Crisis 1 Exam 3
Which nursing intervention has priority during the acute phase of a client's manic episode? A. Providing fluids frequently to promote hydration B. Monitoring the amount of sleep the client achieves C. Identifying triggers for exacerbation of manic behavior D. Including family in regular counseling and therapy sessions
A
Which nursing intervention is believed to have the greatest effect on antipsychotic medication therapy adherence? A. Patient education regarding management of side effects B. Advocating for first-generation medications at lower cost C. Hospitalizing clients until their symptoms are significantly lessened D. Arranging for the client to receive medication at an outpatient center
A
Which statement by a client scheduled for a series of electroconvulsive therapy (ECT) treatments indicates to the nurse that the client has an understanding of the goals of this treatment? A. "It is expected that my chance for remission is very good." B. "If this works, I will likely be able to stop taking lithium." C. "I'm prepared to deal with the certain loss of my short-term memory." D. "My prognosis is so much better since I didn't have any delusional symptoms."
A
Which statement demonstrates a characteristic of depression-associated behaviors that is especially associated with children and adolescents? A. "I don't care that friends say I'm grumpy." B. "I'm so very sad since my sister died." C. "Life is no fun since I lost my sister." D. "I can't go on being so depressed."
A
Which statement is reflective of a commonly held myth about the older adult? A. "It's not realistic to expect grandma to learn to use her "smart phone" effectively." B. "It's important to be sure that granddad doesn't fall for one of those telephone scams." C. "Our older neighbor's house burned and he nearly died because he didn't smell the smoke." D. "It seems that older people get depressed and have a real problem adjusting when they retire."
A
Which statement made by the client demonstrates an understanding of the benefit of clozapine? A. "I'm less likely to develop a stooped, shuffling walk." B. "It will help keep me from developing type 2 diabetes." C. "It will provide me with some protection against a heart attack." D. "This medication cost less than the first-generation antipsychotic types."
A
Which statement, made by a nurse to the family of a terminal ill client, requires immediate attention to prevent future demonstration of ageism? A. "She's had a good life so don't be sad that she is dying." B. "Have you and she discussed her wishes for end-of-life care?" C. "She seems like a wonderful person with delightful stories to tell." D. "Does she need financial help to cover the expense of her palliative care?"
A
A nurse is caring for a client who takes ziprasidone. The client reports difficult swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change to which of the following medications? (select all that apply) A. Olanzapine B. Quetiapine C. Aripirazole D. Clozapine E. Asenapine
A, C, D, E
A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? (Select all that apply) A. Auditory hallucination B. Lack of motivation C. Use of clang associations D. Delusion of persecution E. Constantly waving arms F. Flat affect
A, C, D, E
A charge nurse is preparing a staff education session on personality disorders. Which of the following personality characteristics associated with all of the personality disorders should the charge nurse include in the teaching? (Select all that apply) A. Difficulty in getting along with other members of a group B. Belief in the ability to become invisible during times of stress C. Display of defense mechanisms when routines are changed D. Claiming to be more important than other persons E. Difficulty understanding why it is inappropriate to have a personal relationship with staff
A, C, E
A nurse is teaching a client who has a new prescription for imipramine how to minimize anticholinergic effects. Which of the following instructions should the nurse include in the teaching? (select all that apply) A. Void just before taking this medication B. Increase the dietary intake of potassium C. Wear sunglasses when outside D. Change positions slowly when getting up E. Chew sugarless gum
A, C, E
A home health nurse is making a visit to a client who has Alzheimer's disease to assess the home for safety. Which of the following suggestions should the nurse make to decrease the client's risk for injury? A. Install extra locks at the top of exit doors B. Place rugs over electrical cords C. Put cleaning supplies on the top of a shelf D. Place the client's mattress on the floor E. Install light fixtures above stairs
A, D, E
A nurse is planning care for a client following surgical implantation of a VNS device. The nurse should plan to monitor for which of the following adverse effects? (Select all that apply) A. Voice changes B. Seizure activity C. Disorientation D. Cough E. Neck pain
A, D, E
A patient diagnosed with bipolar disorder lives in the community and is showing early signs of mania. The patient says, "I need to go visit my daughter but she lives across the country. I put some requests on the Internet to get a ride. I'm sure someone will take me." What is the nurse's most therapeutic response? a. "I'm concerned about your safety when meeting or riding with strangers." b. "Have you asked friends and family to donate money for your airfare?" c. "You are not likely to get a ride. Let's consider some other strategies." d. "Have you asked your daughter if she wants you to come for a visit?"
A
A patient diagnosed with schizophrenia says, "I hear the voices every day. They always say bad things about me." Which action by the nurse has the highest priority? a. Assess the patient for suicidal thinking and plans. b. Review the patient's medication regime and compliance. c. Educate the patient about symptoms associated with schizophrenia. d. Suggest distracters for the patient to use when auditory hallucinations occur.
A
The parent of an adolescent recently diagnosed with schizophrenia says to the nurse, "This is entirely my fault. I should have spent more time with my child when he was a toddler." Which response by the nurse is correct? a. "Schizophrenia is genetically transmitted, so it was not in your control." b. "Your child's disorder is more likely the result of an undetected head injury." c. "Environmental toxins are directly implicated in the origins of schizophrenia." d. "Lack of prenatal care causes schizophrenia rather than early childhood events."
A
What intervention will have the greatest positive impact on the older client's quality of life? A. Being screened for depression B. Being screened for signs of dementia C. Having assistance with activities of daily living D. Preserving the usual patterns of their daily lives
A
When considering oppositional defiance disorder (ODD), which behavior will be viewed as a mandatory diagnostic criteria? A. Hid the backpack of a classmate who refused to give up answers to a test B. Repeatedly refuses to follow family rules about completing chores C. Was discovered attempting to drown the neighbor's cat D. Ran away from home twice in the last 6 weeks
A
When considering signs of risk for an adult client diagnosed with a serious and persistent mental illness, which characteristic presents the greatest threat? A. Impaired judgment B. Poor social skills C. Substance abuse D. Depression
A
When considering substance abuse, which individual is at the greatest risk for developing functional deficits in the future? A. The 15-year-old abusing cannabis B. The 28-year-old with a cocaine habit C. The 45-year-old with a 10-year history of heroin abuse D. The 60-year-old who has been dependent on sedatives for 15 years
A
When planning a substance abuse information program for a local university, the nurse will prioritize which screening? A. Alcohol B. Inhalants C. Stimulants D. Hallucinogens
A
Which client will likely benefit from anticonvulsant medication therapy? A. An older adult diagnosed with dementia who demonstrates seriously aggressive behaviors B. A young adult diagnosed with kleptomania who has been arrested 5 times for stealing C. An adolescent diagnosed with conduct disorder who has been expelled three times D. A middle-aged client diagnosed with pathological gambling who is $800,000 in debt
A
Which event described in the life of an older client demonstrates a successful transition after his or her retirement? A. Volunteers 10 hours a week at a local homeless shelter B. Meets twice a month with a mental health counselor C. Reminisces with other retirees weekly at the park D. Regularly attends church services twice a week
A
Which intervention associated with bipolar disorder best minimizes the risk for the development of suicidal ideations? A. Early diagnosis B. Family counseling C. Medication therapy D. Stress identification
A
A client has been prescribed an antipsychotic medication for the management of symptoms associated with schizophrenia. Which behaviors will show improvement as a result of adhering to the medication therapy? Select all that apply. A. Fears being abducted by alien creatures B. Acknowledges regularly hearing voices C. Regularly discusses his or her alter identity as a spy for Hitler D. Consistently avoids the dayroom when other clients are there E. Stays in his or her room most of the day staring out the window
B, C
A nurse is caring for a client who has major depressive disorder. Which of the following should the nurse identify as a risk factor for depression? (select all that apply) A. Male sex B. History of chronic bronchitis C. Recent death in client's family D. Family history of depression E. Personal history of panic disorder
B, C, D, E
A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? (select all that apply) A. Decreased level of consciousness B. Drooling C. Involuntary arm movements D. Urinary retention E. Continual pacing
B, C, E
A nurse is performing an admission assessment for a client who has delirium related to an acute urinary tract infection. Which of the following findings should the nurse expect? (select all that apply) A. History of gradual memory loss B. Family report of personality changes C. Hallucinations D. Unaltered level of consciousness E. Restlessness
B, C, E
A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse include in the plan of care? (Select all that apply) A. Provide flexible client behavior expectations B. Offer concise explanations C. Establish consistent limits D. Disregard client concerns E. Use a firm approach with communication
B, C, E
A nurse is teaching a child who has intermittent explosive disorder about a new prescription for fluoxetine. Which of the following information should the nurse provide? (select all that apply) A. An adverse effect of this medication is CNS depression B. Administer the medication in the morning C. Monitor for weight loss while taking this medication D. Therapeutic effects of this medication will take 1 to 3 weeks to fully develop E. This medication blocks the synaptic reuptake of serotonin in the brain
B, C, E
A nurse is caring for a client who is taking phenelzine. For which of the following manifestations should the nurse monitor as an adverse effect of this medication? (select all that apply) A. Elevated blood glucose level B. Orthostatic hypotension C. Priapism D. Hypomania E. Bruxism
B, D
A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the teaching? (Select all that apply) A. Constipation B. Polyuria C. Rash D. Muscle weakness E. Tinnitus
B, D
A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect? (select all that apply) A. Bradycardia B. Fine tremors of both hands C. Hypotension D. Vomiting E. Restlessness
B, D, E
A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in the teaching? (select all that apply) A. Use caffeine in moderation to prevent relapse B. Difficulty sleeping can indicate a relapse C. Begin taking your medication as soon as a relapse begins D. Participating in psychotherapy can help prevent a relapse E. Anhedonia is a clinical manifestation of a depressive relapse
B, D, E
A nurse is performing an admission assessment on an adolescent client who has depression. Which of the following findings are expected for this disorder? (Select all that apply) A. Fear of being alone B. Substance use C. Weight gain D. Irritability E. Aggressiveness
B, D, E
A nurse is providing teaching to an adolescent client who is to begin taking atomoxetine for ADHD. The nurse should instruct the client to monitor for which of the following adverse effects? (select all that apply) A. Somnolence B. Yellowing skin C. Increased appetite D. Fever E. Malaise
B, D, E
A nurse is providing teaching to the family of a client who has a substance use disorder. Which of the following statements by a family member indicates an understanding of the teaching? (Select all that apply) A. "We need to understand that our sibling is responsible for their disorder" B. "Eliminated codependent behavior will promote recovery" C. "Our sibling should participate in an Al-Anon group to assist with recovery" D. "The primary goal of treatment is abstinence from substance use" E. "Our sibling needs to discuss personal feelings about substance use to help with recovery"
B, D, E
The nurse will encourage the client to engage in regular involvement with which formalized groups as an intervention directed toward the treatment of a primary risk factor associated with depression? Select all that apply. A. Church associated men's group B. Sexual assault survivors group C. Senior citizens travel group D. New moms support group E. Alcoholics Anonymous (AA)
B, D, E
A 28-year-old second-grade teacher is diagnosed with major depressive disorder. She grew up in Texas but moved to Alaska 10 years ago to separate from an abusive mother. Her father died by suicide when she was 12 years old. Which combination of factors in this scenario best demonstrates the stress-diathesis model? a. Cold climate coupled with history of abuse b. Current age of 28 coupled with family history of depression c. Family history of mental illness coupled with history of abuse d. Female gender coupled with the stressful profession of teaching
C
A charge nurse is discussing the care of a client who has major depressive disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "Care during the continuation phase focuses on treating continued manifestations of MDD" B. "The treatment of MDD during the maintenance phase lasts for 6 to 12 weeks" C. "The client is at greatest risk for suicide during the first weeks of an MDD episode" D. "Medications and psychotherapy are most effective during the acute phase of MDD"
C
A client is diagnosed as a child with attention-deficit-hyperactivity disorder (ADHD). Achieving which long-term goal will best indicate personal effective condition management as an adult? A. Absence of classic fidgety physical activity B. Mental focus that allows for completion of tasks C. Medication therapy discontinued by health care provider D. Demonstrates effective time management and organizational skills
C
A nurse begins a therapeutic relationship with a patient diagnosed with schizophrenia. The patient has severe paranoia. Which comment by the nurse is most appropriate? a. "Let's begin by talking about the goals you have for yourself." b. "I understand that you have problems with fear and suspiciousness of others." c. "As you get to know me better, I hope you will feel comfortable talking to me." d. "I am part of your treatment team. Our goal is to help stabilize your symptoms."
C
A nurse is caring for a client who has alcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol? A. Chlordiazepoxide B. Bupropion C. Disulfiram D. Carbamazepine
C
A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should expect a prescription for which of the following medications? A. Chlorpromazine B. Thiothixene C. Risperidone D. Haloperidol
C
A nurse is interviewing a client who has new diagnosis of persistent depressive disorder. Which of the following findings should the nurse expect? A. Wide fluctuations in mood B. Report of a minimum of five clinical findings of depression C. Presence of manifestations for at least 2 years D. Inflates sense of self-esteem
C
A nurse is leading a peer group discussion about the indications for ECT. Which of the following indications should the nurse include in the discussion? A. Borderline personality disorder B. Acute withdrawal related to a substance use disorder C. Bipolar disorder with rapid cycling D. Dysphoric disorder
C
A nurse is making a home visit to a client who is in the late stage of Alzheimer's disease. The client's partner, who is the primary caregiver, whishes to discuss concerns about the client's nutrition and the stress of providing care. Which of the following actions should the nurse take? A. Verify that a current power of attorney document is on file B. Instruct the client's partner to offer finger foods to increase oral intake C. Provide information on resources for respite care D. Schedule the client for placement of an enteral feeding tube
C
A nurse is planning a staff education program on substance use in older adults. Which of the following information should the nurse include in the presentation? A. Older adults require higher doses of a substance to achieve a desired effect B. Older adults commonly use rationalization to cope with a substance use disorder C. Older adults are at an increased risk for substance use following retirement D. Older adults develop substance use to mask manifestations of dementia
C
A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following interventions should the nurse identify as the priority? A. Orient the client frequently to time, place, and person B. Offer fluids and nourishing diet as tolerated C. Implement seizure precautions D. Encourage participation in group therapy sessions
C
A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone. Which of the following client statements indicates understanding of the teaching? A. "I will be able to stop taking this medication as soon as I feel better" B. "If I feel drowsy during the day, I will stop taking this medication and call my provider" C. "I will be careful not to gain too much weight while taking this medication" D. "This medication is highly addictive and must be withdrawn slowly"
C
A nurse is reviewing the medical record of a client who has a new prescription for bupropion for depression. Which of the following findings is the priority for the nurse to report to the provider? A. The client has a family history of seasonal depression B. The client currently smokes 1.5 packs of cigarettes per day C. The client had a motor vehicle crash last year and sustained a head injury D. The client has a BMI of 25 and has gained 10 lb over the last year
C
A nurse is teaching a client who has a new diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following statements by the client indicates understanding of the teaching? A. "I can expect my problems with PMDD to be worst when I'm menstruating" B. "I should avoid exercising when I am feeling depressed" C. "I am aware that my PMDD causes me to have rapid mood swings" D. "I should increase my caloric intake with a nutritional supplement when my PMDD is active"
C
A nurse is teaching a client who has tobacco use disorder about the use of nicotine gum. Which of the following information should the nurse include in the teaching? A. Chew the gum for no more than 10 min B. Rinse out the mouth immediately before chewing the gum C. Avoid eating 15 min prior to chewing the gum D. Use of the gum is limited to 90 days
C
A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? A. "ECT is the recommended initial treatment for bipolar disorder" B. "ECT is contraindicated for clients who have suicidal ideation" C. "ECT is effective for clients who are experiencing severe mania" D. "ECT is prescribed to prevent relapse of bipolar disorder"
C
A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "I can promote my client's sense of control by establishing a schedule." B. "I should encourage clients who have a schizoid personality disorder to increase socialization." C. "I should practice limit-setting to help prevent client manipulation." D. "I should implement assertiveness training with clients who have antisocial personality disorder."
C
A nurse teaches a patient diagnosed with an alcohol addiction about a new prescription for naltrexone (ReVia, Vivitrol). Which comment by the patient indicates the teaching was effective? a. "This medicine will stop my cravings for alcohol." b. "I should take this medication only when I feel cravings to drink alcohol." c. "This medicine is one part of a bigger treatment plan to help me stay sober." d. "I should not use products that contain alcohol, such as cough medicine and aftershave lotion."
C
A nurse working in the county jail assesses four new inmates. The nurse should direct guards to place which inmate under suicide watch? An inmate charged with: a. Breaking and entering. b. Criminal solicitation (prostitution). c. Lewd and lascivious act on a minor. d. Assault and battery on an elderly person.
C
A patient experiencing depression says to the nurse, "My health care provider said I need 'talk' therapy but I think I need a prescription for an antidepressant medication. What should I do?" Select the nurse's best response. a. "Which antidepressant medication do you think would be helpful?" b. "There are different types of talk therapy. Most patients find it beneficial." c. "Let's consider some ways to address your concerns with your health care provider." d. "Are you willing to give 'talk therapy' a try before starting an antidepressant medication?"
C
A patient has a long history of bipolar disorder with frequent episodes of mania secondary to stopping prescribed medications. The patient says, "I will use my whole check next month to buy lottery tickets. Winning will solve my money problems." Select the nurse's best action. a. Educate the patient about the low odds of winning the lottery. b. Present reality by saying to the patient, "That is not good use of your money." c. Confer with the treatment team about appointing a legal guardian for the patient. d. Tell the patient, "If you buy lottery tickets, your money will run out before the end of the month."
C
A young adult tells the nurse, "I have a new prescription for medical marijuana. I use it several times a day for my frequent muscle spasms." What information should the nurse provide first to this patient? a. Guidance that the prescription should not be shared with peers b. Directions to weigh self once a week and maintain a log of the results c. Instructions about safety issues associated with driving or operating machinery d. Information about the potential for amotivational syndrome and memory problems
C
The nurse at a local medical clinic reviews phoned-in requests from patients for prescription refills. As the nurse confers with the health care provider about which prescription refill requests should be authorized, which refill request should be considered first? a. Codeine 10 mg PO q4h PRN for an adult with a persistent cough b. Hydroxyzine (Vistaril) 25 mg PO TID PRN for an adult who experiences uncomfortable muscle spasms c. Lorazepam (Ativan) 1 mg PO BID for an adult who has taken it daily for 3 years for episodes of anxiety d. Paregoric (camphorated tincture of opium) 2 mg PO q6h PRN for an adult experiencing severe diarrhea
C
The nurse cares for a hospitalized adolescent diagnosed with major depressive disorder. The health care provider prescribes a low-dose antidepressant. In consideration of published warnings about use of antidepressant medications in younger patients, which action should the nurse employ? a. Notify the facility's patient advocate about the new prescription. b. Teach the adolescent about Black Box warnings associated with antidepressant medications. c. Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior. d. Remind the health care provider about warnings associated with the use of antidepressants in children and adolescents.
C
The nurse interviews the parent of a 7-year-old child diagnosed with moderate autism spectrum disorder. Which comment from the parent best describes autistic behavior? a. "My child occasionally has temper tantrums." b. "Sometimes my child wakes up with nightmares." c. "My child swings for hours on our backyard gym set." d. "Toilet training was more difficult for this child than my other children."
C
A nurse is assisting in the discharge planning for a client following alcohol detoxification. The nurse should expect prescriptions for which of the following medications to promote long-term abstinence form alcohol? (select all that apply) A. Lorazepam B. Diazepam C. Disulfiram D. Naltrexone E. Acmprosate
C, D, E
A nurse is assisting the guardians of a school-age child who has oppositional defiant disorder in identifying strategies to promote positive behavior. Which of the following strategies should the nurse recommend? (Select all that apply) A. Allow the child to choose which behaviors are unacceptable B. Use role-playing to act out unacceptable behavior C. Develop a reward system for acceptable behavior D. Encourage the child to participate in school sports E. Be consistent when addressing unacceptable behavior
C, D, E
A nurse is assessing a client immediately following an ECT procedure. Which of the following findings should the nurse expect? (Select all that apply) A. Hypotension B. Paralytic ileus C. Memory loss D. Polyuria E. Confusion
C, E
A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. Which of the following findings should the nurse expect? (Select all that apply) A. Demonstrates extreme anxiety when placed in a social situation B. Often engages in magical thinking C. Attempts to convince other clients to relinquish their belongings D. Becomes agitated if personal area is not neat and orderly E. Blames others for personal past and current problems
C, E
A charge nurse is discussing TMS with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "TMS is indicated for clients who have schizophrenia spectrum disorders" B. "I will provide postanesthesia care following TMS." C. "TMS treatments usually last 5 to 10 minutes" D. "I will schedule the client for TMS treatments 3 to 5 times a week for the first several weeks"
D
A client diagnosed with depression has been prescribed various first-line antidepressant agents but has demonstrated only minimal improvement. In preparation for the prescription of a second-line agent, the nurse will educate the client on which classification of antidepressant? A. Atypical B. Tricyclic C. Dual action D. Monoamine oxidase inhibitors
D
A community mental health nurse talks with a 6-year-old child whose divorced parents have shared custody. Which initial question will best help the nurse explore the child's perception of home life? a. "Is your life different from your friends' lives?" b. "Are you happiest at your mother's or your father's house?" c. "Do you find it hard to move back and forth between two homes?" d. "What are some of the good and bad things about living in two places?"
D
A nurse assesses a 78-year-old patient who lives alone at home and is beginning three new prescriptions. Which question by the nurse will provide best for the patient's safety? a. "How do you store your medications at home?" b. "What is your usual bowel elimination pattern?" c. "Who usually helps you with your medications?" d. "How much alcohol do you drink on a normal day?"
D
A patient tells the nurse, "After many years, I finally quit smoking. Now I use e-cigarettes only." Which response should the nurse provide? a. "Using e-cigarettes is now more socially acceptable than using traditional cigarettes." b. "Congratulations on quitting, but e-cigarettes contain nicotine and other hazardous chemicals." c. "Nicotine is a powerful addiction. Quitting smoking is a big step toward adopting a healthier lifestyle." d. "I am glad you have quit smoking. Your loved ones will no longer be exposed to the hazards of secondhand smoke."
B
A person diagnosed with severe mental illness has been homeless for 8 years and says, "I don't have any money because I've never had a job. I can't afford a place to live." Which intervention should the outpatient mental health nurse add to the plan of care? a. Requisition the patient's legal record of arrests and convictions b. Help the patient to apply for Supplemental Security Income (SSI) c. Assist the patient to apply for Social Security Disability Income (SSDI) d. Seek to have the patient adjudicated non compos mentis (incompetent)
B
An 85-year-old woman says to the nurse, "I raised three children, but now two of them barely speak to me. I did not do a good job of instilling a family spirit." Which response should the nurse provide? a. "Do you think this situation is likely to change?" b. "If you could relive those earlier years, what would you do differently?" c. "There's no guidebook for parenting. Your children have made their own choices." d. "Your children are likely to regret their behavior. I hope you can find it in your heart to forgive them."
B
An outpatient nurse has lunch with a group of consumers diagnosed with severe mental illness. The nurse observes an obese adult ask a malnourished adult, "If you aren't going to eat your apple, will you give it to me?" What is the nurse's best action? a. Remind both adults that sharing food with each other is not permitted. b. Remind the malnourished adult of treatment goals related to weight gain. c. Reseat the consumers at two separate tables for the remainder of the meal. d. Overlook the remark. Both adults are permitted to make their own decisions.
B
Lithium is prescribed for a client admitted with a diagnosis of bipolar disorder. Which other therapy is also initially prescribed to temporarily help manage the client's symptoms? A. Antimanic medication B. Antipsychotic medication C. Electroconvulsive therapy (ECT) D. Cognitive behavioral therapy (CBT)
B
The nurse asks an 87-year-old, "How are you doing?" The patient replies, "I have good days and bad days." Select the nurse's therapeutic response. a. "How is your sleep?" b. "Tell me more about that." c. "Are you feeling depressed?" d. "We expect that from people your age."
B
To monitor for a significant health risk, the nurse will prepare to implement which intervention for a client admitted for alcohol detoxification? A. 24-hour urine test B. Cardiac consult C. Nutritional consult D. Falls assessment
B
Which assessment data best establishes that the client has demonstrated the ability to meet a challenge commonly faced by someone diagnosed with a serious and persistent mental illness (SPMI)? A. Medication adherent B. Currently employed C. Attends regular church services D. Is willing to attend AA meetings
B
Which comment by a patient diagnosed with bipolar disorder best indicates the patient is experiencing mania? a. "I have been sleeping about 6 hours each night." b. "Yesterday I made 487 posts on my social network page." c. "I am having dreams about my father's death 8 years ago." d. "My appetite is so robust that I've gained 4 pounds in the past 2 weeks."
B
Which nursing intervention is generally included in the plan of care for any hospitalized client experiencing a psychotic episode associated with schizophrenia? A. Identifying theme of hallucinations B. Suicide precautions per institution policies C. Boundary setting to manage aggressiveness D. Assessing for the presence of feelings of guilt
B
Which scenario presents the highest risk for a pregnancy resulting in offspring with an intellectual developmental disability (IDD)? a. 18-year-old mother who received no prenatal care b. 32-year-old woman diagnosed with anorexia nervosa c. 26-year-old father with a history of episodic alcohol abuse d. 38-year-old father diagnosed with generalized anxiety disorder
B
A nurse in a long-term care facility is caring for a client who has major neurocognitive disorder and attempts to wander out of the building. The client states, "I have to get home." Which of the following statements should the nurse make? A. "You have forgotten that this is your home" B. "You cannot go outside without a staff member" C. "Why would you want to leave? Aren't you happy with your care?" D. "I am your nurse. Let's walk together to your room."
D
A nurse in a pediatric clinic is caring for a preschool-age child who has a new diagnosis of ADHD. When teaching the guardian about this disorder, which of the following statements should the nurse include in the teaching? A. "Behaviors associated with ADHD are present prior to age 3." B. "This disorder is characterized by argumentativeness" C. "Below-average intellectual functioning is associated with ADHD" D. "Because of this disorder, your child is at an increased risk for injury"
D
A nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. When collecting a medical history from the client's caregiver, which of the following statements is the priority to report to the provider? A. "Current medical conditions include diabetes that is controlled by diet" B. "Recent medications include a course of prednisone for acute bronchitis" C. "Current vaccinations include a flu vaccine last month" D. "Current medications include furosemide for congestive heart failure"
D
A nurse is caring for a client who has bipolar disorder. Which of the following is the priority nursing action? A. Set consistent limits for expected client behavior B. Administer prescribed medications as scheduled C. Provide the client with step-by-step instructions during hygiene activities D. Monitor the client for escalating behavior
D
A nurse is caring for a school age child who has conduct disorder and a new prescription for methylphenidate transdermal patches. Which of the following information should the nurse provide about the medication? A. Apply the patch once daily at bedtime B. Place the patch carefully in a trash can after removal C. Apply the transdermal patch to the anterior waist area D. Remove the patch each day after 9 hr
D
A nurse is providing teaching for a client who is scheduled to receive ECT for the treatment of major depressive disorder. Which of the following client statements indicates understanding of the teaching? A. "It is common to treat depression with ECT before trying medications." B. "I can have my depression cured if I receive a series of ECT treatments." C. "I should receive ECT once a week for 6 weeks." D. "I will receive a muscle relaxant to protect me from injury during ECT."
D
A patient tells the nurse, "No matter what I do, I feel like there's always a dark cloud following me." Select the nurse's initial action. a. Assess the patient's current sleep and eating patterns. b. Explain to the patient, "Everyone feels down from time to time." c. Suggest alternative activities for times when the patient feels depressed. d. Say to the patient, "Tell me more about what you mean by 'a dark cloud'."
D
A patient was diagnosed with bipolar disorder many years ago. The patient tells the nurse, "When I have a manic episode, there's always a feeling of gloom behind it and I know I will soon be totally depressed." What is the nurse's best response? a. "Most patients diagnosed with bipolar disorder report the same types of feelings." b. "Feelings of gloom associated with depression result from serotonin dysregulation." c. "If you take your medication as it is prescribed, you will not have those experiences." d. "Your comment indicates you have an understanding and insight about your disorder."
D
A young adult has heavily abused alcohol and prescription drugs since mid-adolescence. This individual now has an ataxic gait and uses a cane. Which comment by the nurse presents reality while demonstrating compassion? a. "I know you must feel self-conscious about using a cane at your age, but it will help prevent falls." b. "Addiction is a fatal disease. If you continue to drink like you have done in past, you will not live another 10 years." c. "It's time to face your addiction. You are disappointing your family and must stop drinking for the sake of the people who love you." d. "Addiction is powerful. You are young yet cannot walk without a cane. If you don't make changes, your health will continue to suffer."
D
Over the past 2 months a patient made eight suicide attempts with increasing lethality. The health care provider informs the patient and family that electroconvulsive therapy (ECT) is needed. The family whispers to the nurse, "Isn't this a dangerous treatment?" How should the nurse reply? a. "Our facility has an excellent record of safety associated with use of electroconvulsive therapy." b. "Your family member will eventually be successful with suicide if aggressive measures are not promptly taken." c. "Yes, there are hazards with electroconvulsive therapy. You should discuss these concerns with the health care provider." d. "Electroconvulsive therapy is very effective when urgent help is needed. Your family member was carefully evaluated for possible risks."
D
Which assessment question is directed at a primary concern associated with the initiation of anti-depressant medication therapy for an older client? A. "Has your depression lessened any since starting the medication?" B. "Have you been taking the medication on the schedule we discussed? C. "Do you remember what to do if you miss a dose of your medication? D. "Have you been experiencing any side effects since starting the medication?"
D
Which life event related to a client demonstrating depressive symptoms supports a diagnosis of persistent depressive disorder (PDD)? A. Abruptly ended a long-term romantic relationship B. Lost employment as a result of frequent absences C. 2 unsuccessful suicide attempts over the last year D. Recognized symptoms of depression over 2 years ago
D
Which statement, by a child who recently lost "Sammy" a beloved pet, best demonstrates the parent's role in nurturing the child's resiliency? A. "It's sad but Dad said that pets die every day." B. "Mom promised that I can get another pet really soon." C. "Dad gave me a picture of Sammy when he was just a puppy." D. "Mom, Dad, and I talk about how much fun we had with Sammy."
D
A nurse plans a psychoeducational group about physical health in an outpatient program for consumers diagnosed with severe mental illness. Which topic has priority? a. Heart-healthy living b. Living with diabetes c. ABCDEs of skin cancer d. Breast and testicular self-examination
A
A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following actions is the nurse's priority? A. Placing the client on one-to-one observation B. Assisting the client to perform ADLs C. Encouraging the client to participate in counseling D. Teaching the client about medication adverse effects
A
A charge nurse is discussing mirtazapine with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? A. "This medication increases the release of serotonin and norepinephrine" B. "I should tell the client about the likelihood of insomnia while taking this medication" C. "This medication is contraindicated for clients who has an eating disorder" D. "Sexual dysfunction is a common adverse effect of this medication"
A
A nurse is providing teaching to a client who has alcohol use disorder and a new prescription for carbamazepine. Which of the following information should the nurse include in the teaching? A. "This medication will help prevent seizures during alcohol withdrawal" B. "Taking this medication will decrease your cravings for alcohol" C. This medication maintains your blood pressure at a normal level during alcohol withdrawal" D. "Taking this medication will improve your ability to maintain abstinence from alcohol"
A
A community mental health nurse counsels a group of patients about the upcoming flu season. What instruction does the nurse provide for patients who are prescribed lithium? a. "Stop taking your medicine and contact me if you have nausea, vomiting, and/or diarrhea." b. "Remember that lithium reduces your immunity, so you are more vulnerable to catching the flu." c. "The flu is contagious. Isolate yourself if you get the flu so that you avoid exposing others to it." d. "Because you take lithium, you may have flu symptoms that are not typically experienced by others."
A
A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder? A. "I'm scared that you're going to leave me." B. "I'll go to group therapy if you'll let me smoke" C. "I need to feel that everyone admires me" D. "I sometimes feel better if I cut myslef"
A
A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the client's lithium blood level is 1.2 mEq/L. Which of the following actions should the nurse take? A. Administer the next dose of lithium carbonate as scheduled B. Prepare for administration of aminophylline C. Notify the provider for a possible increase in the dosage of lithium carbonate D. Request a stat repeat of the client's lithium blood level
A
A nurse is discussing routine follow-up needs with a client who has a new prescription for valproate. The nurse should inform the client of the needs for routine monitoring of which of the following? A. AST/ALT and LDH B. Creatinine and BUN C. WBC and granulocyte counts D. Blood sodium and potassium
A
A nurse is managing the care of a 19-year-old adult diagnosed with Level 1 autism spectrum disorder. Which intervention will the nurse include in the client's plan of care? A. Organization and planning strategies B. Group therapy that focuses on social skills C. Boundary setting to manage aggressive behavior D. Techniques to help manage repetitive ritualistic behaviors
A
A nurse is providing teaching to an adolescent client who has a new prescription for clomipramine for OCD. Which of the following information should the nurse provide? A. Eat a diet high in fiber B. Check temperature daily C. Take medication first thing in the morning before eating D. Add extra calories to the diet as between meal snacks
A
A nurse is teaching a group of guardians about manifestations of conduct disorder. Which of the following findings should the nurse include? (Select all that apply) A. Bullying of others B. Threats of suicide C. Law-breaking activities D. Narcissistic behavior E. Flat affect
A, B, C
A nurse is discussing the use of methadone with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? (select all that apply) A. "Methadone is a replacement for physical dependence to opioids" B. "Methadone reduces the unpleasant effects associated with abstinence syndrome" C. "Methadone can be sued during opioid withdrawal and to maintain abstinence" D. "Methadone increases the risk for acetaldehyde syndrome" E. "Methadone must be prescribed and dispensed by an approved treatment center"
A, B, C, E
A nurse is teaching the guardians of a child who has autism spectrum disorder about indications of imipramine toxicity. Which of the following should the nurse include in the teaching? (Select all that apply) A. Seizures B. Agitation C. Photophobia D. Dry mouth E. Irregular pulse
A, B, E
A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the charge nurse identify as being effectively treated by first-generation antipsychotics? (Select all that apply) A. Auditory hallucinations B. Withdrawal from social situations C. Delusions of grandeur D. Severe agitation E. Anhedonia
A, C, D
A nurse is caring for a client who has substance-induced psychotic disorder and is experiencing auditory hallucinations. The client states, "The voices won't leave me alone!" Which of the following statements should the nurse make? (select all that apply) A. "When did you start hearing these things?" B. "The voices are not real, or else we would both hear them." C. "It must be scary to hear voices." D. "Are the voices you hear telling you to hurt yourself?" E. "Why are the voices talking to only you?"
A, C, D
A patient diagnosed with schizophrenia complains to the nurse about persistent feelings of restlessness and says, "I feel like I need to move all the time." What is the nurse's next action? a. Add an activity group to the patient's plan of care. b. Assess the patient for other extrapyramidal symptoms. c. Perform a full mental status evaluation of the patient. d. Educate the patient about psychomotor agitation associated with schizophrenia.
B
A patient smiles broadly at the nurse and says, "Look at my clean teeth. I brushed them with scouring power because the label said, 'It brightens and whitens everything.'" Which term should the nurse include when documenting this encounter? a. Circumstantiality b. Concrete thinking c. Poverty of speech d. Associative looseness
B
A nurse leads a milieu meeting in an outpatient program for adults diagnosed with serious mental illness. Four consumers complain that another consumer is "always begging us for money." Which comment by the nurse is therapeutic? a. "If you can afford to help each other, it is reasonable to do so." b. "Let's review what we have learned about being assertive with others." c. "No one needs to bring money to our program. Lunch is provided at no charge." d. "Let's show understanding of each other. Money management is a problem for everyone."
B
A nurse plans to lead a group in a residential facility for kindergarten-aged, abused children. Which strategy should the nurse incorporate? a. Building a house using blocks b. Telling a story about a child who felt sad c. Drawing pictures of fun activities at a park d. Reading and discussing a book about abused children
B
A 92-year-old lives alone but family members assist with transportation and home maintenance. This adult tells the nurse, "They mean well but sometimes my family treats me like a child." What is the nurse's best action? a. Encourage the adult to overlook these behaviors from family members. b. Role-play with the adult ways to share these feelings with family members. c. Contact family members privately and educate them about the harmful effects of ageism. d. Reinforce family members' good intentions and say, "It's fortunate your family is so helpful.
B
A client demonstrating delusional behavior is escalating as a result of increasing anxiety regarding his or her safety. Which action demonstrates that the client has an understanding of actions to de-escalate his or her anxiety? A. The client retreats to his or her room accompanied by staff B. The client asks that he or she be allowed to seclude him- or herself C. The client engages in a group therapy session led by nursing staff D. The client expresses the understanding that his or her safety is the primary nursing goal
B
A nurse is assessing a 4-year old child for indications of autism spectrum disorder. For which of the following manifestations should the nurse assess? A. Impulsive behavior B. Repetitive counting C. Destructiveness D. Somatic problems
B
A nurse is caring for a client on an acute mental health unit. The client reports hearing voices that are stating, "kill your doctor". Which of the following actions should the nurse take first? A. Encourage the client to participate in group therapy on the unit B. Initiate one-to-one observation of the client C. Focus the client on reality D. Notify the provider of the client's statement
B
A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which of the following responses should the nurse make? A. "Why do you think you feel the need to give money away?" B. "I am here to provide care and cannot accept this from you." C. "I can request that your case manager discuss appropriate charity options with you." D. "You should know that giving away your money is inappropriate."
B
A nurse is caring for a client who has borderline personality disorder. The client says, "The nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the client's statement as an example of which of the following defense mechanisms? A. Regression B. Splitting C. Undoing D. Identification
B
A nurse is caring for a client who has early stage Alzheimer's disease and a new prescription for donepezil. The nurse should include which of the following statements when teaching the client about the medication? A. "You should avoid taking over the counter acetaminophen while on donepezil" B. "You should take this medication before going to bed at the end of the day" C. "You will be screened for underlying kidney disease prior to started donepezil" D. "You should stop taking donepezil if you experience nausea or diarrhea"
B
A nurse is caring for a client who has schizoaffective disorder. Which of the following statements indicates the client is experiencing depersonalization? A. "I am a superhero and am immortal" B. "I am no one, and everyone is me" C. "I feel monsters pinching me all over" D. "I know that you are stealing my thoughts"
B
A nurse is caring for a client who is prescribed lithium therapy. The client tells of the plan to take ibuprofen for osteoarthritis pain relief. Which of the following statements should the nurse make? A. "That is a good choice. Ibuprofen does not interact with lithium" B. "Regular aspirin would be a better choice than ibuprofen" C. "Lithium decreases the effectiveness of ibuprofen" D. "The ibuprofen will make your lithium level fall too low"
B
A nurse is evaluating a client's understanding of a new prescription for clonidine for the treatment of opioid use disorder. Which of the following statements by the client indicates an understanding of the teaching? A. "Taking this medication will help reduce my craving for heroin" B. "While taking this medication, I should keep a pack of sugarless gum" C. "I can expect some diarrhea from taking this medication" D. "Each dose of this medication should be placed under my tongue to dissolve"
B
A nurse is providing teaching to a client who has a new prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching? A. "I can expect to experience diarrhea while taking this medication." B. "I may feel drowsy for a few weeks after starting this medication" C. "I cannot eat my favorite pizza with pepperoni while taking medication" D. "This medication will help me lose the weight that I have gained over the last year"
B
A nurse is speaking with a client who has schizophrenia when he suddenly seems to stop focusing on the nurse's questions and begins looking at the ceiling and talking to himself. Which of the following actions should the nurse take? A. Stop the interview at this point, and resume later when the client is better able to concentrate. B. Ask the client, "Are you seeing something on the ceiling?" C. Tell the client, "You seem to be looking at something on the ceiling. I see something there, too." D. Continue the interview without comment on the client's behavior.
B
Three days after beginning a new regime of haloperidol (Haldol) 10 mg BID, the nurse observes that a hospitalized patient is drooling, has stiff and extended extremities, and has skin that is damp and hot to the touch. The patient has difficulty responding verbally to the nurse. What is the nurse's correct analysis and action in this situation? a. A seizure is occurring; place the patient in a lateral recumbent position and monitor. b. Serotonin syndrome has developed; place an intravenous line and rapidly infuse D5½ NS. c. Neuroleptic malignant syndrome has developed; prepare the patient for immediate transfer to a medical unit. d. An acute dystonic reaction is occurring; promptly administer an intramuscular injection of diphenhydramine (Benadryl).
C
Which assessment data for a client prescribed a psychotropic medication is a risk factor for developing autonomic dysfunction? A. Male B. 23 years of age C. Diagnosed as depressed D. Also prescribed dantrolene
C
Which intervention will the nurse identify for the care plan of a client diagnosed with a moderate form of intellectual disability? A. Discussing options for vocational training B. Providing choices for independent living C. Re-enforcing the concepts of money management D. Discussing the choices related with buying a home
C
Which nursing intervention will have the greatest impact on both the management of care and on milieu environment when considering the clients diagnosed with bipolar disorder? A. Educating the client to the policies upon admission to the unit B. Instructing the client that intrusive behaviors are not appropriate C. Setting and maintaining consistent unit policies that are enforced by all staff D. Ensuring that the client's medication therapy is administered in a timely manner
C
Which scenario presents the most risk factors for suicide? a. 64-year-old black female whose husband died 3 months ago b. 72-year-old white female scheduled for hip replacement in 2 weeks 451 c. 82-year-old widowed white male recently diagnosed with pancreatic cancer d. 92-year-old black male who recently moved into the home of his adult children
C
Which statement indicates the existence of a codependent relation between a client diagnosed with substance abuse and their life partner? A. "All our savings have been spent on rehab treatment." B. "They are the love of my life but it's so hard living together." C. "I'm always so angry about how the addiction controls our lives." D. "Everyone knows about the addiction and it is so very embarrassing."
C
Which statement made by a client receiving treatment for a substance abuse problem best indicates an understanding of relapse prevention? A. "I want so much to stop abusing." B. "My family has helped me so much in staying sober." C. "I abuse when I'm bored or lonely but now I know how to keep busy." D. "A good time always meant being with friends who abused like I did."
C
Which statement made by a community leader demonstrates a common stigma associated with the serious and persistent mentally ill (SPMI)? A. "Establishing a community treatment center for the mentally ill will be very expensive." B. "It's a serious obligation to commit city funds to provide shelter for the mentally ill." C. "It's difficult to use government money to support people who are unemployable." D. "The city will contribute a sum equal to the money donated by private citizens."
C
Which teaching focused intervention will have the greatest impact on reducing the risk of relapsing for a client diagnosed with bipolar disorder? A. Symptom recognition B. Stress management skills C. Role of family as support D. Available social resources
C