foundations of psychiatry

Question 4 A client lives in a group home and visits the community mental health center regularly. During one visit with the nurse, the client states, "The voices are telling me to hurt myself again." Which question by the nurse is most important to ask?

Correct response: "Are you going to hurt yourself?

Question 1 A nurse is assessing a client with bipolar disorder. Findings include coarse hand tremors, muscle twitching, and mental confusion. These findings suggest: Question 2 In the process of dealing with the intense feelings about being raped, victims commonly verbalize that they were afraid they would be killed during the rape and wish that they had been. The nurse should decide that further counseling is needed if the client makes which statement? You Selected: "I get so angry at times that I have to have a couple of drinks before I sleep." Correct response: "I get so angry at times that I have to have a couple of drinks before I sleep." Question 3 Which of the following client behaviors indicates the nurse-client relationship is in the working phase? You Selected: The client makes an effort to describe his or her problems in detail. Correct response: The client makes an effort to describe his or her problems in detail. Question 4 The client diagnosed with conversion disorder has a paralyzed arm. A staff member states, "I would just tell the client her arm is paralyzed because she had an affair and neglected her baby's care to the point where the baby had to be hospitalized for dehydration." Which response by the nurse is best? You Selected: "Ignore the client's behaviors, and treat her with respect." Correct response: "Pushing insight will increase the client's anxiety and the need for physical symptoms." Question 5 A client brought to the clinic after being arrested for harassing and stalking his ex-wife denies any other symptoms or problems except anger about being arrested. The ex-wife reports to the police, "He's fine except for this irrational belief that we'll remarry." When collaborating with the health care provider about a plan of care, which intervention would be most effective for the client at this time? You Selected: referral to an outpatient therapist Correct response: referral to an outpatient therapist Question 6 An older adult client was prescribed lorazepam 1 mg three times a day to help calm her anxiety after her husband's death. The next day, the client calls her daughter asking when she is picking her up to go to the graveside. The client says she has been walking up and down the driveway for the past hour waiting for her daughter. Noting the client's agitation, hyperactivity, and insistence, the daughter calls the nurse to report her mother's behavior. Which finding would the nurse suspect as the cause of the mother's behavior, and what action would she suggest? You Selected: The client is experiencing a paradoxical reaction to the lorazepam and should stop the new medication immediately. Correct response: The client is experiencing a paradoxical reaction to the lorazepam and should stop the new medication immediately. Question 7 An adolescent client is diagnosed with borderline personality disorder (BPD). The client has an eating disorder behavior consisting of eating and then purging. Which of the following questions by the nurse is the best way to assess the client's nutritional status? You Selected: "What are your feelings about an acceptable weight?" Correct response: "What do you eat in a day?" Question 8 An older client reports episodes of severe anxiety resulting in shortness of breath, palpitations, chest pain, dizziness, and nausea. The physician prescribes lorazepam. What effect of this medication would be most important for the nurse to monitor on this client? You Selected: paradoxical reactions Correct response: sedation Question 9 During a mental health assessment interview, a client does not make eye contact with the nurse. The nurse suspects this behavior is culturally based. What should the nurse do first in relation to this assumption? You Selected: Observe how the client and the client's family interact with each other and with other staff members Correct response: Observe how the client and the client's family interact with each other and with other staff members Question 10 See full question38sReport this Question A nurse is teaching self-esteem to a client. Which statements by the client would indicate understanding of the concept? Select all that apply. Correct response: "I need to have consistent limits." "Living in a critical environment is not good for me." "I need to have healthy boundaries."

Correct response: lithium toxicity.

On admission to the inpatient psychiatric unit, a client's facial expression indicates severe panic. The client repeatedly states, "I know the police are going to shoot me. They found out that I'm the child of the devil." What should the nurse say to initiate a therapeutic relationship with this client? Question 2 A client who is neatly dressed and clutching a leather briefcase tightly in his arms scans the adult inpatient unit on his arrival at the hospital and backs away from the window. The client requests that the nurse move away from the window. The nurse recognizes that doing as the client requested is contraindicated for which reason? You Selected: The action indicates nonverbal agreement with the client's false ideas. Correct response: The action indicates nonverbal agreement with the client's false ideas. Question 3 Even when the client understands problems and is motivated to change, the client may have fears about failing. Which intervention is most likely to facilitate change? You Selected: asking the client about fears that need to be overcome Correct response: having the client practice new behaviors Question 4 Knowing Maslow's hierarchy of needs can assist a nurse in understanding a client's behavior. Place the stages of Maslow's hierarchy of needs in order from basic to most complex. Use all options. Correct response: physiologic needs safety and security love and belonging self-esteem self-actualization Question The nurse correctly judges that the danger of a suicide attempt is greatest with which client behavior? You Selected: increase in energy level Correct response: increase in energy level Question 6 The client is suspicious of staff members and other clients. To help establish a therapeutic relationship with the client, which plan would be best? You Selected: Spend brief intervals with the client each day. Correct response: Spend brief intervals with the client each day. Question 7 A client is admitted to the psychiatric hospital for evaluation after numerous incidents of threatening, angry outbursts, and two episodes of hitting a coworker at the grocery store where he works. The client is very anxious and tells the nurse who admits him, "I didn't mean to hit him. He made me so mad that I just couldn't help it. I hope I don't hit anyone here." How should the nurse respond? You Selected: "When you start to feel angry here, talk to the staff about your feelings." Correct response: "When you start to feel angry here, talk to the staff about your feelings." Question 8 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? You Selected: Participate in group therapy. Correct response: Accept responsibility for personal behavior. Question 9 A nurse is assessing a client at a mental health clinic who threatens suicide and describes having a plan. Which should the nurse recognize as the priority goal for the client? You Selected: Obtaining admission to an acute care facility Correct response: Working with the client to resolve the immediate crisis Question 10 A nurse hears a client state, "I've had it with this marriage. It would be so much easier to just hire someone to kill my husband!" What action should the nurse take? You Selected: An assessment of the client's response to treatment must be performed. Correct response: The nurse must start the process to warn the client's husband.

"Hello, my name is ___. I'm a nurse, and I'll care for you when I'm on duty. Should I call you ___, or do you prefer something else?

Question 9 A client with a personality disorder is upset and calls the nurse a "stupid cow." Which is the most effective initial response by the nurse to this client's behavior?

Correct response: Calmly discuss the inappropriateness of displacing anger to others.

Question 20 The nurse is performing an admission interview when the client attempts to shift the session focus to the nurse by asking personal questions. Which statement by the nurse is most appropriate?

Correct response: "I have a family. Tell me about you and your family."

Question 8 The nurse is instructing a competent client in their legal rights regarding ECT (electroconvulsive therapy). Which statement by the client suggests further explanation is needed?

"Since I was an Emergency Involuntary Commitment, I will be unable to sign the ECT form myself."

Question 5 When assessing an aggressive client, which behavior warrants the nurse's prompt reporting and use of safety precautions?

Correct response: naming another client as his adversary

Question 3 In group therapy, a client angrily speaks up and responds to a peer, "You're always whining, and I'm getting tired of listening to you! Here is the world's smallest violin playing for you." Which role is the client playing? Question 6 During an appointment with the nurse, a client says, "I could hate God for that flood." The nurse responds, "Oh, don't feel that way. We're making progress in these sessions." The nurse's statement demonstrates a failure to do what? You Selected: Look for meaning in what the client says. Correct response: Look for meaning in what the client says. Question 7 A client who comes to the emergency department with multiple bruises on her face and arms, a black eye, and a broken nose says that these injuries occurred when she fell down the stairs. The nurse suspects that the client may have been physically assaulted. What should the nurse do next? You Selected: Ask the client specifically about the possibility of physical abuse. Correct response: Ask the client specifically about the possibility of physical abuse. Question 8 The client has tearfully described her negative feelings about herself to the nurse during their last three interactions. Which goal would be most appropriate for the nurse to include in the plan of care at this time? The client will: You Selected: verbalize three things she likes about herself Correct response: verbalize three things she likes about herself Question 9 The nurse notes that a client is too busy investigating the unit and overseeing the activities of other clients to eat dinner. To help the client obtain sufficient nourishment, which plan would be best? You Selected: Serve foods that the client can carry with her. Correct response: Serve foods that the client can carry with her. Question 10 A client asks the nurse to help make out a will. What should the nurse tell the client? You Selected: "You need to consult an attorney because I'm not trained in such matters. Is there a family lawyer you can call?" Correct response: "You need to consult an attorney because I'm not trained in such matters. Is there a family lawyer you can call?" Question 11 During the conversation with the nurse, a victim of physical abuse says, "Let me try to explain why I stay with my husband." Which response would the nurse find inconsistent with the profile of a battered partner? You Selected: "The abuse adds spice to our relationship." Correct response: "The abuse adds spice to our relationship." Question 12 The nurse is teaching a group of unlicensed personnel new to psychiatry about balance in a therapeutic milieu. Which statement by a member of the group indicates the need for further teaching? You Selected: "Controlling clients helps them feel more comfortable." Correct response: "Controlling clients helps them feel more comfortable." Question 13 A client is admitted to the inpatient psychiatric unit. He is unshaven, has body odor, and has spots on his shirt and pants. He moves slowly, gazes at the floor, and has a flat affect. What should the nurse ask the client about first when completing the admission assessment? You Selected: if he is thinking about hurting himself Correct response: if he is thinking about hurting himself Question 14 The client is laughing and telling jokes to a group of clients. Suddenly, the client is crying and talking about a death in the family. A moment later, the client is laughing and joking again. What should the nurse do? You Selected: Ask the client to come to a quiet area to talk to the nurse individually. Correct response: Ask the client to come to a quiet area to talk to the nurse individually. Question 15 A new client has just been admitted to an adolescent psychiatric inpatient unit. The charge nurse and an unlicensed assistive personnel (UAP) are discussing the client's needs. The UAP says, "She is just showing off to try and get our sympathy. There is no need for her to cut herself. Why would adolescents want to do such a thing to themselves?" What response by the charge nurse would most help the UAP understand the client and her illness? You Selected: "It's hard to see a young person harm herself as she does, but she has serious family issues and doesn't know better ways to handle them, so we have to help her with that." Correct response: "It's hard to see a young person harm herself as she does, but she has serious family issues and doesn't know better ways to handle them, so we have to help her with that." Question 16 A client with depression has been admitted to the mental health unit and is attending group therapy sessions as part of treatment. The client asks the nurse leading the group if he is married or has a girlfriend. The nurse responds, "I am curious what made you ask this question; however, what is important is how you are feeling today." The nurse's response is which of the following? You Selected: Inappropriate, because the nurse should have answered to establish a therapeutic relationship. Correct response: Appropriate, because the focus of the therapeutic relationship is the client, not the nurse. Question 17 A client is admitted to the psychiatric unit following a suicide attempt. The client has suffered identity theft through the Internet and states, "My savings, checking, and retirement accounts are empty. I have nothing left to pay my bills or buy food and medicines. The only thing left is to die." After 1 week, the nurse would conclude that the client has been helped upon hearing which statements? Select all that apply. You Selected: "With all the help I got here, I think I may be able to survive after all." "I realize that I still can get monthly public assistance benefits." *"I filed identity theft claims with the bank, my retirement account, and the government authorities." Correct response: "I realize that I still can get monthly public assistance benefits." *"I filed identity theft claims with the bank, my retirement account, and the government authorities." "With all the help I got here, I think I may be able to survive after all."

Correct response: aggressor

Question 18 A nurse works with clients with persistent mental illness. Cognitive impairments and medication side effects make compliance with the medication regimen difficult for many clients. Which intervention would be most beneficial for the nurse to apply when planning care for these clients?

Correct response: Include the client and support system in teaching medication action and managing side effects.

Question 2 A nurse is counseling a client at a crisis center after the client's house burned down and the client's daughter was killed. Which action by the nurse is a priority?

Correct response: assisting in psychological resolution of the immediate crisis

Question 1 The basis for building a strong, therapeutic nurse-client relationship begins with a nurse's:

Correct response: self-awareness and understanding.

Question 19 The nurse is performing an assessment on a client with a history of a dysfunctional family. Which findings should the nurse anticipate? Select all that apply.

Correct response: unhealthy personal boundaries abuse and neglect

Question 1 A nurse must assess a client's judgment to determine the client's mental status. To best accomplish this, the nurse should have the client: Question 2 A client reports losing a job, not being able to sleep at night, and feeling upset with the client's spouse. The nurse responds, "You may want to talk about your employment situation in group today." The nurse is using which therapeutic technique? You Selected: exploring Correct response: focusing Question 3 A client is taking clozapine and complains of a sore throat. This symptom may be an indication of which adverse reaction? You Selected: agranulocytosis Correct response: agranulocytosis Question 4 A client with major depression is to be discharged home tomorrow. When preparing the client's discharge plan, which area is most important for the nurse to review with the client? You Selected: medication management with outpatient follow-up Correct response: medication management with outpatient follow-up Question 5 A client is admitted to a mental health unit with a diagnosis of depression and is participating in group sessions. The client asks a nurse if they are married or in a romantic relationship. What is the best response by the nurse to maintain a therapeutic relationship? You Selected: "Group therapy is not the appropriate time to discuss my relationships." Correct response: "I'm curious about your question but I want to know how you are feeling today." Question 6 The nurse is performing an assessment on a client after the client's third electroconvulsive therapy (ECT). Which finding should the nurse anticipate most frequently? You Selected: short-term memory loss Correct response: short-term memory loss Question 7 The nurse is performing an admission interview when the client attempts to shift the session focus to the nurse by asking personal questions. Which statement by the nurse is most appropriate? You Selected: "It is not appropriate for you to ask me personal questions." Correct response: "I have a family. Tell me about you and your family." Question 8 A nurse is teaching a client stress management. Which techniques would be considered adaptive coping skills? Select all that apply. You Selected: balance sleep, rest, and exercise set realistic goals for each day practice relaxation techniques Correct response: set realistic goals for each day practice relaxation techniques balance sleep, rest, and exercise Question 9 What should be charted by the nurse when the client has an involuntary commitment or formal admission status? You Selected: The client's receipt of information about status and rights should be charted. Correct response: The client's receipt of information about status and rights should be charted. Question 10 In an ongoing assessment, the nurse should identify the client's thoughts and feelings about a situation in addition to what other factors? You Selected: whether the client's behavior is appropriate in the context of the current situation Correct response: whether the client's behavior is appropriate in the context of the current situation

Correct response: discuss hypothetical ethical situations.