Final Exam

The half-life of a benzodiazepine drug is 20 hours for a young adult, but for an older adult it is likely to be:

80 hours.

The spouse of a patient with Alzheimer's disease (AD) asks, "Can you give me a simple explanation of what happened in my partner's brain?" Select the nurse's best response.

"Brain cells and chemical messengers that form memories are dying."

The family of a patient diagnosed with AD asks the nurse, "How can drugs help our parent?" The reply that provides the most realistic expectations would be:

"Drugs can help preserve mental abilities for a time."

A patient comes to the clinic for a 4-week follow-up after starting Prozac (fluoxetine). The highest priority question the nurse will ask is:

"Have you experienced thoughts of hurting yourself?" Rationale: The risk for self-harm increases in the weeks immediately after antidepressant therapy begins. Questions concerning mood and possible side effects are appropriate but do not have priority. Who brought the patient to the clinic is generally irrelevant.

The patient who will require further teaching while on lithium would state:

"I am really enjoying my aerobics dance class." Rationale: Strenuous exercise increases the risk of diaphoresis and the potential for lithium level to become elevated, resulting in toxicity. All of the remaining statements are true regarding lithium.

An African-American patient tells a nurse with a European-American worldview, "There's no sense talking. You wouldn't understand because you live in a white world." Select the nurse's best response.

"It would be helpful if you described an example of something you think I would not understand."

A patient has taken diazepam (Valium) for 1 week for back spasms. The patient complains of "feeling sleepy all the time." The nurse should tell the patient:

"Tolerance to the sedative effect of the drug will develop quickly."

Which statement is characteristically consistent with those individuals who engage in the restrictive form of anorexia nervosa? A. "I avoid situations where I would be expected to eat." B. "I exercise at the gym at least 6 days a week." C. "I was overweight before the eating disorder began." D. "Everyone who knows me knows I'm very competitive."

A. "I avoid situations where I would be expected to eat." B. "I exercise at the gym at least 6 days a week." D. "Everyone who knows me knows I'm very competitive." The restricters are more often young people in the normal or slightly above normal weight range for height and build before the eating disorder begins. This group views losing weight as more probable if they simply eat less and avoid social situations in which they are expected to eat. Restricters often withdraw to their rooms and avoid family and friends. It is not uncommon for them to be competitive, compulsive, and obsessive about their activities. They might participate in rigid exercise programs to help reduce their weight.

Which client statement would indicate alcohol use disorder according to the criteria determined by the DSM-5? (Select all that apply.) A. "I drink too much to be able to keep a job." B. "I started drinking when I was 14 years old." C. "I know I've damaged my liver but I can't stop drinking." D. "I come from a family of alcohol abusers." E. "I've broken my wrist and an ankle falling when I was drunk."

A. "I drink too much to be able to keep a job." C. "I know I've damaged my liver but I can't stop drinking." E. "I've broken my wrist and an ankle falling when I was drunk."

A newly licensed registered nurse (RN) tells the unit manager, "I'm uncertain when it's appropriate to discuss sexual issues or problems with a patient." The unit manager should provide which response to best address the RN's concern? A. "It is important for you to possess self-awareness and a level of comfort to screen for basic sexual issues and problems when patients discuss them. You are an important link for referral to other health care providers B. "I wouldn't worry about that, since most of the patients are too embarrassed to talk about sex anyway." C. "We each qualify as sex counselors, because we have knowledge of sexual functioning throughout the lifespan." D. "It's acceptable to defer all questions and comments regarding sexuality to other more experienced health care providers."

A. "It is important for you to possess self-awareness and a level of comfort to screen for basic sexual issues and problems when patients discuss them. You are an important link for referral to other health care providers

An abuser is discussing his latest physical attack on his partner. Which statement would the nurse associate with the tension-building period of the violence cycle? A. "She always just wants to leave, and I couldn't let her disrespect me like that." B. "I admit I hit her, but she wasn't really hurt. I didn't even break any bones." C. "She knows she doesn't keep the house as clean as she should." Incorrect D. "I know I was wrong, and I won't ever hit her again."

A. "She always just wants to leave, and I couldn't let her disrespect me like that."

"I don't think my psychiatrist understands me," states the client. How will the nurse appropriately respond to therapeutically meet the client's needs? A. "What concerns do you have?" B. "I don't understand why you would think that." C. "Why don't you discuss those feelings with the psychiatrist?" D. "Yes, relationships like that can be difficult at times."

A. "What concerns do you have?" Asking the patient to provide information encourages the patient to go on and forms a basis for assessment and the initiation of therapeutic rapport. Challenging the patient's feelings is nontherapeutic. "Why" questions are considered nontherapeutic and may create anger or defensiveness in the patient. Supporting the patient in this situation sets the stage for splitting behaviors and the manipulation of staff.

Which question is most important for the nurse to ask when assessing a bulmic patient who admits to using laxitives? A. "When did you last have a bowel movement?" B. "Are your feet and legs swollen?" C. "Do you ever have chest pain when you are exercising?" D. "Have you ever been told you have poor dental enamel?"

A. "When did you last have a bowel movement?" B. "Are your feet and legs swollen?" Laxatives can lead to reflex constipation, and both laxatives and diuretics are associated with rebound edema.

A woman's inability or reluctance to leave an abusive relationship is the result of multiple factors. Which situation is considered a cultural factor? A. Believing she deserves the treatment B. Being socially isolated C. Processing a poor self-image D. Fearing the loss of custody of her children

A. Believing she deserves the treatment

What type of long-acting medication is most often used for the treatment of alcohol withdrawal? A. Benzodiazepines B. Barbiturates C. Antidepressants D. Anxiolytics

A. Benzodiazepines

When a person diagnosed with anorexia nervosa genuinely loses the normal sensations of hunger, the nurse recognizes that the cause is associated with which physiologic process? A. Delayed gastric emptying B. Diminished abdominal peristalsis C. Dehydration D. Refeeding syndrome

A. Delayed gastric emptying Many patients have delayed gastric emptying, causing them to feel full much longer than most people. Thus, these patients do not have the normal desire to eat as often as others. Slower abdominal peristalsis combined with decreased intake leads to constipation, which fuels the use of laxatives, thus leading to dehydration and giving the anorectic a false sense of decreased weight. Dehydration can lead to irreversible renal damage.

28. Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia? Select all that apply. A. Group therapy B. Medication management C. Deterrent therapy D. Supportive family therapy E. Social skills training

A. Group therapy B. Medication management D. Supportive family therapy E. Social skills training The nurse should recognize that group therapy, medication management, supportive family therapy, and social skills training all play an integral part in rehabilitative programs for clients diagnosed with schizophrenia. Schizophrenia results from various combinations of genetic predispositions, biochemical dysfunctions, physiological factors, and psychological stress. Effective treatment requires a comprehensive, multidisciplinary effort.

Twenty-four hours following an admission a patient who experienced a fractured fermur in an automobile accident, begins demonstration signs and symptoms that suggest alcohol withdrawal. What assessment data supports this tentative diagnosis? (Select all that apply.) A. Hand tremors that making holding a glass difficult B. Clothing changed due to extreme sweating C. Reports seeing "bugs crawling on the walls" D. Reporting urinary retention E. Experiencing episodes of trachycardia

A. Hand tremors that making holding a glass difficult B. Clothing changed due to extreme sweating C. Reports seeing "bugs crawling on the walls" E. Experiencing episodes of trachycardia

What is the initial nursing intervention when considering the treatment of sexual dysfunction disorders? A. Identifying any medical conditions that could cause the problem B. Determining how important sexual activity is to the individual C. Establishing when the signs and symptoms of the dysfunction began D. Arranging for couples therapy that focuses on such dysfunctions

A. Identifying any medical conditions that could cause the problem

Which statement regarding medication management goals for children diagnosed with bipolar disorder (BPD) is true? A. Medication dosage is determined by weight. B. Age is a factor when determining the need to increase dosage. C. There are currently only six medications approved by the U.S. Food and Drug Administration (FDA) for such treatment. Incorrect D. The initial goal is to manage the hyperactive symptoms being demonstrated.

A. Medication dosage is determined by weight.

18. A client who is admitted to the inpatient psychiatric unit and is taking Thorazine presents to the nurse with severe muscle rigidity, tachycardia, and a temperature of 105F (40.5C). The nurse identifies these symptoms as which of the following conditions? A. Neuroleptic malignant syndrome B. Tardive dyskinesia C. Acute dystonia D. Agranulocytosis

A. Neuroleptic malignant syndrome Neuroleptic malignant syndrome is a potentially fatal condition characterized by muscle rigidity, fever, altered consciousness, and autonomic instability.

A patient diagnosed with Parkinson disease is at risk for demonstrating behaviors associated with which mental health disorder? A. Psychosis B. Bipolar II C. Simple phobia D. Schizophrenia

A. Psychosis

29. A nurse is administering risperidone (Risperdal) to a client diagnosed with schizophrenia. The therapeutic effect of this medication would most effectively address which of the following symptoms? Select all that apply. A. Somatic delusions B. Social isolation C. Gustatory hallucinations D. Flat affect E. Clang associations

A. Somatic delusions C. Gustatory hallucinations E. Clang associations The nurse should expect that risperidone (Risperdal) would be effective treatment for somatic delusions, gustatory hallucinations, and clang associations. Risperidone is an atypical antipsychotic that has been effective in the treatment of the positive symptoms of schizophrenia and in maintenance therapy to prevent exacerbation of schizophrenic symptoms.

21. A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately? A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention

A. Sore throat, fever, and malaise The nurse should intervene immediately if the client experiences a sore throat, fever, and malaise when taking the atypical antipsychotic drug clozapine (Clozaril). Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. Symptoms of infectious processes would alert the nurse to this potential.

What therapeutic benefit will the nurse include in the patient teaching regarding fluphenazine decanoate? A. The medication is administered weekly not daily B. The client will not experience extrapyramidal side effects (EPSEs). C. The medication requires titration only monthly. D. The client will experience a reduction in both negative and positive symptoms.

A. The medication is administered weekly not daily

What obsessive belief is the basis of workplace-related stalking? A. The stalker has a significant personal relationship with the other employee. B. The stalker has been wronged in some fashion by the other employee. C. The other employee owes something of value to the stalker. D. The other employee poses a physical danger to the stalker.

A. The stalker has a significant personal relationship with the other employee.

13. . Which statement should indicate to a nurse that an individual is experiencing a delusion? A. There's an alien growing in my liver. B. I see my dead husband everywhere I go. C. The IRS may audit my taxes. D. I'm not going to eat my food. It smells like brimstone.

A. There's an alien growing in my liver. The nurse should recognize that a client who claims that an alien is inside his or her body is experiencing a delusion. Delusions are false personal beliefs that are inconsistent with the person's intelligence or cultural background.

22. If clozapine (Clozaril) therapy is being considered, the nurse should evaluate which laboratory test to establish a baseline for comparison in order to recognize a potentially life-threatening side effect? A. White blood cell count B. Liver function studies C. Creatinine clearance D. Blood urea nitrogen

A. White blood cell count The nurse should establish a baseline white blood cell count to evaluate a potentially life-threatening side effect if clozapine (Clozaril) is being considered as a treatment option. Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur.

3. A 16-year-old client diagnosed with schizophrenia experiences command hallucinations to harm others. The clients parents ask a nurse, Where do the voices come from? Which is the appropriate nursing reply? A. Your child has a chemical imbalance of the brain, which leads to altered thoughts. B. Your childs hallucinations are caused by medication interactions. C. Your child has too little serotonin in the brain, causing delusions and hallucinations. D. Your childs abnormal hormonal changes have precipitated auditory hallucinations.

A. Your child has a chemical imbalance of the brain, which leads to altered thoughts. The nurse should explain that a chemical imbalance of the brain leads to altered thought processes. Hallucinations, or false sensory perceptions, may occur in all five senses. The client who hears voices is experiencing an auditory hallucination.

15. A patient's areas of strength are documented in which part of the plan of care? a. Assessment b. Diagnosis c. Outcome identification d. Interventions e. Evaluation

ANS: A Areas of strength are part of the nurse's assessment, and documentation is appropriate only in that part of the plan of care. This information is very important for the later steps of outcome identification and planning.

5. A nurse reads this information in a patient's record: suffered anoxia at birth; foster home placement at age 3; taunted by peers during childhood; low self-esteem since adolescence. Which item would be classified as a biologic factor associated with the patient's mental illness? a. Anoxia at birth b. Low self-esteem c. Taunted by peers d. Trauma caused by parental death

ANS: A Biologic causes arise from nature; that is, they are organic or genetic. Anoxia is an organic etiology. The other conditions are of psychologic etiology.

Which argument effectively supports the importance of funding services for persons with mental illness in the United States? a. During any given year 25% of Americans are affected by mental disorders. b. Increasing toxins in the environment are increasing the incidence of mental illness. c. The high prevalence of mental illness is directly linked to increasing violence in the media. d. The incidence of mental illness is increasing because of deterioration of the American family.

ANS: A Funding is justified based on the high incidence of mental illness. The origins of mental illness are multifaceted. It is overly simplistic to associate these problems with one or two variables.

11. Prevalence rates for substance abuse disorders in the United States are: a. higher for men. b. higher for women. c. equal for both genders. d. higher than anxiety disorders.

ANS: A Prevalence rates for substance abuse disorders are highest in men. The remaining options are not true regarding substance abuse prevalence.

13. A newly admitted patient is experiencing a manic episode. The patient is verbally and physically aggressive. The plan for care should include: a. setting clear limits, providing a quiet environment, and limiting activities. b. avoiding use of antipsychotic drugs for 24 hours and providing nourishment ad lib. c. orienting to unit activities, encouraging gross motor activity, and watching television. d. avoiding confrontations by not enforcing limits and encouraging physical exercise at bedtime.

ANS: A Stimuli should be reduced to provide a simple, quiet, and nonstimulating environment. Clear limits should be explained in as few words as possible, and then maintained. Gross motor activity should be limited to prevent exhaustion, and exercise should not be encouraged at bedtime. Quiet activity is more conducive to initiating sleep. Intake should be monitored and food and fluids encouraged to compensate for the higher energy expenditure of the patient. Antipsychotic drugs will probably be needed to reduce activity and aggressiveness.

6. A general psychotherapeutic management guideline nurses should apply when caring for all patients is to: a. strengthen patients' self-esteem. b. keep reality testing to a minimum. c. ignore hostile behavior when possible. d. provide unrestricted opportunities for self-expression.

ANS: A Strengthening patients' self-esteem is an important aspect of psychotherapeutic management and a key part of the nurse's role. The distracters are not always therapeutic.

12. The spouse of a patient diagnosed with bipolar I disorder says, "We want to have children, but I worry they could inherit this problem. There is also bipolar disorder on my side of the family." What is the nurse's most appropriate action? a. Direct the couple to seek genetic counseling. b. Encourage the couple to consider adopting children. c. Encourage the spouse to discuss options with a spiritual advisor. d. Educate the spouse about environmental determinants of bipolar disorder.

ANS: A The nurse's advice should be based on knowledge that there appears to be a genetic role in the cause of bipolar disorder. Genetic counseling will provide the couple with the best possible basis for decision making. The other options will not provide the information that the couple needs to make an informed decision.

10. When a hyperactive, aggressive patient with bipolar disorder threatens to beat up another patient, the initial nursing intervention should be to: a. provide firm verbal limits. b. place the patient in seclusion. c. ask the patient, "Why are you so angry?" d. distract the patient with diversional activities.

ANS: A Unless a physical attack has taken place, verbal limit-setting should precede the use of more restrictive measures.

3. A patient is hospitalized with new onset of manic behavior. It would be important for the nurse to inspect and report results of which laboratory tests? Select all that apply. a. Calcium b. Creatinine c. Potassium d. Drug screens e. Thyroid function

ANS: A, D, E Medical conditions may cause mania, including hypercalcemia, hyperthyroidism, and selected drugs of abuse, particularly stimulants. Steroids may also produce mania.

1. A nurse teaching about bipolar disorder should inform patients and their families of possible depressive symptoms. Which symptoms should the nurse include? Select all that apply. a. Passivity b. Aggression c. Hyperactivity d. Psychomotor retardation e. Preoccupation with death

ANS: A, D, E The symptoms of a bipolar depressive episode are often atypical, such as those consistent with the atypical depressive symptoms of major depressive disorder. They include preoccupation with death, psychomotor retardation, and passivity.

1. Which indicator of disordered communication is the nurse most likely to assess in a patient having a manic episode? a. Loose associations b. Flight of ideas c. Echolalia d. Mutism

ANS: B Flight of ideas is a continuous flow of speech marked by jumping from topic to topic. The other options are most likely to be assessed in patients with schizophrenia.

8. A patient who has taken antipsychotic medication for a year presents with these signs and symptoms: jaundice, headache, pruritus, and abdominal discomfort. Which finding should be documented as objective data? a. Pruritus b. Jaundice c. Headache d. Abdominal discomfort

ANS: B Objective data are obtained by the nurse through direct observation or measurement. Jaundice is seen by the nurse. The other choices are considered subjective data.

14. A nurse presents a psychoeducational program to patients with bipolar disorder and their families. Information about signs of impending relapse of mania should include: a. diarrhea, thirst, and gross tremor. b. sleep disturbances and racing thoughts. c. decreased libido, anhedonia, and hypersomnia. d. delusional thinking, excessive guilt, and passivity.

ANS: B Relapse symptoms are congruent with early symptoms of a manic episode. They include sleeping less, experiencing racing thoughts, and having boundless energy. Diarrhea, thirst, and tremor relate to lithium side effects. Libido increases. Delusional thinking may occur in an exacerbation of the illness but not usually before relapse.

3. What is the most prevalent psychopathologic condition diagnosed in the United States? a. Schizophrenia b. Mood disorder c. Anxiety disorder d. Alcohol dependency

ANS: C Anxiety disorders are the most prevalent, followed by mood disorders and alcohol disorders.

2. A patient at the clinic describes periods of sadness and depression as well as episodes of elation over the past 3 years. The patient adds, "Fortunately, I have been able to keep my job despite these mood changes." These findings are most consistent with which disorder? a. Bipolar I b. Bipolar II c. Cyclothymic d. Seasonal affective

ANS: C Cyclothymic disorder is characterized by mood swings between hypomania and depressive symptoms, with behavior at the poles being less severe than mania or depression. The patient's ability to remain employed indicates that the periods of elation were hypomania rather than mania. The patient's description does not meet criteria for any of the other options listed.

15. A nurse presents a psychoeducational program to patients with bipolar disorder and their families. Information about signs of impending relapse of depressive episode should include: a. diarrhea, thirst, and gross tremor. b. sleep disturbances and racing thoughts. c. decreased libido, anhedonia, and inertia. d. anorexia, excessive guilt, and aggression.

ANS: C Relapse symptoms are congruent with early symptoms of a depressive episode. They include decreased libido, loss of pleasure, and lack of energy. Sleeping less, experiencing racing thoughts, experiencing aggression, and having boundless energy suggest impending mania. Diarrhea, thirst, and tremor relate to lithium side effects.

5. A patient diagnosed with bipolar I disorder says, "I will lead the next group about medications. I have studied all the effects and problems with drugs on the Internet, so I can answer patients' questions." How should the nurse document this finding? a. Flight of ideas b. Distractibility c. Limit-testing d. Grandiosity

ANS: D Grandiosity is reflected when the individual makes statements that show an inflated sense of self-worth. Flight of ideas refers to rapidly shifting topics of conversation. Limit-testing refers to attempting to override the structure of the milieu. Distractibility refers to inability to maintain concentration when environmental stimuli shift.

MR 1. Which guidelines should be included by the nurse who will provide staff development training to unlicensed assistive personnel about psychotherapeutic management? Select all that apply. a. Support should be minimal to prevent development of dependence. b. Norms and limits are more important than individual needs. c. Hostility should run its course without staff interference. d. Plan opportunities to strengthen patients' self-esteem. e. Provide encouragement for patients in distress.

ANS: D, E Important guidelines include provision of encouragement, especially when patients are in distress, and strengthening patients' self-esteem. The other options are actually the opposite of accepted guidelines.

1. A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this clients safety? A. Assess for medication noncompliance B. Note escalating behaviors and intervene immediately C. Interpret attempts at communication D. Assess triggers for bizarre, inappropriate behaviors

ANS: Note escalating behaviors and intervene immediately The nurse should note escalating behaviors and intervene immediately to maintain this clients safety.

It has been determined that a patient is experiencing life-threatening toxicity related to TCA use. Which intervention will the nurse anticipate?

Administering the acetylcholinesterase inhibitor physostigmine (Antilirium) Rationale: The antidote for severe TCA poisoning (anticholinergic toxicity) is physostigmine, an acetylcholinesterase inhibitor (inhibits the breakdown of acetylcholine). The risks associated with TCA toxicity do not include suicidal ideations, urinary incontinence, or changes in brain activity.

What positive and negative effects can an inpatient hospitalization have on a patient's emotional recovery?

An acute inpatient hospital stay can be beneficial for patients who are suicidal, homicidal, and/or gravely disabled. The structure of the hospital stay provides a sense of security, safety, and predictability. As patients are distanced from their stressful environments, they can begin to process their emotions in a safe environment. Negative effects of hospitalization also occur because of the high acuity level of patients on the units. Outbursts of anger, aggression, irritability, and depression are common characteristics of some patients, contributing to increased anxiety for all patients. Healing also may be inhibited when nursing staff overreact to aggressive and/or irritable patients, which can lead patients to feel distrust for some of their nurses.

Which nursing intervention is most appropriate for the post-crisis depression phase of the assault cycle?

Asking "Can we talk about what triggered your angry behavior?" Rationale: The nursing interventions appropriate to the post-crisis phase focus on processing the incident with the patient, discussing alternative solutions, and the reentry of the patient into the unit environment. Medication and voluntary seclusion are effective during the escalation phase. Physical restraints are not considered before the crisis phase.

A chronically depressed patient tells the nurse, "My antidepressant just doesn't seem to be working as well as it did." What is the nurse's initial assessment intervention?

Asking the patient how long he or she has been taking this particular antidepressant Rationale: After 2 years about 20% of patients who are compliant with these medications experience antidepressant "poop out." It is not known whether this is related to a development of tolerance, worsening of the depression, or the loss of a placebo effect. While the remaining assessments are appropriate, since diminished effect occurs after prolonged therapy, determining length of administration is the initial assessment focus.

Which intervention will best address the low self-esteem issues experienced by a middle-aged adult who has been unemployed for 2 years?

Assist the patient in identifying personal skills and achievements Rationale: Depressed individuals suffer from low self-esteem. The most effective approach to bolster self-esteem is to help them focus on the positive (accomplishments, skills, good points). Encouraging good grooming and problem solving are helpful but have less impact on self-esteem than focusing on the positive aspects. Attentive listening is important, but caution must be exercised to prevent it from being a barrier to the patient's plan of care.

When a patient is initially prescribed carbamazepine (Tegretol) when lithium is ineffective at managing the symptoms of bipolar disorder, the nurse will include what information in the patient education plan?

At first complete blood counts (CBCs) to be scheduled weekly Rationale: Although carbamazepine is generally well tolerated, side effects include nausea, anorexia, and occasional vomiting. Sedation and drowsiness are other relatively common side effects. The most serious potential side effect of carbamazepine is agranulocytosis. CBCs should be determined weekly when this drug treatment is initiated. Lamotrigine (Lamictal) can cause somewhat moderate skin rashes (about 10% of patients) and the potentially fatal Stevens-Johnson syndrome (1% to 2% of children). Topiramate (Topamax) has been reported responsible for weight loss in some patients.

A soldier who served in a combat zone returned home to the United States. The soldier's spouse reports to the nurse, "We had planned to start a family right away, but now he won't talk about it. He won't even look at children." The spouse is describing which symptom associated with PTSD?

Avoidance

A soldier experienced a TBI associated with acceleration-deceleration forces. Which part of the neuron was most likely damaged?

Axon

A patient diagnosed with avoidant personality disorder that focuses on social interactions has just returned from planting flowers with other patients. Which statement by the nurse demonstrates understanding of basic function of this nurse-patient relationship? A. "Tell what you enjoyed most about planting the flowers." B. "How did being among other patients make you feel?" C. "What type of activity would you like to get involved in next?" D. "The more you interact with people, the more comfortable you'll be."

B. "How did being among other patients make you feel?" The nurse helps the patient gradually confront his or her fears. Discussing the patient's feelings and fears before and after doing something that he or she is afraid to do is an essential part of the relationship.

A young adult woman comes to the emergency department following a sexual assault. While meeting the sexual assault nurse examiner, the patient states, "I feel so dirty! Please let me take my clothes off and get a shower now." How should the nurse respond to the woman's request? A. "That will be fine. I can certainly empathize with your feelings. Let me get an evidence bag for your clothes." B. "I will need to assess you first, keep your clothes for evidence, and complete your physical exam. Then you will be able to shower." C. "As much as I understand your feeling, it is necessary that you must be examined first." Incorrect D. "Please tell me what happened to you. It is important to get all the details so that evidence can be provided for any trial that may occur"

B. "I will need to assess you first, keep your clothes for evidence, and complete your physical exam. Then you will be able to shower."

Which statement demonstrates feelings likely expressed by a nurse who sets unrealistically high expectations for a patient with antisocial personality disorder? A. "I really feel that the patients always angry with me." B. "That client is a constant sort of frustration for me." feelings of anger and frustration by the nurse. C. "I think the patient has turned inward and is now depressed." D. "The client is motivated to meet the expectations I've set."

B. "That client is a constant sort of frustration for me." feelings of anger and frustration by the nurse. Changes on the part of the patient will come slowly if at all; patience and consistency are key in the work of the therapeutic nurse-patient relationship. The antisocial patient will not feel discomfort with high expectations, and will generally be unmoved and unconcerned. The patient with antisocial personality disorder is devoid of concern related to others' needs, rights, and property. Such a patient would be in no distress or concern with measuring up to the nurse's expectations.

When initially interviewing an individual experiencing a substance-related disorder, the most therapeutic strategy to establish the nurse-patient relationship would be to ask: A. "How long have you been addicted?" B. "What happens when you use more than is intended?" C. "How has your alcoholism affected your family?" D. "So you use about $500 every week for cocaine?"

B. "What happens when you use more than is intended?"

A hospitalized adolescent is angry when telephone privileges are taken away for 24 hours when it is determined that he was hiding food in his room. While he admits to knowing breaking a unit rule, he justifies his behavior by stating, "I'm a growing boy, and I get hungry. It's not right that I can't eat when I'm hungry." The nurse manages the immediate situation by making what statement to the client? A. "I'll see that you the bedtime snack is increased each evening." B. "Your telephone privileges will be restored in 24 hours." C. "I'll share your concerns with the nursing supervisor." D. "Let's discuss why such a unit rule is necessary."

B. "Your telephone privileges will be restored in 24 hours."

An adult who is a survivor of childhood abuse is adamant that all men are dangerous and insensitive. How should the nurse initially respond to that statement? A. Attempt to determine the underlying trigger for the response. B. Accept it as the patient's true feelings. C.dAsk the patient to explain just what she meant. D. Document that she was deeply traumatized by the abuse.

B. Accept it as the patient's true feelings

Screening for symptoms of which mental health disorder is most appropriate for the older adult population? A. Major depression B. Anxiety C. Somatic disorders D. Phobia

B. Anxiety

11. Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia? A. Establishing personal contact with family members. B. Being reliable, honest, and consistent during interactions. C. Sharing limited personal information. D. Sitting close to the client to establish rapport.

B. Being reliable, honest, and consistent during interactions. The nurse can enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia by being reliable, honest, and consistent during interactions. The nurse should also convey acceptance of the clients needs and maintain a calm attitude when dealing with agitated behavior.

When an older adult is prescribed an antipsychotic medication, which intervention has priority regarding the patient's safety? A. Wearing sunglasses when outdoors B. Changing from a sitting to standing position slowly C. Being frequently monitored for suicidal ideations D. Avoiding foods with high fat content

B. Changing from a sitting to standing position slowly

Which initial nursing intervention best addresses the admission needs of a patient diagnosed with borderline personality disorder (BPD)? A. Implementation of fair but inflexible milieu boundaries B. Completion of a thorough suicide assessment C. Instructions regarding the appropriate handling of anger D. Establishment of a relationship that includes respect and friendship

B. Completion of a thorough suicide assessment The patient is usually in a crisis situation when hospitalized because of suicidal behavior, self-mutilation, acute personality disorganization, or inability to function. Because the nurse's initial concern is patient safety, he or she conducts a suicide assessment and provides a safe environment to decrease self-harm and contain impulses. Attention is then directed to working with the patient to find less destructive ways to handle anger, rage, and psychic pain. The use of empathy by the nurse while maintaining clear boundaries is important in establishing a relationship with the patient diagnosed with BPD. The nurse is not a friend but a health care professional.

In evaluating medication ordered for an older adult experiencing mental illness, the nurse will expect the prescriber to make what action their priority? A. Beginning with a near-maximum dose and then titrating down if necessary B. Considering the hepatic and renal functioning of the individual C. Avoiding the use of medications for depression or anxiety D. Speaking to the caregiver rather than the older adult to minimize stress

B. Considering the hepatic and renal functioning of the individual

7. During an admission assessment, a nurse asks a client diagnosed with schizophrenia, Have you ever felt that certain objects or persons have control over your behavior? The nurse is assessing for which type of thought disruption? A. Delusions of persecution B. Delusions of influence C. Delusions of reference D. Delusions of grandeur

B. Delusions of influence The nurse is assessing the client for delusions of influence when asking if the client has ever felt that objects or persons have control of the clients behavior. Delusions of control or influence are manifested when the client believes that his or her behavior is being influenced. An example would be if a client believes that a hearing aid receives transmissions that control personal thoughts and behaviors.

An individual is admitted with withdrawal symptoms. Which symptoms support the belief that the abused substance is an opioid? A. Anxiety, sweating, and irritability B. Dilated pupils, diarrhea, and runny nose C. General fatigue, depression, and paranoia D. Confusion, seizures, and delirium

B. Dilated pupils, diarrhea, and runny nose

The community health nurse is visiting the senior citizens activity center and notes an older adult with bruises on both upper arms and shoulders. What is the nurse's initial intervention? A. Contact a physician to perform a physical examination on the individual. B. Discuss with the individual their daily routine, medical history, and living situation. C. Alert the activity center director, and contact the police. D. Document the assessments on the treatment record.

B. Discuss with the individual their daily routine, medical history, and living situation.

What approach would be most effective in helping a patient diagnosed with an eating disorder and hospitalized for extremely low weight who has been found sneaking diet pills? A. Education about the health risks and dangers of diet pills B. Discussion concerning the patient's fears of losing control when complying with the weight gain recommended Correct C. Discussion concerning the fears or worries generated in the family about current health status D. Confrontation of the patient regarding sneaking the diet pills and extreme thinness

B. Discussion concerning the patient's fears of losing control when complying with the weight gain recommended The correct option focuses on the significant issue in treatment for the patient; it avoids the diet pill use, which is a symptom and not representative of the key concern. This strategy represents the use of cognitive-behavior therapy with the patient.

25. A client has been recently admitted to an inpatient psychiatric unit. Which intervention should the nurse plan to use to reduce the clients focus on delusional thinking? A. Present evidence that supports the reality of the situation B. Focus on feelings suggested by the delusion C. Address the delusion with logical explanations D. Explore reasons why the client has the delusion

B. Focus on feelings suggested by the delusion The nurse should focus on the clients feelings rather than attempt to change the clients delusional thinking by the use of evidence or logical explanations. Delusional thinking is usually fixed, and clients will continue to have the belief in spite of obvious proof that the belief is false or irrational.

16. A nurse is caring for a client who is experiencing a flat affect, paranoia, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the clients positive and negative symptoms of schizophrenia? A. Paranoia, anhedonia, and anergia are positive symptoms of schizophrenia. B. Paranoia, neologisms, and echolalia are positive symptoms of schizophrenia. C. Paranoia, anergia, and echolalia are negative symptoms of schizophrenia. D. Paranoia, flat affect, and anhedonia are negative symptoms of schizophrenia.

B. Paranoia, neologisms, and echolalia are positive symptoms of schizophrenia. The nurse should recognize that positive symptoms of schizophrenia include paranoid delusions, neologisms, and echolalia. Positive symptoms reflect an excess or distortion of normal functions.

Which assessment data would support a diagnosis of a Cluster B personality disorder? A. Person states, "I never fit in regardless of where I am." B. Person has spent 3 of the last 5 years in jail. C. Person rarely initiates a conversation. D. Person generally seeks guidance when faced with a decision.

B. Person has spent 3 of the last 5 years in jail. The main feature of antisocial personality disorder (Cluster B) is a pattern of disregard for the rights of others, which is usually demonstrated by repeated violations of the law. Individuals with schizotypal personality disorder (Cluster A) feel that they are different and do not fit in. People with schizoid personalities (Cluster A) do not initiate spontaneous conversation. Dependent individuals (Cluster C) want others to make daily decisions for them.

Which intervention is important to providing therapeutic care to a person diagnosed with a Cluster A personality disorder? A. Questioning the patient regarding the presence of childhood traumas B. Providing concise, simple explanations regarding the plan of care C. Directing group discussions to encourage emotional growth D. Supporting the patient's need for confrontation as a tension release

B. Providing concise, simple explanations regarding the plan of care The most important psychotherapeutic task related to Cluster A personality disorders centers on dealing with trust issues. Clear, simple explanations and requests will reduce the patient's feelings of being threatened or controlled. A professional demeanor coupled with honesty and nonintrusiveness will assist in developing some trust. These patients do not tolerate group therapies that expect or involve confrontation or much emotional involvement.

24. A college student has quit attending classes, isolates self because of hearing voices, and yells accusations at fellow students. Based on this information, which nursing diagnosis should the nurse prioritize? A. Altered thought processes R/T hearing voices AEB increased anxiety B. Risk for other-directed violence R/T yelling accusations C. Social isolation R/T paranoia AEB absence from classes D. Risk for self-directed violence R/T depressed mood

B. Risk for other-directed violence R/T yelling accusations The nursing diagnosis that must be prioritized in this situation is risk for other-directed violence R/T yelling accusations. Hearing voices and yelling accusations indicate a potential for violence, and this potential safety issue should be prioritized.

During binge eating, the bulimic patient is most likely to consume what type of food? A. A leafy green salad with a creamy dressing B. Snack cakes with cream filling and icing C. A steak and fried potatoes D. A pizza with "everything" on it.

B. Snack cakes with cream filling and icing A variety of foods might be eaten during a binge, but the most common is high-calorie, high-carbohydrate "snack" food easily ingested in a short period. The other foods may be consumed, but they are not necessarily the food of choice.

6. A client diagnosed with schizophrenia tells a nurse, The Shopatouliens took my shoes out of my room last night. Which is an appropriate charting entry to describe this clients statement? A. The client is experiencing command hallucinations. B. The client is expressing a neologism. C. The client is experiencing a paranoia. D. The client is verbalizing a word salad.

B. The client is expressing a neologism. The nurse should describe the clients statement as experiencing a neologism. A neologism is when a client invents a new word that is meaningless to others but may have symbolic meaning to the client.

A patient is admitted to the emergency department with shallow respirations, clammy skin, and dilated pupils. The nurse suspects: A. withdrawal from benzodiazepines. B. overdose on benzodiazepines. C. withdrawal from cocaine. D. overdose on cocaine.

B. overdose on benzodiazepines.

Which question is relevant to determining whether a sexual act is considered incest? A."Was this a homosexual sex act?" B."Are you related to the person who initiated sex with you?" C."How old were you when this sexual event occurred?" D. "Did the person tell you it was okay to have sex with them?"

B."Are you related to the person who initiated sex with you?"

What presents the greatest postnatal risk to a newborn whose mother is now managing her bipolar disorder with lithium?

Breastfeeding Rationale: Lithium is present in breast milk at 30% to 100% of the mother's serum level; therefore, postnatal treatment also poses problems. The mother's potential for manic behavior is a consideration regarding neglect and abuse, but such a risk is lower than that posed by breastfeeding. The newborn is not at any higher risk for infections because of the mother's use of lithium.

A patient seeking treatment for anxiety says, "I can't think. My job depends on my ability to think. I need medicine, but the drugs I took a few years ago made me too sleepy. I could lose my job." What information is most important for the nurse to consider when formulating a response?

Buspirone (BuSpar) alleviates anxiety without sedation or cognitive clouding.

12. A client diagnosed with schizophrenia states, My psychiatrist is out to get me. Im sad that the voice is telling me to stop him. What symptom is the client exhibiting, and what is the nurses legal responsibility related to this symptom? A. Magical thinking; administer an antipsychotic medication B. Persecutory delusions; orient the client to reality C. Command hallucinations; warn the psychiatrist D. Altered thought processes; call an emergency treatment team meeting

C. Command hallucinations; warn the psychiatrist The nurse should determine that the client is exhibiting command hallucinations. The nurses legal responsibility is to warn the psychiatrist of the potential for harm. A client who is demonstrating a risk for violence could potentially become physically, emotionally, and/or sexually harmful to others or to self.

4. Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia, tells them that voices command him to harm others. Which is the appropriate nursing reply? A. Tell him to stop discussing the voices. B. Ignore what he is saying, while attempting to discover the underlying cause. C. Focus on the feelings generated by the hallucinations and present reality. D. Present objective evidence that the voices are not real.

C. Focus on the feelings generated by the hallucinations and present reality. The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should maintain an attitude of acceptance to encourage communication but should not reinforce the hallucinations by exploring details of content. It is inappropriate to present logical arguments to persuade the client to accept the hallucinations as not real.

The nurse expects to closely monitor which laboratory data when working with the binging-purging type of bulimic patient? A. Hypocalcemia B. Hypernatremia C. Hypokalemia D. Hypervolemia

C. Hypokalemia Hypokalemia is often evident in patients with chronic emesis and subsequent loss of gastrointestinal fluids. Hypocalcemia should be monitored for but is not the highest priority, since its resulting symptoms are less problematic than those of hypokalemia.

8. A client diagnosed with schizophrenia states, Cant you hear him? Its the devil. Hes telling me Im going to hell. Which is the most appropriate nursing reply? A. Did you take your medicine this morning? B. You are not going to hell. You are a good person. C. I'm sure the voices sound scary. I don't hear any voices speaking. D. The devil only talks to people who are receptive to his influence.

C. I'm sure the voices sound scary. I don't hear any voices speaking. The most appropriate reply by the nurse is to reassure the client with an accepting attitude while not reinforcing the hallucination.

What nutritional education should a nurse provide when managing the care of a patient who has been prescribed a newer antipsychotic medication? A. Limit protein intake. B. Increase fluid intake by 200 mL daily. C. Prepare to cope with a craving for carbohydrates. D. Increase calories to manage an expected weight loss.

C. Prepare to cope with a craving for carbohydrates.

What is the focus of nursing intervention during the impact stage of trauma recovery? A. Validating the patient's personal worth B. Explaining to the patient the legal rights afforded victims C. Providing physical safety and emotional security D. Making appropriate referrals to needed service providers

C. Providing physical safety and emotional security

Which behavior demonstrated by a child diagnosed with obsessive-compulsive disorder (OCD) would suggest to the nurse that the child is also experiencing a common comorbid mental health disorder? A. Pays little attention to details. B. Really enjoys being surprised. C. Regularly engages in limit-testing. D. Is not frightened easily.

C. Regularly engages in limit-testing.

A patient describes his involvement in a situation that the nurse suspects demonstrates the sexual abuse of a child. What is the nurse's initial response? A. Verify that the event actually occurred. B. Consider the negative effects of breeching patient trust. C. Report the suspected abuse to the appropriate agency. D.Notify the health care provider of the statement.

C. Report the suspected abuse to the appropriate agency

15. A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol), 50 mg bid; benztropine (Cogentin), 1 mg prn; and zolpidem (Ambien), 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? A. Tactile hallucinations B. Tardive dyskinesia C. Restlessness and muscle rigidity D. Reports of hearing disturbing voices

C. Restlessness and muscle rigidity An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity.

20. An elderly client diagnosed with schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent (propranolol) for hypertension. Understanding the combined side effects of these drugs, the nurse would most appropriately make which statement? A. Make sure you concentrate on taking slow, deep, cleansing breaths. B. Watch your diet and try to engage in some regular physical activity. C. Rise slowly when you change position from lying to sitting or sitting to standing. D. Wear sunscreen and try to avoid midday sun exposure.

C. Rise slowly when you change position from lying to sitting or sitting to standing. The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, this side effect places the client at risk for developing orthostatic hypotension.

9. A client diagnosed with brief psychotic disorder tells a nurse about voices telling him to kill the president. Which nursing diagnosis should the nurse prioritize for this client? A. Disturbed sensory perception B. Altered thought processes C. Risk for violence: directed toward others D. Risk for injury

C. Risk for violence: directed toward others The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices telling him to kill someone is at risk for responding and reacting to the command hallucination. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions.

27. A newly admitted client has taken thioridazine (Mellaril) for 2 years, with good symptom control. Symptoms exhibited on admission included paranoia and hallucinations. The nurse should recognize which potential cause for the return of these symptoms? A. The client has developed tolerance to the antipsychotic medication. B. The client has not taken the medication with food. C. The client has not taken the medication as prescribed. D. The client has combined alcohol with the medication.

C. The client has not taken the medication as prescribed. Altered thinking can affect a clients insight into the necessity for taking antipsychotic medications consistently. When symptoms are no longer bothersome, clients may stop taking medications that cause disturbing side effects. Clients may miss the connection between taking the medications and an improved symptom profile.

When considering those individuals diagnosed with anorexia nervosa, which client has the lowest probability of recovery? A. The client between the ages of 20 to 25 years. B. The client who is only 10 lb overweight. C. The client who self-induces vomiting. D. The client who exercises regularly.

C. The client who self-induces vomiting. Among patients diagnosed with anorexia nervosa, it was indicated that self-induced vomiting and greater trait anxiety predicted a lower likelihood of recovery. The remaining characteristics are generally not considered predictors of recovery.

26. A client states, I hear voices that tell me that I am evil. Which outcome related to these symptoms should the nurse expect this client to accomplish by discharge? A. The client will verbalize the reason the voices make derogatory statements. B. The client will not hear auditory hallucinations. C. The client will identify events that increase anxiety and illicit hallucinations. D. The client will positively integrate the voices into the clients personality structure.

C. The client will identify events that increase anxiety and illicit hallucinations. It is unrealistic to expect the client to completely stop hearing voices. Even when compliant with antipsychotic medications, clients may still hear voices. It would be realistic to expect the client to associate stressful events with an increase in auditory hallucinations. By this recognition the client can anticipate symptoms and initiate appropriate coping skills.

Which statement is true regarding pseudodementia when compared to true dementia? A. Pseudodementia symptoms are more severe than those of true dementia. B. Pseudodementia results in lower functioning abilities than does true dementia. C. True dementia is chronic in nature, while pseudodementia is highly treatable. D. True dementia does not always present with a depressed mood, but pseudodementia sometimes does.

C. True dementia is chronic in nature, while pseudodementia is highly treatable.

The caregiver for an older adult diagnosed with a chronic mental illness has implemented the following interventions to help minimize the individual's tendency to become both physically and verbally aggressive. Which intervention will the nurse recognize as being ineffective? A. Minimizing the noise level in the individual's home B. Redirecting the individual's attention when the aggression first begins C. Utilizing the television as the individual's major source of entertainment D. Diverting the individual's initial anger by offering his or her favorite food

C. Utilizing the television as the individual's major source of entertainment

A patient received one dose of flumazenil (Romazicon). What is the nurse's next action?

Carefully observe for pre-flumazenil symptoms.

A nursing assistant reports to the nurse that a patient diagnosed with AD is experiencing severe diarrhea. Administration of which classification of medication is most associated with this problem?

ChE inhibitor

Growth hormone assessment is a frequently used biologic diagnostic tool to diagnosis depression in which population?

Children Rationale: Growth hormone secretion is often used as a biologic assessment measure in childhood depression. This test is not useful in adolescent and adult populations.

When a patient states, "When I stop drinking vodka, I feel even more depressed," the nurse responds: A. "You feel depressed because of the drinking." B. "How long has this been going on?" C. "When did you last stop drinking?" D. "Alcohol is a depressant and increases feelings of depression."

D. "Alcohol is a depressant and increases feelings of depression."

Which statement best supports the nurse's belief that a patient diagnosed with chronic alcohol abuse is ready to begin a 12-step recovery program? A."My family will be there to help me every step of the way." B."I've heard nothing but good things about this type of program." C. "My life is ruined because of alcohol and the way I abuse it." D. "I have no control over my drinking; I need help to stop."

D. "I have no control over my drinking; I need help to stop."

A patient experiencing an eating disorder is reluctant to step on the scale for weighing this morning. He says, "I just drank juice for breakfast, so I don't want to weigh today." How should the nurse respond to the patient's request? A. "It is okay to postpone your weighing if you will also eat some solid food to go with the juice for breakfast." B. "We can weigh you tomorrow instead. Don't forget to wait before you eat breakfast, though." C. "I will have to ask the team what to do in this case and get back to you with the decision." D. "It is weigh day today. Please step on the scale."

D. "It is weigh day today. Please step on the scale." Appropriate therapy for such a patient includes setting limits and stating in objective terms the expectation of weighing. This helps to manage the attempted manipulation common among such patients.

An older adult patient living in the community is taking an antipsychotic medication. Which statement made by the patient requires the nurse's priority intervention? A. "I am concerned about how much all these pills cost." B. "I cleaned my apartment yesterday." C. "All my medications are in this bag, so you can look at them." D. "My tongue and mouth feel really different this week."

D. "My tongue and mouth feel really different this week."

The nurse is mandated to report which situation occurring in the community? A. Transgendered person leaving a public restroom B. Cross-dressing individuals attending a convention C. Individuals with gender-identity disorder meeting in a local venue D. A known pedophile waiting outside a play park restroom

D. A known pedophile waiting outside a play park restroom

Which intervention by the nurse would help establish the nurse-patient relationship when conducting an assessment interview with a mentally ill older adult? A. Allowing adequate time for the patient to formulate answers to the questions B. Asking questions using common words and short sentences C. Avoiding unnecessary interruptions and distractions D. Addressing the patient by Mr, Mrs, or Miss and their last name

D. Addressing the patient by Mr, Mrs, or Miss and their last name

The nurse working with an individual experiencing borderline personality disorder (BPD) would need to employ interventional strategies that demonstrate what characteristics? A. Firm, structured, and strict B. Kind, gentle, and passive C. Grandiose, broad, and rapid D. Consistent, fair, and planned

D. Consistent, fair, and planned Nurses who intervene with predictability, planning, and equanimity best forge therapeutic relationships with such an individual. Being strict may present problems with power struggles in the therapeutic relationship. Being gentle and passive may not facilitate the therapeutic relationship, nor will grandiose, broad, and rapid interventions.

5. A nurse is assessing a client diagnosed with schizophrenia. The nurse asks the client, Do you receive special messages from certain sources, such as the television or radio? Which potential symptom of this disorder is the nurse assessing? A. Thought insertion B. Paranoia C. Magical thinking D. Delusions of reference

D. Delusions of reference The nurse is assessing for the potential symptom of delusions of reference. A client who believes that he or she receives messages through the radio is experiencing delusions of reference. When a client experiences these delusions, he or she interprets all events within the environment as personal references.

30. Laboratory results reveal elevated levels of prolactin in a client diagnosed with schizophrenia. When assessing the client, the nurse should expect to observe which symptoms? Select all that apply. A. Apathy B. Social withdrawal C. Anhedonia D. Galactorrhea E. Gynecomastia

D. Galactorrhea E. Gynecomastia Dopamine blockage, an expected action of antipsychotic medications, also results in prolactin elevation. Galactorrhea and gynecomastia are symptoms of prolactin elevation.

10. Which nursing intervention would be most appropriate when caring for an acutely agitated client with paranoia? A. Provide neon lights and soft music. B. Maintain continual eye contact throughout the interview. C. Use therapeutic touch to increase trust and rapport. D. Provide personal space to respect the clients boundaries.

D. Provide personal space to respect the clients boundaries. The most appropriate nursing intervention is to provide personal space to respect the clients boundaries. Providing personal space may serve to reduce anxiety and thus reduce the clients risk for violence.

17. A client diagnosed with schizophrenia, who has been taking antipsychotic medication for the last 5 months, presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome, treated by discontinuing antipsychotic medications B. Agranulocytosis, treated by administration of clozapine (Clozaril) C. Extrapyramidal symptoms, treated by administration of benztropine (Cogentin) D. Tardive dyskinesia, treated by discontinuing antipsychotic medications

D. Tardive dyskinesia, treated by discontinuing antipsychotic medications The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medications. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be an irreversible side effect of typical antipsychotic medications.

What aspect of traditional antipsychotic medication therapy is most responsible for a patient's medication nonadherence and resulting rehospitalization? A. The cost of the medication B. The need for frequent blood tests C. The biases against such medications D. The occurrence of EPSEs.

D. The occurrence of EPSEs.

Which statement is true regarding the characteristic behavior of a pedophile? A. The pedophile is generally a person who has had little or no previous contact with the child. B. The majority of pedophiles are males who do not demonstrate an interest in having a sexual relationship with an adult. C. The heterosexual pedophile is most likely to molest a child of the opposite gender. D. The pedophile behavior reflects a sexual fixation and not a crime of opportunity or exploitation.

D. The pedophile behavior reflects a sexual fixation and not a crime of opportunity or exploitation.

A child diagnosed with depression has been prescribed a tricyclic antidepressant when selective serotonin reuptake inhibitors have proven ineffective. What information should the nurse include in family education regarding this classification of medication? A. The child will likely experience a weight loss. B. The child requires frequent assessment for suicidal thoughts. Incorrect C. Strategies for managing night-time bed wetting will be necessary D. There will be a need for a baseline cardiogram

D. There will be a need for a baseline cardiogram

23. During an admission assessment, a nurse notes that a client diagnosed with schizophrenia has allergies to penicillin, prochlorperazine (Compazine), and bee stings. On the basis of this assessment data, which antipsychotic medication would be contraindicated? A. Haloperidol (Haldol), because it is used only in elderly patients B. Clozapine (Clozaril), because of a cross-sensitivity to penicillin C. Risperidone (Risperdal), because it exacerbates symptoms of depression D. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines

D. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines The nurse should know that thioridazine (Mellaril) would be contraindicated because of cross-sensitivity among phenothiazines. Prochlorperazine (Compazine) and thioridazine are both classified as phenothiazines.

A combat veteran diagnosed with a mild TBI returned to college after discharge from the armed forces. The veteran began tutoring after scoring poorly in three courses. Which strategy can the tutor use to assist the veteran's academic achievement?

Decrease extraneous stimuli to improve attention span.

A patient in the emergency room is suspected to have an overdose of benzodiazepines. Which assessment findings validate this diagnosis? Select all that apply.

Diminished reflexes Somnolence Confusion

What factors do you think contribute to the high levels of depression in the United States?

Factors that may contribute to the high levels of depression in the United States include socioeconomic instability, high divorce rates, child abuse and neglect, poverty, high crime rates, increased prevalence of diabetes and hypertension due to obesity, social media, and globalization.

Excitotoxicity in persons diagnosed with TBIs is associated primarily with which neurotransmitter?

Glutamate

Which behavior demonstrates the most lethal plan by an individual who has recently expressed suicidal ideations?

He has been hoarding medications and has a large supply of barbiturates. Rationale: Patients who have a well-developed plan are considered at increased risk for suicide attempt and suicide completion. Lethality associated with suicidality is related to accessibility—the means to commit suicide. Having access to medication with the potential to kill if used to overdose demonstrates lethality. Self-injury followed by a call to significant other is concerning but not the most lethal. Neither of the remaining options demonstrate planning that would possibly bring about a successful suicide.

A soldier was diagnosed with post-traumatic stress disorder (PTSD). The soldier's spouse reports that when a telephone rings during the night, the soldier rolls out of bed and assumes an aggressive stance. How will the nurse document this finding?

Hyperarousal

A nurse cares for a first-generation American whose family emigrated from Germany one generation ago. This patient would probably have which worldview about the source of knowledge?

Knowledge is acquired according to proof of existence.

If a person taking lithium experiences serious diarrhea, what will happen to the person's serum level?

Lithium levels will increase because the patient is losing sodium but not through the kidneys. Lithium excretion is linked to sodium excretion in the urine but not from the bowel (diarrhea) or from sweating. By losing sodium via diarrhea, there is less sodium to be excreted in the urine.

A patient's lithium level is 2.3 mEq/L. Which nursing intervention will the nurse be prepared to implement when ordered?

Managing the administration of parenteral normal saline Rationale: Mild to moderate toxic reactions occur at levels from 1.5 to 2 mEq/L, and moderate to severe reactions occur at 2 to 3 mEq/L. Parenteral normal saline might provide enough volume and sodium to prevent major problems for serum levels lower than 2.5 mEq/L. Increasing the lithium dose, limiting sodium intake, and administering a diuretic will all serve to elevate the lithium level even more.

A patient has just completed his/her sixth electroconvulsive therapy. Which intervention is most important for the nurse to implement?

Monitor the patient's respiratory status. Rationale: Maintaining a patent airway, monitoring breathing status, and collecting oxygen saturation data following general anesthesia are a priority. It is important to assess orientation but not most important, and the patient should be allowed appropriate recovery time before being assessed. Documentation is important but is not most important at this time.

A nurse talks with the caregiver of a combat veteran with severe traumatic brain injury. The caregiver says, "I don't know how much longer I can do it. My whole life is consumed with taking care of my partner." Which resource should the nurse suggest?

Multifamily support group

Which breakfast selections demonstrate that a patient understands the nurse's dietary instructions while taking monoamine oxidase inhibitor (MAOI) antidepressants?

Oatmeal with almonds and milk Rationale: Oatmeal, almonds, and milk are not considered tyramine-rich food and so can be eaten when taking MAOIs. Yogurt, bananas, aged cheeses, and avocados are high in tyramine and should be avoided.

Why do older individuals have a more intense response to anticholinergics?

Older adults have a more intense response to anticholinergics because over time they begin to lose acetylcholine-synthesizing neurons. So, cholinergic blockers have a more pronounced effect on older adults.

Which factors present the greatest risk for developing medication-induced extrapyramidal side effects (EPSEs)?

Older and female Rationale: At-risk populations for EPSE include female gender, older adults, patients with affective symptoms, and patients with their first episode of schizophrenia

Which side effect of MAOI therapy will the nurse be particular concerned about when this classification of antidepressants is precribed to an older adult patient?

Orthostatic hypotension resulting in falls Rationale: Precautions for orthostatic hypotension should be observed in older patient prescribed MAOIs. Hypotension rather than hypertension is associated with this classification of medications. Hypertensive crisis resulting in the ingestion of high-tyramine foods is a concern for any age. Reflex tachycardia is associated with TCA therapy.

A nurse cares for patients who recently immigrated to the United States. The nurse would expect patients from which countries to hold relational worldviews? Select all that apply.

Panama Mexico Ghana

The nurse administers medications to a culturally diverse group of patients on a psychiatric unit. What expectation should the nurse have about pharmacokinetics?

Patients of different cultural groups may metabolize medications at different rates.

Which social event would likely be most disturbing for this soldier diagnosed with PTSD?

Picnic and fireworks display on July 4th

Singer Michael Jackson allegedly abused alprazolam (Xanax) and propofol (Diprivan), an anesthetic. Which inference applies?

Potentially lethal sedation and CNS depression would be expected with this drug combination.

A patient on a TCA for chronic depression is recovering from a myocardial infarction. Which intervention will the nurse anticipate as a result of the patient's medical condition?

Preparing to wean the patient off of the prescribed TCA medication Rationale: TCAs are contraindicated during the recovery phase of myocardial infarction, and so the patient will be weaned off that medication. Increasing the dose would be contraindicated in this situation. There is no guarantee that an MAOI would be the antidepressant of choice. It is not necessarily prudent to discontinue antidepressant therapy for a patient diagnosed with chronic depression.

A combat veteran diagnosed with moderate traumatic brain injuries is agitated and aggressive. Which pharmacologic intervention would the nurse expect to be effective?

Propranolol (Inderal)

A patient takes donepezil (Aricept) for AD. Vital signs for this patient are: temperature 98.2°F; blood pressure 135/82 mm Hg; pulse 54 beats/min; respirations 18 breaths/min. Which variance should the nurse consider most likely attributable to donepezil therapy?

Pulse rate

When a Mexican-American woman and nurse interact, the patient often holds the nurse's hand or links arms with the nurse. The nurse is uncomfortable with this behavior. Which analysis is most accurate?

The patient is accustomed to and comfortable with touch, as are members of many Hispanic cultures.

Which intervention will not be included in the care plan for a patient who is currently being physically restrained?

The patient is allowed to listen to his/her personal radio during the isolation process. Rationale: Restricting visitors, telephone calls, and diversional materials, such as radios and magazines, reduces stimuli. When a patient is placed in seclusion or restraints, intensive nursing care is instituted. The patient is continuously observed directly or by video monitor, with staff having regular contact with the patient to decrease the sense of isolation and loneliness. Every 2 hours, with two staff members present, the restraints are removed one at a time, for 10 minutes each, to allow range-of-motion activities.

What is the connection between PD and schizophrenia from a neurotransmitter perspective?

The relationship is simply this: both are related to decreased dopamine stimulation of dopamine receptors in the basal ganglia. In PD, the decrease is caused by an undetermined pathology. In Extrapyramidal side EPSEs, the decrease is the result of dopamine receptor blockade by antipsychotic agents.

How are the associated or secondary symptoms of Parkinson's Disease PD linked to the primary symptoms? (For example, excessive saliva or drooling is related to difficulty swallowing, which is secondary to rigidity.)

The secondary symptoms are caused by the primary symptoms. For instance, drooling is caused by the rigidity of muscles responsible for swallowing. Impaired breathing and constipation are related to bradykinesia and rigidity.

A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol). Which client behavior would warrant the nurse to administer haloperidiol?

The symptom of tactile hallucinations and reports of hearing disturbing voices would be addressed by an antipsychotic medication such as haloperidol.

A patient with a history of aggressive behavior begins pacing while talking on the telephone. The RN suspects that the patient is in the triggering phases of the assault cycle and implements which intervention?

Using a calm voice, asks the patient to end the conversation immediately Rationale: The nurse demonstrates caring and presents a sense of control to the patient at a time when the aggression may still be deescalated. The patient requires a higher level of intervention than observation from the RN with the demonstrated level of anxiety. At this point, notifying the staff is more crisis oriented than anticipatory regarding this patient's needs. Providing the patient with these choices is confrontational and likely to escalate the anxiety.

A nurse cares for a Chinese-American patient diagnosed with major depression. After the nurse reviews the therapeutic regimen with the patient, which action should occur next?

Verify understanding by asking the patient to restate the information.

The depressed patient who could most benefit from a trial of bupropion (Wellbutrin) would be:

a male young adult with a nicotine addiction. Rationale: The medication is a nicotinic antagonist, thus acting as a smoking-cessation agent. The medication has no specific benefits regarding epilepsy, weight gain, or psychosis.

The nurse can expect the parent of a child with mal ojo (evil eye) to believe that the effects of the spell can be broken after:

a root doctor or native healer intervenes.

A newcomer to a community support meeting asks a nurse, "Why aren't people with mental illnesses treated at state institutions anymore?" What would be the nurse's accurate responses? Select all that apply. a. "Funding for treatment of mental illness now focuses on community treatment." b. "Psychiatric institutions are no longer accepted because of negative stories in the press." c. "There are less restrictive settings available now to care for individuals with mental illness." d. "Our nation has fewer people with mental illness; therefore, fewer hospital beds are needed." e. "Better drugs now make it possible for many persons with mental illness to live in their communities."

a. "Funding for treatment of mental illness now focuses on community treatment." c. "There are less restrictive settings available now to care for individuals with mental illness." e. "Better drugs now make it possible for many persons with mental illness to live in their communities."

The nurse would expect which comment from a patient diagnosed with depersonalization disorder? a. "I feel like I'm outside my body, watching what's happening." b. "I feel as though someone is reading thoughts in my mind." c. "I know I have cancer, but the doctors can't find it." d. "When I woke up, my legs were paralyzed."

a. "I feel like I'm outside my body, watching what's happening."

During a one-on-one interaction with the nurse, a patient frequently looks nervously at the door. Select the best comment by the nurse to this nonverbal cue. a. "I notice you keep looking toward the door." b. "This is our time together. No one is going to interrupt us." c. "It looks as if you are eager to end our discussion for today." d. "If you are uncomfortable in this room, we can move someplace else."

a. "I notice you keep looking toward the door."

A leader begins the discussion at the first meeting of a new group. Which comment should be included? a. "It is important for everyone to arrive on time for our group." b. "Talking to family members about our group will help us achieve our goals." c. "Everyone is expected to share a personal experience at each group meeting." d. "Groups provide more cost-effective treatment in this time of budget constraints."

a. "It is important for everyone to arrive on time for our group."

A patient says to the nurse, "I dreamed I could not breathe and was being attacked. When I woke up, I felt emotionally drained, as though I hadn't rested well." Which comment would be appropriate if the nurse seeks to interpret? a. "It sounds as though you were uncomfortable with the content of your dream." b. "So you are saying that you were not able to breathe and felt in danger?" c. "I understand. Thank you for telling me about your bad dream." d. "So, you feel as though you had a poor night's sleep?"

a. "It sounds as though you were uncomfortable with the content of your dream."

A leader begins the discussion at the first meeting of a new group. Which comment would be most appropriate? a. "Let's start by establishing some rules for our group." b. "Let's begin with each person here defining his or her problem." c. "I want each person to explain why he or she is attending this group." d. "Talking to family about our group will help us achieve our goals."

a. "Let's start by establishing some rules for our group."

Which skill is most important to a nurse working as a member of a community mental health team that strives to use a seamless continuum of care? a. Case management b. Diagnostic ability c. Physical assessment skills d. Patients' rights advocacy

a. Case management

What is the nurse's initial action when working with a patient with PTSD? a. Develop trust. b. Promote problem solving. c. Encourage verbalization of anger. d. Have the patient evaluate past behaviors.

a. Develop trust.

After a mass transit disaster many injured patients are expected at the emergency room. The nurse expects victims to have which assessment findings? a. Dissociative symptoms, numbing, detachment, and derealization b. Auditory hallucinations and other perceptual distortions c. Physical symptoms that mimic neurologic disorders d. Exaggerated mood (either depression or elation)

a. Dissociative symptoms, numbing, detachment, and derealization

A patient is hospitalized with blindness of sudden onset. According to the spouse, the patient entered a room and found the spouse in a romantic embrace with a neighbor. The patient is unconcerned about the blindness and says, "I'm sure things will turn out all right." Which term best describes this reaction? a. La belle indifference b. Agoraphobia c. Dissociation d. Fugue

a. La belle indifference

A patient diagnosed with PTSD has frequent flashbacks and persistent hyperarousal symptoms. Which nursing interventions should be planned? Select all that apply. a. Offer empathy and support. b. Encourage relaxation activities. c. Encourage verbalization of anger. d. Set limits when the patient begins to tell of the story of the traumatic incident. e. Help the patient associate current feelings and behaviors with trauma experience.

a. Offer empathy and support. b. Encourage relaxation activities. c. Encourage verbalization of anger. e. Help the patient associate current feelings and behaviors with trauma experience.

Which adjective best characterizes custodial care? a. Paternalistic b. Beneficent c. Essential d. Safe

a. Paternalistic Custodial care focuses on activities of daily living, hygiene, nutrition, elimination, and safety needs rather than supporting patients to develop skills for self-care. Staff members decide what is best for patients.

Which research findings about the therapeutic environment of an inpatient psychiatric unit have implications for nursing practice? Select all that apply. a. Patients valued interactions with other patients. b. Patients perceived other patients as dissimilar from self. c. Hospitalization interferes with planning for the future. d. Patients failed to experience bonding with other patients. e. Hospitalization creates feelings of safety from self-destructiveness.

a. Patients valued interactions with other patients. e. Hospitalization creates feelings of safety from self-destructiveness. Findings from the work of Thomas and associates suggest that patients see the hospital as a refuge from self-destructiveness and are fearful of discharge from this safe environment. Furthermore, patients confirmed their identity with other patients (bonding), valued socialization with other patients, and perceived peer-administered therapy as the most valuable aspect of hospitalization.

A nurse prepares to lead an anger management group, which is what type of group? a. Psychoeducational b. Self-help c. Activity d. Support

a. Psychoeducational

A patient is withdrawn, suspicious, and maintains physical distance from staff and other patients. Which intervention demonstrates appropriate use of touch with this patient? a. Refraining from touch b. Patting the patient's arm when fear is expressed c. Reaching out to shake the patient's hand as an initial greeting d. Placing an arm around the patient's shoulders while walking down the hall

a. Refraining from touch

A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a patient's insurance form. Which resource should the nurse use to discern the criteria used to establish this diagnosis? a. The Diagnostic and Statistical Manual of Mental Disorders (DSM) b. Nursing Diagnosis Manual c. A psychiatric nursing textbook d. A behavioral health reference manual

a. The Diagnostic and Statistical Manual of Mental Disorders (DSM)

What is the best analysis of this described nurse-patient interaction? Patient: I get discouraged when I realize I've been struggling with my problems for over a year. Nurse: Yes you have, but many people take even longer to resolve their issues. You shouldn't be so hard on yourself. a. The nurse has responded ineffectively to the patient's concerns. b. The patient is expressing lack of willingness to collaborate with the nurse. c. The patient is offering the opportunity for the nurse to revise the plan of care. d. The nurse is using techniques that are consistent with the evaluation step of the nursing process.

a. The nurse has responded ineffectively to the patient's concerns

When a nurse working in a well-child clinic asks a parent's address, the parent responds, "My children and I are homeless." The nurse can assess this response as: a. a common occurrence, because 1 out of 50 children are homeless. b. a signal to investigate the possibility that the parent has severe mental illness. c. evidence of child abuse or neglect that should be reported to social service agencies. d. unusual because most homeless individuals have severe mental illness or substance abuse problems.

a. a common occurrence, because 1 out of 50 children are homeless.

A patient in a support group says, "I'm tired of being sick. Everyone always helps me, but I'll be glad when I can help someone else." This statement reflects: a. altruism. b. universality. c. cohesiveness. d. corrective recapitulation.

a. altruism.

A nurse leads a psychoeducational group for patients diagnosed with residual schizophrenia. A realistic outcome for group members is that they will: a. discuss ways to manage their illness. b. develop a high level of trust and cohesiveness. c. understand unconscious motivation for behavior. d. demonstrate insight about development of their illness.

a. discuss ways to manage their illness.

A priority focus of milieu management for a patient diagnosed with dissociative identity disorder (DID) should be: a. ensuring safety. b. stimulating memory return. c. insight-oriented group therapy. d. gathering data about family relationships.

a. ensuring safety.

Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) standards mandate that: a. orientation programs detail safety issues and precautions. b. patients' room doors remain open during hours of sleep. c. safety precautions are simple and apply commonsense behaviors. d. patients' personal belongings are kept in secure areas under staff control.

a. orientation programs detail safety issues and precautions. JCAHO standards require agencies to provide an orientation program that addresses safety

When explaining risk assessment, the nurse would indicate that the highest priority for admission to hospital-based care is: a. safety of self and others. b. confusion and disorientation. c. withdrawal from harmful substances. d. medical illness complicating a psychiatric disorder.

a. safety of self and others.

Freud's contribution to psychiatry that most affects current psychiatric nursing is: a. the challenge to look at humans objectively. b. recognition of the importance of human sexuality. c. theories about the importance of sleep and dreams. d. discoveries about the effectiveness of free association.

a. the challenge to look at humans objectively.

When a patient voices a delusion during a group session, the nurse can effectively handle the situation by (select all that apply): a. using empathy. b. presenting reality. c. exploring the delusional content. d. focusing on the underlying need expressed. e. asking the group what they think about the delusion.

a. using empathy. b. presenting reality. d. focusing on the underlying need expressed.

The nurse will instruct the patient prescribed an anticholinergic medication to minimize impaired absorption of the medication by avoiding:

antacid medications Rationale: Anticholinergic interactions include an intensification of sedative effects when combined with CNS depressants and a decrease in absorption when combined with antacids and antidiarrheal drugs. Neither exercise nor direct sunlight would affect the medication's absorption

The teaching plan for a patient beginning oxazepam (Serax) should include instructions to (select all that apply):

avoid discontinuing the drug abruptly. avoid herbal preparations.

When assessing a patient's social skills, which remark would serve the nurse best? a. "It sounds as if you need to develop some assertiveness skills." b. "Describe an example of a time when you felt uncomfortable in a social situation." c. "It is not easy to be assertive. We can role-play some situations to give you practice." d. "What do you plan to do the next time you find yourself in an uncomfortable social situation?"

b. "Describe an example of a time when you felt uncomfortable in a social situation."

Select the most important assessment question to ask a patient suspected of having a dissociative disorder. a. "Do any members of your family have problems with drugs or alcohol?" b. "Do you ever find yourself in places with no idea how you got there?" c. "How would you describe your current level of anxiety?" d. "How do you think we can be of help to you?"

b. "Do you ever find yourself in places with no idea how you got there?"

A patient's plan of care includes this nursing diagnosis: Impaired verbal communication related to lack of assertiveness skills. To include the patient in prioritizing this problem, the nurse should say: a. "Who are the people with whom you are most passive?" b. "How important is it for you to become more assertive?" c. "Let's look at how we can address this problem together." d. "Are you interested in attending the assertiveness class?"

b. "How important is it for you to become more assertive?"

A patient scheduled to attend various group sessions complains, "I'm really mad about having to attend all those groups. No one else spends all day in a circle in a little room." Select the nurse's best response. a. "Why are you upset?" b. "I can hear that you are upset. Let's talk about it." c. "Just go along with the plan, even if you do not agree." d. "The groups are carefully planned by staff to benefit patients."

b. "I can hear that you are upset. Let's talk about it."

A patient cries as the nurse explores the patient's feelings about the death of a close friend. The patient sobs, "I shouldn't be crying like this. It happened a long time ago." Which responses by the nurse facilitate communication? Select all that apply. a. "Why do you think you are so upset?" b. "I can see that you feel sad about this situation." c. "The loss of your friend is very painful for you." d. "Crying is a way of expressing the hurt you're experiencing." e. "Let's talk about something else, since this subject is upsetting you."

b. "I can see that you feel sad about this situation." c. "The loss of your friend is very painful for you." d. "Crying is a way of expressing the hurt you're experiencing."

A newly admitted patient asks the nurse, "Can you hear those people laughing at me? They are making fun of me." Select the nurse's best response. a. "You are mistaken. No one is laughing at you." b. "I know the sound of laughter is real to you, but I don't hear it." c. "Your mind is playing tricks on you, making you think you hear laughter." d. "When people are mentally ill, they often experience things that others cannot relate to."

b. "I know the sound of laughter is real to you, but I don't hear it."

Select the best description of therapeutic use of self to provide to a new psychiatric nurse. a. "Most nurses have caring personalities that equip them to be helpful to patients." b. "It's mostly about using good verbal and nonverbal communication, objectivity, genuineness, and empathy." c. "It means that you keep yourself at a distance so you are not affected by patients' problems and emotions." d. "The most important aspect of practice is when and how much to touch, as well as when to listen and give advice."

b. "It's mostly about using good verbal and nonverbal communication, objectivity, genuineness, and empathy."

A patient tells the nurse, "This medication makes me feel weird. I don't think I should take it anymore. Do you?" Select the nurse's best response. a. "I wonder why you think that." b. "Tell me how it makes you feel." c. "One must never stop taking medication." d. "You need to discuss this with your psychiatrist."

b. "Tell me how it makes you feel."

A leader begins the discussion at the first meeting of a new group. Which comments should be included? Select all that apply. a. "We use groups to provide treatment, because it's a more cost-effective use of staff in this time of budget constraints." b. "When someone shares a personal experience, it's important to keep the information confidential." c. "Talking to family members about our group discussions will help us achieve our goals." d. "Everyone is expected to share a personal experience at each group meeting." e. "It is important for everyone to arrive on time for our group."

b. "When someone shares a personal experience, it's important to keep the information confidential." e. "It is important for everyone to arrive on time for our group."

A patient with mental illness was initially treated in an outpatient setting and then hospitalized for a week when the disorder became acute. After discharge to a halfway house, this patient's care was managed by a community mental health nurse. Which inference applies to this community? a. Additional mental health services should be made available for the severely mentally ill. b. A seamless continuum of services is in place to serve persons with severe mental illness. c. Case management services should be expanded to care for acute as well as long-term system consumers. d. There are insufficient data to make a conclusion.

b. A seamless continuum of services is in place to serve persons with severe mental illness.

Which observation during morning rounds should receive a nurse's priority attention? a. Breakfast is late being served. b. A sink is leaking, leaving water on the bathroom floor. c. The daily schedule has not been posted on the unit bulletin board. d. A small group of patients is complaining that one patient turned down the TV volume.

b. A sink is leaking, leaving water on the bathroom floor.

Which intervention would be most appropriate for the nurse to use when conducting a maintenance group? a. Helping patients identify better coping strategies b. Accepting, empathizing, and showing concern c. Asking patients to identify topics for the group d. Confronting ingrained behaviors and defenses

b. Accepting, empathizing, and showing concern

Which patient would benefit most from a group that focuses on reality orientation? a. Adolescent with mixed drug and alcohol abuse b. Adult with undifferentiated schizophrenia c. Older adult with depression d. Young adult in crisis

b. Adult with undifferentiated schizophrenia

Which individual should the nurse assess as having the highest risk for homelessness? a. An older adult woman with mild dementia who resides in an assisted-living facility b. An adult with serious mental illness and no family c. An adolescent with an eating disorder d. A married person with alcoholism

b. An adult with serious mental illness and no family

A psychiatric nurse clinician on an inpatient unit plans to lead a special-problems group for withdrawn patients. Which information will be of most assistance as the nurse prepares for this assignment? a. Inpatient groups rarely have a lasting beneficial effect. b. Inpatient groups have short-term, goal-oriented sessions. c. Inpatient groups are helpful for patients with verbal skills. d. Inpatient groups facilitate insight into deeply rooted life issues.

b. Inpatient groups have short-term, goal-oriented sessions.

Which changes in psychiatric nursing practice are directly attributable to events occurring during the Decade of the Brain? Select all that apply. a. Homeless shelters became practice sites. b. Nurses upgraded knowledge of psychopharmacology. c. Nurses provided psychoeducation to patients and families. d. Nurses viewed psychiatric symptoms as resulting from brain irregularities. e. Nurses were more likely to advocate for patients' rights related to involuntary commitment.

b. Nurses upgraded knowledge of psychopharmacology. c. Nurses provided psychoeducation to patients and families. d. Nurses viewed psychiatric symptoms as resulting from brain irregularities.

A nurse is assigned to care for a patient diagnosed with moderate (+2) anxiety. Which assessment findings are most likely? a. Distorted perceptions, disorientation, and defensiveness. b. Poor concentration, narrow perceptions, and irritability. c. Irrational reasoning and loss of contact with reality. d. Alertness, attentiveness, and accurate perceptions.

b. Poor concentration, narrow perceptions, and irritability.

Which intervention should the nurse use first when caring for a patient experiencing anxiety? a. Assist the patient to problem solve. b. Provide support and understanding. c. Reorient the patient. d. Provide privacy.

b. Provide support and understanding.

A former pediatric nurse begins working in a clinic housed in a homeless shelter. The nurse asks the clinic director, "What topic should I review to improve my effectiveness as I begin my new job?" Which topic should the clinic director suggest? a. Care of school-age children b. Psychiatric and substance abuse assessment c. Communicable disease prevention strategies d. Sexually transmitted disease signs and symptoms

b. Psychiatric and substance abuse assessment

A patient with long-standing bipolar disorder comes to the mental health center. The patient says, "I lost my job and home. Now, I eat in soup kitchens and sleep at a shelter. I am so depressed that I thought about jumping from a railroad bridge into a river." Which factor has priority for the nurse who determines the appropriate level of care? a. Long-standing bipolar disorder b. Risk for suicide c. Homelessness d. Lack of income

b. Risk for suicide

A nurse wants to provide opportunities for a patient to try out new, more assertive behaviors. Which technique should the nurse use? a. Clarifying b. Role-playing c. Giving feedback d. Encouraging evaluation

b. Role-playing

A nurse considers environmental aspects of milieu management while planning care for a newly admitted patient. Which element has the highest priority? a. Norms b. Safety c. Balance d. Structure

b. Safety

While nurses are engaged in shift change report, one patient becomes loud and aggressive. This patient verbally harasses and frightens another patient. Which element of the therapeutic environment has been jeopardized? a. Norms b. Safety c. Balance d. Structure

b. Safety Psychologic safety is violated when one patient is allowed to harass another. Staff must set limits to protect the vulnerable patient. Norms, balance, and structure refer to other elements of the environment.

The effects of stress can be seen by measurement of clinical changes of the body. This statement is a tenet of which theorist? a. Freud b. Selye c. Peplau d. Sullivan

b. Selye

A patient says, "I wish I could express my depressed feelings rather than keeping them inside." The nurse should schedule the patient to attend which type of group? a. Social skills b. Special problems c. Reality orientation d. Relapse prevention

b. Special problems

The nurse is assigned to care for a patient with moderate anxiety (+2). The most effective nursing intervention will be: a. use of time-out. b. initiation of problem solving. c. providing firm guidance and control. d. administering a parenteral antianxiety drug.

b. initiation of problem solving.

The broadened scope of psychiatric nursing practice is attributable primarily to: a. increased use of psychotropic drugs. b. opening of community mental health centers. c. legislation that changed nurse practice acts across the country. d. recidivism of seriously mentally ill patients in public mental hospitals.

b. opening of community mental health centers.

A patient in a detoxification unit asks, "What good will it do to go to Alcoholics Anonymous and talk to other people with the same problem?" The nurse's best response would be to explain that self-help groups such as AA provide opportunities for: a. newly discharged alcoholics to learn about the disease of alcoholism. b. people with common problems to share their experiences with alcoholism and recovery. c. patients with alcoholism to receive insight-oriented treatment about the etiology of their disease. d. professional counselors to provide guidance to individuals recovering from alcoholism.

b. people with common problems to share their experiences with alcoholism and recovery.

A patient diagnosed with obsessive-compulsive disorder (OCD) experiences improvement after beginning treatment with a selective serotonin reuptake inhibitor (SSRI). This phenomenon supports the theory that OCD is associated with: a. norepinephrine deficiency. b. serotonin dysregulation. c. dopamine excess. d. GABA deficiency.

b. serotonin dysregulation.

A Hispanic parent says, "An old woman gave my baby the evil eye." The health care provider determines that the infant is physically healthy. The most culturally competent intervention would be to:

bring a root doctor into the consultation to restore the baby's lost soul.

As members disperse at the conclusion of a productive group meeting, one member says, "Let's have a big group hug." Select the leader's most appropriate response. a. "Hugging is not permitted." b. "I am glad you found the meeting so helpful." c. "Thanks for that suggestion, but not everyone may be comfortable with hugs." d. "The group is over now. Members may not have continued contact with each other."

c. "Thanks for that suggestion, but not everyone may be comfortable with hugs."

A patient has difficulty expressing anger appropriately. The nurse encourages the patient to set realistic goals by stating: a. "You seem to have problems expressing anger in a nonaggressive way." b. "I thought you sounded angry when I told you it was time for group." c. "What do you think needs to change about how you express anger?" d. "What bothers you about your actions when you get angry?"

c. "What do you think needs to change about how you express anger?"

What is the primary purpose of referring a patient to an activity group? a. Assess the patient's social skills. b. Provide cognitive and sensory stimulation. c. Encourage socialization and communication. d. Educate the patient about use of leisure time.

c. Encourage socialization and communication.

The nurse asks members of a group for recovering alcoholics how they handle the urge to drink. Which communication technique is the nurse using? a. Summarizing b. Presenting reality c. Encouraging comparison d. Seeking consensual validation

c. Encouraging comparison

Which principle best applies to care of a patient diagnosed with conversion disorder? a. Structure care to provide time for rituals. b. Facilitate progressive review of the trauma. c. Give attention to the patient, not the symptom. d. Permit dependence while the symptoms are acute.

c. Give attention to the patient, not the symptom.

Which type of group is a staff nurse with 2 months' psychiatric experience best qualified to conduct? a. Social skills group b. Family therapy group c. Medication education group d. Insight-oriented psychotherapy group

c. Medication education group

What concerns were shared by society during both the Period of Enlightenment and the Period of Community Mental Health? a. Moving patients out of asylums b. Studying brain structure and function c. Meeting basic human needs humanely d. Providing medication to control symptoms

c. Meeting basic human needs humanely

A patient admitted to an inpatient unit after a suicide attempt says, "I feel so overwhelmed. There are so many issues I have to deal with." The nurse should schedule the patient to attend which type of group? a. Social skills b. Psychodrama c. Problem-solving d. Medication information

c. Problem-solving

The greatest impact in the care of the mentally ill over the past 50 years has resulted from progress and improvement in which area? a. Self-help groups b. Outpatient therapy c. Psychotropic drugs d. Patients' rights awareness

c. Psychotropic drugs

An anxious, withdrawn patient is experiencing auditory hallucinations. This patient could benefit most at this time from participation in: a. a recreation group. b. an insight-oriented group. c. a reality orientation group. d. a stress management group.

c. a reality orientation group.

The primary element required to match individual patient needs with appropriate services is proper: a. planning. b. evaluation. c. assessment. d. implementation.

c. assessment.

A key factor motivating passage of the Community Mental Health Centers Act in 1963 was that mentally ill individuals had been: a. hospitalized only if they demonstrated violent behavior. b. geographically isolated from family and community. c. discharged before receiving adequate treatment. d. used as subjects in pharmacologic research.

c. discharged before receiving adequate treatment.

An adult with serious mental illness is being admitted to a community behavioral health inpatient unit. Recognizing current trends in hospitalization, this patient is likely to: a. comply readily with the prescribed treatment. b. have a clear understanding of the illness. c. display aggressive behavior. d. stabilize within 24 hours.

c. display aggressive behavior.

When working with a patient diagnosed with dissociative amnesia, the nurse should begin by: a. setting mutual goals for behavioral changes. b. instituting measures to prevent identity diffusion. c. identifying and supporting the patient's strengths. d. helping the patient develop a realistic self-concept.

c. identifying and supporting the patient's strengths.

A person says, "Now that many state hospitals are closed, patients with psychiatric problems are free in our community. It is not safe for me." The nurse's reply should be based on knowledge that: a. depressed patients are nonviolent. b. state hospitals are no longer needed. c. major depression is very prevalent. d. bizarre behavior is viewed as sensational.

c. major depression is very prevalent.

An anxious patient has distorted perceptions and ineffective reasoning. On an anxiety rating scale, the nurse would expect to record the patient's level of anxiety as: a. mild, +1. b. moderate, +2. c. severe, +3. d. panic, +4.

c. severe, +3.

A Hispanic patient reports symptoms consistent with the cultural phenomena of susto. A physical examination reveals no pathology, and depression is diagnosed. The effectiveness of selective serotonin reuptake inhibitors (SSRIs) may be increased if combined with:

care from a traditional healer.

Most drugs used to treat AD affect:

cholinergic pathways, enzymes, and receptors.

A patient states, "I have the same thoughts over and over. I feel compelled to count all my footsteps." The nurse can expect the health care provider to prescribe:

clomipramine (Anafranil).

Which patient has the greatest risk for overdose with a benzodiazepine? A patient who:

combines the drug with alcohol.

The nurse will teach the patient beginning Cogentin (benztropine) to watch for:

constipation, urinary retention, and nasal congestion. Rationale: Potential effects of benztropine include constipation, urinary retention, and nasal congestion; these will require discussion with patient. None of the remaining options are side effects of the medication

A positive outcome from attending a special-problems group is evidenced by which statement by a patient? a. "You're a great group leader and kept things moving smoothly." b. "This experience wasn't as bad as I thought it would be." c. "I rely on the group to help me make decisions." d. "I learned how my anger affects other people."

d. "I learned how my anger affects other people."

Which statement by an individual with PTSD best indicates that treatment was effective? a. "I'm drinking less now that I've faced my problems." b. "I feel like the accident happened to someone else." c. "I sleep for 3 to 4 hours a night without nightmares." d. "My artwork distracts me and eases my anxiety."

d. "My artwork distracts me and eases my anxiety."

After attending a group, which statement by a patient shows evidence of benefits associated with universality? a. "I've learned to identify my anxious feelings." b. "The group really gave me the support to change." c. "I've learned that I can be helpful to others." d. "My problems are not unique. I'm not alone."

d. "My problems are not unique. I'm not alone."

These comments are made by patients in a support group. Which comment best contributes to group cohesiveness and effectiveness? a. "Talking about my problems helps me think of ways to solve them. Let me explain them to everyone." b. "We aren't making progress because our group leader has as many problems as we do." c. "No one in this group wants to hear anything else about your financial problems." d. "We started out talking about guilt, but we wandered off from that subject."

d. "We started out talking about guilt, but we wandered off from that subject."

A patient with bipolar disorder has stabilized and is being discharged from the hospital. The patient will live independently at home but lacks social skills and transportation. Which referral would be most appropriate? a. A group home b. A self-help group c. A day treatment program d. Assertive community treatment (ACT)

d. Assertive community treatment (ACT)

Which term describes the final stage in the normal process of anxiety? a. Panic b. Crisis c. Disorganization d. Coping

d. Coping

After a patient's first group session, the nurse asks, "How was the experience of participating in group for you?" Which communication technique is the nurse using? a. Summarizing b. Seeking clarification c. Making observations d. Encouraging evaluation

d. Encouraging evaluation

A patient with panic attacks awakens from sleep complaining of chest pain. The patient is diaphoretic and breathlessly says, "I feel like I'm going to die." Select the nurse's priority action. a. Have the patient lie flat and relax. b. Bring the crash cart to the patient's room. c. Shake the patient and shout, "Are you okay?" d. Instruct the patient to breathe into a paper bag.

d. Instruct the patient to breathe into a paper bag.

During a support group meeting focusing on strategies to manage symptoms, a patient asks the nurse leader how to deal with angry outbursts from a supervisor. Select the nurse's best action. a. Answer the question, and then move on to another topic. b. Offer to answer the question privately after the group session. c. Inform the patient that only illness-related problems can be discussed in the group. d. Matter-of-factly explain that the topic being discussed is the importance of medication.

d. Matter-of-factly explain that the topic being discussed is the importance of medication.

A patient says, "I have the same continuous and intrusive thoughts that my house is contaminated with lethal bacteria. I spend hours cleaning the walls, floors, and furniture." These symptoms are most consistent with which diagnosis? a. Social phobia b. Panic disorder c. Somatoform disorder d. OCD

d. OCD

Select the most accurate characterization of treatment of the mentally ill prior to the Period of Enlightenment. a. Large asylums provided custodial care. b. Care for the mentally ill was more compassionate. c. Care focused on reducing stress and meeting basic human needs. d. Patients were banished from communities or displayed for public amusement.

d. Patients were banished from communities or displayed for public amusement.

A patient diagnosed with OCD paces up and down the corridor counting every tile. Select the nurse's best action. a. Offer to play cards with the patient in the dayroom. b. Ask the patient, "Why are you pacing and counting?" c. Take the patient's arm and escort the patient to a quiet area. d. Permit the patient to pace and count until feeling more comfortable.

d. Permit the patient to pace and count until feeling more comfortable.

While a member of a group shares painful feelings of guilt, another member begins humming and tapping the side of the chair. Select the leader's best initial action with the disruptive patient. a. Recognize that the behavior is an expression of anxiety, and do not interrupt it. b. Say, "Please stop humming and tapping. It is disruptive to our group." c. Say, "Please leave the group now. Your behavior is inappropriate." d. Say, "You seem uncomfortable with our discussion."

d. Say, "You seem uncomfortable with our discussion."

A patient's family member died in the 9/11 World Trade Center explosion. The patient says, "I can't go into tall buildings because I get sweaty, my heart races, and I can't breathe. I get terrifying feelings the building will explode." These symptoms suggest which diagnosis? a. OCD b. Generalized anxiety disorder c. Acute stress disorder d. Specific phobia

d. Specific phobia

Which symptom would the nurse expect in a patient diagnosed with dissociative fugue? a. Worry about having a serious disease b. A feeling of detachment from one's body c. Belief that part of the body is ugly or disproportionate d. Travel away from home and assumption of a new identity

d. Travel away from home and assumption of a new identity

A talkative member of a support group for patients diagnosed with bipolar disorder has monopolized the group discussion for 15 minutes. The nurse leading the group would best intervene by: a. maintaining silence. It is important for group members to give feedback to each other. b. encouraging the patient to continue. Patients learn from each other in group sessions. c. saying, "You must allow some of the other members of the group to talk. You cannot monopolize the conversation." d. addressing the patient by name and saying, "I'm glad you shared your thoughts with us. Let's hear what others think."

d. addressing the patient by name and saying, "I'm glad you shared your thoughts with us. Let's hear what others think."

A patient is demonstrating severe (+3) anxiety. Nursing interventions will center around: a. encouraging ventilation and refocusing attention. b. discussing possible sources of anxiety. c. taking control to guide the patient. d. decreasing stimuli and pressure.

d. decreasing stimuli and pressure.

During an interview with a depressed patient, the nurse sits with folded arms and fidgets when long silences occur. When the patient expresses hopelessness about getting better, the nurse replies, "You will feel better when your medication takes effect." This interaction: a. shows therapeutic use of limit-setting. b. is minimally therapeutic but effective. c. evidences therapeutic use of self. d. is nontherapeutic and ineffective.

d. is nontherapeutic and ineffective.

An adult with schizophrenia is discharged from a state mental hospital after 20 years of institutionalization. When planning care in the community, which premise applies? This patient is likely to: a. independently find support services to aid transition from hospitalization to community. b. adjust smoothly to the community if provided with sufficient support services. c. self-administer antipsychotic medications correctly if provided with education. d. need crisis or emergency psychiatric interventions from time to time.

d. need crisis or emergency psychiatric interventions from time to time.

A community mental health nurse works in a mental health services system that is undergoing change to become a seamless system. To promote integrity of the new system, the nurse should focus on (select all that apply) a. psychopathology. b. symptom stabilization. c. medication management. d. patient and family psychoeducation. e. patient reintegration into the community. f. holistic issues relating to patient care.

d. patient and family psychoeducation. e. patient reintegration into the community. f. holistic issues relating to patient care.

A driver was trapped in a car for several hours after an earthquake caused a bridge to collapse. A year later this person still has nightmares and reexperiences feelings of fear associated with being trapped in the car. The assessment findings are consistent with symptoms of: a. agoraphobia. b. panic attacks. c. generalized anxiety disorder. d. posttraumatic stress disorder (PTSD).

d. posttraumatic stress disorder (PTSD).

A shift in the psychiatric nursing focus during the community mental health period of the 1960s resulted in: a. disillusionment with the high numbers of people seeking treatment. b. focusing more attention on complications associated with substance abuse. c. spending more time providing services to persons with serious mental illness. d. shifting focus away from the most acutely ill and to persons with a perceived greater potential for improvement.

d. shifting focus away from the most acutely ill and to persons with a perceived greater potential for improvement.

A parent said, "My child had mal ojo, so I did not give her the medicine for an ear infection." The nursing diagnosis of noncompliance was documented by the nurse who saw the child last. A culturally competent nurse would analyze that the situation occurred because of:

differences in perceptions of how illness occurs.

Prior to initiating a tricyclic antidepressant (TCA), the nurse will evaluate the patient's:

electrocardiogram Rationale: Anticholinergic effects on the cardiovascular system caused by tricyclic medication are common enough to warrant serious consideration. Tachycardias and arrhythmias can lead to myocardial infarction. The medication does not cause effects that would warrant an EEG, lipids, or CBC.

A clinic patient comes to an appointment carrying a baby. The nurse notes abrasions on the baby's thighs and determines that skin scraping has been used. In an effort to use cultural negotiation, the nurse should:

encourage using less pressure during scraping to prevent abrasions and infections.

A clinic nurse encounters many patients who request acupuncture, nutritional therapies, moxibustion, cupping, and coining. The nurse understands that these patients are seeking to restore:

equilibrium.

A nurse begins work at an agency that provides care to members of a minority ethnic population. The nurse will be better able to demonstrate cultural competence after:

exploring commonly held beliefs and values of the population.

The negative symptoms of schizophrenia include

flat affect, anhedonia, and anergia Negative symptoms reflect a decrease or loss of normal functions.

A 70-year-old man comes to the clinic for his annual physical exam and influenza vaccine. He shares that his "life has no meaning," he "feels tired all the time," and "has lost all hope for the future." The initial nursing intervention is to:

further assess his concerns and history of psychiatric issues. Rationale: Initially it is wise to gather more assessment data and determine if this has been of concern in his life previously, and assess for depression and the potential for suicide. This individual is in a high-risk group statistically for self-harm. The nurse should commence the mental status examination and key themes and/or issues for the patient. Assessment should come first, followed by determining the next step of care needed. The patient's verbal cues indicate distress and suggest hopelessness beyond that of aging; his statements demand further assessment

Later life depression and resulting suicide deaths among the older adult population are believed to be most related to:

increased exposure to grief-induced losses. Rationale: Later-life depression (i.e., first depressive episode occurring in later life) may be related to grief issues confronted by older adults: loss of spouse, family members, children, jobs, housing, income, mobility, and health. While the remaining options may contribute to this risk, they are not thought to be the most influential factor.

A patient diagnosed with AD is being treated with a ChE inhibitor drug. The patient develops facial flushing, sweating, and leg cramps. The nurse should attribute these symptoms to:

inhibition of butyrylcholinesterase(BChE).

Which statement by a family member of a patient diagnosed with AD demonstrates that medication education was effective? "The medication my parent is receiving:

inhibits breakdown of an important neurotransmitter and may slow disease progression."

A patient diagnosed with agoraphobia took alprazolam (Xanax) 0.5 mg three times daily for 3 months and then discontinued it. The next day the patient called the nurse reporting insomnia, shakiness, and sweating. The nurse's assessment questions should focus on whether the patient:

is having withdrawal symptoms from abrupt discontinuation of the drug.

A Hispanic patient says, "I have no energy and cannot eat. I want to sleep but can't, because pain moves around different parts of my body." A physical examination reveals no pathology. The nurse should hypothesize that the patient may be experiencing:

lost soul (susto).

Select the most realistic short-term goal for the care of a patient with mild AD who takes donepezil (Aricept). The patient will:

maintain present cognitive ability.

A depressed patient who originally responded to a failure by stating, "I can't do anything right" is overheard telling a staff member, "I've learned that everyone makes mistakes." This is an example of:

negative thought reprogramming Rationale: To learn to rethink the way we view negative situations is referred to as reprogramming negative thoughts. While this is a positive statement, it is not necessarily associated with the patient's perception of his/her worth or value. There is no indication of how the patient intends to solve the current problem

Lorazepam (Ativan) reduces anxiety by:

potentiating gamma-aminobutyric acid (GABA).

A patient has been expressing beliefs that are not in touch with reality. The nurse's decision not to argue with the patient concerning these delusions is based on the understanding that to argue would:

reinforce the delusion Rationale: Hallucinations, delusions, or irrational beliefs must never be reinforced. The nurse cannot agree with the delusions, and arguing seems to reinforce them. The effect of arguing will probably have no effect on the patient's sense of reality and self-worth. The chance of triggering psychotic behavior is low.

The teaching plan for a patient beginning buspirone (BuSpar) should include information identifying this drug as a:

serotonin agonist.

A patient diagnosed with social phobia begins propranolol (Inderal). The nurse should teach the patient to expect:

that sympathetic nervous system symptoms of anxiety will be reduced.

A psychiatric nurse leads a medication education group for Hispanic outpatients. This nurse holds an analytic worldview and uses pamphlets as teaching tools. Group sessions are short and concise. After the group session, the patients are most likely to believe that:

the nurse was uncaring.

A patient started diazepam (Valium) 5 mg twice daily 6 months ago. Now, the patient requires 10 mg to achieve the same effect. This phenomenon results from:

tolerance.

At the time of discharge, a patient with a European-American worldview demands copies of all medical records. Which analysis most accurately explains the patient's behavior? The patient:

values the written evidence of illness and treatment.

Culture is defined as a group's shared:

values, beliefs, and norms.

A nurse prepares to assess a newly hospitalized patient who moved to the United States 6 months ago from Somalia. The nurse should first determine:

whether or not an interpreter is needed.

A patient took a benzodiazepine for 4 weeks but will now change to buspirone (BuSpar) for long-term treatment of anxiety. The benzodiazepine is tapered off as the buspirone is begun. Important information the patient should receive about buspirone is that it:

will be effective in 7 to 10 days.

The nurse would expect to administer flumazenil (Romazicon) for a patient:

with a benzodiazepine overdose.

The challenge to the nurse inherent in establishing and maintaining a working relationship with a severely depressed patient is the patient's:

withdrawal from and disinterest in the relationship. Rationale: Withdrawal and disinterest are hallmarks of the psychopathology of depression and the difficulties in establishing the therapeutic relationship. A depressed patient is not always receptive to relationships with others. Gratitude may not be realistic given the signs and symptoms of this disease process. Depression may linger, and marked signs of improvement demand time and therapeutic work to appear.

Which assessment question will the nurse ask to help identify the cause of a patient's decreased lithium levels?

"How much coffee do you drink daily?" Rationale: Some drugs and other agents decrease serum lithium levels and pose the problem of inadequate treatment and symptom exacerbation. Those that increase lithium excretion decrease lithium levels. Caffeine and alcohol are included in this group. Diuretics (except acetazolamide [Diamox]) decrease lithium excretion and thereby elevate serum lithium levels. Indomethacin and other nonsteroidal antiinflammatory drugs reduce renal elimination of lithium by preventing the natural antagonism of antidiuretic hormone by prostaglandin, thereby increasing serum lithium levels. Switching to a low-salt diet after commencement of treatment also elevates serum lithium levels.

An individual calls the hospital during the night shift in crisis and is considering suicide. The nurse will begin the interaction by saying:

"Let's see what we can work on together." Rationale: Providing the patient with support will help develop trust and understanding, which are necessary components of a nurse-patient relationship. Asking how the patient is feeling and how long they have been in distress are not responsive to the current crisis. Ascertaining who is with the patient is important but does not have priority over developing the initial rapport and therapeutic relationship.

Medication teaching regarding lithium is regarded as successful when the nurse hears the patient state:

"My body treats lithium just like salt." Rationale: An important concept to understand, given the inverse relationship of sodium to lithium, is that lithium is a salt. Potassium is not dangerous when included in the diet. Multivitamins are not necessarily important when considering lithium. Serum lithium levels, assessments, and follow-up with the prescriber may be indicated before 3 months.

A soldier returned home last year after deployment to a war zone. The soldier's spouse reports, "We had planned to start a family right away, but now he won't talk about it. He won't even look at children. I wonder if we're going to make it as a couple." Select the nurse's best response.

"PTSD often strains relationships. Here are some community resources for help."

An adult says, "I take provastatin (Pravachol) for my high cholesterol. It will prevent stroke and heart attack." Select the nurse's most informative response.

"Some research indicates that statin drugs may also interfere with development of AD."

A patient who has been taking a benzodiazepine for panic attacks is to be started on buspirone (BuSpar). Which instruction should the nurse provide?

"Take decreasing doses of the benzodiazepine for several days until the buspirone becomes effective."

Important teaching for a patient who is beginning treatment with antipsychotic medication includes:

"Take your temperature, and call if you have a fever." Rationale: Fever may signal NMS. Monitoring and reporting elevated body temperature are important, since this condition can be fatal. Driving and operating other heavy machinery should be discouraged until the new medication's effects are determined. One should avoid vague statements and outline what specifically feeling "strange" means in terms of reporting. All medications generally exert some side effects. This statement is an example of false reassurance, which is inaccurate psychoeducation

A 63-year-old woman says, "I want to take estrogen to prevent AD, but my doctor won't prescribe it." Select the nurse's most informative response.

"There is conflicting evidence about whether estrogen prevents Alzheimer's disease, but research clearly shows cardiovascular problems with estrogen therapy."

An adult says, "I take vitamins B and E to prevent AD, but these vitamins are so expensive." Select the nurse's most informative response.

"There is conflicting research evidence about effectiveness of these vitamins for prevention of AD."

A patient asks why he has been prescribed a selective serotonin reuptake inhibitor (SSRI) rather than one of the other classifications of antidepressants. The nurse addresses the patient's question best when responding:

"This classification is usually effective and generally causes fewer side effects." Rationale: SSRIs are effective antidepressants that have fewer side effects than TCAs and are far less dangerous than MAOIs. SSRIs have fewer anticholinergic, cardiovascular, and sedating side effects. It is not necessarily true that SSRIs are less expensive than other classifications of antidepressants. Responding that the health care provider has made the decision does not directly address the patient's questions. While information gathering is appropriate, asking the patient about the eexistence of doubt does not initially address the patient's question

A veteran with a suspected TBI is scheduled for diffusion tensor imaging (DTI). What information should the nurse provide?

"This test will help show whether tracts in your central nervous system are damaged."

A patient's inability to deescalate his aggressive behavior has resulted in the response team coming to the unit. When the patient demands to know, "Why are all these people here?", the nurse responds most therapeutically when stating:

"We are here to keep you safe and stop you from hurting anyone else." Rationale: The team approaches the patient calmly, in a "show of concern." The patient is told that the team is here to help, will not hurt the patient, and will not allow the patient to hurt anyone else. While it is true that the patient may be out of control and may hurt someone, it is important to stress that the patient's safety is also of importance. Placing the patient in seclusion may become necessary, but the presence of the team may have a calming effect on the patient.

What is the nurse's best response when asked by a patient who will begin lithium therapy, "When can I expect to see improvement in my symptoms?"

"We generally see symptom improvement in 7 to 10 days after beginning treatment." Rationale: Lithium has a narrow therapeutic index and a lag time of 7 to 10 days between the beginning of treatment and symptom improvement. While it is true that response to lithium is individualized, this answer doesn't address the patient's question. Discussing the patient's anxiety issue is appropriate, but doing so doesn't address the question either. It is not appropriate to dismiss the patient's question with the suggestion to be patient.

Which questions should the nurse ask to determine an individual's worldview? Select all that apply.

"What is more important: the needs of an individual or the needs of a community?" "How would you describe an ideal relationship between individuals?" "Do you speak any foreign languages?"

When a patient is demonstrating symptoms of neuroleptic malignant syndrome (NMS), which medication will the nurse be prepared to administer?

A muscle relaxant like dantrolene (Dantrium) Rationale: NMS can be treated with muscle relaxants (e.g., dantrolene) and with centrally acting dopaminergics (e.g., bromocriptine [Parlodel]). Parkinson's disease is treated with antiparkinsonian agents that increase dopamine (or dopaminergic) levels, such as levodopa-carbidopa and levodopa, or with anticholinergic agents (e.g., benztropine). Diphenhydramine, the prototype antihistamine, is effective for most parkinsonian-like disorders

16. Which adjective best describes a therapeutic psychiatric nurse? a. Holistic b. Organized c. Diplomatic d. Compassionate

ANS: A Holism is crucial to knowledgeable, safe, and effective practice as a psychiatric nurse. The distracters are incomplete. Compassion is an aspect of holism.

Which patient requires the most immediate intervention by the nurse?

A young woman with a wry neck and face rotated upward Rationale: The female demonstrating a wry neck and face rotation is probably experiencing acute dystonia and the possibility of laryngeal-pharyngeal constriction, which is a threat to maintenance of a patent airway and thus is life-threatening. Fine hand tremors and hand cramping are not life-threatening but do require further assessment. The tendency to lean may indicate Pisa syndrome, which also requires further assessment.

12. Which assessment finding should be documented as objective information? a. Rated anxiety 8 on a scale of 10 b. Reported depressed mood c. Reports of headache d. Wore layered clothing

ANS: D Objective data are measurable data obtained or observed by the nurse. Layered clothing is an example of objective data. Subjective data are what the patient relates to the nurse.

A Chinese-American infant is seen in a well-baby clinic. The parent reports that the baby is irritable and not eating well. The nurse notices several skin abrasions on the thighs and upper arms. What is the nurse's most appropriate initial intervention?

Ask if the parent has used coining.

When an individual is found to have a serum blood alcohol level of 0.17%, which identifying symptom specific to that level of alcohol intoxication would be observed? (Select all that apply.) A. Double vision B. Slurred speech C. Staggering D. Tremors E. Euphoria

B. Slurred speech C. Staggering D. Tremors

A nurse counsels an 87-year-old veteran of World War II who tearfully shares memories of sights associated with Nazi concentration camps. Which term will be most familiar to this veteran?

Battle fatigue

A patient has taken clonazepam (Klonopin) for years to manage panic attacks but impulsively stopped the drug. Thirty hours later, the patient comes to the emergency room in distress. What is the nurse's priority action?

Begin seizure precautions.

Does it make sense that a bright light could improve a person's mental health? Does a sunny day help your mood?

Bright light may be associated with many positive emotions during the course of a person's life. Due to this classical conditioning, many individuals may benefit from the use of bright light treatment.

Put these services in order from least to most intensive. a. Day treatment b. Hospitalization c. Scheduled visits at a community mental health center

C, A, B

Which statement made by a patient who has been severely depressed for the past year (with minimal relief using therapy and medications) requires an immediate response from the nurse? A. "I have hope that I will feel better someday." B. "My family is supportive and patient with me." C. "Alcohol helps me feel like I am a real person again." D. "The new medication I just started is promising for me."

C. "Alcohol helps me feel like I am a real person again."

Which question is most important for the nurse to ask when assessing a bulmic patient who admits to using syrup of ipecac to cause post-binge vomiting? A. "When did you last have a bowel movement?" Incorrect B. "Are your feet and legs swollen?" C. "Do you ever have chest pain when you are exercising?" D. "Have you ever been told you have poor dental enamel?"

C. "Do you ever have chest pain when you are exercising?" Use of ipecac syrup to induce vomiting is dangerous and can cause fatal cardiomyopathy that can cause chest pain when the heart is stressed.

A tearful adolescent confides in the school nurse that he is concerned about how anxious he feels and that he "may be depressed." The nurse's next priority is to ask: A. "How long have you felt this way?" B. "What do you mean by 'anxious'?" C. "Have you felt as though you could harm yourself?" D. "Have you told anyone else?"

C. "Have you felt as though you could harm yourself?"

An older adult is reporting fatigue and periods when breathing is difficult. All examinations, lab, and diagnostic values are in acceptable ranges. The nurse will best initiate a discussion regarding the patient's emotional health by asking which assessment question? A. "What do you think is wrong with you?" B. "Are you depressed?" C. "How have you been feeling emotionally? D. "Do you see yourself as being an anxious person?"

C. "How have you been feeling emotionally?

Which statement is characteristically consistent with those individuals who engage in the vomiting-purging form of anorexia nervosa? A. "I avoid situations where I would be expected to eat." B. "I exercise at the gym at least 6 days a week." C. "I was overweight before the eating disorder began." D. "Everyone who knows me knows I'm very competitive."

C. "I was overweight before the eating disorder began." Compared with restricters, vomiters-purgers are more often overweight before the eating disorder begins, and their weight tends to fluctuate.

n event crowded with people presents the greatest risk for the demonstration of which sexually focused disorder? A. Exhibitionism B. Fetishism C. Frotteurism D.Masochism

C. Frotteurism

Which behavior in a 10-year-old child best supports the diagnosis of bipolar disorder (BPD)? A. Telling classmates that "I'm this school's best basketball player, ever" B. Consistently invading classmates' personal space when interacting with them C. Having to take turns during a class activity triggering an immediate temper tantrum D Being overheard sharing with several classmates that, "I know everything about having sex"

C. Having to take turns during a class activity triggering an immediate temper tantrum

2. A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be taught by the nurse? A. The side effects of medications B. Deep breathing techniques to decrease stress C. How to make eye contact when communicating D. How to be a leader

C. How to make eye contact when communicating The nurse should plan to teach the client how to make eye contact when communicating. Social skills, such as making eye contact, can assist clients in communicating needs and maintaining

The multidisciplinary team discusses the potential side effects of what medication prescribed to treat a patient's negative symptoms of schizophrenia? A. Fluphenazine B. Haloperidol C. Quetiapine D. Chlorpromazine

C. Quetiapine

14. A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? A. Haloperidol (Haldol) to address the negative symptom B. Clonazepam (Klonopin) to address the positive symptom C. Risperidone (Risperdal) to address the positive symptom D. Clozapine (Clozaril) to address the negative symptom

C. Risperidone (Risperdal) to address the positive symptom The nurse should expect the physician to order risperidone (Risperdal) to address the positive symptoms of schizophrenia. Risperidone (Risperdal) is an atypical antipsychotic used to reduce positive symptoms, including disturbances in content of thought (delusions), form of thought (neologisms), or sensory perception (hallucinations).

19. A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse immediately report to the clients attending psychiatrist? A. Respirations of 22 beats/minute B. Weight gain of 8 pounds in 2 months C. Temperature of 104F (40C) D. Excessive salivation

C. Temperature of 104F (40C) When assessing a client diagnosed with schizophrenia who takes an antipsychotic agent daily, the nurse should immediately address a temperature of 104F (40C). A temperature this high can be a symptom of the rare but life-threatening neuroleptic malignant syndrome.

The priority nursing intervention when working with a patient who has entered the escalation phase of the assault cycle is to:

Call the patient by name while letting him/her know that the staff is there to help. Rationale: The escalation phase is characterized by an escalation of inappropriate and/or irrational behaviors such as swearing, screaming, and threatening. Deescalation techniques in this phase include allowing the patient whatever time is necessary to reduce his or her anxiety, fear, or anger. Telling aggressive patients that nurses are there to "support" them helps to reframe the situation from a confrontational to a collaborative encounter. The need to notify staff or medicate hasn't yet been determined as necessary. A patient experiencing this stage of aggression isn't capable of analyzing the situation.

The nurse will include patient education on the development of which condition as a result of anticholinergic medication therapy presecribed for an older patient?

Cognitive impairment Rationale: Older individuals are particularly sensitive to anticholinergic agents. Cognitive, cardiovascular, and gastrointestinal side effects are more pronounced in this age group compared with the younger population. Older men with prostatic enlargement can exacerbate these difficulties with the use of these agents. Further, cognitive impairment is also associated with anticholinergic drugs. Asthma, skin rashes, and muscle atrophy are not associated with anticholinergic medication therapy.

Which personal statement suggests a possible narcissistic personality disorder? A. "I never seem to do anything right." B. "I'll hurt anyone who touches my stuff." C. "I can't trust anyone who works for the government." D. "No one can do the job better than me."

D. "No one can do the job better than me." A key component of narcissistic personality disorder is grandiosity not low self-esteem. The patient with narcissistic personality disorder displays grandiosity about his or her importance and achievements. Poor impulse control may exist, but paranoia is not a characteristic trait.

A new RN demonstrates an understanding of clozapine when making what statement? A. "I need to carefully assess each patient for Tardive Dyskinesia, since it is a major risk factor with clozapine." B. "The team decided to offer clozapine to the patient who was newly admitted and diagnosed with schizophrenia. I will discuss it with his family today." C. "I gave the first dose of clozapine this morning. He is experiencing no abnormal motor movements so far." D. "The patient's WBC and ANC meet the criteria to start clozapine.

D. "The patient's WBC and ANC meet the criteria to start clozapine.

The family of a severely suicidal adolescent is seen by the nurse following a diagnosis of major depressive disorder. Which statement by the family member indicates that the family is effectively coping with the crisis and illness? A. "We were working too much and not paying attention." B. "What we need to do is have more fun as a family." C."I think all families go through this—not just us." D. "We want to learn what we can and focus on getting better together."

D. "We want to learn what we can and focus on getting better together."

A client's risk for the development of blurred vision is high when prescribed which antipsychotic medication? A. Ziprasidone B. Risperidone C. Haloperidol D. Clozapine

D. Clozapine

Which diagnostic intervention is necessary at regular intervals during clozapine treatment? A. Electroencephalogram (EEG) B. Electrocardiogram (ECG) C. Lipids D. Complete blood count (CBC)

D. Complete blood count (CBC)

ECT is more effective than antidepressants in the treatment of severe depression. Nonetheless, patients and their families are reluctant to use ECT as a form of treatment. If you or a member of your family were severely depressed, which of these two treatment forms would you want? Carefully consider the stigma of ECT, as well as the effects of anesthesia and memory loss.

ECT and antidepressants are both invasive interventions for depression; they affect the body in radically different ways. Both have unwanted side effects that must be weighed against the benefit of treatment.

A soldier who served in a combat zone tells the nurse, "I saw a child get blown up over 2 years ago, but even now when I see something red, the visions race back to my mind and I smell burnt flesh." How should the nurse document this experience?

Flashbacks

The nurse would expect a patient with which co-morbid diagnosis to have a magnified response to the usual dose of a benzodiazepine drug?

Hepatic cirrhosis

A patient takes antacids, cimetidine (Tagamet), and phenytoin (Dilantin). The health care provider prescribes a benzodiazepine for anxiety. Which drug interactions would the nurse anticipate? Select all that apply.

Increased plasma level of benzodiazepine related to cimetidine therapy Potential phenytoin toxicity

A nurse manages a program providing day treatment services to combat veterans diagnosed with PTSD. During breaks between activities, which type of music would be most appropriate?

Jazz

Of the drugs given to treat AD, which one has a potential to slow neurodegeneration?

Memantine (Namenda)

A combat veteran with TBI, depression, and anxiety begins new prescriptions for sertraline (Zoloft) and lorazepam (Ativan). In recognition of potential long-term repercussions, the nurse should provide teaching related to which topic?

Nonpharmacologic strategies for managing anxiety

What factors determine when seclusion of an aggressive patient is terminated?

Nursing judgment and facility protocols Rationale: Nurses make the decision to initiate and terminate the seclusion of patients according to established protocols and are almost always involved in the care of patients during seclusion. While the other options may be considered, they are not the factors that determine the termination of patient seclusion interventions.

An emergency room patient was very anxious after a serious car accident. Lorazepam (Ativan) 2 mg intramuscularly was administered. One hour later, which finding indicates to the nurse that the medication was effective?

Reduced agitation and environmental scanning

A soldier in a combat zone tells the nurse, "I saw a child get blown up over a year ago, but I keep seeing bits of flesh everywhere. I see something red and the visions race back to my mind." The soldier is describing which phenomenon associated with PTSD?

Reexperiencing

Which intervention will be included in the care plan of a patient prescribed an anticholinergic medication?

Regular oral hygiene to minimize dry mouth Rationale: The effects of this medication may result in a dry mouth that is addressed by frequent oral hygiene that includes mouth rinses. Urinary hesitation, constipation, and decreased sweating are side effects of an anticholinergic medication

A nurse is scheduled to interview a new patient, a Muslim college professor from the Middle East. Which action by the nurse would support cultural competence?

Review Middle Eastern cultural values before the interview.

A nurse is assigned to an outreach program on a Native-American reservation. Which tenet should the nurse consider when communicating with these consumers?

Rules regarding roles and status are important and must be observed.

2. Many older, experienced clinicians believe that Tricyclic antidepressants (TCAs) are the best drugs for treating depression. Based on your reading about TCAs and the short paragraph on scopolamine, why may that be?

Scopolamine is an anticholinergic and has been found to be an effective antidepressant. TCAs are also anticholinergic, and it is thought that perhaps the reason they are good at reducing depressive symptoms may be related to that mechanism of action as much as their ability to increase intrasynaptic norepinephrine and serotonin.

When is it most important for the nurse to screen for signs and symptoms of post-combat PTSD?

Screening should be ongoing

What does refeeding syndrome involve?

Severe shifts in fluid and electrolyte levels from extracellular to intracellular spaces in severely emaciated patients can occur, causing cardiovascular, neurologic, and hematologic complications, and even death.

Johnny is a good basketball player. He is 23 years old and is taking lithium. Because Johnny sweats a lot on the days he plays (approximately four times per week), his nurse is concerned about his serum levels being consistent. What is this nurse considering?

She is concerned that Johnny will have excessively high lithium levels on basketball days and "normal" levels on the days he does not play (and sweat). According to unofficial sources, there was a pro player who had this problem and had difficulty adjusting his lithium.

General George Patton led U.S. troops in Europe and Africa during World War II. His career was marred by an incident of scolding a distressed, frightened soldier as "a coward" and "yellow." Patton's behavior embodied which phenomenon associated with symptom delay in PTSD?

Stigma

A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol), 50 mg bid. Which client behavior would warrant the nurse to disontinue haloperidiol?

Tardive dyskinesia, a potentially irreversible condition, would warrant the discontinuation of an antipsychotic medication such as haloperidol.

A visitor to the unit begins to hit a patient. How would you handle this situation?

Tell the visitor to stop and leave the unit, if possible. Call for staff assistance. Provide protection for the all patients and visitors, getting them out of the area. Escort the offending visitor off the unit (by staff or security), if necessary. Get personal information on the visitor for consideration of assault charges. In addition, since the visitor is probably a family member or close friend, the nurse can process the event with the patient and allow him or her to express his or her feelings. Also, just talking about the situation can provide some relief for the patient. If possible, a plan should be put in place for the patient and visitor to get help resolving their differences after the patient is discharged.

Why is it important for patients to share their opinions and reactions about the seclusion and restraint of another patient?

The act of putting a patient in seclusion and restraint is a last resort intervention that is disturbing for the patient, nursing staff, and all patients on the unit. Group meetings are a good time to process all of the patients' fears and emotional reactions to the event. Patients need to have their feelings validated as normal responses to stressful situations in their environment. In addition, patients should be reminded that seclusion and restraint are for safety concerns only, not for punishment purposes. Therefore, if any of the patients start feeling upset or like they are losing control, they need to talk with their nurse

Do you think physicians have the right to help terminally ill patients end their lives? Should adults in their right minds be allowed to commit suicide?

The answer to this question is both ethical and legal. Physicians are required to abide by the laws of the state in which they practice. That said, ethical and legal concerns may be at odds for some physicians who sympathize with the plight of individuals enduring severe emotional and physical pain. Asking a physician to assist with suicide is a different matter from allowing a patient in their right minds to commit suicide. What would a prudent physician do in a similar situation is the norm that will be questioned after the fact.

Meeting the immediate safety needs of an aggressive patient is based on which principle of care?

The least restrictive option is implemented. Rationale: Verbal and physical aggression require safe, immediate interventions based on the principle of the least restrictive alternative, which contradicts the use of any means available. The remaining options, while true, are not related to the issue of aggressive patients in particular.

A Korean-American patient showed rare eye contact. This nursing diagnosis was formulated: Chronic low self-esteem related to shame and guilt as evidenced by lack of eye contact. Interventions were sought to improve the patient's self-esteem, but after 3 weeks the patient's eye contact was unchanged. Select the accurate analysis of this scenario.

The nurse should have assessed the patient's culture before formulating this diagnosis and plan.

Although you have not read the chapter on antidepressants yet, it is known that selective serotonin reuptake inhibitors (SSRIs, such as fluoxetine [Prozac] or paroxetine [Paxil]) can cause EPSEs. Can you determine why?

This is a tough one. This is the author's answer and there may be those who disagree. When activated by serotonin, serotonin 5H2A receptors decrease dopamine release. Then, when those receptors are stimulated in the basal ganglia, the decreased expression of dopamine leads to EPSEs. Please note that many antidepressants now warn against the possibility of Neuroleptic NMS-like side effects.

Electroconvulsive therapy ECT has been considered a political issue. Do you think opponents of ECT tend to be more on the more liberal or conservative side of the political spectrum?

While there are opponents and advocates to ECT on both sides of the political spectrum, it is our experience that greater concern is typically expressed by those on the liberal side of the spectrum.

A patient of Cuban descent is hospitalized with depression. Which factor is most applicable to care planning?

With the patient's permission, the nurse should consult with family and religious advisors to plan care.

Which statement by a patient diagnosed with somatic symptom disorder indicates that goals for treatment are being achieved? a. "I need to be very careful about what I eat." b. "I can focus on things other than my symptoms." c. "I understand that my doctor is not an expert in everything." d. "I try to figure out my diagnosis by reading articles on the Internet."

b. "I can focus on things other than my symptoms."

Which techniques are therapeutic when interacting with a patient? Select all that apply. a. Avoiding direct questions b. Validating and clarifying c. Using empathy sparingly d. Assuming an attending posture e. Maintaining constant eye contact

b. Validating and clarifying d. Assuming an attending posture

A community mental health nurse assesses a person with a psychiatric disorder on an initial visit. The nurse should refer this person to services on the care continuum that: a. are the least costly. b. are the least restrictive. c. offer psychoeducation. d. promote rapid symptom stabilization.

b. are the least restrictive.

If a patient's threshold set point for anxiety is lowered, the nurse can expect subsequent stressors to: a. have a lesser effect. b. easily reactivate the anxiety response. c. produce marked personality disorganization. d. be easily managed using familiar coping strategies.

b. easily reactivate the anxiety response.

Complete the sentence. In a therapeutic environment, norms are: a. opportunities for self-expression that relieve stress. b. expectations for socially acceptable behavior. c. the behaviors most people display daily. d. shared experiences among patients.

b. expectations for socially acceptable behavior. Norms are defined as specific expectations of behavior that pervade a setting. They are intended to promote community living through socially acceptable behaviors. The other explanations are not as comprehensive as the correct answer.

A patient in the emergency room has status epilepticus. The nurse should anticipate administration of:

diazepam (Valium).

A patient had five emergency room visits in the past month and reports, "I feel so nervous. I think I'm having heart attacks." The patient is diagnosed with panic attacks. Which comment by the nurse shows understanding of treatment for panic attacks?

"SSRI antidepressants are often helpful for long-term treatment and prevention of panic attacks."

Which individual would be most likely to experience a paradoxical reaction to a benzodiazepine drug?

A child with attention deficit-hyperactivity disorder (ADHD)

Which statement made by a client demonstrates an understanding of the use of antipsychotic medications during pregnancy? A. "Their use should be monitored closely by my health care provider." B. "Such medication poses severe risks when used during pregnancy." C. "Medications like these do not cross the placental barrier." D. "There is no record of side effects in newborns exposed to such medications."

A. "Their use should be monitored closely by my health care provider."

The daughter of a patient admitted to the intensive-care unit with delirium tremens asks the nurse how long this condition will last. The RN responds: A. "This typically clears in a matter of hours or a few days." B. "This is a progressive disorder. Some get better, while others never recover." C. "Seclusion and restraint will be used to protect her from injury." D. "Her condition will improve once intravenous fluids are started."

A. "This typically clears in a matter of hours or a few days."

A health care provider prescribes lorazepam (Ativan) for an anxious older adult. What is the nurse's best action?

Administer the drug as prescribed.

A nurse assesses soldiers in a combat zone. When is it most important for the nurse to screen for signs and symptoms of traumatic brain injury (TBI)?

After exposure to a blast

The patient refuses lithium for acute mania but is agreeable to another medication. The nurse will expect the prescriber to order:

An anticonvulsant Rationale: Because of the seriousness of bipolar disorder, researchers have diligently sought alternatives for patients who do not respond to lithium. Accordingly, an anticonvulsant is increasingly often the first drug prescribed. Unless court-ordered or legally mandated, the patient's request is reasonable. An SSRI will not be appropriate for the treatment of acute mania; it is contraindicated, with the potential to promote mania. MAOIs are not indicated in the treatment of acute mania.

A nurse manager is interviewing nurses to staff a new clinic for treatment of clients experiencing sexual disorders. What key attribute should the potential staff A. "I've worked with sex offenders in the past." B. "I believe that it is my duty to be open-minded. C. "This client population can present many challenges." D. "I always try to find humor in every situation I face."

B. "I believe that it is my duty to be open-minded.

What is the supposed pharmacologic effect that causes Selective serotonin reuptake inhibitors (SSRIs) to result in sexual dysfunction?

When the serotonin 5-HT2A receptor is stimulated by serotonin, a downward modulation of dopamine occurs. SSRIs are thought to cause sexual dysfunction because serotonin reduces dopamine release from dopaminergic neurons. Further, serotonin also reduces levels of norepinephrine and acetylcholine, which are both involved in sexual functioning.

9. A patient diagnosed with bipolar disorder is laughing and giddy one minute and seconds later is angry and sarcastic. How should the nurse document the patient's mood? a. Incongruent b. Inappropriate c. Blunted d. Labile

ANS D Lability refers to rapid mood shifts, often seemingly without provocation. This is the only term that fits the description given in the scenario.

3. Which principle is most useful and effective when interacting with a patient experiencing a manic episode? a. Encourage the patient to freely express feelings. b. Use a calm, matter-of-fact approach. c. Do not interrupt the patient. d. Frequently use silence.

ANS: B A calm, matter-of-fact approach minimizes the need for the patient to respond defensively and avoids power struggles. Using this approach, the nurse conveys both control of the situation and empathy. The other options are not principles related to therapeutic interactions with a patient experiencing a manic episode. The distracters allow for manipulation of the nurse and for the patient to control the interaction.

10. How does a multiaxial diagnostic and classification tool contribute to successful treatment of persons with mental illness? a. It provides for consistency and continuity in formulation of diagnoses. b. It assesses more dimensions of illness than simply the medical diagnosis. c. It establishes prevalence rates for psychiatric disorders across various cultural groups. d. It provides treatment algorithms for psychotherapeutic management of persons with mental illness.

ANS: B A multiaxial tool looks more holistically at the individual. The DSM-V-TR axes consider medical conditions, presence of personality and developmental disorders, relevant psychosocial and environmental factors, and global assessment of functioning. The other options listed are not advantages that contribute to treatment success.

6. The nurse prepares to take vital signs for a patient experiencing mania. What is the nurse's best intervention when the patient's talking interferes with the assessment? a. Use a voice volume louder than the patient's to say, "Stop talking now." b. Interrupt by saying, "It's time to take your vital signs now." c. Delay taking the vital signs until the patient is quieter. d. Wait tolerantly for the patient to finish talking.

ANS: B There are times when the nurse must simply, calmly, and firmly interrupt a manic patient. Waiting is counterproductive. Yelling at the patient and delaying necessary assessments are inappropriate.

7. Which principle is applicable to nursing care of patients with all types of psychopathology? a. Avoid competitive situations. b. Treat patients as individuals. c. Confront patients with consequences of behavior. d. Assume that patients will make self-enhancing decisions.

ANS: B Treating all patients as individuals is a key aspect of showing respect. The distracters are not universally therapeutic measures.

14. Long- and short-term goals are documented in which part of the plan of care? a. Assessment b. Diagnosis c. Outcomes d. Interventions e. Evaluation

ANS: C Long- and short-term goals are the product of outcome identification, and documentation is appropriate only in the "outcomes" part of the plan of care.

2. What is the purpose of the DSM-V? a. It provides a detailed list of clinical psychiatric disorders. b. It details data and statistics about mental disorders in the United States. c. It serves as the official American resource manual detailing diagnostic criteria of psychiatric disorders. d. It acts as a compendium of the international demographics of substance abuse and mental disorders.

ANS: C The Diagnostic and Statistical Manual, Fifth Edition (DSM-V) is published by the American Psychiatric Association. It provides diagnostic criteria for mental and substance abuse disorders and is used throughout the United States. The other options are not descriptive of the DSM-V.

8. Within a 15-minute period, a patient having a manic episode voices these complaints. "Dinner was cold. The bath towels are rough. The solarium is too hot. I have a sore throat. Another patient needs a shower. The medication nurse is too slow." The nurse should: a. listen but ignore the patient's complaints. b. tell the patient to use the suggestion box. c. assess the patient's throat, and take vital signs. d. invite the patient to share the concerns at the community meeting

ANS: C The hypercritical manic patient offers so many complaints that it is easy to discount his or her concerns. Legitimate complaints should always be investigated, however. By listening and ignoring complaints, the nurse might fail to intervene to provide care. Telling the patient to use the suggestion box or asking him to share his complaints at the community meeting are placating and may anger the patient.

7. During community lunch, a manic patient tells another patient, "Push yourself away from the table. You're too fat for your own good!" How should the nurse intervene? a. Say to the patient, "You may remain at lunch only if you apologize." b. Tell the patient, "You must leave lunch and go to your room now." c. Calmly tell the patient that insulting others is not permitted. d. Extinguish the behavior by ignoring it.

ANS: C The nurse must protect vulnerable patients and keep them from being drawn into the manic patient's angry behavior. By stating that the behavior is not permitted, the nurse sets limits and does not enter into an argument. The distracters will further anger the patient, may cause escalation, or may allow for loss of control

4. A nurse assesses a new patient experiencing a manic episode. Which behavior is most likely to have occurred before hospitalization? a. Watching others closely but avoiding interaction b. Taking frequent rest periods during the day c. Going rapidly from one activity to another d. Remaining in the home for long periods

ANS: C There is increased physical and mental activity exhibited during a manic episode. Moving rapidly from one activity to another is characteristic behavior during a manic episode. The other behaviors mentioned are not consistent with what occurs during a manic episode.

2. What are the best menu selections for lunch for a hyperactive patient during a manic episode? Select all that apply. a. Cherry pie b. Macaroni and cheese c. Chocolate chip cookies d. Tossed salad with ranch dressing e. Roast beef sandwich on whole-grain bread

ANS: C, E A hyperactive patient experiencing a manic episode is often too overactive to sit and eat, so the nurse must provide food that can be eaten out of hand while the patient walks around. A sandwich and cookies provide protein, carbohydrates, fat, and fiber.

11. A medication teaching plan for a patient receiving lithium should include: a. directions to eat one or two bananas daily. b. dietary teaching to limit daily sodium intake. c. the need to restrict daily fluid intake to 1000 ml. d. the importance of laboratory testing to monitor the lithium level.

ANS: D Maintaining serum lithium levels within 0.6 and 1.2 mEq/L is vital to symptom control. The patient must be made aware that frequent monitoring will foster symptom control and prevent toxicity. The other options are inappropriate in a teaching plan.

9. A patient with low self-esteem and feelings of failure would benefit most from which activity? a. Attending a dance b. Playing board games c. Leading the chorus for a party d. Helping make favors for a party

ANS: D Making favors is a productive task that holds little opportunity for failure and ample opportunity for receiving support and positive feedback. The other options hold a greater risk for failure.

13. The nurse reads this information in a patient's record: history of agranulocytosis from antipsychotic medication; victim of childhood sexual abuse; weight loss of 27 lb in 3 months; parent diagnosed with bipolar disorder. Which item would be classified as a psychodynamic factor associated with the patient's mental illness? a. History of agranulocytosis from antipsychotic medication b. Parent diagnosed with bipolar disorder c. Weight loss of 27 lb in 3 months d. Victim of childhood sexual abuse

ANS: D Psychodynamic causes of mental illness arise from "nurture"—for example, childhood sexual abuse. The distracters are of biologic ("nature") etiology.

4. Which assessment finding should be documented as subjective information? a. Flushed face b. White blood cell (WBC) count 12,000 cells/μL c. Lithium level 1.2 mEq/L d. Reports of abdominal pain

ANS: D Subjective data are what the patient relates to the nurse such as reports of pain. Objective data are measurable data obtained by the nurse.

Which nursing action best supports maintenance of a therapeutic environment? a. Creating therapeutic relationships with patients b. Providing purposeful structured activities c. Maintaining patient records and care plans d. Administering medication

a. Creating therapeutic relationships with patients A therapeutic environment requires nurses to be active and willing to engage in therapeutic relationships with patients. These relationships support patients' development of coping and problem-solving skills. Maintaining records, administering medications, and providing activities are important in the therapeutic environment, but to a lesser extent than meaningful nurse-patient interactions.

Which statement about balance provides a basis for a nurse's management of the therapeutic environment? a. Independence is best gained in increments. b. Independence is a fundamental right of all patients. c. Independence jeopardizes safety in an inpatient setting. d. Dependence is a characteristic of most persons with mental illness.

a. Independence is best gained in increments. Balance is the process of gradually allowing independent behaviors in a dependent situation. Independence must be gained in increments to avoid overwhelming the patient. The distracters are false, since they do not describe the basis of balance.

Which aspects of the environment of a psychiatric unit comply with JCAHO environment-of -care standards? Select all that apply. a. Visitor badges b. Identification badges for employees c. Telephones located in enclosed booths d. Requiring patients to wear hospital-issue clothing e. Guidelines for staff interaction with media representatives.

a. Visitor badges b. Identification badges for employees c. Telephones located in enclosed booths e. Guidelines for staff interaction with media representatives JCAHO standards mandate clothing suitable for the clinical environment, but they do not require patients to wear hospital-issue clothing. The other answers comply with standards.

Which statement most accurately describes a nurse's role regarding psychopharmacology? The psychiatric nurse: a. frequently makes decisions regarding administration of PRN medications. b. might adjust a medication dose if a patient is not responding positively. c. administers medications but is not responsible for monitoring drug effectiveness. d. should refer a patient's questions about drug side and adverse effects to the psychiatrist.

a. frequently makes decisions regarding administration of PRN medications.

Effective use of the nursing process is dependent on communication that: a. is structured and goal-directed. b. meets the needs of both patient and nurse. c. is spontaneous and affords mutual self-disclosure. d. fosters emotional distance between patient and nurse.

a. is structured and goal-directed.

During a community meeting, a patient reports about having only two patient-accessible phones on the unit. Many other patients join in, all talking at the same time. The nurse requests that only one person talk at a time. The nurse's request seeks to maintain: a. norms. b. safety. c. balance. d. structure.

a. norms. Norms establish expectations that promote safety and trust in a therapeutic environment through sanctioning of socially appropriate behaviors. The other elements cannot be assessed as related to the scenario.

The spouse of a patient with panic attacks tells the nurse, "I am afraid my husband has a permanent disorder and will have many hospitalizations in the future. I wonder how I will be able to raise our children alone." The nurse's reply should be based on knowledge of: a. psychopathology. b. milieu management. c. psychopharmacology. d. nursing relationship therapy.

a. psychopathology.

The framework of schedules, rules, and activities around which a therapeutic environment revolves is termed: a. structure. b. balance. c. norms. d. safety.

a. structure. Structure refers to the physical environment, regulations, and daily schedule of classes and groups provided in a treatment setting. Structure provides the base on which the other elements are built.

Which scenarios demonstrate that a nurse is functioning within the scope of psychotherapeutic management? The nurse (select all that apply) a. structures meaningful unit activities. b. administers electroconvulsive therapy. c. encourages a patient to express feelings. d. interprets the results of psychological testing. e. assesses a patient for medication side effects.

a. structures meaningful unit activities. c. encourages a patient to express feelings. e. assesses a patient for medication side effects.

An adult with paranoid schizophrenia is hospitalized. This patient has frequent auditory hallucinations and walks about the unit, muttering. To use psychotherapeutic management effectively, it is most important for the nurse to: a. understand the disease process of schizophrenia. b. minimize contact between this patient and other patients. c. administer PRN medication before interacting with the patient. d. use behavior modification to decrease the frequency of hallucinations.

a. understand the disease process of schizophrenia.

Which statements indicate that a patient understands the unit norms? Select all that apply. a. "I need quiet time after art therapy today." b. "I will not yell during the community meeting." c. "I realize that I need help with my problems." d. "I will show up on time to take my medication." e. "I will talk to staff if I get angry instead of punching somebody."

b. "I will not yell during the community meeting." d. "I will show up on time to take my medication." e. "I will talk to staff if I get angry instead of punching somebody." Norms are specific expectations of socially acceptable behavior intended to promote community living, such as behaving with civility during a community meeting, behaving in nonviolent ways, maintaining personal control, and accepting personal responsibility. The correct options are desirable behaviors related to norms rather than individual treatment goals.

2. Four nurses describe their unit environments. Which description can most clearly be identified as therapeutic? a. "My unit uses behavior modification to enhance patients' social skills." b. "My unit allows patients to test new behaviors in a secure environment." c. "My unit helps patients deal with childhood issues by providing a safe setting." d. "My unit allows patients to deal with personal issues without interpersonal stressors."

b. "My unit allows patients to test new behaviors in a secure environment." The unit described in the correct answer provides a broad therapeutic focus for providing corrective experiences that helps patients recover. The distracters are too narrow in their therapeutic scope.

What explanation about the unit milieu would be most important for the nurse to give to a newly admitted patient? a. "Your behavior will be carefully monitored during your hospital stay." b. "Unit activities will help you cope with immediate needs and stressors." c. "You will be given enough medication to bring your symptoms under control." d. "I will be gathering information about you to plan your care and your discharge."

b. "Unit activities will help you cope with immediate needs and stressors."

A patient at the crisis intervention clinic states, "When I got up this morning, I realized I could not go on any longer." Select the nurse's best response to facilitate analyzing the problem and making a nursing diagnosis. a. "How long have you been feeling this way?" b. "What is different about your feelings today?" c. "We are here to help you. I'm glad you decided to come to the center." d. "You said you felt like you could not go on. Tell me more about that."

b. "What is different about your feelings today?"

5. Which nursing action best supports the maintenance of psychologic safety for a patient with mental illness? a. Helping a depressed patient to inventory personal flaws b. Assisting a patient to change clothes after an episode of incontinence c. Allowing an anxious patient to pace in isolation and without interruptions d. Requiring a restrained patient to remain silent until restraints are removed

b. Assisting a patient to change clothes after an episode of incontinence Assisting a patient to change clothes after an episode of incontinence saves embarrassment for the patient, which contributes to a positive self-concept. Requiring a restrained patient to remain silent implies punishment rather than use of an external control until they are able to regain control. The other options are not therapeutic and do not promote psychologic safety.

An acutely psychotic patient is restricted to an inpatient unit. Which milieu element has been adapted? a. Norms b. Balance c. Therapy d. Psychopathology

b. Balance

When the treatment team in an inpatient psychiatric unit institutes a new unit schedule that provides for all patients to be involved in activities continuously throughout both the day and early evening, which element of milieu management needs reflection and reconsideration? a. Norms b. Balance c. Limit setting d. Environmental modification

b. Balance

Which guideline should a nurse use when applying the components of psychotherapeutic management to the care of a patient with mental illness? a. The nurse's role in milieu management is secondary to that of social work. b. Omitting any one component usually will result in less effective treatment. c. The most important element of psychotherapeutic management is drug therapy. d. A therapeutic nurse-patient relationship is the most important aspect of treatment.

b. Omitting any one component usually will result in less effective treatment.

What data should a nurse analyze when deciding to refer a patient with a psychiatric disorder to community-based care? Select all that apply. a. Need for PRN medication b. Severity of the patient's illness c. Need for structured formal therapy d. Presence of suicidal or homicidal ideation e. Amount of supervision required by the patient

b. Severity of the patient's illness d. Presence of suicidal or homicidal ideation e. Amount of supervision required by the patient

The nurse leading a social skills group is engaged in managing which environmental element? a. Balance b. Structure c. Accountability d. Risk management

b. Structure By definition, the element of structure includes the schedule of planned therapeutic activities and groups. Balance refers to dependence-independence behaviors. Accountability and risk management are not identified elements of the therapeutic environment.

In which instance would it be most important for the nurse to set limits? a. An involuntarily hospitalized patient insists on being discharged. b. Two patients are found kissing in an obscure area of the unit. c. A patient with suicidal ideation asks to leave the unit. d. A depressed patient seeks daily telephone privileges.

b. Two patients are found kissing in an obscure area of the unit. Limits should be set on acting-out behavior, self-destructive acts, physical aggressiveness, sexual behavior, lack of compliance, use of illicit substances, and elopement. The correct answer is an example of sexual behavior. The distracters depict instances in which a therapeutic response is indicated from the nurse but not necessarily limit-setting.

A patient has been bumping and pushing other patients. The nurse carefully explains to the patient that such behavior is unacceptable. The nurse has provided: a. balance. b. limit-setting. c. personal control. d. environmental modification.

b. limit-setting. Limit-setting provides a patient with a clear explanation of the acceptability or unacceptability of a behavior. Limit-setting reinforces norms and encourages the milieu concept of responsibility for self. The other options are not applicable.

A patient diagnosed with schizophrenia, paranoid type, frequently gets up and walks away during interactions with a nurse. The nurse can best increase the patient's comfort level by: a. arranging the chairs side by side, about 2 feet apart. b. sitting at eye level across the table from the patient. c. standing a few feet away from where the patient sits. d. talking in the patient's room with the door closed.

b. sitting at eye level across the table from the patient.

A patient attends outpatient programs at a community mental health center and meets with the primary nurse regularly. Last week, the patient's haloperidol (Haldol) dose was reduced from 5 mg to 2 mg daily to decrease side effects. The nurse will need to monitor changes in: a. the activity schedule at the center. b. the nature of the patient's symptoms. c. attention given to the patient by other staff. d. balance among psychotherapeutic management elements.

b. the nature of the patient's symptoms.

6. Which element of therapeutic environmental management has the highest priority? a. Clearly establishing norms and designating limits b. Scheduling purposeful activities throughout the day c. Creating an environment of psychologic and physical safety d. Promoting a balance between patient dependence and independence

c. Creating an environment of psychologic and physical safety Safety is the most basic milieu element and therefore is of highest priority. Norms often contribute to safety. Activities and balance are other important milieu elements but are of lower priority.

Risk assessment for a patient shows these findings: schizophrenia but not acutely psychotic at the moment; not a danger to self or others; lives in parents' home. Which decision regarding placement on the continuum of care is appropriate? a. Hospitalize the patient. b. Discharge the patient from the system. c. Refer the patient to outpatient services. d. Refer the patient to self-help resources in the community.

c. Refer the patient to outpatient services.

A newly admitted patient is withdrawn and does not seek out interaction with staff or patients. Nursing interventions should focus on which element of the treatment environment? a. Norms b. Safety c. Structure d. Limit-setting

c. Structure Structure refers to the physical environment, regulations, and daily schedule of classes and groups provided. The unit activities will provide an opportunity for the nurse to interface with the patient to develop a trusting relationship. The other treatment environment elements are important but are of lower priority for this patient.

During orientation the clinical nurse leader tells a novice nurse, "You will be involved in purposeful creation of corrective learning experiences for all patients so as to provide a healing atmosphere." The clinical nurse leader is explaining aspects of: a. balance. b. limit-setting. c. a therapeutic environment. d. establishing behavioral norms.

c. a therapeutic environment. A therapeutic environment requires creation of corrective learning experiences to promote a therapeutic atmosphere. Limit-setting, balance, and norms are individual elements of the therapeutic environment and are answers that are too narrow.

During the risk assessment phase of care for a psychiatric patient, the nurse will: a. make an initial assessment. b. confirm the patient's problem. c. assess potential dangerousness to self or others. d. determine the level of supervision needed for the patient.

c. assess potential dangerousness to self or others.

A common mistake nurses make when developing therapeutic communication techniques is: a. using too many different techniques during an interaction. b. allowing patients to become too anxious before responding. c. giving advice rather than encouraging patients to solve problems. d. focusing on what patients say rather than on communication techniques.

c. giving advice rather than encouraging patients to solve problems.

A patient tells the nurse, "This medicine makes me feel weird. I don't think I should take it anymore. Do you?" The most effective reply that the nurse could make is based on the psychotherapeutic management model component of: a. psychopathology. b. milieu management. c. psychopharmacology. d. therapeutic nurse-patient relationship.

c. psychopharmacology.

During an interaction with a patient, a nurse encourages the patient to express feelings, identify stressors, and review coping strategies. These nursing interventions relate most to the use of: a. risk assessment. b. behavior modification. c. therapeutic communication. d. environmental manipulation.

c. therapeutic communication.

A patient says to the nurse, "My family was mean to me when they visited today. They have no right to treat me like that." Select the nurse's best initial response. a. "Why do you think they were mean?" b. "Perhaps you overreacted to what they said." c. "How do you feel about your family treating you that way?" d. "Describe what happened when your family visited you today."

d. "Describe what happened when your family visited you today."

A patient states, "I'm tired of all these therapy sessions. It's just too much for me." Using supportive confrontation, the nurse should reply: a. "It will get better if you just keep trying." b. "You are doing fine. Don't be so hard on yourself." c. "Tell me more about how the therapy sessions are too much." d. "I know you find this difficult, but I believe you can get through it."

d. "I know you find this difficult, but I believe you can get through it."

A nurse realizes that the comment just made to a patient was inconsiderate. Select the nurse's most therapeutic statement in this situation. a. "How do you feel about what I just said?" b. "See, even nurses say stupid things sometimes." c. "Sorry about that. Let's continue where we left off." d. "That was an insensitive remark. I'm sorry if it hurt you."

d. "That was an insensitive remark. I'm sorry if it hurt you."

When inpatient psychiatric care is not indicated, an individual with schizophrenia who has a history of medication noncompliance should be referred to which service? a. Primary care b. Outpatient counseling c. Apartment residential living d. A group home with 24-hour supervision

d. A group home with 24-hour supervision

Referral to a psychiatric extended-care facility would be most appropriate for which of the following patients? a. An adult with generalized anxiety disorder b. A severely depressed 70-year-old retiree c. A patient with personality disorder who frequently self-mutilates d. A severely ill person with schizophrenia who is regressed and withdrawn

d. A severely ill person with schizophrenia who is regressed and withdrawn

Select the best description of nursing practice in the psychiatric setting. a. The nurse primarily serves in a supportive role to other members of the team. b. The multidisciplinary approach eliminates the need to clearly define the responsibilities of nursing. c. Clearly differentiated nursing actions have been identified that distinguish nursing from other professions. d. Although professional role overlap exists, nursing offers unique contributions to psychotherapeutic management.

d. Although professional role overlap exists, nursing offers unique contributions to psychotherapeutic management.

A patient demonstrating manic behaviors gathered other patients in the dayroom and gave a sales talk, pressuring others to purchase shares of stock in a gold mine. Which element of a therapeutic environment is jeopardized? a. Connection b. Exploration c. Structure d. Balance

d. Balance The patient is violating the rights of others by being allowed to give unsolicited discourses and exert pressure on others. Balance is lacking when patients are not protected from the symptom expression of other patients.

The nurse tells a patient, "I noticed that you frowned when we discussed your relationship with your family." Which communication technique is the nurse using? a. Clarifying b. Interpreting c. Giving information d. Making observations

d. Making observations

A depressed adult is hospitalized after a suicide attempt. The patient receives an antidepressant medication, is closely supervised, attends a variety of group therapies and activities, watches television during free time, and talks to visitors in the evening. Which additional intervention is needed in the patient's care? a. Milieu therapy b. Adequate drug therapy c. Increased contact with significant others d. Meaningful communication with nursing staff

d. Meaningful communication with nursing staff

When observing and interpreting a patient's nonverbal communication, which nursing consideration is important? a. Patients are usually aware of their nonverbal cues. b. Verbal responses are more important than nonverbal cues. c. Nonverbal cues have obvious meaning and are easily interpreted. d. Nonverbal cues provide significant information but must be validated.

d. Nonverbal cues provide significant information but must be validated.

A psychiatric facility is "accredited by JCAHO." Which asset would be expected? a. A 4:1 patient-to-staff ratio b. Private rooms for all patients c. Use of a therapeutic milieu treatment model d. Telephones for private patient conversations

d. Telephones for private patient conversations JCAHO environment-of-care standards stipulate that telephones must be available to allow patients to conduct private conversations. The other options are not specified in JCAHO standards.

Which skill is most important for a nurse preparing to work in the psychiatric setting? a. Helpful transference b. Sympathetic listening c. Supportive confrontation d. Therapeutic communication

d. Therapeutic communication

A nurse plans ways to promote patient safety and security. A proactive approach would include: a. restricting psychotic patients' rights. b. enforcing consequences of limit-setting. c. setting limits when a patient acts out aggressively. d. clearly communicating expectations for patients' behavior.

d. clearly communicating expectations for patients' behavior. Proactive is the key word in this question. Communicating clear rules for expected behavior from the beginning reinforces norms and structure, and encourages self-responsibility. The other options are reactive.