NUR 316: Nursing Concepts for Psychiatric/Mental Health Exam 1

What is the therapeutic blood level range for lithium?

0.6 - 1.4 mEq/L

What extrapyramidal symptoms (EPS) are major side effects associated with typical antipsychotic medications?

Dystonia Akathisia Parkinson syndrome Tardive dyskinesia (TD)

How does crisis intervention differ from other types of interventions?

Is immediate

In a group, the ___ sits in judgment of what is right and wrong.

Moralist

What type of therapy is "person-centered" and utilizes a method of communication rather than a set of techniques?

Motivational interviewing

In a group, the ___ seeks control through passive silence.

Mute

What is important to consider when evaluating the dose of lithium to be administered?

Narrow therapeutic index - too little will not produce effects, while too much can cause toxicity

According to the CDC (2001), what are the factors related to violence?

Neurobiology Hormones Neurochemistry Early childhood experience Mental illness

A patient who subordinates his rights to his perception of the rights of others demonstrates ___ behavior.

Passive behavior

What is a behavioral contract and to whom does it apply?

Patient and nurse devise contract together for patient Patient writes the contract - is what he/she is deciding to do

What are the fundamental concepts of dialectical behavioral therapy (DBT)?

Patients are doing the best they can Patients are motivated and willing to change Radical acceptance is essential Mindfulness is key to managing emotions

Before initiating a patient's psychotropic medication for mood stabilization, what actions are important for the nurse to take?

Perform serum pregnancy test Obtain informed consent

What type of disorders does aggression most commonly occur in?

Personality disorders

What side effects of lithium might indicate toxicity?

Polyuria, polydipsia, edema Course hand tremor Twitching, hyperactive deep tendon reflexes Lethargy Dysarthria Ataxia, vertigo Tinnitus Seizures, coma, death

What are the symptoms of a hypertensive crisis?

Sudden elevation of blood pressure Explosive occipital headache Head and face flushing Feeling "full" Palpitation Chest pain Sweating Fever Nausea/vomiting Dilated pupils Photophobia

Influencing a person to accept an idea or belief, particularly the belief that the nurse can help and that the person will feel better in time, is referred to as a ___.

Suggestion

Serious contemplation about ending one's life is defined as ___.

Suicidal ideation (SI)

What are some forms of direct self-destructive behavior?

Suicidal ideation (SI) Threats Attempts Completed suicide

The threat to kill oneself is defined as ___.

Suicidal intent

The willful behavior to end one's life is defined as ___.

Suicide

What is the tenth leading cause of death in the United States across all age groups?

Suicide

Unsuccessful actions taken to kill oneself is defined as ___.

Suicide attempt

In a group, the ___ states the current position of the group.

Summarizer

Encouraging the use of healthy, adaptive defenses and discouraging those that are unhealthy or maladaptive is referred to as ___.

Support of defenses

What is the goal of acute treatment?

Symptom relief

After long use of typical antipsychotics, which condition involves symptoms that include stereotyped involuntary movements such as tongue protrusion, lip smacking/chewing, blinking, grimacing, foot tapping, or choreiform movements of the limbs and trunk?

Tardive dyskinesia (TD)

What type of antidepressant medication is not frequently used due to its lethality in overdose?

Tricyclic antidepressants (TCAs)

Which type of antidepressant pharmaceutical increases the availability of serotonin and norepinephrine by blocking their reuptake at the presynaptic membrane?

Tricyclic antidepressants (TCAs)

What types of antidepressant medications are never given to suicidal patients? Why?

Tricyclic antidepressants (TCAs) - highly lethal in overdose

In a group, the ___ attempts to devalue the significance of the group.

Truant

(True/False) Suicide has a message and a purpose; it is not a random act.

True

What is most important in establishing a therapeutic relationships?

Trust & rapport

What criteria must an individual meet in the state of Arizona to classify as having a serious mental illness (SMI)?

Unable to live independently Unable to work Unable to socialize

Members of a group realizing that they are not alone demonstrate Yalom's curative factor ___.

Universality

A patient describes an emotionally taxing experience to which the nurse responds, "I can see why that would be upsetting." This is an example of ___.

Validation

What are the two main priorities of the nurse when conversing with a psychiatric/mental health patient?

Validation & clarification

What benzodiazepines are commonly given to patients experiencing symptoms related to alcohol withdrawal?

Valium, Ativan, & Librium

___ are concepts that are formed as a result of life experiences with family, friends, culture, education, work, and relaxation.

Values

In a group, the ___ works to deflect responsibility for own actions from self.

Victim

What is the difference between voluntary and involuntary patient admission?

Voluntary: check self in Involuntary: court-ordered; do not want to be there

What are some common side effects of lithium?

Weight gain Fine hand tremor Fatigue Headache Acne Nausea/vomiting, diarrhea

When is electroconvulsive therapy (ECT) used?

When medications are ineffective For pregnant patients with severe depression who cannot take certain pharmaceuticals

When are patients most likely to engage in behavior change?

When provider assesses readiness for change & tailors interventions accordingly

What is the goal of rehabilitation?

Work towards stabilization to improve functionality

The positive factors often involved in groups, including imparting information, installation of hope, universality, altruism, corrective reenactment, development of social interaction techniques, imitative behaviors, interpersonal learning, existential factors, catharsis, and group cohesion, are referred to as ___.

Yalom's curative factors

The nurse works with a patient to explore his thoughts, feelings, and actions to ultimately define his goals. This is completed in which of the following phases? A. Preinteraction phase B. Introductory/orientation phase C. Working phase D. Termination phase

B. Introductory/orientation phase

Define self-destructive behavior.

Maladaptive measures an individual uses to restore equilibrium when unable to cope

In a group, the ___ attempts to control the group by talking.

Monopolizer

Describe the phases of a crisis.

1. Initial rise in tension that activates usual coping 2. If no relief, increased anxiety 3. New coping tried or problem redefined 4. If no resolution, severe panic or anxiety

Identify and define the five stages of change addressed in motivational interviewing.

1. Precontemplation: denial of problem; goal is to listen, create climate to encourage patient to consider, explore, or see value in benefits of changing 2. Contemplation: recognize need to change; goal is to create supportive environment for change without pressuring to do so 3. Determination: made decision to change and assess how decision feels; goal is to help set realistic goals and find different ways to reach those goals 4. Action: firm commitment to change and plan is identified; goal is to help patient take steps to change 5. Maintenance: continued commitment to sustaining new behavior; goal is to help prevent relapse

What are the three most critical indications (balancing factors) for determining if a stressful event will become a crisis?

1. Realistic perception of event 2. Situational support system 3. Adequacy of coping mechanisms

When did the Community Mental Health movement reach its apex?

1960s

Which information is most important for the nurse to include in a teaching plan for a schizophrenic client taking clozapine (Clozaril)? 1. Monthly blood tests will be necessary. 2. Report a sore throat or fever to the physician immediately. 3. Blood pressure must be monitored for hypertension. 4. Stop the medication when symptoms subside.

2. Report a sore throat or fever to the physician immediately.

The nurse works with her patient to identify his problems and mutually formulate a contract. This is completed in which of the following phases? A. Preinteraction phase B. Introductory/orientation phase C. Working phase D. Termination phase

B. Introductory/orientation phase

Involving the patient in the plan of action to change a specific behavior illustrates the cognitive behavioral intervention technique of ___.

Behavior modification

The ability of a group to help members deal with reality of existence, difficult life issues, death, ultimate aloneness, and responsibility that each of us has for how we live our lives demonstrates Yalom's curative factor ___.

Existential factors

What is the targeted size for a group therapy group to ensure all members have a chance to speak, but there are enough people to provide a variety of feedback and viewpoints?

7 - 10 members

A month prior to their suicide, ___% of older suicide victims had visited a primary care provider.

75%

Approximately ___% of people who end their lives have a psychiatric illness.

90%

Anger is a response to what?

A perceived threat

What class of pharmaceuticals enhances GABA to calm the brain, producing an inhibitory response?

Benzodiazepines

What pharmaceuticals may have decreased effects when taken with antacids or tobacco?

Benzodiazepines

Which question best assesses an individual's ability to cope with the potential emotional crisis resulting from the death of a parent? A. "Have you ever lost a loved one before?" B. "Do you think you will be able to cope well?" C. "Do you feel you have supportive people to rely upon?" D. "Are you able to draw on fond memories of your parent?"

A. "Have you ever lost a loved one before?"

Which statement made by a teenager indicates an increased risk for poor stress management as a result of a psychosocial factor? A. "I couldn't survive if my boyfriend left me." B. "My father tried to kill himself when I was 10 years old." C. "Our religion does not accept homosexuality as a lifestyle choice." D. "In my culture mental illness is thought of as a punishment not a sickness."

A. "I couldn't survive if my boyfriend left me."

The clinical performance appraisal of a psychiatric nurse is generally accomplished through: A. A mentoring relationship with a more experienced, skilled, and formally educated nurse. B. The evaluation of the nurse's competencies by a representative of the supervisory staff. C. Review of performance by members of the nurse's interdisciplinary team. D. Regular self-evaluation of one's skills and effectiveness.

A. A mentoring relationship with a more experienced, skilled, and formally educated nurse.

Which statement demonstrates the effective implementation of evidence-based practice guidelines? A. A nurse explains that, "Negative responses to suicidal ideation assessments are documented on each client diagnosed with depression at least once a shift." B. A family member states that, "My mother has been introduced to an antipsychotic medication that has significantly decreased her paranoia." C. A nursing assistant's comment that, "Working here is a very rewarding job since I can help those who are really in need." D. A client reports, "I'm so happy I was admitted to this mental health unit because they really care about me here."

A. A nurse explains that, "Negative responses to suicidal ideation assessments are documented on each client diagnosed with depression at least once a shift."

Which nursing intervention best builds a therapeutic nurse-client relationship? A. Actively listening as the client expresses his or her thoughts and feelings B. Intervening when the client begins to state beliefs that come from his or her illness C. Evaluating a client's behaviors and interpersonal relationships frequently to identify stressors D. Passively allowing the client to control the communication and tone of the discussions

A. Actively listening as the client expresses his or her thoughts and feelings

Which of the following groups are considered to be at highest risk for suicide? A. Adolescents, men over age 45, and persons who have made previous suicide attempts B. Teachers, divorced persons, and substance abusers C. Alcohol abusers, widows, and young married men D. Depressed persons, physicians, and persons living in rural areas

A. Adolescents, men over age 45, and persons who have made previous suicide attempts

A client has not been taking his antidepressant medication as prescribed and is admitted with suicidal ideations. The nurse demonstrates an understanding of a possible underlying cause of a client's noncompliance with the treatment plan designed to help manage his depression when: A. Asking, "Do you feel that you don't have any control over your depression?" B. Assessing the client's understanding of the risk depression presents for suicide. C. Documenting the son's statement that, "We will do everything we can to help." D. Observing the client interacting with family members when they visit the mental health unit.

A. Asking, "Do you feel that you don't have any control over your depression?"

During alprazolam (Xanax) therapy, the nurse should be alert for which dose-related adverse reaction? A. Ataxia B. Hepatomegaly C. Urticaria D. Rash

A. Ataxia

Which nursing activity is a direct result of the Community Mental Health Centers Act of 1963? A. Being a member of a client's multidisciplinary treatment team B. Performing an extensive admissions assessment for each hospitalized client C. Using physical restraints as only the last resort when client safety requires it D. Educating a client on the role of neurotransmitters in chronic depression

A. Being a member of a client's multidisciplinary treatment team

A patient admitted voluntarily for treatment of an anxiety disorder demands to be released from the hospital. Which action shoul dthe nurse take initially? A. Contact the patient's health care provider (HCP). B. Call the patient's family to arrange for transportations. C. Attempt to persuade the patient to stay "for only a few more days." D. Tell the patient that leaving would likely result in an involuntary commitment.

A. Contact the patient's health care provider (HCP).

Which of the following statements should be included when teaching clients about monoamine oxidase (MAO) inhibitor antidepressants? A. Don't take prescribed or over-the-counter medications without consulting the physician. B. Avoid strenuous activity because of the cardiac effects of the drug. C. Have blood levels screened weekly for leukopenia. D. Don't take with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).

A. Don't take prescribed or over-the-counter medications without consulting the physician.

A client with chronic schizophrenia receives 20 mg of fluphenazine decanoate (Prolixin Decanoate) by I.M. injection. Three days later, the client has muscle contractions that contort the neck. This client is exhibiting which extrapyramidal reaction? A. Dystonia B. Akinesia C. Akathisia D. Tardive dyskinesia

A. Dystonia

It has been estimated that 20%, or 45 million, adults ages 18 or older in the United States have experienced a mental illness in the past year. Which nursing intervention is directed toward addressing the greatest barrier to successful treatment outcomes for these individuals? A. Educating clients as to the importance of completing their treatment recommendations B. Identifying resources where medications can be secured at reduced or no cost C. Actively involving the client in the planning of his or her mental health care D. Evaluating the client for compliance with his or her plan of care frequently

A. Educating clients as to the importance of completing their treatment recommendations

The nurse demonstrates an understanding of the first assumption of Stuart's Stress Adaptation Model when: A. Encouraging a client's adult children to accompany their parent to family group therapy sessions. B. Discussing with a client's health team which interventions should be included in the plan of care. C. Planning interventions based on a particular nursing theory that is relevant to the client's problem. D. Identifying community resources that will help a mentally ill client live in his own home.

A. Encouraging a client's adult children to accompany their parent to family group therapy sessions.

Access to mental health care services has been identified as a necessary component in an effective mental health care system. Which intervention demonstrates an attempt to meet the needs of an underserved group of Americans? A. Establishing a mobile mental health clinic that serves residents in a rural farming community B. Providing instructions on a variety of stress management techniques to police and fire personnel C. Conducting eating disorder screenings at local high schools and colleges D. Educating the parents of adolescents on the signs of depression

A. Establishing a mobile mental health clinic that serves residents in a rural farming community

The Mini Mental State Exam is most appropriately used when the: A. Focus of the exam is the client's cognitive function. B. Interview must be completed in 10 minutes or less. C. Client is agitated and unwilling to complete the full version. D. Test is meant to establish a client's mood at the time of admission.

A. Focus of the exam is the client's cognitive function.

An individual is being admitted for psychiatric treatment. The initial role of the nurse regarding this individual's psychopharmacologic therapy is to: A. Gather data to create a baseline assessment that includes a medication history. B. Assess the individual's understanding of the therapeutic value of his or her current medications. C. Evaluate the effectiveness of the medication regime by focusing on the client's current symptoms. D. Begin the admission interview in such a manner that will foster a therapeutic nurse-client relationship.

A. Gather data to create a baseline assessment that includes a medication history.

Which nursing action is most appropriate when trying to diffuse a client's impending violent behavior? A. Helping the client identify and express feelings of anxiety and anger B. Involving the client in a quiet activity to divert attention C. Leaving the client alone until he can talk about his feelings D. Placing the client in seclusion

A. Helping the client identify and express feelings of anxiety and anger

The nurse is engaging in patient- and family-centered care most effectively when: A. Including a client's homosexual partner in the discussion regarding discharge planning. B. Allowing a client admitted for acute psychiatric care to be visited by family members. C. Helping a cognitively impaired client call his parents who live out of state. D. Volunteering at a clinic that provides free services to clients of all ages.

A. Including a client's homosexual partner in the discussion regarding discharge planning.

The greatest negative personal result of stigma directed toward those diagnosed with a mental illness is: A. Low self-esteem. B. Impaired social skills. C. Poor employment prospects. D. Increased risk for substance abuse.

A. Low self-esteem.

When reviewing the admission assessment, the nurse notes that a patient was admitted to the mental health unity involuntarily. Based on this type of admission, the nurse should provide which intervention for this patient? A. Monitor closely for harm to self or others. B. Assist in completing an application for admission. C. Supply the patient with written information about their mental illness. D. Provide an opportunity for the family to discuss why they felt the admission was needed.

A. Monitor closely for harm to self or others.

A client has been voluntarily admitted to a mental health unit for treatment of acute depression. Which client request will the nurse deny based on this type of commitment? A. Notifying his wife to bring him his personal cell phone B. Arranging for him to cast his absentee vote for a city election C. Mailing out his driver's license renewal form as a registered letter D. Arranging for a private space where he can meet with his attorney

A. Notifying his wife to bring him his personal cell phone

The nurse demonstrates an understanding of the importance of assessment in prevention of mental illness when: A. Observing the partner of a pregnant woman for evidence of effective support and caring. B. Educating the family of a client diagnosed with depression as to the signs of suicide planning. C. Encouraging the parents of a teenager diagnosed with anorexia to attend family counseling. D. Assessing the problem-solving skills of a client diagnosed with obsessive-compulsive disorder.

A. Observing the partner of a pregnant woman for evidence of effective support and caring.

What are the three factors that impact mental health and mental illness?

Biological Social Cultural

The forensic psychiatric nurse oftentimes has conflicting goals when providing psychiatric care while serving the legal system. Which situation best demonstrates this conflict? A. Performing a mental health assessment on an individual diagnosed with paranoid schizophrenia who is accused of violently attacking a neighbor he believed was "spying for the government" B. Providing both physical and emotional care to a female who was raped while securing and preserving the evidence that will be used in a court of law C. Arranging for and then leading an anger management therapy group for a group of female offenders who are about to be paroled D. Conducting a depression screening on a newly incarcerated prisoner serving a 25-year sentence in a federal prison

A. Performing a mental health assessment on an individual diagnosed with paranoid schizophrenia who is accused of violently attacking a neighbor he believed was "spying for the government"

The nurse gathers data about a patient to plan their first meeting. This is completed in which of the following phases? A. Preinteraction phase B. Introductory/orientation phase C. Working phase D. Termination phase

A. Preinteraction phase

High school programs, drug and alcohol programs, and seminars or groups for elders are examples of ___ prevention of suicide. A. Primary B. Secondary C. Tertiary D. Post

A. Primary

The nurse's goal in crisis intervention is to provide: A. Problem-solving techniques and structured activities. B. An insight-oriented analytic approach. C. Medication to sedate the client. D. Nondirective techniques such as free association.

A. Problem-solving techniques and structured activities.

The key to asking culturally competent assessment questions is to: A. Remove all bias from the questions. B. Ask simple, simply worded questions. C. Address all age groups and genders within the culture. D. Recognize that culture affects all aspects of an individual's life.

A. Remove all bias from the questions.

A man with a 5-year history of multiple psychiatric admissions is brought to the emergency department by the police. He was found wandering the streets disheveled, shoeless, and confused. Based on his previous medical records and current behavior he is diagnosed with chronic undifferentiated schizophrenia. The nurse should assign highest priority to which nursing diagnosis? A. Risk for injury B. Impaired verbal communication C. Disturbed thought processes D. Dressing or grooming self-care deficit

A. Risk for injury

The nurse is caring for a client diagnosed with panic disorder. The client begins to hyperventilate. How should the nurse respond initially? A. Stay with the client during the anxiety attack. B. Shout for help and obtain assistance. C. Teach the client relaxation exercises. D. Help the client explore the reason for the anxiety.

A. Stay with the client during the anxiety attack.

The nurse demonstrates appropriate Asian-American cultural sensitivity when: A. Substituting the word "sadness" for depression when participating at a health fair at a local Asian-American senior center. B. Anticipating that the Asian-American teenager is well educated concerning the dangers of tobacco and marijuana abuse. C. Being particularly interested in the older Asian-American's view regarding the role of alcohol in managing stress. D. Evaluating the critical thinking skills and short-term recall abilities of the Asian-American female over the age of 70.

A. Substituting the word "sadness" for depression when participating at a health fair at a local Asian-American senior center.

A client is admitted to a psychiatric facility with a diagnosis of chronic schizophrenia. The history indicates that the client has been taking neuroleptic medication for many years. Assessment reveals unusual movements of the tongue, neck, and arms. Which condition should the nurse suspect? A. Tardive dyskinesia B. Dystonia C. Neuroleptic malignant syndrome D. Akathisia

A. Tardive dyskinesia

A client is admitted to an inpatient psychiatric unit. After the assessment and admission procedures are completed, the nurse states, "I'll try to be available to talk with you when needed and will spend time with you each morning from 10:00 until 10:30 in the corner of the dayroom." What is the main rationale for communicating these planned nursing interventions? A. To attempt to establish a trusting relationship B. To provide a structured environment for the client C. To instill hope in the client D. To provide time for completing nursing responsibilities

A. To attempt to establish a trusting relationship

There appears to be a power struggle among the members of an outpatient therapeutic support group. Which event that occurred during a session demonstrates a need for the leader to intervene? A. Two members consistently engaged in debates that made voting on issues very difficult. B. A member abruptly left the group session when his proposal did not gain enough votes to pass. C. Three members monopolized the session debating what stress management technique is most helpful. D. The decision regarding the admission of late members had to be postponed since no agreement could be reached.

A. Two members consistently engaged in debates that made voting on issues very difficult.

The steps of the nursing process as described by the standards of psychiatric nursing practice all share the nursing behavior of: A. Validation with the client. B. Prioritizing of client care needs. C. Coordinating client care with other team members. D. Establishment of a therapeutic relationship with the client.

A. Validation with the client.

A client is questioning why she was told that the nausea she is experiencing with this new antidepressant medication will subside once her medication is regulated. Based on the pharmacologic principle of steady state, the nurse explains that: A. When her body reaches a steady point where introduction and elimination of the medication are constant the nausea will stop. B. Blood work can be done to determine the appropriate time her body will reach a steady state when the new medication will not cause the nausea. C. Antidepressants commonly cause nausea for the first 10 doses and once her body can steady the absorption of the medication the side effect will stop. D. Antidepressants have a relatively short half life that will allow for the blood serum's steady state to occur within a few days and then the nausea will stop.

A. When her body reaches a steady point where introduction and elimination of the medication are constant the nausea will stop.

What disorders have the best treatment outcomes when medications are given?

Bipolar disorder Psychosis

In the relationship process, what occurs during the preinteraction phase?

Explore own feelings, fantasies, fears Analyze own professional strengths & limitations Gather data about patient Plan first meeting with patient

In the relationship process, what occurs during the working phase?

Explore relevant (current) stressors Promote development of insight Promote use of constructive coping mechanisms Overcome resistance behaviors

Bonding or solidarity of a group that is necessary for therapeutic factors to occur and is needed for risk taking, catharsis, and interpersonal learning demonstrates Yalom's curative factor ___.

Group cohesiveness

Why are cardiovascular medications, such as beta blockers and alpha-2 receptor agonists, used in patients with anxiety?

Block manifestations: Tremors Palpitations Tachycardia Sweating

A nurse who threatens to take away a patient's cigarette break if he does not take his medication could be charged with ___.

Assault

A patient who conveys a sense of self-assurance and communicates respect for others demonstrates ___ behavior.

Assertive behavior

What class of medications is helpful for treating the negative symptoms of schizophrenia?

Atypical antipsychotics

___ involves being open to self-exploration of thoughts, needs, emotions, values, defenses, actions, communications, problems, and goals.

Authenticity

In a group, the ___ works at keeping or making peace.

Harmonizer

A nurse who establishes social, economic, or personal relationships with a patient is exhibiting ___.

Boundary violations

What non-addictive, non-benzodiazepine is commonly implemented for patients who suffer from generalized anxiety disorder (GAD)?

Buspirone (BuSpar)

What age group is most likely to experience aggression and why?

Adolescents - undeveloped/insufficient coping mechanisms

What antipsychotic is most commonly used for adults? For children?

Adults: Seroquel Children: Tegretol

A patient who ignores the rights of others demonstrates ___ behavior.

Aggressive behavior

What are some forms of indirect self-destructive behavior?

Alcohol/drug abuse Eating disorders Cigarette smoking Reckless driving Gambling Criminal activity Sexual promiscuity Socially deviant activity High-risk sports Noncompliance with medical treatment

Name five common benzodiazepines.

Alprazolam (Xanax) Chlordiazepoxide (Librium) Clonazepam (Klonopin) Diazepam (Valium) Lorazepam (Ativan)

Why would a nurse inquire about a depressed patient's use of alternative medications?

Alternative medications, such as St. John's wort, can precipitate serotonin syndrome when added to antidepressant medication

Members of a group sharing parts of themselves to help others and learning that one can help others to make all feel needed and useful and promoting self-growth and self-esteem demonstrate Yalom's curative factor ___.

Altruism

___ is concern for the welfare of others.

Altruism

A natural phase in the process of change in which a person thinks, "I want to, and I don't want to" that must be resolved in order for change to occur is defined as ___.

Ambivalence

Name three common tricyclic antidepressants.

Amitriptyline (Elavil) Imipramine (Tofranil) Nortriptyline (Pamelor)

___ is the central force to self-destructive behavior.

Anxiety

What does the third level of crisis intervention, generic approach, help to do?

Applies specific method to all people faced with similar type of crisis/disaster Reach high-risk individuals and large groups as quickly as possible Ensure course of crisis results in adaptive response

What questions might the nurse ask to assess a patient for risk for harm to self?

Are you having thoughts of suicide? Have you ever had thoughts of suicide? Have you ever attempted suicide? Do you have a plan? If so, what is the plan?

What is the nurse's primary concern for psychiatric patients?

Assessing for safety - inquire about thoughts of harming self or others

Atypical antipsychotics affect which hormones? Typical antipsychotics affect which hormones?

Atypical = dopamine & serotonin Typical = dopamine

The nurse is providing care to a client admitted to the hospital with a diagnosis of acute anxiety disorer. The patient says to the nurse, "I have a secret that I want to tell you. You won't tell anyone about it, will you?" What is the most appropriate nursing response? A. "No, I won't tell anyone." B. "I cannot promise to keep a secret." C. "It depends on what the secret is about." D. "If you tell me the secret, I may need to document it."

B. "I cannot promise to keep a secret."

Which statement made by a client who has been the victim of physical abuse by her partner supports the nurse's belief that the client has developed competence? A. "Women in my family seem to be destined to be victims." B. "I have the strength to leave if I ever begin to feel threatened." C. "My partner loves me but he has an anger management issue." D. "He cares about me and has promised never to hurt me again."

B. "I have the strength to leave if I ever begin to feel threatened."

In a group, the ___ attempts to maintain distance and gain personal attention.

Seducer

Which statement made by a client demonstrates a prominent behavior related to noncompliance with prescribed treatment? A. "I broke my hip last fall and it's still hard to get around." B. "I have type 2 diabetes but I can still eat the way I always have." C. "Weight has been a problem I've struggled with my entire adult life." D. "My wife says I need to exercise if I'm ever going to get my blood pressure down."

B. "I have type 2 diabetes but I can still eat the way I always have."

The son of a client with Alzheimer's disease reports feeling guilty because, at times, he wishes his father would die. What is the nurse's best response? A. "Everyone in your situation must feel like that at times." B. "Being responsible for your father's care must be difficult." C. "Perhaps you should consider putting your father in a nursing home." D. "There is no reason to feel guilty. You've given your father excellent care."

B. "Being responsible for your father's care must be difficult."

During an initial assessment interview, the client reports using an herbal product to help manage his depression after his recent heart attack. The nurse demonstrates an understanding of the greatest risk of injury these circumstances pose to the client when asking: A. "Are you aware that quality control measures are often lacking in the packaging of herbals?" B. "Have you been having any difficulty stopping bleeding from cuts or bruises?" C. "Who suggested that you use herbal remedies to treat your depression?" D. "Did you ever experience depression prior to your heart attack?

B. "Have you been having any difficulty stopping bleeding from cuts or bruises?"

When an older adult diagnosed with depression reports that she has been taking over-the-counter (OTC) melatonin, the nurse asks: A. "Are you experiencing difficulty with remembering things? B. "Have you been having trouble sleeping?" C. "Is anxiety a problem for you as well?" D. "Are you trying to lose weight?"

B. "Have you been having trouble sleeping?"

Which statement by an older adult who has recently had hip replacement surgery supports that her positive attitude is contributing to her mental health wellness? A. "I know I can't go hiking like I did, but I really miss it so much." B. "I can't go hiking, but I still enjoy walking in the park in the afternoon." C. "If I work really hard in rehab, I think I'll be able to hike again next spring." D. "Hiking gave me such pleasure, but if I can't hike, I'll just have to get used to it."

B. "I can't go hiking, but I still enjoy walking in the park in the afternoon."

Which statement demonstrates an understanding of the value of using rating scales when assessing and documenting client responses? A. "Documentation is standardized for all depressed clients when you use the depression rating scale." B. "The depression rating scale makes tracing a client's response to antidepressant medication much more reliable." C. "Clients seem to be able to assign a number to their feelings of depression better than describing them verbally." D. "Depressed clients seldom have the energy to adequately respond to an assessment if a depression rating scale isn't used."

B. "The depression rating scale makes tracing a client's response to antidepressant medication much more reliable."

Which statement made by a nurse who manages care for a number of culturally diverse Hispanic clients demonstrates an understanding of the challenges this assignment presents? A. "I find the Hispanic language very difficult to master." B. "There are many differences between Hispanic subcultures." C. "Addressing the Hispanic culture's religious needs can be challenging. D. "I find Hispanic children to be very dependent upon their elders."

B. "There are many differences between Hispanic subcultures."

A member of a group verbally lashes out at the nurse leading the discussion on assuming responsibility for behaviors. When the individual states, "I was abused as a child by my father; you can't make me take responsibility for all the problems he created for me," the nurse replies: A. "Can we talk about when your father started abusing you?" B. "This is a safe place to express your anger about the abuse and about your father." C. "May I suggest we end the session today so you don't direct your anger toward me?" D. "I sense that you have unresolved issues with your father but we need to work on your anger."

B. "This is a safe place to express your anger about the abuse and about your father."

A client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, "It felt so wonderful to get high." Which of the following is the most appropriate response? A. "If you continue to talk like that, I'm going to stop speaking to you." B. "You told me you got fired from your last job for missing too many days after taking drugs all night." C. "Tell me more about how it felt to get high." D. "Don't you know it's illegal to use drugs?"

B. "You told me you got fired from your last job for missing too many days after taking drugs all night."

Mental health is defined as: A. The ability to distinguish what is real from what is not. B. A state of well-being where a person can realize his own abilities can cope with normal stresses of life and work productively. C. Is the promotion of mental health, prevention of mental disorders, nursing care of patients during illness and rehabilitation. D. Absence of mental illness.

B. A state of well-being where a person can realize his own abilities can cope with normal stresses of life and work productively.

The nurse is concerned that a depressed client may be displaying a nonverbal suicidal threat when he presents another client with his favorite shirt as a "gift." The nurse's initial intervention is to: A. Place the client on suicide precautions including 15-minute checks. B. Ask the client if he is experiencing suicidal ideations with a plan to hurt himself. C. Support the client by telling him that he will need the shirt when he's discharged. D. Document that the client has shown behaviors that are likely subtle suicide threats.

B. Ask the client if he is experiencing suicidal ideations with a plan to hurt himself.

The nurse best engages in self-analysis that will benefit a specific nurse-client relationship when: A. Refraining from expressing any negative feelings about a client's behaviors. B. Asking, "What barriers exist that make it difficult for me to provide effective care for this client?" C. Reporting to the nurse manager that, "I've tried but I just can't work therapeutically with this client." D. Avoiding conflict with the client by seldom setting boundaries or disagreeing with his or her beliefs.

B. Asking, "What barriers exist that make it difficult for me to provide effective care for this client?"

Which nursing intervention best demonstrates an understanding of the effects of mental illness in the creation of secondary at-risk populations? A. Educating junior high school students concerning the dangers of drug and alcohol abuse B. Assessing the parenting skills of a father diagnosed with obsessive-compulsive disorder (OCD) C. Assessing the friends of a teenager who was recently hospitalized for an eating disorder for signs of the same disorder D. Providing the parents of a child diagnosed with obsessive-compulsive disorder (OCD) with information on behavior modification

B. Assessing the parenting skills of a father diagnosed with obsessive-compulsive disorder (OCD)

The focus of generic crisis intervention is to: A. Introduce the nurse as a caring resource to those in crisis. B. Assist as many in-crisis individuals as quickly as possible. C. Remove the individual in crisis from immediate sources of stress. D. Serve as a liaison between the individual in crisis and needed services.

B. Assist as many in-crisis individuals as quickly as possible.

The nurse best assures that a psychiatric client's rights are respected and preserved by: A. Educating each client as to his or her legally protected rights. B. Being knowledgeable of the state laws that regulate client rights. C. Participating as a member of the client's multidisciplinary health care team. D. Referring all issues of a legal nature to the appropriate facility committee.

B. Being knowledgeable of the state laws that regulate client rights.

The nurse demonstrates an understanding of effective data collection when interviewing a client regarding a family history when: A. Basing the assessment on a universally accepted definition of family. B. Constructing a genogram as a basis for documenting the information gathered. C. Recognizing that the Family Apgar tool is used for assessing single parent families. D. Gathering information on at least four generations of the client's family members.

B. Constructing a genogram as a basis for documenting the information gathered.

Diverse cultural beliefs can result in dramatically varied perceptions of wellness, disease, and the treatment of disease. In order to best address these variations when planning nursing care, the nurse and client initially: A. Agree to respect each other's beliefs and values. B. Discuss what the client believes is the cause of his or her illness. C. Agree that treatment planning will include family members when possible. D. Discuss the incorporation of both traditional nursing practice and culturally based practices.

B. Discuss what the client believes is the cause of his or her illness.

When administering medications, a nurse would hold which medication for a patient who presents with jaundice? A. Valium B. Divalproex (Depakote) C. Lithium D. Verapamil

B. Divalproex (Depakote)

Which intervention is likely to have the greatest positive impact on a client who has a history of medication noncompliance? A. Being admitted to an inpatient facility until his medication is at therapeutic levels B. Enrollment in an in-home psychiatric nursing service that provides his medication by injection C. Required attendance at an outpatient daycare program that focuses on reinforcing self-care skills D. Having the client sign a compliance contract that states his prescriptions will be free if he is compliant

B. Enrollment in an in-home psychiatric nursing service that provides his medication by injection

The nurse is assigned to care for a suicidal client. Initially, which is the nurse's highest care priority? A. Assessing the client's home environment and relationships outside the hospital B. Exploring the nurse's own feelings about suicide C. Discussing the future with the client D. Referring the client to a clergyperson to discuss the moral implications of suicide

B. Exploring the nurse's own feelings about suicide

The nurse is caring for a client who experiences false sensory perceptions with no basis in reality. These perceptions are known as: A. Delusions. B. Hallucinations. C. Loose associations. D. Neologisms.

B. Hallucinations.

The nurse is monitoring a client receiving tranylcypromine sulfate (Parnate). Which serious adverse reaction can occur with high dosages of this monoamine oxidase (MAO) inhibitor? A. Hypotensive episodes B. Hypertensive crisis C. Muscle flaccidity D. Hypoglycemia

B. Hypertensive crisis

A teenager who has a history of alcohol abuse wants to host a holiday party at his home. In order to best implement family-based measures to prevent the use of alcohol or drugs the parents will: A. Refuse to allow the teenager to host the party. B. Insist upon being home and visible to the guests during the party. C. Allow the party only if it is held at a public space such as a church recreation room. D. Have all those attending sign a contract promising not to drink or use drugs during the party.

B. Insist upon being home and visible to the guests during the party.

The nurse works to establish trust, acceptance, and open communication with his patient. This is completed in which of the following phases? A. Preinteraction phase B. Introductory/orientation phase C. Working phase D. Termination phase

B. Introductory/orientation phase

The nurse works with Pete to determine why he sought help. This is completed in which of the following phases? A. Preinteraction phase B. Introductory/orientation phase C. Working phase D. Termination phase

B. Introductory/orientation phase

A client is admitted to the psychiatric unit with a diagnosis of unipolar disorder. When the client doesn't respond to antidepressant drugs, the physician orders electroconvulsive therapy (ECT). What is the mechanism of action for ECT? A. It's related to the client's perception of ECT as a well-deserved punishment. B. It's unknown. C. It's related to increased production of chemicals in the brain. D. It resembles that of antidepressant drugs.

B. It's unknown.

The nurse is aware that antipsychotic medications may cause which of the following adverse effects? A. Increased production of insulin B. Lower seizure threshold C. Increased coagulation time D. Increased risk of heart failure

B. Lower seizure threshold

The nurse is preparing a patient for the termination phase of the nurse-patient relationship. The nurse prepares to implement which nursing task that is most appropriate for this phase? A. Planning short-term goals B. Making appropriate referrals C. Developing realistic solutions D. Identifying expected outcomes

B. Making appropriate referrals

Nursing advocacy directed towards eliminating the stigma attached to mental illness is based on the fact that: A. Stigmatization only serves to increase the stress felt by the mentally ill. B. No one is immune to mental illness or emotional problems. C. Mental illness is often chronic and incurable. D. The mentally ill deserve our support.

B. No one is immune to mental illness or emotional problems.

Which nursing intervention is directed toward one of the aims of primary preventive psychiatric nursing care? A. Counseling both physical and sexual abuse victims B. Providing stress management classes to new parents C. Screening senior citizens for both acute and chronic depression D. Arranging for clients to be transported to area Alcoholics Anonymous meetings

B. Providing stress management classes to new parents

The nurse demonstrates an appropriate use of outcome measurements on a mental health unit when: A. Requiring a client's caregiver to attend a discharge planning meeting prior to the client's release to home. B. Reassigning a client's activity level based on his demonstration of disregard of appropriate social boundaries. C. Providing the client with clean linen according to the schedule established by the facility. D. Permitting the son of an Asian-American client to bring some ethnic foods to his father.

B. Reassigning a client's activity level based on his demonstration of disregard of appropriate social boundaries.

A client with depression doesn't respond to drug therapy. At a team conference, staff members recommend electroconvulsive therapy (ECT). The nurse knows that most people respond emotionally to the thought of an electric current passing through the brain. Therefore, when discussing ECT with the client, the nurse should: A. Use the term "shock" in a neutral, calm manner. B. Refer to the procedure as a "treatment" instead of "shock therapy." C. Refer to the procedure as ECT. D. Explain how the convulsions are artificially induced.

B. Refer to the procedure as a "treatment" instead of "shock therapy."

The nurse is managing the care of a client who recently lost his job and is diagnosed with mild situational depression. During the assessment interview, the client volunteered that he stopped attending school in the 8th grade. The nurse is satisfied that a client's lack of formal education has not become a risk factor to his mental health when he: A. Asks the nurse to provide him with materials on depression to read. B. Reflects on his problem and formulates a realistic plan to find another job. C. Signs a safety contract that states he will notify staff of any suicidal ideations he develops. D. Promises to attend his group sessions and take his prescribed antidepressant medication.

B. Reflects on his problem and formulates a realistic plan to find another job.

The nurse is addressing a primary symptom of schizophrenia when: A. Arranging for the client to attend stress management classes. B. Reinforcing the client's ability to interrupt intrusive paranoid thoughts. C. Working with the client to arrive at a budget that allows him to live independently. D. Supporting the client in his attempts to stop using alcohol to cope with his hallucinations.

B. Reinforcing the client's ability to interrupt intrusive paranoid thoughts.

A client's history documents that there have been examples of indirect self-destructive behavior. Which nursing assessment data supports this diagnosis? A. Client has attempted suicide on three other occasions. B. Reports of abusing alcohol since the age of 16. C. Client experiences episodes of hypoglycemia on a regular basis. D. While acknowledging suicidal thoughts, the client denies any plan.

B. Reports of abusing alcohol since the age of 16.

What is a generally accepted criterion of mental health? A. Absence of anxiety B. Self-acceptance C. Ability to control others D. Happiness

B. Self-acceptance

Currently, the mental health system in the United States focuses on managing client disabilities. It has been suggested that the focus be changed. Which nursing intervention demonstrates an attempt to work toward that recommended focus? A. Assessing the depressed client often for suicidal ideations B. Teaching stress management techniques to new mothers C. Sharing the client's wish that his medications be provided in liquid form if possible D. Discussing with the client when his follow-up mental health visit can be scheduled

B. Teaching stress management techniques to new mothers

What differentiates the Psychiatric-Mental Health Registered Nurse (RN-PMH) from the Psychiatric-Mental Health Advanced Practice Registered Nurse (APRN-PMH)? A. Only the APRN-PMH is responsible for milieu management. B. The APRN-PMH exercises a greater degree of autonomy when providing care. C. Only the RN-PMH provides medication education to the client. D. The RN-PMH has less experience working with the mentally ill.

B. The APRN-PMH exercises a greater degree of autonomy when providing care.

Which evaluation data supports that the client diagnosed with schizophrenia has benefited from his family's involvement in psychoeducational programming? A. The client is living with his parents. B. The client has not relapsed in three years. C. The family is supplementing the client's disability income. D. The family provides the client with transportation to his part-time job.

B. The client has not relapsed in three years.

A client experiencing alcohol withdrawal is upset about going through detoxification. Which of the following goals is a priority? A. The client will commit to a drug-free lifestyle. B. The client will work with the nurse to remain safe. C. The client will drink plenty of fluids daily. D. The client will make a personal inventory of strengths.

B. The client will work with the nurse to remain safe.

The primary impact that the development and use of psychotropic drugs had on nursing's role in the care of clients with mental health disorders was: A. The availability of mental health therapies as an outpatient service. B. The expansion of the role assumed by professionally trained nurses. C. Nurses were needed to fill the gap created by a lack of medical personnel. D. More nurses were required to address the needs of the now treatable mental health clients.

B. The expansion of the role assumed by professionally trained nurses.

12-year-old Lafawnduh finds out she is pregnant. This is an example of a ___ crisis.

Situational crisis

When preparing a client for electroconvulsive therapy (ECT), the nurse discusses with the client that: A. Maintenance treatments are seldom required. B. The initial course of therapy requires 6 to 12 treatments. C. This form of therapy is particularly successful for positive symptoms of schizophrenia. D. The initial therapy involves an ECT treatment repeated once a week for a prescribed time period.

B. The initial course of therapy requires 6 to 12 treatments.

A client diagnosed as having panic disorder with agoraphobia is admitted to the inpatient psychiatric unit. Until her admission, she had been a virtual prisoner in her home for 5 weeks, afraid to go outside even to buy food. When planning care for this client, what is the nurse's overall goal? A. To help the client perform self-care activities B. To help the client function effectively in her environment C. To help control the client's symptoms D. To help the client participate in group therapy

B. To help the client function effectively in her environment

Which serious side effect of Elavil requires immediate intervention? A. Orthostatic hypotension B. Urinary retention C. ECG changes D. Sedation

B. Urinary retention

A nurse who forces a patient to take a medication without consent in a non-emergency situation could be charged with ___.

Battery

A 33-year-old woman loses her daughter in a motor vehicle accident. This is an example of a ___ crisis.

Situational crisis

A ___ crisis occurs when an unexpected life event upsets equilibrium.

Situational crisis

John is laid off from his job as a teacher due to budget cuts. This is an example of a ___ crisis.

Situational crisis

A nurse plans to confront a patient who supposedly stole belongings from another patient. The nurse should say: A. "I need to confront you about something." B. "Do you know why I'm angry with you?" C. "Can I address something with you?" D. "I know you stole Sally's hairbrush."

C. "Can I address something with you?"

Which nursing statement describes the basis of the ethical theory called utilitarianism? A. "The client has a right to make decisions based on what he wants and needs." B. "Every client deserves the care that I would want if I were in his situation." C. "I can't allow a client to smoke in the day room since it isn't healthy for the other clients." D. "The homeless need access to quality mental health care just as much as any other group."

C. "I can't allow a client to smoke in the day room since it isn't healthy for the other clients."

Which statement made by a mental health nurse demonstrates the need for further education regarding active listening as a therapeutic communication technique? A. "When I use therapeutic silence, I'm giving the client time to think and reflect." B. "Sharing perceptions doesn't mean I tell the client how my experiences are similar to his." C. "I generally find it helpful to ask the client why he blames others for the mistakes he's made." D. "It's not therapeutic to give the client suggestions as to what he needs to do to fix his problems."

C. "I generally find it helpful to ask the client why he blames others for the mistakes he's made."

Which statement describes the basis for including the client in the problem-solving process of determining appropriate care that is unique for psychiatric nursing? A. "Clients diagnosed with psychiatric illnesses are more compliant if they play a part in the planning of their own care." B. "Clients diagnosed with psychiatric problems are often incapable of expressing effective problem-solving skills due to their cognitive impairment." C. "Involving a client diagnosed with a psychiatric disorder in the planning of his care will help give him back a sense of responsibility that is often lacking." D. "It is a nursing responsibility to include the psychiatric client in the planning of his or her care."

C. "Involving a client diagnosed with a psychiatric disorder in the planning of his care will help give him back a sense of responsibility that is often lacking."

The psychiatric nurse best demonstrates an understanding of the general health challenges facing a mentally ill client who reports auditory hallucinations when asking: A. "When did you first start hearing voices?" B. "What did you have to eat last night for supper?" C. "May I have your permission to take your blood pressure?" D. "Do you understand why you need to take your medication?"

C. "May I have your permission to take your blood pressure?"

When asked if complementary and alternative medicine (CAM) therapies have value as nursing interventions for mentally ill individuals the nurse replies: A. "If the client is interested in CAM therapies, as a nurse I need to support that interest." B. "CAM therapies are controversial; as a nurse I think their use should be discussed with the physician first." C. "Some of these therapies have been proven to have a positive impact on a variety of mental health conditions; to provide effective care for my clients I need to be aware and open to their appropriate use." D. "These nontraditional therapies seem to work for some people; as a nurse, I need to educate my clients as to their limitations."

C. "Some of these therapies have been proven to have a positive impact on a variety of mental health conditions; to provide effective care for my clients I need to be aware and open to their appropriate use."

Which statement by the nurse will have the greatest impact on medication adherence for a client diagnosed with depression? A. "I can see about getting your medication for free if you promise to take it." B. "You will feel so much better if you take your medication as we've discussed." C. "Taking this medication will help you start enjoying the time you spend with your grandchildren again." D. "Take your medication and the depression you are feeling will go away and you'll be your old self again."

C. "Taking this medication will help you start enjoying the time you spend with your grandchildren again."

The adult children of an elderly client are interested in the use of complementary and alternative medicine (CAM) therapies to help manage their mother's poststroke depression. The nurse responds: A. "There has been no research done to investigate the effectiveness of CAM on depression like your mother's." B. "At your mother's age CAM therapies are not indicated since they may affect her impaired renal function." C. "There has been some research to support the use of acupuncture in managing depression that occurs after strokes." D. "I'd suggest you discuss this with your mother's physician before you mention the idea to her since the research on the subject is inconclusive."

C. "There has been some research to support the use of acupuncture in managing depression that occurs after strokes."

A young adult tells the nurse at the local free clinic that he is currently living in his car and panhandling for money. The nurse asks the individual the reason for his decision to live as he does. Which response will the nurse follow up on to determine if the individual is experiencing mental health issues? A. "I'll live in a house and get a job when the government gives everyone those opportunities." B. "I live like this for 3 months each year just to remind myself how much I really have." C. "This way they can't find me and if they can't find me they can't hurt me." D. "The law says I can live any way I want to as long as I'm not hurting anyone."

C. "This way they can't find me and if they can't find me they can't hurt me."

A client diagnosed with depression has reported fatigue and poor concentration. When she is told that the results of her sleep study show that she has excessive REM sleep cycles, the client asks the nurse to explain what those results mean. The nurse best answers the client's concerns by replying: A. "It means that you are sleep deprived." B. "REM sleep stands for rapid eye movement sleep." C. "Too much REM sleep deprives you of deep restoring sleep." D. "Depressed individuals generally experience prolonged periods of REM sleep."

C. "Too much REM sleep deprives you of deep restoring sleep."

A client with a history of substance abuse has been attending Alcoholics Anonymous meetings regularly in the psychiatric unit. One afternoon, the client tells the nurse, "I'm not going to those meetings anymore. I'm not like the rest of those people. I'm not a drunk." What is the most appropriate response? A. "If you aren't an alcoholic, why do you keep drinking and ending up in the hospital?" B. "It's your decision. If you don't want to go, you don't have to." C. "You seem upset about the meetings." D. "You have to go to the meetings. It's part of your treatment plan."

C. "You seem upset about the meetings."

When the community health nurse visits a patient at home, the patient states, "I haven't slept at all the last couple of nights." Which response by the nurse illustrates a therapeutic communication response to this patient? A. "I see." B. "Really?" C. "You're having difficulty sleeping?" D. "Sometimes, I have trouble sleeping too."

C. "You're having difficulty sleeping?"

Which client has met the criteria for psychiatric homebound care? A. A 67-year-old retired teacher who has been depressed since the death of his longtime partner B. A 21-year-old diagnosed with paranoid schizophrenia who has delusions that the world is about to end C. A 45-year-old who, for the last 5 years, has experienced severe panic attacks whenever she attempts to leave her home D. A 16-year-old who has demonstrated obsessive-compulsive behaviors involving cleaning rituals since she was 10 years old

C. A 45-year-old who, for the last 5 years, has experienced severe panic attacks whenever she attempts to leave her home

Nursing care for a client after electroconvulsive therapy (ECT) should include: A. Nothing by mouth for 24 hours after the treatment because of the anesthetic agent. B. Bed rest for the first 8 hours after a treatment. C. Assessment of short-term memory loss. D. No special care.

C. Assessment of short-term memory loss.

Which mental health service focuses on a largely underserved at-risk population? A. Stress management classes for new mothers B. A support group for recovering male alcoholics C. A depression support group for adolescent children D. Socialization therapy for adults diagnosed with schizophrenia

C. A depression support group for adolescent children

During the mental status examination, a client may be asked to explain such proverbs as "Don't cry over spilled milk." The purpose is to evaluate the client's ability to think: A. Rationally. B. Concretely. C. Abstractly. D. Tangentially.

C. Abstractly.

A client with major depression must take tranylcypromine sulfate (Parnate), a monoamine oxidase inhibitor (MAOI). During medication teaching, the nurse should instruct the client to avoid consuming: A. Free-range poultry. B. Whole grain bread. C. Aged cheese. D. Fresh fish.

C. Aged cheese.

A client suspected of being schizophrenic is scheduled for a computed tomography (CT). The nurse informs the client that the diagnostic test will: A. Confirm the diagnosis of schizophrenia. B. Trace the flow of blood through his brain. C. Allow the doctors to view the structures of his brain. D. Help determine the areas of his brain that are overreacting.

C. Allow the doctors to view the structures of his brain.

Which of the following drugs may be abused because of tolerance and physiologic dependence? A. Lithium (Lithobid) and divalproex (Depakote). B. Verapamil (Calan) and chlorpromazine (Thorazine) C. Alprazolam (Xanax) and phenobarbital (Luminal) D. Clozapine (Clozaril) and amitriptyline (Elavil)

C. Alprazolam (Xanax) and phenobarbital (Luminal)

The primary advantage of a heterogeneous therapeutic group is that: A. There will be a variety of backgrounds represented in the group. B. Individuals will be expected to function outside their comfort zone. C. An opportunity to examine experiences from varied points of view will exist. D. Members will see that they are not alone and that others have problems as well.

C. An opportunity to examine experiences from varied points of view will exist.

Which nurse-focused action demonstrates an understanding of the importance of value clarification to the therapeutic relationship between nurse and client? A. Intently listening while the client describes physical abuse she was exposed to as a child B. Offering to arrange for the hospital chaplain to visit a client who is severely depressed C. Asking a client to explain his or her cultural beliefs regarding the role of women D. Encouraging the client to read a newspaper article that debates various political issues

C. Asking a client to explain his or her cultural beliefs regarding the role of women

A client diagnosed with chronic depression appears sad and joyless when arriving at the mental health clinic for a scheduled appointment. The nurse best assesses the client's mood by: A. Observing the client's posture, dress, and hygiene in detail. B. Asking, "You seem very sad and forlorn; are you depressed today?" C. Asking, "On a scale of 0 to 10 with 10 being as happy as you can ever remember being, how do you feel today?" D. Observing the way the client interacts with other staff to determine whether the client is demonstrating signs of depression.

C. Asking, "On a scale of 0 to 10 with 10 being as happy as you can ever remember being, how do you feel today?"

The nurse is conducting a family assessment. When asked about her children's performance at school, the single mother reported that her oldest, a 10-year-old, "does OK with schoolwork but doesn't have any interest in being friends with the kids in her school." To further investigate this situation the nurse asks the: A. Child why she doesn't have friends at school. B. Mother if her younger children have friends at school. C. Child what she does at home after she comes home from school. D. Mother to discuss the situation with the child's teacher or school counselor.

C. Child what she does at home after she comes home from school.

The client's chart indicates that she has experienced trauma to the cerebral cortex as a result of injuries sustained during an attempted suicide. Which observation is most likely the result of this injury? A. Client is often found crying into her pillow. B. Client demonstrates involuntary twitching of facial muscles. C. Client states, "What do you mean 'it's raining cats and dogs'?" D. Client asks, "Can you address this letter to my mom; I forget her address?"

C. Client states, "What do you mean 'it's raining cats and dogs'?"

A nurse unfamiliar with the mental health unit is preparing to provide care for a newly admitted client. Where will the nurse find a comprehensive description of the client's mental disorders provided by the physician caring for this client? A. Admission assessment B. Nursing notes C. DSM-IV-TR D. Care plan

C. DSM-IV-TR

The goal of crisis intervention has been met when a mother who lost her job: A. Is able to begin a search for a new job. B. Is no longer angry with her employer. C. Describes her new job as being better than the old one. D. Accepts a new job that requires a move to another state.

C. Describes her new job as being better than the old one.

The nurse is managing the care of an older adult who has recently immigrated to the United States from an Asian country. The client is depressed and is neither sleeping nor eating well. In order to best facilitate the client's care in a culturally competent manner, the nurse: A. Encourages the client's adult children to visit as often as possible especially around meals and bedtime. B. Assesses the client's ability to understand the importance of both eating and sleeping in a healthy manner. C. Discusses interventions that may support the client in sleeping and eating with the adult members of the family. D. Requests a consult with the dietitian to discuss how to supplement the client's diet while using food to effectively promote sleep.

C. Discusses interventions that may support the client in sleeping and eating with the adult members of the family.

Ethnic minorities are often victims of stigmatization regarding their mental illnesses. The nurse initially addresses this potential problem by: A. Informing a client of his civil rights. B. Educating a client as to various available counseling services. C. Discussing with the client how family and friends are reacting to his illness. D. Helping the client develop the confidence to stand up for himself.

C. Discussing with the client how family and friends are reacting to his illness.

Which intervention will have the greatest impact on reducing the stigma and rejection currently experienced by individuals with mental illness? A. Providing services to the mentally ill that minimize the need to rely upon the community B. Holding activities at mental health facilities that are open to the community to foster acceptance C. Educating local citizen groups on the needs and experiences of the mentally ill in their community D. Focusing on improving the socialization skills of mentally ill individuals living in the community

C. Educating local citizen groups on the needs and experiences of the mentally ill in their community

A client who has been prescribed chronotherapy for disrupted sleep patterns resulting from his chronic depression tells the nurse that he can't afford to stay in the hospital for the treatments since he has to get back to work. The nurse responds that: A. The therapy requires only a few treatments that can be accomplished in just a few days. B. Most employers will view the treatments as a medical necessity and provide sick leave. C. He can administer the treatments at home once he is trained to do so. D. His treatment team will discuss outpatient alternatives to this form of therapy.

C. He can administer the treatments at home once he is trained to do so.

A patient taking Phenelzine (Nardil) demonstrates effective learning when she states: A. I should take this medication with a glass of chocolate milk B. I can discontinue this medication immediately when I stop feeling depressed C. I will avoid eating and drinking tyramine-containing substances D. I can continue to take St. John's wort, as this will not cause serotonin syndrome with this type of drug

C. I will avoid eating and drinking tyramine-containing substances

The primary factor that makes an event a crisis is the: A. Type of loss that the event causes. B. Nature of the stress caused by the event. C. Ineffectiveness of one's usual coping strategies. D. Preexistence of a stress-related mental illness.

C. Ineffectiveness of one's usual coping strategies.

To minimize the risk of injury during an electroconvulsive therapy (ECT) treatment, the nurse: A. Times the seizure so it will not last more than 60 seconds. B. Monitors the client's electroencephalogram (EEG) for changes in wave patterns. C. Inserts a bite-block into the client's mouth prior to the delivery of the electrical stimulus. D. Applies a cuff to the client's ankle to facilitate monitoring of blood pressure during the seizure.

C. Inserts a bite-block into the client's mouth prior to the delivery of the electrical stimulus.

The greatest benefit derived from current work being done related to pharmacogenetics is that: A. The cost of medication manufacturing will be drastically reduced. B. Research and development of new drugs will be much less costly. C. Medications will be designed so that they do not cause unwanted side effects. D. Medications will be formulated so that only one dose per day will be required.

C. Medications will be designed so that they do not cause unwanted side effects.

According to the World Health Organization study, which nursing activity addresses the number one psychiatric cause of disability in the world today? A. Arranging for a client's transportation to Alcoholics Anonymous meetings B. Helping the family understand their mother's obsessive-compulsive disorder C. Offering a depression screening at a local school for students in grades 8 through 12 D. Providing nursing care at a free clinic that serves the schizophrenic population in a large city

C. Offering a depression screening at a local school for students in grades 8 through 12

In order to best evaluate the achievement of goals of individual stress management group members, the nurse leading the group: A. Has each member at the last meeting write a short description of how the sessions helped him or her manage stress more effectively. B. Asks each member at each session to demonstrate a stress management technique he or she has learned while attending the sessions. C. Periodically asks the members to rate their ability to manage stress using the techniques learned in the group sessions on a Likert scale. D. Has each member's ability to manage stress evaluated by the group at the final session.

C. Periodically asks the members to rate their ability to manage stress using the techniques learned in the group sessions on a Likert scale.

Which nursing activity demonstrates the role of a professional psychiatric nurse as identified by Hildegard Peplau? A. Managing the milieu B. Caring for the client's physiological needs C. Providing counseling D. Documenting client behaviors

C. Providing counseling

Which action by a nurse on the psychiatric nursing unit best supports effective use of evidence-based practice on the unit? A. Asking that the nurse manager arrange for a subscription to an evidence-based nursing journal to be included in the unit's yearly budget B. Suggesting that the unit staff take part in a research study that involves care of the newly diagnosed obsessive-compulsive client C. Recommending changes to a client's care plan based on information provided from randomized controlled research trials D. Volunteering to recruit clients for a unit-based research project that focuses on the abused teenage client

C. Recommending changes to a client's care plan based on information provided from randomized controlled research trials

Words are powerful and language can stigmatize the individual dealing with mental illness. How can a nurse personally advocate for such individuals with this in mind? A. Encouraging all clients to be aware of their communication so as to not offend others B. Teaching the client diagnosed with schizophrenia to avoid pressured speech C. Role modeling language that is respectful to those with mental illnesses D. Engaging in communication that is always therapeutic

C. Role modeling language that is respectful to those with mental illnesses

During an assessment interview with a newly admitted client, the nurse identifies a sense of anger developing in response to the client's defiant statements. In order to maintain a therapeutic environment, the nurse: A. Asks that another nurse continue the assessment. B. Identifies for the client the inappropriateness of his statements. C. Shares with the client that he appears angry about being admitted. D. Postpones the remainder of the interview until the client is more cooperative.

C. Shares with the client that he appears angry about being admitted.

A client with schizophrenia tells the nurse, "My intestines are rotted from the worms chewing on them." This statement indicates a: A. Delusion of persecution. B. Delusion of grandeur. C. Somatic delusion. D. Jealous delusion.

C. Somatic delusion.

An Asian-American client has been prescribed an antidepressant medication for severe depression. When the nurse prepares discharge teaching topics for this client, which specific information will be included? A. The Asian culture is traditionally resistant to the use of antidepressant medication and so the importance of compliance with the prescribed treatment plan is stressed. B. Ethnic Asian foods have been shown to cause poor absorption of many medications and so the antidepressant medication should be taken on an empty stomach. C. Some racial and ethnic groups are genetically predisposed to enzyme deficiencies that require that their medications be prescribed at lower than normal dosages. D. Antidepressants can take weeks to reach the therapeutic blood serum levels required for the symptoms of severe depression to demonstrate improvement.

C. Some racial and ethnic groups are genetically predisposed to enzyme deficiencies that require that their medications be prescribed at lower than normal dosages.

Which nursing intervention would be most helpful for a client experiencing a panic attack? A. Encouraging the client to identify what precipitated the attack B. Promoting the client's interaction with others to reduce anxiety through diversion C. Staying with the client and remaining calm, confident, and reassuring D. Reducing intolerable stimuli by encouraging the client to stay in the room alone until the anxiety abates

C. Staying with the client and remaining calm, confident, and reassuring

The initial step in providing effective mental health-focused public health services is: A. Securing adequate funding to support needed psychiatric services. B. Identifying key providers to assure the delivery of required services. C. Surveying the targeted community to identify needs of the high-risk groups. D. Recruiting community leaders to provide support for utilization of provided services.

C. Surveying the targeted community to identify needs of the high-risk groups.

Primary level of prevention is exemplified by: A. Helping the client resume self care. B. Ensuring the safety of a suicidal client in the institution. C. Teaching the client stress management techniques. D. Case finding and surveillance in the community.

C. Teaching the client stress management techniques.

Which of the following statements reflects an expected outcome for a client who has difficulty with interpersonal relationships? A. The client will identify three barriers to effective interaction with others on the unit by the end of 3 days. B. The client will identify two people on the unit whom he will attempt to socialize with by the end of 3 days. C. The client will socially engage with others on the unit without prompting from the staff. D. The client will initiate conversation to support social relationships within 3 months.

C. The client will socially engage with others on the unit without prompting from the staff.

A nurse performing a somatic assessment for suicide would observe a patient's:

Sleeping & eating patterns

A client has been receiving chlorpromazine (Thorazine), an antipsychotic, to treat his psychosis. Which findings should alert the nurse that the client is experiencing pseudoparkinsonism? A. Restlessness, difficulty sitting still, and pacing B. Involuntary rolling of the eyes C. Tremors, shuffling gait, and masklike face D. Extremity and neck spasms, facial grimacing, and jerky movements

C. Tremors, shuffling gait, and masklike face

A nurse asks a patient to write down everything that is currently stressing her out, as well as what angers her the most. This is completed in which of the following phases? A. Preinteraction phase B. Introductory/orientation phase C. Working phase D. Termination phase

C. Working phase

The nurse works with a patient to explore his relevant, current stressors. This is completed in which of the following phases? A. Preinteraction phase B. Introductory/orientation phase C. Working phase D. Termination phase

C. Working phase

The nurse works with a patient to promote development of insight and se of constructive coping mechanisms. This is completed in which of the following phases? A. Preinteraction phase B. Introductory/orientation phase C. Working phase D. Termination phase

C. Working phase

What type of mood stabilizing medication is useful for patients with cardiac conditions or patients who are pregnant?

Calcium channel blockers

A patient is scheduled for electroconvulsive therapy (ECT) and when the nurse goes to obtain consent, the patient informs the nurse that her husband is forcing her to have the procedure done and she really does not want to go through with it. The best response by the nurse is:

Call physician & don't have the patient sign consent form

A patient who has voluntarily admitted himself to the psych/mental health unit covertly expresses suicidal ideation, but is scheduled to return home later this afternoon. What action does the nurse take?

Call physician and inform that patient has been expressing suicidal ideation

What is important to note about Divalproex (Depakote)?

Can be toxic to liver Lethal in overdose Category D - contraindicated in first trimester of pregnancy

A patient arrives at the hospital and describes his inability to achieve an erection after taking his Zoloft for the last three months. The nurse instructs:

Can discuss switching medications with physician, but do not abruptly stop taking medication - can cause withdrawal symptom

Which anticonvulsant medication is associated with agranulocytosis and can be helpful for patients with a history of rapid cycling (more than four episodes of mania or depression in a year)?

Carbamazepine (Tegretol)

Group members expressing their innermost feelings demonstrate Yalom's curative factor ___.

Catharsis

The release of feelings that takes place as the patient talks about emotionally-charged areas is referred to as ___.

Catharsis

What does the first level of crisis intervention, environmental manipulation, help to do?

Change physical or interpersonal situation Ex.: Red Cross - temporary shelter, food, clothing; sick leave

Cognitive behavioral therapy interventions are used to:

Change thinking to affect change in feeling and thus, behavior Identify thoughts that are unrealistic, negative, or otherwise problematic Acquire new skills

What nursing action is important to remember prior to administering Propranolol to a client with anxiety?

Check blood pressure first

Encouraging the patient to express more clearly the relationship between certain events is defined as ___.

Clarification

What cardiovascular medication is often prescribed for persons suffering from opioid withdrawal, side effects of clozapine, or ADHD?

Clonidine (Catapres)

Which atypical antipsychotic medication initially requires a weekly WBC count for 6 months and may cause agranulocytosis, seizures, or myocarditis?

Clozapine (Clozaril)

Which atypical antipsychotic medication, used only when all other options are deemed ineffective or intolerable, can potentially cause life-threatening constipation?

Clozapine (Clozaril)

The strength of group therapy members' desire to work together toward common goals is defined as ___.

Cohesion

What is the purpose of the Stuart Stress Adaptation Model?

Combines nursing model (adaptation vs. maladaptation) & medical model (health vs. illness)

In a group, the ___ works to discourage positive work and often vents anger.

Complainer

In a group, the ___ attempts to minimize conflict by seeking alternatives.

Compromiser

___ is used when perceived discrepancies in the patient exist.

Confrontation

Describe the rationale for placing patients in seclusion.

Containment: restrict to place where they are safe from harming selves or others Isolation: distance themselves from relationships with others Decrease in sensory input: quiet atmosphere provides relief from sensory overload (reduce stimuli) *Goal is safety of patients & others

What does the second level of crisis intervention, general support, help to do?

Convey feeling that the nurse is on the patient's side - a helping person

Group members resolving early family conflicts and developing self-awareness demonstrate Yalom's curative factor ___.

Corrective recapitulation of primary family group

___ is created by a nurse's emotional response to qualities of a patient, resulting in intense love or caring, disgust or hostility, or anxiety in response to a patient's resistance.

Counter-transference

A person who avoids any topic that might cause conflict is demonstrating a(n) [overt/covert] norm.

Covert

A person who refuses to share anything he believes is "too personal" is demonstrating a(n) [overt/covert] norm.

Covert

___ are self-limiting and last approximately four to six weeks.

Crises

A false belief firmly maintained, even though it is not shared by others and is contradicted by social reality, is referred to as a ___.

Delusion

Which question asked by the nurse best serves as a screening tool for the assessment of a possible problem with alcohol abuse? A. "When was the last time you drank alcohol?" B. "Is there a history of alcohol abuse in your immediate family?" C. "How old were you when you had your first drink of alcohol?" D. "In the last year, did you ever drink more alcohol than you intended to?"

D. "In the last year, did you ever drink more alcohol than you intended to?"

During the client-teaching session, which instruction should the nurse give to a client receiving alprazolam (Xanax)? A. "Discontinue the medication immediately if you experience nausea." B. "Notify the physician if you experience urine retention." C. "Apply sunscreen to prevent photosensitivity." D. "Inform the physician if you become pregnant or intend to do so."

D. "Inform the physician if you become pregnant or intend to do so."

Which statement best demonstrates that the nurse understands the benefit of the effective introduction of evidence-based practice into the practice of professional nursing? A. "Evidence-based practice has made consistency of nursing care easier to assure for clients diagnosed with chronic depression." B. "I'm going to suggest that one of our in-services this year deals with the current evidence-based practice in managing obsessive-compulsive-related anxiety." C. "Professional nursing has benefited tremendously from the introduction of evidence- based practice to nursing students." D. "It's been my experience that atypical antipsychotic medications are very therapeutic but I wonder what the literature says."

D. "It's been my experience that atypical antipsychotic medications are very therapeutic but I wonder what the literature says."

Which statement made by a family member of an individual recently diagnosed with schizophrenia supports the nurse's assessment that the family will respond well to care strategies that support the competence model of care? A. "How long will it be before he will need to be cared for by others?" B. "Is his illness chronic or does he have a chance of getting well again?" C. "My mother will be devastated to hear that my brother is mentally ill." D. "Our brother is family and we will be there to support him in every way we can."

D. "Our brother is family and we will be there to support him in every way we can."

Which statement is most concerning regarding a depressed client's state of mind? A. "I just want to go to sleep and not wake up." B. "When I get out of here I'm going to kill myself." C. "I'm so tired of living like this; I want it to be over." D. "Shooting myself with dad's gun will end it all quickly."

D. "Shooting myself with dad's gun will end it all quickly."

When it is suggested that a stress management therapy group have its membership limited to 15 participants, the nurse manager responds: A. "That is really too many people; enroll only the first 7 who demonstrate a genuine interest in attending." B. "OK, but stop enrollment at 15; chances are excellent that not everyone who signed up will end up attending." C. "Well, 15 is a lot but it is manageable if the individuals include spouses, family members, siblings, or even long-term partners." D. "The maximum number that supports therapeutic work is 10; we can create two separate groups if we have that much interest in the service."

D. "The maximum number that supports therapeutic work is 10; we can create two separate groups if we have that much interest in the service."

Which statement describes the basis of an ethical dilemma? A. "It's so difficult when the client doesn't agree with the treatment team." B. "The client insists on behaving in a manner that will likely cause him injury." C. "It's difficult to determine who makes decisions for an incompetent client without a medical surrogate." D. "There are only two treatment choices; both are very painful and neither has a high rate of success."

D. "There are only two treatment choices; both are very painful and neither has a high rate of success."

A client diagnosed with chronic severe depression has been prescribed a series of electroconvulsive therapy (ECT) treatments. The nurse's initial intervention is to ask: A. "Would you feel more relaxed about the treatments if I stayed with you?" B. "What can I do to help you feel more comfortable about these treatments?" C. "Do you know very much about the benefits and drawbacks of ECT treatments?" D. "Will you let me know if you want or need to talk about these ECT treatments?"

D. "Will you let me know if you want or need to talk about these ECT treatments?"

A patient with a diagnosis of major depression who has attempted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response demonstrates therapeutic communication? A. "You have everything to live for." B. "Why do you see yourself as a failure?" C. "Feeling like this is all part of being depressed." D. "You've been feeling like a failure for a while?"

D. "You've been feeling like a failure for a while?"

A client with schizophrenia hears a voice telling him he is evil and must die. The nurse understands that the client is experiencing: A. A delusion B. Flight of ideas C. Ideas of reference D. A hallucination

D. A hallucination

A client diagnosed with anxiety disorder is prescribed buspirone (BuSpar). Teaching instructions for newly prescribed buspirone should include which of the following? A. A warning that immediate sedation can occur with a resultant drop in pulse B. A reminder of the need to schedule blood work in 1 week to check blood levels of the drug C. A warning about the incidence of neuroleptic malignant syndrome (NMS) D. A warning about the drug's delayed therapeutic effect, which occurs in 14 to 30 days

D. A warning about the drug's delayed therapeutic effect, which occurs in 14 to 30 days

On review of the patient's record, the nurse notes the admission was voluntary. Based on this information, the nurse anticipates which patient behavior? A. Fearfulness regarding treatment measures. B. Anger and agressiveness directed toward others. C. An understanding of the pathology and symptoms of the diagnosis. D. A willingness to participate in the planning of the care and treatment plan.

D. A willingness to participate in the planning of the care and treatment plan.

Since admission 4 days ago, a client has refused to take a shower, stating, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is most appropriate? A. Dismantling the showerhead and showing the client that there is nothing in it B. Explaining that other clients are complaining about the client's body odor C. Asking a security officer to assist in giving the client a shower D. Accepting these fears and allowing the client to take a sponge bath

D. Accepting these fears and allowing the client to take a sponge bath

Which of the following actions demonstrates that the nurse has an understanding of the impact that continued advancements in psychopharmacology has on both client outcomes and professional psychiatric nursing practice? A. Working towards achieving advanced practice nursing credentials in psychiatric nursing B. Stressing the importance of medication therapy compliance with each client upon discharge C. Participating in interdisciplinary treatment teams as a means of staying current regarding the latest clinical treatments and guidelines D. Accessing information on the best evidence-based practices regarding the psychopharmacology medications being prescribed to his or her clients

D. Accessing information on the best evidence-based practices regarding the psychopharmacology medications being prescribed to his or her clients

The nurse documents, "The client described her husband's abuse in an emotionless tone and with a flat facial expression." This statement describes the client's: A. Feelings B. Blocking C. Mood D. Affect

D. Affect

In group therapy, a client angrily speaks up and responds to a peer, "You're always whining and I'm getting tired of listening to you! Here is the world's smallest violin playing for you." Which role is the client playing? A. Blocker B. Monopolizer C. Recognition seeker D. Aggressor

D. Aggressor

Your client is taking clozapine (Clozaril) and complains of a sore throat. This symptom may be an indication of which adverse reaction? A. Extrapyramidal reaction B. Tardive dyskinesia C. Reye's syndrome D. Agranulocytosis

D. Agranulocytosis

Which individual has not met the criteria for involuntary commitment to a mental health facility? A. A teenager who has threatened to shoot himself if his girlfriend leaves him B. A young adult who is 20% below normal weight as a result of dramatically restricting food C. An older adult found wandering in the mall who is unable to provide his name D. An adult who reports that he drinks way too much in order to forget the abuse he's endured

D. An adult who reports that he drinks way too much in order to forget the abuse he's endured

A family has presented at a community mental health clinic. The mother reports that the children ages 8 and 10 are "not doing well since their father died three months ago." The nurse demonstrates an understanding of the goals of a family mental health assessment when initially: A. Assessing the mother's ability to provide physical care for her children. B. Encouraging the mother to discuss the problems with the children's teachers. C. Observing how the children interact with both their mother and with each other. D. Arranging for the family members to attend age-appropriate grief management groups.

D. Arranging for the family members to attend age-appropriate grief management groups.

An older adult client has been asked to participate in a randomized controlled trial (RCT) related to the development of a new psychotropic medication. The nurse responsibly acts as the client's advocate when: A. Reassuring the client that the process of RCTs is a perfectly safe one. B. Explaining to the client the possible risks involved in participating in this particular RCT. C. Educating the client's family concerning the details of participating in such a medication- focused RCT. D. Assessing the degree of understanding the client has about what a medication-focused RCT will involve.

D. Assessing the degree of understanding the client has about what a medication-focused RCT will involve.

A client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is the nurse most likely to administer to reduce the symptoms of alcohol withdrawal? A. Naloxone (Narcan) B. Haloperidol (Haldol) C. Magnesium sulfate D. Chlordiazepoxide (Librium)

D. Chlordiazepoxide (Librium)

The nurse notifies the treatment team that the client's electroconvulsive therapy treatment scheduled for 9:45 a.m. is to be cancelled when the: A. Client's wife calls and reports she will be unable to get to the hospital before the treatment. B. Medication nurse gives him his regularly scheduled antihypertensive medication at 7 a.m. C. Night shift staff reports that the client slept fitfully and reports having "bad dreams." D. Client eats his usual breakfast of buttered toast, cooked cereal, tea, and juice.

D. Client eats his usual breakfast of buttered toast, cooked cereal, tea, and juice.

What is the long-term benefit of successfully implementing a constructive coping mechanism? A. Similar stressors will no longer have a negative affect in the future. B. One's ability to avoid stressors in the future is greatly improved. C. Stress is no longer viewed as a barrier to future happiness and success. D. Confidence in one's ability to manage stress in the future is reinforced.

D. Confidence in one's ability to manage stress in the future is reinforced.

A client is transferred to the locked psychiatric unit from the emergency department after attempting suicide by taking 200 acetaminophen (Tylenol) tablets. The client is now awake and alert but refuses to speak with the nurse. In this situation, the nurse's first priority is to: A. Establish a rapport to foster trust. B. Place the client in full leather restraints. C. Try to communicate with the client in writing. D. Ensure safety by initiating suicide precautions.

D. Ensure safety by initiating suicide precautions.

An example of a maturational crisis would be: A. Experiencing an unplanned pregnancy. B. Losing one's job within months of retiring. C. Working at a bank that was recently robbed. D. Having one's only child leave home to attend college.

D. Having one's only child leave home to attend college.

The mental health nurse is about to conduct an admissions interview with an older adult being admitted for depression. Which action demonstrates an understanding of the appropriate integration of the mental health status examination into an assessment interview? A. Conducting the interview in a quiet, private location B. Informing the client that his mental health status will be assessed C. Asking the mental health assessment questions at the beginning of the interview D. Including mental health questions among the general assessment interview questions

D. Including mental health questions among the general assessment interview questions

The physician prescribes lithium carbonate (Eskalith) for a client who has just been diagnosed with bipolar disorder. Now the nurse is teaching the client about signs and symptoms of lithium toxicity, which include: A. Skeletal muscle contractions, cogwheel rigidity, and a thick tongue. B. Dry mouth, blurred vision, and urine retention. C. Edema, orthostatic hypotension, and rash. D. Lethargy, vomiting, and diarrhea.

D. Lethargy, vomiting, and diarrhea.

A patient prone to manic episodes is reevaluated and diagnosed with acute kidney injury. Which medication would the nurse anticipate holding? A. Xanax B. Carbamazepine (Tegretol) C. Nifedipine D. Lithium

D. Lithium

Which adverse reaction to lithium should the client with bipolar disorder report? A. Black tongue B. Increased tearing C. Periods of disorientation D. Persistent GI upset

D. Persistent GI upset

Which nursing-focused activity is best directed toward the future of evidence-based psychiatric nursing practice? A. Offering depression screening to all ages on a regular basis B. Working towards an advanced practice psychiatric nursing degree C. Discussing nursing interventions with the client's multidisciplinary care team D. Re-evaluating the validity of traditionally accepted psychiatric nursing care interventions

D. Re-evaluating the validity of traditionally accepted psychiatric nursing care interventions

In order to become political advocates for the mentally ill, psychiatric nurses must first: A. Be willing to learn the legislative and regulatory processes at both the federal and state levels. B. Recognize the need to work in partnership with the American Medical Association. C. Be willing to put aside differences and unite for a common mental health cause. D. Recognize the value of their understanding of the needs of the mentally ill.

D. Recognize the value of their understanding of the needs of the mentally ill.

A home visiting psychiatric program focuses on pregnant women who have been diagnosed with depression. The success of the intervention is best demonstrated by a client's: A. Ability to manage her gestational diabetes well through diet and exercise. B. Statement, "It's nice to think that I will have a baby of my very own." C. Willingness to take her antidepressant medications as prescribed. D. Regular attendance at a series of birthing preparation classes.

D. Regular attendance at a series of birthing preparation classes.

What medication is used most often for bipolar disorder?

Divalproex (Depakote)

A client refuses his evening dose of haloperidol (Haldol), then becomes extremely agitated in the day room while other clients are watching television. He begins cursing and throwing furniture. The nurse's first action is to: A. Check the client's medical record for an order for an I.M. as needed dose of medication for agitation. B. Place the client in full leather restraints. C. Call the physician and report the behavior. D. Remove all other clients from the day room.

D. Remove all other clients from the day room.

A patient's unresolved feelings related to loss would most likely be observed during which phase of the therapeutic nurse-patient relationship? A. Trusting B. Working C. Orientation D. Termination

D. Termination

The nurse must establish reality of separation in which of the following stages? A. Preinteraction phase B. Introductory/orientation phase C. Working phase D. Termination phase

D. Termination phase

The nurse reviews the progress of a patient's ECT therapy. This is completed in which of the following phases? A. Preinteraction phase B. Introductory/orientation phase C. Working phase D. Termination phase

D. Termination phase

Complementary and alternative medicine (CAM) therapies have been growing in popularity and surveys show that they are being used to treat several mental health conditions. With these statistics in mind the nurse is careful to assess which client for the possible use of CAM therapies? A. The teenager who is dealing with sexual identity issues B. The older adult who has developed early onset dementia C. The young adult who is experiencing chronic pain as a result of a knee injury D. The middle-aged adult who is experiencing depression after the death of a parent

D. The middle-aged adult who is experiencing depression after the death of a parent

The terms "judgment" and "insight" are sometimes used incorrectly. Insight is the ability to: A. Make appropriate choices. B. Control inappropriate impulses. C. Explain one's psychiatric diagnosis. D. Understand the nature of one's problem or situation.

D. Understand the nature of one's problem or situation.

Which statement best demonstrates the current status of the benefit of family involvement to the individual who is mentally ill? A. Family involvement is limited by the current confidentiality laws enforced by HIPAA. B. Family involvement is best stressed once the individual's mental health status has been stabilized. C. Despite education, families are generally ill prepared to significantly impact the mental health of their family member. D. While the benefits are well documented, the service is not consistently offered in the majority of mental health systems.

D. While the benefits are well documented, the service is not consistently offered in the majority of mental health systems.

Interventions following acute stress are referred to as ___ in which patients are asked to recall events and clarify traumatic experiences.

Debriefing

Low self-esteem leads to ___, which is always present in self-destructive behavior.

Depression

What is the leading cause of disability worldwide?

Depression

What psychiatric illnesses act as predisposing factors for self-destructive behavior?

Depression Schizophrenia Substance abuse Bipolar disorder

In the relationship process, what occurs during the introductory or orientation phase?

Determine why patient sought help Establish trust, acceptance, open communication Mutually formulate contract Explore thoughts, feelings, & actions Identify patient's problems Define goals with patient

Group members who increase awareness of social interactions to learn new skills demonstrate Yalom's curative factor ___.

Development of social skills

Which treatment has been identified as a best practice for persons with borderline personality disorder?

Dialectical behavioral therapy (DBT)

What is the difference between direct and indirect self-destructive behavior?

Direct: intent is death and person is aware of that outcome Indirect: any activity that is harmful to well-being and potentially may result in death; person may be unaware of this potential and may deny it if confronted

What are the effects of action dimensions? What does timing depend on?

Effects: confrontation/challenge, exposure, risk, growth Timing: trust, stress level, defense mechanisms, need for space

What risk factors predispose an individual to suicidal thoughts or actions?

Elderly (over 80) Previous suicide attempt(s) Presenting symptoms Psychiatric illness Severe life events Poor impulse control Family history Anxiety - at the core of every self-destructive behavior

What treatment method may enhance dopamine sensitivity by increasing wave activity and the amount of GABA, activating brain systems that use norepinephrine and reducing uptake of serotonin?

Electroconvulsive therapy (ECT)

What treatment produces a deliberate, artificially-induced grand mal seizure of the brain lasting about one minute?

Electroconvulsive therapy (ECT)

Which somatic therapy requires a medical evaluation, review or prior care by two psychiatrists and the need to be recommended for this therapy, informed consent, and can be appropriate for clients who are pregnant?

Electroconvulsive therapy (ECT)

A patient is being prepped for hip surgery and wants to talk with the nurse about every previous surgery she's had, which seems to help her relax. This is an example of ___.

Emotional catharsis

Encouraging a patient to discuss the recent death of his parent is an example of ___.

Emotional catharsis

In a group, the ___ has a positive effect on the group by supporting and motivating members.

Encourager

In the relationship process, what occurs during the termination phase?

Establish reality of separation Review progress of therapy and attainment of goals Mutually explore feelings of rejection, loss, sadness, anger, & related behaviors

In a group, the ___ assesses the group's performance and progress.

Evaluator

___ transference is demonstrated by patients who become overly dependent on the nurse or view the nurse as "godlike."

External transference

In a group, the ___ helps to keep the group focused.

Facilitator

(True/False) Confrontation can be used with anyone, including patients the nurse has not met yet.

False

In a group, the ___ is a member of the audience, who is needed in all groups.

Follower

The nurse discusses the side effects of Paxil with a newly-prescribed patient. He makes sure to include:

GI disturbances Sexual dysfunction Nervousness Activation Headache Insomnia Serotonin syndrome

What are the common side effects of the anticonvulsant Divalproex (Depakote)?

GI upset Headache Dizziness Weight gain

What common side effects would the nurse inform a patient of who has just been prescribed Celexa?

Gastrointestinal disturbances Sexual dysfunction

In a group, the ___ determines the level of group acceptance of individual members.

Gatekeeper

Why are tricyclic antidepressants infrequently used?

Have many side effects Have many interactions with other medications Can cause cardiac problems Lethal in overdose

What are some side effects of electroconvulsive therapy (ECT)?

Headache Confusion Disorientation Memory loss

What are the two major side effects of electroconvulsive therapy (ECT)?

Headache Memory loss

Why are beta blockers given to patients experiencing anxiety?

Help to slow heart rate and decrease blood pressure

What is the number one predictor of violence?

History of violence

A patient taking Tranylcypromine (Parnate) is experiencing an intense headache in the back of his head, persistent chest pain, and nausea. Upon further evaluation, the nurse notes a significant increase in the patient's blood pressure, as well as a fever and dilated pupils. What does the nurse suspect?

Hypertensive crisis

A student who is able to picture himself graduating from college is demonstrating the cognitive behavioral intervention technique of ___.

Imagery

Group members who imitate healthy behavior of other group members demonstrate Yalom's curative factor ___.

Imitative behavior

A nurse is preparing to converse with a patient regarding the effectiveness of his medication regimen. When she walks over, he begins yelling about how someone on the floor stole his cigarettes. The nurse deals with the patient's yelling before asking about his medications. This is an example of ___.

Immediacy

The need to focus on the immediate concern or stressor is defined as ___.

Immediacy

Members of a group receiving didactic information and suggestions, such as how to decrease stress, and who learn about specific illness, symptoms, and treatment demonstrate Yalom's curative factor ___.

Imparting information

What is important to know regarding cultural values?

In order to understand the patient, the nurse must be aware of own values and patient's values

In person-centered motivational interviewing, what is the most important component for the nurse to consider?

Including the individual's family

What are the warning signs of a hypertensive crisis?

Increased BP Palpitations Severe headache

The fourth level of crisis intervention, ___, is helpful when a patient presents with homicidal or suicidal symptoms. Interventions are aimed at cognitive and emotional processing.

Individual approach

In a group, the ___ begins group discussion.

Initiator

Members of a group gaining hope from others with similar problems who have made positive changes are demonstrating Yalom's curative factor ___.

Installation of hope

When providing instructions to a patient who has just been prescribed Isocarboxazid (Marplan), it is important for the nurse to include:

Interactions with other medications Requires tyramine-free diet: avoid food and drugs that increase norepinephrine levels to prevent hypertensive crisis

___ transference is demonstrated by patients who are hostile towards the health care professionals, leading to depression, defiance, and irritability.

Internal transference

Grou members who transfer what is learned in group to situations outside the group demonstrate Yalom's curative factor ___.

Interpersonal learning

Which anticonvulsant medication can cause Stevens-Johnson syndrome?

Lamotrigine (Lamictal)

Which anticonvulsant medication is the mood stabilizer of choice during pregnancy?

Lamotrigine (Lamictal)

In a group, the ___ sets the direction for the group.

Leader

What are persons who exhibit self-destructive behavior commonly experiencing?

Low self-esteem

To think about or attempt self-destruction, a person must have ___.

Low self-regard

What is the difference between managed care and behavioral managed care?

Managed care includes all medical care except mental illness and addiction Behavioral managed care includes mental illness and addiction

A "midlife crisis" is an example of a ___ crisis.

Maturational crisis

A ___ crisis involves changes that require role change.

Maturational crisis

Becoming a parent is an example of a ___ crisis.

Maturational crisis

Fred retires from his job as a police officer after 35 years with the force. This is an example of a ___ crisis.

Maturational crisis

What is a major side effect of atypical antipsychotic medications?

Metabolic syndrome

What technique is key in managing emotions and being in the moment without the burden of outside thoughts?

Mindfulness

In patients undergoing dialectical behavioral therapy (DBT), what value is the nurse attempting to instill in the client?

Mindfulness - to become more responsive and mindful to certain situations

What type of antidepressant increases the availability of serotonin and norepinephrine by inhibiting enzymes that metabolize serotonin and norepinephrine?

Monoamine oxidase inhibitors (MAOIs)

Why is early detection of tardive dyskinesia (TD) essential for patients taking typical antipsychotics?

No treatment

Standards of behavior in a group therapy group that influence communication and interactions, created to facilitate accomplishment of the group's goals or tasks, control interpersonal conflict, interpret social reality, and foster group interdependence, are defined as ___.

Norms

The criteria for sharing personal statements about self to model and educate, foster therapeutic alliance, validate reality, or encourage patient autonomy is defined as ___.

Nurse self-disclosure

What factor determines a nurse's ability to safely intervene in situations where a patient expresses serious anger?

Nurse's self-awareness

What is the purpose of crisis intervention?

Offers immediate help to reestablish equilibrium Inexpensive & short-term Focuses on presenting problem

A person who is on time to each group meeting is demonstrating a(n) [overt/covert] norm.

Overt

The understanding that "what is shared in group stays in group" is an example of a(n) [overt/covert] norm.

Overt

Why are patients advised not to abruptly discontinue a benzodiazepine regimen?

Potential for seizures

What should be considered when assessing the effectiveness of the dosage of Valium a patient has been receiving for six months?

Potential for tolerance/dependence exists - doses may need to be increased

Group therapy members' ability to influence the group as a whole and its members individually, determined by who is listened to most, who receives the most attention, and who makes decisions for the group, is defined as ___.

Power

The nurse takes time to analyze her own feelings, strengths, and weaknesses. This is done in which of the following phases? A. Preinteraction phase B. Introductory/orientation phase C. Working phase D. Termination phase

Preinteraction phase

What is the best indication for a patient's potential to harm himself/herself?

Previous suicide attempt

What are the risk factors for suicide or homicide?

Prior attempt Depression, other mental disorders, substance abuse Family history of mental disorder/substance abuse Family history of suicide/homicide Family violence - physical, sexual Firearms in the home Incarceration Exposure to suicidal behavior of others

In a group, the ___ encourages solving problems related to the group task.

Problem solver

What cardiovascular medication is often introduced for persons suffering from performance anxiety, social phobia, or panic disorder?

Propranolol (Inderal)

___ is defined as the diagnosis and treatment of human responses to actual or potential mental health problems that "is a specialized area of nursing practice employing theories of human behavior as its science and purposeful use of self as its art."

Psychiatric nursing

A ___ crisis occurs in an individual who is unable to solve a problem and feels helpless, throwing him into a state of disequilibrium due to ineffective previous coping mechanisms.

Psychological crisis

In a group, the ___ clarifies issues and information.

Questioner

Giving a patient positive responses to adaptive behavior is known as ___.

Reinforcement of behavior

The nurse knows the lithium, a naturally-occurring salt that is excreted by the kidneys, has the potential to adversely affect:

Renal function Thyroid function ECG

When meeting with a patient who was raped, she states that "she doesn't want to deal with it." This is an example of ___, which causes therapeutic impasse.

Resistance

Within the nurse-client relationship, ___ dimensions allow patients to achieve insight while ___ dimensions help to identify obstacles to process and the need for behavioral change.

Responsive dimensions Action dimensions

A student who failed an exam who states, "perhaps I need to study differently to do better on the next exam" is demonstrating the cognitive behavioral intervention technique of ___.

Restructuring

What is the goal of crisis intervention?

Return or reengage in previous coping, social supports, etc.

The predisposing factors included in the Stuart Stress Adaptation Model represent what?

Risk factors

What are some nursing diagnoses for a patient with suicidal ideation?

Risk for violence, self-directed Ineffective individual coping Hopelessness Powerlessness Chronic low self-esteem Situational low self-esteem Spiritual distress

What is true in regard to psychotic patients' risk for suicide?

Risk is high regardless of a plan, lethality of proposed methods, and availability of means Impulse control, judgment, and thinking seriously impaired Especially at-risk with command hallucinations

Which atypical antipsychotic medication elevates serum prolactin levels, potentially causing gynecomastia?

Risperidone (Risperdal)

In a group, the ___ sets the standards for group behavior.

Rule maker

Which class of medications increases the availability of serotonin by blocking the reuptake of serotonin at the presynaptic membrane?

Selective serotonin reuptake inhibitors (SSRIs)

The key therapeutic tool in crisis intervention is ___.

Self

In therapeutic communication, compassion and critical distance are key in being effective. Being conscious of our own attitudes, expectations, myths, and values is defined as ___.

Self-awareness

The nurse's goal to achieve authentic, open, and personal communication through exploration of his or her own beliefs is defined as ___.

Self-awareness

What are some nursing interventions for a suicidal patient?

Self-awareness Protection and safety Increasing self-esteem (focusing on strengths) Regulating emotions and behaviors Support Patient and family education

A patient arrives at the hospital complaining of nausea and diarrhea and presents with an unsteady gait, agitation, a heart rate of 160, and a rapidly increasing blood pressure. What does the nurse suspect?

Serotonin syndrome

What treatment does a nurse expect to initiate for a depressed patient who is agitated, vomiting, hyperthermic, hyperreflexive, and tachycardic?

Serotonin syndrome: Anticonvulsants for seizures Clonazepam for myoclonus Lorazepam for restlessness and agitation

What are some precipitating stressors that might cause a person to contemplate suicide?

Stress that feels overwhelming Attempt to escape from uncomfortable, intolerable life situation Anxiety from attempt to harm self Loss of ability to value self

Blocks to progress are defined as ___.

Therapeutic impasse

A homeless patient is refusing to discuss anything that is troubling him and is overheard telling another patient that he does not want to work with the health care team to get better because he wants to stay in the hospital longer. This is an example of ___.

Therapeutic impasse due to resistance

The purposeful use of people, resources, events, and environments to ensure safety, promote optimum functioning, develop and improve social skills, and enhance the capacity to live independently is referred to as ___.

Therapeutic milieu

How are personality disorders best treated?

Therapy - drugs ineffective

A patient with generalized anxiety disorder (GAD) is prescribed BuSpar. What is important to inform the patient before discharge?

This medication may take several weeks to take effect

A patient who says, "I won't be around much longer, so you won't have to worry about me" is an example of a ____.

Threat

Why are patients who convey suicidal ideation put on one-to-one?

To protect their self-esteem and protect them from harm

What adverse effects may be caused by benzodiazepines?

Tolerance/dependency Sedation Ataxia Detachment Amnesia Irritability Concentration/memory problems

The unconscious response in which a patient experiences feelings and attitudes toward the nurse that were originally associated with other significant figures is defined as ___.

Transference