Foundations and Practice of Mental Health Nursing

The nurse should first discuss terminating the nurse-client relationship with a client during the:

Orientation phase, when a contract is established

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?

Fluphenazine

After a traumatic event, a client is extremely upset and exhibits pressured and rambling speech. What therapeutic technique can the nurse use when a client's communication rambles?

Focusing

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?

Arrange a unit meeting to discuss what has just happened

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:

Make the client more receptive to psychotherapy

Which tool is used to standardize and measure nursing treatments?

Nursing Interventions Classification (NIC)

A client's hands are raw and bloody from a ritual involving frequent handwashing. Which defense mechanism does the nurse identify?

Undoing

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.)

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

A client tells the nurse in the mental health clinic that the practitioner said that the cornerstone of therapy used in the clinic is cognitive therapy. The client asks what this therapy entails. What concept should the nurse explain as the basis of cognitive therapy?

"Negative thoughts can precipitate anxiety."

The way individuals cope with an unexpected hospitalization depends on many factors. However, the one that is most significant is:

Basic personality

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:

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

Olanzapine (Zyprexa) is prescribed for a client with bipolar disorder, manic episode. What cautionary advice should the nurse give the client?

Sit up slowly.

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?

Splitting

What is an initial client objective in relation to anger management?

Taking responsibility for the hostile behavior

A nurse suggests a crisis intervention group to a client experiencing a developmental crisis. The nurse knows that these groups are successful because the:

Client is assisted in investigating alternative approaches to solving the identified problem

What should a nurse recognize that a client who uses the defense mechanism of sublimation is doing?

Channeling unacceptable impulses into socially approved behavior

A married woman is brought to the emergency department of a local hospital. Her eyes are swollen shut, and she has a bruise on her neck. She reports that she is being beaten by her husband. How does the nurse expect the husband to behave when he arrives at the emergency department?

Charming

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.

Increasing tension in facial expression indicates increasing anxiety, but the client is still maintaining self-control. Impulsivity, as demonstrated by the inability to take turns with others, indicates that the client is having some difficulty setting limits on his or her own behavior. When anxiety escalates to the point of hyperactivity and pacing behaviors, the client is attempting to cope with the anxiety and to discharge physical and psychic energy. Engaging in verbal abuse may precipitate physical abuse and is a sign that the client is not able to maintain self-control. The laying on of the hands in an offensive manner is a physical act of aggression.

Erik Erikson posited life as a sequence of achievements. Place the levels of development in their order of achievement according to Erikson's theory.

Industry versus inferiority is the conflict of the school-aged child; identity versus role confusion is the conflict associated with adolescence; intimacy versus isolation is the conflict that occurs during young adulthood; generativity versus stagnation is the conflict of adulthood; and integrity versus despair is the conflict that occurs at maturity.

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?

Informing him that he should seek emergency intervention for his wife

What conflict associated with Erikson's psychosocial stages of development should the nurse remember when caring for a client 30 years of age?

Intimacy versus isolation

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:

Is controlling the expression of feelings

A 13-year-old boy who recently was suspended from school for consistently bullying other children is brought to the pediatric mental health clinic by his mother. The child is assessed by the psychiatrist and referred to a psychologist for psychological testing. The day after the tests are completed, the mother returns to the clinic and asks the nurse for results of the tests. The nurse should:

Refer the mother to the psychiatrist

A nurse greets a client who has been experiencing delusions of persecution and auditory hallucinations by saying, "Good evening. How are you?" The client, who has been referring to himself as "the man," answers, "The man is bad." Of what is this an example?

Dissociation

A disturbed client starts to repeat phrases that others have just said. How should the nurse document this speech?

Echolalia

A client is scheduled for a 6-week electroconvulsive therapy (ECT) treatment program. What intervention is important during the course of treatment?

Elimination of benzodiazepines for nighttime sedation

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?

Fluvoxamine (Luvox)

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?

Hospital policy

After caring for a terminally ill client for several weeks, a nurse becomes increasingly aware of a need for a respite from this assignment. What is the best initial action by the nurse?

Seeking support from colleagues on the unit

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?

That their problems are not unique

To therapeutically relate to parents who are known to have maltreated their child, the nurse must first:

Identify personal feelings about child abusers

A nurse is caring for clients with a variety of psychiatric illnesses. For which diagnoses is the establishment of a psychiatric advance directive (PAD) most beneficial? (Select all that apply.)

Bipolar disease Paranoid schizophrenia

The nurse explains to the mother of a preschool child that Erikson identified the developmental conflict of children from 3 to 5 years as:

Initiative versus guilt

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?

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

Certain questions are applicable in determining nursing negligence. (Select all that apply.)

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