MH FINAL
A nurse is working with a Middle-Eastern patient being treated for major depression. The patient is expressing feelings of guilt for not being able to "snap out of it". A therapeutic response by the nurse would be:
"Clinical depression is not something you have brought on yourself"
A nurse is meeting with a crisis support group. In efforts to help patients identify with one another, the nurse explains which of the following about the crisis experience?
"Even happy events can cause a crisis if the stress is overwhelming."
The manager determines that a nurse is using motivational interviewing when talking with a client. Which statement made by the nurse did the manager observe to make this clinical determination?
"How important is it to you to stop drinking?"
The nurses is working with a client who has quit several jobs and no longer sends financial support to his two children living with their mother. This behavior is in conflict with the nurses values concerning responsible parenting. When discussing family roles with the client, the nurse shows positive regard through which statement?
"How is not working right now affecting you?"
A married client expresses to the nurse that the client's spouse's frequent nagging angers the client. The nurse role plays assertive communication techniques with the client. Which indicates that the client understands how to use assertive techniques effectively?
"I feel unappreciated when you criticize me."
Which of the following questions is best to ask when assessing the client's judgment?
"If you found yourself downtown without money or a car, how would you get home?"
The nurse has just completed her admission assessment of the client with anorexia. When documenting the mental status exam findings in the chart, the nurse notes poor judgment and insight. Which client statement would support this impression?
"Others are just trying to keep me from looking good."
An anxiolytic agent, lorazepam, has been prescribed for the client. Which statement by the client would indicate to the nurse that client education about this medication has been effective?
"This medication will relax me, so I can focus on problem solving."
A nurse can best assess a patient's ability to use abstract thinking by asking the patient which of the following questions?
"What do I mean when I say, 'Don't sweat the small stuff?'"
The client spoke of a current event in the national news and described it as it relates to the client. Then the client spoke of a historical event and described it as being directly related to the client. Which question might the nurse ask to determine if the client is experiencing ideas of reference?
"Where were you when this happened?"
Which of the following statements would be an empathetic response in a client interaction?
"You must have been embarrassed when your father yelled at you in the grocery store."
The nurse should avoid nontherapeutic techniques. Which of the following are nontherapeutic techniques? Select all that apply.
-Agreeing -Challenging -Giving approval
Assessment of sensorium and intellectual processes include which of the following? Select all that apply.
-Concentration -Memory -Orientation
The nurse's documentation includes the following for assessment of thought process and content when examining the mental status of the patient during her shift? Select all that apply.
-Loose association -ideas of reference -Delusion
Which of the following theories could be classified as humanistic theories? Select all that apply.
-Maslow's hierarchy of needs -Rogers' client-centered therapy
A nurse is assessing several clients who have experienced loss. Which client would the nurse most likely identify as experiencing complicated grieving? Select all that apply.
-The spouse of a person who died 7 years ago -A driver whose spouse and children died as a result of his drunk driving -An adult who insisted for many years she hated her deceased parents -The parent of a child who died after having left the child in a car on a hot day
The geriatric psychiatry nurse understands that the DSM-5 describes all mental disorders with specific criteria. Which are the purposes of the the DSM-5? Select all that apply.
-To provide a standardized nomenclature and language for all mental health professionals. -To present defining characteristics or symptoms that differentiate specific diagnoses. -To assist in identifying the underlying causes of disorders.
A nurse is caring for a Hispanic client in the mental health unit. What can the nurse do to promote cultural competence? Select all that apply.
-demonstrate genuine interest and respect for the client -tailor interventions to the client -do not assume that all individuals of a racial/ethnic group are the same -learn about the client's country of origin before assessing them
Which of the following personal characteristics influence a client's response to stressors? Select all that apply.
-self-efficacy -spirituality -hardiness -resilience -resourcefulness
A client is being admitted to the in-patient psychiatric unit with a diagnosis of bulimia nervosa. The nurse would expect this client to fall within which age range?
18 to 22 years old
An airplane carrying 180 people crashed in a residential community near a municipal airport. the survivors, families, and community will experience:
An adventitious crisis
A client tells the nurse, "Everybody smiles at me because they know the I was chosen by God for this mission." The nurse interprets this statement as which finding?
An idea of reference
A nurse is integrating Peplau's model when providing care to a client with a mental illness. Which would the nurse identify as a key component?
Anxiety
A psychiatric nurse is planning an educational program addressing primary prevention strategies in the community. The nurse explores current research regarding which health care need?
Assisting high school students to effectively manage stress
The client with schizophrenia makes the following statement, I just don't know how to count. The sky turned to fire. I have a ball in my head. The nurse documents this entire statement as an example of
Associative looseness
A nurse is performing safety assessments on a client in mechanical restrains as required by policy. Which action by the nurse demonstrates the ethical principle of nonmaleficence?
Assuring that the restraints are not causing injury to the client
A nurse makes the statement in a treatment team meeting, "It's not worth it to try to teach this patient how to make better choices. He has been here many times before and goes back home and does the same thing." The nurse is sharing which of the following?
Attitude
Anorexia nervosa would be placed on which of the following DSM-IV-TR axes?
Axis 1
The client follows the nurse down the hall consistently. The nurse reinforces that this behavior is inappropriate. Which of the following is the best reason that many psychiatric care units have policies against clients touching one another or staff?
Because some clients with mental illness have difficulty knowing when touch is or is not appropriate.
The nurse is aware that a person who repeatedly seeks cosmetic surgery to correct a perceived flaw in his or her appearance may have which of the following disorders?
Body dysmorphic disorder
When interacting with a client in the day room, the nurse determines that a violent outburst is imminent. Which of the following should the nurse do first?
Call for assistance.
During the admission assessment, the nurse asks the client, How are you feeling?i The client responds, I was able to purchase gas for 7 cents a gallon less than yesterday, which saved me a total of 84 cents. My car has a 12-gallon gas tank. Usually I am able to put in 11.7 gallons. I am very happy to have saved so much money. The nurse recognizes this response as which of the following?
Circumstantial thinking
The nurse asks a patient to list the days of the week in reverse order. The nurse is assessing which of the following?
Concentration
a female nurse who has teenage children and who is experiencing extreme frustration with an adolescent client may respond by adopting a parental or chastising tone. This is an example of:
Countertransference
The most commonly supported neuroanatomic theory of schizophrenia suggests which etiology?
Decreased brain tissue in the frontal and temporal regions of the brain
The client is being assessed for anger attacks. Which psychiatric disorder makes a person most susceptible to anger attacks that do not result in physical aggression?
Depression
Which of the following would best assess a client's judgment?
Discussing hypothetical situations
The supervisor reprimands the nurse in charge of the nursing unit because the charge nurse of the unit has not adhered to the unit budget. Later that afternoon, the charge nurse accuses the nursing staff of wasting supplies.. This behavior is an example of:
Displacement
A nurse is assessing a client with chronic illness. The client is whimpering. The nurse asks the client, "Is something wrong?" Which type of therapeutic communication technique is this indicative of?
Encouraging description of perception
During the working phase of a therapeutic relationship, which of the following actions by the nurse would best help the client to explore problems?
Encouraging the client to clarify feelings and behavior
The client's son is yelling and is hitting his hand with a rolled up newspaper. Which stage of aggression does the nurse identify that the client's son is exhibiting?
Escalation
Which type of community residential treatment setting is most likely to be permanent in any state?
Evolve consumer household
A client states, " Right before I got here I was doing all right. My job was going well, my wife and I were happy, and we just moved into a new apartment." The nurse responds, "You said you and your wife were happy. Tell me more about that." This is an example of which therapeutic technique?
Exploring
Psychotropic medications that are strong blockers of D2 receptors are more likely to result in which of the following side effects?
Extrapyramidal symptoms
Which of the following is a psychosocial explanation for the development of personality disorders?
Failure to complete a developmental task jeopardizes future personality development.
Which one of the following types of antipsychotic medications is most likely to produce extrapyramidal effects?
First-generation antipsychotic drugs
A patient is being transferred from a group home to an evolving consumer household. The goal of this transition is for the patient to eventually do what?
Fulfill daily responsibilities without supervision.
Where there is congruence between what is felt and what is being expressed, the nurse is exhibiting which of the following characteristics?
Genuineness
A patient is actively involved in community service activities. The benefit of involvement in meaningful daily activities will most directly contribute to which of the following attributes?
Hardiness
Nurses must be aware of the importance of boundaries, not only for the client but also for the nurse. Which of the following occurrences is considered a breach of professional boundaries?
Having a lengthy social conversation with a patient
Which would most likely be a type of behavior that would be manifested by a client who has histrionic personality disorder?
Having a tantrum if not getting enough attention
The nurse is assessing for negative symptoms of schizophrenia in a newly admitted client. The nurse would note which behavior as indicative of a negative symptom?
Hesitant to answer the nurse's questions during the assessment interview
Two nurses are discussing the rights of hospitalized psychiatric clients. Which of the following statements is an error?
If a committed client is also found to be incompetent, he loses his rights under the Patient's Bill of Rights.
All of the following nursing diagnoses are appropriate for the care of a client with anorexia nervosa. Which nursing diagnosis has the highest priority?
Imbalanced nutrition: less than body requirements
A client with schizophrenia is admitted to the inpatient unit. He does not speak when spoken to but has been observed talking to himself on occasion. At this time, the priority goal for this client is to
Increase his reality orientation.
"How does Jerry make you upset?" is a nontherapeutic communication technique because it:
Indicates an external source of the emotion
The nurse is working with a client who has sought counseling after trying to rescue a neighbor involved in a house fire. In spite of the client's efforts, the neighbor died. Which action does the nurse engage in with the client during the working phase of the nurse-client relationship?
Inquiring about and examining the client's feelings that may block adaptive coping
The nurse is preparing a client with schizophrenia for discharge. The nurse asks the client, "How are you going to care for yourself at home?" The purpose of the nurse's question is to assess the client's
Insight
The nurse asks the client "What is similar about a cow and a horse?" and, "What do a bus and airplane have in common?" These question would best assess which of the following areas?
Intellectual function
The nurse is assessing a client who is talking about her son's recent death but who shows no emotion of any kind. The nurse recognizes this behavior as which of the following defense mechanisms?
Intellectualization
A 35 year old man was discharged form care 6 months ago after successfully recovering from depression. The nurse therapist and the client spent many hours working through relevant issues. Now, the client is back at the healthcare facility with severe depression, and all the former issues have returned. The nurse says to a coworker, "This is unbelievable, we're back at square one again. He should know better at this point." The nurse's comments reflect:
Judgement
A patient reported to the nurse that on his way to the clinic, a policeman in a patrol car turned on his lights and pulled him over. When asked what he did next, the patient stated, "I pulled over, of course." Which of the following was the nurse trying to assess?
Judgement
In the space of five minutes, the client has been laughing and euphoric, then angry, and then crying for no reason that is apparent to the nurse. This behavior would be best described as..
Labile mood
Which of the following parts of the brain is associated with multiple feelings and behaviors and is referred to as the "emotional brain"?
Limbic system
Throughout the assessment, the client displays disorganized thinking, jumping from one idea to another with no clear relationship between the thoughts. The nurse would assess the client as having which of the following?
Loose associations
Which is a result of federal legislation?
Making it more difficult to commit people for mental health treatment against their will.
During rounds, a client with depression is discovered to have completed a suicide attempt in the bathroom. The staff members on the inpatient psychiatric unit have been very busy and fell behind on periodic assessment for this client. The client's family decides to pursue legal action against the staff and facility. The client's family would most likely claim:
Malpractice
A client diagnosed with a mild anxiety disorder has been referred to treatment in a community mental health center. Treatment most likely provided at the center includes:
Medical management of symptoms
One week after beginning therapy with thiothixene (Navane), the client demonstrates muscle rigidity, a temperature of 103 °F, an elevated serum creatinine phosphokinase level, stupor, and incontinence. The nurse should notify the physician because these symptoms are indicative of
Neuroleptic malignant syndrome
The physician orders a neurotransmitter for a client who has difficulty in regulating some chemicals in the brain. The nurse knows which is a neuromodulator?
Neuropepides
The distraught parents of an adolescent escort their child to the emergency room because of disrespectful and bizarre behavior. The nurse expects that this behavior is due to a chemical imbalance. Which parts of the nervous system contribute to the alteration of chemicals in the brain?
Neurotransmitters
The nurse considers cultural variations pertaining to a patient's non-verbal communication. Which of the following is the primary rationale for considering alternative meanings of non-verbal
Non-verbal messages have different meanings in various cultures
The nurse is attending an inservice training on safe take-down techniques for aggressive clients. Practicing these techniques helps to reinforce the proper handling of this situation. Preparation for safe physical handling prepares the nurse to practice which ethical principle?
Nonmaleficence
Which nursing intervention would be most likely to help the client with anorexia to establish healthy eating patterns?
Offer liquid protein supplements if the client is unable to complete meal
A client is seeking treatment for a specific phobia. The nurse in the anxiety disorders clinic documents that the client's anxiety is related to exposure to the phobic object. Which is a realistic outcome for anxiety self-control in this situation?
Practice relaxation techniques and report decreased physiological sensations associated with thoughts of the feared object
A student nurse asks the charge nurse what is involved with Axis IV of the DSM. The charge nurse would most likely reply that it identifies:
Psychosocial and environmental problems
One of the first steps that a nurse should take to deal effectively with aggressive clients is which of the following?
Reflect on abilities to handle own feelings of anger
Individuals who grew up in "at risk" environments but are able to become productive, successful citizens are believed to possess which characteristic?
Resilience
A client is engaged in the orientation phase of the nurse-client relationship. The client should be involved in which activity?
Seeking assistance
The client says to the nurse, "I know I can learn to cope with my family situation. By getting help here at the clinic, I'll be able to deal with them more effectively, and I won't be so stressed out all the time." This client is demonstrating a high level of
Self efficacy
The nurse is assessing the client who states he is a spiritual healer. Which term describes the extent to which a person considers himself to be an integral part of the universe?
Self-transcendence
The nurse is sitting down with a client to begin a conversation. Which position should the nurse take to convey acceptance of the client?
Sitting upright facing the client with both feet on the floor.
All of the following are nursing diagnoses identified for a client with schizophrenia. The student nurse correctly anticipates which diagnosis will resolve when the client's negative symptoms improve?
Social isolation
A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of
Tardive dyskinesia
The treatment team recommends that a client take an assertiveness training class offered in the hospital. Which behavior indicates that the client is becoming more assertive?
The client asks his roommate to put away his dirty clothes after telling the roommate that this bothers him.
When the nurse asks the client to restate the following in his or her own words, which sensorium and intellectual process is the nurse attempting to identify? The nurse states, "A stitch in time saves nine."
The client's ability to use abstract thinking
The nurse is discharging her client today to be placed in a community rehabilitation area that will provide the client with meaningful work, relationships, a place to come to and a place to return if necessary. Which type of referral will she make?
The clubhouse model
Which of the following factors is primarily responsible for the changes in inpatient hospital treatment between the 1980s and the present?
The growth of managed care
Legislation enacted in 1963 was largely responsible for which of the following shifts in care for the mentally ill?
The widespread use of community-based services
A client who has schizophrenia is having a conversation with the nurse suddenly stops talking in the middle of a sentence. The client is experiencing which type of thought disruption?
Thought blocking
A newly admitted schizophrenic client refuses to complete the admission interview. A nurse determines that the client has been living on the streets for several weeks and has barely eaten. The nurse streamlines the assessment, establishing baseline safety, and offers the client a warm meal. The nurse then shows the client to his room to rest. Which characteristic of the therapeutic nurse-client relationship has the nurse established?
Trust
A client who has been physically aggressive arrives at the emergency room for a psychiatric assessment. Which would be the best approach for the nurse to use?
Use brief statements and questions to obtain
A client being served in a busy inpatient psychiatric unit becomes very noisy and combative. The other clients are complaining about the noise and are afraid that they will be hurt by the client. The nurse determines that the best course of action for all involved is to seclude the client until the client is able to regain control of his behavior. On which ethical principle did the nurse base this decision?
Utilitarianism
The nurse must be able to make decisions that are based on the principles of right and wrong. The nurse must be an advocate for the client. What is the standard establishing such a code of conduct or living?
Values
A patient is known to express tangential thinking. The nurse would assess for which of the following when interacting with the patient?
Wandering off the topic and never answering the question
The nurse best assesses a client's memory by asking which of the following questions?
What is the name of the current president?
Which client on the mental health unit should be assessed as being at highest risk for directing violent behavior toward others?
a client who has paranoid delusions and believes is being followed by members of the mafia
A client is seen in the clinic with clinical manifestations of an inability to sit still and a rigid posture. as the nurse performs the assessment, which of these side effects would be correctly identified?
akathisia
A nurse detects that a client is experiencing panic-level anxiety. Which intervention should be immediately implemented?
provide calm, brief, directive communication
A client made threats to harm his parents if they come too close to him. The parents called 911, and the client is now held involuntarily for a psychiatric evaluation. During this time of involuntary admission, the client retains all client rights except for which of the following?
right to freedom
