Mental Health 61-90
C
A 20-year-old economics major became severely depressed after failing two examinations in economics. She cried for 2 hours, then called her parents who live in a neighboring state, planning to ask if she could return home. However, her parents were in Europe. When her roommate went home for the weekend, the patient gave her three expensive sweaters to keep. Later, the dormitory resident assistant returned a book to the patient's room and found her unconscious on the floor, with an empty pill bottle nearby. The patient behavior that provided a clue to the suicide attempt was: a. calling her parents. b. staying in her dorm room. c. giving away her sweaters. d. excessive crying.
C
A 45-year-old married woman who works full time in a factory has recently been absent for 3-day periods on several occasions. Each time, she returned to work wearing dark glasses. Facial and body bruises were apparent. Her supervisor became suspicious that she was a victim of battering and referred her to the occupational health nurse. What should the nurse first focus on as she meets the patient? a. Notifying the police of the abuse b. Documenting the woman's injuries c. Establishing trust and building rapport d. Collecting evidence to prosecute the abuser
C
A cognitively impaired patient who has been a widow for 30 years is frantically trying to leave the unit, saying, "I have to go home to start dinner before my husband comes home from work." To intervene with validation therapy, the nurse should say: a. "Please, you must come away from the door." b. "Mrs. Smith, you have been a widow for many years." c. "You want to go home to get your husband's dinner." d. "I think your husband said he is going to eat out tonight."
A
A college student who attempted suicide by overdose was treated in the emergency department. Because she had no available social supports, she was hospitalized. An outcome related to the nursing diagnosis Risk for self-directed violence is that the patient will: a. exercise self-control by refraining from attempting to harm herself. b. verbalize a desire and intent to live by the end of the second hospital day. c. demonstrate two new coping mechanisms by the fourth hospital day. d. discuss two personal strengths by the end of first week of hospitalization.
D
A highly suspicious patient who has delusions of persecution about being poisoned has refused all hospital meals for 3 days. Which of the following interventions would be most appropriate under these circumstances? a. Feed the patient via tube, involuntarily via court order if needed. b. Offer to taste each food item on the tray yourself while he watches. c. Allow the patient to contact a local restaurant to deliver his meals. d. Allow him supervised access to use food vending machines in the hospital lobby.
B
A newly admitted patient required seclusion immediately on entering the inpatient unit. His assessment was incomplete, and no medical orders had been written. Immediately after secluding the patient, the priority action of the nurse should be to: a. provide a chance for the patient to use the bathroom. b. notify the physician and obtain an order for seclusion. c. complete necessary forms and notify the unit manager. d. debrief the staff and any witnesses to the incident.
D
A patient is admitted for psychiatric observation after being arrested for breaking windows in the home of his former girlfriend, who had refused to see him. His history reveals abuse as a child by a punitive father, torturing family pets, and one arrest for disorderly conduct. The priority nursing diagnosis that should be considered is: a. Stress overload. b. Ineffective coping. c. Risk for self-directed violence. d. Risk for other-directed violence.
B
A patient is noted to be bending over backward in the group room. A peer asks what he is doing, and he replies, "People say they are bending over backwards to help me, so I am bending over backwards to help myself." This is an example of: a. abstract thinking. b. concrete thinking. c. impaired reality testing. d. boundary impairment.
A
A patient receiving risperidone (Risperdal) reports severe muscle stiffness midmorning. During lunch he has difficulty swallowing food and speaking, and when vital signs are taken 30 minutes later, he is noted to be stuporous and diaphoretic, with a temperature of 38.8° C, pulse of 110 beats/min, and blood pressure of 150/90 mm Hg. The nurse should suspect _________ and should ______________. a. neuroleptic malignant syndrome...place him in a cooling blanket and transfer to ICU b. anticholinergic toxicity...check vital signs and prepare to use a cooling blanket stat c. relapse of his psychosis...administer PRN antipsychotic drugs and notify his physician d. agranulocytosis...hold his antipsychotic and draw blood for a complete blood count
B
A patient who has been depressed for the past several months presents in the clinic stating, "I'm at the end of my rope." Which of the following inquiries would be most effective to use for assessing suicide risk? a. "You seem very depressed and stressed. What is that like for you? What sort of feelings are you having when you say that?" b. "Tell me more about what you mean when you say you're at the end of your rope—are you thinking about killing yourself?" c. "Tell me about your family history. Do you have relatives or ancestors who suffered from depression?" d. "Tell me about your depression and being at the end of your rope; what are you thinking and feeling?"
B
A patient with acute mania has exhausted staff by noon after joking, manipulating, and insulting all morning. Staff members feel defensive and fatigued. Select the best action. a. Call the health care provider to evaluate the patient. b. Hold a staff meeting to discuss consistency and limit-setting approaches. c. Seclude the patient, and then call the health care provider to write an order. d. Explain to the patient that the behavior is unacceptable. Ask the patient to be more cooperative.
D
A patient with antisocial personality disorder tells Nurse A, "You're a much better nurse than Nurse B said you were." The patient tells Nurse B, "Nurse A's upset with you for some reason." To Nurse C the patient states, "You'd like to think you're perfect, but I've seen three of your mistakes this morning." These comments can best be assessed as: a. seductive. b. detached. c. guilt producing. d. manipulative.
B
A patient with mania dances around the unit, seldom sits or sleeps, and monopolizes conversations. Which nursing intervention will best assist the patient with energy conservation? a. Monitor physiological functioning. b. Provide a subdued environment. c. Observe for mood changes. d. Supervise personal hygiene.
A
A patient with mania has not eaten or slept for 3 days. Which nursing diagnosis has priority? a. Risk for injury b. Ineffective coping c. Ineffective management of therapeutic regime d. Imbalanced nutrition, less than body requirements
D
A patient with paranoid personality disorder is noted to sit alone in a corner of the unit living room. When anyone approaches, the patient is haughty or simply ignores the other person. When staff invite her to join an activity, she tells them, "I do not care to be with people who do not like me." A nursing diagnosis that should be considered is: a. splitting. b. activity intolerance. c. powerlessness. d. impaired social interaction.
B
A patient with schizophrenia has received typical (first-generation) antipsychotics for a year. His hallucinations are less intrusive, but he remains apathetic, has poverty of thought, cannot work, and is socially isolated. To address these symptoms, the nurse might consult the prescribing health care provider to suggest a change to: a. haloperidol (Haldol). b. olanzapine (Zyprexa). c. diphenhydramine (Benadryl). d. chlorpromazine (Thorazine).
C
A patient with schizophrenia refuses to take his medication because he believes he is not ill. What phenomenon most likely underlies this presentation? a. The patient is unable to face having an illness and is in denial. b. Stigma causes the patient to refuse to admit his mental illness. c. The illness itself is preventing the patient from realizing he is ill. d. Command hallucinations are instructing him to deny the illness.
D
A patient with schizophrenia tells the nurse "I don't know, it's just all the same. You never know. It comes, it goes, it blows away. Get it?" The best response for the nurse to make would be: a. "Nothing you are saying is clear; you are not making sense." b. "Yes, life can be like that sometimes, very confusing." c. "Try to organize your thoughts and then tell me again." d. "I am having difficulty understanding what you are saying."
C
A salesman has had difficulty holding a job because he accuses co-workers of conspiring to take his sales. Today, he argued with several office mates and threatened to kill one of them. The police were called, and he was brought to the mental health center for evaluation. He has had previous admissions to the unit for stabilization of paranoid schizophrenia. When the nurse meets him, he points at staff in the nursing station and states loudly, "They're all plotting to destroy me. Isn't that true?" Which would be the most appropriate response? a. "No, that is not true. People here are trying to help you if you will let them." b. "Let's think about it: what reason would people have to want to destroy you?" c. "Thinking that people want to destroy you must be very frightening." d. "That doesn't make sense; staff are health care workers, not murderers."
D
A severely depressed patient who has been on suicide precautions tells the nurse, "I am feeling a lot better, so you can stop watching me. I have taken too much of your time already." The best response for the nurse to make would be: a. "I wonder what this sudden change is all about. Care to elaborate?" b. "I am glad you are feeling better. The team will consider what you have said." c. "You should not try to direct your plan for care. Leave that to the team." d. "Because we are concerned about your safety, we will continue with our plan."
B
During a manic episode, a patient is hyperactive, restless, and disorganized. The patient goes to the dining room and begins to throw food and dishes. Verbal intervention is ineffective. The patient's behavior poses a substantial risk of harm to others. Staff escorts the patient to the patient's room to dine alone. What is the rationale for this action? a. Prevent other patients from observing the behavior. b. Reduce environmental stimuli that negatively affect the patient. c. Protect the patient's biological integrity until medication takes effect. d. Reinforce limit setting, enabling the patient to learn to follow unit rules.
A
The emergency department nurse realizes that the husband of a patient appears increasingly irritable as he waits alone in the waiting room. Which intervention would best prevent further escalation? a. Periodically update the husband about his wife and what is being done for her. b. Explain that waiting is necessary because patients are treated in order of need. c. Reassure him that everything possible is being done and suggest ways to relax. d. Suggest that he return home and await an update from the physician in 3 hours.
C
The nurse who assesses a patient previously diagnosed as having paranoid personality disorder is most likely to describe the patient as: a. superficially charming. b. intense and impulsive. c. guarded and distant. d. friendly and open.
B
The nursing diagnosis for a patient with mania is Imbalanced nutrition: less than body requirements related to caloric intake insufficient to balance with hyperactivity as evidenced by 5 lb weight loss in 4 days. Select the most appropriate outcome. The patient will: a. reduce hyperactivity within 1 week. b. drink four high-calorie, high-protein supplements per day. c. consistently wear appropriate attire for age and sex within 1 week. d. display consistently nonviolent behavior toward others within 1 week.
D
To plan effective interventions, the nurse should understand that the underlying reason a patient with paranoid personality disorder is so critical of others probably lies in the patient's: a. need to control all aspects of the world around him. b. use of intellectualization to protect against anxiety. c. inflexible view of the environment and the people in it. d. projection of blame for his own shortcomings onto others.
D
When a patient with paranoid schizophrenia has a recurrence of positive symptoms after stopping his antipsychotic medication because of its postural hypotension (orthostasis) side effect, he is readmitted to the mental health unit. What measure should the nurse suggest to help the patient address this side effect? a. Ask the doctor to prescribe an anticholinergic drug like trihexyphenidyl (Artane). b. Chew sugarless gum or use sugarless hard candy to moisten your mouth. c. Increase the amount of sleep you get, and try to take frequent rest breaks. d. Wear elastic support hose, drink adequate fluids, and change position slowly.
A
Which intervention would be appropriate for a patient with a nursing diagnosis of Ineffective coping as evidenced by manipulation of others? a. Refer patient requests and questions about care to the primary nurse. b. Provide negative reinforcement for any acting-out behavior. c. Ignore rather than confront inappropriate interpersonal behavior. d. Encourage the patient to discuss feelings of fear and inferiority.
B
Which nursing diagnosis is a priority for both a patient with depression and one with acute mania? a. Deficient diversional activity b. Disturbed sleep pattern c. Fluid volume excess d. Defensive coping
A
Which of these statements about suicide is accurate? a. The majority of persons who attempt suicide have given overt or covert indications of their intentions to others. b. A background in health care has a protective effect, leading to a lower rate of suicide among physicians and nurses than in the general public. c. Most persons with previous suicide attempts survived because they did not truly intend to die; they are at lower risk than those making their first attempt. d. Use of a low-lethality means or likelihood of being discovered in time to prevent death are merely suicide gestures, not genuine attempts.
A
Which statement provides the best rationale for monitoring the severely depressed patient closely as treatment proceeds? a. As depression lifts, physical energy and cognitive organization improve and enable the patient to carry out a plan for suicide. b. Effective therapy involves confronting the depressed patient about inadequacies that the patient has been unwilling to face. c. Severely depressed persons tend to conceal their feelings and true intentions related to suicide and should not be trusted. d. Severely depressed persons tend to be labile; their mood can change quickly in response to even the smallest stressors.
