Psych/Mental Health Nursing Final Exam Review

The sibling of a client who was diagnosed with a serious mental illness (SMI) asks why a case manager has been assigned. Which nurse's reply best cites the major advantage of the use of case management? A. "The case manager can modify traditional psychotherapy for homeless clients so that it is more flexible." B. "Case managers coordinate services and help with accessing them, making sure the client's needs are met." C. "The case manager can focus on social skills training and esteem building in the real world where the client lives." D. "Having a case manager has been shown to reduce hospitalizations, which prevents disruption and saves money."

B. "Case managers coordinate services and help with accessing them, making sure the client's needs are met." The case manager helps theclient gain entrance into thesystem of care, can coordinate multiple referrals that so often confuse theseriously mentally ill person and his family, and can help overcome obstacles to access and treatment participation. Case managers do not usually possess thecredentials needed to provide psychotherapy or function as therapists. Case management promotes efficient use of services in general, but only ACT programming has been shown to reduce hospitalization (which thesibling might see as a disadvantage). Case managers operate in thecommunity, but this is not theprimary advantage of their services.

Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful? A. "I can be successful if I do all the things required to learn the job." B. "I can never learn all there is to know for the job." C. "I do not have the ability to handle that job." D. "I may be fired from the job but eventually I will find something else to do with my life."

A. "I can be successful if I do all the things required to learn the job." Cognitive reframing changes the individual's perceptions of stress by reassessing a situation and replacing irrational beliefs with more positive self-statements. The other options are all negative cognitive distortions that would prevent the individual from success.

When considering the duty to warn and protect third parties, which client statement should the nurse report to the treatment team members? A. "That judge is going to really regret putting me in here." B. "All politicians need to be shot." C. "When I'm elected president, I'll make them all pay for doubting me." D. "The man out there who is laughing at me is going to die."

A. "That judge is going to really regret putting me in here." The duty to protect is an ethical and legal obligation of health care workers to protect patients from physically harming themselves or others. This duty arises when the patient presents a serious danger to another. While all that statements infer the client's intention to harm, only the correct option is credible since it actually identifies the possible victim.

Which of the following classifications of medication may be prescribed in intermittent explosive disorder? A. Anticonvulsants B. Psychostimulants C. Antianxiety agents such as benzodiazepines D. Monoamine oxidase (MAO) inhibitors

A. Anticonvulsants Although considered off-label use, anticonvulsants may reduce outbursts and contribute to mood stabilization. The other options are incorrect for use in intermittent explosive disorder.

What are the advantages of therapy groups? (Select all that apply.) A. Feedback from peers B. Treatment of multiple people at one time C. Promotion of independence in problem solving D. Provision of an opportunity to practice communication E. Promotion of a feeling of belonging F. Promotion of confidentiality

A. Feedback from peers B. Treatment of multiple people at one time D. Provision of an opportunity to practice communication E. Promotion of a feeling of belonging All these options are advantages of groups. Since the members openly discuss and provide feedback, confidentiality is not possible.

What are the risks associated with the use of complementary and alternative medicine (CAM) therapies? (Select all that apply.) A. Lack of standards or regulations that ensure safety for herbal products. B. There are no specialized educational programs that focus on CAM therapies. C. Interactions between CAM products and prescribed medication. D. Insurance companies do not always cover these forms of treatment. D. Credentialing is unavailable for most CAM modalities.

A. Lack of standards or regulations that ensure safety for herbal products. C. Interactions between CAM products and prescribed medication. D. Insurance companies do not always cover these forms of treatment. Poor standardization of herbal products and the possible drug-to-herb interaction as well as the fact that these therapies may not be covered by health care insurance are risks associated with CAM therapies. The remaining options are untrue statements concerning CAM therapies.

The mother of a 4-year-old daughter states that the child has recently begun, "Touching her vagina and rubs herself down there all the time." The child drew a picture showing two people with one on top of the other and said they were "doing sex." Based on the assessment description, what conclusion should the nurse explore further? A. There is a possibility that the child has been sexually abused. B. Educate the mother to normal developmental behavior in a 4-year-old child. C. The mother should be enrolled in parenting classes to improve her parenting skills. D. The child's exposure to graphic sexual images on television should be monitored closely.

A. There is a possibility that the child has been sexually abused. Sexualized behavior is one of the most common symptoms of sexual abuse in children. Younger children may draw sexually explicit images, demonstrate sexual aggression, or act out sexual interactions in play, for example, with dolls. Masturbation may be excessive in sexually abused children. It is not normal developmental behavior for a 4-year-old child.

When considering mental illness, recovery is best described to a client by which statement? A. Working, living, and participating in the community B. Never having to visit a mental health provider again C. Being able to understand the nature of the diagnosed illness D. A period of time when signs and symptoms are being managed

A. Working, living, and participating in the community Recovery is described as the ability of the individual to work, live, and participate in the community. Never having to visit a mental health provider is unrealistic. While important to recovery understanding of the disorder is not a demonstration of recovery. Remission is a period of time when signs and symptoms are being managed.

When a client states "That nurse never seems comfortable being with me." How is the client characterizing the nurse? A. not seeming genuine to the client. B. transmitting fear of clients. C. unfriendly and aloof. D. controlling.

A. not seeming genuine to the client. Hiding behind a role, using stiff or formal interactions, and creating distance between self and client suggest a nurse is lacking in genuineness, or the ability to interact in a person-to-person fashion. This characteristic is not associated with the other options.

Nurses working in emergency departments and walk-in clinics should be aware that some victims of violence may present: A. with vague physical complaints such as insomnia or pain. B. with extreme anger and unpredictable behavior. C. with many family members there to support them. D. with psychosis and/or mania as a result of long-term abuse.

A. with vague physical complaints such as insomnia or pain. Patients may present with symptoms that may be vague and can include chronic pain, insomnia, hyperventilation, or gynecological problems. Attention to the interview process and setting is important to facilitate accurate assessment of physical and behavioral indicators of family violence. Presenting with extreme anger is possible but not as common as presenting with vague physical complaints. Having many family members there is unlikely as many victims keep their history of being battered a secret. It is not known that psychosis or mania is a result of physical violence, and this would not be a usual presenting complaint.

What term best describes a family dynamic where boundaries are not clear and whose members are overinvolved with each other? A. Clear boundaries B. Enmeshment C. Scapegoating D. Rigid boundaries

B. Enmeshment When boundaries are diffuse, individuals tend to become "enmeshed." As a consequence, it is not clear who is in charge, who is responsible for decisions, and who has permission to act or take charge; family members are often overinvolved with each other. Clear boundaries are adaptive and healthy. They are well understood by all members of the family and give family members a sense of "I-ness" and also "we-ness." Scapegoating refers to a situation in which one member of the family is seen as the cause of all the problems. Rigid boundaries are characterized by the consistent adherence to rules and roles—some apparent and some less so—no matter what.

Nico, a 22-year-old patient, is diagnosed with schizophrenia. Which of the following symptoms would alert a provider to a possible diagnosis of schizophrenia in a 22-year-old male client? A. Excessive sleeping with disturbing dreams B. Hearing voices telling him to hurt his roommate C. Withdrawal from college because of failing grades D. Chaotic and dysfunctional relationships with his family and peers

B. Hearing voices telling him to hurt his roommate People diagnosed with schizophrenia all have at least one psychotic symptom such as hallucinations, delusional thinking, or disorganized speech. The other options do not describe schizophrenia but could be caused by a number of problems.

A 38-year-old patient referred for sleep studies reports frequent daytime lethargy, unintended lapses into sleep, and never feeling rested on awakening in the morning. These symptoms support which sleep-related diagnosis? A. Circadian rhythm disorder B. Hypersomnolence C. REM sleep behavior disorder D. Breathing-related sleep disorder

B. Hypersomnolence The patient with hypersomnolence reports recurrent periods of sleep or unintended lapses into sleep, frequent napping, nonrefreshing nonrestorative sleep regardless of the amount of time slept, and difficulty with full alertness during the wake period. Circadian rhythm sleep disorders occur when there is a misalignment between the timing of the individual's normal circadian rhythm and external factors that affect the timing or duration of sleep. Patients with REM sleep disorder display elaborate motor activity associated with dream mentation. Breathing-related sleep disorder is characterized by frequent upper airway obstruction.

A 43-year-old client being seen in the mental health clinic states, "I have always been a practicing Jew, but in the past few months I am questioning everything. I just don't know if I believe in it anymore." Which of the following nursing diagnoses best describes the client's comment? A. Ineffective coping B. Spiritual distress C. Risk for self-harm D. Hopelessness

B. Spiritual distress The client is expressing distress regarding his religion and spiritual well-being. The client could be experiencing ineffective coping, but this does not directly relate to his comment. There is nothing in the client's comment that would lead to the conclusion that the client is having thoughts of harming himself or experiencing hopelessness.

Which supplement(s) may be helpful in managing the symptoms of depression? (Select all that apply.) A. Lavender B. St. John's wort C. Melatonin D. Fish oil E. SAMe

B. St. John's wort D. Fish oil E. SAMe St. John's wort, Fish oil, and SAMe have been identified as having some possible positive effect on the symptoms of depression. Melatonin and lavender are associated with insomnia.

After 5 years in a state hospital, an adult diagnosed with schizophrenia was discharged to the community. This client now requires continual direction to accomplish activities of daily living and expects others to provide meals and do laundry. The nurse assesses this behavior as the probable result of what factor? A. side effects of antipsychotic medications. B. dependency caused by institutionalization. C. cognitive deterioration from schizophrenia. D. stress associated with acclimation to the community.

B. dependency caused by institutionalization. Institutions tend to impede independent functioning; for example, daily activities are planned and directed by staff; others provide meals and only at set times. Over time, clients become dependent on theinstitution to meet their needs and adapt to being cared for rather than caring for themselves. When these clients return to thecommunity, many continue to demonstrate passive behaviors despite efforts to promote. Cognitive dysfunction and antipsychotic side effects can make planning and carrying out activities more difficult, but thequestion is more suggestive of adjustment to institutional care and difficulty readjusting to independence instead.

The nurse wants to assess a family's rational patterns by creating their genogram. Which statement best describes the purpose of such an analysis? A. "A genogram will assess risk for mental illness in future generations." B. "A genogram is a tool used for deciding on the best type of therapy for your family." C. "A genogram will help me see your family structure, history, and current functioning." D. "A genogram will help us determine the cause of Jeremy's schizophrenia."

C. "A genogram will help me see your family structure, history, and current functioning." By creating a genogram, nurses and therapists are able to map the family structure and record family information that reflects both history and current functioning. The other options do not describe the function of a genogram.

Which client statement demonstrates the mental health concept of resilience? A. "My kids' happiness is worth any sacrifice I have to make." B. "My mother made decisions about my husband's funeral when I just couldn't do that." C. "Losing my job was hard but my skills will help me get another one." D. "In spite of all the treatment, I know I'll never be really healthy."

C. "Losing my job was hard but my skills will help me get another one." Resilience is a characteristic that helps individuals cope with loss and trauma that may occur in life. Dependence is described as relying on others for decision making and care. Pessimism is a life philosophy that things are more likely to go wrong than right. Altruism is described as putting others before yourself.

A patient who recently loss a parent begins crying during a one-to-one session with the nurse. Which response by the nurse illustrates empathy? A. "I'm so sorry. My father died 2 years ago, so I know how you are feeling." B. "You need to focus on yourself right now. You deserve to take time just for you." C. "That must have been such a hard situation for you to deal with." D. "I know that you will get over this. It just takes time."

C. "That must have been such a hard situation for you to deal with." This response reflects understanding of the patient's feelings, which is empathy. Feeling sorry for the client represents sympathy, whereas not addressing the patient's concern belittles the patient's feelings of grief she is expressing by changing the subject. Telling the patient, she will get over it does not reflect empathy and is closed-ended.

Which service would be expected to provide resources 24 hours a day, 7 days a week if needed for persons with serious mental illness (SMI)? A. Clubhouse model B. Cognitive-behavioral therapy (CBT) C. Assertive community treatment (ACT) D. Cognitive enhancement therapy (CET)

C. Assertive community treatment (ACT) ACT involves consumers working with a multidisciplinary team that provides a comprehensive array of services. At least one member of theteam is available 24 hours a day for crisis needs, and theemphasis is on treating theclient within his own environment.

What would be an appropriate expected outcome of the treatment plan for a client diagnosed with a conversion disorder that interferes with the ability to walk effective? A. Client will walk unassisted within 1 week. B. Client will return to a pre-illness level of functioning within 2 weeks. C. Client will be able to state two new effective coping skills within 2 weeks. D. Client will assume full self-care within 3 weeks.

C. Client will be able to state two new effective coping skills within 2 weeks. An appropriate outcome for somatization disorders is to be aware of negative coping strategies and learn new, effective skills for coping within a realistic timeframe. In the other options, the time frames of these outcomes are unrealistic

A client is sitting with arms crossed over their chest, with their left leg is rapidly moving up and down, and there is an angry facial expression. When approached by the nurse, the client states harshly, "I'm fine! Everything's great." Which statement related to communication should the nurse focus on when working with this client? A. Verbal communication is always more accurate than nonverbal communication. B. Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. C. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. D. Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.

C. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. Communication is roughly 10% verbal and 90% nonverbal, so nurses must pay close attention to nonverbal cues to accurately assess what the client is really feeling. The other options are all untrue of verbal and nonverbal communication and are actually the opposite of what is believed of communication.

A client asks the nurse what kind of therapy will help. Based on current knowledge, what form of therapy is most appropriate for a client diagnosed with a conversion disorder? A. "A combination of antianxiety and antidepressant therapy is the most effective therapy." B. "Aversion therapy is often used because in effect you are punishing yourself by not being able to walk." C. "Modeling will be used; as you see desired behaviors modeled by the therapist you will be able to also achieve the expected outcome." D. "Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders."

D. "Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders." CBT is the most consistently supported treatment for the full spectrum of somatic disorders. All the other options are incorrect and do not describe the most used and effective therapy for this

The nurse being aware that certain mental illnesses have a prevalence among a specific gender, will suspect which statement was made by a female client? (Select all that apply.) A. "I'm so anxious, about everything." B. "There is no way I could make a presentation to a group of people." C. "I freeze in panic when I see a spider." D. "I've been depressed most of my adult life." E. "I've been arrested 6 times in the last 15 years."

D. "I've been depressed most of my adult life." E. "I've been arrested 6 times in the last 15 years." Antisocial personality disorder, characterized by repeated illegal behavior, is more commonly diagnosed in men while major depressive disorder, characterized by chronic feelings of sadness negatively impacts life, is more common among women.

A client is presenting with behaviors that indicate anger. When approached, the client states harshly, "I'm fine! Everything's great." Which response should the nurse provide to the client? A. "Okay, but we are all here to help you, so come get one of the staff if you need to talk." B. "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." C. "I don't believe you. You are not being truthful with me." D. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?"

D. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?" This response uses the therapeutic technique of clarifying; it addresses the difference between the client's verbal and nonverbal communication and encourages sharing of feelings. The other options do not address the client's obvious distress or are confrontational and judgmental. None of the other options provides this support.

It is most important for the nurse to employ which holistic strategy when managing clients diagnosed with a somatization disorder? A. Utilizing many different therapeutic strategies or modalities for enhanced coping B. Involving every member of the family as well as the patient in treatment C. Incorporating spirituality and religion into treatment D. Considering all dimensions of the patient, including biological, psychological, and sociocultural

D. Considering all dimensions of the patient, including biological, psychological, and sociocultural It is important to use a holistic approach in nursing care so that we may address the multidimensional interplay of biological, psychological, and sociocultural needs and its effects on the somatization process. All nurses need to be aware of the influence of environment, stress, individual lifestyle, and coping skills of each patient. The other options do not explain the concept of holistic care.

The nurse is providing teaching to a preoperative client just before surgery. The client is becoming more and more anxious and begins to report dizziness and heart pounding. The client also appears confused and is trembling noticeably. Considering the scenario, what decision should the nurse make? A. To reinforce the preoperative teaching by restating it slowly. B. Have the client read the teaching materials instead of providing verbal instruction. C. Have a family member read the preoperative materials to the client. D. Do not attempt any further teaching at this time.

D. Do not attempt any further teaching at this time. Clients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. The other options would not be effective because you are still attempting to teach someone who has a severe level of anxiety.

A homeless individual diagnosed with serious mental illness (SMI) and a history of persistent treatment nonadherence plans to begin attending the day program at a community mental health center. Which intervention should be the team's initial focus? A. Teach appropriate health maintenance and prevention practices. B. Educate the client about the importance of treatment adherence. C. Help the client obtain employment in a local sheltered workshop. D. Interact regularly and supportively without trying to change the client.

D. Interact regularly and supportively without trying to change the client. Given the history of treatment nonadherence and the difficulty achieving other goals until psychiatrically stable and adherent, getting the client to accept and adhere to treatment is the fundamental goal to address. the intervention most likely to help meet that goal at this stage is developing a trusting relationship with the client. Interacting regularly, supportively, and without demands is likely to build the necessary trust and relationships that will be the foundation for all other interventions later on. No data here suggest the client is in crisis, so it is possible to proceed slowly and build this foundation of trust.

Tara and Aaron are twins who are both diagnosed with schizophrenia. Aaron was diagnosed at 23 years old and Tara at 31 years old. Based on your knowledge of early and late onset of schizophrenia, which of the following is true? A. Tara and Aaron have the same expectation of a poor long-term prognosis. B. Tara will experience more positive signs of schizophrenia such as hallucinations. C. Aaron will be more likely to hold a job and live a productive life. D. Tara has a better chance for positive outcomes because of later onset.

D. Tara has a better chance for positive outcomes because of later onset. Female patients diagnosed with schizophrenia between the ages of 25 and 35 years have better outcomes than do their male counterparts diagnosed earlier. These two patients do not have the same expectation of a poor prognosis. There is no evidence suggesting that Tara will have more positive signs of schizophrenia. It is actually more unlikely that Aaron will be able to live a productive life because of his earlier onset, which has a poorer prognosis.

A nurse's neighbor says, "My sister has been diagnosed with bipolar disorder but will not take her medication. I have tried to help her for over 20 years, but it seems like everything I do fails. Do you have any suggestions?" What is the nurse's best response? A. "National Alliance on Mental Illness (NAMI) offers a family education series that you might find helpful." B. "Since your sister is noncompliant, perhaps it's time for her to be changed to injectable medication." C. "You have done all you can. Now it's time to put yourself first and move on with your life." D. "You cannot help her. Would it be better for you to discontinue your relationship?"

A. "National Alliance on Mental Illness (NAMI) offers a family education series that you might find helpful." NAMI offers a family education series that assists with thestress caregivers and other family members often experience. thenurse should not give advice about injectable medication or encourage thefamily member to give up on theclient.

A 38-year-old patient diagnosed with major depression states, "my provider said something about the medicine I've been prescribed will affect my neurotransmitters. What exactly are neurotransmitters?" What is the nurse's best response to the patient's question? A. "Neurotransmitters are chemical messengers in the brain that help regulate specific functions such as depression." B. "Neurotransmitters are too complicated to explain easily. Just know that the medication will help your mood and make you less depressed." C. "Neurotransmitters are chemicals in the brain that are the reason you are depressed." D. "I will ask your provider to give you a more in-depth explanation about why this medication will help your depression."

A. "Neurotransmitters are chemical messengers in the brain that help regulate specific functions such as depression." Neurotransmitters are chemicals released from neurons that function as a neuromessenger and influence brain functions. Telling the patient that the answer is too complicated belittles the patient by implying she cannot understand, while stating that neurotransmitters are the reason she is depressed is too simplistic. Asking the provider to give the education abdicates your responsibility to provide patient education.

A 23-year-old is admitted with reports of abdominal pain, dizziness, and headache. When told that all the results of a physical workup have been negative, the client shares, "Now I am having back pain." Which notation in the client's medical record may alert the nurse to the possibility of malingering? A. A court date this week for drunk driving B. Was adopted at the age of 5 years C. A history of physical abuse by his stepfather D. A history of oppositional-defiant disorder E. Raised primarily in a single parent household

A. A court date this week for drunk driving Malingering is a process of fabricating an illness or exaggerating symptoms to gain a desired benefit or avoid something undesired, such as to obtain prescription medications, evade military service, or evade legal action. It is more common in men, those who have been neglected or abused in childhood, and those who have had frequent childhood hospitalizations. Adoption is not known to be a causative factor in malingering. A history of oppositional-defiant disorder is not known to a causative factor in malingering. Being raised in a single parent home is not known to be a causative factor in malingering.

The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for which characteristic of a dysfunctional nurse-patient relationship? A. Boundary blurring B. Value dissonance C. Covert anger D. Empathy

A. Boundary blurring Boundary blurring is often signaled by the nurse being either too helpful or not helpful enough. The behavior is not associated with any of the other options.

Which of the following statements are true regarding childhood-onset conduct disorder? (Select all that apply.) A. It is more commonly diagnosed in males. B. It is characterized by feelings of remorse and regret. C. It is usually diagnosed in late teen years. D. It is characterized by disregard for the rights of others. E. Those with conduct disorder rationalize their aggressive behaviors. F. It is usually outgrown by early adulthood.

A. It is more commonly diagnosed in males. D. It is characterized by disregard for the rights of others. E. Those with conduct disorder rationalize their aggressive behaviors. Childhood-onset conduct disorder is more common in male clients and is seen before the age of 10 years. Hallmarks include disregard for the rights of others, physical aggression, poor peer relationships, and lack of feelings of guilt or remorse. The other options are the opposite of what is correct.

A client diagnosed with a serious mental illness (SMI) died suddenly at age 52. The client lived in the community for 5 years without relapse and held supported employment the past 6 months. The distressed family asks, "How could this happen?" Which response by the nurse accurately reflects research and addresses the family's question? A. "A certain number of people die young from undetected diseases, and it's just one of those sad things that sometimes happen." B. "Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, smoke more, or are overweight." C. "We will have to wait for the autopsy to know what happened. There were some medical problems, but we were not expecting death." D. "We are all surprised. The client had been doing so well and saw the nurse every other week."

B. "Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, smoke more, or are overweight." The family is in distress. Because they do not understand his death, they are less able to accept it and seek specific information to help them understand what happened. Persons with SMI die an average of 25 years prematurely. Contributing factors include failing to provide for their own health needs (e.g., forgetting to take medicine), inability to access or pay for care, higher rates of smoking, poor diet, criminal victimization, and stigma. themost accurate answer indicates that seriously mentally ill people are at much higher risk of premature death for a variety of reasons. Staff would not have been surprised that theclient died prematurely, and they would not attribute his death to random, undetected medical problems. Although thecause of death will not be reliably established until theautopsy, this response fails to address thefamily's need for information.

Institutionalization leads to what specific type of behaviors in adults old enough to have been confined to institutions before deinstitutionalization? A. Anger and aggression B. Passivity and dependence C. Assertiveness and candor D. Fearfulness and paranoia

B. Passivity and dependence Medical paternalism, in which the health care provider made all decisions for patients with serious mental illnesses (SMIs), was pervasive at the time of common institutionalization for mental illness. As a result, patients became dependent on the services and structure of institutions and unable to function independently outside such institutions. It was difficult to distinguish whether behaviors such as regression were the result of the illness or institutionalization. The other options are incorrect regarding the common resulting behavior of institutionalized patients.

A patient admitted with anxiety asks, "What exactly are stressors?" What is the nurse's best response to the patient's question? A. "Instead of focusing on what stressors are, let's explore your coping skills." B. "Stressors are events that happen that threaten your current functioning and require you to adapt." C. "Stressors are complicated neuro stimuli that cause mental illness." D. "It's best if you ask questions like that of your provider for a complete answer."

B. "Stressors are events that happen that threaten your current functioning and require you to adapt." Stressors are psychological or physical stimuli that are incompatible with current functioning and require adaptation. Stressors are not complicated neuro stimuli; telling the patient to address these questions to her provider fails to educate the patient, which is the nurse's responsibility. Exploring coping skills would be a good intervention at a later time but does not address the patient's question and changes the subject.

A nurse, active in local consumer mental health groups and in local and state mental health associations, keeps aware of state and national legislation affecting mental illness treatment. How can this nurse positively affect the climate for effective, mental health treatment? A. By becoming active in politics leading to a potential political career. B. By educating the public on the effects that stigmatizing has on mental health clients. C. Advocating for laws that would make the involuntary long-term commitment process easier and faster for caregivers of mentally ill persons. D. Advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions.

B. By educating the public on the effects that stigmatizing has on mental health clients. Nurses who are aware of legislative concerns and who are active in organizations that promote mental health awareness and appropriate and equal treatment for mental illness help achieve the goal of parity, or equality of treatment for mentally ill individuals. Becoming active in politics may be a personal goal but does not directly or necessarily reduce stigma or encourage treatment equality. The other options are undesirable outcomes.

Which nursing intervention is appropriate for the management of intermittent explosive disorder? A. Providing intensive family therapy B. Establishing a trusting relationship with the client C. Setting up loose boundaries so the client will feel relaxed D. Limiting decision-making opportunities to avoid frustration

B. Establishing a trusting relationship with the client Establishing rapport with the client is essential in working to set goals, boundaries, and consequences, and providing opportunities for goal achievement. Intensive family therapy would not be a basic level RN intervention. Boundaries and structure are essential. Opportunities for clients to make good decisions and reach goals should be given, not limited.

A 17-year-old client is admitted to the psychiatric unit after threatening his mother during an argument and is diagnosed with conduct disorder. Which of the following would be an appropriate short-term outcome for this client? A. Engages in appropriate coping skills to manage stressors B. Expresses feelings C. Maintains self-control during hospitalization D. Mother will improve communication skills to interact with Eli.

B. Expresses feelings Expressing feelings is an appropriate short-term outcome and would be a good start to working with the client to establish rapport, develop coping skills, and set goals. Engaging in appropriate coping skills and maintaining self-control are desired outcomes. Outcomes for the client are being discussed, not outcomes for the client's mother.

What term is used to describe care that places the attention on a patient's physical, mental, and spiritual needs while focusing on prevention and wellness? A. Orthodox B. Integrative C. Allopathic D. Mainstream

B. Integrative Integrative care is holistic and focuses on the patient and on prevention and wellness. The other options all refer to conventional health care systems in the United States.

A nuclear family consists of married parents, a 16-year-old daughter, and a 19-year-old son recently diagnosed with schizophrenia. The rest of the family is bewildered with his symptoms and express that they feel lost in knowing how to deal with things. Which of the following approaches to family therapy should the nurse implement at this time to provide support and give information to the family that will help them cope with their son's illness? A. Insight-oriented family therapy B. Psychoeducational family therapy C. Behavioral family therapy D. Multigenerational family therapy

B. Psychoeducational family therapy The primary goal of psychoeducational family therapy is the sharing of mental health care information. This helps family members better understand their member's illness, prodromal symptoms (symptoms that may appear before a full relapse), medications needed to help reduce the symptoms, and more. Psychoeducational family meetings allow feelings to be shared and strategies for dealing with these feelings to be developed. Insight-oriented therapy focuses on developing increased self-awareness, other awareness, and family awareness among family members. Behavioral family therapy focuses on changing behaviors of family members to influence overall patterns of family interactions. The last option is a distractor and is incorrect.

The nurse is caring for an admitted client with a history of becoming aggressive when angry and has caused physical injury to another client and two staff members. When this client begins to demonstrate signs of anger while in the day room what intervention should the nurse implement to address the safety of the milieu? A. Alert security to come to the unit for a show of strength B. Request that the client accompany the nurse to the client's room C. Inform the client that restraints will be used if the behavior continues D. Prepare to administer a prn chemical restraint to the client

B. Request that the client accompany the nurse to the client's room Least restrictive alternative doctrine requires using the least drastic means of achieving a specific goal. By first attempting to remove the client to a safer location, the nurse is respecting the client's right to treatment that is less restrictive than the other options.

When considering client rights, which client can be legally medicated against his or her wishes? A. The client has accepted the medication in the past. B. The client may cause imminent harm to self or others. C. The client's primary provider orders the medication. D. The client's mental illness may relate to cognitive impairment.

B. The client may cause imminent harm to self or others. A patient may be medicated against their will without a court hearing in an emergency if the patient poses a danger to himself or herself or to others. The other options are not legally valid reasons to give medication against a patient's will.

A 55-year-old client recently came to the United States from England on a work visa. The client was admitted for severe depression following the death of a life partner weeks ago. While discussing the death and its effects the client shows little emotion. Which of the following explanations is most plausible for this lack of emotion? A. The client is in denial. B. The response may reflect cultural norms. C. The response may reflect personal guilt. D. The client may have an antisocial personality.

B. The response may reflect cultural norms. Showing little emotion while in distress may be a cultural phenomenon. Some cultures, such as the British and German cultures, tend to value highly the concept of self-control and may show little facial emotion in the presence of emotional turmoil. There is no evidence to suggest the client's lack of emotion is a result of any of the other options.

How is serious mental illness (SMI) characterized? A. any mental illness of more than 2 weeks' duration. B. a major long-term mental illness marked by significant functional impairments. C. a mental illness accompanied by physical impairment and severe social problems. D. a major mental illness that cannot be treated to prevent deterioration of cognitive and social abilities.

B. a major long-term mental illness marked by significant functional impairments. "Serious mental illness" has replaced the term "chronic mental illness." Global impairments in function are evident, particularly social. Physical impairments may be present. SMI can be treated, but remissions and exacerbations are part of thecourse of theillness.

A 26-year-old client is brought to the emergency room by a friend. The client is unable to give any coherent history. Which response should the nurse provide when the client's friend offers to provide information regarding the client? A. "I'm sorry, but I cannot take any information from you as it would violate confidentiality laws." B. "There is no need for that as I will call his primary care provider to obtain the information we need." C. "Yes, I will be happy to get any information and history that you can provide." D. "Yes, however, we will have to get a release signed from the client for you to be able to talk with me."

C. "Yes, I will be happy to get any information and history that you can provide." The friend is a secondary source of information that will be helpful since the client is not able to give any history or information at this time. Confidentiality laws do not prohibit obtaining information from a secondary source. The friend can provide information and/or history immediately and may be able to relate events that happened just before coming to the hospital. A release would not be necessary to take information about the client from a secondary source, and a psychotic client would not be competent to sign a release.

Which of the following patients meets the criteria for an involuntary admission to a psychiatric mental health unit? A. A 23-year-old college student who has developed symptoms of anxiety and is missing classes and work B. A 30-year-old accountant who has developed symptoms of depression C. A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road D. A 76-year-old retired librarian who is experiencing memory loss and some confusion at times

C. A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road Inpatient involuntary admission is reserved for patients who are at risk for self-harm or who cannot adequately protect themselves from harm because of their illness (e.g., a psychotic patient). The other options can all be managed at this point in the community setting and don't meet criteria (risk of harm to self and/or others) for admission.

A prescription for which medication would require the nurse to monitor the client for potential development of the side effect of hypothyroidism? A. Fluoxetine B. Bupropion C. Lithium D. Imipramine

C. Lithium Long-term use of lithium may cause hypothyroidism. The other options refer to drugs whose long-term use does not cause hypothyroidism.

Assessment for oppositional defiant disorder should include which interventions? A. Assessing the history, frequency, and triggers for violent outbursts B. Assessing moral development, belief system, and spirituality for the ability to understand the impact of hurtful behavior on others, to empathize with others, and to feel remorse C. Assessing issues that result in power struggles and triggers for outbursts D. Assessing sibling birth order to understand the dynamics of family interaction

C. Assessing issues that result in power struggles and triggers for outbursts Oppositional defiant disorder is characterized by defiant behavior, power struggles, outbursts, and arguing with adults, so assessment of these factors would be important. Assessing for violent outbursts refers to assessment for intermittent explosive disorder. Oppositional defiant disorder is not characterized by violent behaviors. Assessing for the ability to understand the impact of hurtful behaviors on others refers to assessment for conduct disorder. Birth order is not known to play a part in oppositional defiant disorder.

Which nursing diagnosis is likely to apply to an individual diagnosed with a serious mental illness (SMI) who is homeless? A. Insomnia B. Substance abuse C. Chronic low self-esteem D. Impaired environmental interpretation syndrome

C. Chronic low self-esteem Many individuals with SMI do not live with their families and become homeless. Life on thestreet or in a shelter has a negative influence on theindividual's self-esteem, making this nursing diagnosis one that should be considered. Substance abuse is not an approved North American Nursing Diagnosis Association (NANDA)-International diagnosis. Insomnia may be noted in some clients but is not a universal problem. Impaired environmental interpretation syndrome refers to persistent disorientation, which is not seen in a majority of thehomeless.

The family that consists of a married mother and father and three biological children all living together is referred to using which term? A. Blended family B. Cohabitating family C. Nuclear family D. Other family

C. Nuclear family A nuclear family consists of one or more children who live with married parents who are the biological or adoptive parents to all the children. Blended family refers to one or more children living with a biological or adoptive parent and an unrelated stepparent who are married to each other. Cohabitating family refers to one or more children living with a biological or adoptive parent and an unrelated adult who are cohabitating. "Other" refers to one or more children living with related or unrelated adults who are not biological or adoptive parents. This includes children living with grandparents and foster families.

An outpatient diagnosed with schizophrenia attends programming at a community mental health center. The client says, "I threw away the pills because they keep me from hearing God." Which response by the nurse would most likely to benefit this client? A. "You need your medicine. Your schizophrenia will get worse without it." B. "Do you want to be hospitalized again? You must take your medication." C. "I would like you to come to the medication education group every Thursday." D. "I noticed that when you take the medicine, you are able to keep the job you wanted."

D. "I noticed that when you take the medicine, you are able to keep the job you wanted." The client appears not to understand that he has an illness. He has stopped his medication because it interferes with a symptom that he finds desirable (auditory hallucinations—the voice of God). Connecting medication adherence to one of theclient's goals (the job) can serve to motivate theclient to take themedication and override concerns about losing thehallucinations. Exhorting a client to take medication because it is needed to control his illness is unlikely to be successful; he does not believe he has an illness. Medication psychoeducation would be appropriate if thecause of nonadherence was a knowledge deficit.

Which of the following persons has the highest risk factors for physical abuse? A. Emma, a 7-month-old baby who has colic and doesn't sleep through the night B. Roland, a 53-year-old man with cardiovascular disease living with his son C. Penny, a 28-year-old wife whose husband has a diagnosis of an anxiety disorder D. Rose, a 77-year-old woman living with her daughter and son-in-law

D. Rose, a 77-year-old woman living with her daughter and son-in-law Older women dependent on family members for care are at higher risk for abuse. The other options do not describe specific characteristics that put them at higher risk for abuse.

Which medication is FDA approved for treatment of anxiety in children? A. Sertraline (Zoloft) B. Fluoxetine (Prozac) C. Clomipramine (Anafranil) D. Duloxetine (Cymbalta, Irenka)

D. Duloxetine A few drugs are approved specifically for anxiety and obsessive-compulsive disorders in children and adolescents. The FDA approved the selective SNRI duloxetine in 2014 for children aged 7 to 17 years for generalized anxiety disorder. The FDA has approved four medications for use in children with obsessive-compulsive disorder. They are clomipramine, fluoxetine, fluvoxamine, and sertraline.

Which interventions and/or goals related to planning for discharge of a client diagnosed with a serious mental illness (SMI) would support the recovery model of care? A. Attending groups that teach how to cope with one's present illness. B. The client's parents will receive education on how to manage the patient's deficits. C. Care plan interventions will focus on medication adherence. D. Interventions will focus on the client's stated wish for independent living.

D. Interventions will focus on the client's stated wish for independent living. The recovery model is patient centered, instills hope and empowerment, emphasizes the person and the future, encourages independence and self-determination, and focuses on achieving goals of the patient's choosing and meaningful living. The National Alliance on Mental Illness (NAMI) and the President's New Freedom Commission on Mental Health (2003) both support the recovery model of care rather than the rehabilitation model, which focuses on the illness and the present. The other options all follow the rehabilitation model, focusing on the illness.

A client states, "I found out that I was in the section of the research study not actually taking the medicine. I don't understand that, because all my symptoms improved!" This reaction may be related to what concept? A. Mind-body effect B. Meditation C. Homeopathy D. Naturopathy

A. Mind-body effect Mind and body approaches are built on theories that focus on the continuous interaction between mind and body. Most of these techniques emphasize the mind's capacity to affect bodily function and symptoms, but the reverse—the effects of bodily illness on mental health—is also part of the equation. None of the remaining options are associated with the patient's statement.

A nurse works with a nuclear family that includes an adult child diagnosed with schizophrenia. The child's mother confides that she and her husband "have not been getting along well." She states that her teenage daughter provides much support to her and claims that "she doesn't really like her dad much anymore and doesn't talk to him." The nurse suspects that the family is experiencing which family dysfunctional dynamic? A. Emotional abuse B. Neglect C. Boundary blurring D. Triangulation

D. Triangulation Triangulation refers to a family "triangle" of three. When the tension in a dyad (two people) builds, a third person (child, friend, or parent) may be brought in by one of the members. This third person of the dyad serves to help lower the tension by solving the crisis or offering understanding. Family triangles may create emotional instability in the long run and are not optimal for dealing with problems in an open and direct way. There is nothing that indicates abuse. There is nothing to indicate neglect. Boundary blurring occurs when boundaries are diffuse, or unclear.

The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to which outcome? A. enhanced client coping. B. lessening of client emotional pain. C. increased hope for client improvement. D. decreased client communication.

D. decreased client communication Sympathy and the resulting projection of the nurse's feelings limits the client's opportunity to further discuss the problem.

Which statement by a patient who was educated about the importance of acquiring adequate sleep indicates a need for further teaching? A. "I will be sure to try to get 8 hours of sleep every night, and 9 or 10 hours of sleep if I can." B. "Getting less than 6 hours of sleep at night may increase my risk for medical problems." C. "Getting enough sleep will increase my productivity at work." D. "Since I have to drive for my job, getting enough sleep will help me avoid accidents."

A. "I will be sure to try to get 8 hours of sleep every night, and 9 or 10 hours of sleep if I can." Sleeping more than 8 hours per night is associated with up to a twofold increased risk of obesity, diabetes, hypertension, incident cardiovascular disease, stroke, depression, and substance abuse. The other options are all true.

Serious mental illness (SMI) affects how many adults in the United States? A. 11 million B. 8 million C. 4 million D. 1 million

A. 11 million SMI affects about 11.4 million adults in the United States. The other options are incorrect percentages.

A 20-year-old Amish client was diagnosed with paranoid schizophrenia 1 year ago who lives with his parents. When the nurse attempts to educate him about his diagnosis and the need for medication, the client persistently mumbles, "I don't have mental illness. No, I am not sick." What term is used to describe this response? A. Anosognosia B. Resistance C. Apathy D. Religiosity

A. Anosognosia Anosognosia is the inability to recognize one's deficits as a result of one's illness. In serious mental illnesses (SMIs), the brain, the organ one needs to have insight and make good decisions, is the organ that is diseased. An illness that makes one unable to recognize that illness can understandably cause one to be resistant to treatment. Although the patient may be resistive to treatment, it does not best describe the patient's denial of the illness. Apathy is lack of caring. Nothing in the scenario depicts the patient being preoccupied with religion at this time.

Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide? A. Break-away closet bars to prevent hanging B. Bedroom and dining areas with locked windows to prevent jumping C. Double-locked doors to prevent escaping from the unit D. Platform beds to prevent crush injuries

A. Break-away closet bars to prevent hanging Hangings are the most common method of inpatient suicide. The other options are important safety measures but don't directly address the suicide method of hanging.

Which statements are true regarding the differences between social & therapeutic relationships? (SATA) A. In a social relationship, both parties' needs are met; in a therapeutic relationship, only the patient's needs are to be considered. B. A soc. relationship is instituted for the main purpose of exploring one member's feelings & issues; a ther. relationship is instituted for the purpose of friendship. C. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. D. In a social relationship, both parties come up with solutions to problems & solutions may be implemented by both; in a therapeutic relationship, solutions are discussed but are only implemented by the patient. E. In a soc. relationship, communication is usually deep & evaluated; in a therap. relationship, communication remains on a more superficial level, allowing patients to feel comfortable.

A. In a social relationship, both parties' needs are met; in a therapeutic relationship, only the patient's needs are to be considered. C. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. D. In a social relationship, both parties come up with solutions to problems & solutions may be implemented by both; in a therapeutic relationship, solutions are discussed but are only implemented by the patient. The other options describe the opposite meanings of social and therapeutic relationships.

Which statement is true regarding incarcerated persons demonstrating behaviors associated with serious mental illness? A. Incarceration often causes decompensation in those with serious mental illness. B. Those with serious mental illness who are incarcerated see remission of symptoms while in prison. C. Incarceration doesn't appear to play a role in how a person with serious mental illness functions. D. Incarceration plays a role in that people with serious mental illness are ensured of receiving treatment they may have not had outside of prison.

A. Incarceration often causes decompensation in those with serious mental illness. Correctional nurses provide care for many patients with serious mental illness. Because psychiatric facilities for the management of such emergencies are scarce, often these patients end up in jail instead of in a hospital. Once they are in jail, their psychiatric condition often worsens without adequate psychiatric intervention. The other options are not correct and incarceration may in fact prevent the inmate from receiving appropriate treatment.

A client diagnosed with a serious mental illness (SMI) lives independently and attends a psychosocial rehabilitation program. The client presents at the emergency department seeking hospitalization. The client has no acute symptoms but says, "I have no money to pay my rent or refill my prescription." What is the nurse's best action? A. Involve the client's case manager to provide crisis intervention. B. Send the client to a homeless shelter until housing can be arranged. C. Arrange for a short in-client admission and begin discharge planning. D. Explain that one must have active psychiatric symptoms to be admitted.

A. Involve the client's case manager to provide crisis intervention. Impaired stress tolerance and problem-solving abilities can cause persons with SMI to experience relatively minor stressors as crises. This client has run out of money, and this has overwhelmed her ability to cope, resulting in a crisis for which crisis intervention would be an appropriate response. Inpatient care is not clinically indicated nor is theclient homeless (although she may fear she is). Telling theclient that she is not symptomatic enough to be admitted may prompt malingering.

When preparing to hold an admission interview with a client, the nurse pulls up a chair and sits facing the client with their knees almost touching. When the nurse leans in close to speak, the client becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for client's behavior? A. The nurse violated the client's personal space by physically being too close. B. The client has issues with sharing personal information. C. The nurse failed to explain the purpose of the admission interview. D. The client is responding to the voices by ending the conversation.

A. The nurse violated the client's personal space by physically being too close. By sitting and leaning in so closely, the nurse has entered into intimate space (0 to 18 inches), rather than social distance. This has likely made the client may feel uncomfortable with being so close to someone unknown to them. All the other options lack evidence and jump to conclusions regarding the client's behavior.

A nurse on the psychiatric unit has a past history of alcoholism and has regular meetings with a mentor. Which statement made to the nurse's mentor would indicate the presence of countertransference? A. "My patient is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again." B. "My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" C. "My patient started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA (Alcoholics Anonymous) meetings five times a week after discharge." D. "My patient, is an elderly woman with depression. She calls me by her daughter's name because she says I remind her of her daughter."

B. "My patient has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now!" This statement indicates countertransference; the nurse may be overidentifying with the patient because of a past history of alcoholism. Providing adamant advice to the patient that, besides being nontherapeutic, may be more relevant to personal past experiences than to the patient's. The discharge teaching for a patient being discharged and focusing on the treatment plan for the alcoholic patient are appropriate and show no signs of countertransference. The patient calling the nurse by her daughter's name is transference rather than countertransference.

Many persons brought before a criminal court have mental illness, have committed minor offenses, and are non-medication adherent. The judge consults the nurse at the local community mental health center for guidance about how to respond when handling such cases. Which advice from the nurse would be most appropriate? A. "Sometimes a little time in jail makes a person rethink what they've been doing and puts them back on the right track." B. "Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses." C. "Arresting these people helps them in the long run. Sometimes we cannot hospitalize them, but in jail they will get their medication." D. "Research suggests that special mental health courts do not make much difference so far, but outpatient commitment does seem to help."

B. "Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses." Research supports theuse of special mental health courts that can sentence mentally ill persons to treatment instead of jail. Jail exposes vulnerable mentally ill persons to criminals, victimization, and high levels of stimulation and stress. Incarceration can also interrupt eligibility for benefits or lead to theloss of housing and often provides lower-quality mental health treatment in other settings. Recidivism rates for both mentally ill and non-mentally ill offenders are relatively high, so it does not appear that incarceration necessarily leads people to behave more appropriately. In addition, a criminal record can leave them more desperate and with fewer options after release. Research indicates that outpatient commitment is less effective at improving themental health of mentally ill persons than was expected.

A client on the psychiatric unit asks the nurse, "What does group work mean? I was told I would be going to group and doing group work." How should the nurse respond to provide the best answer to the client's question? A. "You will attend group therapy and find solutions for each other's problems." B. "You will give and receive feedback from a group of your peers who may also have similar problems to work through." C. "You will share your issues with the group and then split up to work separately on solutions based on the ideas the other members provide." D. "Group work is the work that you do beforehand so you can present it to the group when you meet."

B. "You will give and receive feedback from a group of your peers who may also have similar problems to work through." Group work is a method whereby individuals with a common purpose come together and benefit by mutually giving and receiving feedback within the dynamic and unique group context. None of the other options accurately and adequately describe group work.

Ever since participating in a village raid where explosives were used, a military veteran has been unable to walk. After all diagnostic testing were negative for any physical abnormalities, the client was diagnosed with conversion disorder. What is the nurse's best response when asked by the client, "Why can't I walk?" A. "Your legs don't work because your brain is screwed up." B. "Your emotional distress is being expressed as a physical symptom." C. "You are making up your symptoms as a cry for help." D. "You are overly anxious about having a severe illness."

B. "Your emotional distress is being expressed as a physical symptom." Conversion disorder is attributed to channeling of emotional conflicts or stressors into physical symptoms. Telling the patient her brain is "screwed up" is unprofessional and does not give any useful education. Symptoms of conversion disorder are not within the patient's voluntary control. Being overly anxious about having a severe illness describes illness anxiety disorder.

Which client behavior illustrates eustress? A. A man is laid off from his job. B. A bride is planning for her wedding. C. An adolescent gets into a fight at school. D. A college student fails an exam.

B. A bride is planning for her wedding. Eustress is the result of a positive perception toward a stressor, such as having a baby, planning a wedding, or getting a new job. The other options all describe distress, or a negative energy.

The nurse is conducting an admission interview with a client who was raped 2 weeks ago. When asked about the rape, the client becomes very anxious and upset and begins to sob. What should be the nurse's response to the client's reaction? A. Push gently for more information about the rape because the information needs to be documented. B. Acknowledge that the topic of the rape is upsetting and reassure the client that it can be discussed at another time when she feels more comfortable. C. Use silence as a therapeutic tool and wait until the client is done sobbing to continue discussing the rape. D. Reassure the client that anything she says to you will remain confidential.

B. Acknowledge that the topic of the rape is upsetting and reassure the client that it can be discussed at another time when she feels more comfortable. The best atmosphere for conducting an assessment is one with minimal anxiety on the client's part. If a topic causes distress, it is best to abandon the topic at that time. It is important not to pry or push for information that is difficult for the client to discuss. The use of silence continues to expect the client to discuss the topic now. Reassurance of confidentiality continues to expect the client to discuss the topic now.

A client's daughter states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." This information supports that the client may be experiencing which anxiety-related disorder? A. Panic disorder B. Adult separation anxiety disorder C. Agoraphobia D. Social anxiety disorder

B. Adult separation anxiety disorder People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. There may also be fear that something horrible will happen to the other person. Adult separation anxiety disorder may begin in childhood or adulthood. The scenario doesn't describe panic disorder. Agoraphobia is characterized by intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available. Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others.

A 49-year-old client diagnosed with schizophrenia at 22 years old is prescribed risperidone. Which nursing assessment is the priority for this client? A. Monitoring blood levels to avoid toxicity B. Monitoring for abnormal involuntary movements C. Observing for secondary mania D. Observing for memory changes

B. Monitoring for abnormal involuntary movements Risperidone has the highest rate of extrapyramidal side effects (EPSs) of the second-generation antipsychotic medications, thus making it imperative to monitor for EPSs. Risperidone is not monitored with blood levels and does not cause mania or memory changes.

A patient diagnosed with borderline personality disorder is attending a court-ordered therapy group. The patient projects an angry affect, does not speak much, except to make a snide comment about another member of the group or the group's leader. What is the best way for the leader to handle this patient's behavior? A. Remove the patient from the group because this behavior is disrupting the group process for other participants. B. Respond neutrally to the patient's comments, ask for group feedback, and talk privately with the patient to form a therapeutic connection. C. Spend an entire group session focused on that patient and try to get him/her to open up to other members in depth. D. Confront the patient firmly each time he/she makes a rude comment and let him/her know they will be taken out of group if the behavior continues.

B. Respond neutrally to the patient's comments, ask for group feedback, and talk privately with the patient to form a therapeutic connection. The group leader should listen to the comments objectively and without becoming defensive. The leader may choose to speak to the group member in private and ask what is causing the anger, to form a connection with the patient that may result in less disruptive behavior in group. In the group setting, the leader can focus on positive group members whose comments may reduce the hostility of the negative group member. Part of the group process includes problem-solving skills and getting group feedback for issues. Spending an entire session discussing one patient is inappropriate in a group setting. Confrontation done on a continual basis would disrupt the group process and focus heavily on the hostile client.

A client living independently had command hallucinations to shout warnings to neighbors. After a short hospitalization, the client was prohibited from returning to the apartment. The landlord said, "You cause too much trouble." What problem is the client experiencing? A. Grief B. Stigma C. Homelessness D. Nonadherence

B. Stigma The inability to obtain shelter because of negative attitudes about mental illness is an example of stigma. Stigma is defined as damage to reputation, shame, and ridicule society places on mental illness. Data are not present to identify grief as a client problem. Data do not suggest that theclient is actually homeless. See relationship to audience response question

A client, whose friend recently committed suicide, asks the nurse about some ways to help cope with the stress regarding the event. Which option should the nurse discuss with the client? A. Isolation for a short time so that the pain isn't reinforced by explaining her feelings over and over B. Talking with friends and attending a loss support group C. Starting a hobby to keep her mind off the troubling event D. Antianxiety medication to help her relax

B. Talking with friends and attending a loss support group Social supports and support groups are two effective ways to cope with stress and stressful events. Isolation is never a healthy option; talking about feelings usually decreases stress, not increases. There is no evidence to suggest Melissa is anxious. Trying to "keep her mind off" the stressor does not develop coping mechanisms to deal with stress but rather encourages not dealing with the problem.

A 72-year-old client diagnosed with Parkinson's disease is demonstrating behaviors associated with anxiety and has had several falls lately and is reluctant to take medications as prescribed. When the healthcare provider orders lorazepam, 1 mg PO bid, the nurse questions the prescription based primarily on what fact? A. The client may become addicted faster than younger clients. B. The client is at risk for falls. C. The client has a history of nonadherence with medications. D. The client should be treated with cognitive therapies because of his advanced age.

B. The client is at risk for falls. An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In a client who has a history of falls, lorazepam would be contraindicated because it may cause sedation and ataxia leading to more falls. There is no evidence to suggest that elderly clients become addicted faster than younger clients. A history of nonadherence would not lead to you to question this drug order. Medication and other therapies are used congruently with all age levels.

Which statement, made by a female adult concerning her boyfriend, should cause the nurse to suspect that the client is at risk for being emotionally abused? A. "He has a good job and keeps control of all the finances but our electricity still got turned off last week." B. "I didn't tell him I was coming because he is under so much stress at work I didn't want to add to it." C. "He yells a lot and calls me names, but that's because I am so stupid and make so many mistakes." D. "He has always had a fiery temper.

C. "He yells a lot and calls me names, but that's because I am so stupid and make so many mistakes." Emotional abuse may be less obvious and more difficult to assess than physical violence, but it can be identified through indicators such as low self-esteem, reported feelings of inadequacy, and anxiety. Controlling the finances and having the electricity turned off describes the possibility of economic abuse. Not wanting to add to the boyfriend's stress does not describe an abusive situation. Describing the boyfriend as having a temper would more likely hint at physical abuse rather than emotional.

The nurse is caring for a client on day 1 post-surgical procedure. The client becomes visibly anxious and short of breath, and states, "I feel so anxious! Something is wrong!" What action should the nurse take initially in response to the client's actions? A. Reassure the client that what they are feeling is normal anxiety and do deep breathing exercises with her. B. Use the call light to inquire whether the client has been prescribed prn anxiety medication. C. Call for staff help and assess the client's vital signs. D. Reassure the client that you will stay until the anxiety subsides.

C. Call for staff help and assess the client's vital signs. In anxiety caused by a medical condition, the individual's symptoms of anxiety are a direct physiological result of a medical condition, such as hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias. In this case, Lana is postoperative and could be experiencing a pulmonary embolism, as evidenced by the shortness of breath and anxiety. She needs immediate evaluation for any serious medical condition. The other options would all be appropriate after it has been determined that no serious medical condition is causing the anxiety.

The nurse wants to enroll a client with poor social skills in a training program for clients diagnosed with schizophrenia. Which description accurately describes social skills training? A. Clients learn to improve their attention and concentration. B. Group leaders provide support without challenging clients to change. C. Complex interpersonal skills are taught by breaking them into simpler behaviors. D. Clients learn social skills by practicing them in a supported employment setting

C. Complex interpersonal skills are taught by breaking them into simpler behaviors. In social skills training, complex interpersonal skills are taught by breaking them down into component behaviors that are covered in a stepwise fashion. Social skills training is not based in employment settings, although such skills can be addressed as part of supported employment services. the other distracters are less relevant to social skills training.

What is the group leader's responsibility in the termination phase? A. Allowing members to exchange contact information so they may remain as a support for each other. B. Removing himself or herself from the group so they can function independently. C. Encouraging group members to reflect on progress made while providing group feedback. D. Encouraging group members to fill out evaluation forms so the group leader can further improve his or her therapeutic technique.

C. Encouraging group members to reflect on progress made while providing group feedback. In the termination phase, the group leader's role is to encourage members to reflect on progress they have made and identify posttermination goals. Contact with other members in the group outside of the group is not therapeutic and is usually discouraged. The group leader does not remove himself or herself from the group process. Group members do not fill out evaluation forms in group therapy.

A 53-year-old client with a pacemaker implant has been prescribed warfarin. The patient tells the nurse, "I feel so much better now that I've been taking ginseng to relieve my menopausal symptoms." The nurse's response should be based on what knowledge about ginseng? A. It is an appropriate herbal supplement for this patient. B. It has no proven effect on menopausal symptoms. C. It has anticoagulation effects. D. It is implicated in triggering strokes.

C. It has anticoagulation effects. Ginseng has anticoagulant effects. Drinking ginseng tea may increase the effects of prescription anticoagulants, and the consequences could seriously affect blood clotting. The other options are untrue.

A nurse is providing care to a 28-year-old client diagnosed with bipolar disorder who was admitted in a manic state. According to Maslow's Hierarchy of Needs theory, the nurse should identify which client symptom as having priority? A. Rapid, pressured speech B. Grandiose thoughts C. Lack of sleep D. Hyperactive behavior

C. Lack of sleep Based on Maslow's theory, physiological needs such as food, water, air, sleep, etc., are the priority and must be taken care of first. The other options are symptoms of mania but not as critical as lack of sleep.

Which statement is true of the relationship between serious mental illnesses (SMIs) and substance abuse? A. Substance abuse rarely occurs within this population. B. Substance abuse occurs at approximately the same rate as in the general population. C. Of those diagnosed with SMI, substance abuse is high. D. Smoking has declined in this population at the same rate as the general public.

C. Of those diagnosed with SMI, substance abuse is high. Comorbid substance abuse occurs in 30% of those with SMI. It may be a form of self-medication, countering the dysphoria or other symptoms caused by illness or its treatment (e.g., the sedation caused by one's medications) or a maladaptive response to boredom. Nicotine use has always been higher in the population of those with SMI and is not declining as it has been in the general population. Substance abuse contributes to comorbid physical health problems, reduced quality of life, incarceration, relapse, and reduced effectiveness of medications. Substance abuse in those with SMI is higher than in the general population. Smoking has not declined in this population at the same rate as for the general public.

The nurse is planning long-term goals for a 17-year-old male client recently diagnosed with schizophrenia. Which statement should serve as the basis for the goal-setting process? A. If treated quickly following diagnosis, schizophrenia can be cured. B. Schizophrenia can be managed by receiving treatment only at the time of acute exacerbations. C. Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability. D. If patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms.

C. Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability. Unfortunately, in most cases, schizophrenia does not respond fully to available treatments; it leaves residual symptoms and causes varying degrees of dysfunction or disability. The other options are all untrue of schizophrenia.

Jacob is a college student whose friend recently committed suicide. Jacob rates his stress as low. Melissa was also friend with the person who committed suicide, but she rates her stress as high. The difference in how Jacob and Melissa rate their stress may be explained by which coping mechanism? A. Projection B. Denial C. Perception D. Repression

C. Perception Perception, which is influenced by gender, culture, age, and life experience, plays a part in how someone will respond to a stress. The perception of a stressor determines the person's emotional and psychological reactions to it. The other options are all defense mechanisms that do not explain the difference in reactions to a stressor.

A teenaged client is being discharged from the psychiatric unit with a prescription for risperidone. The nurse providing medication teaching to the client's mother should provide which response when asked about the risk her son faces for extrapyramidal side effects (EPSs)? A. All antipsychotic medications have an equal chance of producing EPSs. B. Newer antipsychotic medications have a higher risk for EPSs. C. Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics. D. Advise the mother to ask the provider to change the medication to clozapine instead of risperidone.

C. Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics. Risperidone is a newer, atypical antipsychotic. All newer antipsychotic medications have a lower incidence of EPSs than older, traditional antipsychotics. The other responses are untrue. There is no reason to advise a medication change at this time.

A client states, "I will always be alone because nobody could ever love me." The nurse recognizes that the client is expressing what cognitive-behavioral concept? A. Actualization B. Aversion C. Schema D. Emotional consequence

C. Schema Schemas are unique assumptions about ourselves, according to Beck's theory. This statement is an example of a negative schema. Emotional consequence is the end result of negative thinking process, as described by Ellis. Actualization is a level of Maslow's Hierarchy of Needs. Aversion is a therapy characterized by punishment.

What is the priority outcome for a toddler who has been sexually abused? A. The child will be able to verbalize exactly what happened to her. B. The child will no longer demonstrate inappropriate sexual behavior. C. The sexual abuse will cease immediately. D. The mother will learn coping techniques to support the child.

C. The sexual abuse will cease immediately. The highest priority in this case is that the abuse stops so that the patient can be safe and undergo recovery. The question is asked about the priority outcome for the victim, not the mother. Verbalizing exactly what happened is not a priority. The victim will most likely stop the sexualized behavior when the abuse has stopped and recovery is supported by age-appropriate interventions.

What is the primary difference between a social and a therapeutic relationship? A. Type of information exchanged B. Amount of satisfaction felt C. Type of responsibility involved D. Amount of emotion invested

C. Type of responsibility involved In a therapeutic relationship the nurse assumes responsibility for focusing the relationship on the client's needs, facilitating communication, assisting the client with problem-solving, and helping the client identify and test alternative coping strategies.

An adult diagnosed with a serious mental illness (SMI) says, "I do not need help with money management. I have excellent ideas about investments." This client usually does not have money to buy groceries by the middle of the month. The nurse assesses the client as demonstrating what defense mechanism? A. rationalization. B. identification. C. anosognosia. D. projection.

C. anosognosia. The client scenario describes anosognosia, theinability to recognize one's deficits due to one's illness. theclient is not projecting an undesirable thought or emotion from himself onto others. He is not justifying his behavior via rationalization and is not identifying with another.

A client diagnosed with schizophrenia states to the nurse, "My, oh my. My mother is brother. Anytime now it can happen to my mother." Your best response would be: A. "You are having problems with your speech. You need to try harder to be clear." B. "You are confused. I will take you to your room to rest a while." C. "I will get you a prn medication for agitation." D. "I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?"

D. "I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?" The guidelines that are useful in communicating with a patient with disorganized or bizarre speech are to place the difficulty in understanding on yourself, not the patient, and look for themes that may be helpful in interpreting what the patient wants to say. Telling the patient he needs to try harder to be clearer is unrealistic since the patient would be unable do this. The other options are not useful in communicating with this patient and attempting to find common themes

A family discusses the impact of a seriously mental ill member. Insurance partially covers treatment expenses, but the family spends much of their savings for care. The client's sibling says, "My parents have no time for me." The parents are concerned that when they are older, there will be no one to care for the client. Which response by the nurse would be most helpful? A. Acknowledge their concerns and consult w treatment team about ways to bring theclient's symptoms under better control. B. Give them names of financial advisors that could help them save/borrow sufficient funds to leave a trust fund to care for their loved one. C. Refer them to crisis intervention services to learn ways to manage caregiver stress and provide titles of some helpful books for families. D. Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the client become more independent

D. Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the client become more independent. The family has raised a number of concerns, but themajor issues appear to be theeffects caregiving has had on thefamily and their concerns about theclient's future. NAMI offers support, education, resources, and access to other families who have experience with theissues now facing this family. NAMI can help address caregiver burden and planning for thefuture needs of SMI persons. Improving theclient's symptom control and general functioning can help reduce caregiver burden but would likely be a slow process, whereas NAMI involvement could benefit them on a number of fronts, possibly in a shorter time period. thefamily will need more than financial planning; their issues go beyond financial. thefamily is distressed but not in crisis. Crisis intervention is not an appropriate resource for thelonger-term issues and needs affecting this family

A hospitalized client diagnosed with schizophrenia has a history of multiple relapses. The client usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply first as the client transitions from hospital to community? A. Administer a second-generation antipsychotic to help negative symptoms. B. Use a quick-dissolving medication formulation to reduce "cheeking." C. Prescribe a long-acting intramuscular antipsychotic medication. D. Involve the client in decisions about which medication is best.

D. Involve the client in decisions about which medication is best. Persons with schizophrenia are at high risk for treatment nonadherence, so thestrategy needs primarily to address that risk. Of theoptions here, involving theclient in thedecision is best because it will build trust and help establish a therapeutic alliance with care providers, an essential foundation to adherence. Intramuscular depot medications can be helpful for promoting adherence if other alternatives have been unsuccessful, but IM medications are painful and may jeopardize theclient's acceptance. All of theother strategies also apply but are secondary to trust and bonding with providers.

The advanced practice nurse running a group on the adolescent unit makes no attempt to control the topic and makes no comment unless asked a direct question. What leadership style is the nurse implementation? A. Autocratic B. Authoritarian C. Democratic D. Laissez-faire

D. Laissez-faire A laissez-faire leader allows the group members to behave in any way they choose and does not attempt to control the direction of the group. Autocratic leaders control the group, pick the topic, and do not allow for much interaction. Authoritarian is another word for autocratic. A democratic leader involves the group members in decision making.

A client tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the client may be experiencing which unconscious emotion? A. Congruence B. Empathetic feelings C. Countertransference D. Positive transference

D. Positive transference Transference involves the client experiencing feelings toward a nurse that belong to a significant person in the client's past. If a patient is motivated to work with you, completes assignments between sessions, and shares feelings openly, it is likely the patient is experiencing positive transference. The behavior is not associated with any of the other options.

A client diagnosed with schizophrenia tells the community mental health nurse, "I threw away my pills because they interfere with God's voice." How should the nurse identify the etiology of the client's ineffective management of the medication regime? A. inadequate discharge planning. B. poor therapeutic alliance with clinicians. C. dislike of antipsychotic medication side effects. D. impaired reasoning secondary to the schizophrenia.

D. impaired reasoning secondary to the schizophrenia. The client's ineffective management of themedication regime is most closely related to impaired reasoning associated with thethought disturbances of schizophrenia. theclient believes in being an exalted personage who hears God's voice, rather than an individual with a serious mental disorder who needs medication to control symptoms. Data do not suggest any of theother factors often related to medication nonadherence.

An outpatient diagnosed with schizophrenia tells the nurse, "I am here to save the world. I threw away the pills because they make God go away." What does the nurse suspect is the client's reason for medication nonadherence? A. poor alliance with clinicians. B. inadequate discharge planning. C. dislike of medication side effects. D. thought disturbances associated with the illness

D. thought disturbances associated with the illness The client's nonadherence is most closely related to thought disturbances associated with theillness. theclient believes he is an exalted personage who hears God's voice rather than an individual with a serious mental disorder who needs medication to control his symptoms. While thedistracters may play a part in theclient's nonadherence, thecorrect response is most likely