Foundations of Psychiatric

The nurse in a psychiatric unit has formed a therapeutic relationship with a client with a borderline personality disorder. When the client is readmitted to the unit for a suicide attempt, the nurse exclaims to another staff nurse, "Why? Everything was going well. How could they do this to me?" What response by the staff nurse reflects an understanding of the client's borderline disorder? "I could have told you this would happen. A client like this one always gets you in the end." "I know what you mean. You put a lot of energy into working with our client. It must be disappointing to have the client do something like this." "Clients with borderline disorder act out to relieve anxiety, and something must have provoked a great deal of anxiety." "I know what you mean. I hope this will teach you not to get so involved with a client's welfare."

"Clients with borderline disorder act out to relieve anxiety, and something must have provoked a great deal of anxiety."

A 21-year-old college student works full time and takes college courses in the evening. The client reports having difficulty concentrating. Which response by the nurse is best? "You should find time to study during the day." "A glass of wine before bedtime promotes sleep." "Describe your sleep patterns to me." "Have you been screened for depression?"

"Describe your sleep patterns to me."

The nurse is preparing to discharge a client with depression from inpatient care. The client tells the nurse, "You helped me more than anyone else in this place. I am hoping you will still be there to help me once I am discharged." How should the nurse respond? "We discussed the boundaries of the nurse-client relationship when you were admitted to the facility. Did you want to review these rules now?" "Have confidence in yourself! You have come a long way and did the work required to improve. I am sure you will continue to do well without me!" "I really like you too and am happy to hear you enjoyed our time together. However, I am not able to stay in contact with you after you are discharged." "I am glad you found our work together productive. I am confident you will continue to improve with the support of the outpatient program team."

"I am glad you found our work together productive. I am confident you will continue to improve with the support of the outpatient program team."

A client on short-term mental health disability leave undergoes required psychiatric evaluation and counseling. The client requests that their evaluation and counseling records be e-mailed to the client's Human Resources representative. How should the nurse respond? "We need to review our administrative policy with the agency director before we can release records." "The treatment team must review disability-related records before we release them." "Think about whether you want us to release your entire counseling record to the company that employs you." "It's best not to e-mail your personal records because doing so might jeopardize your right to privacy."

"It's best not to e-mail your personal records because doing so might jeopardize your right to privacy."

A client who had a myocardial infarction 8 weeks ago tells a nurse, "My wife wants to make love, but I don't think I can. I'm worried that it might kill me." Which response from the nurse would be most appropriate? "Tell your wife that, when you're able, you'll make love." "Tell me about your feelings." "Let's have you do more rehabilitation." "Let me call the health care provider for you."

"Tell me about your feelings."

An adult client arrives at the emergency department and has just learned that a parent has died as a result of an automobile accident. The client states, "No, I don't believe it. It can't be true." How should the nurse respond? "It is normal to experience denial when given such news." "This is shocking news. May I sit with you for a while?" "You are in shock right now. Give yourself some time." "Would you like to see your mother's body now?"

"This is shocking news. May I sit with you for a while?"

A client who identifies as gay tells the nurse, "My family is not supportive." What is the best response by the nurse? "Would you like to arrange for counseling?" "What do you mean by not supportive?" "How do they treat you?" "They will understand later."

"What do you mean by not supportive?"

A group of college students was walking back to their dorm at night when a stranger indecently exposes themselves to the group. One of the students became extremely upset and went to the clinic. Which response by the nurse would be most therapeutic? "Do you know the person who exposed themselves to you?" "You appear upset. Can you tell me more about this?" "Have you ever had an experience like this before?" "I will call security right away so you can report the incident."

"You appear upset. Can you tell me more about this?"

A young client has been arrested for assault and battery. The client has been admitted to the forensic psychiatric facility for a pretrial evaluation. Which client goal is most appropriate for the client? Avoid contact with others on the psychiatric forensic unit. Verbalize ways to express anger, such as playing age-appropriate video games. Accept responsibility for personal behavior. Participate in group therapy.

Accept responsibility for personal behavior.

When preparing a lecture on psychiatric nursing, which particularly useful principle of the psychoanalytic model would the nurse educator include? Behavior that is reinforced will be perpetuated. Behavioral deviations result from an incongruence between verbal and nonverbal communication. All behavior has meaning. The first 6 years of a person's life determine personality.

All behavior has meaning.

A client with ulcerative colitis has recently had a colostomy and is anxious. The client reports to the nurse, "I don't think I can ever have a sexual relationship now that I have this." Which response by the nurse would be most appropriate? Offer to research statistics on this topic. Explore the positive aspects of her treatment regimen. Offer to refer to a support group. Allow the client to express concerns.

Allow the client to express concerns.

The nurse is caring for a client who continually has paranoid thoughts. How should the nurse interact with this client? Be as specific as possible when giving commands. Approach him or her in a nonthreatening way. Touch him or her gently when initiating a conversation. Ask simple questions about concrete topics.

Approach him or her in a nonthreatening way.

On admission to the mental health unit, a client tells the nurse she's afraid to leave the house for fear of criticism. She informs the nurse, "My nose is so big. I know everyone is looking at me and making fun of me. I had plastic surgery and it still looks awful!" These symptoms are an indication of which disorder? Antisocial disorder Body dysmorphic disorder Paranoid personality disorder Schizophrenia

Body dysmorphic disorder

A client admitted to the facility continually acts out a preoccupation with hand washing. The nurse should use which term to document this behavior? Obsession Hallucination Compulsion Delusion

Compulsion

A client with long-term body-focused repetitive behaviors including trichotillomania (hair pulling) finds support through an online website. The client begins to attend local meetings and realizes that a nurse from the clinic also attends. When approached outside of these meetings, how should the nurse respond? Stop attending this support group. Pretend not to know the client. Discuss this to define the relationship. Let the client establish the rules.

Discuss this to define the relationship.

An extremely manipulative client is evoking angry feelings in a nurse. Which action should the nurse take first? Confront the client about his manipulative behavior. Ask the client if his intention was to anger the nurse. Explore the personal feelings behind her anger. Identify the meaning behind the client's behavior.

Explore the personal feelings behind her anger.

A client in an acute care setting tells the nurse, "I don't think I can face going home tomorrow." The nurse replies, "Do you want to talk more about it?" The nurse is using which technique? Presenting reality Restating Making observations Exploring

Exploring

A healthcare provider has ordered a new antipsychotic medication for a client with schizophrenia whose previous medication no longer provides the expected symptom relief. The client tells the nurse, "I can't afford the additional cost of this new medication." What is the first action the nurse should take to be a client advocate? Talk with the client and the healthcare provider about whether this particular drug is necessary. Teach the client to accept that full reimbursement for the cost of the medication is not possible. Help the client explore other financial options for obtaining medication reimbursement with a social worker. Suggest the client contact a friend or family member to assist with the financial situation.

Help the client explore other financial options for obtaining medication reimbursement with a social worker.

The nurse is performing an assessment on a newly admitted client. She asks the client to remember three words: apple, house, and umbrella. Then she asks the client, "What are the three words I want you to remember?" What is the nurse assessing? Remote memory Delayed recall Immediate recall Attention level

Immediate recall

A client with an ileostomy tells the nurse he cannot have an erection. What pertinent information should the nurse know? The client has no problem with self-control. The client will never regain function. The client needs an abdominal x-ray. Impotence is uncommon after an ileostomy.

Impotence is uncommon after an ileostomy.

The behavior of a client with borderline personality disorder causes a nurse to feel angry toward the client. Which response by the nurse is the most therapeutic? Report the feelings to the client's health care provider. Restrict the client to the client's room until supper. Ignore the client's irritating behavior. Tell the client how the client's behavior makes the nurse feel.

Tell the client how the client's behavior makes the nurse feel.

A client reports severe pain in the back and joints. Upon reviewing the client's history, the nurse notes a diagnosis of depression and frequent hospitalizations for somatic illnesses. What should the nurse encourage this client to do? Remember all of the previous "health problems" that weren't real. Ignore the pain and focus on happy things. Tell the physician about the pain so that its cause can be determined. Try to get more rest and use relaxation techniques.

Tell the physician about the pain so that its cause can be determined.

The terms "judgment" and "insight" are sometimes used incorrectly. How would the nurse appropriately define insight? The ability to make appropriate choices The ability to control inappropriate impulses The ability to explain one's psychiatric diagnosis The ability to understand the nature of one's problem or situation

The ability to understand the nature of one's problem or situation

A caregiver is suspected of neglect and abuse. What warning signals should the nurse document and report? Select all that apply. The caregiver states that he or she would like to go visit a friend for a week. The caregiver has alcohol on his or her breath and acts as though he or she is impaired. The caregiver informs the nurse that he or she is having trouble obtaining supplies for care. The caregiver places blame on the client for his or her illness or limitations. The caregiver does not allow the client to speak for him or herself, have visitors, or be alone with others.

The caregiver does not allow the client to speak for him or herself, have visitors, or be alone with others. The caregiver places blame on the client for his or her illness or limitations. The caregiver has alcohol on his or her breath and acts as though he or she is impaired.

A client is admitted to an inpatient psychiatric unit. After data collection and admission procedures are completed, the nurse states, "I'll try to be available to talk with you when needed and will spend time with you each morning from 10:00 until 10:30 in a specific corner of the dayroom." The nurse is communicating these planned nursing interventions for which main rationale? To provide time for completing nursing responsibilities To provide a structured environment for the client To instill hope in the client To establish a trusting relationship

To establish a trusting relationship

Nursing care for a client after electroconvulsive therapy (ECT) should include: no special care. nothing by mouth for 24 hours after the treatment because of the anesthetic agent. bed rest for the first 8 hours after a treatment. assessment of short-term memory loss.

assessment of short-term memory loss.

The nurse is planning care for a client in restraints. Which nursing intervention is most important when restraining this client? reviewing facility policy regarding how long the client may be restrained checking that the restraints have been applied correctly asking if the client needs to use the bathroom or is thirsty preparing an as-needed dose of the client's psychotropic medication

checking that the restraints have been applied correctly

A nurse is caring for a client admitted to the inpatient psychiatric unit. When is it most important to introduce information about the end of the nurse-client relationship? during the orientation phase at least one or two sessions before the last meeting as the goals of the relationship are reached when the client can tolerate it

during the orientation phase

A client is transferred to the locked psychiatric unit from the emergency department after attempting suicide by taking 200 acetaminophen tablets. Now the client is awake and alert but refuses to speak with the nurse. In this situation, the nurse's first priority is to: place the client in full leather restraints. try to communicate with the client in writing. establish a rapport to foster trust. ensure safety by initiating suicide precautions.

ensure safety by initiating suicide precautions.

An appropriate way for the nurse to set limits for a newly admitted client who puts out cigarettes on the floor of the room designated for smoking is to: hand the client an ashtray and state that he must use it or he won't be allowed to smoke. encourage other clients to speak with the client about keeping the floor clean. restrict the client's smoking to times when a staff member can supervise closely. ask if the client puts out cigarettes on the floor at home.

hand the client an ashtray and state that he must use it or he won't be allowed to smoke.

According to Erikson, an adolescent who's suffering from gender dysphoria can't progress through which developmental task? identity versus role confusion intimacy versus isolation industry versus inferiority initiative versus guilt

identity versus role confusion

A client refuses his evening dose of haloperidol then becomes extremely agitated in the day room while other clients are watching television. He begins cursing and throwing furniture. The nurse's first action is to: place the client in full leather restraints. remove all other clients from the day room. call the physician and report the behavior. check the client's medical record for an order for an I.M. as needed dose of medication for agitation.

remove all other clients from the day room.

A manager observes a nurse interacting with clients on a psychiatric unit. Which nursing action(s) would cause the manager to intervene? Select all that apply. posting a picture of the nurse and client on social media asking a client to meet for lunch outside the hospital setting spending more time than necessary with a client and showing favoritism talking with a client about personal issues such as the nurse's recent divorce giving a client the crisis helpline phone number and encouraging the client to call

talking with a client about personal issues such as the nurse's recent divorce spending more time than necessary with a client and showing favoritism asking a client to meet for lunch outside the hospital setting posting a picture of the nurse and client on social media