Practice Questions for MH E2

A mother whose baby was born 3 weeks ago calls the nurse and reports symptoms of feeling down and tired. The mother asks what could possibly cause this since she is so excited to have her baby. The best response by the nurse is which of the following?

"'Baby blues' is self-limiting and can signal an emotional letdown after delivery."

A client admitted to the hospital for a recent suicide attempt has been taking antidepressants as prescribed and attending group therapy. The client is sleeping 6 hours per night and reports a significant improvement in mood. The client states, "I have lots of things to do when I get home, and I don't really need to be in the hospital anymore." Which of the following responses by the nurse would be most appropriate?

"Are you still having thoughts of suicide?"

The school nurse teaches elementary school teachers about occurrences of violence towards children. The nurse knows that further teaching is necessary if a teacher makes which of the following statements?

"Children with special needs are less vulnerable to physical abuse than other children."

A client who attempted suicide five years ago with an overdose was brought to the emergency department by a friend. The client states, "I just don't feel like living anymore. No one would care if I lived or died." What question should the nurse ask next?

"Do you have a plan for suicide at this time?"

Which of the following client statements indicates a positive outcome to treatment for suicidal behavior?

"I am thankful for my husband and children."

A 10-year-old whose dog died last year is in the clinic for an annual physical examination. The nurse determines that goals for the child have been met when the child states which of the following?

"I have asked for a new dog for Christmas."

The nurse is evaluating a client with depression who is about to be discharged. The nurse determines that the client is meeting a short-term goal when the client makes which of the following statements?

"I made friends with another client and talked about my problems."

The nurse working with the family of a client with suicidal ideations is asked if the medication the client is taking will prevent suicide. The best response by the nurse is:

"Medication helps decrease the frequency and intensity of suicidal thoughts."

A client who is a victim of elder abuse has been attending counseling sessions with the family. The nurse evaluates that the abusive family member has learned positive coping skills when which statement is made?

"Now that I know what my resources are, I think I can do a better job of caring for my parent."

During a family support group, a family member asks the nurse the difference between bipolar disorder and depression. The best response by the nurse is:

"Often, individuals with bipolar disorder can feel elated, are productive, and do not think there is anything wrong when they have manic feelings."

The adult child of an 82-year-old client with depression asks the nurse why the depression developed so late in life with no previous history of depression. Which of the following responses by the nurse is most appropriate?

"Older clients have higher levels of the enzyme called monoamine oxidase that results in slower signals to the brain, causing depression."

The nurse is evaluating a mother at 6 weeks postpartum who had the baby blues at 3 weeks postpartum. The nurse concludes that goals have been met when the client states which of the following?

"The baby and I visited my cousin yesterday."

The spouse of a client on lithium for bipolar disorder tells the nurse that the client is experiencing more mood swings but the lithium level is 1.3. Which of the following should the nurse tell the spouse to assist with coping?

"The part of the brain that controls emotion becomes hypersensitive to stress over time and releases extra neurotransmitters, causing more rapid mood swings."

The family has brought a client to the hospital and tells the admitting nurse that the client is expressing feelings of worthlessness even though the family tells the client that the feelings are wrong. The nurse tells the family that which of the following responses would be best when the client states these feelings?

"This must be a difficult time for you."

A 63-year-old client with Alzheimer's disease is brought to the emergency department (ED) with pressure sores and severe dehydration. Upon further assessment, the nurse notices bruises on the client's neck, arms, and legs. Which of the following questions should the nurse ask the client's spouse?

"What kind of support do you have at home to care for your spouse?"

Which of the following statements would hinder the therapeutic relationship between the nurse and an adult victim of a recent sexual assault?

"You may want to have an abortion if you find out you are pregnant."

For the client with bipolar disorder who is experiencing mania, the nurse offers trazodone (Desyrel) prior to bedtime. The client responds, "I feel great, and I do not need to sleep." The most therapeutic response by the nurse is:

"You stated that you did not sleep at all last night. That can be tough on your system."

The nurse is conducting a teaching session at a community center for women about rape. The nurse would include that which individual is at highest risk for experiencing rape?

A student

The nurse would look for which of the following characteristics in the behavior of a client experiencing obsessive-compulsive personality disorder (OCPD)?

Anxious/fearful

A client comes to the emergency department with multiple bruises about the face and head. The nurse suspects that domestic violence may be related to the injuries. What is the most appropriate initial action for the nurse to take?

Ask if the client is afraid of being hurt by someone at home.

Which of the following is the most important intervention by the nurse when a client does not respond to less restrictive methods and is rapidly escalating toward violent assault?

Cease negotiations and implement a plan of intervention to control the client and provide safety.

The care plan formulated with a client includes the goal: client describes self as a rape survivor. For which client would this goal be inappropriate?

Client in the emergency department immediately after the rape

A client with a personality disorder has a nursing diagnosis of impaired social interaction. Applying the principles for caring with this client, which of the following nursing interventions is essential to the care plan?

Demonstrate honesty and sincerity in interactions with client.

The nurse has concluded that an assigned client's anxiety has reached the *panic level* as evidenced by which of the following manifestations?

Dizziness, palpitations, nausea

A nurse came to work with a black eye and a swollen lip. Coworkers have noticed that the partner calls the nurse at least 10 times during a 12-hour shift. The nurse has refused all invitations to go out with coworkers, saying that the partner will be there after work and doesn't like to wait. What is the most helpful response by the coworkers?

Encourage the nurse to talk to a professional.

The nurse is planning care for a client who has witnessed a violent assault. Which of the following is a key component of crisis intervention that the nurse should utilize at this time?

Identify the client's coping patterns and then offer support.

The nurse is teaching a 16-year-old client about risk factors and complications of anorexia and includes which of the following as a priority?

Increased risk of mortality

In a final exam, a client performs poorly and receives a low grade for the test. The client grieves the grade and flirts with the professor who gave the low grade. Which characteristics common to all three categories of personality disorders does the nurse conclude are evident in the client? (Select all that apply.)

Lack of insight. External response to stress. Failure to accept consequences

The nurse places highest priority on which of the following nursing interventions when caring for a client with antisocial personality disorder?

Maintaining consistent limits

The nurse is leading a group for depressed clients who have attempted suicide in the past. Which of the following topics is not appropriate to discuss in this group?

Movies that dramatize suicidal behavior

The nurse is planning care for a client who has been admitted with a first episode of mania. The nurse is told by the client's partner that the client was laid off from work, but the client insists that a big promotion is coming soon. Which of the following techniques will the nurse employ when the client is talking about the big future that is coming?

Promoting reality-based thinking

A 17-year-old high school student who was recently raped is reluctant to discuss the event. She can no longer use tampons during her period because she becomes dizzy and nauseated when trying to insert them. She states that she will never have another boyfriend because "I'm ruined." Which of the following nursing diagnoses is most appropriate for this client?

Rape-trauma Syndrome: silent reaction

The nurse states to a client, "In the past, you have made your appointments very well on your own." What is the most likely rationale for the nurse's action?

Reinforcing the client's sense of mastery

Which of the following nursing diagnoses is the most important for a homosexual client who has been repeatedly physically assaulted by the partner?

Risk for injury related to history of abuse by significant other

The nurse assesses pregnant women before and after delivery for the possibility of depression because of which of the following risks? (Select all that apply.)

Suicide. Infanticide

The nurse is working with a woman 4 weeks after childbirth who is experiencing mild depression. The woman's partner asks the nurse if there is anything he can do to help the new mother during this transition. The nurse suggests which of the following?

Take the mother out for dinner once a week.

A client has recently been admitted for depression and suicidal ideations. The nurse observes the client most carefully for risk for attempting suicide when:

The client demonstrates clinical improvement.

The nurse has been working with a teenage female client who was assaulted and robbed late one night after shopping. Which of the following outcomes indicates that the client has achieved the expected outcomes of treatment? (Select all that apply.)

The client talks about the event without excessive distress. The client states a plan to choose parking spaces close to a building. The client is enrolling in a self-defense class for women.

A female was sexually assaulted in the parking lot of a mall and was brought to the emergency department by a friend. Which of the following is improper procedure for conducting a sexual assault assessment?

The victim uses the bathroom and washes her hands before the examination begins.

According to the *family system theory*, the nurse recognizes family behavior characteristics associated with anorexia nervosa as which of the following? (Select all that apply.)

Unclear boundaries between family members. Family members' preoccupation with food and eating

The nurse is caring for two assigned clients, one with anorexia and the other with bulimia. The nurse expects that the most common coexisting mental health issue with both clients is which of the following?

Depression

The nurse is caring for a client with a major depressive disorder who was recently placed on a high-potency neuroleptic (antipsychotic) medication. The client has not been eating well, is starting to get dehydrated, and has a temperature of 101°F. The physician orders antibiotics. Six hours later, the nurse notice that the client's temperature has risen to 103°F and the client has muscle rigidity and a fluctuating blood pressure. The priority of action for the nurse is to:

Discontinue the neuroleptic and report the symptoms to the physician immediately.

A client has been told that more surgery will be needed to correct a physical problem. The client responds with "I just can't take any more; everything is going wrong." The nurse interprets that the client is in which stage of anxiety?

Exhaustion

According to *systems theory*, families in which sexual abuse occurs are characterized by:

Fluid boundaries.

The nurse is working with a family who has just experienced a theft of most of their furniture and electronics from their home. Which of the following priority interventions will the nurse initiate for this family?

Focus on managing the feelings provoked by the theft.

The nurse is interviewing a client admitted with anorexia and expects to find that the client manages anxiety in which of the following ways?

Follows rigid rules

During the 2-month postpartum checkup, a client who is a single mother tells the nurse that she's a terrible mother because she doesn't know what to do when her baby continues to cry after feeding and changing. She also reports insomnia, lack of energy, and anxiety. Which of the following nursing diagnoses is appropriate for this client?

Ineffective Coping

The nurse is caring for a client who is experiencing a divorce and has symptoms of depression. Which of the following nursing diagnoses would be appropriate for this client? (Select all that apply)

Ineffective Coping. Fear

The nurse is assigned to care for a 6-year-old whose dog was killed by a car. The child was injured when attempting to save the dog. Which action is the nurse engaged in with the client during the working phase of the nurse-client relationship?

Inquiring about the child's feelings that may affect the ability to cope

The nurse enters the room of a client diagnosed with anorexia nervosa and finds the client vigorously exercising. Which of the following nursing interventions is appropriate for this client?

Interrupt the client and offer to take a walk.

The nurse is planning care for a 75-year-old depressed client who also has impaired cognition. Which of the following interventions will the nurse initiate for this client?

Involve the client in simple, noncompetitive recreational activities.

The nurse is working with a client who has been treated for depression in the past and is planning on getting married in a few weeks. The nurse is aware that marriage could cause symptoms of depression since this is considered a:

Maturational crisis

There are several biopsychosocial theories associated with the causation of rape and intrafamily abuse. However, the nurse knows that:

None of the contributing factors consistently results in or is predictive of rape.

The nurse is overseeing care of a client admitted with bulimia who is being cared for by the new nursing graduate. During care planning, the nurse intervenes when the new graduate documents which incorrect intervention in the plan of care?

Observe for excessive exercise.

The mental health nurse is giving a presentation in a rural community to increase the awareness of suicide risks. Which of the following population groups has a high risk for suicide and is an appropriate target audience?

Older men with a terminal disease

Which of the following objective data would the nurse expect to find in the client with anorexia nervosa?

Osteoporosis

A client who recently moved into a basement apartment asks the nurse how to cope with a depressed mood, craving for carbohydrates, and increased appetite. Which of the following treatment modalities would the nurse recommend?

Phototherapy

Which of the following would the nurse recommend for an early-discharge postpartum family in order to foster positive adjustments at home and screen for potential depression?

Place a telephone follow-up call to the mother at 2-3 weeks postpartum.

A 10-year-old client with conduct disorder is hospitalized for aggressive behaviors in the home and school. When told it is time for a group meeting, the client begins throwing furniture and yelling at staff members. Which of the following nursing interventions is not appropriate for this client?

Place client in time-out for 20 minutes.

The nurse is caring for a teen mother and is discussing postpartum depression with her. Which of the following strategies might the nurse teach this young mother about prevention of postpartum depression?

Plan daily time for yourself.

The nurse is planning care for a newly admitted client who is experiencing hypomania. The nurse selects the nursing diagnosis of risk for injury based on which of the following?

Possible attacks by other clients

A client who has had many different physical illnesses in the past few years is no longer employed, rarely does housework or shopping, and states "I just can't seem to do anything." Which of the following is a priority nursing diagnosis?

Powerlessness

The nurse is caring for a client who is experiencing a major depressive episode. The nurse monitors the client for signs of urinary retention and constipation, knowing that these problems are possible due to which of the following?

Psychomotor retardation and medication

Which of the following would the nurse expect to observe in a client in the hypomanic phase of bipolar disorder? (Select all that apply.)

Rapid speech. Preoccupation with sex. Lack of sleep.

The nurse is caring for a woman who is one day postpartum, has a history of depression, and plans to breastfeed her baby. The nurse expects the physician to order which of the following?

Referral to a mental health professional for follow-up

A high school freshman has been teased and taunted about his small size by senior class members. He has no close friends and usually sits alone when eating lunch in the cafeteria. When he fell down in physical education class, the other students laughed and called him "klutz." The school nurse should provide further teaching if the nursing student selected which of the following nursing diagnoses for this teen?

Risk for other-directed violence related to history of violent behaviors

A nurse is planning for the discharge from the clinic of a client who experienced depression following the loss of a job. The nurse understands that the client's unresolved feelings of loss may resurface during which phase of the nurse-client therapeutic relationship?

Termination phase

The nurse is aware that changing levels of hormones and neurotransmitters may contribute to violent behavior. The nurse is most concerned about a potential for violence if a client has elevated levels of which of the following?

Testosterone

Which of the following behaviors does the school nurse recognize is an indicator that a school-age child has been physically abused?

The child bullies other children and threatens them to "keep quiet about it or else."

Which of the following outcomes indicates that a client taking lithium is responding effectively to therapy?

The client completes the crossword puzzle in the daily newspaper.

The guardian of a client diagnosed with paranoid schizophrenia is concerned that the client is at risk for suicide. The nurse should assess which of the following behaviors as a significant sign that the client is contemplating suicide?

The client has been asking how to load a gun.

The nurse is teaching coping skills to clients who have experienced sexual trauma. Which of the following demonstrates that the teaching has been successful? (Select all that apply.)

The client restructures negative thoughts and makes positive self-statements. The client verbalizes feelings of anger and despair from past sexual abuse. The client enjoys an intimate relationship with a significant other. The client practices deep breathing techniques when intrusive memories occur.

A nurse is teaching a group of high school students about eating disorders. The nurse plans to include in the teaching that cultural stereotypes may contribute to the development of eating disorders in which of the following ways?

The culture has a strong emphasis on low body weight justifying high self-esteem.

The nurse is caring for a client with obsessive-compulsive personality disorder. Most of the client's cognitive content will be centered on which of the following?

The importance of rules and regulations

When interviewing a potentially violent or aggressive client, which environmental factor is most important for the nurse to consider?

The interview should take place in a calm, quiet area to reduce stimuli.

Which of the following population groups are most likely to be victims of murder, rape, robbery, or aggravated assault?

Young adult male gang members

A client who has been physically abused asks the nurse, "What makes people so violent toward others?" Which of the following is the best response to this question?

"It is difficult to give one specific reason for violent behavior."

A client who has experienced the loss of a job and is depressed asks the nurse how cognitive-behavioral therapy can help return the client's good mental health. The best response by the nurse is which of the following?

"It will help you to explore new ways to react to negative situations."

The client's child died in a car accident while the client survived. The client tells the nurse, "I should have died. I've always been a failure." The nurse plans to respond with which of the following?

"You've been feeling like a failure for awhile?"

A client in the hospital in a hypomanic state comes to the common room dressed in a sexually suggestive manner and is making sexual remarks and gestures. The appropriate nursing action is which of the following?

Approach the client calmly and escort the client back to the client's room.