Mental Health Nursing Boyd Exam 1

Inhalants are considered a CNS stimulant. True or False?

False It depresses.

Name adverse effects of Divalproex sodium.

Hepatotoxicity

Name adverse effects of Lamotrigine. When would you use it?

SJS It's effective when depressive episodes co-occur.

Name adverse effects of Carbamazepine.

SJS anemia agranulocytosis

How much does Abs rock? :)

a hell of an f***in lot

A nurse is reading a journal article about cognitive behavior therapy and cognitive processes involved in the development of common mental disorders such as depression. The nurse demonstrates understanding of the information by identifying which area as being included in the cognitive triad? Select all that apply. a. oneself b. nurse c. future d. present e. world

a, c, e The cognitive triad includes thoughts about oneself, the world, and the future.

A psychiatric-mental health nurse is conducting a presentation for a group of nurses at the local community center about depression. After the presentation, the nurse determines that it was successful when the group identifies which substances as potentially playing roles in depression? Select all that apply. a. Norepinephrine b. Dopamine c. Epinephrine d. GABA e. Serotonin

a, e, b Neurobiologic theories of the etiology of depression posit that major depression is caused by a deficiency or dysregulation in central nervous system (CNS) concentrations of the neurotransmitters norepinephrine, dopamine, and serotonin or in their receptor functions. GABA and epinephrine have not been implicated.

When administering and monitoring antidepressant therapy in a client, what would be most appropriate for the nurse to do? Select all that apply. a. Ask the client about the use of any herbal supplements b. Assess orthostatic vital signs before beginning therapy c. Observe the client for cheeking of medications d. Check plasma drug concentrations 1 hour before the next dose e. Obtain liver function studies at least once a week.

a,b,c When administering and monitoring a client receiving antidepressant therapy, the nurse should observe the client for cheeking or saving medications for a later suicide attempt. Orthostatic vital signs should be obtained as a baseline before initiating therapy, and regularly after therapy begins. Laboratory testing should occur periodically; it does not need to be assessed at least once a week. Specimens for monitoring plasma drug concentrations should be drawn as close as possible to 12 hours away from the last dose. Herbal substances can interact with antidepressants and their use should be avoided.

A client is brought to the Emergency Department by a friend who tells the staff that the friend thinks the client has overdosed on cocaine. Which findings would help support this situation? Select all that apply. a. cardiac dysrhythmia b. seizures c. resp depression d. chest pain e. nystagmus

a,b,c,d Signs of overdose include cardiac dysrhythmias or arrest, increased or lowered BP, chest pain, vomiting, seizures, psychosis, confusion, dyskinesias, dystonias, and coma. Nystagmus is a sign of inhalant overdose.

A nurse is reviewing information about the drug, lithium carbonate. The nurse demonstrates understanding of the information by identifying which situation as a potential cause of lithium toxicity. Select all that apply. a. Diarrhea b. Vomiting c. Hot climate d. Hypernatremia e. Strenuous exercise

a,b,c,e If body fluid decreases significantly because of a hot climate, strenuous exercise, vomiting, diarrhea, or drastic reduction in fluid intake, then lithium concentrations can rise sharply, causing an increase in side effects and a progression to lethal lithium toxicity. The higher the sodium concentration, the lower the lithium concentrations will be.

Which must be present in a client diagnosed with serotonin syndrome? Select all that apply. a. Fever b. Agitation c. Constipation d. Hyporeflexia e. Diaphoresis f. Ataxia

a,b,e,f The symptoms of serotonin syndrome include altered mental status, autonomic dysfunction, and neuromuscular abnormalities. At least three of the following must be present for a diagnosis: mental status changes, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, and diarrhea.

The nurse is facilitating a support group for people who have lost a family member or friend to suicide. When discussing strategies for coping with grief, which should the nurse include? Select all that apply. a. cognitive behavioral therapy b. take anti-anxiolytic medications as often as possible c. completing a daily journal entry before bedtime d. writing out the events leading up to the loved one's suicide e. encourage time spent in solitude

a,c,d The intensity and duration of the postsuicide grief process for many survivors has led to the development of family intervention programs. Although the evidence base for these interventions is still small, strategies that support a positive sense of self, enhance problem-solving such as that embedded within cognitive behavioral therapy, promote the formation of a suicide story, encourage social reintegration, reduce stigma, use journaling, or permit the survivor to debrief may be effective in reducing subjective distress and to resolve grief. Clients should be encouraged to spend time with others, not only to encourage social reintegration, but also because recovery from grief may be most effective when delivered in survivor peer help groups. Although clients may benefit from medications for relief of anxiety symptoms early in post-suicide, anti-anxiolytic medication is not an effective long term coping strategy and may delay an adaptive recovery process for survivors.

A psychiatric-mental health nurse is conducting a class for a community group about the rights of individuals with mental health problems. As part of the program, the nurse is describing the concept of self-determinism. The nurse determines that the program was successful when the group identifies which idea as exemplifying self-determinism? (Select all that apply.) a. Right to choose other forms of treatment b. Right to participate in experimentation without informed consent c. Right to obtains other opinions d. Right to refuse treatment e. Right to refuse treatment during emergency situation

a,c,d The right to self-determination entitles all clients to refuse treatment (except during emergency situation), to obtain other opinions, and to choose other forms of treatment. A client has a right not to participate in experimentation in the absence of the client's informed, voluntary, written consent.

A nurse taking an admission history from a client suspects that the physician will diagnose major depression. For the physician to make this diagnosis, the client will have to demonstrate specific symptoms. What are some of these symptoms? Select all that apply. a. disruption in concentration b. obsessive desire to exercise c. disruption in appetite d. excessive guilt e. disruption in sleep

a,c,d,e Four of seven symptoms must be present along with the episodes of depressed mood to qualify for a diagnosis of major depressive disorder. Symptoms include disruption in sleep, appetite, concentration, or energy; psychomotor agitation or retardation; excessive guilt or feelings of worthlessness; and suicidal ideation.

A client with bipolar disorder is prescribed divalproex sodium as part of the treatment plan. Before administering the medication, what tests should be done? Select all that apply. a. Liver function tests b. Blood glucose concentration c. platelet count d. Urinalysis e. CBC

a,c,e CLients with known liver disease should not be given divalproex sodium. There is no need to obtain urinalysis or bg concentration.

A nurse is reviewing the medical record of a client prescribed lithium carbonate. The nurse would be alert for possible increases in serum lithium concentrations based on the client's use of which substance? Select all that apply. a. Alcohol b. Haloperidol c. Furosemide d. Ibuprofen e. Fluoxetine

a,c,e Furosemide, alcohol, and fluoxetine may increase serum lithium concentrations. Haloperidol increases neurotoxicity despite normal serum concentrations and dosage. Nonsteroidal anti-inflammatory drugs such as ibuprofen decrease renal clearance of lithium. Ibuprofen increases serum lithium concentrations by 30% to 50% in 3 to 10 days.

A client with bipolar disorder has a plasma lithium concentration of 2.7mE/L. Which finding would a nurse most likely assess in this client? Select all that apply. a. seizures b. tinnitus c. incoordination d. nystagmus e. fasciculations

a,d,e A plasma lithium concentration of 2.7mE/L indicated severe toxicity manifested by seizures, nystagmus, and fasciculations. Tinnitus and incoordination are noted with moderate toxicity, with plasma drug concentration ranging from 1.5 to 2.5 mE/L.

A . nurse suspects that an older adult client may be a victim of abuse. Which factor associated with the abuser would the nurse most likely identify as increasing the person's risk? Select all that apply. a. Financial dependence b. Cognitive disability c. History of intergenerational conflict d. Use of drugs e. Isolation from others

a,d,e High risk factors for those who are more likely to abuse older adults include using drug or alcohol, high levels of stress, lack of social support, high emotional or financial dependence on the older adult, lack of training in taking care of older adults, and depression.

After educating a client with bipolar disorder on his prescribed lithium therapy, the nurse determines that additional education is needed when the client states which of the following? a. "l need to cut back on my salt intake when it's really hot outside." b. "l need to avoid drinking any alcohol." c. "l can use sugarless candies to help with any metallic taste." d. "l need to report any problems with severe diarrhea or slurred speech."

a. "l need to cut back on my salt intake when it's really hot outside." Clients should increase their intake of salt during periods of perspiration (e.g., when it is hot outside) and periods of increased exercise and dehydration. Severe diarrhea and slurred speech suggest moderate toxicity, which needs to be evaluated. Alcohol interacts with lithium, causing increased serum concentrations of the drug, placing the client at risk for toxicity. Sugarless candies and throat lozenges can help to combat metallic taste.

Carbamazepine has a black box warning for which of the following side effects? a. Agranulocytosis b. Skin rash c. Liver damage d. Birth defects

a. Agranulocytosis Carbamazepine has a boxed warning for aplastic anemia and agranulocytosis, but frequent, clinically unimportant decreased in WBC count occurs. The increased risk of birth defects may occur with use of divalproex. Lamotrigine has a boxed warning for skin rash. Liver damage may occur with carbamazepine, but is not noted with a boxed warning.

A client who is to receive cognitive behavior therapy asks the nurse, "What will we be focusing on with this type of therapy?" Which information would the nurse integrate into the response? a. Dysfunctional thinking through the examination of the cognitive triad b. Identification of irrational beliefs that lead to negative consequences c. Identification of possible solutions before addressing the problem d. Achieving more rational thoughts to reduce stress by changing irrational beliefs

a. Dysfunctional thinking through the examination of the cognitive triad. Cognitive behavioral therapy focuses on dysfunctional thinking through the examination of the cognitive triad, cognitive distortions, and schema. Rational emotive behavior therapy focuses on identifying and changing irrational beliefs that lead to negative consequences. Solution-focused therapy identifies the possible solution before addressing the problem.

A client is prescribed a selective serotonin reuptake inhibitor (SSRI) as a treatment for depression. Which would the nurse most likely administer? a. Escitalopram (Lexapro) b. Venlafaxine c. Maprotiline d. Phenelzine

a. Escitalopram Escitalopram is classified as an SSRI. Venlafaxine is classified as a serotonin-norepinephrine reuptake inhibitor. Maprotiline is a cyclic antidepressant. Phenelzine is a monoamine oxidase inhibitor.

Which is accurate regarding solution-focused brief therapy? a. The emphasis is on what is functional and healthful b. Solution-focused approaches emphasize the uniqueness of groups c. The focus is on problems. d. The approach challenges the existence of problems.

a. The emphasis is on what is functional and healthful. Solution-focused brief therapy, although basically a cognitive approach, differs in philosophy and approach from other cognitive- based approaches. The primary difference is the deemphasis on the client's problems, or symptoms, and an emphasis on what is functional and healthful.

A client with acute mania is prescribed lithium. During this time, the nurse would anticipate obtaining blood concentrations how often? a. Weekly b. Every three weeks c. Twice weekly d. Monthly

c. Twice weekly

Which nursing action would be a protective factor in the prevention of suicide for a client who has been identified at risk? a. The nurse facilitates a referral to a drug and alcohol recovery program. b. The nurse encourages clients to spend more time alone. c. The nurse emphasizes medical interventions for depression. d. The nurse counsels clients to avoid conflict.

a. The nurse facilitates a referral to a drug and alcohol recovery program. Protective factors buffer individuals from suicidal thoughts and behavior. Protective factors have not been studied as extensively as risk factors, but identifying and understanding them are very important. Protective factors include effective clinical care for mental, physical, and substance abuse disorders. The nurse facilitating a referral for a client to a drug and alcohol recovery program can serve to mitigate or prevent the risk for suicide in a client who also has risk factors. Although medical interventions for depression are important, effective depression treatment is multitudinal and should incorporate psycho-social and spiritual care as well. Clients should not be told to avoid conflict rather the nurse should assist the client in building personal capacity to manage conflict in adaptive ways. Clients who are at risk for suicide would find social support to be a protective factor in mitigating or preventing self harm. Client's should be encouraged to be connected to family and community support whenever possible.

A nurse understands the importance of protecting clients' rights of self-determinism. Self-determinism is similar to which ethical principle? a. autonomy b. justice c. veracity d. beneficence

a. autonomy Self-determinism can be defined as being empowered by having the free will to make moral judgements. Autonomy is the right to make one's own decisions. Personal autonomy and avoidance of dependence on others are key values of self-determinism. Veracity is truthfulness. Justice encompasses equal treatment for all. Beneficence is doing no harm.

The nurse is teaching a client about the importance of adhering to a medication regimen. The client does not believe that it is important. The nurse is communicating which ethical principle? a. beneficence b. paternalism c. veracity d. justice

a. beneficence According to the principle of beneficence, the health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximum health care potential. Justice is the duty to treat all fairly, distributing the risk and benefits equally. Veracity is the duty to tell the truth. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of the client.

Mandatory use of helmets when driving a motorcycle is an example of which ethical principle? a. paternalism b. veracity c. fidelity d. justice

a. paternalism Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of a client. Mandatory use of seat belts and motorcycle helmets is an example of paternalism. Justice is the duty to treat all fairly, distributing the risk and benefits equally. Veracity is the duty to tell the truth. Fidelity is faithfulness to obligation and duties.

Which type of group is usually associated with clients who have dementia and have difficulty with recent memory? a. reminiscence groups b. anger management groups c. self-care groups d. medication groups

a. reminiscence groups Reminiscence groups are usually associated with clients who have dementia who are having difficulty with recent memory. Recalling distant memories is comforting to clients and improves their well-being. In self-care groups, the leader not only reinforces basic self-care skills but also, more importantly, helps identify strategies that can motivate the clients and provide structure to their daily lives. The purposes of anger management groups are to discuss the concept of anger, identify antecedents to aggressive behavior, and develop new strategies to deal with anger other than verbal and physical aggression. A medication group can be used primarily to transmit information related to medications, such as compliance, management of side effects, and lifestyle adjustments.

A client diagnosed with schizophrenia is having hallucinations. Which type of group would be beneficial for this client? a. symptom management b. medication c. anger management d. self-care

a. symptom management In symptom management groups, members learn when a symptom indicates that relapse is imminent and what to do about it. Handling hallucinations, being socially appropriate, and staying motivated to complete activities of daily living are a few common topics. In self-care groups, the leader reinforces basic self-care skills and helps identify strategies that can motivate the clients and provide structure to their daily lives. The purposes of anger management groups are to discuss the concept of anger, identify antecedents to aggressive behavior, and develop new strategies to deal with anger other than verbal and physical aggression. A medication group can be used primarily to transmit information related to medications, such as compliance, management of side effects, and lifestyle adjustments.

When developing a plan of care for a client with depression who is receiving medication therapy, what would the nurse identify as the primary goal during the acute phase? a. symptom reduction b. effective prophylaxis c. relapse reduction d. discontinuation

a. symptom reduction The primary goal of therapy for the acute phase is symptom reduction or remission. The objective is to choose the right match of medication and dosage for the client. The goal of the continuation treatment phase is to decrease the risk for relapse (a return of the current episode of depression). The goal of the maintenance phase is effective prophylaxis, especially for those at high risk for recurrence. The goal of the discontinuation phase is the cessation of active treatment.

When seeing a young adult client who has been depressed and expressing thoughts of hopelessness but has not overtly reported having thoughts of suicide. Despite the fact that the client has not reported suicidal thoughts, the nurse should initiate a suicide risk assessment with the client for which reason? a. the client feels vulnerable to stigma b. the client lives with extended family c. young adults tend to use manipulation d. this is a standard assessment

a. the client feels vulnerable to stigma Suicide is so rejected in contemporary society that people with strong suicidal thoughts do not seek treatment for fear of being stigmatized by others. Reports and portrayals of suicide in the popular media and television further stigmatize those who consider or attempt suicide. There is no evidence that young adults tend to use manipulation more than any other age group. To assume this, the nurse misses the opportunity to reduce the client's risk of self harm by conducting a risk assessment. The suicide risk assessment is not standard in mental status examinations. the skilled clinician is aware of signs and symptoms that signal the nurse should engage the client in an assessment to determine risk for harm to self. If the client is living with extended family, this may actually act as a protective factor against suicide. Having strong social ties can mitigate the risk of suicidal acts.

Wernicke's encephalopathy is a degenerative brain disorder characterized by which type of deficiency? a. thiamine b. Vitamin C c. Vitamin A d. Vitamin D

a. thiamine Wernicke encephalopathy, a degenerative brain disorder cause by thiamine (vitamin B1 deficiency, is characterized by vision impairment, ataxia, hypotension, confusion, and coma

If lithium does not work, what is the other choice for treating bipolar depression?

anticonvulsants - Carbamazepine

A nurse is developing a plan of care for a client bipolar disorder. When preparing to administer medications, which agent would the nurse anticipate as being prescribed as the mainstay of pharmacotherapy? Select all that apply. a. Fluoxetine b. Carbamazepine c. Lithium carbonate d. Lamotrigine e. Divalproex

b,c,d,e

Which are effects of alcohol withdrawal syndrome? Select all that apply. a. Decreased BP b. Increased pulse c. Delirium tremens d. seizures e. hand tremors

b,c,d,e

The nurse who is developing a suicide prevention strategy would need to ensure which step is included? a. Consulting with family members about risk for suicide b. Using assertive interventions if there is a threat of suicide c. Figuring out who is at risk for suicide d. Determining imminent risk of suicide e. Following up with interventions to prevent suicide in the future

b,c,d,e The beginning evidence points to four steps in preventing suicide and promoting long-term mental health: identification of those thinking about suicide (case finding), assessment to determine an imminent suicidal threat, intervening to change suicidal behavior associated with a specific suicidal threat, and institution of effective interventions to prevent future episodes of suicidal behavior.Consulting with family members about the risk for suicide is not one of the four steps that have been identified in the research as evidence to support actions of health care providers in intervening and preventing suicide.

A client experiencing severe alcohol withdrawal. Which would the nurse most likely assess? Select all that apply. a. decreased appetite b. gross uncontrollable tremors c. auditory hallucinations d. HR around 100 beats/min e. marked diaphoresis

b,c,e

A nurse is assessing a client with substance abuse for evidence of possible long-term . complications. Which finding would alert the nurse to the development of a complication affecting the hematologic system? Select all that apply. a. ulcers b. leukemia c. hematomas d. pancreatitis e. anemia

b,c,e Medical complication associated with the hematologic system related to alcohol abuse include anemia, leukemia, and hematomas. GI complications include pancreatitis, ulcers, and liver diseases.

A client is diagnosed with Korsakoff amnesic syndrome. Which of the following would the nurse most likely assess? Select all that apply. a. diaphoresis b. vision impairment c. hypertension d. confabulation e. attention deficit

b,d,e Korsakoff amnesic syndrome, associated with alcoholism, involves the heart, vascular and nervous systems, but the primary problem is acquiring new information and retrieving memories. Symptoms include amnesia, confabulation (telling a plausible but imagined scenario to compensate for memory loss), attention deficit, disorientation, and vision impairment. Although Wernicke encephalopathy and Korsakoff amnesic syndrome can appear as two different disorders, they are generally considered to be different stages of the same disorder called Wernicke-Korsakoff syndrome. Wernicke encephalopathy represents the acute phase and Korsakoff amnesic syndrome the chronic phase. Diaphoresis and hypertension are not associated with this condition.

A loss of pleasure or interest in a client diagnosed with depression would be documented as what? a. Hopelessness b. Anhedonia c. Discouragement d. Flat affect

b. Anhedonia A person with depression has a sustained period of feeling depressed, sad, or hopeless and may experience anhedonia (loss of interest or pleasure). The client may report "not caring anymore" or not feeling any enjoyment in activities that were previously considered pleasurable. Flat affect is the complete or near absence of affective expression. Hopelessness and discouragement would not be the correct documentation for this symptom.

Which of the following is the treatment setting of choice for persons who are severely psychotic? a. Residential apartments b. Inpatient admission c. Partial hospitalization d. Intensive outpatient programs

b. Inpatient admission Inpatient admission is the treatment setting of choice for clients who are severely psychotic, or who are an immediate threat to themselves or others. Intensive outpatient programs, such as partial hospitalization, and residential apartment would not be immediate options for this client.

A client with bipolar disorder I is experiencing a depressive episode. Which of the following would the nurse expect to be prescribed? a. Carbamazepine b. Lamotrigine c. Valproate d. Lithium

b. Lamotrigine Although lithium, valproate and carbamazepine are used to treat bipolar disorder, lamotrigine is often prescribed for a depressive episode.

A nurse is assessing a survivor of abuse. Which assessment would be most important for the nurse to complete first? a. Mental status exam b. Lethality assessment c. Cardiac assessment d. Social assessment

b. Lethality assessment It should be the first assessment used to ascertain whether the survivors life is in danger, wither from homicide or suicide and, if children are in the home whether they are in danger.

A client is prescribed lithium to treat mania. The client also has a history of hypertension for which the client takes lisinopril and hydrochlorothiazide. When monitoring this client, the nurse would be especially alert for signs and symptoms of which condition? a. Hypernatremia b. Lithium toxicity c. Hypertensive crisis d. Hypokalemia

b. Lithium toxicity Lisinopril is an ACE inhibitor; hydrochlorothiazide is a thiazide diuretic. Both drugs interact with lithium to increase serum lithium levels. Therefore, the nurse should be especially alert for signs and symptoms of lithium toxicity. Hypokalemia and hyponatremia are possible effects of hydrochlorothiazide when given alone but these wouldn't be as great a concern as the increased risk for lithium toxicity. Hypertensive crisis would be more commonly associated with the use of MAOIs and tyramine foods.

Which statement is inconsistent with the social domain of the biopsychosocial model? a. Treatment of psychiatric disorders can be affected by the society in which the client lives b. Psychiatric disorders are caused by societal factors c. Family support can improve treatment outcomes d. Community forces shape the client's manifestation of disorders

b. Psychiatric disorders are caused by societal factors. Psychiatric disorders are not caused by societal factors, but their manifestations and treatment can be significantly affected by the society in which the client lives. Family support can actually improve treatment outcomes. Community forces, including cultural and ethnic groups within larger communities, shape the client's manifestation of disorders, response to treatment, and overall view of mental illness.

A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which nursing diagnosis has priority? a. Ineffective coping related to inadequate stress management b. Risk for suicide related to highly lethal plan c. Hopelessness related to recent divorce d. Spiritual distress related to conflicting thoughts about suicide and sin

b. Risk for suicide related to highly lethal plan Safety is the priority. The overall goals for the client who is suicidal is first to keep the client safe and later to help him or her develop new coping skills that do not involve self-harm. Hopelessness related to recent divorce, ineffective coping related to inadequate stress management, and spiritual distress related to conflicting thoughts about suicide and sin would not be the priority diagnosis for this client.

Which is accurate about schema? a. They develop late in childhood. b. They are the individual's life rules. c. They are expressly the accumulation of learning. d. They become fixed in adulthood.

b. They are the individual's life rules. Schema are the individual's life rules that act as a sieve or filter. Schema develop in early childhood and become relatively fixed by middle childhood. They are the accumulation of both learning and experience from the individual's genetic makeup, family and school environments, peer relationships, and society as a whole.

Which mental health client criteria to be involuntarily committed? a. a client diagnosed with mania who is pacing the hallways b. a client diagnosed with borderline personality disorder (BPD) who is threatening to self-harm c. A client is diagnosed with schizophrenia who is singing in the client's room d. a client diagnosed with anxiety disorder who is fidgeting

b. a client diagnosed with borderline personality disorder who is threatening to self-harm Involuntary commitment is confined hospitalization of a person without the person's consent but with a court order. Three common elements found in most statues for involuntary commitments. The individual must be: (1) mentally disordered, (2) dangerous to himself or herself, or (3) unable to provide for his/her basic needs. The client diagnosed with BPD is a danger to the self. The other clients are not in immediate danger to themselves or others.

Which of the following is the most abused substance in the United States? a. cocaine b. alcohol c. benzos d. marijuana

b. alcohol Second most abused drug is marijuana.

A client diagnosed with schizophrenia insists on stopping medication because it causes the client to gain weight, The client is exercising which ethical principle? a. beneficence b. autonomy c. veracity d. justice

b. autonomy The client is exercising autonomy and is making the client's own decision to stop taking the medication. Although it is probably not in the client's best interest, the client does have that right. According to the principle of beneficence, the health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential. Justice is the duty to treat all fairly, distributing the risk and benefits equally. Veracity is faithfulness to obligation and duties.

Providing milieu therapy is an example of the use of which ethical principle? a. veracity b. beneficence c. autonomy d. fidelity

b. beneficence When using the ethical principle of beneficence, a health care provider uses knowledge of science and incorporates the art of caring to develop an environment in which individuals achieve their maximal health care potential, as in milieu therapy. Veracity is the duty to tell the truth. Fidelity is faithfulness to obligations and duties. According to the principle of autonomy, each person has the fundamental right of self-determination.

When a person avoids mental health treatment for fear of being labeled mentally ill, which type of stigma is occuring? a. discrimination b. label avoidance c. self-stigma d. public stigma

b. label avoidance Label avoidance is the avoidance of treatment or care so as not to be labeled as mentally ill. This is one reason so few people with mental problems actually recieve help. Self-stigma occurs when negative stereotypes are internalized by people with mental illness. Public stigma occurs after individuals are publically "marked" asa being mentally ill. ALthough discrimination occurs as part of the stigma, it is not a type of stigma.

A client who is prescribed a tricyclic antidepressant is brought to the emergency department with a suspected overdose. Which would the nurse assess to support this suspicion? Select all that apply. a. diarrhea b. pale, moist skin c. blurred vision d. urinary retention e. headache

c, d In acute overdose, almost all symptoms develop within 12 hours. Anticholinergic effects are prominent and include dry mucous membranes, warm and dry skin (not pale, moist skin), blurred vision, decreased bowel motility (not diarrhea), and urinary retention. Central nervous system suppression (ranging from drowsiness to coma) or an agitated delirium may occur. Headache is a side effect of monoamine oxidase inhibitors.

A client is prescribe carbamazepine as part of the treatment plan for bipolar disorder. The nurse obtains a CBC and differential before initiating therapy. The nurse would instruct the client to return to the outpatient facility for repeat blood testing at which time? a. 12 mos b. 3 mos c. 1 month d. 6 mos

c. 1 month Liver function tests and CBC with differential are minical pretreatment lab tests. They should be repeated about 1 month after initiating treatment, and at 3 months, 6 months, and yearly.

A client with alcohol abuse is to receive disulfiram. The client's last drink was at 4pm. The client should receive the medication no earlier than at which time? a. 8pm b. 8am c. 4am d. 12 midnight

c. 4am A client should not receive disulfiram until he or she has abstained from alcohol for at least 12 hrs.

A client who has been abusing opioids for about one year has run out of the drug. The last time he used the drug was at 12 noon. The client would most likely develop signs and symptoms of withdrawal by which time? a. 2am b. 2pm c. 9pm d. 6pm

c. 9pm Signs and symptoms of opioid withdrawal begin about 8 to 12 hrs after the last time use.

According to Yalom (2005), there are 11 therapeutic factors through which changes occur in group psychotherapy. Which factor correlates with learning to give to others? a. catharsis b. group cohesiveness c. altruism d. universality

c. altruism Altruism is learning to give to others. Universality refers to finding out that others have similar problems. Catharsis is the open expression of effect to purge or "cleanse" oneself. Group cohesiveness is the group members' relationship with the therapist and other group members.

The nurse is preparing a community education session on suicide awareness. Which point should the nurse include in the presentation? a. Being a Hispanic male poses the greatest risk for completing suicide. b. Suicide rates are lowest among adolescent minorities who identify as bisexual. c. A firearm in the home increases the risk that a person will complete suicide. d. Suicide is attributable solely to social and psychological factors.

c. A firearm in the home increases the risk that a person will complete suicide. Access to firearms is associated with the risk of completed suicides, particularly for white males. In 2009, 51.8% of deaths from suicide were firearm related and most suicides occur in the victim's home. Firearm ownership in more prevalent in the United States than in any other country—approximately 35% to 39% of households have firearms. The nurse should be sure to include this it the educational session as this is a critical topic for discussion in suicide prevention in any age group. Suicide is attributable to a multitude of factors including biological and genetic factors. In 2014, suicide rate per 100,000 for white males was 23.3 versus for Hispanic males, the rate was 10.3. Although suicide is prevalent in the Hispanic population, it has been found to be the most common in white males. Depressive symptoms and suicidality rates in early adolescence are higher among bisexual minority youth than among heterosexual youth and these disparities persist into young adulthood. These disparities are largest for females and bisexually identified youth.

Which antidepressant medication is classified as a selective serotonin reuptake inhibitor (SSRI)? a. Tranylcypromine b. Phenelzine c. Fluoxetine d. Isocarboxazid

c. Fluoxetine Fluoxetine is included among the SSRls. Phenelzine, isocarboxazid, and tranylcypromine are monoamine oxidase inhibitors (MAOIs).

Which could be incorporated into the plan of care for a client receiving an antidepressant who is experiencing orthostatic hypotension? a. Eat a nutritionally balanced diet b. Take medication with food c. Increase hydration d. Get daily exercise

c. Increase hydration Increasing hydration and sitting or standing up slowly are nonpharmacologic interventions for orthostatic hypotension. Taking medications with food would counteract nausea and vomiting. Daily exercise and eating a nutritionally balanced diet would help with weight gain that occurs in clients taking antidepressants.

Electroconvulsive therapy (ECT) has been shown to be an effective treatment for people with severe depression. However, ECT is contraindicated in which of the following disease processes? a. Diabetes b. Hypertension c. Increased intracranial pressure d. Anxiety disorder

c. Increased intracranial pressure ECT is contraindicated for clients with increased intracranial pressure. Other high-risk groups include those with recent myocardial infarction, recent cerebrovascular accident, retinal detachment, or pheochromocytoma. ECT is prescribed as a treatment modality for depression.

A client is exhibiting rapid shifts in mood. The nurse documents this as which of the following? a. Irritable mood b. Elevated mood c. Mood lability d. Expansive mood

c. Mood lability Mood lability is a term used for rapid shifts in mood that often occur with bipolar disorder. Elevated mood refers to exaggerated feelings of well-being (euphoria) or feeling ecstatic or high (elation). An expansive mood is characterized by lack of restraint in expressing feelings, an overvalued sense of self-importance, and a constant and indiscriminate enthusiasm for interpersonal, sexual or occupational interactions. An irritable mood is indicated by being easily annoyed and provoked to anger, especially when wishes are challenged or thwarted.

Which of the following is used to treat the overdose of heroin? a. Methadone b. L-acetyl-α-methadol c. Naloxone (Narcan) d. Buprenorphine (Subutex)

c. Naloxone

A nurse is caring for a client diagnosed with bipolar disorder. The client is experiencing a manic episode. The nurse would be especially alert for signs indication what? a. Weight loss b. Dehydration c. Self-injury d. Sleep disruption

c. Self-injury Pts safety is a priority. Risk of suicide is always present for those have depressive or manic episodes. Although changes in sleep, fluid balance/dehydrations, and weight loss are important to assess, safety and prevention are the priority.

What is a myth regarding suicide? a. Many people who die by suicide have given definite warnings of their intentions. b. The suicide rate is lowest in December. c. Suicidal people are fully intent on dying. d. Most suicidal people are undecided about living or dying.

c. Suicidal people are fully intent on dying A myth regarding suicide is that suicidal people are fully intent on dying. Most suicidal people are undecided about living or dying. Facts about suicide include that the suicide rate is the lowest in December and that many people who die by suicide have given definite warnings of their intentions.

Which of the following is a cognitive intervention for clients diagnosed with depression? a. Activity scheduling b. Problem-solving c. Thought stopping d. Social skills training

c. Thought stopping Cognitive interventions such as thought stopping and positive self-talk can dispel irrational beliefs and distorted attitudes, and in turn reduce depressive symptoms during the acute phase of major depression. Behavioral interventions include activity scheduling, social skills training, and problem-solving.

A nurse is caring for a client who uses phencyclidine (PCP). PCP is classified as which type of substance? a. inhalant b. opioid c. hallucinogen d. cannabis

c. hallucinogen

A client has a blood alcohol level of 0.05%. The nurse would expect which behavior to occur? a. coma b. difficulty driving c. impaired judgement d. stupor

c. impaired judgement A blood alcohol level of 0.05% (1-2 drinks) would produce impaired judgement, giddiness, and mood changes. Difficulty driving occurs at a level of 0.10%. Stupor and coma occur at levels of 0.30% and 0.40%, respectively.

Electroconvulsive therapy would be contraindicated for a client with: a. myocardial infarction, five years ago b. stroke, 10 years ago c. increased intracranial pressure d. hypertension

c. increased intracranial pressure. ECT is contraindicated for clients with increased intracranial pressure. Other high-risk clients include those with recent myocardial infarction, recent cerebrovascular accident, retinal detachment, or pheochromocytoma (a tumor on the adrenal cortex or other tumors) and those at risk for complications of anesthesia. Older age has been associated with a favorable response to EC T, but the effectiveness and safety in this group have not been shown. Hypertension is not a contraindication.

When providing care to a client with a mental illness, the nurse assists the client in recovery. The nurse needs to keep in mind that which ethical principle can be in direct conflict with the mental health recovery belief of self-determinism? a. justice b. veracity c. paternalism d. autonomy

c. paternalism Paternalism can be in direct conflict with the mental health recovery belief of self-determinism. Paternalism is the belief that knowledge and education authorize professionals to make decisions for the good of the client. Justice, autonomy, and veracity do not conflict with the mental health recovery belief of self-determinism.

A nurse is conducting a community program with a local group that is to have an outpatient mental health facility built in the neighborhood. One of the participants states, 'I don't want those people in this area. They are dangerous and very unpredictable.' The nurse interprets this statement as an example of: a. label avoidance b. self-stigma c. public stigma d. cultural syndrome

c. public stigma The statement about individuals being dangerous and unpredictable reflects public stigma, in which individuals are publically marked as being mentally ill and experience prejudice and discrimination. Self-stigma occurs when negative stereotypes are internalized by people with mental illness. Label avoidance refers to an individual avoiding treatment in order not to be labeled as mentally ill. Cultural syndrome is a specific pattern of symptoms that occurs within a specific cultural group or community.

When clients are asked to consider the points of view of significant others in their lives, the nurse is asking which type of question? a. scaling b. exception c. relationship d. compliments

c. relationship When relationship questions are used, clients are asked to consider the points of view of significant others in their lives. Scaling questions are useful in making the client's problem or issue more specific, quantifying exceptions noted in intensity, and tracking change over time. Exception questions are rooted in the belief that nothing is constantly present at the same level of intensity—that there are fluctuations on how the client experiences 'the problem." Compliments are affirmations of the client; they reinforce the client's success and the strengths needed to achieve those successes.

When a therapist is interviewing a client diagnosed with depression, the client's feelings toward the client's parents as a child are being directed at the therapist. This is an example of: a. countertransference b. object relations c. transference d. psychoanalysis

c. transference Transference is the displacement of thoughts, feelings, and behaviors originally associated with significant others from childhood onto a person in a current therapeutic relationship. Countertransference is defined as the direction of all of the therapist's feelings and attitudes toward the client. Psychoanalysis is the therapeutic process of accessing the unconscious conflicts that originate in childhood and then resolving the issues with a mature adult mind. Object relations is the psychological attachment to another person or object.

Which types of questions reinforce the client's successes and the strengths needed to achieve those successes? a. relationship b. exception c. scaling d. compliments

d) compliments Compliments are affirmations of the client; they reinforce the client's success and the strengths needed to achieve those successes. Scaling questions are useful in making the client's problem or issue more specific, quantifying exceptions noted in intensity, and tracking change over time. Scaling questions ask the client to rate the issue or problem on a scale of 1 to 10, with 1 being the worst, or greatest intensity, and 10 being the complete absence of the issue. Relationship questions ask clients to consider the points of view of significant others in their lives. Exception questions are rooted in the belief that nothing is constantly present at the same level of intensity; that there are fluctuations on how the client experiences "the problem."

When the nurse asks the client to rate the issue or problem on a scale of 1 to 10, the nurse is using which question type? a. compliments b. relationship c. exception d. scaling

d) scaling Scaling questions are useful in making the client's problem or issue more specific, quantifying exceptions noted in intensity, and tracking change over time. Scaling questions ask the client to rate the issue or problem on a scale of 1 to 10, with 1 being the worst, or greatest intensity, and 10 being the complete absence of the issue. When relationship questions are used, clients are asked to consider the points of view of significant others in their lives. Exception questions are rooted in the belief that nothing is constantly present at the same level of intensity; that there are fluctuations on how the client experiences "the problem." Compliments are affirmations of the patient that reinforce the patient's success and the strengths needed to achieve those successes.

In a person who abuses alcohol or is a chronic drinker, alcohol withdrawal syndrome usually begins within which time frame from abrupt discontinuation or an attempt to decrease consumption? a. 48 hrs b. 18 hrs c. 24 hrs d. 12 hrs

d. 12 hrs

Disulfiram should not be administered until a client has abstained from alcohol for at least how long? a. 16 hrs b. 8 hrs c. 4 hrs d. 12 hrs

d. 12 hrs Warnings related to disulfiram include never administering the drug to an intoxicated client or without the client's knowledge, and not administering the drug until the client had abstained from alcohol for at least 12 hours.

When conducting a risk assessment for suicide, the nurse most likely identifies which client as having the greatest risk for completing suicide? a. A 30 year-old male client who is married with a new baby b. A 30-year-old female client who had a baby three months prior c. A 25-year-old female client who attends school full time d. A 50-year-old male client who lives on a farm outside the city

d. A 50-year-old male client who lives on a farm outside the city Males have a higher suicide completion rate four times more than females. Rural men have a much higher risk of suicide than urban men, and that gap is widening, perhaps attributable to the higher rates of gun ownership in rural areas. Unmarried, unsociable men between the ages of 42 and 77 years with minimal social networks and no close relatives have a significantly increased risk for committing suicide. The 50-year-old client living on a rural farm is the most likely in this list of clients to complete suicide. The 30-year-old male client with the new baby does not fit the profile of a client most likely to complete suicide. Females are more likely to attempt suicide but not kill themselves as a result of the attempt.

Which is a food that might be incorporated into the plan of care for a client diagnosed in the manic phase of bipolar disorder? a. Steak b. Broccoli c. Spaghetti d. Bananas

d. Bananas For a client who is unable to sit long enough to eat, snacks and high-energy foods that can be eaten while moving should be provided.

A nurse is caring for a client receiving a tricyclic antidepressant and is monitoring for anticholinergic side effects. Anticholinergic effects include which of the following? a. Hyperactive bowel sounds b. Moist skin c. Urinary incontinence d. Blurred vision

d. Blurred vision Anticholinergic effects are prominent with tricyclic antidepressants. These include potentiation of central nervous system drugs, dry mucous membranes, warm and dry skin, blurred vision, decreased bowel motility, and urinary retention.

Several questions can be used to assess a suicidal person's intent to die, the severity of the suicidal ideation, and the degree of planning. Which question may be used to elicit information regarding the severity of suicidal ideation? a. Have you made any plans to kill yourself? b. How seriously do you want to die? c. Have you done anything to put the plan into action? d. Can you dismiss thoughts of killing yourself, or do they tend to return?

d. Can you dismiss thoughts of killing yourself, or do they tend to return? A question to ask the person regarding severity of the suicidal ideation may be, Can you dismiss thoughts of killing yourself, or do they tend to return?" The other questions focus on the intent to die and the degree of planning.

A nurse is teaching a client newly diagnosed with a mental disorder and their family. What is an important aspect of a psychiatric advance directive (PAD)? a. It must be signed by the case manager and two witnesses b. A physician cannot override the declaration c. It allows family members to make the choice of treatment for incompetent individuals d. During periods of competency, PADs can be revoked

d. During periods of competency, PADs can be revoked PASs are relatively new legal instructions that allow clients, while they are competent, to document their choice of treatment and care. This declaration must be made in advance and signed by two witnesses. Although a physician can override this declaration during times when the client's decision making is clearly distorted because of mental illness, the client must be informed first and the order made by the court. During periods of competency, PADs can be revoked.

Both valproate and carbamazepine may be lethal if high doses are ingested, Toxic symptoms appear in 1 to 3 hours and include which of the following? a. Tinnitus b. Bradycardia c. Urinary Frequency d. Neuromuscular disturbances

d. Neuromuscular disturbances Symptoms include neuromuscular disturbances, dizziness, stupor, agitation, disorientation, nystagmus, urinary retention, nausea and vomiting, tachycardia, hypotension or hypertension, cardiovascular shock, coma, and resp depression. Tinnitus does not occur with lethal doses of these drugs.

A client is prescribed naltrexone as part of the treatment plan for alcohol and opioid abuse. When developing an education plan about this drug for the client, which of the following would the nurse need to keep in mind. a. A naloxone challenges test will be needed within 2 weeks of starting the drug. b. Using small doses of heroin can lead to coma and death. c. The client will most likely report complaints of a metallic aftertaste. d. The individuals should be free of opioids for at least 1 week.

d. The individuals should be free of opioids for at least 1 week. Naltrexone is not given unless the client has been opioid free for 7 to 10 days. A naloxone challenge test is given before starting this drug, except in clients showing clinical signs of opioid withdrawal. Disulfiram, not naltrexone, is associated with metallic taste. Heroin and other opioids drugs should be avoided, because although small doses may have no effect, large doses can cause death, serious injury, or coma.

Which is an accurate statement regarding women and suicide? a. They are more likely to choose a more lethal method than men. b. They attempt suicide less often than men. c. They are more likely to die from attempted suicide than men. d. They are less likely to complete suicide than men.

d. They are less likely to complete suicide than men. Women are less likely to complete suicide than men, in part because they are more likely to choose a less lethal method. Women are less likely to die from an attempted suicide than men, but they attempt suicide more often.

Which is an accurate characteristic of small groups? a. They have fewer interpersonal experiences than large groups. b. They tend to be less cohesive than large groups. c. They usually form subgroups. d. They are usually no more than seven to eight members.

d. They are usually no more than seven to eight members. Small groups (usually no more than seven to eight members) become more cohesive, are less likely to form subgroups, and can provide a richer interpersonal experience than large groups.

One of the major problems facing individuals with mental illness and their families is stigman. What is inconsistent with stigmatization? a. discrimination b. prejudice c. misunderstanding d. approval

d. approval Stigma can be defined as a mark of shame, disgrace, or disapproval that results in an individual being shunned or rejected by others. Stigma leads to community misunderstanding, prejudice, and discrimination.

Which is a example of benzodiazepine? a. haloperidol b. disulfiram c. naltrexone d. diazepam

d. diazepam

The majority of suicides among men are attributed to: a. overdose b. drowning c. hanging d. firearms

d. firearms Men complete 79% of all suicides; 57.5% of these deaths are by firearms. The other means of suicide listed do not account for the majority of suicides in men.

Which is an accurate statement regarding an advance care directive? a. it needs to be written by an attorney b. it applies to those who can make their own decisions c. it needs to be signed by an attorney d. it must be witnessed by two people and notarized

d. it must be witnessed by two people and notarized An advance care directive does not need to be written, reviewed, or signed by an attorney. It must be witnessed by two people and notarizes, and applies only if the individual is unable to make hir or her own decisions as a result of being incapacitated or if, in the opinion of two physicians, the person is otherwise unable to make decisions for him-or-herself.

A nurse is caring for a client diagnosed with bipolar disorder who has been prescribed divalproex. The nurse knows that the client should have which test completed before initiation of drug therapy? a. cardiac enzymes b. WBC count c. thyroid level d. liver function

d. liver function Baseline liver function tests and a CBC with platelets should be obtained before starting therapy, and pts with known liver disease should not be given divalproex sodium. There is a boxed warning for hepatotoxicity. Thyroid level, WBC count, and cardiac enzymes do not have to be performed routinely before starting this medication.

When an individual experiences cocaine intoxication, which of the following occurs first? a. depression b. anxiety c. craving d. mental alertness

d. mental alertness It's a stimulant.

People who complete suicide often have extremely low levels of which neurotransmitter? a. norepinephrine b. GABA c. acetylcholine d. serotonin

d. serotonin People who complete suicide often have extremely low levels of the neurotransmitter serotonin. Impairments in the serotonergic system contribute to suicidal behavior. People who make near-lethal suicide attempts have much lower levels of the neurotransmitter dopamine and omega-3. Low levels of the other neurotransmitters have not been implicated in completed suicides.

Which term describes a nonfatal, self-inflicted destructive act with an explicit or implicit intent to die? a. suicidal ideation b. suicidality c. parasuicide d. suicide attempt

d. suicide attempt A suicide attempt is a nonfatal, self-inflicted destructive act with explicit or implicit intent to die. Suicidal ideation is thinking about and planning one's own death. Suicidality refers to all suicide-related behaviors and thoughts of completing or attempting suicide and suicide ideation. Parasuicide is a voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death.

The onset of major depressive disorder is most common among people who are in their: a. forties b. teens c. thirties d. twenties

d. twenties The highest onset of depression occurs among people who are in their twenties.

Approximately 65% of the time, women are raped by someone they know. True or False?

true

One in three women are victims of IPV at some point in their lives. True or False?

true