarcastic, which may reflect anger.

The nurse is working with a client in psychological distress. Which event experienced by the client would the nurse document as a situational crisis? a. Approaching the age of retirement b. Recently losing a job c. Being a survivor of a flood following a hurricane d. Recently returning home from military duty after an armed conflict

b. Recently losing a job

While entering the building, an elementary school nurse observes a person in the distance emerging from a forest and approaching the school. The person is dressed in black from head to toe, wearing a backpack and carrying a long, narrow, dark object. Which action should the nurse take first? a. Move to a secure location b. Observe the intruder's features c. Take note of the intruder's location d. Activate the school code for an intruder

a. Move to a secure location

A client newly admitted to an in-patient psychiatric unit is scanning the environment continuously. Which nursing intervention is most appropriate to address this client's behavior? a. Offer self to build a therapeutic relationship with the client b. Assist the client in formulating a plan of action for discharge c. Involve the family in discussions about dealing with the client's behaviors d. Reinforce the need for medication adherence on discharge

a. Offer self to build a therapeutic relationship with the client

A patient diagnosed with major depressive disorder tells the community mental health nurse, "I usually spend all day watching television. If there's nothing good to watch, I just sleep or think about my problems." What is the nurse's best action? a. Refer the patient for counseling with a recreational therapist. b. Ask the patient, "What kinds of program do you like to watch?" c. Suggest to the patient, "Are there some friends you could call instead?" d. Advise the patient, "Watching television and thinking about problems makes depression worse."

a. Refer the patient for counseling with a recreational therapist.

The nurse hands the medication cup to a client who is psychotic and exhibiting concrete thinking, and tells the client to take his medicine. The client takes the cup, holds it in his hand, and stares at it. What should the nurse do next? a. Tell the client to put the medicine in his mouth and swallow it with some water. b. Instruct the client to sit in the dayroom and wait for the nurse to assist him. c. Ask another staff member to stay with the client until he takes the medication. d. Say nothing and wait for the client to put the medication in his mouth and swallow it.

a. Tell the client to put the medicine in his mouth and swallow it with some water.

The nurse is performing an admission assessment on a client at high risk for suicide. Which assessment question will best elicit data related to this risk? a. "What are you feeling right now?" b. "Do you have a plan to commit suicide?" c. "How many times have you attempted suicide in the past?" d. "Why were your attempts at suicide unsuccessful in the past?"

b. "Do you have a plan to commit suicide?"

A nurse is caring for a client who is speaking in a loud voice with clenched fists. Which of the following actions should the nurse take? a. Insist that the client stop yelling. b. Request that other staff members remain close by. c. Move as close to the client as possible. d. Walk away from the client.

b. Request that other staff members remain close by.

An individual lives in a community adjacent to a military base. Loud jets fly overhead multiple times daily. The person tells the nurse, "They're so loud I can't hear myself think." What is the nurse's best first action? a. Direct the individual to report the jet noise to local authorities. b. Teach relaxation and stress reduction techniques to the individual. c. Assess the individual for sensory impairments, particularly auditory. d. Encourage the individual to form a community action group to oppose noise pollution.

b. Teach relaxation and stress reduction techniques to the individual.

Which behavior in a client with schizophrenia demonstrates the client's cognitive inability to appropriately process data from external stimuli? a. The client remains in the same physical position for hours. b. The client is convinced that the curtains are actually ghosts. c. The client looks for a cat when someone says, "It's raining cats and dogs." d. The client repeatedly asks, "Can you see my dead sister over by the door?"

b. The client is convinced that the curtains are actually ghosts.

A client with a history of anxiety appears to be in the second phase of crisis response. The nurse prepares for which client behavior? a. The client will show the initial signs that coping methods are failing. b. The client will employ new coping methods that will resolve the problem. c. The client will experience severe anxiety as a result of failed coping methods. d. The client will begin to implement coping methods that have been successful in the past.

b. The client will employ new coping methods that will resolve the problem.

The nurse observes that a client with a potential for violence is agitated, pacing up and down the hallway, and is making aggressive and belligerent gestures at other clients. Which statement would be most appropriate to make to this client? a. "You need to stop that behavior now." b. "You will need to be placed in seclusion." c. "You seem restless; tell me what is happening." d. "You will need to be restrained if you do not change your behavior."

c. "You seem restless; tell me what is happening."

Three days after beginning a new regime of haloperidol (Haldol) 10 mg BID, the nurse observes that a hospitalized patient is drooling, has stiff and extended extremities, and has skin that is damp and hot to the touch. The patient has difficulty responding verbally to the nurse. What is the nurse's correct analysis and action in this situation? a. A seizure is occurring; place the patient in a lateral recumbent position and monitor. b. Serotonin syndrome has developed; place an intravenous line and rapidly infuse D5½ NS. c. Neuroleptic malignant syndrome has developed; prepare the patient for immediate transfer to a medical unit. d. An acute dystonic reaction is occurring; promptly administer an intramuscular injection of diphenhydramine (Benadryl).

c. Neuroleptic malignant syndrome has developed; prepare the patient for immediate transfer to a medical unit.

A client in a manic state presents to the dayroom only partially dressed and is making sexual remarks and gestures toward the staff and other clients. Which is the initial nursing action? a. Instruct the client to go back to his room. b. Inform the client that such behavior will not be accepted. c. Instruct the other clients to go to their rooms immediately. d. Escort the client to his room to get appropriately dressed.

d. Escort the client to his room to get appropriately dressed.

An adult required a heart transplant 5 years ago. Multiple medical complications followed, resulting in persistent irritability, depression, and insomnia. The adult's spouse says, "I've walked on eggshells for five years, never knowing when something else will go wrong." What is the nurse's priority intervention regarding the spouse? a. Explore the spouse's feelings, showing care and compassion. b. Encourage the spouse to attend a community support group. c. Teach stress reduction and relaxation techniques to the spouse. d. Refer the spouse to the primary care provider for health assessment.

d. Refer the spouse to the primary care provider for health assessment.

What information regarding possible prognosis will the nurse provide to the parents of a 15-year-old newly diagnosed with schizophrenia? a. Their child will very likely experience difficulty in school. b. The prognosis for their child is good because he is so young. c. With medication, their child is not likely to experience relapses. d. Their child will be treated for an imbalance of the chemical dopamine.

d. Their child will be treated for an imbalance of the chemical dopamine.

A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which of the following responses should the nurse make? a. "Why do you feel the need to give money away?" b. "I am here to provide care and cannot accept this from you." c. "I can request that your case manager discuss appropriate charity options with you." d. "You should know that giving your money away is inappropriate."

b. "I am here to provide care and cannot accept this from you."

A client has recently been admitted for depression and suicidal ideations with a plan to hang himself. The nurse assesses the client most carefully for risk for attempting suicide at which time? a. When the client is silent and unlikely to tell anyone b. When the client is ready to go home and afraid of leaving the hospital c. When the client's family goes on vacation d. When the client begins to demonstrate clinical improvement

d. When the client begins to demonstrate clinical improvement

The nurse caring for a client diagnosed with severe depression is planning activities for the client. Which activity would be most appropriate for this client? a. Drawing b. Playing checkers c. Painting by numbers d. Putting a puzzle together

a. Drawing

What is the appropriate nursing intervention in dealing with a suicidal client? a. Provide authority, action, and participation. b. Display an attitude of detachment, confrontation, and efficiency. c. Demonstrate confidence in the client's ability to deal with stressors. d. Promote hope and reassurance that the problems will resolve themselves.

a. Provide authority, action, and participation.

The nurse observes that a client is pacing, agitated, and presenting aggressive gestures. The client's speech pattern is rapid, and affect is belligerent. Based on these observations, which is the nurse's immediate priority of care? a. Provide safety for the client and other clients on the unit. b. Provide the clients on the unit with a sense of comfort and safety. c. Assist the staff in caring for the client in a controlled environment. d. Offer the client a less stimulating area in which to calm down and gain control.

a. Provide safety for the client and other clients on the unit.

Which statement, made by a client who has recently experienced an emotional crisis, is most likely to assure the nurse that the client has returned to her precrisis level of functioning? a. "My husband tells me that I'm back to my old cheerful self." b. "My boss tells me that I'm being considered for a promotion and a raise." c. "When I find myself getting stressed, I immediately use the relaxation techniques I've learned." d. "I have a different perspective on life now. I'm more confident of my ability to handle any problem."

b. "My boss tells me that I'm being considered for a promotion and a raise."

The client diagnosed with mild depression says to the nurse, "I haven't had an appetite at all for the last few weeks." Which response by the nurse best assesses the client's nutritional issue? a. "The last few weeks?" b. "You haven't had an appetite at all?" c. "Have patience, it will take time for your appetite to improve." d. "When the medication begins to work, your appetite will return."

b. "You haven't had an appetite at all?"

A client who has a history of being sexually assaulted is found sucking her thumb while rocking in her bed and does not respond to verbal communication. The nurse should recognize that this behavior demonstrates which coping mechanism? a. Fantasy b. Regression c. Displacement d. Compensation

b. Regression

Ms. T., a single mother of four, comes to the crisis center 24 hours after an apartment fire in which all the family's household goods and clothing were lost. Ms. T. has no family in the area. Her efforts to mobilize assistance have been disorganized, and she is still without shelter. She is distraught and confused. The nurse assesses the situation as which of the following types of crisis? A. Maturational crisis B. Situational crisis C. Adventitious crisis D. Evidence of an inadequate personality

C. Adventitious crisis

A patient has a long history of bipolar disorder with frequent episodes of mania secondary to stopping prescribed medications. The patient says, "I will use my whole check next month to buy lottery tickets. Winning will solve my money problems." Select the nurse's best action. a. Educate the patient about the low odds of winning the lottery. b. Present reality by saying to the patient, "That is not good use of your money." c. Confer with the treatment team about appointing a legal guardian for the patient. d. Tell the patient, "If you buy lottery tickets, your money will run out before the end of the month."

c. Confer with the treatment team about appointing a legal guardian for the patient.

An 8-year-old tells a parent, "I like to scare kids at school by showing them pictures of clowns. Some kids are terrified." How should the nurse counsel the parents regarding this behavior? a. Recommend family therapy for the child, siblings, and parents. b. Suggest the parents enroll the child in an anger management program. c. Educate both parents about bullying, including possible origins and long-term effects. d. Teach the parents about the developmental phase and tasks for an 8-year-old child.

c. Educate both parents about bullying, including possible origins and long-term effects.

A 28-year-old second-grade teacher is diagnosed with major depressive disorder. She grew up in Texas but moved to Alaska 10 years ago to separate from an abusive mother. Her father died by suicide when she was 12 years old. Which combination of factors in this scenario best demonstrates the stress-diathesis model? a. Cold climate coupled with history of abuse b. Current age of 28 coupled with family history of depression c. Family history of mental illness coupled with history of abuse d. Female gender coupled with the stressful profession of teaching

c. Family history of mental illness coupled with history of abuse

Mr. Quang is dancing under the overhead television of the crisis stabilization unit and taunting the other patients in the room. He shouts, "I own the TV networks, so they have to do what I say!" As Mr. Quang's nurse, what is your best initial intervention at this time? a. Leave him alone, and remove the other patients. b. Tell Mr. Quang that he has to obey the rules, or he will be restrained. c. Medicate Mr. Quang with an anxiolytic agent, and place him in seclusion. d. Calmly motion for Mr. Quang to come with you to the dining room for a snack.

d. Calmly motion for Mr. Quang to come with you to the dining room for a snack.

A patient on an acute psychiatric unit removed the cap from the ceiling sprinkler, resulting in rapid flooding of the unit. After moving patients to a safe area, which action should the nurse take next? a. Conduct individual sessions with patients regarding the experience. b. Increase the volume of overhead music to distract patients from the event. c. Implement a psychomotor activity to reduce anxiety associated with the event. d. Lead a group session with patients to discuss feelings associated with the event.

d. Lead a group session with patients to discuss feelings associated with the event.

During a client's periods of extreme mania and hyperactivity, how should the nursing staff provide for the client's nutritional needs? a. Accept the fact that the client will eat if hungry b. Follow the client around the dining room with a tray c. Allow the client to prepare own meals to eat when desired d. Provide the client with frequent, high-calorie feedings that can be hand-held

d. Provide the client with frequent, high-calorie feedings that can be hand-held

The nurse assigned to care for a female client diagnosed with acute depression would be appropriate in making which statement to the client? a. "You look lovely today." b. "You're wearing a new blouse." c. "Don't worry; everyone gets depressed once in a while." d. "You will feel better when your medication starts to work."

b. "You're wearing a new blouse."

When planning discharge care for a client diagnosed with bipolar disorder, the nurse determines the need for further teaching when the client makes which statement? a. "I hope I am going to like my new counselor." b. "I sure hope I will still be productive at work." c. "I am going to keep a close check on any stress I have in my life." d. "I will take the medicine until I am sure I can handle my own problems."

d. "I will take the medicine until I am sure I can handle my own problems."

A hospitalized client is receiving clozapine for the treatment of a schizophrenic disorder. The nurse determines that the client may be having an adverse reaction to the medication if abnormalities are noted on which laboratory study? a. Platelet count b. Cholesterol level c. Blood urea nitrogen d. White blood cell count

d. White blood cell count

A nurse is providing teaching to a client who has a new prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching? a. "While taking this medication, I'll need to stay out of the sun to avoid a skin rash." b. "I may feel drowsy for a few weeks after starting this medication." c. "I cannot eat my favorite pizza with pepperoni while taking this medication." d. "This medication will help me lose the weight that I have gained over the last year."

b. "I may feel drowsy for a few weeks after starting this medication."

A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? (select all that apply) a. Decreased level of consciousness b. Drooling c. Involuntary arm movements d. Urinary retention e. Continual pacing

b. Drooling c. Involuntary arm movements e. Continual pacing

A client recently prescribed fluphenzaine (Prolixin) complains to the nurse of severe muscle spasms. On examination, heart rate is 110, BP is 160/93 mmHg, and temperature is 101.5 F. Which nursing intervention takes priority? a. Check the chart for a prn order of benztropine mesylate (Cogentin) because of increased EPSs b. Hold the next dose of fluphenazine and call the physician immediately to report the findings c. Schedule an examinaton with the client's physician to evlaute cardiovascular fnction d. Ask the client about any recreational drug use, and ask the physician to order a drug screen

b. Hold the next dose of fluphenazine and call the physician immediately to report the findings

During the admission assessment process, the nurse observes that a client diagnosed with paranoid schizophrenia has multiple dental caries and mouth ulcers. The client denies oral pain or difficulty eating and does not present any concern over the nurse's finding. The nurse recognizes the client's response as most likely the result of which client factor? a. Apathy b. Impaired pain perception c. Distrust of authority figures d. Poor verbal communication skills

b. Impaired pain perception

A nurse is conducting chart reviews of multiple clients at a community mental health facility. Which of the following events is an example of client experiencing a maturational crisis? a. rape b. marriage c. severe physical illness d. job loss

b. marriage

An experienced nurse in a major medical center requests a transfer from a general medical unit to an acute care psychiatric unit. Which organizational feature would best support this nurse's successful transition? a. Assignment to medication administration for the first 6 months b. Working with a seasoned mental health technician for the first month c. Co-assignment with a knowledgeable psychiatric nurse for an extended orientation d. Staff development activities focused on developing therapeutic communication skills

c. Co-assignment with a knowledgeable psychiatric nurse for an extended orientation

Which goal addresses the therapeutic management needs of a client experiencing hallucinations? a. Support the client through the hallucination in a caring, therapeutic manner. b. Provide the client with insight as to why he or she is experiencing the hallucination. c. Facilitate the client's awareness that the hallucination is not the reality of the world. d. Help the client to ignore the hallucination through appropriate coping mechanisms.

c. Facilitate the client's awareness that the hallucination is not the reality of the world.

The nurse is caring for a client diagnosed with schizophrenia who states, "I decided not to take my medication because I realize that it really can't help me. Only I can help me." Which question asked by the nurse has the best therapeutic value? a. "Why do you think this is a wise decision?" b. "I don't understand. Only you can help you?" c. "You've decided not to take your medication. Is that right?" d. "Do you recall what it was like before you started your medication?"

d. "Do you recall what it was like before you started your medication?"

The client who is actively hallucinating is fearful that the voices will direct him to kill himself. Which therapeutic statement should the nurse make at this time? a. "I can hear the voices too, but ignore them and just go to bed now." b. "I know whose voices you are hearing and told them not to hurt you." c. "I know you believe they are going to cause you harm, but it's not true." d. "I don't hear them, but it must be frightening to hear voices that others can't hear."

d. "I don't hear them, but it must be frightening to hear voices that others can't hear."

Mrs. Chauncey receives a visit from her priest. He runs out of her room and then pulls the nurse assistant back into her room. Mrs. Chauncey is cutting her left wrist (superficially) with the 5 x 7 glass from a framed photo of a grandchild. She is taken to the emergency department, where her wrist is bandaged. Her daughter and son-in-law are notified. As her nurse, which of the following statements help clarify what has taken place? a. "Don't worry, I think your mom is just confused." b. "Your mom has been more withdrawn over the last few days." c. "I am very concerned that your mom is suicidal." d. "When your mom's priest arrived, he found her cutting her wrist with the glass from a framed photo."

d. "When your mom's priest arrived, he found her cutting her wrist with the glass from a framed photo."

A nurse is conducting group therapy with a group of clients. Which of the following statements made by a client is an example of agressive communication? a. "I wish you would not make me angry." b. "I feel angry when you leave me." c. "It makes me angry when you interrupt me." d. "You'd better listen to me."

d. "You'd better listen to me."

A patient was diagnosed with bipolar disorder many years ago. The patient tells the nurse, "When I have a manic episode, there's always a feeling of gloom behind it and I know I will soon be totally depressed." What is the nurse's best response? a. "Most patients diagnosed with bipolar disorder report the same types of feelings." b. "Feelings of gloom associated with depression result from serotonin dysregulation." c. "If you take your medication as it is prescribed, you will not have those experiences." d. "Your comment indicates you have an understanding and insight about your disorder."

d. "Your comment indicates you have an understanding and insight about your disorder."

The nursing care plan indicates a problem of self-directed violence and the risk for suicide, related to suicidal ideations with a specific plan. The nurse develops a plan of care for the client and identifies which expected client outcome? a. Displays less anxiety and agitation b. Denies presence of suicidal ideations c. Develops adequate problem solving skills d. Establishes a relationship with staff and peers

b. Denies presence of suicidal ideations

A client says to the nurse, "The federal guards were sent to kill me." Which is the best response by the nurse to the client's concern? a. "I don't believe this is true." b. "The guards are not out to kill you." c. "Do you feel afraid that people are trying to hurt you?" d. "What makes you think the guards were sent to hurt you?"

c. "Do you feel afraid that people are trying to hurt you?"

A hospitalized client experiencing delusions reports to the nurse, "I know that the doctor is talking to the top man in the mob to get rid of me." Which response should the nurse make to the client? a. "I don't believe this is true." b. "The doctor is not talking to the mob." c. "Do you feel afraid that people are trying to hurt you?" d. "What makes you think the doctor wants to get rid of you?"

c. "Do you feel afraid that people are trying to hurt you?"

A nurse is teaching a newly licensed nurse about the use of ECT for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? a. "ECT is the recommended initial treatment for bipolar disorder." b. "ECT is contraindicated for clients who have suicidal ideation." c. "ECT is effective for clients who are experiencing severe mainia." d. "ECT is prescribed to prevent relapse of bipolar disorder."

c. "ECT is effective for clients who are experiencing severe mainia."

A client is admitted to the mental health unit with a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention? a. Encouraging quiet reading and writing for the first few days b. Identification of physical activities that will provide exercise c. No socializing activities, until the client asks to participate in milieu d. A structured program of activities in which the client can participate

d. A structured program of activities in which the client can participate

A physician informed an adult of the results of diagnostic tests that showed lung cancer. Later in the day the patient says to the nurse, "My doctor said I have breathing problems, right?" Which nursing diagnosis is applicable? a. Denial related to acceptance of new diagnosis b. Chronic sorrow related to unresolved life conflicts c. Situational low self-esteem related to stress of new diagnosis d. Acute confusion related to metastatic changes to cerebral function

a. Denial related to acceptance of new diagnosis

A veteran of the war in Afghanistan tells the nurse, "Everyday, something happens that makes me feel like I'm still there. My family has grown impatient with me. They say it's time for me to move on from that time in my life but I can't." What is the nurse's first priority? a. Assess the veteran for suicide risk. b. Refer the veteran for specialized mental health services. c. Assess the veteran for evidence of traumatic brain injury. d. Refer the veteran's family to a posttraumatic stress disorder group.

a. Assess the veteran for suicide risk.

A patient smiles broadly at the nurse and says, "Look at my clean teeth. I brushed them with scouring power because the label said, 'It brightens and whitens everything.'" Which term should the nurse include when documenting this encounter? a. Circumstantiality b. Concrete thinking c. Poverty of speech d. Associative looseness

b. Concrete thinking

A charge nurse is reviewing Kubler-Ross: Five Stages of Grief with a group of newly licensed nurses. Which of the following stages should the charge nurse include in the teaching? (Select all that apply.) a. Disequilibrium b. Denial c. Bargaining d. Anger e. Depression

b. Denial c. Bargaining d. Anger e. Depression

The nurse creating a plan of care for the client demonstrating paranoia should include which interventions in the plan of care? (Select all that apply.) a. Ask permission before touching the client. b. Provide a warm, social approach to the client. c. Eliminate all unnecessary physical contact with the client. d. Defuse any anger or verbal attacks with a nondefensive stance. e. Use simple and clear language when communicating with the client.

a. Ask permission before touching the client. c. Eliminate all unnecessary physical contact with the client. d. Defuse any anger or verbal attacks with a nondefensive stance. e. Use simple and clear language when communicating with the client.

A suicidal client is placed on one-to-one observation. When the nurse accompanies the client to the bathroom, the client loudly shouts, "I'm sick of being followed around and treated like a child who can't be trusted." What would be the best response by the nurse? a. "I understand that you don't like this but I must be able to see you at all times to make sure you are safe." b. "You don't have to be so loud, I do trust you, but I can't change the rules for you." c. "Since this is upsetting you, leave the door open and I'll wait outside it for you." d. "Being angry and uncooperative won't change anything. I can't leave a suicidal client alone."

a. "I understand that you don't like this but I must be able to see you at all times to make sure you are safe."

A client admitted to the mental health unit after attacking his father for disturbing him at his computer, interrupts the nurse during morning rounds and says, "I need to get out of here so I can work on my computer project to save the world!" Which nursing response will have the greatest therapeutic impact? a. "I will be back to talk with you in 15 minutes after I complete nursing rounds." b. "You hurt your father, and you won't leave here until you can control yourself better." c. "You have a project to save the world? I'd really like to hear about that after I finish rounds." d. "Well, sit right down and eat your breakfast. You're not going to save the world on an empty stomach."

a. "I will be back to talk with you in 15 minutes after I complete nursing rounds."

A nurse is assessing a client who has major depressive disorder. The nurse should identify which of the following client statements as an overt comment about suicide? (select all that apply) a. "My family will be better off if I'm dead." b. "The stress in my life is too much to handle." c. "I wish my life was over." d. "I don't feel like I can ever be happy again." e. "If I kill myself then my problems will go away."

a. "My family will be better off if I'm dead." c. "I wish my life was over." e. "If I kill myself then my problems will go away."

A charge nurse is discussing mirtazapine with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? a. "This medication increases the release of serotonin and norepineprhine." b. "I will need to monitor the client for hyponatremia while taking this medication." c. "This medication is contraindicated for clients who have an eating disorder." d. "Sexual dysfunction is a common adverse effect of this medication."

a. "This medication increases the release of serotonin and norepineprhine."

A client with a potential for violence is exhibiting aggressive gestures, making belligerent comments to the other clients, and is continuously pacing in the hallway. Which comment by the nurse would be therapeutic at this time? a. "What is causing you to behave so agitated?" b. "Why are you intent on upsetting the other clients?" c. "Please stop so I don't have to put you in seclusion." d. "You are going to be restrained if you do not change your behavior."

a. "What is causing you to behave so agitated?"

A nurse is caring for a client who lost his mother to cancer last month. The client states, "I'd still have my mother if the doctor would have diagnosed her sooner." Which of the following responses should the nurse make? a. "You sound angry. Anger is a normal feeling associated with loss." b. "I think you would feel better if you talked about your feelings with a support group." c. "I understand just how you feel. I felt the same when my mother died." d. "Do other members of your family also feel this way?"

a. "You sound angry. Anger is a normal feeling associated with loss."

A client diagnosed with acute depression says to the nurse, "Things would be so much better for everyone if I just weren't around." Which response should the nurse make at this time to assess the client's state of mind? a. "You sound very unhappy. Are you thinking of harming yourself?" b. "Have you talked to anyone specifically about what is bothering you?" c. "Those feelings will go away when your medication really takes effect." d. "I know what you mean; everyone gets that way when they are depressed."

a. "You sound very unhappy. Are you thinking of harming yourself?"

A client diagnosed with depression is scheduled to receive three sessions of electroconvulsive therapy. The nurse should tell the client that he or she will likely start to see improvement in approximately what time frame? a. 1 week after the 3rd treatment session b. 3 weeks after the treatment sessions begin c. Midway between the 2nd and 3rd treatment session d. 8 weeks after the treatment sessions are completed

a. 1 week after the 3rd treatment session

The nurse recognizes which assessment and diagnostic data as being associated with a newly diagnosed schizophrenic client? (Select all that apply.) a. A birthday of March 30 b. A loss of interest in hobbies c. A suicide attempt 6 months ago d. Adopted by family at age 14 months e. Brain scan shows increased blood flow to the frontal lobes f. Magnetic resonance imaging shows temporal lobe atrophy

a. A birthday of March 30 b. A loss of interest in hobbies c. A suicide attempt 6 months ago f. Magnetic resonance imaging shows temporal lobe atrophy

Which statement about crisis theory provides a basis for nursing intervention? a. A crisis is an acute, time-limited phenomenon experienced as an overwhelming emotional reaction to a problem perceived as unsolvable. b. A person in crisis usually has had adjustment problems and has inadequately coped in his or her usual life situations. c. Crisis is precipitated by an event that enhances the person's self-concept and self-esteem. d. Nursing intervention in crisis situations rarely has the effect of ameliorating the crisis.

a. A crisis is an acute, time-limited phenomenon experienced as an overwhelming emotional reaction to a problem perceived as unsolvable.

A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the client's lithium blood level is 1.2 mEq/L. Which of the following actions should the nurse take? a. Administer the next dose of lithium carbonate as scheduled. b. Prepare for administration of aminophylline. c. Notify the provider for a possible increase in the dosage of lithium carbonate. d. Request a stat repeat of the client's lithium blood level.

a. Administer the next dose of lithium carbonate as scheduled.

What is your best intervention when you assess that a patient is responding to an auditory hallucination? a. Ask the patient, "Can you tell me what you are hearing?" b. Ask the patient, "Are you afraid of the voice you are hearing?" c. Tell the patient, "Try to ignore the voices you hear." d. Tell the patient, "The voices you hear are not real."

a. Ask the patient, "Can you tell me what you are hearing?"

A patient diagnosed with schizophrenia says, "I hear the voices every day. They always say bad things about me." Which action by the nurse has the highest priority? a. Assess the patient for suicidal thinking and plans. b. Review the patient's medication regime and compliance. c. Educate the patient about symptoms associated with schizophrenia. d. Suggest distracters for the patient to use when auditory hallucinations occur.

a. Assess the patient for suicidal thinking and plans.

Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? (Select all that apply.) a. Communicate expected behaviors to the client. b. Ensure that the client knows that they are not in charge of the nursing unit. c. Assist the client in identifying ways of setting limits on personal behaviors. d. Follow through about the consequences of behavior in a nonpunitive manner. f. Enforce rules by informing the client that he/she will not be allowed to attend therapy groups. g. Have the client state the consequences for behaving in ways that are viewed as unacceptable.

a. Communicate expected behaviors to the client. c. Assist the client in identifying ways of setting limits on personal behaviors. d. Follow through about the consequences of behavior in a nonpunitive manner. g. Have the client state the consequences for behaving in ways that are viewed as unacceptable.

A nurse is assisting with the development of protocols to address the increasing number of suicide attempts in the community. Which of the following interventions should the nurse include as a primary intervention? (select all that apply) a. Conducting a suicide risk screening on all new clients b. Creating a support group for family members of clients who completed suicide c. Educating high school teens about suicide prevention d. Initiating one-on-one observation for a client who has current suicidal ideation e. Teaching middle-school educators about warning indicators of suicide

a. Conducting a suicide risk screening on all new clients c. Educating high school teens about suicide prevention e. Teaching middle-school educators about warning indicators of suicide

The nurse is planning to instruct a mental health client and the family about the importance of medication compliance. The nurse should plan for which interventions that are associated with increased compliance? (Select all that apply.) a. Including the family in the medication planning process b. Arranging medication administration to occur once per day c. Working with the psychiatrist to find the right medication at the right dose d. Providing the client with the injectable, long-acting form of the medication if available e. Working with the psychiatrist to find the medication that provides the least side effects for the client

a. Including the family in the medication planning process c. Working with the psychiatrist to find the right medication at the right dose d. Providing the client with the injectable, long-acting form of the medication if available e. Working with the psychiatrist to find the medication that provides the least side effects for the client

Three weeks after being assaulted by a patient, a nurse develops headaches, insomnia, and gastrointestinal problems. The nurse has four absences from work over a 2-week period. Which action should the nursing supervisor employ? a. Refer the nurse for counseling and support. b. Ask the nurse about current personal problems. c. Direct the nurse to take paid vacation for the following week. d. Schedule the nurse for administrative tasks rather than patient care.

a. Refer the nurse for counseling and support.

Which behavior observed by the nurse indicates a suspicion that a depressed adolescent client may be suicidal? a. The adolescent gives away a DVD and a cherished autographed picture of a performer. b. The adolescent runs out of the therapy group, swearing at the group leader, and to her room. c. The adolescent becomes angry while speaking on the telephone and slams down the receiver. d. The adolescent gets angry with her roommate when the roommate borrows the client's clothes without asking.

a. The adolescent gives away a DVD and a cherished autographed picture of a performer.

Which situation will present the most prominent problem when attempting to manage the outpatient care of a client diagnosed with schizophrenia? a. The client's noncompliance with medication therapy b. The community's opposition to outpatient mental health clinics c. The associated increased risk that the client may become homeless d. The family's negative reaction to transferring the client to community-based care

a. The client's noncompliance with medication therapy

The nurse is developing a plan of care for a client who believes the unit's food is being poisoned. Which strategy should the nurse plan to implement that will encourage the client to discuss feelings? a. Use open-ended questions and silence. b. Encourage the client's family to bring in food. c. Focus on the fact that the client's beliefs are untrue. d. Instruct the client about the need for adequate nutrition.

a. Use open-ended questions and silence.

A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat? a. Using open-ended questions and silence b. Sharing personal preference regarding food choices c. Documenting reasons why the client does not want to eat d. Offering opinions about the necessity of adequate nutrition

a. Using open-ended questions and silence

Which client behavior is indicative of negative symptoms associated with schizophrenia? (Select all that apply.) a. Verbal communication is almost nonexistent. b. Gross motor skills are impacted by involuntary body movements. c. The client needs frequent redirection because of short attention span. d. Interpersonal relationships are negatively impacted because of delusional thoughts. e. Conversations are difficult to follow because of demonstration of loose associations of thought.

a. Verbal communication is almost nonexistent. c. The client needs frequent redirection because of short attention span.

A nurse is working with a client who has recently lost his mother. The nurse recognizes that which of the following factors influence a client's grief and coping ability? (Select all that apply.) a. interpersonal relationships b. culture c. birth order d. religious beliefs e. prior experience with loss

a. interpersonal relationships b. culture d. religious beliefs e. prior experience with loss

A nurse is teaching a client who has a new prescription for imipramine how to minimize anticholinergic effects. Which of the following instructions should the nurse include in the teaching? (select all that apply) a. void just before taking the medication b. increase the dietary intake of potassium c. wear sunglasses when outside d. change positions slowly when getting up e. chew sugarless gum

a. void just before taking the medication c. wear sunglasses when outside e. chew sugarless gum

A client with chronic schizophrenia has been receiving an atypical antipsychotic for three months. The nurse concludes that the client is experiencing a reduction in negative symptoms of schizophrenia if a family members says which of the following? (select all that apply) a. "We walked together for 15 minutes, and I could see no evidence he was 'hearing voices.'" b. "For the past week, he has gotten up, dressed, and taken a walk early each morning." c. "It's ben more than a month since he said that he is a Martian prince." d. "We went to a musucal concert, and he smiled and applauded the muscicians."

b. "For the past week, he has gotten up, dressed, and taken a walk early each morning." d. "We went to a musucal concert, and he smiled and applauded the muscicians."

A client is admitted with a recent history of severe anxiety following a home invasion and robbery. During the initial assessment interview, which statement by the client should indicate to the nurse the possible diagnosis of posttraumatic stress disorder? (Select all that apply.) a. "I'm afraid of spiders." b. "I keep reliving the robbery." c. "I see his face everywhere I go." d. "I don't want anything to eat now." e. "I might have died over a few dollars in my pocket." f. "I have to wash my hands over and over again many times."

b. "I keep reliving the robbery." c. "I see his face everywhere I go." e. "I might have died over a few dollars in my pocket."

A female nurse is appointed to a committee with seven men. At the beginning of the meeting, the chairman asks the nurse to be the secretary. The nurse responds, "No. You're just asking me to be secretary because I'm the only the woman here." Which response would have been more effective? a. "There are others more qualified than I am to be secretary." b. "I would be glad to perform another role for our committee." c. "I'm probably overreacting, but I find your request offensive." d. "Thank you for asking, but your request is sexually discriminatory."

b. "I would be glad to perform another role for our committee."

A client whose wife recently died of cancer says to the home care nurse, "I can't believe that my wife died yesterday. I keep expecting to see her everywhere I go in this house." What is the therapeutic nursing response? a. "It will take time to adjust to your terrible loss." b. "It must be hard to accept that she has passed away." c. "Try to focus on the fact that you and your wife loved one another for years." d. "Focus on the fact that her suffering is over and that she had a good life with you."

b. "It must be hard to accept that she has passed away."

Which statement indicates that a patient has successfully mourned a loss in his or her life? a. "She was so strong after her husband died. She never cried the whole time. She kept a stiff upper lip." b. "She was a wreck when her sister died. She cried and cried. It took her about a year before she resumed her usual activities with any zest." c. "You know, he still talks about his mother as if she were alive today, and she's been dead for 4 years." d. "He never talked about his wife after she died. He just picked up and went on life's way."

b. "She was a wreck when her sister died. She cried and cried. It took her about a year before she resumed her usual activities with any zest."

The parents of a 20 year old female client diagnosed with paranoid schizophrenia admitted 4 days ago are attending a family psychoeducation group in the hospital. Which of the following statements by the mother indicates that she understands her daughter's illness and management? a. "I know that I'll have to do everything for my daughter when she comes home." b. "Tasks as simple as getting out of bed and showering in the morning may be difficult for her." c. "I know that visits from her friends at home should be discouraged for a while." d. "She won't experience a relapse as long as sh takes her prescribed medication."

b. "Tasks as simple as getting out of bed and showering in the morning may be difficult for her."

A client who has recently lost her spouse says, "No one cares about me anymore. All the people I loved are dead." Which response demonstrates an understanding of therapeutic communication when dealing with a grieving client? a. "I certainly care about you." b. "You must be feeling all alone at this point." c. "I don't believe that, and neither should you." d. "It isn't unusual to feel alone when you are grieving."

b. "You must be feeling all alone at this point."

A nurse is caring for a group of clients. Which of the following clients should a nurse consider for referral to an assertive community treatment (ACT) group? a. A client in an acute mental health facility who has falled several times while running down the hallway b. A client who lives at home and keeps "forgetting" to come in for his monthly antipsychotic injection for schizophrenia c. A client in a day treatment program who says he is becoming more anxious during group therapy d. A client in a weekly grief support group who says she still misses her deceased husband who has been dead for 3 months

b. A client who lives at home and keeps "forgetting" to come in for his monthly antipsychotic injection for schizophrenia

An adult with paranoia becomes agitated and threatens to assault a staff person. Select the best initial nursing intervention. a. Tell the patient, "If you do not calm down, seclusion will be needed." b. Address the patient with simple directions and a calming voice. c. Help the patient focus by rubbing the patient's shoulders. d. Offer the patient a dose of antipsychotic medication. e. Reorient the patient to the time and place.

b. Address the patient with simple directions and a calming voice.

Mrs. H, 87, is anxious. She tells you she must go home immediately, saying: "My twins need me. They're barely a year old!" Select the best response. a. Help reorient her by explaining patiently that she is too old now to still have babies. b. Ask her questions to describe her need to go home and sympathize with how hard it can be to be away from home. c. Implement withdrawal and promise to return in 10 minutes when she is calmer and more rational. d. Reward her with attention when she focuses on reality.

b. Ask her questions to describe her need to go home and sympathize with how hard it can be to be away from home.

Which behavior demonstrated by a client diagnosed with depression indicates a need for suicide precautions? a. Refuses to attend group therapy b. Asks about how to get a will notarized c. Argues with family members during visiting hours d. Becomes easily agitated when roommate changes the television channel

b. Asks about how to get a will notarized

A patient diagnosed with schizophrenia complains to the nurse about persistent feelings of restlessness and says, "I feel like I need to move all the time." What is the nurse's next action? a. Add an activity group to the patient's plan of care. b. Assess the patient for other extrapyramidal symptoms. c. Perform a full mental status evaluation of the patient. d. Educate the patient about psychomotor agitation associated with schizophrenia.

b. Assess the patient for other extrapyramidal symptoms.

A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in the teaching? (select all that apply) a. Use caffeine in moderation to prevent relapse. b. Difficulty sleeping can indicate a relapse. c. Begin taking your medications as soon as a relapse begins. d. Participating in psychotherapy can help prevent a relapse. e. Anhedonia is a clinical manifestation of a depressive relapse.

b. Difficulty sleeping can indicate a relapse. d. Participating in psychotherapy can help prevent a relapse. e. Anhedonia is a clinical manifestation of a depressive relapse.

When administering antipsychotics to a client with paranoid schizophrenia, the nurse understands that the newer atypical antipsychotics, such as Olanzapine (Zyprexa) and Risperidone (Risperdal), are more effective than the other medications in treating the negative symptoms of schizophrenia because of which of the following? a. Serotonin and GABA levels are not affected b. Dopamine and serotonin receptors are blocked c. GABA and norepipnephrine levels are increased d. Norepinephrine and dopamine receptors are blocked

b. Dopamine and serotonin receptors are blocked

The nurse is creating a plan of care for a newly admitted client at high risk for suicide. With the focus of the plan being to promote a safe and therapeutic environment, which intervention should the nurse include? a. Place the client in a private room. b. Establish a therapeutic relationship. c. Assign a leadership task to the client. d. Maintain a distance of 10 inches at all times.

b. Establish a therapeutic relationship.

The home care nurse is visiting an older client whose spouse died 6 months ago. Which behaviors by the client indicates effective coping? (Select all that apply.) a. Neglecting personal grooming b. Looking at old snapshots of family c. Participating in a senior citizens program d. Visiting the spouse's grave once a month e. Decorating a wall with the spouse's pictures and awards received

b. Looking at old snapshots of family c. Participating in a senior citizens program d. Visiting the spouse's grave once a month e. Decorating a wall with the spouse's pictures and awards received

Several nurses are engaged in an assignment report when a client with a history of aggressive behavior approaches the nurses' station. The client becomes very loud and offensive, and demands to be seen by the health care provider (HCP) immediately. Which intervention will address the needs of both the client and the milieu? a. Inform the client that the behavior is unacceptable. b. Offer to assist the client to an examination room until the HCP is notified. c. Assure the client that the HCP will be called as soon as the report is completed. d. Tell the client to wait in his room, and inform him that a nurse will come when the report is finished.

b. Offer to assist the client to an examination room until the HCP is notified.

The nurse caring for a client diagnosed with schizophrenia should include which interventions in the plan of care to assist in managing the client's concrete thinking? a. Provide the client with written instructions regarding the routine of the unit. b. Present verbal instructions regarding expectations in single, simple commands. c. Assess the client's understanding of instructions by requiring restatement of expectations. d. Incorporate family members in determining the emotional and physical needs of the client.

b. Present verbal instructions regarding expectations in single, simple commands.

The nurse is assigned to a client who is pacing, agitated, and using aggressive gestures and rapid speech. The nurse should determine that which action is the priority of care at this time? a. Providing the other clients on the unit with a sense of comfort and safety b. Providing a safe place for the client to pace that is away from the other clients c. Offering the client a less stimulated area in which to calm down and gain control d. Assisting in caring for the client in a controlled environment, such as a quiet room

b. Providing a safe place for the client to pace that is away from the other clients

The nurse is creating a discharge plan for the family of a client diagnosed with a mood disorder. The nurse should plan to provide which priority information to the family? a. Brain anomalies that are responsible for this disorder b. Signs that indicate the client may be considering suicide c. The importance benzodiazepines play in the management of this disorder d. The possibility that the client will experience medication-induced tinnitus

b. Signs that indicate the client may be considering suicide

Mrs. Chauncey, 80 years of age, complains of stomach pain and is now mute and staring out of her window. She is refusing food. Which of the following interventions are appropriate? (Select all that apply.) a. Give her privacy, and close her door. b. Speak with her, although she may not answer. c. Continue to offer her food and fluids. d. Regularly assess vital signs and skin turgor.

b. Speak with her, although she may not answer. c. Continue to offer her food and fluids. d. Regularly assess vital signs and skin turgor.

What is an appropriate short-term outcome for a client grieving the recent loss of a spouse? a. The client reports three additional coping strategies. b. The client verbalizes stages of grief and plans to attend a community grief group. c. The client verbalizes connections between significant losses and low self-esteem. d. The client verbalizes decreased desire for self-harm and discusses two alternatives to suicide.

b. The client verbalizes stages of grief and plans to attend a community grief group.

The nurse is reviewing the assessment data of a client admitted to the mental health unit. The nurse notes that the admission nurse documented that the client is experiencing anxiety as a result of a situational crisis. The nurse plans care for the client, determining that this type of crisis could be caused by which event? a. Witnessing a murder b. The death of a loved one c. A fire that destroyed the client's home d. A recent rape episode experienced by the client

b. The death of a loved one

When you hear the 3-11 shift report, you learn that one of your patients was aggressive during a manic phase and restrained (wrists and ankles) in the seclusion room. Which nursing action is your top priority? a. Offer fluids, a snack, and toileting. b. Wake your patient, and assess vital signs. c. Check each extremity for circulation. d. Check the electronic medication administration record (e-MAR) for recently administered scheduled and as-needed medications. e. Assess mental status.

b. Wake your patient, and assess vital signs.

The nurse is caring for an older client whose husband died approximately 6 weeks ago. The client says, "There's no one left to care about me. Everyone that I have loved is now gone." Which nursing response allows for continued communication about the client's state of mind? a. "That doesn't sound like the real you talking!" b. "I'm sure you have someone if you think hard enough." c. "It sounds as though you are feeling all alone right now." d. "I don't believe that, and I really don't think you do either."

c. "It sounds as though you are feeling all alone right now."

An adult has had long-term serious medical problems resulting in decreased libido and sexual performance. The adult's spouse privately says to the nurse, "I don't feel loved anymore. I feel sexual urges but my partner is not interested." Select the nurse's therapeutic response. a. "Tell me about how your partner shows love for you." b. "You're describing a scenario that many couples face." c. "Let's consider some other ways you can satisfy your needs." d. "I'm glad you are able to talk about and accept your situation."

c. "Let's consider some other ways you can satisfy your needs."

A client diagnosed with depression shares with the outclinic nurse, "I lost my job this week and can't pay my rent. My daughter is my only family, but I don't want to burden her with my problems." Which response by the nurse would effectively address the client's concern? a. "Let's talk about the circumstances that caused you to lose your job." b. "There are homeless shelters available for people who are experiencing this exact situation." c. "Wouldn't you want to know if your daughter was having difficulties so you could help if you could?" d. "Being homeless would allow us to admit you to the hospital so you will have a place to eat and sleep."

c. "Wouldn't you want to know if your daughter was having difficulties so you could help if you could?"

A client diagnosed with terminal cancer says to the nurse, "I'm going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's dying." Which response by the nurse is therapeutic? a. "Have you shared your feelings with your family?" b. "I think we should talk more about your anger with your family." c. "You're feeling angry that your family continues to hope for you to be cured?" d. "You are probably very depressed, which is understandable with such a diagnosis."

c. "You're feeling angry that your family continues to hope for you to be cured?"

A nurse is caring for several clients who are attending community-based mental health programs. Which of the following clients should the nurse plan to visit first? a. A client who recently burned her arm while using a hot iron at home. b. A client who requests that her antipsychotic medication be changed due to some new adverse effects. c. A client who says he is hearing a voice that tells him he is not worthy of living anymore. d. A client who tells the nurse he experienced manifestations of severe anxiety before and during a job interview.

c. A client who says he is hearing a voice that tells him he is not worthy of living anymore.

A nurse in an acute mental health facility is assisting with discharge planning for a client who has severe mental illness and requires supervision much of the time. The client's wife works all day but is home by late afternoon. Which of the following strategies should the nurse suggest as appropriate follow-up care? a. Receiving daily care from a home health aide b. Having a weekly visit from a nurse case worker c. Attending a partial hospitalization program d. Visiting a community mental health center on a daily basis

c. Attending a partial hospitalization program

A depressed client verbalizes feelings of low self-esteem and self-worth typified by statements such as "I'm such a failure. I can't do anything right." How should the nurse plan to respond to the client's statement? a. Reassure the client that things will get better. b. Tell the client that this is not true and that we all have a purpose in life. c. Identify recent behaviors or accomplishments that demonstrate the client's skills. d. Remain with the client and sit in silence; this will encourage the client to verbalize feelings.

c. Identify recent behaviors or accomplishments that demonstrate the client's skills.

A homeless shelter has sustained severe damage as a result of a fire, and most of the structure and people's belongings were destroyed. Ten of the individuals who are being displaced have a history of chronic mental illness. The mental health team coordinating support initially should focus their efforts on which action? a. Assessing the clients' need for supportive therapy b. Evaluating the clients for signs of stress overload c. Providing the clients with shelter, clothing, and food d. Planning means for the clients to receive their medications

c. Providing the clients with shelter, clothing, and food

Which client's death was achieved by what is considered a soft suicide method? a. Claimed to be going hunting and then shot himself while alone in the woods b. Hung himself after becoming aware that he would be arrested for domestic violence c. Sat in a running car parked in her locked garage to die of the carbon monoxide inhalation d. Left a suicide note sharing that she was planning to jump off the bridge into a secluded part of the river

c. Sat in a running car parked in her locked garage to die of the carbon monoxide inhalation

The nurse is caring for a client just admitted to the mental health unit and diagnosed with catatonic stupor. The client is lying on the bed in a fetal position. Which is the most appropriate nursing intervention? a. Ask direct questions to encourage talking. b. Leave the client alone so as to minimize external stimuli. c. Sit beside the client in silence with occasional open-ended questions. d. Take the client into the dayroom with other clients so that they can help watch them.

c. Sit beside the client in silence with occasional open-ended questions.

Community mental health teams recognize that in the immediate postdisaster period, the most effective means of identifying individuals experiencing difficulty coping psychologically with the disaster is to take which action? a. Establish a centrally located mental health disaster center. b. Ask for referrals from local health care providers and clergy. c. Station mental health professionals at established assistance centers. d. Distribute fliers identifying the availability of psychological counseling.

c. Station mental health professionals at established assistance centers.

Over the past 2 months a patient made eight suicide attempts with increasing lethality. The health care provider informs the patient and family that electroconvulsive therapy (ECT) is needed. The family whispers to the nurse, "Isn't this a dangerous treatment?" How should the nurse reply? a. "Our facility has an excellent record of safety associated with use of electroconvulsive therapy." b. "Your family member will eventually be successful with suicide if aggressive measures are not promptly taken." c. "Yes, there are hazards with electroconvulsive therapy. You should discuss these concerns with the health care provider." d. "Electroconvulsive therapy is very effective when urgent help is needed. Your family member was carefully evaluated for possible risks."

d. "Electroconvulsive therapy is very effective when urgent help is needed. Your family member was carefully evaluated for possible risks."

A client who has been hospitalized with a paranoid disorder refuses to turn off the lights in the room at night and states, "My roommate will steal me blind." Which is the appropriate response by the nurse? a. "Why do you believe your roommate would steal from you?" b. "I'll see if I can arrange for you to move in with a different roommate." c. "Tell me more about your belief that your roommate would steal from you." d. "I hear what you are saying, but I have no reason to believe your roommate steals."

d. "I hear what you are saying, but I have no reason to believe your roommate steals."

The spouse of a client prescribed an antidepressant tells the home health nurse, "Now that the antidepressant is working, the suicidal risk is over and you can stop making these home visits." How does the nurse appropriately respond? a. "I need to continue with my visits since this disease tends to run in families." b. "I agree with you that the medication will greatly reduce the risk for suicidal behavior." c. "I agree with you that continuing to visit would reintroduce the possibility of suicidal ideations." d. "I need to continue visiting since the client may now have the energy to act on suicidal intentions."

d. "I need to continue visiting since the client may now have the energy to act on suicidal intentions."

The nurse is discussing discharge and outpatient follow-up plans with a client hospitalized for acute depression. Which statement demonstrates the client's use of a defense mechanism and would indicate the need for follow-up treatment? a. "I don't think I can do this on my own. I still need help coping with things. I know I need to keep working with staff, even now that I'm going home." b. "This has been the hardest thing I've ever had to deal with. I've made progress in learning how to communicate, especially with my family. It's hard to tell them when I need help." c. "I really tried to listen to what people said in the group sessions. Sometimes it was hard, but I think we really helped each other. I think I've learned it's all right to get disappointed sometimes." d. "I was really depressed about not getting the promotion I was promised. Looking back on it, the pay raise wouldn't have been worth the huge increase in responsibility. It's just as well; it all worked out in the end."

d. "I was really depressed about not getting the promotion I was promised. Looking back on it, the pay raise wouldn't have been worth the huge increase in responsibility. It's just as well; it all worked out in the end."

The nurse is preparing a client with a history of command hallucinations for discharge by providing instructions on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggests to the nurse that the client has a need for additional information? a. "My medications will help my anxious feelings." b. "I'll go to support group and talk about what I am feeling." c. "I need to get enough sleep and eat well to help prevent feeling anxious." d. "When I have command hallucinations, I'll call a friend and ask him what I should do."

d. "When I have command hallucinations, I'll call a friend and ask him what I should do."

A client with a diagnosis of depression who has attempted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response by the nurse demonstrates therapeutic communication? a. "You have everything to live for." b. "Why do you see yourself as a failure?" c. "Feeling like this is all part of being depressed." d. "You've been feeling like a failure for a while?"

d. "You've been feeling like a failure for a while?"

The nurse is creating a plan of care for a client in a crisis state. When developing the plan, the nurse should consider which factor? a. A crisis state indicates that the client has a mental illness. b. A crisis state indicates that the client has an emotional illness. c. Presenting symptoms in a crisis situation are similar for all clients experiencing a crisis. d. A client's response to a crisis is individualized and what constitutes a crisis for one client may not constitute a crisis for another client.

d. A client's response to a crisis is individualized and what constitutes a crisis for one client may not constitute a crisis for another client.

A nurse is conducting a class for a group of newly licensed nurses on caring for clients who are at risk for suicide. Which of the following information should the nurse include in the teaching? a. A client's verbal threat of suicide is attention-seeking behavior b. Interventions are ineffective for clients who really want to commit suicide c. Using the term suicide increases the clint's risk for suicide attempt d. A no-suicide contract decreases the client's risk for suicide

d. A no-suicide contract decreases the client's risk for suicide

A patient has committed suicide while under team care in your facility. A coworker says, "Why are we being called to a 'postmortem' meeting? We didn't do anything wrong." Which is your best explanation? a. There is almost always litigation after an inhouse suicide, and it only makes sense that someone must be held responsible. b. Staff are at high-risk for hurting themselves after a suicide. c. It's important that the entire team collaborate to make documentation say the right things. d. A postmortem assessment can help the team determine any changes that might be made in agency protocol to improve safety.

d. A postmortem assessment can help the team determine any changes that might be made in agency protocol to improve safety.

The nurse determines that which client is at highest risk for suicide? a. An African American male lawyer who is 47 years old and recently divorced b. A 25-year-old housewife who cares for a 2-year-old son and a 3-year-old stepdaughter c. A 39-year-old single parent who dropped out of high school and whose children are both in medical school d. An 18-year-old who abuses both alcohol and drugs and who will not meet the requirements for graduation

d. An 18-year-old who abuses both alcohol and drugs and who will not meet the requirements for graduation

Which is the appropriate nursing intervention to address the poor nutritional intake demonstrated by a client diagnosed with depression? a. Weigh the client three times per week before breakfast. b. Explain to the client the importance of a good nutritional intake. c. Report the nutritional concern to the psychiatrist, and obtain a nutritional consultation as soon as possible. d. Arrange for the client to receive several small meals daily, and plan to be present while the meals are being served.

d. Arrange for the client to receive several small meals daily, and plan to be present while the meals are being served.

The nurse reviewing a client's diagnostic results recognizes that which is a possible positive indication for a diagnosis of schizophrenia? a. Abnormally high blood flow to the frontal lobes b. Atrophy of both the limbic structures and cerebellum c. Abnormally small fissures on the surface of the brain d. Atrophy of the lateral and/or third ventricles of the brain

d. Atrophy of the lateral and/or third ventricles of the brain

The nurse is reviewing the medical record of a hospitalized client who received electroconvulsive therapy (ECT) 3 years ago. Which assessment data would support that the therapy resulted in retrograde amnesia in the client? a. The staff needs to frequently reorient the client to the rules of this current unit. b. The client has demonstrated difficulty remembering the address of the family's new home. c. The medical record states that the client experienced memory loss for 2 days after the ECT treatment. d. During the admission interview, the client can't remember why the ECT treatment was originally prescribed.

d. During the admission interview, the client can't remember why the ECT treatment was originally prescribed.

A depressed client who appeared sullen, distraught, and hopeless a few days ago now suddenly appears calm, relaxed, and more energetic. Which is the nurse's best initial action with regard to the client's altered demeanor? a. Continue to assess the client's behaviors and document clearly in the chart. b. Report to the health care provider that the client is adapting to the unit and is feeling safe. c. Notify the health team of these observations and alert them to the suspicion that the client is contemplating suicide. d. Engage the client in one-to-one supervision, share with the client the observations that have been assessed, and ask whether the client is thinking about suicide.

d. Engage the client in one-to-one supervision, share with the client the observations that have been assessed, and ask whether the client is thinking about suicide.

When should the nurse determine that it will be safe to remove the restraints from a client who demonstrated violent behavior? a. Administered medication has taken effect. b. The client verbalizes the reasons for the violent behavior. c. The client apologizes and tells the nurse that it will never happen again. d. No aggressive behavior has been observed for 1 hour after the release of two of the extremity restraints.

d. No aggressive behavior has been observed for 1 hour after the release of two of the extremity restraints.

The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania. Which client symptoms require the nurse's immediate action? a. Incessant talking and sexual innuendoes b. Grandiose delusions and poor concentration c. Outlandish behaviors and inappropriate dress d. Nonstop physical activity and poor nutritional intake

d. Nonstop physical activity and poor nutritional intake

A single adult says to the nurse, "Both of my parents died several years ago and my only sibling committed suicide 2 weeks ago. I feel so alone." After determining that the adult has no suicidal ideation, the nurse should: a. Explore the adult's feelings of survivor's guilt. b. Assess the adult's cultural beliefs and spirituality. c. Refer the adult for cognitive behavioral therapy (CBT). d. Refer the adult to a self-help group for suicide survivors.

d. Refer the adult to a self-help group for suicide survivors.

During a group session, a client threatens to "punch every one of you." Which is the appropriate initial nursing action? a. Call security to come to the session immediately. b. Require the client to leave the group immediately. c. Remind the client that punching anyone is a reason for being placed into seclusion. d. Remind the client that talking about personal anger is appropriate, but acting on it is not.

d. Remind the client that talking about personal anger is appropriate, but acting on it is not.

A homebound client confidentially discusses suicidal plans with the visiting nurse. Based on professional duty to observe confidentiality, which statement describes the nurse's obligation to the client? a. Arrange for the client go to the local mental health center daily for counseling. b. Ask the client's permission to reveal the suicidal plans to the health care provider (HCP). c. Assure the client that the confidence between nurse and client will be strictly adhered to. d. Share that the risk to their safety requires that the client's HCP be notified.

d. Share that the risk to their safety requires that the client's HCP be notified.