Foundations and Practice of Mental Health, Mental Health Final

The nurse interviews a young female client with anorexia nervosa to obtain information for the nursing history. What will the client's history most likely reveal? (Select all that apply.) 1. Ritualistic behaviors 2. Desire to improve her self-image 3. Supportive mother-daughter relationship 4. Low achievement in school and little concern for grades 5. Satisfaction with and a desire to maintain her current weight

1. Ritualistic behaviors 2. Desire to improve her self-image

Three years after the loss of her husband of 35 years, the wife has a full-time job but finds that she cannot sleep well at night, has frequent mood changes, and attends the couples night out with friends that she and her husband attended. Upon seeking counseling, she discovers that she is exhibiting symptoms of:

Complicated grief

The set of emotional reactions that accompany a loss is called:

Grief

To make the remainder of a terminally ill persons life as meaningful and comfortable as possible is the goal of:

Hospice care

Sleep terrors usually occur only once a night, during stages 3 and 4 of NREM sleep. They are often accompanied by which physical sign?

Intense stress

The client is 21 years old and has just been given the diagnosis of terminal cancer. She is coping with a(n) ____ loss.

Internal

What is the term for physical expression of anxiety by an individual in ways such as nausea or headaches?

Somatization

Loss of which of the following can result in the individuals experiencing external losses? (Select all that apply.)

Spouse Possession Favorite piece of jewelry Friendship

On the morning of a final exam, the student is feeling tense and excited, with her heart rate and breathing slightly increased. She is feeling energized and alert with her attention focused on the exam. Based on these findings, what advice can the student be given?

The level of anxiety described should allow for a positive outcome

Decisions about a terminally ill clients remaining time belong to the:

Person

A client tells the nurse that exercising in the gym helps him keep his stress level reduced. Which type of coping mechanism best describes this situation?

Physical

The persistent eating of nonfood items such as clay, laundry starch, insects, leaves, or pebbles that lasts for longer than 1 month is called:

Pica

Which of the following conditions are eating disorders? (Select all that apply.)

Pica Purging Binge eating

The medical term for a sleep test is __________.

Polysomnogram

The client thinks her nose is so ugly that most people cannot bear to look at her. She often describes herself as ugly. Which condition is the client experiencing? a. Somatization b. Hypochondriasis c. A conversion reaction d. Body dysmorphic disorder

d

The nurses ability to interpret communication effectively in the mental health setting depends mostly on: a. How well the client communicates b. The nurses relationship with the client c. The nurses understanding of mental health disorders d. The nurses ability to listen to and observe the clients verbal and nonverbal messages

d

The nurse who is caring for a 23-year-old client with bulimia knows that the most common method of purging to monitor this client for is:

Vomiting

The average age for onset of anorexia nervosa is

17 years old

A nurse notes that haloperidol (Haldol) is most effective for clients who exhibit behavior that is: 1. Depressed 2. Overactive 3. Withdrawn 4. Manipulative

2. Overactive

A client with generalized anxiety disorder says to the nurse, "What can I do to keep myself from overreacting to stress?" What is the best response by the nurse? 1. "Work on problem-solving skills." 2. "Improve your time-management skills." 3. "Ignore situations that you cannot change." 4. "Work on identifying and developing coping strategies."

4. "Work on identifying and developing coping strategies."

A female nurse has been caring for a depressed 75-year-old woman who reminds her of her grandmother. The nurse spends extra time with her every day and brings her home-baked cookies. The nurse's behavior reflects: 1. Affiliation 2. Displacement 3. Compensation 4. Countertransference

4. Countertransference **With countertransference the professional provider of care exhibits an emotional reaction to a client based on a previous relationship or on unconscious needs or conflicts.

What is the most important information for a nurse to teach to prevent relapse in a client with a psychiatric illness? 1. The need to develop a close support system 2. The need to create a stress-free environment 3. The need to refrain from activities that cause anxiety 4. The need to follow the prescribed medication regimen

4. The need to follow the prescribed medication regimen

Of individuals who suffer from panic attacks, ____% are women.

70

Which of the following persons is most likely a candidate for primary hypersomnia?

An 18-year-old college student whose mother complains he sleeps all night and still naps during the day

The main focus of medical management for anorexia is to:

Encourage the client to eat voluntarily

Which of the following activities are examples of addictive behaviors? (Select all that apply.)

Gambling Shopping Working Excessive sexual activity

Which term best describes an individuals feelings of anxiety that are broad, long-lasting, and excessive?

Generalized anxiety disorder

The inability to fall asleep or stay asleep is called

Insomnia

Although all age groups can be affected, sleep disorders occur most frequently in:

Older adulthood

A 6-year-old is preparing to have a dental procedure. His anxious mother is in the room with him. When the child asks if everything will be okay, she assures him it will, but continues to pace and wring her hands. What is the most appropriate action for the dentist to take?

Request that the mother wait in the waiting room

A female college student is seeking help from the counseling center for test anxiety. She reports that during an exam, she freezes, and says, It feels like the time I have to take the exam is racing by, and I cant answer any of the questions when I know the answers. Which level of anxiety is the client experiencing?

Severe

Which are key features of anorexia nervosa? (Select all that apply.)

Severe weight loss Introverted personality Hunger is denied

A male client has had agoraphobia for several years. In the past 2 years, he has not left his home and only speaks to people on the phone occasionally. Which nursing diagnosis has the highest priority in this situation?

Social isolation

The first step in the treatment of sleep disorders is to

Teach prevention

A prolonged emotional state that influences ones whole personality and life functioning is called: a. Mood b. Feeling c. Attitude d. Intellectual response

a

Which are the essential features of conversion disorder? (Select all that apply.) a. Preoccupation with fears of disease b. Deficits in motor function c. Long history of vague complaints d. Deficits in sensory function

b, d

The client had recently witnessed a horrific auto accident. Now she is complaining of double vision, loss of balance, and a constant lump in her throat. She is exhibiting the signs and symptoms of: a. Anxiety reaction b. Behavioral disorder c. Conversion disorder d. Posttraumatic stress reaction

c

People who are able to recognize and defuse their stressors early ____ suffer from the physical effects of stress. a. Never b. Often c. Always d. Seldom

d

A client is experiencing an episode at the level of mania. Which behaviors are characteristic of this level? (Select all that apply.) a. Outgoing, happy, and worry free b. Decreased ability to concentrate c. Confident d. Disoriented e. Unstable affect f. Pressured speech g. Poor hygiene

e, f

With regard to the environment, it is important for the nurse to be aware of lighting for some clients. Clients with a diagnosis of schizophrenia may be bothered by lights that are flickering because this may trigger: a. overstimulation b. hallucinations c. aggressive behaviors d. [hotophobia

hallucinations

When establishing a client's level of consciousness, the nurse is aware that this is determined by assessing the client's: a. level of awareness b. ability to tell the nurse where he or she is at any given time c. accuracy in expressing the current month, date, or yer d. capability to explain why he or she is in the facility

level of awareness

The nurse is talking with a newly admitted male client while in the activity room. The client begins to become tearful when talking about his children at home. What is the nurse's best action? a. ask the client to talk more about his children b. take the client into a private area to continue the conversation c. ask the client why he is crying d. distract the client by encouraging him to join the group activitiy

take the client into a private area to continue the conversation

A male client is being discharged from a mental health facility and is worried about what to tell his friends and co-workers regarding his time away. The nurse help the client plan what to say to others about his disease. The nurse if function in the role of: a. change agent b. teacher c. therapist d. technicin

teacher

Discharge planning for an inpatient mental health facility client begins on ___________.

the day of admission

Showing empathy toward a client is an effective tool in establishing rapport. Which nurse statement is the best example of an empathetic response? a. "I am sorry for your loss." b. "It must be difficult for you going through this loss." c. "I am sure you will feel better soon." d. "Try to look on the bright side."

"It must be difficult for you going through this loss."

Crisis stabilization provides care to clients in treatment settings with the purpose of reestablishing homeostasis; it usually lasts for: a. 1 to 2 days b. 2 to 4 days c. 4 to 6 days d. 6 to 8 days

1 to 2 days

The nurse explains to a nursing assistant that behavior usually is viewed and accepted as normal if it: 1. Fits within standards accepted by one's society 2. Helps the person reduce the need for coping skills 3. Expresses the individual's feelings and thoughts accurately 4. Allows achievement of short-term and long-term goals by the individual

1. Fits within standards accepted by one's society

What is the basic therapeutic tool used by the nurse to foster a client's psychological coping? 1. Self 2. Milieu 3. Helping process 4. Client's intellect

1. Self

The nurse who works in a sleep clinic knows that approximately __________% of adults suffer from insomnia.

30 to 40

The 39-year-old daughter of a client with a terminal illness tells the nurse that she thinks something is wrong with her because she frequently cries, is often sad, and cant imagine losing her mother. The nurse assures the daughter that these are normal feelings associated with:

Anticipatory grief

Which disorder is associated with persons with a body weight that is normal or even slightly above average?

Bulimia

What is the main issue for adolescents with anorexia?

Control

Place the steps of grieving in proper chronological order.

Denial Yearning Depression and identification Acceptance and recovery

Which is a typical symptom of posttraumatic stress disorder?

Flashbacks

Sleep disorders that are characterized by abnormal behavioral or physical events during sleep are called:

Parasomnias

Persons may refuse to acknowledge that a loss has occurred during the first stage of:

The grieving process

A female client is taking a benzodiazepine for her anxiety disorder. She complains of anorexia and nausea since she started taking the medication a few days ago. What is the nurses best response?

Try taking the medication with food or milk and see if the symptoms improve

A learned response to an anticipated event, such as when the person who does not like to fly experiences nausea and sweaty palms before boarding the airplane, is best described as: a. A normal anxiety response b. Signal anxiety c. An anxiety state d. An anxiety trait

b

Depression in the elderly is: a. Rare b. Common c. Nonexistent d. Seen occasionally

b

The theorist Eric Berne theorized that an individuals three ego states of parent, child, and adult make up ones: a. Conscience b. Personality c. Thought processes d. Ability to communicate

b

A client response to the termination phase of the therapeutic relationship is withdrawal. This response most often is manifested by client behaviors such as: a. bringing up new problems b. being absent from appointments c. returning to maladaptive behaviors d. having increased anxiety

being absent from appointments

A disorder defined as daily moderate depression that lasts longer than 2 years is called a(n) ____ disorder. a. Anxiety b. Bipolar c. Dysthymic d. Major depressive

c

Most psychosomatic problems and somatoform disorders begin in: a. Puberty b. Adulthood c. Childhood d. Adolescence

c

A therapeutic relationship has four phases. Place these phase in proper order. a. orientation b. termination c. preparation d. working

c, a, d, b

When a caregiver becomes a role model for a client during therapeutic relationship the caregiver is functioning in the role of a: a. teacher b. therapist c. technician d. change agent

change agent

The human physiological stress response mechanism is also called the ____ response. a. Startle b. Neuroleptic c. Homeostasis d. Fight-or-flight

d

Limit setting in facilities, such as rules for television use in the recreation room or visiting hours, aids in the client's feelings of: a. personal identity b. privacy c. safety and security d. high self-esteem

safety and security

______________ refers to the process of achieving one's full potential in life.

self-actualization

Which age group through the life cycle has the most difficult time relating to their own death?

Adolescent

Which of the following are therapeutic interventions for unresolved grief? (Select all that apply.)

Listening Providing emotional support Referring to appropriate resources

According to Glaser and Strauss, the closed awareness model can be applied to family, friends, care providers, and the dying individual. Which of the following statements are true of the closed awareness model? (Select all that apply.)

Medical personnel and family keep the condition secret from the client. Dying client feels isolated from the ability to share with family. Dying client becomes suspicious of the truth, and information is tightly controlled by family.

A family experiences the loss of their wife and mother to a car accident. Which family member reacts by asking When is mommy coming back?

The 4-year-old son

Several studies have demonstrated that significant ____ changes occur in people who displayed hostile or negative behaviors. a. Attitudinal b. Behavioral c. Gastrointestinal d. Immune-mediated

d

The characteristic of genuineness helps i establishing a therapeutic relationship with a client. Which nurse response is the best example of display of genuineness to a client who is going through a difficult divorce? a. "I know exactly how you feel. My husband and I divorced 2 years ago because of his infidelity." b. "Divorcing my husband was the best thing I ever did." c. "I have friends who have gone through a divorce. It must be difficult for you." d. "I am sorry that you have to go through this difficult time."

"I have friends who have gone through a divorce. It must be difficult for you."

The nurse is caring for a female client with a diagnosis of severe disorder. Out of many treatment methods, the one treatment that the client and the team have found to be most effective is the medication lithium. The client voices concern about her future with this diagnosis. Which nurse response best represents the concept of hope? a. "You need to take your lithium unless you want to relapse?" b. "You are doing so well that there is nothing you can't do if you put your mind to it." c. "You are doing very well since we found that lithium helps. You should do well as long as you continue your therapy and medication." d. "A lot of people are much worse off than you are, so you should be thankful that you are doing as well as you are."

"You are doing very well since we found that lithium helps. You should do well as long as you continue your therapy and medication.

The nurse is attempting to develop trust with a newly admitted female client for the purpose of establishing a therapeutic relationship. The nurse is in the middle of administering medications to all client on the unit upon the client's arrival to the unit. The client asks the nurse to sit and talk with her for awhile. What is the nurse's best response? a. "I am busy right now, but I will come back later." b. "Give me just a few more minutes to finish passing medications to the other clients." c. "I will return I 20 minutes so we can talk." d. 'I have to finish giving all the clients their medications, but I will then come back so we can talk."

'I have to finish giving all the clients their medications, but I will then come back so we can talk."

A college student is brought to the mental health clinic by his parents. The diagnosis is borderline personality disorder. Which factors in the client's history support this diagnosis? (Select all that apply.) 1. Impulsiveness 2. Lability of mood 3. Ritualistic behavior 4. Psychomotor retardation 5. Self-destructive behavior

1. Impulsiveness 2. Lability of mood 5. Self-destructive behavior

A client who had to be cut out of a car after a motor vehicle collision has no visible physical effects from the ordeal. The client responds to the emergency department nurse's questions factually in a soft voice with a composed manner. This behavior may indicate that the client: 1. Is controlling the expression of feelings 2. Has repressed the details of the accident 3. Has blocked out the events of the last few hours 4. Is experiencing the reorganization phase of the trauma experience

1. Is controlling the expression of feelings

A client with a diagnosis of borderline personality disorder (BPD) has negative feelings toward the other clients on the unit and considers them all "bad." Which defense is the client using when identifying the other clients thusly? 1. Splitting 2. Ambivalence 3. Passive aggression 4. Reaction formation

1. Splitting

For which adverse effect should the nurse continually observe a client who is receiving valproic acid (Depakene)? 1. Yellow sclerae 2. Motor restlessness 3. Ringing in the ears 4. Torsion of the neck

1. Yellow sclerae **Yellow sclerae are a sign of jaundice; pancreatitis and hepatic failure are life-threatening adverse effects of valproic acid (Depakene).

The parents of a toddler with recently diagnosed moderate cognitive impairment discuss their child's possibility of future independent function. What should the nurse conclude? 1. They accept the child's diagnosis. 2. Denial is being used as a defense. 3. They want to explore their child's limitations. 4. Intellectualization helps them put the diagnosis into perspective.

2. Denial is being used as a defense.

A client is admitted to the psychiatric hospital with a diagnosis of obsessive-compulsive disorder. The client's anxiety level is approaching a panic level, and the client's ritual is interfering with work and daily living. Which selective serotonin reuptake inhibitor (SSRI) should the nurse anticipate that the health care provider may prescribe? 1. Haloperidol (Haldol) 2. Fluvoxamine (Luvox) 3. Imipramine (Tofranil) 4 .Benztropine (Cogentin)

2. Fluvoxamine (Luvox) **Fluvoxamine (Luvox) inhibits central nervous system neuron uptake of serotonin but not of norepinephrine.

An injured child is brought to the emergency department by the parents. While interviewing the parents, the nurse begins to suspect child abuse. Which parental behaviors might support this conclusion? (Select all that apply.) 1. Demonstrating concern for the injured child 2. Focusing on the child's role in sustaining the injury 3. Changing the story of how the child sustained the injury 4. Asking questions about the injury and the child's prognosis 5. Giving an explanation of how the injury occurred that is not consistent with the injury

2. Focusing on the child's role in sustaining the injury 3. Changing the story of how the child sustained the injury 5. Giving an explanation of how the injury occurred that is not consistent with the injury

The nurse should first discuss terminating the nurse-client relationship with a client during the: 1. Working phase, when the client initiates it 2. Orientation phase, when a contract is established 3. Working phase, when the client shows some progress 4.Termination phase, when discharge plans are being made

2. Orientation phase, when a contract is established

Which psychotherapeutic theory uses hypnosis, dream interpretation, and free association as methods to release repressed feelings? 1. Behaviorist model 2. Psychoanalytical model 3. Psychobiological model 4. Social-interpersonal model

2. Psychoanalytical model

The nurse is caring for a client experiencing a crisis. What role is most important for the nurse to assume when providing therapeutic crisis intervention? 1. Passive listener 2. Friendly adviser 3. Active participant 4. Participant observer

3. Active participant

What developmental task should the nurse consider when caring for toddlers? 1. Trust 2. Industry 3. Autonomy 4. Identification

3. Autonomy

A nurse encourages a client to attend Alcoholics Anonymous (AA) meetings after discharge. What do self-help groups such as AA help their members do? 1. Set long-term goals 2. Limit excessive drinking 3. Foster changes in behavior 4. Identify underlying causes of behavior

3. Foster changes in behavior

A client with depression is to be given fluoxetine (Prozac). What precaution should the nurse consider when initiating treatment with this drug? 1. It must be given with milk and crackers to avoid hyperacidity and discomfort. 2. Eating cheese or pickled herring or drinking wine may cause a hypertensive crisis. 3. The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks. 4. The blood level should be checked weekly for 3 months to monitor for an appropriate level.

3. The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks. **Fluoxetine (Prozac) does not produce an immediate effect; nursing measures must be continued to reduce the risk for suicide

Thirty minutes after administering fluphenazine (Prolixin) to a client, the nurse notes that the client's jaw is rigid, the client is drooling, and her speech is slurred. There are a number of as-needed prescriptions in the client's chart. What should the nurse administer? 1. Diazepam (Valium), 10 mg by mouth 2. Trihexyphenidyl (Artane), 1 mg by mouth 3. Haloperidol (Haldol), 2 mg intramuscularly 4. Benztropine (Cogentin), 2 mg intramuscularly7

4. Benztropine (Cogentin), 2 mg intramuscularly7 **Benztropine (Cogentin) is an anticholinergic, antiparkinsonian drug used to treat drug-induced extrapyramidal symptoms associated with phenothiazine therapy; the intramuscular (IM) route will relieve symptoms more rapidly.

A young mother of three children, all born 1 year apart, has been hospitalized after trying to hang herself. The client is being treated with milieu therapy. The nurse understands that this therapeutic modality consists of: 1. Providing individual and family therapy 2. Using positive reinforcement to reduce guilt 3. Uncovering unconscious conflicts and fantasies 4. Manipulating the environment to benefit the client

4. Manipulating the environment to benefit the client

The concerns of children in whom terminal conditions have been diagnosed focus on how the illness affects the childs:

Activities of daily living

A client with a diagnosis of anorexia is admitted to an inpatient setting. Which therapeutic intervention is used with caution prior to stabilization and weight gain?

Administering antidepressants

A 10-year-old patient on a childrens oncology unit has had an unsuccessful bone marrow transplant. The family is distraught but remains positive in front of the child. One night the child asks the nurse about death and dying. What counseling should the nurse give to the parents?

Allow the child to have an honest discussion about dying.

Which statements best describe an anxiety disorder? (Select all that apply.)

Anxiety is expressed in ineffective ways. Coping mechanisms do not relieve anxiety

Following the funeral of her husband, the wife is seen crying and holding his picture. She is demonstrating __________.

Bereavement

The behavioral state of thoughts, feelings, and activities that follow a loss is called:

Bereavement

The client lost her husband of 50 years 10 months ago. She now sees every day as a gray fog with no light. She has begun to experience changes in eating, sleeping, and activity levels; angry, hostile moods; and an inability to concentrate or complete work tasks. What is the client experiencing?

Bereavement-related depression

During an episode of binge eating, what type of food is usually consumed in large amounts?

Cakes, donuts, or sweets

A policeman complains of feeling tired and not able to sleep for an extended period of time after being assigned to work the night shift. He is most likely suffering from

Circadian rhythm sleep disorder

The death rate from anorexia is higher than any other mental illness. Death usually results from which of the following? (Select all that apply.)

Dehydration Loss of critical muscle mass Electrolyte imbalances Suicide

The last stage of growth and development is called:

Dying

The nurse is meeting with a client suffering from agoraphobia who recently moved to the United States from a country where acts of violence and civil unrest are common. The theoretical model that links anxiety to the uncontrollable events the client experienced in his previous country is the ________ model.

Environmental

What are the criteria for the diagnosis of bulimia? (Select all that apply.)

Excessive emphasis placed on body shape and weight Eating binges at least twice per week for at least 3 months

Trends that have contributed to the recent increase in eating disorders in the United States include a(n):

Focus on being thin as a measure of attractiveness

Adolescents who ineffectively cope with anxiety often express their anxiety through:

Inappropriate behaviors

__________ occurs when an individual who has experienced a loss is working through or resolving his or her grief.

Mourning

A disorder that interrupts normal sleep patterns and is characterized by repeated, brief jerks of the arms and legs that occur every 20 to 60 seconds during the beginning of sleep is called:

Nocturnal myoclonus

When care is provided for a dying client in pain, addiction to analgesics is:

Not an issue

A client has constant thoughts about locking his front door every time he leaves his house. This client is experiencing a(n):

Obsession

An adolescent caught stealing a classmates laptop says that he needed it to write his paper and the classmate has enough money to buy another one anyway is demonstrating which of the following defense mechanisms?

Rationalization

When a client has a mild level of anxiety, his or her emotional response is:

Relaxed and calm

To assist them with their grief experiences, many health care facilities offer caregivers who work with dying clients:

Support groups

A person with terminal cancer makes a call to a family member she has not spoken to in 30 years in order to make amends. According to Kbler-Ross, what stage of dying is this person in?

Working

The father of three young children dies. The wife expresses how worried she is about how to raise the children on her own without the support of her husband. She finds herself crying and living through each day without accomplishing anything. In which grieving stage is this behavior typically experienced?

Yearning

In order to be therapeutic when communicating with a client living in a homeless shelter, it is important to apply which techniques? (Select all that apply.) a. Show acceptance and respect. b. Avoid clarifying terms. c. Use medical terminology to avoid talking down. d. Consider the clients environment. e. Assess clients pattern of verbal and nonverbal communication.

a, d, e

A client seen in the community mental health clinic appears for one appointment in multiple layers of brightly colored clothing. Her speech is very pressured, and she is telling everyone in the waiting room about a date she had the previous evening. The next visit she is dressed in old, drab clothes and has no makeup on. She has a flat affect and is not making eye contact. The most probable cause of her behaviors is which of the following conditions? a. Bipolar I disorder b. Psychosis c. Bipolar II disorder d. Major depressive episode

a

The moods of adolescents: a. Are stable b. Vary widely c. Develop slowly d. Are not related to growth and development

b

Which client is suffering from a major depressive episode? a. An adolescent who expresses feeling lost after the death of his mother last week b. A 50-year-old male who has been depressed for a month and is contemplating suicide c. A 30-year-old female who is being treated for episodes of depression she has suffered since the age of 21 d. An elderly adult who feels like she is in a fog after the diagnosis of terminal cancer given to her 8 days ago

b

_____________ refers to the ability of the nurse to establish a meaningful connection with a client.

rapport

Antipsychotic drugs can cause extrapyramidal side effects. Which responses should the nurse document as indicating pseudoparkinsonism? (Select all that apply.) 1. Rigidity 2. Tremors 3. Mydriasis 4. Photophobia 5. Bradykinesia

1. Rigidity 2. Tremors 5. Bradykinesia

Somatization disorder is a polysymptomatic disorder, which means that the disorder is associated with ____ symptoms. a. Few signs and b. Polymorphic c. Many signs and d. Specific signs and

c

What statement by a 45-year-old woman scheduled for an abdominal hysterectomy and bilateral salpingo-oophorectomy should alert the nurse to the potential for postoperative coping difficulties? 1. "I'm not the least bit worried." 2. "I don't want any more children." 3. "I get along very well with my husband." 4. "I'll be glad not to have any more periods."

1. "I'm not the least bit worried." **Not being worried indicates potential denial and possible failure to address the problem emotionally

Certain questions are applicable in determining nursing negligence. (Select all that apply.) 1. "Was reasonable care provided?" 2. "Was there a breach of nursing duty?" 3. "Was there an act of omission that resulted in harm? 4. "Except for the nurse's action, would the injury have occurred?" 5. "Did the nurse fully understand the actions would result in harm?"

1. "Was reasonable care provided?" 2. "Was there a breach of nursing duty?" 3. "Was there an act of omission that resulted in harm? 4. "Except for the nurse's action, would the injury have occurred?"

One day while shaving, a male client with the diagnosis of bipolar disorder tells the nurse, "I've hidden a razor blade, and tonight I'm going to kill myself." What is the best reply by the nurse? 1. "You're going to kill yourself?" 2. "Things really can't be that bad." 3. "Are you sure you really mean that?" 4. "Killing yourself is not going to solve your problems."

1. "You're going to kill yourself?"

The nurse is working with a client who talks freely about feeling depressed. During the interaction the client states, "Things will never change." What findings support the nurse's conclusion that the client is experiencing hopelessness? (Select all that apply.) 1. Bouts of crying 2. Self-destructive acts 3. Presence of delusions 4. Feelings of worthlessness 5. Intense interpersonal relationships

1. Bouts of crying 2. Self-destructive acts 4. Feelings of worthlessness

Sildenafil (Viagra) is prescribed for a man with erectile dysfunction. A nurse teaches the client about common side effects of this drug. (Select all that apply.) 1. Flushing 2. Headache 3. Dyspepsia 4. Constipation 5. Hypertension

1. Flushing 2. Headache 3. Dyspepsia

A psychiatric nurse is hired to work in the psychiatric emergency department of a large teaching hospital. While reviewing the manuals, the nurse reads, "People with mental health emergencies shall be triaged within 5 minutes of entering the emergency department." What does the nurse consider this statement to represent? 1. Hospital policy 2. Standard of care 3. Hospital procedure 4. Mental Health Bill of Rights

1. Hospital policy

A primary nurse notes that a client has become jaundiced after 2 weeks of antipsychotic drug therapy. The nurse continues to administer the antipsychotic until the health care provider can be consulted. What does the nurse manager conclude about this situation? 1. Jaundice is sufficient reason to discontinue the antipsychotic. 2. Jaundice is a benign side effect of antipsychotic agents that has little significance. 3. The blood level of an antipsychotic drug must be maintained once it has been established. 4 .The prescribed dosage for the antipsychotic agent should have been reduced by the nurse.

1. Jaundice is sufficient reason to discontinue the antipsychotic.

The nurse anticipates that the medication that will be used to prevent symptoms of withdrawal in clients with a long history of alcohol abuse is: 1. Lorazepam (Ativan) 2. Phenobarbital (Luminal) 3. Chlorpromazine (Thorazine) 4. Methadone hydrochloride (Methadone)

1. Lorazepam (Ativan) **Lorazepam (Ativan) is most effective in preventing the signs and symptoms associated with withdrawal from alcohol.

A client is to begin lithium carbonate therapy. The nurse should ensure that before the drug's administration the client has baseline: 1. Renal studies 2. Liver enzyme studies 3. Adrenal function studies 4. Pulmonary function studies 5. New Choice 6. New Choice 7. New Choice

1. Renal studies

A 17-year-old client is admitted to the hospital because of weight loss and malnutrition, and the health care provider diagnoses anorexia nervosa. After the client's physical condition is stabilized, the provider, in conjunction with the client and parents, decides to institute a behavior-modification program. What component of behavior modification verbalized by one of the parents leads the nurse to conclude that the parent has an understanding of the therapy? 1. Rewarding positive behavior 2. Deconditioning fear of weight gain 3. Decreasing unnecessary restrictions 4. Reducing anxiety-producing situations

1. Rewarding positive behavior

What is the most appropriate intervention for the nurse to implement after finding a disturbed client in bed in the fetal position? 1. Sitting down in a chair by the client and saying, "I'm here to spend time with you." 2. Touching the client gently on the shoulder and saying, "I'm going to sit with you for a while." 3. Going to the client and saying, "I'll be waiting for you in the community room, so please get up and join me." 4. Leaving the client alone because the behavior demonstrates that the client has regressed too far to benefit from talking with the nurse

1. Sitting down in a chair by the client and saying, "I'm here to spend time with you."

According to Erikson, a child's increased vulnerability to anxiety in response to separation or pending separation from significant others results from failure to complete a developmental stage. What does the nurse call this stage? 1. Trust 2. Identity 3. Initiative 4. Autonomy

1. Trust

A nurse is monitoring a client with the diagnosis of schizophrenia who is experiencing opposing emotions simultaneously. When providing a change-of-shift report, how should the nurse refer to this emotional experience of the client? 1. Double bind 2. Ambivalence 3. Loose association 4. Inappropriate affect

2. Ambivalence

With the client's permission, the nurse should inform the family about what is happening. The main reason for this action is that informed families: 1. Ease the client's anxiety 2. Are better equipped to assist the client 3. Appear more relaxed with the situation 4. Commonly cause fewer nursing problems

2. Are better equipped to assist the client

A client with a diagnosis of paranoid schizophrenia throws a chair across the room and starts screaming at the other clients. Several of these clients have frightened expressions, one starts to cry, and another begins to pace. A nurse removes the agitated client from the room. What should the nurse remaining in the room do next? 1. Continue the unit's activities as if nothing has happened 2. Arrange a unit meeting to discuss what has just happened 3. Refocus clients' negative comments to more positive topics 4. Have a private talk with the clients who cried and started to pace

2. Arrange a unit meeting to discuss what has just happened

The way individuals cope with an unexpected hospitalization depends on many factors. However, the one that is most significant is: 1. Cognitive age 2. Basic personality 3. Financial resources 4. General physical health

2. Basic personality

A client is admitted with a conversion disorder. What is the primary nursing intervention? 1. Talking about the physical problems 2. Exploring ways to verbalize feelings 3. Explaining how stress caused the physical symptoms 4. Focusing on the client's concerns regarding the symptoms

2. Exploring ways to verbalize feelings

A nurse in the mental health clinic concludes that a client is using confabulation when: 1. The flow of thoughts is interrupted 2. Imagination is used to fill in memory gaps 3. Speech flits from one topic to another with no apparent meaning 4. Connections between statements are so loose that only the speaker understands them

2. Imagination is used to fill in memory gaps **Using imagination to fill in memory gaps is the definition of confabulation; it is a defense mechanism used by people experiencing memory deficits.

An older retired client is visiting the clinic for a regularly scheduled checkup. The client tells the nurse about the great life he has lived and the activities that he enjoys at the senior center. According to Erikson, what developmental conflict has been resolved by this client? 1. Trust versus mistrust 2. Integrity versus despair 3. Generativity versus self-absorption 4. Autonomy versus shame and doubt

2. Integrity versus despair

A nurse teaches dietary guidelines to a client who will be receiving tranylcypromine sulfate (Parnate), a monoamine oxidase inhibitor (MAOI). The client compiles a list of foods to avoid. Which foods included on the list indicate that the teaching has been effective? (Select all that apply.) 1. French fries 2. Pepperoni pizza 3. Bologna sandwich 4 . Hamburger on a bun 5 . Hash brown potatoes

2. Pepperoni pizza 3. Bologna sandwich

After several interactions with a client, the nurse at the mental health clinic identifies a pattern of withdrawal and nonparticipation in situations requiring communication with others. In which area should the nurse expect the client to have difficulty? 1. Personal identity 2. Social interaction 3. Sensory perception 4. Verbal communication

2. Social interaction

What is an initial client objective in relation to anger management? 1. Expressing remorse over aggressive actions 2. Taking responsibility for the hostile behavior 3. Developing alternative methods to release feelings 4. Teaching others how to avoid triggering the angry behavior

2. Taking responsibility for the hostile behavior

Symptoms of obsessive-compulsive disorder can occur in children as young as _____ years old.

3

One morning a client tells the nurse, "My legs are turning to rubber because I have an incurable disease called schizophrenia." The nurse identifies that this as an example of: 1. Hallucinations 2. Paranoid thinking 3. Depersonalization 4. Autistic verbalization

3. Depersonalization

A client in the mental health clinic who has been seeing a therapist for more than 6 months begins to talk and act like a therapist who is analyzing coworkers. What defense mechanism does the nurse identify? 1. Undoing 2. Projection 3. Introjection 4. Intellectualization

3. Introjection **Introjection is treating something outside the self as if it is actually inside the self; it is unconsciously incorporating the wishes, values, and attitudes of another as if they were one's own.

A group of clients from a psychiatric unit, accompanied by staff members, are going to a professional baseball game. The purpose of visits into the community under the supervision of staff members is: 1. Helping clients adjust to stressors in the community 2. Helping clients return to reality under controlled conditions 3. Observing the clients' abilities to cope with a more complex society 4. Broadening the clients' experiences by providing exposure to cultural activities

3. Observing the clients' abilities to cope with a more complex society

How long after the last dose should the nurse schedule to have a client's blood drawn to evaluate the serum lithium level? 1. 2 to 4 hours 2. 4 to 6 hours 3. 6 to 8 hours 4. 8 to 12 hours

4. 8 to 12 hours

Imipramine (Tofranil), 75 mg three times per day, is prescribed for a client. What nursing action is appropriate when this medication is being administered? 1. Telling the client that barbiturates and steroids will not be prescribed 2. Warning the client not to eat cheese, fermented products, and chicken liver 3. Monitoring the client for increased tolerance and reporting when the dosage is no longer effective 4. Having the client checked for increased intraocular pressure and teaching about symptoms of glaucoma

4. Having the client checked for increased intraocular pressure and teaching about symptoms of glaucoma **Glaucoma is one of the side effects of imipramine (Tofranil), and the client should be taught the symptoms.

It is estimated that __________%of clients with mental health disorders do not comply with their prescribed treatment plan. a. 10 to 20 b. 20 to 70 c. 40 to 50 d. 40 to 80

40 to 80

The group best able to accept their losses and grow from their experiences is:

Adults

The collection of perceptions, thoughts, feelings, and behaviors that relate to one's size and appearance is called

Body image

The treatment team and a male client in whom obsessive-compulsive disorder associated with hand washing has been diagnosed decide on a treatment plan for the disorder. The nurse begins to implement the plan by having the client gradually extend the time between hand washes. This intervention is an example of which type of therapy?

Desensitization

The nurse is aware that several theories have been proposed to explain anxiety. Which theory explains anxiety as a result of interactions with others?

Interpersonal model

Which symptoms may be seen in a person who is having a panic attack? (Select all that apply.)

Shortness of breath Fear of dying Palpitations Chills Feelings of depersonalization

The client lives his life by rapidly bouncing from feelings of deep sadness to great joy. The clients diagnosis is most likely: a. Bipolar disorder b. Major depression c. An anxiety disorder d. Dysthymic disorder

a

The goal of treatment during the first phase of depression is to: a. Develop a plan for treatment. b. Reduce uncooperative behaviors. c. Help the client to adjust to antidepressants. d. Reduce symptoms and inappropriate behaviors

d

A nurse who talks to teens about the dangers of tanning beds in causing skin cancer but loves to tan herself and does so before she goes on vacation is using which defense mechanism?

Substitution

A male client is so preoccupied with his thinning hair that he is missing work and avoiding social gatherings. This client is exhibiting signs of: a. Hypochondriasis b. Conversion disorder c. Body dysmorphic disorder d. Factitious disorder

c

A client who usually is very active in her therapy group tells the nurse that she really does not feel well today and would rather not attend the group therapy session. Which is the nurses most appropriate response? a. You dont feel like attending the group therapy today? b. I will just stay with you for a while. c. Its okay to skip a session every once in a while. d. Why dont you want to attend group therapy?

a

A female client frequently complains of chest pain, has had extensive physiological testing with negative results, and sees several different medical doctors. This client is exhibiting signs and symptoms characteristic of: a. Hypochondriasis b. Conversion disorder c. Body dysmorphic disorder d. Factitious disorder

a

A male client with a diagnosis of schizophrenia begins to have hallucinations during a conversation with the nurse; this prevents him from receiving the message that the nurse is trying to communicate to him. According to Rueschs theory of communication, this unsuccessful interaction is called _____ communication. a. Disturbed b. Nontherapeutic c. Blocked d. Therapeutic

a

A woman arrives at the hospital complaining of chest pains and shortness of breath. She has come in several times over the past two 2 weeks and the staff is doubtful that her symptoms are real. What is the first action for the health care team to implement? a. Complete a history, physical, and diagnostics. b. Arrange for a psychiatric consult. c. Provide discharge instructions and arrange for a follow-up visit. d. Obtain a prescription for an antianxiety agent

a

The client complains of severe back pain and is excused from work. Later, he is seen water skiing and jogging. These behaviors describe: a. Malingering b. Somatization c. Hypochondriasis d. A factitious disorder

a

The nursing student is assigned a client to interview and is asked to practice the therapeutic communication technique of sharing perceptions. Which statement made by the student nurse best describes this technique? a. I noticed that you pace the halls, and you have a tense look on your face. I sense that you are anxious about something. b. Can you tell me more about how you feel when you are arguing with your daughter? c. I would like to talk with you about your plan of care. d. Tell me if I understand you correctly.

a

The physiological stress response has an effect on _____ system(s). a. Many body b. Only the nervous c. The gastrointestinal d. The cardiovascular and respiratory

a

Which interventions assist the nurse to effectively communicate with clients from other cultures? (Select all that apply.) a. The nurse adapts his or her behavior to accommodate the difference in communication styles. b. The nurse identifies and clarifies confusion during the interaction. c. The nurse recognizes the difference between communication styles and assists the client to change to the nurses communication style. d. The nurse uses a limited number of slang terms when communicating with the client.

a, b

Which nurse responses could block effective communication with a client? (Select all that apply.) a. This is what I think you should say b. Dont stress over it. Everything will turn out fine. c. Why did you do that? d. Most people in your circumstance

a, b, c, d

Which elements must be present for communication to occur? (Select all that apply.) a. Feedback b. Transmission c. Sender d. Clarification e. Receiver f. Focusing g. Context

a, b, c, e, g

For which role is the caregiver responsible in a therapeutic relationship? Select all that apply. a. teacher b. therapist c. technician d. friend e. change agent f. confidante

a, b, c,e

Inpatient services provided care mainly for mental health clients who are experiencing which conditions? Select all that apply. a. acute mental or emotional problems b. chronic metal or emotional problems c. depression d. crisis e. bipolar disorder

a, b, d

Which are common causes for client noncompliance in the plan of care? Select all that apply. a. financial concerns b. lack of support by family c. staff dislike of a client d. inability to understand the treatment plan e. lack of access to treatment services

a, b, d, e

Which qualities must be communicated to a client for the establishment of a therapeutic relationship between the nurse and the client? Select all that apply. a. genuineness b. love c. rapport d. acceptance e. enjoyment

a, c, d

Which of the following are characteristics of somatoform disorders? (Select all that apply.) a. Relieve anxiety b. Decrease depression c. Have no organic medical source d. Are related to a medical condition e. Significantly impair ones level of functioning f. Often occur in those who must cope with illness g. Occur in clients who are unaware of or unable to express emotional distress

a, c, e, g

Which group of medications for depression will the nurse tell the client to take at bedtime? (Select all that apply.) a. Tricyclic antidepressants b. Nontricyclic antidepressants c. Monoamine oxidase inhibitors (MAOIs) d. Selective serotonin reuptake inhibitors (SSRIs)

a, d

Which of the following statements are true regarding depression in the elderly? (Select all that apply.) a. Highest rates are among individuals who receive long-term care. b. It is a normal consequence of aging. c. Most depressed older adults volunteer to share their feelings. d. Depression is higher in elderly women than elderly men. e. Older adults express feelings of depression in more subtle ways than younger persons.

a, d, e

Which statements regarding depression are correct? (Select all that apply.) a. It occurs in all age groups. b. It rarely occurs in the elderly. c. It occurs in men more often than in women. d. It occurs in women more often than in men. e. It is rarely seen but is severe when it occurs. f. It is common in those who must cope with illness. g. It is one of the most common and treatable mental disorders

a, d, f, g

An adult female inpatient client with a diagnosis of paranoid schizophrenia will not take her medications form the nurse. She states, "I know you are poisoning that medicine. That's why you put it int those little cups." Which nursing action is most appropriate? a. promise the client that the staff would not do anything to harm her b. let the client watch the medication preparation process c. administer medications to her in unit dose packages so that she can open the packages herself d. allow the client to retrieve the medications out of the medication cart with supervisoin

administer medications to her in unit dose packages so that she can open the packages herself

The nurse can assist a client best in meeting his or her needs for self-esteem and/or self-actualization by: a. setting rules and regulations b. allowing the client to set rules and regulations for the impatient unit c. informing the client what the treatment team has decide regarding the plan of care d. allowing the client to make choices involving his or her care when appropriate

allowing the client to make choices involving his or her care when appropriate

A male client with bipolar disorder who takes lithium tells the nurse that he has been nauseous a lot lately, feels tired, and has had some blurry vision. The client most likely is suffering from what level of lithium toxicity? a. Insignificant b. Mild c. Moderate d. Severe

c

An important aspect of developing a therapeutic relationship with a mental health client is for the nurse to show that she cares about the client. The nurse who is working on an inpatient unit can show signs of caring by: a. telling a client several times a day that he or she cared about him or her b. asking a client what his or her favorite movie is, then showing that movie during a movie night on the unit c. giving a client a car that has a sentiment that say the nurse c are about him or her d. telling a client that he or she is the favorite client

asking a client what his or her favorite movie is, then showing that movie during a movie night on the unit

A female client on the mental health unit experiences periods of psychosis at intervals. She often asks what day she came to the facility and what day it is now, and she seems never to be aware of the time. Which nursing intervention would help this client the most? a. remind her of the time of day every time she asks b. assist her to keep a written schedule, including her day of admission, on a calendar posted in her room and a clock beside the calendar. c. tell her it doesn't really matter what day she came to the facility; what matters is what day and time it is now d. instruct the staff to not answer her repetitive questions she has been told numerous times her day of admission, and there is a clock on the wall

assist her to keep a written schedule, including her day of admission, on a calendar posted in her room and a clock beside the calendar.

The nurse enters the room of a male client who demonstrates suspicious tendencies. As the curse walks through the room, the client yells, " Get away from my closet." What is the nurse's most appropriate action? a. ask the client what he has in the closet that is so important b. avoid getting close to the closet c. inform the client that because of his actions, the staff will have to examine the contents of the closet d. inspect the client's closet when the client is involved in an activity away from the unit

avoid getting close to the closet

A client with major depressive disorder is scheduled for electroconvulsive therapy (ECT). Which point will the nurse teach the client? a. ECT treatments take about 1 hour. b. You will most likely receive between 6 and 12 treatments over several weeks. c. ECT often is used as one of the first treatments for major depression. d. ECT treatments help your depression by decreasing levels of the neurotransmitter norepinephrine

b

A nurse has just graduated from nursing school and has been hired on a mental health unit. The nurse wants to practice good communication skills with clients but knows that a mistake made by many new nurses in trying to communicate effectively involves: a. Focusing b. Parroting c. Restating d. Clarifying

b

La belle indifference is a characteristic that most often is associated with: a. Anxiety reaction b. Conversion disorder c. Depressive disorder d. Posttraumatic stress reaction

b

Once the acute feelings of illness are resolved, what is an appropriate intervention when treating a client with a psychosocial problem? a. Avoid expression of feelings as this will provide a relapse of acute symptoms. b. Minimize secondary gains. c. Convey an attitude that such behavior is not acceptable. d. Assist the client to limit social network to avoid additional stress

b

Severe, prolonged depression affects a persons risk for physical illness by ____ the risk. a. Decreasing b. Increasing c. Not affecting d. Having little effect on

b

The client can acknowledge the possibility that she exaggerates her symptoms, but she continues to hold on to the belief that something is physically wrong, in the face of evidence to the contrary. What is the clients diagnosis most likely to be? a. Malingering b. Hypochondriasis c. A conversion reaction d. Body dysmorphic disorder

b

The client tells the nurse that she believes there is no improvement in her manic episodes. Her clothing matches, and her makeup is more subdued. She sits quietly in the chair during the session. What does this indicate? a. Verbal communication takes priority. b. Verbal communication is not congruent with nonverbal communication. c. Nonverbal communication indicates the client is lying. d. Nonverbal communication should take priority.

b

The main feature of a factitious disorder is that symptoms are purposefully produced to allow the individual to: a. Get out of work. b. Assume the sick role. c. Assume control of treatment. d. Get the attention of health care providers.

b

The nurse asks a client how she is feeling, and the client provides a detailed description of everything she is experiencing. This is an example of: a. Echolalia b. Circumstantiality c. Neologism d. Perseveration

b

The nurse must be alert to signs of suicidal thoughts with clients in whom major depressive disorders have been diagnosed because approximately _____ die from suicide. a. 5% b. 15% c. 25% d. 35%

b

Theories that view depression as a group of learned responses are called ____ theories. a. Social b. Behavioral c. Biological d. Psychoanalytical

b

Which of the following are indicative of hypochondriasis? (Select all that apply.) a. Symptoms most commonly appear in early childhood. b. First diagnosed following a severe stressor. c. More frequent in person exposed to a serious illness in childhood. d. Sufferers usually have strained interpersonal relationships

b, c, d

A client has difficulty in communicating as a result of his illness. He displays a rapid, confusing delivery of speech patterns. Which term best describes this difficulty in communicating? a. Aphasia b. Dyslexia c. Speech cluttering d. Incongruent communications

c

A female client has been attending group therapy for support regarding an abusive relationship with her husband. The client voices concern about her 10-year-old daughter growing up in this environment but states that she just cant find the strength to leave her husband. The nurse responds by using the nontherapeutic technique of reassuring. Which statement is the best example of this nontherapeutic technique? a. I cant believe that you would want your daughter to grow up in this environment. b. I understand your concern. Let me give you some information on our local council for domestic abuse. c. Im sure it wont be that bad to be out on your own. I know you can do it. d. I think you should not think about leaving and should just do it.

c

The nurse is talking with a male client regarding his recent relapse of alcohol addiction. The client alludes to the fact that he started to drink again after a fight with his wife. The nurse uses clarification to ensure an accurate understanding of the client. Which statement is the best example of clarification? a. You said that the fight you had with your wife caused you to start drinking again? b. Lets discuss what made you feel the need to drink. c. Could you tell me again when and what happened that you feel caused you to start drinking again? d. Tell me what your childhood was like

c

Therapeutic communication techniques support effective communication between the client and the nurse. Which group of therapeutic techniques is most likely to be effective when one is conversing with a client? a. Broad openings, restating, and advising b. Clarification, focusing, and confrontation c. Listening, silence, and reflection d. Humor, informing, and reassuring

c

When the adolescent client is asked about the magazine she is reading, she responds, Its an article about my favorite movie star. Did you see all the stars out last night? I used to be afraid of the dark at night. Which speech pattern is this an example of? a. Echolalia b. Flight of ideas c. Loose association d. Neologism

c

Which client would be a candidate for ECT? a. A client with mild depression b. A severely depressed client with congestive heart failure c. A client with severe, long-lasting depression d. A severely depressed client with history of a brain tumor

c

Which nurse response is the best example of the therapeutic principle of respect? a. Im interested in what you have to say. b. Describe how you are feeling for me. c. I hear how worried you are about your future and can imagine how you feel. d. You signed a contract stating that you would let me know when you have those thoughts

c

While the nurse is talking with a female client, the client becomes silent for several seconds. Which is the nurses best response? a. To interpret this action as an indication that the client is finished with the conversation b. To ask the client a question so the interaction can continue c. To remain silent and be attentive to the clients nonverbal communication d. To tell the client that help can be more effective if she shares her feelings

c

During the night shift, several staff members are being loud at the nurses' station of an inpatient mental health unit. The nurse asks them to "hold down the noise." The nurse has asked this of the staff most likely because she knows that excessive noise: a. does not present a professional environment b. encourages excessive client noise c. can interfere with client's thinking processes and perceptions d. causes relaxation in clients

can interfere with client's thinking processes and perceptions

A male client with schizophrenia has lost his job and home and has been living in a homeless shelter. He voluntarily admits himself into a mental health treatment facility. The clients' current living situation and lack of a job at this time likely will contribute to his having difficulty with which dimension of hope? a .affective b. contextual c. temporal d. affiliative

contextual

The nurse is preparing an adult male client, who has been successfully treated for a social phobia, for the termination phase of the therapeutic relationship. During their last meeting, the client told the nurse that he noticed he has developed a nervous habit that started a few days ago of checking his door at home several times a day to be sure it is looked. This client is exhibiting the client response to termination known as: a. continuation b. regression c. withdrawal d. confabulation

continuation

The nurse who is caring for a client begins to have a very protective feelings toward the client that are interfering with the therapeutic relationship between the nurse, the client,and the client's family. This is an example of a problem that is encountered in some therapeutic relationship and is knows as: a. an environmental problem b. resistance c. transference d. countertransference

countertransference

A client asks the nurse which types of antidepressants have the fewest side effects. What is the nurses most accurate response? a. Tricyclic antidepressants b. Nontricyclic antidepressants c. Monoamine oxidase inhibitors (MAOIs) d. Selective serotonin reuptake inhibitors (SSRIs)

d

A female client discusses her feelings of jealousy regarding the relationship between her mother and her daughter. The nurse responds in a nontherapeutic way by making a statement that is defensive and challenging. Which statement is the best example of a defensive and challenging nontherapeutic response? a. Tell me more about the feelings you have regarding their relationship. b. I think that you should tell them how you feel. c. Lets not talk about that right now. d. Dont you think that you should be thankful that your daughter has a good relationship with her grandmother?

d

A female client is being discharged from an inpatient mental health unit after receiving treatment for bipolar disorder. She has responded well to treatment but voices concern about going home and maintaining balance in her life. The client would benefit most by a response from the nurse that conveyed the therapeutic communication principle of: a. Permission b. Respect c. Interest d. Protection

d

A mother brings her 9-month-old son to the emergency department because he stopped breathing at home. She demands that he receive a full diagnostic work-up. When asked for the name of her pediatrician, she states she has not found one she is satisfied with. The nurse suspects: a. Projection b. Malingering c. Conversion disorder d. Munchausens syndrome by proxy

d

During the continuation phase of therapy, a client with a diagnosis of depression asks, What is the goal of therapy during this 4- to 9-month period? What is the nurses best response? a. We are going to work together to try to reduce your symptoms. b. Our goal is to determine the cause of your depression and cure it. c. We want to prevent you from ever having any depressive episodes in the future. d. Our goal is to prevent you from relapsing and experiencing distressing emotional states.

d

In the __________ culture, mental and emotional disorders are expressed as somatoform complaints on the basis of the belief that the body is the property of the ancestors. a. Japanese b. Hispanic c. Southeast Asian d. Korean

d

Recent studies have demonstrated that daily exposure to full-spectrum light (phototherapy) is most effective in improving symptoms in people who are experiencing: a. Bipolar disorder b. Moderate depression c. Postpartum depression d. Seasonal affective disorder

d

The nurse is talking with a male client with a diagnosis of schizophrenia who often experiences auditory hallucinations. For this communication to be most effective, the nurse should: a. Sit with the client and encourage him to not verbalize. b. Do most of the talking. c. Discuss several different topics to keep the clients attention. d. Use simple, concrete language.

d

When practicing therapeutic communication with a client, the nurse demonstrates which of the following listening skills? a. Finishing the clients sentences to indicate listening b. Not clarifying messages to avoid interrupting c. Avoiding taking notes to detract from listening d. Changing the environment to decrease distractions

d

Which one of the following are biological causes of mood disorders? a. Anger turned inward b. Impaired nurturing c. Reactions to external stressors d. Imbalance of neurotransmitters

d

Your client is a wife and mother who, in addition to doing most of the household tasks, has a difficult time saying no to helping out with functions at school and church. Based on Fromms psychodynamic theory, what illness is she more prone to develop? a. Cardiac problems b. High blood pressure c. Alcoholism d. Gastric ulcer

d

In which groups does postpartum depression occur more frequently? (Select all that apply.) a. Older mothers b. Younger mothers c. Women who do not have a husband d. Women who have had a difficult delivery e. Women who experienced complicated pregnancies f. Those who are also coping with illness g. Women who are not emotionally prepared for motherhood

d, e, g

A male client is in the process of being admitted to a mental health facility. He is sure that the nurse is the administrator of the hospital, despite the nurse's insistence that he is a staff nurse on the unit. This client is experiencing: a. acute confusion b. visual hallucinations c. delusions d. auditory hallucinations

delusions

A 15 y/o female client is noted to often sit alone in the activity room of the facility while watching television. She often begins to join in activities on the unit but then retreats back to her room. Which intervention is most appropriate in this situation? a. encourage her to join in on a group activity and actively participate in the activity with her until she feels more comfortable on her own b. keep encouraging her to participate in the group activity c. offer her rewards, such as extended television privileges, for joining in a group activity d. offer her support as she tries to become more involved in activities

encourage her to join in on a group activity and actively participate in the activity with her until she feels more comfortable on her own

A female client with obsessive-compulsive disorder is undergoing treatment in an outpatient setting and is attending group therapy sessions. She is working on controlling setting and is attending group therapy sessions. She is working on controlling the compulsion of touching her head three times every time she talks. To maintain the therapeutic relationship established with the client, by which action can the nurse show acceptance? a. ignoring the compulsion during the group therapy session and talking with the client about the behavior b. asking the group to remind the client every time she touches her head to help her consciously stop the compulsion c. pointing out the compulsion to the group each time the client exhibits the behavior d. asking the client to stop talking during the group session until she has learned to control her compulsion

ignoring the compulsion during the group therapy session and talking with the client about the behavior

A male inpatient client who is experiencing depression has no interest in eating. He skips meals frequently and has been losing weight. What is the best nursing action in this situation? a. ask the client to "Please eat one meal for me" b. leave food with him at meal time and offer snacks frequently c. give the client information on the benefits of good nutrition d. remove client privileges every time he doesn't eat

leave food with him at meal time and offer snacks frequently

Encouragement for clients to practice good hygiene habits not only meets basic physiological needs, it also meets the hierarchical need of: a. love and belonging b. safety and security c. infection control d. self-care

love and belonging

_________ describes the setting environment in which mental health care is provided.

milieu

The nurse should monitor the temperature of the environment of a client who becomes easily agitated, with awareness that increased temperatures sometimes may cause the client to become: a. calm b. confused c. cooperative d. more distressed

more distressed

The nurse is aware that during the admission process to a mental health facility, the anxious client: a. is acutely aware of his or her surroundings b. often forgets some of what is said in the unfamiliar surroundings c. has a keen memory in his or her heightened state of awareness d. frequently has not recollection of what is said by the staff during admission

often forgets some of what is said in the unfamiliar surroundings

When should the nurse begin preparations for the termination phase of a therapeutic relationship? a. during the orientation phase b. prior to last meeting c. during the last meeting d. after all goals have been meet

prior to last meeting

A male client with a diagnosis of schizophrenia refuses to take his medications because of his paranoia that the medication may be poisoned. Frequent inpatient readmission to the facility occur as a result. Which term is given to repeated inpatient admissions? a. milieu b. chronicity c. noncompliance d. recidivism

recidivism

A 19 y/o male client is being treated for a drug addiction. He continually voices his dread of being discharged because he knows he will have to live with his parents and follow their rules until he can earn enough money to live on his own.He is showing increasing resistance to treatment measures, such as attending group sessions, but is refusing to acknowledge that he has an addiction or that he needs treatment. Which behavior is the client demonstrating? a. transference b. primary resistance c. secondary resistance d. tertiary resistance

secondary resistance

A 30 y/o man is brought to the mental health inpatient unit with diagnosis of schizophrenia. His clothes are dirty, his hair is uncombed, he has not shaved for several days, and his teeth are chipped, with several cavities evident. He is having hallucinations and delusions. What is the priority nursing diagnosis at this time? a. ineffective coping, individual b. therapeutic regiment management, ineffective c. self-care deficit: bathing, hygiene d. confusion, chronic

self-care deficit: bathing, hygiene

Bright colors in the environment of the client are often: a. depressing b. stimulating c. calming d. frightening

stimulating

A female client is admitted with suicidal tendencies. The client is place in suicide precautions for the the first 24 hours of her stay. Ensuring client safety is included in the therapeutic role of: a. change agent b. teacher c. therapist d. technician

technician

A therapeutic relationship differs from other relationships in that the focus of a therapeutic relationship is on: a. the client b. establishing a friendships c. the nurse d. the plan of care

the client

Which is an accepted criterion for inpatient admission to a mental health facility? a. the client likes the security and comfort of the mental health facility b. the client feels that he is no linger able to cope with life stressors or maintain control of his behavior c. a client's behavior becomes unusual d. the client suffers from depression

the client feels that he is no linger able to cope with life stressors or maintain control of his behavior

A nurse is working with a male client health outpatient clinic. The client voices a desire to become autonomous. Which goal will assist the client in becoming more autonomous? a. the client will check his calendar each night to plan for commitments scheduled on the following day b. the nurse will remind the client weekly of his appointment at the clinic for the following week c. the client will ask the nurse to call him to remind him of his appointment d. the nurse will complete the clients calendar of daily commitment scheduled for the week

the client will check his calendar each night to plan for commitments scheduled on the following day

During the preparation phase of a therapeutic relationship with a client, what is the main task to be completed by the nurse? a. to establish with the client the purpose of the relationship b. to gather and review all possible information c. to build trust withe the client d. to obtain agreement from the client to work in conjunction with the nurse

to gather and review all possible information

The acronym, TEACH represents the components of a therapeutic relationship: ____________ , _____________ ,____________ and ______________.

trust, empathy, autonomy, caring, hope

A 16 y/o female client with a eating disorder is an inpatient at a mental health clinic. A mutually agreed upon goal is for her to limit her amount of exercise to 1 hour per day and to consume at least 1000 calories per day for 1 week. This is an example of an interaction that occur during which phase of the therapeutic relationship? a. orientation b. preparation c. working d. termination

working

One afternoon a nurse sees a client rushing down the hall of the mental health unit, rapidly tapping his fingers against the wall. What is the most appropriate nursing action at this time? 1. Approaching the client in a nonthreatening manner to determine the cause of the agitation 2. Summoning additional staff members to forcefully subdue the client and stop the acting-out behavior 3. Observing the client to see whether the behavior escalates and whether it may pose a risk to other clients or staff 4. Immediately obtaining staff assistance to enable administration of medication prescribed for the client's agitation

1. Approaching the client in a nonthreatening manner to determine the cause of the agitation

The nurse should suspect that a client who had a recent myocardial infarction is experiencing denial when the client: 1. Attempts to minimize the illness 2. Lacks an emotional response to the illness 3. Refuses to discuss the condition with the client's spouse 4. Expresses displeasure with the prescribed activity program

1. Attempts to minimize the illness

What characteristic is most essential for the nurse caring for a client undergoing mental health care? 1. Empathy 2. Sympathy 3. Organization 4. Authoritarianism

1. Empathy **Empathy—understanding and to some extent sharing the emotions of another—encourages the expression of feelings. Empathy is an essential tool in caring for emotionally ill clients.

A child in the first grade is murdered, and counseling is planned for the other children in the school. What should a nurse identify first before evaluating a child's response to a crisis? 1. Developmental level of the child 2. Quality of the child's peer relationships 3. Child's perception of the crisis situation 4. Child's communication patterns with family members

1. Developmental level of the child **Rationale: Knowledge of the developmental level is essential to understanding a child's response to a crisis situation; the variety of coping abilities usually increases as the child progresses through the stages of growth and development.

On the psychiatric unit a client has been receiving high doses of haloperidol (Haldol) for 2 weeks. The client says, "I just can't sit still, and I feel jittery." Which side effect does the nurse suspect that the client is experiencing? 1. Akathisia 2. Torticollis 3. Tardive dyskinesia 4. Parkinsonian syndrome

1. Akathisia **Akathisia, a side effect of haloperidol (Haldol), develops early in therapy and is characterized by restlessness and agitation.

A parent of four is remanded to the psychiatric unit by the court for observation. The client was arrested and charged with abusing a 2-year-old son, who is in the pediatric intensive care unit in critical condition. The nurse approaches the client for the first time. How should the nurse anticipate that the client will likely respond? (Select all that apply.) 1. By denying beating the son 2. By avoiding talking about the situation 3. By expressing excessive concern for the son 4. By asking where the other three children are 5. Emotional response is inconsistent with degree of injury

1. By denying beating the son 2. By avoiding talking about the situation 5. Emotional response is inconsistent with degree of injury

An adult who has been in a gay relationship for 3 years arrives at the emergency department in a state of near-panic. The client says, "My partner just left me. I'm a wreck." What should the nurse do to help the client cope with this loss? (Select all that apply.) 1. Identify the client's support systems 2. Explore the client's psychotic thoughts 3. Reinforce the client's current self-image 4. Encourage the client to talk about the situation 5 . Suggest that the client explore personal sexual attitudes

1. Identify the client's support systems 4. Encourage the client to talk about the situation

Which nursing intervention involves providing, structuring, and maintaining a safe and therapeutic environment in collaboration with patients, families, and other health care providers? 1. Milieu therapy 2. Coordination of care 3. Health teaching and health maintenance 4. Pharmacologic, biologic, and integrative therapies

1. Milieu therapy **Milieu therapy involves providing, structuring, and maintaining a safe and therapeutic environment in collaboration with psychiatric patients, families, and other health care providers.

A client is receiving doxepin (Sinequan). For which most dangerous side effect of tricyclic antidepressants should a nurse monitor the client? 1. Mydriasis 2. Dry mouth 3. Constipation 4. Urine retention

1. Mydriasis

A nurse is teaching clients about dietary restrictions during monoamine oxidase inhibitor (MAOI) therapy. What response does the nurse tell them to anticipate if they do not follow these restrictions? 1. Occipital headaches 2. Generalized urticaria 3. Severe muscle spasms 4. Sudden drop in blood pressure

1. Occipital headaches

When intimate partner violence (IPV) is suspected, the nurse plays an important role as an advocate for the victim. The advocate role includes several important components. (Select all that apply.) 1. Planning for future safety 2. Normalizing victimization 3. Validating the experiences 4 .Promoting access to community services

1. Planning for future safety 3. Validating the experiences 4 .Promoting access to community services

A young client who has become a mother for the first time is anxious about her new parenting role. With the nurse's encouragement, she joins the new mothers' support group at the local YMCA. What kind of prevention does this activity reflect? 1. Primary prevention 2. Tertiary prevention 3. Secondary prevention 4. Therapeutic prevention

1. Primary prevention

When talking with a client who has alcoholism, the nurse notes that the client becomes irritable, makes excuses, and blames family and friends for the drinking problem. Which defense mechanisms does the nurse conclude that the client is using? (Select all that apply.) 1. Projection 2. Suppression 3. Sublimation 4. Identification 5. Rationalization

1. Projection 5. Rationalization **Projection is the unconscious denial of unacceptable feelings and emotions in one's self while attributing them to others. This defense mechanism commonly is used by clients with alcoholism because it helps make reality more acceptable. Rationalization is making acceptable excuses for behavior; this defense is used by people with alcoholism because it makes reality more acceptable.

A client with the diagnosis of schizophrenia, paranoid type, has been receiving a phenothiazine drug. The daycare center is planning a fishing trip. It is important that the nurse: 1. Provide the client with sunscreen 2. Caution the client to limit exertion during the trip 3. Give the client an extra dose of medication to take after lunch 4. Take the client's blood pressure before allowing him to participate in the outing

1. Provide the client with sunscreen

A client begins fighting and biting other clients. The practitioner prescribes a stat injection of haloperidol (Haldol). How should the nurse implement this prescription? 1. Quickly, with an attitude of concern 2. Before the client realizes what is happening 3. After the client agrees to receive the injection 4. Quietly, without any explanation of the reason for it

1. Quickly, with an attitude of concern **Quickness is used for safety; an attitude of concern may help reduce the client's anxiety.

What should a nurse ensure when creating an environment that is conducive to psychological safety? 1. Realistic limits are set. 2. Passive acceptance is promoted. 3. The client's physical needs are met. 4. The physical environment is kept in order

1. Realistic limits are set.

An older female client is concerned about maintaining her independent living status. What initial intervention strategy is of primary importance? 1. Reinforcing routines and supporting her usual habits 2. Helping her secure assistance with cleaning and shopping 3. Writing down and repeating important information for her use 4. Setting clear goals and time limitations for her visits with the nurse

1. Reinforcing routines and supporting her usual habits

A depressed client often sleeps past the expected time of awakening and spends excessive time resting and sleeping. Which nursing intervention is appropriate for this client? 1. Restricting the client's access to the bedroom 2. Offering the client a series of relaxation tapes 3. Rescheduling the client's bedtime to an earlier hour 4. Suggesting that the client exercise before going to bed

1. Restricting the client's access to the bedroom **The goal is 6 to 8 hours of rest at night; too much time spent sleeping in the daytime will defeat the goal of adequate rest at night.

The nurse refers a client to a self-help group. What does the nurse anticipate that a self-help groups such as Alcoholics Anonymous (AA) will help its members learn? 1. That their problems are not unique 2. That they do not need a crutch to lean on 3. That their problems are caused by alcohol 4. That the group can stop them from drinking

1. That their problems are not unique **Sharing problems with others who have similar problems can help one explore feelings and begin to enhance coping abilities.

Amitriptyline (Elavil) is an antidepressant medication used to treat anxiety disorders. Which class of antidepressant medications does it belong to? 1. Tricyclics 2. Monoamine oxidase inhibitors (MAOIs) 3. Selective serotonin reuptake inhibitors (SSRIs) 4. Serotonin-norepinephrine reuptake inhibitors (SNRIs)

1. Tricyclics

Oral chlordiazepoxide (Librium) 100 mg/ hr is prescribed for a client with a Clinical Institute Withdrawal Assessment (CIWA) score of 25. The client has had 300 mg in 3 hours but is still displaying acute alcohol withdrawal symptoms. What is the next nursing action? 1. Informing the client that the limit of chlordiazepoxide has been reached 2. Administering chlordiazepoxide as indicated by the client's CIWA score 3. Requesting a prescription for another medication to replace the chlordiazepoxide. 4. Informing the health care provider that the maximum dose of chlordiazepoxide has been reached

2. Administering chlordiazepoxide as indicated by the client's CIWA score **Medication of clients in acute withdrawal from alcohol should be based on withdrawal symptoms, not medication dosage.

A 2½-year-old child is admitted for treatment of injuries supposedly sustained in a fall down a flight of stairs. Child abuse is suspected. What statements might the nurse expect from a parent who engages in child abuse? (Select all that apply.) 1. "Kids have to learn to be careful on the stairs." 2. "Every time I turn around the kid is falling over something." 3. "He tends to be adventurous and doesn't understand about getting hurt on the stairs." 4. "I can't understand it. He didn't have a problem using the stairs without my help before this." 5. "I try to keep an eye on him, but little kids are always on the go and I just can't keep running after him."

2. "Every time I turn around the kid is falling over something." 4. "I can't understand it. He didn't have a problem using the stairs without my help before this."

Before a treatment requiring informed consent can be performed, what information must the client be given? (Select all that apply.) 1. The cost of the treatment 2. Alternative treatment options 3. The risks and benefits of the treatment 4.The risks involved in refusing the treatment 5. The nature of the problem requiring the treatment

2. Alternative treatment options 3. The risks and benefits of the treatment 4.The risks involved in refusing the treatment 5. The nature of the problem requiring the treatment

A hospitalized 7-year-old boy wakes up crying because he has wet his bed. It is most appropriate for the nurse to: 1. Allow the child to change his bed and pajamas 2. Change the child's bed while he changes his pajamas 3. Take the child to the bathroom and change his pajamas 4. Remind the child to call the nurse next time to avoid the need to change his pajamas

2. Change the child's bed while he changes his pajamas **Changing the child's bed while the child changes his pajamas will not call attention to the accident and will minimize the child's embarrassment.

A recently married 22-year-old woman is brought to the trauma center by the police. She has been robbed, beaten, and sexually assaulted. The client, although anxious and tearful, appears to be in control. The health care provider prescribes alprazolam (Xanax) 0.25 mg for agitation. The nurse should administer this medication when the: 1. Client's crying increases 2. Client requests something to calm her 3. Nurse determines a need to reduce her anxiety 4. Health care provider is getting ready to perform a vaginal examination

2. Client requests something to calm her **Because a sexual assault is a threat to the sense of control over one's life, some control should be given back to the client as soon as possible.

A client has been prescribed chlorpromazine (Thorazine) for the management of positive symptoms of schizophrenia. When the client reports difficulty sustaining an erection, the nurse: 1. Reassures him this side effect will resolve in a few weeks 2. Consults with his provider regarding alternative medication therapies 3. Explains that all conventional antipsychotic medications cause impotence 4. Provides additional medication education to explain the medication's side effects in detail

2. Consults with his provider regarding alternative medication therapies

A woman who is emotionally and physically abused by her husband calls a crisis hotline for help. The nurse works with the client to develop a plan for safety. What should be included in the safety plan? (Select all that apply.) 1. Limiting contact with the abuser 2. Determining a safe place to go in an emergency 3. Memorizing the domestic violence hotline number 4. Obtaining a bank loan to finance leaving the abuser 5. Arranging for a family member to assist her in leaving

2. Determining a safe place to go in an emergency 3. Memorizing the domestic violence hotline number

Neuroleptic malignant syndrome is a potentially fatal reaction to antipsychotic therapy. What signs and symptoms of this syndrome should the nurse identify? (Select all that apply.) 1. Jaundice 2. Diaphoresis 3. Hyperrigidity 4. Hyperthermia 5. Photosensitivity

2. Diaphoresis 3. Hyperrigidity 4. Hyperthermia **Diaphoresis, hyperrigidity, and hyperthermia occur with neuroleptic malignant syndrome as a result of dopamine blockade in the hypothalamus.

A client on the psychiatric unit is undergoing a pretreatment evaluation for electroconvulsive therapy (ECT). Because of the client's profoundly depressed behavior, the nurse doubts that the client can provide informed consent. What should the nurse's initial intervention be? 1. Consulting with the hospital's legal staff and following their recommendation 2. Having the client verbalize her understanding and the outcomes of the procedure 3. Asking the client to sign the consent form because the client has not been declared incompetent 4. Suggesting to the health care provider that a family member sign the consent form for the client

2. Having the client verbalize her understanding and the outcomes of the procedure

When a newly admitted client with paranoid ideation tells the nurse about people coming through the doors to commit murder, the nurse should: 1. Ignore the client's stories 2. Listen to what the client is saying 3. Explain that no one can get through the door 4. Ask for an explanation of where the information was obtained

2. Listen to what the client is saying

A 23-year-old woman is admitted to a psychiatric unit after several episodes of uncontrolled rage at her parents' home, and borderline personality disorder is diagnosed. While watching a television newscast describing an incident of violence in the home, the client says, "People like that need to be put away before they kill someone." The nurse concludes that the client is using: 1. Denial 2. Projection 3. Introjection 4. Sublimation

2. Projection **Projection is the process of attributing one's thoughts about one's self to others.

A client who is being treated in a mental health clinic is to be discharged after several months of therapy. The client anxiously tells the nurse, "I don't know what I'll do when I can't see you anymore." The nurse determines that the client is: 1. Expressing thanks to the nurse 2. Reacting to the planned discharge 3. Attempting to manipulate the nurse 4. Indicating a need for further treatment

2. Reacting to the planned discharge

A health care provider writes a prescription of "Restraints PRN" for a client who has a history of violent behavior. What is the nurse's responsibility in regard to this order? 1. Asking that the order indicate the type of restraint 2. Recognizing that PRN orders for restraints are unacceptable 3. Implementing the restraint order when the client begins to act out 4. Ensuring that the entire staff is aware of the order for the restraints

2. Recognizing that PRN orders for restraints are unacceptable

A client sits huddled in a chair and leaves it only to assume the fetal position in a corner. The nurse, observing this, identifies the behavior as: 1. Reactive 2. Regressive 3. Dissociative 4. Hallucinatory

2. Regressive **Curling up in a corner reflects the early fetal position; the individual curls up for both protection and security

After an automobile collision involving a fatality and a subsequent arrest for speeding, a client has amnesia regarding the events surrounding the accident. Which defense mechanism is being used by the client? 1. Projection 2. Repression 3. Suppression 4. Rationalization

2. Repression

An older client whose family has been visiting on the psychiatric unit is visibly angry and says to the nurse, "My daughter-in-law says they can't take me home until the doctor lets me go. She doesn't understand how important this is to me; she's not from our culture." What should the nurse do? 1. Ignore the statement for the present 2. Say, "You feel she doesn't want you at home. 3. Reflect on the client's feelings about the cultural differences 4. Respond, "The doctor is the one who makes decisions about discharge."

2. Say, "You feel she doesn't want you at home.

The emergency department nurse is conducting an interview and assisting with the physical examination of a female sexual assault victim. What is most important for the nurse to document on this client's record? 1. Observations about the client's reaction to male staff members 2. Statements by the client about the sexual assault and the rapist 3. Information about the client's previous knowledge of the rapist 4. Summary statement about the client's description of the assault and the rapist

2. Statements by the client about the sexual assault and the rapist

A health care provider prescribes haloperidol (Haldol) for a client. What should the nurse teach the client to avoid while taking this medication? 1. Driving at night 2. Staying in the sun 3. Ingesting aged cheeses 4. Taking medications containing aspirin

2. Staying in the sun **Haloperidol (Haldol) causes photosensitivity. Severe sunburn may occur on exposure to the sun.

An executive, busy at work, receives a phone call from a friend relating bad news. The woman makes a conscious effort to put this information out of her mind and continues to work at the task at hand. The next day she remembers that her friend telephoned her but is unable to recall the message. Which defense mechanism does this behavior represent? 1. Regression 2. Suppression 3. Passive aggression 4. Reaction formation

2. Suppression **Suppression is the voluntary exclusion from awareness of anxiety-producing feelings, ideas, and situations.

A client with a history of aggressive, violent behavior is admitted to the psychiatric unit involuntarily. The nurse, who understands the need to use deescalation approaches during the preassaultive stage of the violence cycle, monitors the client's behavior closely for progression of signs of impending violence. List these client behaviors in order of escalating aggression, from the lowest risk to the highest. 1.Pacing in the hall 2.Increasing tension in facial expression 3.Engaging in verbal abuse toward the nurse 4.Pushing another client while waiting in line to the dining room 5.Having difficulty waiting to take turns during a group project

2.Increasing tension in facial expression 5.Having difficulty waiting to take turns during a group project 1.Pacing in the hall 3.Engaging in verbal abuse toward the nurse 4.Pushing another client while waiting in line to the dining room

A client asks the nurse how psychotropic medications work. The nurse correctly replies: 1. "These medications decrease the metabolic needs of your brain." 2. "These medications increase the production of healthy nervous tissue." 3. "These medications affect the chemicals used in communication between nerve cells." 4. "These medications regulate the sensory input received from the external environment."

3. "These medications affect the chemicals used in communication between nerve cells."

In response to a question posed during a group meeting, the nurse explains that the superego is that part of the self that says: 1. "I like what I want." 2. "I want what I want." 3. "I shouldn't want that." 4. "I can wait for what I want."

3. "I shouldn't want that." **Conscience and a sense of right and wrong are expressed in the superego, which acts to counterbalance the id's desire for immediate gratification.

A family member brings a relative to the local community hospital because the relative "has been acting strange." Which statements meet involuntary hospitalization criteria? (Select all that apply.) 1. "I cry all the time; I'm just so sad." 2 . "Since I retired I've been so depressed." 3. "I'd like to end it all with sleeping pills." 4 . "The voices say I should kill all prostitutes." 5 . "My boss makes me so angry—he's always picking on me."

3. "I'd like to end it all with sleeping pills." 4 . "The voices say I should kill all prostitutes." **Rationale: The statement about ending it all is a suicide threat; it is a direct expression of intent without action. Likewise, the threat to harm others must be heeded.

A nurse leads an assertiveness training program for a group of clients. Which statement by a client indicates that the treatment has been effective? 1. "I know that I should put the needs of others before mine." 2. "I won't stand for it, so I told my boss he's a jerk and to get off my back." 3. "It annoys me when people call me 'sweetie,' so I told him not to do it anymore." 4. "It's easier for me to agree up front and then do just enough so that no one notices."

3. "It annoys me when people call me 'sweetie,' so I told him not to do it anymore."

In conjunction with which classification of medication are trihexyphenidyl, biperiden (Akineton), and benztropine (Cogentin) often prescribed? 1. Anxiolytics 2. Barbiturates 3. Antipsychotics 4. Antidepressants

3. Antipsychotics

What is the most therapeutic nursing intervention to help a late-middle-aged individual cope with the emotional aspects of aging? 1. Focusing on the individual's past experiences 2. Having the individual attend lectures on aging 3. Assisting the individual with plans for the future 4. Encouraging the individual to focus on his or her career

3. Assisting the individual with plans for the future **Helping an individual maintain an interest in the future is therapeutic. It is forward looking and fosters a positive attitude.

As the nurse is discussing psychiatric care with an older adult client, the client says, "When I was growing up I was taught to accept my lot in life and not complain. I'm proud of the fact that despite my issues I can still function independently. I don't want to be just put away." The nurse understands that the factors that influence the client's mental health are examples of: 1. Setting of care 2. Anxiety disorder 3. Attitudes and beliefs 4. Cultural and ethnic disparities

3. Attitudes and beliefs

A parent whose daughter is killed in a school bus accident tearfully tells the nurse, "My daughter was just getting over the chickenpox and didn't want to go to school, but I insisted that she go. It's my fault that she's dead." How should the nurse anticipate that perceiving a death as preventable will likely influence the grieving process? 1. The loss may be easier to understand and accept. 2. The mourner may experience pathological grief. 3. Bereavement may be of greater intensity and duration. 4. The grieving process may progress to a psychiatric illness

3. Bereavement may be of greater intensity and duration.

What should a nurse recognize that a client who uses the defense mechanism of sublimation is doing? 1. Acting out in reverse something already done or thought 2. Returning to an earlier, less mature stage of development 3. Channeling unacceptable impulses into socially approved behavior 4. Excluding from consciousness thoughts that are psychologically disturbing

3. Channeling unacceptable impulses into socially approved behavior

A client is admitted for treatment of obsessive-compulsive disorder that is interfering with activities of daily living. Which medication should the nurse anticipate the health care provider will prescribe? 1. Benztropine (Cogentin) 2. Amantadine (Symmetrel) 3. Clomipramine (Anafranil) 4. Diphenhydramine (Benadryl)

3. Clomipramine (Anafranil)

A male college student who is smaller than average and unable to participate in sports becomes the life of the party and a stylish dresser. What defense mechanism does the nurse determine that the client is using? 1. Introjection 2. Sublimation 3. Compensation 4. Reaction formation

3. Compensation **By developing skills in one area, the individual compensates for a real or imagined deficiency in another, thereby maintaining a positive self-image.

On the first day of the month a practitioner prescribes an antipsychotic medication for a client with schizophrenia. The initial dosage is 25 mg once a day, to be titrated in increments of 25 mg every other day to a desired dosage of 175 mg daily. On what day of the month will the client reach the desired daily dose of 175 mg? 1. Day 7 2. Day 9 3. Day 13 4. Day 15

3. Day 13 **The client will reach the desired dosage of 175 mg on the 13th day of the month; on the first day it is 25 mg, on the third day it is 50 mg, on the fifth day it is 75 mg, on the seventh day it is 100 mg, on the ninth day it is 125 mg, on the 11th day it is 150 mg, and on the 13th day it is 175 mg.

What is the most difficult initial task in the development of a nurse-client relationship? 1. Remaining therapeutic and professional 2. Being able to understand and accept a client's behavior 3. Developing an awareness of self and the professional role in the relationship 4. Accepting responsibility for identifying and evaluating the real needs of a client

3. Developing an awareness of self and the professional role in the relationship **The nurse's major tool in mental health nursing is the therapeutic use of self. Mental health nurses must learn to identify their own feelings and understand how they affect the situation.

A health care provider refers a 52-year-old man to the mental health clinic. The history reveals that the man lost his wife to colon cancer 6 months ago and that since that time he has seen his health care provider seven times with the concern that he has colon cancer. All tests have had negative results. Recently the client stopped seeing friends, dropped his hobbies, and stayed home to rest. Which disorder should the nurse identify as consistent with the client's preoccupation with the fear of having a serious disease? 1. Conversion disorder 2. Somatization disorder 3. Hypochondriac disorder 4. Body dysmorphic disorder

3. Hypochondriac disorder **Preoccupation with fears of getting or having a serious disease is called hypochondriasis

A nurse is caring for an adolescent who has anorexia nervosa. The nutritional treatment of anorexia is composed of several guidelines. Which guidelines should the nurse emphasize? (Select all that apply.) 1. Increasing high-fiber foods 2. Eating just three meals a day 3. Increasing food intake gradually 4. Limiting mealtime to half an hour 5. Providing privileges for goal achievement

3. Increasing food intake gradually 4. Limiting mealtime to half an hour 5. Providing privileges for goal achievement

A client is receiving a monoamine oxidase inhibitor (MAOI). What should the nurse teach the client? 1. It is necessary to avoid the sun. 2. Drowsiness is an expected side effect of this medication. 3. The therapeutic and toxic levels of the drug are very close. 4. Many prescribed and over-the-counter drugs cannot be taken with this medication

4. Many prescribed and over-the-counter drugs cannot be taken with this medication

A client with schizophrenia who has type II (negative) symptoms is prescribed risperidone (Risperdal). Which outcomes indicate that the medication has minimized these symptoms? (Select all that apply.) 1.There is less agitation. 2.There are fewer delusions. 3. More interest is shown in unit activities. 4. The client reports that the hallucinations have stopped. 5. The client performs activities of daily living independently.

3. More interest is shown in unit activities. 5. The client performs activities of daily living independently.

Which tool is used to standardize and measure nursing treatments? 1. Nursing Outcomes Classification (NOC) 2. NANDA-I-Approved Nursing Diagnoses 3. Nursing Interventions Classification (NIC) 4. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

3. Nursing Interventions Classification (NIC) **Nursing Interventions Classification (NIC) is a tool that helps to define nursing interventions, as well as helps to standardize and measure the nursing care provided.

What should the nurse do to develop a trusting relationship with a disturbed child who acts out? 1. Ask the child's feelings about the parents 2. Implement one-on-one interactions every half hour 3. Offer support and encourage safety during play activities 4. Begin setting limits and explain the rules that must be followed

3. Offer support and encourage safety during play activities

Methylphenidate (Ritalin) is prescribed to treat a 7-year-old child's attention deficit-hyperactivity disorder (ADHD). The nurse understands that methylphenidate is used in the treatment of this disorder in children for its: 1. Diuretic effect 2. Synergistic effect 3. Paradoxical effect 4. Hypotensive effect

3. Paradoxical effect **Methylphenidate (Ritalin), a stimulant, has an opposite effect on hyperactive children; the reason for this action is as yet totally unexplained

What should the nurse do when a client with the diagnosis of schizophrenia talks about being controlled by others? 1. Express disbelief about the client's delusion 2. Divert the client's attention to unit activities 3. React to the feeling tone of the client's delusion 4. Respond to the verbal content of the client's delusion

3. React to the feeling tone of the client's delusion

A client has been prescribed lithium. What important nursing intervention must be implemented while this medication is being administered? 1. Restricting the client's daily sodium intake 2. Testing the client's urine specific gravity weekly 3. Regularly testing the level of the drug in the client's blood 4. Withholding the client's other medications for several days

3. Regularly testing the level of the drug in the client's blood

A 19 year-old, arrested for assault and robbery, has a history of truancy and prostitution but is unconcerned that her behavior has caused emotional distress to others. The diagnosis of antisocial personality disorder is made. According to psychoanalytical theory, the client's lack of remorse and repetitive behavior probably are related to an underdeveloped: 1. Id 2. Ego 3. Superego 4. Limbic system

3. Superego

A nurse is caring for a client who is experiencing a crisis. Which nervous system is primarily responsible for the clinical manifestations that the nurse is likely to identify? 1. Central nervous system 2. Peripheral nervous system 3. Sympathetic nervous system 4. Parasympathetic nervous system

3. Sympathetic nervous system **The sympathetic nervous system reacts to stress by releasing epinephrine, which prepares the body to fight or flee by increasing the heart rate, constricting peripheral vessels, and increasing oxygen supply to muscles.

A young female client admitted to the trauma center after being sexually assaulted continues to talk about the rape. Toward what goal should the primary nursing intervention be directed? 1. Getting her involved with a rape therapy group 2. Remaining available and supportive to limit destructive anger 3. Exploring her feelings about men to promote future relationships 4. Providing a safe environment that permits the ventilation of feelings

4. Providing a safe environment that permits the ventilation of feelings

A client with schizophrenia is started on an antipsychotic/neuroleptic medication. The nurse explains to a family member that this drug primarily is used to: 1. Keep the client quiet and relaxed 2. Control the client's behavior and reduce stress 3. Reduce the client's need for physical restraints 4. Make the client more receptive to psychotherapy

4. Make the client more receptive to psychotherapy

A woman who is frequently physically abused tells the nurse in the emergency department that it is her fault that her husband beats her. What is the most therapeutic response by the nurse? 1. "Maybe it was your husband's fault, too." 2. "I can't agree with that—no one should be beaten." 3. "Tell me why you believe that you deserve to be beaten." 4. "You say that it was your fault—help me understand that."

4. "You say that it was your fault—help me understand that."

A nurse determines that confrontation is an appropriate tool for use with a client. What is an example of therapeutic confrontation? 1. "I find that hard to believe." 2. "I noticed that you're not wearing any makeup today." 3. "You feel frustrated because you think your mother doesn't understand you." 4. "You say you're not a good parent, but you were effective when you were talking with your son today."

4. "You say you're not a good parent, but you were effective when you were talking with your son today."

An older man is widowed suddenly when his wife is killed in an automobile accident. What should the nurse in the emergency department do first to best help the client at this time? 1. Ask a member of the clergy to visit him 2. Have the practitioner prescribe a sedative for him 3. Refer him to a support group that meets near his home 4. Assure him that everything possible was done for his wife

4. Assure him that everything possible was done for his wife

A nurse is teaching a client about side effects of medications. Which drug will cause a heightened skin reaction to sunlight? 1. Lithium 2. Sertraline 3. Methylphenidate 4. Chlorpromazine

4. Chlorpromazine

In the process of development the individual strives to maintain, protect, and enhance the integrity of the self. The nurse determines that this is usually accomplished through the use of: 1. Affective reactions 2. Withdrawal patterns 3. Ritualistic behaviors 4. Defense mechanisms

4. Defense mechanisms **When the individual experiences a threat to self-esteem, anxiety increases, and defense mechanisms are used to protect the self

After speaking with the parents of a child dying of leukemia, the practitioner gives a verbal do-not-resuscitate order but refuses to put it in writing. What should the nurse do? 1. Follow the order as given by the practitioner 2. Refuse to follow the practitioner's order unless the nursing supervisor approves it 3. Ask the practitioner to write the order in pencil on the child's chart before leaving the room 4. Determine whether the family is in accord with the practitioner while following hospital policy

4. Determine whether the family is in accord with the practitioner while following hospital policy

A nurse concludes that a client is using displacement. Which behavior has the nurse identified? 1. Ignoring unpleasant aspects of reality 2. Resisting any demands made by others 3. Using imaginative activity to escape reality 4. Directing pent-up emotions at someone other than the primary source

4. Directing pent-up emotions at someone other than the primary source

A client with a diagnosis of schizophrenia is discharged from the hospital. At home the client forgets to take the medication, is unable to function, and must be rehospitalized. What medication may be prescribed that can be administered on an outpatient basis every 2 to 3 weeks? 1. Lithium 2. Diazepam 3. Fluvoxamine 4. Fluphenazine

4. Fluphenazine **Fluphenazine can be given intramuscularly every 2 to 3 weeks to clients who are unreliable about taking oral medications; it allows them to live in the community while keeping the disorder under control.

The husband of a woman who gave birth to a baby 2 weeks ago calls the postpartum unit at the hospital, seeking assistance for his wife. He reports that he found his wife in bed and that the baby was wet, dirty, and crying in the crib. He says, "She says she just can't do it." What is the best response by the nurse? 1. Encouraging him to express his feelings about the situation 2. Telling him to schedule an appointment with the gynecologist 3. Asking whether he can afford a home health aide for several weeks 4. Informing him that he should seek emergency intervention for his wife

4. Informing him that he should seek emergency intervention for his wife **The inability to care for herself or her infant is a significant sign that the wife is depressed and in need of immediate intervention

The nurse is explaining the Client Bill of Rights to a female client whose psychiatrist has admitted her to an inpatient facility. Her admission is voluntary. The statement that is not a client right is the right to: 1. Personal mail 2. Refuse treatment 3. Written treatment plans 4. Select health team members

4. Select health team members **Clients may not select the members of the health care team when admitted to an inpatient setting that delivers care 24 hours a day, 7 days a week. The other rights are included in the Client Bill of Rights.

A client on the psychiatric unit who has suicidal ideas says to the nurse, "I signed myself in. I'll sign myself out." What concept provides the basis for the nurse's response? 1. Voluntary clients may sign out at any time. 2. Voluntary clients may sign out by following unit procedures. 3. Suicidal clients may sign out if they are able to contract for their safety. 4. Suicidal clients may not sign out even if they voluntarily admitted themselves.

4. Suicidal clients may not sign out even if they voluntarily admitted themselves. **The priority is to keep the client safe; a client admitted on a voluntary basis may be kept involuntarily if professional judgment indicates that the client may harm him- or herself or others.

A nurse is caring for several clients who have severe psychiatric disorders. What is the major reason that a health care provider prescribes an antipsychotic medication for these clients? 1. To improve judgment 2. To promote social skills 3. To diminish neurotic behavior 4. To reduce the positive symptoms of psychosis

4. To reduce the positive symptoms of psychosis **Antipsychotics are used to decrease positive signs and symptoms associated with psychoses, including hallucinations, delusions, paranoia, and disorganized speech.