Mental Health Nursing Exam 2
What are some predisposing factors that have been associated with hair-pulling disorder?
Preceded by an increasing sense of tension, released by hair pulling; stress, age, family history
Bob, a newly admitted patient, diagnosed with bipolar disorder states to the nurse, "I was looking at the sky, blue is the color of my eyes, too. I went to Florida on a plane." How might the nurse response to this patient's statement?
"Bob, I'm not sure I understand what you are saying. Are your thoughts racing?" (Clarifying, assessing)
Shelley enters the emergency department accompanied by a friend who reports that Shelley was raped after leaving a college campus party the night before. Shelley is staring off into space, exhibits a closed posture, and is mumbling inaudibly. How will you introduce yourself and begin to intervene in this crisis situation?
"Hi Shelley, my name is Mrs. Smith, and I am a registered nurse here to help you. I'm so glad you came in to seek help. I'd like to ask you some questions about the event you've experienced. Alright?" Convey respect, reassurance of help, and empower the client to be involved in decision making.
Jane's husband has been hospitalized for several days in end-stage congestive heart failure and she has just been told that her husband has died. She begins sobbing and screams at the nurse "You killed my husband! I should have never brought him to the hospital!" What would be an appropriate, empathetic response by the nurse?
"I believe we did everything we could to provide care for your husband, and it's so hard to lose someone you love even when they are terminally ill. I'll stay with you and try to answer any questions you have."
"You're really cute. Are you married? I'm pretty sure my lawyer can get me out of this rap, and I'll be a free man! Why don't you give me your phone number and I'll call you sometime. We could go out and have some fun!" How would the nurse respond appropriately to this statement by Nathan?
"I do not give out personal information to patients, and I do not go out with patients. I hope that you will be able to get your life straightened out in a positive way." (confrontation with caring)
A patient you have been working with for several days approaches you with apparent signs of agitation and yells in a loud voice, "I want out of this hospital right now! You don't listen to a thing I say, and my doctor just wants my money!" How will you respond?
"I'll try to help you to the best of my ability. Please tell me what is upsetting you." Establish rapport, convey respect, and assess precipitating events.
Mr. J tells the nurse that ever since his wife died 3 months ago, he doesn't want to go on living. What would be an example of empathic communication in response to this statement by Mr. J?
"It sounds like you are grieving, that must be very painful, tell me more about your experience and feelings related to losing your wife." (Empathy, exploring/encouraging description)
John, who is in a manic phase of bipolar disorder is jumping from chair to chair in the patient lounge during visiting hours, loudly proclaiming to the visitors that he is a famous gymnast. He begins doing somersaults, nearly tripping a visitor. How might the nurse respond to the patient at this point?
"John, I have an activity in the next room that I could use your help with. Would you please come with me?" (Offering an alternative activity, redirecting, reducing stimulation)
John, who was just admitted to the psychiatric unit with panic disorder, approaches the nurse with complaints of numbness in his fingers and shortness of breath. What would be some appropriate responses by the nurse?
"John, I'd like to check your vital signs and then discuss how I can best help you feel more comfortable."
Mr. J was brought to the emergency department by his brother who is concerned about Mr. J's worsening depression. During the assessment, Mr. J tells the nurse, "None of this matters. There's nothing that can make this any better." What would be an appropriate response by the nurse?
"Mr. J, it sounds like you have been feeling hopeless; this is a common symptom of depression." (giving information) "Have you been having any thoughts of taking your own life?" (closed-ended, directive questioning to assess for the presence of suicide ideation)
Nathan, age 37, has been admitted to the hospital for a psychiatric evaluation after being arrested for armed robbery of a convenience store. He has a history of encounters with law enforcement since early adolescence. He has been diagnosed with Antisocial Personality Disorder. Nathan says to the nurse, "Hey pretty lady! Where have you been all my life?" How would the nurse respond appropriately to this statement by Nathan?
"My name is Nancy. I am your nurse on this shift, and you will be in my care until 11 p.m. You may ask for me by my name if you have any request." (giving information)
Nancy has been told that she has a terminal illness. She says to the nurse, "Why would God do this to me?" What response by the nurse would demonstrate sensitivity to Nancy's spiritual distress?
"Nancy, these are difficult spiritual questions. Would you like to talk more with the chaplain?"
After attending a group that discussed irrational thinking patterns, John asks the nurse, "How does this cognitive behavior therapy work?" What would be some appropriate responses to John's question?
"Often, when people become very anxious they develop irrational thinking patterns that contribute to worsening their mood and impacting their behavior in negative ways. By becoming aware of though patterns that increase your anxiety you can learn how to replace those automatic thoughts with more rational patterns in a way that improves your mood, symptoms, and behavior."
Thomas was secluded and restrained after punching another patient on the inpatient psychiatric unit. The next day he asks you what happened last night, stating he doesn't remember, and says he wants to know why he was arrested and tied up like an animal. What will you communicate to Thomas about the prior events and the crisis intervention process?
"Thomas, last evening you became very upset, stating you thought the FBI was trying to kill you, and you struck another patient" (Giving information) "Do you remember any of those events?" (Assessing patient's perception and memory) "Restraint is an intervention that we only use when other efforts have failed to protect your safety and the safety of others" (Giving information) "Let's talk about what you think would be helpful in preventing that from happening again." (Formulating a plan, empowering the client to be involved in problem-solving)
The doctor has shared test results with John revealing that his terminal cancer is not responding to treatment. John looks at the nurse and asks, "Am I dying?" What would be an appropriate response by the nurse?
"Yes, John, it's probable that you are in the end stage of life. Let's talk about how to prepare for this."
"I have spent my whole life taking care of others. Now someone else has to take care of me. I feel so useless." What would be an appropriate response by the nurse to this statement by Carrie?
"You feel sad because you can no longer do the thing that you used to do... the things that made you feel good about yourself." (Statement that focuses on feelings)
Carrie, age 75, is a patient on the psychiatric unit with a diagnosis of Major Depressive Disorder. She says to the nurse, "I never knew my life would end up like this. I've lost my husband, all my friends, and my home." What would be an appropriate response by the nurse to this statement by Carrie?
"You have had a lot of losses. You are feeling very much alone right now." (Verbalizing the implied)
"I really got a bum rap! I had no intentions of hurting anyone. The gun only had one bullet in it! I just wanted to scare that clerk into giving me a few bucks! just my bad luck and off-duty cop had to walk in about that time." How would the nurse respond appropriately to this statement by Nathan?
"You were arrested because you broke the law." (confronting reality)
Name the three factors that determine whether or not a person experiences a crisis in response to a stressful situation.
1. The individual's perception of the event 2. The availability of situational supports 3. The availability of adequate coping mechanisms
The nurse is prioritizing nursing diagnoses in the plan of care for a patient experiencing a manic episode. Number the diagnoses in order of the appropriate priority. a. Disturbed sleep pattern evidenced by sleeping only 4 to 5 hours per night b. Risk for injury related to manic hyperactivity c. Impaired social interaction evidenced by manipulation of others d. Imbalanced nutrition: Less than body requirements evidenced by loss of weight and poor skin turgor
1: b. Risk for injury related to manic hyperactivity 2: d. Imbalanced nutrition: less than body requirements evidenced by loss of weight and poor skin turgor 3: a. Disturbed sleep pattern evidenced by sleeping only 4 to 5 hours per night 4: c. Impaired social interaction evidenced by manipulation of others
Somatic symptom and dissociative disorder are the physical and behavioral responses to what unconscious phenomenon?
Repression of distressing mental contents from conscious awareness?
Depression in adolescence is very hard to differentiate from the normal stormy behavior associated with adolescence. What is the best clue for determining a problem with depression in adolescence?
A visible manifestation of behavioral change that lasts for several weeks is the best clue for a mood disorder
All antidepressants carry a black-box warning. What is it?
A warning that the drug may increase suicidal thoughts/ideation in patients diagnosed with MDD
What is the most common medication that has been known to trigger manic episodes?
Steroids used to treat chronic illnesses
How do age, race, and gender affect suicide risk?
Adolescents and elderly are high-risk groups. Women attempt suicide more often, but men succeed more often. Whites are at the highest risk for suicide.
Behavior of depression often changes with diurnal variation in the level of neurotransmitters. Describe the difference in this phenomenon between moderate and severe depression.
Affective: in severe depression the symptoms are more intense. Persons with severe depression will have a flat affect whereas those with moderate depression will maintain a pessimistic outlook. Behavioral: psychomotor retardation is much more pronounced in persons with severe depression than with moderate. While those with moderate depression may not not feel like doing any of their usual activities, those with severe depression have a complete inability to do/make most movements or maintain personal hygiene habits. Cognitive: those with moderate depression have a slowed thinking process. Those with severe depression have a lot of confused thinking and/or delusions. Physiological: in severe depression all body systems experience a "slow-down", leading to constipation and urinary retention. Those with moderate depression usually feel best early in the morning and feel progressively worse as the day moves on; the opposite is true in severe depression.
With what types of behaviors is grief manifested in school-age children?
Anger outbursts, irritability, protest behavior, changes in sleeping and eating patterns, indifference towards schoolwork, isolation from peers
Mr. J admits to the nurse that he has had suicide ideas for the last couple of weeks. How would the nurse intervene with Mr. J at this point?
Communication at this point should be focused on thorough assessment of Mr. J's expressed suicide ideas. Assessment questions include (not comprehensive): "When you have these ideas do you have a plan in mind?" "How strong is your intention to die?" "Do you have access to the means for implementing this plan?"
Alterations in which of the neurotransmitters are most closely associated with depression?
Deficiency of norepinephrine, serotonin, and dopamine
"I don't know why anyone would want to bother taking care of me. I really have nothing left to live for." What would be an appropriate response by the nurse to this statement by Carrie?w
Direct questions assessing suicide potential: "Are you or have you been thinking about harming yourself? Do you have a plan for doing so? Have you ever acted on that plan?"
What type of maladaptive response to loss occurs when an individual becomes fixed in the anger stage of grief? What clinical disorder is associated with this occurrence?
Distorted/Exaggerated Grief Response; Depressive Mood Disorder
The nurse notes that the mood of a patient being treated for depression and suicidal ideation suddenly brightens and the patient states, "I feel fine now. I don't feel depressed anymore." Why would this statement alert the nurse of a potential problem?
Sudden lifts in mood can be a behavioral clue for suicidal intention
Which neurotransmitter has been implicated in the development of obsessive-compulsive disorder?
Glutamate or Serotonin
Past experience with serious or life-threatening physical illness, either personal or that of a close family member, can predispose an individual to what somatic symptom disorder?
Illness Anxiety Disorder: unrealistic or inaccurate physical symptoms; leads to preoccupation and fear of having a serious illness
Describe the similarities and differences between narcissistic and borderline personality disorders.
In both, may have very low self-worth. In NPD that leads to egotistical behavior and lack of empathy. In BPD, anger is turned inward, resulting in frequent changes in behavior and mood
According to Engel, when is the grief response thought to be resolved?
In stage 4, resolution of the loss; preoccupation with the loss gradually decreases over a year or more
Individuals in crisis need to develop more adaptive coping strategies. How does the nurse provide assistance with this process?
Using the four phases of crisis intervention: Phase 1: Assessment Phase 2: Planning of therapeutic intervention Phase 3: Intervention Phase 4: Evaluation of crisis resolution and anticipatory planning
The physician orders lithium carbonate 600 mg tid for a client newly diagnosed with Bipolar I Disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. What is the therapeutic range for acute mania? a. 0.5 to 1.5 mEq/L b. 10 to 15 mEq/L c. 0.5 to 1 mEq/L d. 5 to 10 mEq/L
a. 0.5 to 1.5 mEq/L
A patient with depression asks the nurse, "Why would they be checking my thyroid function when I clearly have depression and I'm not overweight?" Which of these is an accurate response? a. An underactive thyroid can manifest as depression b. Depression has been proven to be a hormonal illness c. Thyroid hormone replacement is a first-line treatment for most people with depression d. Abnormal thyroid function predicts positive response to antidepressant medication
a. An underactive thyroid can manifest as depression
Annie has a hair-pulling disorder. She is receiving treatment at the mental health clinic with habit-reversal therapy (HRT). Which of the following elements would be included in this therapy? Select all that apply: a. Awareness training b. Competing response training c. Social support d. Hypnotherapy e. Aversive therapy
a. Awareness training b. Competing response training c. Social support
The nurse in the emergency department encounters a patient, Niko, who is expressing suicide ideation. The nurse recognizes that which of the following considerations are important to good suicide risk assessment? (select all that apply) a. Collaborating with the patient b. Asking specific questions about leisure activities c. Establishing trust and open communication with the patient d. Asking the patient specific questions about the strength of his intention to die e. Identifying whether the patient has thought about a plan for trying to kill himself
a. Collaborating with the patient c. Establishing trust and open communication with the patient d. Asking the patient specific questions about the strength of his intention to die e. Identify whether the patient has thought about a plan for trying to kill himself
Amanda's mobile home was destroyed by a tornado. Amanda received only minor injuries, but is experiencing disabling anxiety in the aftermath of the event. This type of crisis is called? a. Crisis resulting from traumatic stress b. Maturational or developmental crisis c. Dispositional crisis d. Crisis of anticipated life transitions
a. Crisis resulting from traumatic stress
Demitrius informs the nurse that his doctor is considering ECT and asks for some information about the procedure. Which of the following are accurate statements that the nurse can share with this patient? (Select all that apply.) a. ECT is typically used to treat patients who have not responded to antidepressant therapy. b. A long-acting anesthetic agent is given to the patient the morning of the treatment. c. One treatment is usually all that is needed to relieve depression. d. Side effects may include headache and some confusion or memory loss.
a. ECT is typically used to treat patient who have not responded to antidepressant therapy d. Side effects may include headache and some confusion or memory loss
The goal of cognitive therapy with depressed clients is to: a. Identify and change dysfunctional patterns of thinking b. Resolve the symptoms and initiate or restore adaptive family functioning c. Alter the neurotransmitters that are creating the depressed mood d. Provide feedback from peers who are having similar experiences
a. Identify and change dysfunctional patterns of thinking
What is the ultimate goal of therapy for a client with DID? a. Integration of the identities into one b. For the client to have the ability to switch from one identity to another voluntarily c. For the client to select which identity he or she want to be the dominant self d. For the client to recognize that the various identities exist
a. Integration of the identities into one
Which of the following individuals demonstrates the highest number of risk factors for suicide? a. John, who reports that he is in deep emotional pain, feels hopeless, and says "No one is there for me." b. Kelly, who has been seeing a doctor for chronic, intractable pain, verbalizes a deep commitment to her religious faith and is taking pain medication c. Jim, an American Indian, who graduated from high school with honors but does not yet have a job d. Mike, a physician, who reports feeling "burnt out" and is considering retirement
a. John, who reports that he is in deep emotional pain, feels hopeless, and says "No one is there for me."
Jack is a new patient on the psychiatric unit with a diagnosis of antisocial personality disorder. Which of the following characteristics would you expect to assess in Jack? a. Lack of guilt for wrongdoing b. Insight into his own behavior c. Ability to learn from past experiences d. Compliance with authority
a. Lack of guilt for wrongdoing
A patient expresses interest in alternative treatments for depression with seasonal variations and asks the nurse about light therapy. Which of the following are evidence-based teaching points that the nurse may share with the patient? (Select all that apply) a. Light therapy has demonstrated effectiveness that is comparable to antidepressants b. Light therapy should be used regularly until the season changes c. Light therapy should only be used when ECT has proven to be ineffective d. Side effects such as headache, nausea, or agitation, when they occur, are usually mild or transient e. Light therapy can cause sedation so the best time to use it is before bedtime
a. Light therapy has demonstrated effectiveness that is comparable to antidepressants b. Light therapy should be used regularly until the season changes d. Side effects such as headache, nausea, or agitation, when they occur, are usually mild or transient
The most appropriate nursing intervention with Jenny would be to: a. Make arrangements for her to start attending Alateen meetings b. Help her identify the positive things in her life and recognize that her situation could be a lot worse than it is c. Teach her about the effects of alcohol on the body and that it can be hereditary d. Refer her to a psychiatrist for private therapy to learn to deal with her home situation
a. Making arrangements for her to start attending Alateen meetings
Lorraine has been diagnosed with somatic symptom disorder. Which of the following symptom profiles would you expect when assessing Lorraine? a. Multiple somatic symptoms in several body systems b. Fear of having a serious disease c. Loss or alteration in sensorimotor functioning d. Belief that her body is deformed or defective in some way
a. Multiple somatic symptoms in several body systems
Used historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? (select all that apply) a. Olanzapine (Zyprexa) b. Oxycodone (Oxycontin) c. Carbamazepine (Tegretol) d. Gabapentin (Neurontin) e. Tranylcypromine (Parnate)
a. Olanzapine (Zyprexa) c. Carbamazepine (Tegretol) d. Gabapentin (Neurontin)
Which of the following behavioral patterns is characteristic of individuals with narcissistic personality disorder? a. Overly self-centered and exploitative of others b. Suspicious and mistrustful of others c. Rule conscious and disapproving of change d. Anxious and socially isolated
a. Overly self-centered and exploitative of others
Kim, a patient diagnosed with BPD, manipulates the staff in an effort to fulfill her own desires. All of the following may be examples of manipulative behaviors in the borderline client except: a. Refusal to stay in room alone, stating, "It's so lonely." b. Asking the nurse for cigarettes after 30 minutes, knowing that the assigned nurse has explained she must wait 1 hour. c. Stating to the nurse, "I really like having you for my nurse. You're the best one around here." d. Cutting arms with razor blade after discussing discharge plans with physician.
a. Refusal to stay in room alone, stating, "It's so lonely."
Which of the following interventions are appropriate for a patient on suicide precautions? (select all that apply) a. Remove all sharp objects, belts, and other potentially dangerous articles from the patient's environment b. Accompany the patient to off-unit activities c. Reassess intensity of suicidal thoughts and urges on a regular basis d. Put all of the patient's possessions in storage and explain to her that she may have them back when she is off suicide precautions
a. Remove all sharp objects, belts, and other potentially dangerous articles from the patient's environment b. Accompany the patient to off-unit activities c. Reassess intensity of suicidal thoughts and urges on a regular basis
A patient has just been admitted to the psychiatric unit with a diagnosis of Major Depressive Disorder. Which of the following manifestations may be apparent in a patient with this diagnosis? (Select all that apply) a. Slumped posture b. Delusional thinking c. Feelings of despair d. Feels best early in the morning and worse as the day progresses e. Anorexia
a. Slumped posture b. Delusional thinking c. Feelings of despair e. Anorexia
Tina, who is experiencing a panic attack, has just arrived at the emergency department. Which is the priority nursing intervention for this patient? a. Stay with Tina and reassure her of her safety. b. Administer a dose of diazepam. c. Leave Tina alone in a quiet room so that she can calm down. d. Encourage Tina to talk about what triggered the attack.
a. Stay with Tina and reassure her of her safety
Shondra is admitted to the hospital with major depressive disorder and repeatedly makes negative statements about herself. Which of the following interventions is identified as an approach that promotes positive self-esteem in the patient? (Select all that apply.) a. Teach assertive communication skills. b. Make observations to Shondra when she completes a goal or task. c. Instruct Shondra that you will not talk with her unless she stops talking negatively about herself. d. Offer to spend time with Shondra using a nonjudgmental, accepting approach.
a. Teach assertive communication skills b. Make observations to Shondra when she completes a goal or task d. Offer to spend time with Shondra using a nonjudgmental, accepting approach
The nurse identifies the primary nursing diagnosis for Theresa as "Risk for Suicide related to feelings of hopelessness from loss of relationship." Which is the outcome that would be most appropriate for this diagnosis? a. The patient has experienced no physical harm to herself b. The patient sets realistic goals for hersel c. The patient expresses some optimism and hope for the future d. The patient has reached a stage of acceptance in the loss of the relationship with her boyfriend
a. The patient has experienced no physical harm to herself
A patient with OCD spends many hours each day washing her hands. What is the most likely reason she washes her hands so much? a. To relieve her anxiety b. To reduce the probability of infection c. To gain a feeling of control over her life d. To increase her self-concept
a. To relieve her anxiety
Which of the following is most likely to initiate a grief response in an individual? (Select all that apply) a. Death of a pet dog b. Being told by her doctor that she has begun menopause c. Failing an examination d. Losing a spouse through divorce
a. death of a pet dog b. being told by her doctor that she has begun menopause c. failing an examination d. losing a spouse through divorce
When Frank's wife of 34 years dies, he is very stoic, handles all the funeral arrangements, doesn't cry or appear sad, and comforts all of the other family members in their grief. Two years later, when Frank's best friend dies, Frank has sleep disturbances, difficulty concentrating, loss of weight, and difficulty performing on his job. This is an example of which of the following maladaptive responses to loss? a. Delayed grieving b. Distorted grieving c. Prolonged grieving d. Exaggerated grieving
a. delayed grieving
Which of the following is a correct statement when attempting to distinguish normal grief from clinical depression? a. In clinical depression, anhedonia is prevalent b. In normal grieving, the person has generalized feelings of guilt c. The person who is clinically depressed relates feelings of depression to a specific loss d. In normal grieving, there is a persistent state of dysphoria
a. in clinical depression, anhedonia is prevalent
Which of the following is thought to facilitate the grief process? a. The ability to grieve in anticipation of the loss b. The ability to grieve alone without interference from others c. Having recently grieved for another loss d. Taking personal responsibility for the loss
a. the ability to grieve in anticipation of the loss
Jareth has a diagnosis of generalized anxiety disorder. His physician has prescribed buspirone 15 mg daily. Jareth says to the nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she is feeling anxious." Which of the following would be an appropriate response by the nurse? a. "Xanax is not effective for generalized anxiety disorder." b. "Buspirone must be taken daily in order to be effective." c. "I will ask the doctor if he will change your dose of buspirone to prn so that you don't have to take it every day." d. "Your friend really should be taking the Xanax every day."
b. "Buspirone must be taken daily in order to be effective."
An acutely depressed patient isolates herself in her room and just sits and stares into space. Which of these is the best example of an active communication approach with this patient? a. "Do you like exercise?" b. "Come with me. I will go with you to group therapy." c. "Would you like to go to group therapy, stay in bed, or come out to the day lounge for some activities?" d. "Why do you stay in your room all the time?"
b. "Come with me. I will go with you to group therapy."
The physician orders sertraline (Zoloft) 50 mg PO bid for Margaret, a 68-year-old woman with major depressive disorder. After 3 days of taking the medication, Margaret says to the nurse, "I don't think this medicine is doing any good. I don't feel a bit better." What is the most appropriate response by the nurse? a. "Cheer up, Margaret. You have so much to be happy about." b. "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms." c. "I'll report that to the physician, Margaret. Maybe he will order something different." d. "Try not to dwell on your symptoms, Margaret. Why don't you join the others down in the dayroom?"
b. "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms."
Which of the following behavioral patterns is characteristic of individuals with schizotypal personality disorder? a. Belittling themselves and their abilities b. A lifelong pattern of social withdrawal c. Suspicious and mistrust of others d. Overreacting inappropriately to minor stimuli
b. A lifelong pattern of social withdrawal
"Splitting" by the client with BPD denotes which of the following? a. Evidence of precocious development b. A primitive defense mechanism in which the client sees object as all good or all bad c. A brief psychotic episode in which the client loses contact with reality d. Two distinct personalities within the borderline client
b. A primitive defense mechanism in which the client sees objects as all good or all bad
Theresa, who has been hospitalized following a suicide attempt, is placed on suicide precautions on the psychiatric unit. She admits she is still feeling suicidal. Which of the following interventions is the most appropriate in this instance? (select all that apply) a. Restrict access to any item that might be harmful by placing the patient in a seclusion room b. Check on Theresa every 15 minutes at irregular intervals or assign a staff person to stay with her on a one-to-one basis c. Obtain an order from the physician to give Theresa a sedative to calm her and reduce suicide ideas d. Do not allow Theresa to participate in any unit activities while she is on suicide precautions e. Ask Theresa specific questions about her thoughts, plans, and intentions related to suicide
b. Check on Theresa every 15 minutes at irregular intervals or assign a staff person to stay with her on a one-to-one basis e. Ask Theresa specific questions about her thoughts, plans, and intentions related to suicide
Marie, age 56, is the mother of five children. Her youngest child, who had been living at home and attending the local college, recently graduated and accepted a job in another state. Marie has never worked outside the home and has devoted her life to satisfying the needs of her husband and children. Since the departure of her last child from home, Marie has become more and more despondent. Her husband has become very concerned, and takes her to the local mental health center. This type of crisis is called? a. dispositional crisis b. crisis of anticipated life transitions c. psychiatric emergency d. crisis resulting from traumatic stress
b. Crisis of anticipated life transitions
The most appropriate crisis intervention with Amanda would be to: a. Encourage her to recognize how lucky she is to be alive b. Discuss stages of grief and feelings associated with each c. Identify community resources that can help Amanda d. Suggest that she find a place to live that provides a storm shelter
b. Discuss stages of grief and feelings associated with each
Milieu therapy is a good choice for clients with antisocial personality disorder because it: a. provides a system of punishment and rewards for behavior modification b. emulates a social community in which the client may learn to live harmoniously with others c. provides mostly one-to-one interaction between the client and therapist d. provides a very structured setting in which the clients have very little input into the planning of their care
b. Emulates a social community in which the client may learn to live harmoniously with others
In determining degree of suicide risk with a suicidal patient, the nurse assesses the following behavioral manifestations: severely depressed, withdrawn, statements of worthlessness, difficulty accomplishing activities of daily living, no close support systems. The nurse identifies the patient's risk for suicide as which of the following? a. Low risk b. High risk c. Imminent risk d. Unable to determine
b. High risk
In establishing trust with Ellen, a client with the diagnosis of DID, the nurse must do which of the following? a. Try to relate to Ellen as though she did not have multiple identities b. Listen nonjudgmentally and respond empathetically when Ellen transitions to different identity states c. Ignore behaviors that Ellen attributes to other subpersonalities d. Explain to Ellen that he or she will work with her only if she maintains the status of the primary identity
b. Listen nonjudgmentally and respond empathetically when Ellen transitions to different identity states
The ultimate goal of therapy for a client with DID is most likely achieved through which of the following interventions? a. Crisis intervention and directed association b. Psychotherapy and hypnosis c. Psychoanalysis and free association d. Insight psychotherapy and dextroamphetamines
b. Psychotherapy and hypnosis
Which of the following ego defense mechanisms describes the underlying psychodynamics of somatic symptom disorder? a. Denial of depression b. Repression of anxiety c. Suppression of grief d. Displacement of anger
b. Repression of anxiety
Margaret, a 68-year-old widow, is brought to the emergency department by her sister-in-law. Margaret has a history of bipolar disorder and has been maintained on medication for many years. Her sister-in-law reports that Margaret quit taking her medication a few months ago, thinking she didn't need it anymore. Margaret is agitated, pacing, demanding, and speaking very loudly. Her sister-in-law reports that Margaret eats very little, is losing weight, and almost never sleeps. "I'm afraid she's going to just collapse!" Margaret is admitted to the psychiatric unit. What is the priority nursing diagnosis for Margaret? a. Imbalanced nutrition: Less than body requirements related to not eating b. Risk for injury related to hyperactivity c. Disturbed sleep pattern related to agitation d. Ineffective coping related to denial of depression
b. Risk for injury related to hyperactivity
Lorraine, a client diagnosed with somatic symptom disorder, states, "My doctor thinks I should see a psychiatrist. I can't imagine why he would make such a suggestion." What is the most common basis for Lorraine's statement? a. She thinks her doctor wants to get rid of her as a client. b. She does not understand the correlation of symptoms and stress. c. She thinks psychiatrists are only for "crazy" people. d. She thinks her doctor has made an error in diagnosis.
b. She does not understand the correlation of symptoms and stress
The initial care plan for a patient with OCD who washes her hands obsessively would include which of the following nursing interventions? a. Keep the patient's bathroom locked so she cannot wash her hands all the time b. Structure the patient's schedule so that she has plenty of time for washing her hands c. Place the patient in isolation until she promises to stop washing her hands so much d. Explain the patient's behavior to her because she is probably unaware that it is maladaptive
b. Structure the patient's schedule so that she has plenty of time for washing her hands
Success of long-term psychotherapy with Theresa (Who attempted suicide following a break up with her boyfriend) could be measured by which of the following behaviors? a. Theresa has a new boyfriend b. Theresa has an increased sense of self-worth c. Theresa does not take antidepressants anymore d. Theresa told her old boyfriend how angry she was with him for breaking up with her
b. Theresa has an increased sense of self-worth
The most appropriate nursing intervention with Ginger would be to: a. Suggest she move to a college closer to home b. Work with Ginger on unresolved dependency issues c. Help her find someone in the college town from whom she could seek assistance rather than calling her mother regularly d. Recommend that the college physician prescribe an antianxiety medication for Ginger
b. Work with Ginger on unresolved dependency issues
Margaret, a 68-year-old widow experiencing a manic episode, is admitted to the psychiatric unit after being brought to the emergency department by her sister-in-law. Margaret yells, "My sister-in-law is just jealous of me! She's trying to make it look like I'm insane!" This behavior is an example of which of the following? a. delusion of grandeur b. delusion of persecution c. delusion of reference d. delusion of control or influence
b. delusion of persecution
A major difference between normal and maladaptive grieving has been identified by which of the following? a. There are no feelings of depression in normal grieving b. There is no loss of self-esteem in normal grieving c. Normal grieving lasts no longer than 1 year d. In normal grief, the person does not show anger toward the loss
b. there is no loss of self-esteem in normal grieving
A nurse is educating a patient about his lithium therapy. She is explaining signs and symptoms of lithium toxicity. Which of the following would she instruct the patient to be on the alert for? a. Fever, sore throat, malaise b. Tinnitus, severe diarrhea, ataxia c. Occipital headache, palpitations, chest pain d. Skin rash, marked rise in blood pressure, bradycardia
b. tinnitus, sever diarrhea, ataxia
Lorraine, a client diagnosed with somatic symptom disorder, tells the nurse about a pain in her side. She says she has not experienced it before. Which is the most appropriate response by the nurse? a. "I don't want to hear about another physical complaint. You know they are all in your head. It's time for group therapy now." b. "Let's sit down here together, and you can tell me about this new pain you are experiencing. You'll just have to miss group therapy today." c. "I will report this pain to your physician. In the meantime, group therapy starts in 5 minutes." d. "I will call your physician and see if he will order a new pain medication for your side. The one you have now doesn't seem to provide relief. Why don't you get some rest for now?"
c. "I will report this pain to your physician. In the meantime, group therapy starts in 5 minutes."
A patient whose husband died 6 months ago is diagnosed with major depressive disorder. She says to the nurse, "I start feeling angry that Harold died and left me all alone; he should have stopped smoking years ago! But then I start feeling guilty for feeling that way." What is an appropriate response by the nurse? a. "Yes, he should have stopped smoking. Then he probably wouldn't have gotten lung cancer." b. "I can understand how you must feel." c. "Those feelings are a normal part of the grief response." d. "Just think about the good times that you had while he was alive."
c. "Those feelings are a normal part of the grief response."
Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Theresa says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll choose a no-fail method." Which is the best response by the nurse? a. "You are safe here. We will make sure nothing happens to you." b. "You're just lucky your roommate came home when she did." c. "What exactly do you plan to do?" d. "I don't understand. You have so much to live for."
c. "What exactly do you plan to do?"
Theresa, age 27, was admitted to the psychiatric unit from the medical intensive care unit where she was treated for taking a deliberate overdose of her antidepressant medication, trazodone (Desyrel). She says to the nurse, "My boyfriend broke up with me. We had been together for 6 years. I love him so much. I know I'll never get over him." Which is the best response by the nurse? a. "You'll get over him in time, Theresa." b. "Forget him. There are other fish in the sea." c. "You must be feeling very sad about your loss." d. "Why do you think he broke up with you, Theresa?"
c. "You must be feeling very sad about your loss."
Which of the following is a correct assumption regarding the concept of crisis? a. Crises occur only in individuals with psychopathology b. The stressful event that precipitates crisis is seldom identifiable c. A crisis situation contains the potential for psychological growth or deterioration d. Crises are chronic situations that recur many times during an individual's life
c. A crisis situation contains the potential for psychological growth or deterioration
Jenny reported to the high school nurse that her mother drinks too much. She is drunk every afternoon when Jenny gets home from school. Jenny is afraid to invite friends over because of her mother's behavior. What is this type of crisis called? a. Crisis resulting from traumatic stress b. Maturational or developmental crisis c. Dispositional crisis d. Crisis reflecting psychopathology
c. Dispositional crisis
Which of the following is the most appropriate therapy for a client with agoraphobia? a. 10 mg Valium qid b. Group therapy with other people with agoraphobia c. Facing her fear in gradual step progression d. Hypnosis
c. Facing her fear in gradual step progression
Joselyn is a new patient at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medications is the psychiatric nurse practitioner most likely to prescribe for Joselyn? a. Alprazolam (Xanax) b. Diazepam (Valium) c. Fluoxetine (Prozac) d. Olanzapine (Zyprexa)
c. Fluoxetine (Prozac)
In evaluating the progress of Jack, a client diagnosed with antisocial personality disorder, which of the following behaviors would be considered the most significant indication of positive change? a. Jack got angry only once in group this week b. Jack tells the nurse how much he respects her work and that she has helped him immensely c. On his own initiative, Jack sent a note of apology to a man he had injured in a recent fight d. Jack stated that he would not start any more fights
c. On his own initiative, Jack sent a note of apology to a man he had injured in a recent fight
Sandy, a patient with OCD says to the nurse, "I've been here four days now, and I'm feeling better. I feel comfortable on this unit, and I'm not ill-at-ease with the staff or other patients anymore." In light of this change, which nursing intervention is most appropriate? a. Give attention to the ritualistic behaviors each time they occur and point out their inappropriateness. b. Ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement. c. Set limits on the amount of time Sandy may engage in the ritualistic behavior. d. Continue to allow Sandy all the time she wants to carry out the ritualistic behavior.
c. Set limits on the amount of time Sandy may engage in the ritualistic behavior
Andrew, a firefighter, and his entire unit responded to the aftermath of an earthquake. Working as a team, he and his best friend, Carlo, entered a building together to search for survivors. Carlo was killed when the building collapsed. Andrew was injured but survived. Since that time, Andrew has had frequent nightmares and anxiety attacks. He says to the mental health worker, "I don't know why Carlo had to die and I didn't!" This statement by Andrew suggests that he is experiencing: a. Spiritual distress. b. Night terrors. c. Survivor's guilt. d. Suicidal ideation.
c. Survivor's guilt
Gloria, a recent widow, states, "I'm going to have to learn to pay all the bills. Hank always did that. I don't know if I can handle all of that." This is an example of which of the tasks described by Worden? a. Task I. Accepting the reality of the loss b. Task II. Processing the pain of grief c. Task III. Adjusting to a world without the lost entity d. Task IV. Finding an enduring connection with the lost entity in the midst of embarking on a new life
c. Task III. Adjusting to a world without the lost entity
A child with bipolar disorder also has attention-deficit/hyperactivity disorder (ADHD). How would these comorbid conditions most likely be treated? a. No medication would be given for either condition b. Medication would be given for both conditions simultaneously c. The bipolar condition would be stabilized first before medication for the ADHD would be given d. The ADHD would be treated before consideration of the bipolar disorder
c. The bipolar condition would be stabilized first before medication for the ADHD would be given
Which of the following is the desired outcome of working with an individual who has witnessed a traumatic event and is now experiencing panic anxiety? a. The individual will experience no anxiety b. The individual will demonstrate hope for the future c. The individual will identify that anxiety is at a manageable level d. The individual will verbalize acceptance of self as worthy
c. The individual will identify that anxiety is at a manageable level
Which grief reaction can the nurse anticipate in a 10-year-old child? a. Statements that the deceased person will soon return b. Regressive behaviors, such as loss of bladder control c. A preoccupation with the loss d. Thinking that he or she may have done something to cause the death
c. a preoccupation with the loss
Which of the following is NOT true regarding grieving by an adolescent? a. Adolescents may not show their true feelings about the death b. Adolescents tend to have an immortal attitude c. Adolescents do not perceive death as inevitable d. Adolescents may exhibit acting-out behaviors as part of their grief
c. adolescents do not perceive death as inevitable
Nancy, who is dying of cancer, says to the nurse, "I just want to see my new grandbaby. If only God will let me live until she is born. Then I'll be ready to go." This is an example of which of Kübler-Ross's stages of grief? a. Denial b. Anger c. Bargaining d. Acceptance
c. bargaining
Margaret, age 68, is diagnosed with Bipolar I Disorder, current episode manic. She is extremely hyperactive and has lost weight. One way to promote adequate nutritional intake for Margaret is to? a. sit with her during meals to ensure that she eats everything on her tray b. have her sister-in-law bring all her food from home because she knows Margaret's likes and dislikes c. provide high-calorie, nutritious finger foods and snacks that Margaret can eat "on the run" d. tell Margaret that she will be on room restriction until she starts gaining weight
c. provide high-calorie, nutritious finger foods and snacks that Margaret can eat "on the run"
Katerina, who is experiencing a manic episode, enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? a. Tell her, in front of the other patients, that she cannot dress like a ***** while she is in the hospital. b. Do nothing and allow her to learn from the responses of her peers. c. Quietly walk with her back to her room and help her change into something more appropriate. d. Explain to her that if she wears this outfit, she must remain in her room.
c. quietly walk with her back to her room and help her change into something more appropriate
Margaret, age 68, is a widow of 6 months. Since her husband died, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband was buried. She told her sister today that she "didn't have anything more to live for." She has been hospitalized with Major Depressive Disorder. The priority nursing diagnosis for Margaret would be: a. imbalanced nutrition; less than body requirements b. complicated grieving c. risk for suicide d. social isolation
c. risk for suicide
How should a nurse care for the self-inflicted wounds of a patient with BPD?
care for the client's wounds in a matter-of-fact manner. do not give positive reinforcement to this behavior by offering sympathy or additional attention
What are some of the types of family dynamics that may predispose a person to antisocial personality disorder?
chaotic home environment; parental deprivation during first 5 years of life
What are the primary psychosocial predisposing factors to borderline personality disorder?
childhood trauma, a vulnerable temperament, and a series of triggering events
What is the speech pattern of a person experiencing a manic episode?
continuous flow of accelerated, pressured speech; disorganized and incoherent when severe
The most appropriate nursing intervention with Marie would be to: a. Refer her to her family physician for a complete physical examination b. Suggest she seek outside employment now that her children have left home c. Identify convenient support systems for times when she is feeling particularly despondent d. Begin grief work and assist her to recognize areas of self-worth separate and apart from her children
d. Begin grief work and assist her to recognize areas of self-worth separate and apart from her children
Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Klonsky and May's "Three-Step Theory" suggests that the nurse should assess which three issues to evaluate Theresa's active risk for a suicide attempt? a. Level of education, ethnic background, and current employment b. Relationship with previous boyfriends, coping mechanisms, an intent to have future boyfriends c. Self-esteem, grade point average, and physical attractiveness d. Degree of psychological pain, connectedness with others, and suicide ideation in combination with capacity to make an attempt
d. Degree of psychological pain, connectedness with others, and suicide ideation in combination with capacity to make an attempt
Jessica is a nurse who was floated to the psychiatric unit to cover for a staff nurse who called out sick. She encounters a patient who is diagnosed with BPD, and the patient states, "Thank goodness they sent you to the unit. No one else here has taken the time to listen to my concerns." This may be an example of which symptom common in BPD? a. Impulsivity b. Self-harming behaviors c. Dissociation d. Splitting
d. Dissociation
Crisis occur when an individual: a. Is exposed to a precipitating stressor b. Perceives a stressor to be threatening c. Has no support systems d. Experiences a stressor and perceives coping strategies to be ineffective
d. Experiences a stressor and perceives coping strategies to be ineffective
Lucille has a diagnosis of Illness Anxiety Disorder. Which of the following symptoms would be consistent with this diagnosis? a. Complains of a multitude of incapacitating physical symptoms b. Manifests with pseudoseizures or pseudocyesis c. Takes substances to induce vomiting in order to convince the nurse that she needs treatment d. Expresses persistent fears of having life-threatening disease e. All of the above
d. Expresses persistent fears of having life-threatening disease
Nursing care for Jenna, a patient with somatic symptom disorder, would focus on helping her to do which of the following? a. Eliminate the stress in her life b. Discontinue her numerous physical complaints c. Take her medication only as prescribed d. Learn more adaptive coping strategies
d. Learn more adaptive coping strategies
Ginger, age 19 and an only child, left 3 months ago to attend a college of her choice 500 miles away from her parents. It is Ginger's first time away from home. She has difficulty making decisions and will not undertake anything new without first consulting her mother. They talk on the phone almost every day. Ginger has recently started having anxiety attacks. She consults the nurse practitioner in the student health center. What is this type of crisis called? a. Crisis resulting from traumatic stress b. Dispositional crisis c. Psychiatric emergency d. Maturational or developmental crisis
d. Maturational or developmental crisis
Ms. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder? a. Ms. T experiences panic anxiety when she encounters snakes b. Ms. T refuses to fly in an airplane c. Ms. T will not eat in a public place d. Ms. T stays in her home for fear of being in a place from which she cannot escape
d. Ms. T stays in her home for fear of being in a place from which she cannot escape
With implosion therapy, a client with phobic anxiety would be: a. Taught relaxation exercises b. Subjected to graded intensities of the fear c. Instructed to stop the therapeutic session as soon as anxiety is experienced d. Presented with massive exposure to a variety of stimuli associated with the phobic object or situation
d. Presented with massive exposure to a variety of stimuli associated with the phobic object or situation
According to Margaret Mahler, predisposition to BPD occurs when developmental tasks go unfulfilled in which of the following phases? a. Autistic phase, during which the child's needs for security and comfort go unfulfilled b. Symbiotic phase, during which the child fails to bond with the mother c. Differentiation phase, during which the child fails to recognize a separateness between self and mother d. Rapprochement phase, during which the mother withdraws emotional support in response to the child's increasing independence
d. Rapprochement phase, during which the mother withdraws emotional support in response to the child's increasing independence
Ellen has a history of childhood physical and sexual abuse. She was diagnosed with dissociative identity disorder (DID) 6 years ago. She has been admitted to the psychiatric unit following a suicide attempt. What is the primary nursing diagnosis for Ellen? a. Disturbed personal identity related to childhood abuse b. Disturbed sensory perception related to repressed anxiety c. Impaired memory related to disturbed thought processes d. Risk for suicide related to unresolved grief
d. Risk for suicide related to unresolved grief
Kim has a diagnosis of BPD. She often exhibits alternating clinging and distancing behaviors. Which of the following is the most appropriate nursing intervention with this type of behavior? a. Encourage Kim to establish trust in one staff person with whom all therapeutic interaction should take place b. Secure a verbal contract from Kim that she will discontinue these behaviors c. Withdraw attention if these behaviors continue d. Rotate staff members who work with Kim so that she will learn to relate to more than one person
d. Rotate staff members who work with Kim so that she will learn to relate to more than one person
Education for the patient who is taking MAOIs should include which of the following? a. Fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity b. Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks c. Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at the end of treatment d. Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification
d. Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification
Which of the following is the most common comorbid condition in children with bipolar disorder? a. Schizophrenia b. Substance disorders c. Oppositional defiant disorder d. Attention deficit-hyperactivity disorder
d. attention deficit-hyperactivity disorder
Engel identifies which of the following as successful resolution of the grief process? a. When the bereaved person can talk about the loss without crying b. When the bereaved person no longer talks about the lost entity c. When the bereaved person puts all remembrances of the loss out of sight d. When the bereaved person can discuss both positive and negative aspects about the lost entity
d. when the bereaved person can discuss both positive and negative aspects about the lost entity
Intervention with Andrew would include: a. Encouraging expression of feelings b. Antianxiety medications c. Participation in a support group d. a and c e. All of the above
e. All of the above
John's father died by suicide when John was a teenager. John's wife, Mary, tells the mental health nurse that she is afraid John "inherited" that predisposition from his father. How should the nurse respond to Mary?
family history of suicide increases an individual's risk for suicide; encourage talking about the suicide and listen to feelings of guilt John may be expressing
What is the difference between cyclothymic disorder and bipolar disorder?
never without symptoms for more than 2 months; elevated mood does not meet hypomanic episode criteria and depressed mood does not meet major depressive episode criteria
Conversion symptoms most commonly occur in an individual for what reason?
psychological conflict; stress or trauma
Describe behaviors common to preschool children following a traumatic event.
separation anxiety, regressive behaviors, nightmares, and hyperactive or withdrawn behaviors
What are the symptoms of a person with agoraphobia?
similar to panic attack; rapid HR, hyperventilating, chest pain, dysphagia, diaphoresis
What is the primary nursing intervention for a person in panic anxiety?
stay with the client and offer reassurance of safety and security. do not leave the client in panic anxiety alone
In an individual with dissociative identity disorder, what most commonly precipitates transition from one personality to another?
stress
Describe the phenomenon of bereavement overload
the complicated and challenging feeling associated with experiencing multiple losses
What is the goal of crisis intervention?
the resolution of an immediate crisis. Focus on the supportive, with the restoration of the individual to precrisis level of functioning
What should a person on lithium therapy have blood levels drawn regularly?
the therapeutic range for lithium is close to the toxic level