354 Exam 2 Mental Health NCLEX Questions

An 8-year-old patient is newly diagnosed with attention deficit hyperactivity disorder (ADHD). It is important that the parents be educated to the fact that symptoms will take which form? Select all that apply. a. Low frustration tolerance b. Poor school performance c. Impulsive behaviors d. Easily intimidated e. Mood swings

a. Low frustration tolerance b. Poor school performance c. Impulsive behaviors e. Mood swings Attention problems and hyperactivity contribute to low frustration tolerance, temper outbursts, labile moods, poor school performance, peer rejection, and low self-esteem.

The impulse control spectrum can begin in childhood and continue on into adulthood, often morphing into criminal behaviors. Working with patients diagnosed with these disorders, the best examples of expressed emotion by the nursing staff are: a. Low to prevent emotional reactions b. Matched to the patient's level of emotion c. Flat without evidence of any emotional output d. High expression to improve therapeutic patient emotions

a. Low to prevent emotional reactions

What is a common behavior observed in a patient diagnosed with intermittent explosive disorder? Select all that apply. a. Short attention span b. Threatens suicide c. Often purges after eating d. Uses alcohol to excess e. States, "Everyone is out to get me."

a. Short attention span b. Threatens suicide d. Uses alcohol to excess

You as the nurse believes that the young man you are admitting to your unit is suffering from command auditory hallucinations (CAH). What would be a follow up question you would want to ask this patient? (select all that apply). a. What are the voices saying? b. Do you believe the voices are real? c. Would you follow the commands? d. Why do these voices tell you to do bad things? e. Do you recognize the voice? f. Have the voices ever told you to hurt yourself in any way?

a. What are the voices saying? b. Do you believe the voices are real? c. Would you follow the commands? e. Do you recognize the voice? f. Have the voices ever told you to hurt yourself in any way?

Schizophrenia is best characterized as presenting which personality trait? a. Split b. Multiple c. Ambivalent d. Deteriorating

d. Deteriorating The course of schizophrenia is marked by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.

Which activity is most appropriate for a child with ADHD? a. Reading an adventure novel b. Monopoly c. Checkers d. Tennis

d. Tennis

Which neuroimaging technique would the nurse expect the provider to order to reveal suspected problems in a patient's brain function? (Select all that apply). a. CT b. PET c. SPECT d. MRI

b. PET c. SPECT Functional imaging techniques (e.g., positron emission tomography [PET] and single photon emission computed tomography [SPECT]) reveal physiological activity in the brain.

A child with ADHD had this nursing diagnosis: impaired social interaction, related to excessive neuronal activity, as evidenced by aggressiveness and dysfunctional play with others. Which finding indicates the plan of care was effective? a. Improved ability to identify anxiety and use self-control strategies b. Increased expressiveness in communication with others c. Engages in cooperative play with other children d. Increased responsiveness to authority figures

c. Engages in cooperative play with other children

A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms? a. Her memory problems will likely decrease. b. Depressive episodes should be less severe. c. She will probably enjoy social interactions more. d. She should experience a reduction in hallucinations.

d. She should experience a reduction in hallucinations.

Which child would the nurse recognize as being the most difficult to diagnose for a neurodevelopmental disorder? a. 3 year old b. 5 year old c. 8 year old d. 12 year old

a. 3 year old

The most common course of schizophrenia is an initial episode followed by what course of events? a. Recurrent acute exacerbations and deterioration b. Recurrent acute exacerbations c. Continuous deterioration d. Complete recovery

a. Recurrent acute exacerbations and deterioration The course of schizophrenia is marked by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.

Claude is a new nurse on the psychiatric unit. He asks a senior nurse on staff for the "best advice" when working with oppositional defiant disorder. Which statement reflects advice on solid therapeutic communication? a. "When correcting behavior, use a loud firm tone." b. "Use language beyond the patient's education level." c. "When setting limits, be specific and outline consequences." d. "An aggressive body language will make the patients respect your position."

c. "When setting limits, be specific and outline consequences."

The medical record of a patient diagnosed with schizophrenia states that the patient has cognitive dysfunction. Which presentation would the nurse expect to see? a. Anxiety, fear, and agitation b. Aggression, anger, hostility, or violence c. Blunted or flat affect or inappropriate affective responses d. Impaired memory and attention as well as formal thought disorder

d. Impaired memory and attention as well as formal thought disorder

A 4 year old frequently lashes out in anger at adults and other children. This child's style of behavior is an aspect of what? a. Neurobiology b. Temperament c. Resilience d. Culture

b. Temperament

Larry, a middle-aged male in a treatment facility, is loudly displaying anger in the day room with a visiting family member. It is obvious to the nurse this pattern has played out before. Violence is often escalated when family members or authority figures: a. Use a soft tone of voice to gain control of the situation b. Move away from the agitated person in fear c. Use simple words to communicate d. Engage in a power struggle

d. Engage in a power struggle

What part of the brain is dysfunctional in persons with schizophrenia? Research has implicated the: a. Medulla and cortex b. Cerebellum and cerebrum c. Hypothalamus and medulla d. Prefrontal and limbic cortices

d. Prefrontal and limbic cortices

A patient with schizophrenia, who experienced an acute exacerbation of symptoms, was admitted to an inpatient unit to be stabilized 2 weeks ago. The nurse is now preparing to discharge the patient, what are some considerations that should be made by the nurse in order to help the patient best maintain treatment achievements and prevent relapse? (select all that apply). a. Provide medication education and explain the importance of adherence b. Discuss goals with the patient of how they can control their environment to avoid triggers c. Explain the chronic nature of the illness and how preventing relapse is essential to them not becoming homeless in the future d. Refer the patient and their family to support groups e. Provide information about early signs and symptoms that may indicate impending relapse to promptly seek treatment

a. Provide medication education and explain the importance of adherence b. Discuss goals with the patient of how they can control their environment to avoid triggers d. Refer the patient and their family to support groups e. Provide information about early signs and symptoms that may indicate impending relapse to promptly seek treatment Although homelessness is not uncommon in individuals suffering from schizophrenia, the unfortunate truth is that the cycle of "remission" and relapse in relation to homelessness involves many other factors such as the ability to work and have income, stigma, episodes leading to eviction or criminal justice system involvements preventing them from obtaining housing, losing housing due to entering into inpatient hospitalization, and more. Prevention of relapse is important, but indicating that the patient will become homeless due to relapse is inappropriate.

Individuals with severe mental illness (SMI) diagnoses can suffer from ineffective healthcare. Providers may be unaccustomed to working with this population or not comprehend obscure details described by the person seeking medical attention. This hurdle can be overcome by: a. Seeking medical attention at the emergency department. b. Having a community clinic in the area where the SMI live. c. Medicate the patient before a medical examination. d. Integrating mental and physical health in one setting.

d. Integrating mental and physical health in one setting.

Pam, the nurse educator, is teaching a new nurse about seclusion and restraint. Order the following interventions from least (1) to most (5) restrictive: a. With the patient identify the behaviors that are unacceptable and consequences associated with harmful behaviors b. Placing the patient in physical restraints c. Allowing the patient to take a time-out and sit in his or her room d. Offering a PRN medication by mouth e. Placing the patient in a locked seclusion room

1 - a. With the patient identify the behaviors that are unacceptable and consequences associated with harmful behaviors 2 - d. Offering a PRN medication by mouth 3 - c. Allowing the patient to take a time-out and sit in his or her room 4 - e. Placing the patient in a locked seclusion room 5 - b. Placing the patient in physical restraints

Which remark would signal to the nurse that there is a teaching need for the family of a client diagnosed with schizophrenia? a. "We always reprimand him whenever his behavior is bothersome." b. "We watch him closely for signs of illness associated with relapse." c. "We have taught him to use the bus so we do not have to drive him everywhere." d. "We give positive recognition to him whenever he does even simple things well."

a. "We always reprimand him whenever his behavior is bothersome." An important need of families caring for the severely and persistently mentally ill is psychoeducation to help them understand the disease process. Families need to be prepared to meet the many concerns related to safety, communication, medication compliance, and symptom management. Family interventions are now considered an evidence-based practice, with research showing improved outcomes of decreased relapses and rehospitalizations for clients whose families participate. The only negative approach to the client and his/her needs is reflected in the option that suggests reprimanding when bothersome.

The term dual diagnosis refers to having a severe mental illness and what other dysfunctional behavior? a. A substance abuse problem b. Medication noncompliance c. A personality disorder d. HIV infection

a. A substance abuse problem Dual diagnosis is the term used to identify a client with severe mental illness and a substance abuse problem. Both problems must be treated if the client is to be successfully rehabilitated.

A 20-year-old Amish patient 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.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.

The mother of a client with severe, persistent schizophrenia tells the nurse, "My son has slipped so far away from me over the past few years. We really don't have a relationship anymore. I miss him." The nursing diagnosis that best describes the mother's feelings uses which term? a. Grieving b. Powerlessness c. Caregiver role strain d. Ineffective coping

a. Grieving The mother is mourning the loss of her son as she formerly knew him. Grief is a common experience for families with mentally ill members.

Which statement best reflects the way clients who are severely and persistently mentally ill generally perceive how others in the community see them? a. Many feel stigmatized and alienated. b. Most feel undersupported by family and friends. c. A large number are intensely hostile toward others. d. The majority are incapable of such self-reflective thought.

a. Many feel stigmatized and alienated. Studies have shown that many clients experience stigmatization, alienation, loss of relationships, and loss of vocational opportunities. While some clients may have the perceptions described in the other options, none are as generally expressed as feeling stigmatized and alienated.

A 5-year-old who consistently omits the sound for 'r' and 's' when speaking is demonstrating which type of disorder? a. Speech b. Language c. Social communication d. Specific learning

a. Speech Speech disorders are marked by problems in making sounds. Children may have trouble making certain sounds, or may distort, add, or omit sounds.

When a nurse assesses the style of behavior a child habitually uses to cope with the demands and expectations of the environment, he or she is assessing which characteristic? a. Temperament b. Resilience c. Vulnerability d. Cultural assimilation

a. Temperament Temperament is the behavior the child habitually uses to cope with the environment. It is a constitutional factor thought to be genetically determined. It may be modified by the parent-child relationship.

A nurse understands that the priority goal when caring for a psychotic client who is withdrawn and reclusive is for them to develop which of the following? a. Trust b. Self-worth c. A sense of identity d. An ability to socialize

a. Trust

Which statement by a young client who has severe and persistent mental illness would alert the nurse to the need for psychoeducational intervention? a. "I like to watch cartoons every morning." b. "I hear that marijuana helps calm you down." c. "I am looking for a job washing dishes at a diner." d. "I hate having my thoughts so messed up all the time."

b. "I hear that marijuana helps calm you down." Clients with mental illness should receive information about the dangerous negative impact of using illegal drugs.

Cognitive-behavioral therapy is going well when a 12-year- old patient in therapy reports to the nurse practitioner: a. "I was so mad I wanted to hit my mother." b. "I thought that everyone at school hated me. That's not true. Most people like me and I have a friend named Todd." c. "I forgot that you told me to breathe when I become angry." d. "I scream as loud as I can when the train goes by the house."

b. "I thought that everyone at school hated me. That's not true. Most people like me and I have a friend named Todd."

The role of a case manager working with severely and persistently mentally ill clients who are homeless would include which intervention? a. Administer medication b. Coordinate needed services c. Ensure that the clients are not rehospitalized d. Teach the clients to function independently

b. Coordinate needed services Community mental health services are designed to provide outreach and case management for severely mentally ill persons who are homeless. A team approach is used to gain access to clients and connect them with various services available to meet their needs. The role of the outreach worker is to be an advocate in all areas of client need and to foster client self-care.

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 don't describe schizophrenia, but could be caused by a number of problems.

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 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.

The nurse working with a client diagnosed with severe and persistent mental illness will implement rehabilitation principles by concentrating on which intervention? a. Assessment on the client's deficits b. Reinforcing the client's strengths c. Reviewing earlier treatment plans for errors d. Considering the need to lower expectations periodically

b. Reinforcing the client's strengths Although deficits are assessed and addressed, implementation of rehabilitation is dependent on reinforcement of identified client strengths. Neither of the remaining options is fundamental to the rehab process.

A client diagnosed with a severe and persistent mental illness tells the case manager, "I think people are laughing at me behind my back. I get real upset and anxious when I have to be around others in the group home. It's better when I just stay by myself." The nurse should consider which nursing diagnosis to address the client's concerns? a. Acute confusion b. Social isolation c. Risk for activity intolerance d. Impaired comfort

b. Social isolation Social isolation is aloneness experienced by the individual and perceived as imposed by others. None of the other options would be supported by the information provided in the question.

A client diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. Which response should the nurse provide to this client statement? a. "You are safe here in the hospital; nothing bad will happen to you." b. "The voices are wrong about the hospital food. It is not contaminated." c. "I understand that the voices are very real to you, but I do not hear them." d. "Other people are eating the food, and nothing is happening to them."

c. "I understand that the voices are very real to you, but I do not hear them." This reply acknowledges the client's reality, but offers the nurse's perception that he or she is not experiencing the same thing. This is the only option that provides such support.

A nurse teaches a client about the side effects and precautions associated with the typical antipsychotic haloperidol (Haldol). The nurse evaluates that the teaching is understood when the client states: a. "I will immediately report any diarrhea or vomiting to my doctor." b. "I will not eat any tyramine-containing foods while I'm taking this drug." c. "I'll avoid direct sunlight and use a sunscreen product when I go outdoors." d. "I'll maintain an adequate fluid intake because I may urinate more than usual."

c. "I'll avoid direct sunlight and use a sunscreen product when I go outdoors." Photosensitivity is a side effect of many antipsychotic medications including Haldol. Diarrhea/vomiting and increased urination are side effects of lithium, avoid tyramine-containing foods is a precaution associated with MAOIs.

Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient's nursing diagnosis is altered thought processes? a. "I know you say you hear voices, but I cannot hear them." b. "Stop listening to the voices, they are NOT real." c. "You say you hear voices, what are they telling you?" d. "Please tell the voices to leave you alone for now."

c. "You say you hear voices, what are they telling you?"

Serious mental illness (SMI) affects how many adults in the United States? a. 6 million b. 8 million c. 10 million d. 1 million

c. 10 million SMI affects about 10 million adults in the United States. The other options are incorrect percentages.

The goal of a nurse working in psychiatric rehabilitation would be to help clients in the community achieve which outcome? a. Complete mental health b. Live comfortably in a psychiatric treatment facility c. Cope more effectively with their symptoms d. Learn to live with dependency

c. Cope more effectively with their symptoms The long-term outcomes of rehabilitation for severely mentally ill clients include the concepts of illness management and recovery. Illness management refers to the focus in the early stage of treatment that assists the client to gain control over symptoms. Clients are taught to collaborate with professionals in mental health treatment, reduce susceptibility to relapse, and cope more effectively with symptoms. Complete mental health is not always achievable.

The clinical nurse specialist should suggest which cognitive intervention initially for a client experiencing auditory hallucinations? a. Seclusion when escalation begins b. Physical restraints when the client is disruptive c. Initiating a distracting technique d. Giving as-needed medication for anxiety

c. Initiating a distracting technique Strategies have been successfully applied to treat hallucinations, delusions, and negative symptoms, making cognitive interventions an evidence-based practice. For example, distraction techniques can be taught when auditory hallucinations occur, such as listening to music or humming. The remaining options should only be considered when less restrictive interventions, like distraction, prove to be ineffective and the client is at risk for injury to self or to others.

Which statement is true of the relationship between SMI 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 60% 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.

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.

What are the foundational concerns regarding the use of restraint and seclusion when providing care to children? Select all that apply. a. Parents may initiate a lawsuit if injury occurs. b. Staff have conflicted feelings leading to ineffectiveness. c. Research suggests both are psychologically and physically harmful. d. Staff tends to be undertrained in use of restraints in children. e. The principle of least restrictive intervention is a primary concern.

c. Research suggests both are psychologically and physically harmful. e. The principle of least restrictive intervention is a primary concern. Restraint and seclusion have been shown to be psychologically harmful and may also be physically harmful and result in injury or death. To ensure that the civil and legal rights of individuals are maintained, techniques are selected according to the principle of least restrictive intervention, which requires that you use more restrictive interventions only after less restrictive have been unsuccessful.

Child protective services have removed 10-year-old Christopher from his parents' home due to neglect. Christopher reveals to the nurse that he considers the woman next door his "nice" mom, that he loves school, and gets above average grades. The strongest explanation of this response is: a. Temperament b. Genetic factors c. Resilience d. Paradoxical effects of neglect

c. Resilience

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 antipsychotics have a lower incidence than older, traditional antipsychotics. There is no reason to advise a medication change at this time.

What is the primary reason the nurse should include the family of a patient with a serious mental illness in treatment planning? a. They know the patient better than anyone. b. The patient is likely willing to listen to them. c. They are likely the patient's support system. d. The patient will turn to them first when needing help.

c. They are likely the patient's support system.

A client who has been prescribed an antipsychotic medication comes to the clinic 3 days after his scheduled visit and demonstrates evidence of restlessness and agitation. He states, "My medicine ran out, and I didn't remember where to get more." The client's case manager should initially implement which intervention to support medication adherence? a. Arrange to have the client's nursing care plan reflect the need for a medication change b. Arrange for the client to see his psychiatrist as soon as the psychiatrist has an open appointment. c. Arrange for the client to get to the nearest emergency department for treatment. d. Arrange for a dose of the client's medication immediately.

d. Arrange for a dose of the client's medication immediately. The role of the case manager is to coordinate access to psychiatric treatment, housing, rehabilitation or work setting, socialization, and medical care. The client's immediate need for medication is best addressed by arranging for an immediate dose. None of the other options addresses the client's needs as effectively.

Which interventions and/or goals related to planning for discharge of a client diagnosed with a 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.

Severely mentally ill (SMI) clients often express a strong desire to be employed. According to the evidence-based research, what is the most effective model of employment for these clients? a. Vocational rehabilitation b. Productive employment c. A placement program of rehabilitation d. Supported employment

d. Supported employment In the past, vocational rehabilitation programs required extensive evaluation procedures and training before attempting job placement. However, these programs were unsuccessful at helping severely mentally ill clients to maintain jobs. Research efforts have identified a more productive model called supported employment.

Which statement made by a 9-year-old child after hitting a classmate is a typical comment associated with childhood conduct disorder? a. "I'm sorry, I won't hit him again." b. "He deserved it for being a sissy." c. "I didn't think I hit him very hard." d. "He hit me first. You just didn't see it."

b. "He deserved it for being a sissy."

Which statement made by a patient diagnosed with a serious mental illness reflects a common situation associated with this disorder in today's healthcare system? Select all that apply. a. "I have been in a state institution most of my life." b. "I've been homeless for years." c. "Once a care provider knows my psychiatric history, my physical problems are not taken seriously." d. "No one wants to hire a person with mental issues." e. "My family doesn't want to be around me because I hear voices."

b. "I've been homeless for years." c. "Once a care provider knows my psychiatric history, my physical problems are not taken seriously." d. "No one wants to hire a person with mental issues." e. "My family doesn't want to be around me because I hear voices."

Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with: a. Generally good health despite the mental illness. b. An aversion to drinking fluids. c. Anxiety and depression. d. The ability to express his needs.

c. Anxiety and depression.

A 7-year-old, who is described as impulsive and hyperactive, tells the nurse, "I am a dummy, because I don't pay attention, and I can't read like the other kids." The nurse notes that these behaviors are most consistent with which diagnosis? a. Attention deficit disorder b. Attention deficit hyperactivity disorder c. Autism d. Conduct disorder

b. Attention deficit hyperactivity disorder

Isadora is a middle-aged woman living in a group home after being discharged from a psychiatric institution nearly 20 year ago. Isadora keeps to herself, stays in her room most of the day, and only ventures out for meals. Cassandra, the house manager, encourages Isadora to: a. Begin looking for a job b. Join a day program clubhouse c. Assist in the kitchen washing dishes d. Take on a roommate so as not to be alone

b. Join a day program clubhouse

When a client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be: a. "You are safe here. This is a locked unit, and no one can get in." b. "I do not believe I understand the word volmers. Tell me more about them." c. "Why do you think someone or something is going to harm you?" d. "It must be frightening to think something is going to harm you."

d. "It must be frightening to think something is going to harm you." This response focuses on the client's feelings and neither directly supports the delusion nor denies the client's experience. Option A provides false global reassurance, option B encourages elaboration about the delusion, and option C asks for information that the client will likely be unable to answer.

Which neurological deficits would the nurse be most likely to encounter when assessing a patient diagnosed with schizophrenia? a. Weakness and loss of function b. Paralysis and diminished reflexes c. Drooping eyelids and reddened cornea d. Increased blinking and impaired fine motor skills

d. Increased blinking and impaired fine motor skills

To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition? Select all that apply. a. Alcohol use disorder b. Major depressive disorder c. Stomach cancer d. Polydipsia e. Metabolic syndrome

a. Alcohol use disorder b. Major depressive disorder d. Polydipsia e. Metabolic syndrome

Which statement demonstrates a well-structured attempt at limit setting? a. "Hitting me when you are angry is unacceptable." b. "I expect you to behave yourself during dinner." c. "Come here, right now!" d. "Good boys don't bite."

a. "Hitting me when you are angry is unacceptable."

What assessment question should the nurse ask when attempting to determine a teenager's mental health resilience? Select all that apply. a. "How did you cope when your father deployed with the Army for a year in Iraq?" b. "Who did you go to for advice while your father was away for a year in Iraq?" c. "How do you feel about talking to a mental health counselor?" d. "Where do you see yourself in 10 years?" e. "Do you like the school you go to?"

a. "How did you cope when your father deployed with the Army for a year in Iraq?" b. "Who did you go to for advice while your father was away for a year in Iraq?" d. "Where do you see yourself in 10 years?"

Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia? a. Always afraid another student will steal her belongings. b. An unusual interest in numbers and specific topics. c. Demonstrates no interest in athletics or organized sports. d. Appears more comfortable among males.

a. Always afraid another student will steal her belongings.

A child diagnosed with attention deficit hyperactivity disorder (ADHD) is reprimanded for taking the nurse's pen without asking first. He responds by shouting, "You don't like me! You won't let me have anything, even a pen!" The nurse is most therapeutic when responding with which statement? a. "I do like you, but I don't like it when you grab my pen." b. "Liking you has nothing to do with whether I will loan you my pen." c. "It sounds as though you are feeling helpless and insecure." d. "You must ask for permission before taking someone else's things."

a. "I do like you, but I don't like it when you grab my pen." This reply shows positive regard for the child while describing the behavior as undesirable. Feedback such as this helps the child feel accepted while making her aware of the effect her behavior has on others.

Currently what is understood to be the causation of schizophrenia? a. A combination of inherited and nongenetic factors b. Deficient amounts of the neurotransmitter dopamine c. Excessive amounts of the neurotransmitter serotonin d. Stress related and ineffective stress management skills

a. A combination of inherited and nongenetic factors Causation is a complicated matter. Schizophrenia most likely occurs as a result of a combination of inherited genetic factors and extreme nongenetic factors (e.g. viral infection, birth injuries, nutritional factors) that can affect the genes governing the brain or directly injure the brain

A client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as a. A neologism. b. A clang association. c. Blocking. d. A delusion.

a. A neologism. A neologism is a newly coined word that has meaning only for the client.

The nurse finds a client with schizophrenia lying under a bench in the hall. The client states, "God told me to lie here." What is the best response by the nurse? a. A."I didn't hear anyone talking. Come with me to your room." b. "What you heard was in your head; it was your imagination." c. "Come to the dayroom and watch television. You will feel better." d. "God would not tell you to lie in the hall. God wants you to behave reasonably."

a. A."I didn't hear anyone talking. Come with me to your room."

The family of a child diagnosed with attention deficit hyperactivity disorder (ADHD), inattentive type, is told the evaluation of their child's care will focus on symptom patterns and severity. What is the focus of child's evaluation? Select all that apply. a. Academic performance b. Activities of daily living c. Physical growth d. Social relationships e. Personal perception

a. Academic performance b. Activities of daily living d. Social relationships e. Personal perception For those with ADHD, inattentive type, the focus of eval will be academic performance, ADLs, social relationships, and personal perception. For those with ADHD, hyperactive-impulsive type or combined type, the focus will be on both academic and behavioral responses.

Which of the following would be assessed as a negative symptom of schizophrenia? a. Anhedonia b. Hostility c. Agitation d. Hallucinations

a. Anhedonia Negative symptoms refer to deficits that characterize schizophrenia. They include affective blunting (facial masking), anergia (lack of energy), anhedonia (inability to experience happiness), avolition (lack of motivation), poverty of content of speech, poverty of speech, and thought blocking

The nurse is caring for a client who is experiencing disturbed thought processes as a result of paranoia. In formulating nursing interventions with the members of the health care team, what best instruction should the nurse provide to the staff? a. Avoid laughing or whispering in front of the client b. Increase socialization of the client with peers c. Begin to educate the client about social supports in the community d. Have the client sign a release of information for appropriate parties for assessment purposes

a. Avoid laughing or whispering in front of the client The client is experiencing paranoia and is distrustful and suspicious of others. The members of the health care team need to establish a rapport and trust with the client. Laughing or whispering in front of the client would be counterproductive. The remaining options ask the client to trust on a multitude of levels. These options are actions that are too intrusive for a client who is paranoid.

Which neuroimaging technique would the nurse expect the provider to order to reveal problems in the anatomic structure of the brain? a. CT b. PET c. SPECT d. None of the above

a. CT Structural imaging techniques (e.g., computed tomography [CT] and magnetic resonance imaging [MRI]) provide overall images of the brain and the layers of the brain.

In pediatric mental health there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: Select all that apply. a. Children of color and poor economic conditions being underserved b. Increased stress in the family unit c. Markedly increased funding d. Premature termination of services

a. Children of color and poor economic conditions being underserved b. Increased stress in the family unit d. Premature termination of services

When discussing oppositional defiant disorder with a group of parents, what information should the nurse include about the disorder? Select all that apply a. Classic symptoms include anger, irritation, and defiant behavior. b. Children generally outgrow the behaviors without formal treatment. c. Severity is considered mild when symptoms are present in only one setting. d. Disorder is diagnosed equally in both males and females. e. Argumentative and defiant are terms often used to describe the patient.

a. Classic symptoms include anger, irritation, and defiant behavior. b. Children generally outgrow the behaviors without formal treatment. c. Severity is considered mild when symptoms are present in only one setting. e. Argumentative and defiant are terms often used to describe the patient.

Which functions are often simultaneously impaired when a patient is experiencing a serious mental illness? Select all that apply. a. Cognition b. Emotions c. Perceptions d. Social interactions e. Self-care

a. Cognition b. Emotions c. Perceptions d. Social interactions e. Self-care

Tommy, a 12-year-old boy admitted to the pediatric psychiatric unit, has recently been diagnosed with conduct disorder. In the activity room, the games he wanted to play were already in use. He responded by threatening to throw furniture and to hurt his peers who had the game he wanted. Nancy, a registered nurse, recognizes that Tommy's therapy must include: a. Consistency in implementing the consequences of breaking rules b. Empathetic reasoning when Tommy acts out in the activity room c. Teaching Tommy the benefits of socializing d. Solitary time so that Tommy can think about his actions

a. Consistency in implementing the consequences of breaking rules

A patient's chart reports that he is displaying positive symptoms of schizophrenia. Which would the nurse expect the patient to show evidence of? a. Delusions and hallucinations b. Grimacing and mannerisms c. Echopraxia and echolalia d. Avolition and anhedonia

a. Delusions and hallucinations

Frontal lobe deficits in schizophrenia are thought to be responsible for: a. Disorganized thinking b. Hallucinations c. Depression d. Parkinsonism

a. Disorganized thinking

What assessment data would support a diagnosis of conduct disorder? Select all that apply. a. Evidence of social isolation b. Arrested twice for disorderly conduct c. Expresses difficulty in keeping employment d. Demonstrates objective signs of phobia e. Exhibits signs of chronic self-mutilation

a. Evidence of social isolation b. Arrested twice for disorderly conduct c. Expresses difficulty in keeping employment

Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply. a. Hold his medication and contact his prescriber. b. Wipe him with a washcloth wet with cold water or alcohol. c. Administer a medication such as benztropine IM to correct this dystonic reaction. d. Reassure him that although there is no treatment for his tardive dyskinesia, it will pass. e. Hold his medication for now and consult his prescriber when he comes to the unit later today.

a. Hold his medication and contact his prescriber. b. Wipe him with a washcloth wet with cold water or alcohol.

Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply. a. Limited language skills b. Level of cognitive development c. Level of emotional development d. Parental denial that a problem exists e. Severity of the typical mental illnesses observed in young children

a. Limited language skills b. Level of cognitive development c. Level of emotional development

A client who has been admitted with a diagnosis of schizophrenia says to the nurse, "Yes, it's March. March is Little Women. That's literal you know." These symptoms illustrate which of the following? a. Loose associations b. Word salad c. Flight of ideas d. Echolalia

a. Loose associations

Which factor can reduce the vulnerability of a child to etiological influences predisposing to the development of psychopathology? a. Resilience b. Malnutrition c. Child abuse d. Having a depressed parent

a. Resilience Resilience refers to developing and using certain characteristics that help a child to handle the stresses of a difficult childhood without developing mental problems. Resilient children can adapt to changes in the environment, form nurturing relationships with adults other than their parents, distance themselves from the emotional chaos of the family, and have social intelligence and the ability to use problem-solving skills.

Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia? a. Screening a group of males between the ages of 15 and 25 for early symptoms. b. Forming a support group for females aged 25 to 35 who are diagnosed with substance use issues. c. Providing a group for patients between the ages of 45 and 55 with information on coping skills that have proven to be effective. d. Educating the parents of a group of developmentally delayed 5- to 6-year-olds on the importance of early intervention.

a. Screening a group of males between the ages of 15 and 25 for early symptoms.

Which nursing diagnosis would most likely be applicable for a person who has been diagnosed with schizophrenia, paranoid type? a. Social isolation related to impaired ability to trust b. Impaired mobility related to fear of losing control of hostile impulses c. Fear of being alone related to lack of confidence in significant others d. Impaired memory related to poor information processing associated with brain deficits

a. Social isolation related to impaired ability to trust

A 9-year-old patient has been diagnosed with an intellectual development disorder (IDD). Which assessment findings support this diagnosis? Select all that apply. a. Unable to explain the phrase, "Raining cats and dogs" b. Reads below age level c. Is capable of providing effective oral self care d. Enjoy interacting with developmentally similar peers e. Physically lashes out when frustrated

a. Unable to explain the phrase, "Raining cats and dogs" b. Reads below age level e. Physically lashes out when frustrated IDD is characterized by severe deficits in 3 major areas of functioning: intellectual, social, and managing daily life. These children demonstrate difficulty with self-care and with almost any social interactions.

The mother of a 3-year-old boy just diagnosed with autism spectrum is tearful and states, "The doctor said we need to start therapy right away. I just don't understand how helpful it will be—he's only 3 years old!" What response should the nurse provide to the mother's statement? a. "You are right, 3 years old is very young to start therapy, but it will make you feel better to be doing something." b. "Starting him on treatment now gives Taylor a much greater chance for a productive life." c. "If your child starts therapy now, he will be able to stop therapy sooner." d. "If you have questions, its best to ask the doctor."

b. "Starting him on treatment now gives Taylor a much greater chance for a productive life." Early intervention for children with autism can greatly enhance their potential for a full, productive life. The sooner therapy is started, the better the outcome. The patient will most likely not be able to stop therapy as interventions will continue indefinitely. Telling the mother to ask the provider abdicates the nurse's responsibility to provide education to patients and families.

A 12-year-old male patient diagnosed with Tourette's disorder is visiting his provider. The nurse will prepare medication teaching on which class of medication to help manage the tics associated with this disorder? Select all that apply. a. Mood stabilizers b. Antianxiety agents c. Anticholinesterase inhibitors d. First-generation antipsychotics e. Second-generation antipsychotics

b. Antianxiety agents d. First-generation antipsychotics e. Second-generation antipsychotics The FDA has approved the typical antipsychotics haloperidol and pimozide, and the atypical antipsychotic aripiprazole for treating tics. Clonidine hydrochloride, an alpha-2 adrenergic agonist typically for HTN is also prescribed for tics. While less effective and far slower acting than the antipsychotics, it has fewer side effects. The antianxiety drug clonazepam is used as a supplement to other meds and may work by reducing anxiety and resultant tics.

Charlie is coping well with a severe mental illness diagnosis. He and his 91-year-old father live together on the family farm. This stable and secluded life has allowed Charlie to live with minimal stimulation, and his relapses have been few. Charlie's caseworker makes a visit to open up a conversation on where Charlie will live when his father can no longer care for him. By bringing up the topic now, the caseworker is hoping to: a. Arrange housing for Charlie for when his father dies. b. Avert a relapse and preserve stability in Charlie's life. c. Rescue Charlie when the crisis occurs. d. Make Charlie realize he will soon live independently.

b. Avert a relapse and preserve stability in Charlie's life.

Which social behavior is often a result of a child having been exposed to some form of abuse? a. Speech disorders b. Bullying others c. Eating disorders d. Delayed motor skills

b. Bullying others Children who have experienced abuse are at risk for identifying with their aggressor and may act out, bully others, become abusers, or develop dysfunctional interpersonal relationships in adulthood.

Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to: a. Limited executive function b. Cerebellum maturation c. Cerebral stasis and hormonal changes d. A slight reduction in brain volume

b. Cerebellum maturation

As the assessment interview progresses, and Eleanor demonstrates more slowness and difficulty answering questions, Doreen takes her hand and explains that Eleanor has been having more difficulty with memory lately "... both in small things, like whether she just ate lunch, and in bigger things, like what she was in the middle of discussing during a classroom lecture." Which part of the brain is most responsible for Eleanor's difficulty with delivering her lectures and remembering whether she has eaten? a. Brainstem b. Cerebrum c. Cerebellum d. Hypothalamus

b. Cerebrum The cerebrum is responsible for mental activities, memory, language, and the ability to communicate, among other conscious tasks. The brainstem controls functions such as heart rate, breathing, digestion, and sleeping. The cerebellum regulates skeletal muscle coordination and equilibrium. The hypothalamus controls basic drives and provides a link between thought and emotion and function of internal organs. The hypothalamus works with the brainstem to regulate the circadian rhythm.

When assessing the mental status of a 7- or 8-year-old child, it is most important for the nurse to: a. Listen to the parent's description of the child's behavior b. Compare the child's functioning from one day to another c. Engage parents in a discussion about the child's feelings d. Determine the child's mental status by using direct questions

b. Compare the child's functioning from one day to another Comparison over time is the only way for the nurse to accurately assess mental status of a child. Listening to the parent's descriptions of behavior should be considered, but not relied upon because they can be unrealistic or biased. The child's ability to discuss feelings is limited, and using direct questions can be threatening and may precipitate anxiety.

Some cultures have lower rates of diagnosed conduct disorders than observed in Western societies. The lower rate of incidence may be contributed to: a. Strict parenting with corporal punishment b. Cultural expression of anger as normal behavior c. Parents' limited tolerance for externalizing behavior d. Widespread acceptance of conduct disorders

b. Cultural expression of anger as normal behavior

Jimmy has been hospitalized three times for schizophrenia. Typically, he is very disorganized, spends his money irresponsibly, and loses his housing when he does not pay the rent. In turn, Jimmy cannot be located by his case manager, which leads to treatment nonadherence and relapse. Which response would be most therapeutic? Select all that apply. a. Advise Jimmy that if he does not pay his rent, he will be placed in a group home instead of independent housing. b. Discuss with Jimmy the option of having a guardian who will ensure that the rent is paid and that his money is managed to meet his basic needs. c. Suggest to Jimmy and his prescribing clinician that he be placed on a long-acting injectable form of antipsychotic medication to improve treatment nonadherence. d. Encourage Jimmy's case manager to hold him responsible for the outcomes of his poor decisions by allowing periods of homelessness to serve as a natural consequence.

b. Discuss with Jimmy the option of having a guardian who will ensure that the rent is paid and that his money is managed to meet his basic needs. c. Suggest to Jimmy and his prescribing clinician that he be placed on a long-acting injectable form of antipsychotic medication to improve treatment nonadherence.

Which event experienced in the patient's childhood increases the risk of the development of behaviors associated with intermittent explosive disorder? a. Orphaned at age 4 b. Physically abused from ages 3 to 10 c. Born with a chronic congenital disorder d. One parent was diagnosed with obsessive-compulsive disorder

b. Physically abused from ages 3 to 10

A young adult client is admitted to the hospital with a diagnosis of schizophrenia, paranoid type. The client has been saying, "The voices in heaven are telling me to come home to God." Which of the following would be the priority nursing diagnosis? a. Disturbed self-esteem b. Potential for self-harm c. Dysfunctional verbal communication d. Impaired perception of environmental stimuli

b. Potential for self-harm

Which nursing diagnosis should be considered for a child with attention deficit hyperactivity disorder ADHD? a. Anxiety b. Risk for injury c. defensive coping d. impaired verbal communication

b. Risk for injury The child's marked hyperactivity puts him or her at risk for injury from falls, bumping into objects, impulsively operating equipment, pulling heavy objects off shelves, etc.

The nurse notes that a client with schizophrenia and receiving an antipsychotic medication is moving her mouth, protruding her tongue, and grimacing as she watches television. The nurse determines that the client is experiencing which medication complication? a. Parkinsonism b. Tardive dyskinesia c. Hypertensive crisis d. Neuroleptic malignant syndrome

b. Tardive dyskinesia Tardive dyskinesia is a reaction that can occur from antipsychotic medication. It is characterized by uncontrollable involuntary movements of the body and extremities, particularly the tongue. Parkinsonism is characterized by tremors, masklike facies, rigidity, and a shuffling gait. Hypertensive crisis can occur from the use of monoamine oxidase inhibitors and is characterized by hypertension, occipital headache radiating frontally, neck stiffness and soreness, nausea, and vomiting. Neuroleptic malignant syndrome is a potentially fatal syndrome that may occur at any time during therapy with neuroleptic (antipsychotic) medications. It is characterized by dyspnea or tachypnea, tachycardia or irregular pulse rate, fever, blood pressure changes, increased sweating, loss of bladder control, and skeletal muscle rigidity.

The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has been diagnosed with schizophrenia is early detection of: a. Acute dystonia. b. Tardive dyskinesia. c. Cholestatic jaundice. d. Pseudoparkinsonism.

b. Tardive dyskinesia. An AIMS assessment should be performed periodically on clients who are being treated with antipsychotic medication known to cause tardive dyskinesia

Which nursing intervention is designed to help a schizophrenic client minimize the occurrence of a relapse? a. Schedule the client to attend group therapy that includes those who have relapsed. b. Teach the client and family about behaviors associated with relapse. c. Remind the client of the need to return for periodic blood draws to minimize the risk for Relapse. d. Help the client and family adapt to the stigma of chronic mental illness and periodic relapses.

b. Teach the client and family about behaviors associated with relapse. By knowing what behaviors signal impending relapse, interventions can be quickly invoked when the behaviors occur. The earlier the intervention, the greater the likelihood that a recurrence can be averted.

April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April's mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that: a. Time-out is an important part of April's baseline discipline. b. Time-out is no longer an effective therapeutic measure. c. April enjoys time-out, and acts out to get some alone time. d. Time-out will need to be replaced with seclusion and restraint.

b. Time-out is no longer an effective therapeutic measure

A child diagnosed with autism will demonstrate impaired development in which area? a. Adhering to routines b. playing with other children c. swallowing and chewing d. eye-hand coordination

b. playing with other children Autism affects the normal development of the brain in social interaction and communication skills. Associated symptoms include significant deficits in social relatedness, nonverbal behavior, and age-appropriate interaction. Other behaviors include stereotypical repetitive speech, obsessive focus on specific objects, over adherence to routines/rituals, hyper- or hypo-reactivity to sensory input, and extreme resistance to change.

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

c. "Do you feel afraid that people are trying to hurt you?" It is most therapeutic for the nurse to empathize with the client's experience. The remaining options lack this connection with the client. Disagreeing with delusions may make the client more defensive, and the client may cling to the delusions even more. Encouraging discussion regarding the delusion is inappropriate.

A client, who has been prescribed clozapine 6 weeks ago, reports flulike symptoms including a fever and a very sore throat, the nurse should initiate which nursing intervention? a. Suggest that the client take something for the fever and get extra rest. b. Advise the physician that the client should be admitted to the hospital. c. Arrange for the client to have blood drawn for a white blood cell count. d. Consider recommending a change of antipsychotic medication.

c. Arrange for the client to have blood drawn for a white blood cell count. Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms.

Eleanor, a political science professor, comes to the community clinic complaining of lack of sleep. She speaks slowly, hesitating to think before she answers questions, and her partner, Doreen, who has brought her here is obviously worried. Eleanor smiles at Doreen. "I just need something to help me sleep. I'll be fine." The nurse knows that sleep is a function of the brain controlled by: a. Homeostasis b. ANS regulation c. Circadian rhythm d. Impulse conduction

c. Circadian rhythm The circadian rhythm controls a person's cycles of sleep and wakefulness. The brainstem controls functions such as heart rate, breathing, digestion, and sleeping. The hypothalamus controls basic drives and provides a link between thought and emotion and function of internal organs. The hypothalamus works with the brainstem to regulate the circadian rhythm.

When a child demonstrates a temperament that prompts the mother to say, "She is just so different from me; I just can't seem to connect with her." The nurse should plan to provide which intervention? a. Suggest that the child's father become her primary caregiver. b. Encourage the mother to consider attending parenting classes. c. Counsel the mother regarding ways to better bond with her child. d. Educate the father regarding signs that the child is being physically abused.

c. Counsel the mother regarding ways to better bond with her child. All people have temperaments, and the fit between the child and parent's temperament is critical to the child's development. The caregiver's role in shaping the relationship is of primary importance, and the nurse can intervene to teach parents ways to modify their behaviors to improve the interaction.

Which behavior is most indicative of a 4-year-old child diagnosed with Tourette's syndrome? a. Difficulty in social relationships b. Humming while performing activities that require concentration c. Frequent eye blinking d. Difficulty in completing tasks on time

c. Frequent eye blinking Persistent motor or vocal ticking is characteristic of Tourette's syndrome. Dysfunctional social relationship is an inconclusive symptom, especially for a 4 y/o. Humming can be a normal response of a child at play. Ineffective time management is usually associated with ADHD.

A client diagnosed with disorganized schizophrenia would have greatest difficulty with which nursing intervention? a. Interacting with a neutral attitude b. Using concrete language c. Giving multistep directions d. Providing nutritional supplements

c. Giving multistep directions The thought processes of the client with disorganized schizophrenia are severely disordered, and severe perceptual problems are present, making it extremely difficult for the client to understand what others are saying. All communication should be simple and concrete, and may need to be repeated several times.

Due to the need to self-medicate for anxiety, a patient diagnosed with schizophrenia smokes two packs of cigarettes a day. What unique risk does nicotine pose to this patient's health? a. Lung cancer b. Cardiovascular constriction c. Impaired psychotropic medication therapy d. Increased incidence of lung-reacted disorders

c. Impaired psychotropic medication therapy

A nurse is assessing an adolescent client with the diagnosis of schizophrenia, undifferentiated type. Which signs and symptoms should the nurse expect the client to experience? a. Paranoid delusions and hypervigilance b. Depression and psychomotor retardation c. Loosened associations and hallucinations d. Ritualistic behaviors and obsessive thinking

c. Loosened associations and hallucinations Loosened associations and hallucinations are the primary behaviors associated with a thought disorder such as schizophrenia. Paranoid delusions and hypervigilance are more common in paranoid-type schizophrenia, depression and psychomotor retardation are not characteristic of schizophrenia and ritualistic behavior and obsessive thinking are generally associated with obsessive-compulsive disorders.

A 73-year-old man was diagnosed with a serious mental illness at age 20. Subsequently, he was frequently hospitalized. Two years ago, he was transferred to a group home. When considering the effects of institutionalization, which behavior demonstrates adaptation to the new environment? a. Willingly takes his medications b. Keeps his room neat and clean c. Makes himself lunch when he is hungry d. Enjoys spending the afternoon watching television

c. Makes himself lunch when he is hungry

A hyperactive self-destructive child is to be discharged from an inpatient setting in a few days. In preparation for the child's discharge, it is most important for the nurse to plan to: a. Establish, maintain, and enforce limits on behavior b. Meet with the child's teacher to review the child's needs c. Schedule a team conference with the child and the parents d. Help the child begin to terminate relationships with the nursing team

c. Schedule a team conference with the child and the parents This provides an opportunity for the team, the child, and the parents to interact in a therapeutic environment.

An issue for severely and persistently mentally ill clients living in the community is inadequate long-term medication monitoring by community mental health workers. What is a remedy for this problem? a. Discontinue antipsychotics that cause untoward side effects. b. Develop tools to predict relapse and assess the potential for violence. c. Shift follow-up from social workers to the ACT model. d. Use client empowerment techniques to increase client autonomy.

c. Shift follow-up from social workers to the ACT model. Adequate monitoring of medication effects by the community-based health care provider is often difficult but more achievable when the client is being monitored by the assertive community treatment (ACT) model.

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?" When communicating with a patient with disorganized or bizarre speech, the nurse should place the difficulty in understanding on themselves, rather than the patient, and look for themes that may be helpful in interpreting what the patient wants to say.

Jeff, 15, who is diagnosed with oppositional defiant disorder, is taken to the principal's office after assaulting and injuring another student. Which comment is this adolescent most likely to make? a. "I lost my temper, but it will not happen again." b. "I'm sorry and embarrassed that this happened." c. "I failed my math test, and guess I was just having a bad day." d. "So what if that kid was hurt? I should have beaten him more."

d. "So what if that kid was hurt? I should have beaten him more."

The nurse is preparing a client with a history of command hallucinations for discharge by providing instructions on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggests to the nurse that the client understands the instructions? a. "My medications aren't likely to make me more anxious." b. "I'll go to support groups and talk so that I don't hurt anyone." c. "It's not likely that I'll get anxious or hear things if I get enough sleep and eat well." d. "When I begin to hallucinate, I'll call my therapist and talk about what I should do."

d. "When I begin to hallucinate, I'll call my therapist and talk about what I should do." The risk for impulsive and aggressive behavior may increase if a client is receiving command hallucinations to harm self or others. The correct option is a specific agreement to seek help and evidences self-responsible commitment and control over one's own behavior.

The nurse manager is evaluating a primary nurse who is working with a hospitalized adolescent client with the diagnosis of conduct disorder. Which intervention by the primary nurse should the nurse manger question? a. Discussing rules of the unit b. Allows for opportunities for choices c. Explaining the consequences for not following unit regulations d. Encouraging the verbalization of negative feelings toward others

d. Encouraging the verbalization of negative feelings toward others Verbalization of negative feelings toward others can often escalate and result in antisocial or acting-out behavior. Discussing the unit rules limits manipulative behavior due to a consistent and predictable environment. Being clear on the consequences of breaking this rules can motivate individuals to act appropriately, and offering choices provides opportunities for the client to have some control.

A female consumer with severe and recurrent mania argues with outpatient staff about her medication. She does not believe she has a mental illness. Although she takes medication during hospitalizations, she stops taking them after discharge. Which intervention is most helpful in promoting medication adherence? a. Assign a new outpatient staff to reduce the conflicts she is experiencing with her current providers. b. Explain that the medications will help her and that all medications have side effects, but she can learn to live with these. c. Involve her in a medication group that will teach her the types and names of psychotropic medications, their purpose, and possible side effects. d. Explore her perceptions and experiences regarding medication and help her to connect taking medications with achieving her goals.

d. Explore her perceptions and experiences regarding medication and help her to connect taking medications with achieving her goals.

To help a disturbed, acting-out child develop a trusting relationship, the nurse should: a. Inquire as to the child's feelings about the parents b. Implement a half hour one-to-one interaction daily c. Initiate limit setting and explain the rules to be followed d. Offer periodic support and emphasize safety in play activities

d. Offer periodic support and emphasize safety in play activities This action sets a foundation for trust because it allows the child to see that the nurse cares. Inquiring about the child's feelings about parents can be threatening at this stage of the relationship. Half an hour per day is too infrequent to develop trust, and although limit setting is necessary, it does not support the development of a trusting relationship as much as providing support and emphasizing safety.

Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia? a. Depersonalization b. Pressured speech c. Negative symptoms d. Paranoia

d. Paranoia

A client has reached the stable plateau phase of schizophrenia. What is the appropriate clinical planning focus for this client? a. Safety and crisis intervention b. Acute symptom stabilization c. Stress and vulnerability assessment d. Social, vocational, and self-care skills

d. Social, vocational, and self-care skills During the stable plateau phase, planning is geared toward client and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community. All other options should have been handled previously.

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 have better outcomes than do their male counterparts diagnosed earlier. These two patients do not have the same expectation of a poor prognosis and there is no evidence suggesting that Tara will have more positive symptoms. 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.

Which side effect of antipsychotic medication is generally nonreversible? a. Anticholinergic effects b. Pseudoparkinsonism c. Dystonic reaction d. Tardive dyskinesia

d. Tardive dyskinesia Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. The other side effects often appear early in therapy and can be minimized with treatment.

When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that: a. Medications provided are ineffective. b. Nurses are trying to control their minds. c. The medications will make them sick. d. They are not actually ill.

d. They are not actually ill.

Gilbert, age 19, is described by his parents as a "moody child" with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert's early and slow onset of what is now recognized as schizophrenia, his prognosis is considered: a. Favorable with medication b. In the relapse stage c. Improvable with psychosocial interventions d. To have a less positive outcome

d. To have a less positive outcome

A 10-year-old who is frequently disruptive in the classroom begins to fidget and then moves on to disruptive behavior. What is the most appropriate initial technique for managing this sort of disruptive behavior? a. Therapeutic holding b. Seclusion c. Quiet room d. Touch control

d. Touch control The appropriate adult can move closer to the child and place a hand on his/her arm, or an around around his/her shoulder for a calming effect when the fidgeting is first noted. The closeness signals the child to use self-control. It is the least restrictive treatment approach and should be tried before any of the other options.

A client with schizophrenia has been started on medication therapy with clozapine (Clozaril). The nurse should assess the results of which laboratory study to monitor for adverse effects from this medication? a. Platelet count b. Blood glucose c. Liver function tests d. White blood cell count

d. White blood cell count A client taking clozapine (Clozaril) may experience agranulocytosis, which is monitored by reviewing the results of the white blood cell count. Treatment is interrupted if the white blood cell count decreases to less than 3000 cells/mm3. Agranulocytosis could be fatal if undetected and untreated.