PSYCH

A nurse educator is orienting a new staff nurse to the unit when asked, "How will I know which clients are potentially violent?" Which is the best response?

"As you plan care, review the clients charts for histories of violence"

Which of these instructions should a nurse include for a client who is taking lithium carbonate (Eskalith)?

"Drink 6 to 8 glasses of water daily"

A client is given instructions about starting fluoxetine (Prozac). Which of the following statements, if made by the client, would indicate that the client understands the instructions?

"I will continue taking the medications, even when I'm feeling better"

Staff members have expressed fear of a client who has a history of violence. What response by the charge nurse would be most beneficial in addressing he staff's concerns?

"It may be hard, but we need to appear calm &nonthreatening but alert to his behavior"

A nurse is evaluating a client diagnosed with paranoid schizophrenia who reports hearing a voice that says, "Do not remove your hat because they will be able to read your mind." Which response by the nurse is the most therapeutic?

"It must be very frightening to believe that someone can read your mind"

A client with schizophrenia has a history of hearing voices that tell him to harm others. He states that he is hearing voices again. What is the best response by the nurse?

"What are the voices saying to you?"

A nurse is discussing the importance of taking medication as prescribed with a client diagnosed with paranoid schizophrenia. Which response demonstrated that the nurse understands the importance of relapse prevention?

"Your overall mental health will suffer with each relapse that occurs"

The nurse is to administer Chlorpomazine (Thorazine) 200 mg PO. The available tablets have 50 mg per tablet. How many will the nurse administer?

4 tablets

A nurse is caring for multiple clients on a hospital unit. Which client should the nurse expect to have the greatest risk for suicide behavior?

A 27 year-old client whose girlfriend recently ended their relationship

Which of the following is an example of a client who requires emergency admission to a mental health facility?

A client with psychosis who assaulted a homeless man with a man with a metal rod

During the admission interview the client states that he believes that the news reporter on TV is talking about events that happened to the client.

A delusion

A nurse suggests to client a suitable place to attempt to gain control over increasing anger. The most therapeutic site would be:

A quiet area where the client can be observed

A nursing colleague tells you that the staff is being unfair to a client and that they are the only one who can understand what that client has been through. This is an example of:

A therapeutic nurse- client relationship

The client request no visitors or phone calls except from designated family members. The nurse should:

Acknowledge that you are legally bound to protect his privacy

Which approach should the nurse use during crisis intervention?

Active & goal-directed

A client's boyfriend was killed trying to protect her from muggers. The guilt is overwhelming and she is talking about suicidal thoughts. Which intervention is most therapeutic?

Admit her to an inpatient mental health unit to ensure her safety

When a new bill introduced in congress reduces funding for care of persons with mental illness a group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled?

Advocacy

A 26- month old displays negative behavior, refuses toilet training, and often says, "No!" Which stage of psychosexual development is evident?

Anal

A depressed client says that he doesn't have any strength to get up and do things. This is called:

Anergia

A nurse is caring for a patient form another culture. Which nursing action would be appropriate?

Ask the client if family, a healer or cleric should be included in the decision making process

A client has become upset in the day room. What should the first nursing action be :

Assess for the safety of the situation

Which is the nurse's primary goal of seclusion for a client exhibiting violent behavior?

Assure the safety of the client and others

A patient is receiving the drug haloperidol (Haldol). Which medication should the nurse expect to administer if extrapyramidal side effects develop?

Benztropine (Cogentin)

A client on the MAOI phenelzine (Nardil), should have the following monitored often:

Blood Pressure

A suicide attempt on the part of a teenager is usually a:

Call for help

The type of schizophrenic disorder characterized by stupor and waxy flexibility is called:

Catatonic

The nurse knows that sublimation is a defense mechanism that helps the individual:

Channel unacceptable impulses into socially approved behavior

A nurse is assessing a client with dysthymia who reports symptoms of depressed mood. Which assessment finding supports the essential feature of dysthymia?

Chronically depressed mood for most of the day for at least 2 years

In report you learn that your client has Steven-Johnson syndrome. You know that you should be aware of what?

Client's medications

The nurse is providing care for a client admitted with a manic episode. What is a priority nursing intervention for this client?

Closely monitor the client's eating and sleeping habits.

A client diagnosed with an anxiety order tells the nurse that being in crowds makes him anxious. What could the nurse recommend as an effective, non-pharmacological therapy for managing the client's symptoms of anxiety?

Cognitive behavioral therapy

A client often expresses anxiety through physical symptoms. Which defense mechanism is being used by the client?

Conversion

A client is admitted to an inpatient unit. He states that his "anxiety is unmanageable." Which of the following activities is appropriate for the client?

Daily walks with the nurse

A client who has diagnosis of undifferentiated schizophrenia is to take chlorpromazine hydrochloride (Thorazine). Which of these outcomes should a nurse expect for the client if the medication is having the desired effect?

Decreased frequency of hallucinations

In the process of development, the individual strives to maintain and protect the self. The nurse understands that this usually is accomplished through the use of:

Defense mechanism

The nurse knows that the diagnostic symptoms lasting for 1 month for paranoid schizophrenia are:

Delusions & hallucinations

St. John's wart is an herbal preparation that is helpful in treating mild:

Depression

Transcranial Magnetic Stimulation uses magnetic pulses to stimulate the cerebral cortex and treat:

Depression

After formulating the nursing diagnosis for a new patient, what is a nurses next action?

Determining the goals and outcome criteria

For most nurses the most difficult part of the nurse- client relationship is:

Developing an awareness of self and the professional role in the relationship

A husband is angry with his wife, so he kicks the dog. This is an example of the defense mechanism:

Displacement

The psychiatrist may prefer to order Buspirone (Buspar) over Alprazolam (Xanex) for anxiety because of a history of:

Drug addiction

A nurse is reviewing diet restrictions with a client taking monoamine oxidase inhibitor (MAOI). Which symptom could occur with nonadherence to dietary restrictions while taking a MAOI?

Explosive occipital headache

A nurse is assessing an elderly client diagnosed with diabetes and chronic obstructive pulmonary disease whose spouse died 3 weeks ago. Which of the following should the nurse address first?

Expressed thoughts of being "better off dead"

Hilegard Peplau nurse- client relationship is best promoted by which nursing interventions?

Focusing on communication with the client

Which of the following medications should not be given concurrently with lithium?

Furoesmide (Lasix)

The nurse conducting a mini-mental status exam documents what characteristics in the general appearance sections?

Grooming

Which of the following is an emphasis of milieu therapy?

Group and social interactions are fostered

While the nurse is performing an admission assessment , the client keeps turning his head to the side and listening carefully. Which of the following is the client most likely experiencing?

Hallucinations

When assessing the individual who has had several infections in a short-term period of time, it is important to as which question?

Have you had an increase in stressful event s in your life?

Which positive symptoms of schizophrenia should the nurse document in the client's chart?

Hyperactivity, auditory hallucinations, loose associations

A client says to the nurse, "I don't know what to do. I can't decide if I should tell my son to move out unless he stops drinking. What do you think I should do?" The nurse replies:

I can help you look at the positives ad negatives, so that you can make the decision.

The nurse instructor explains that the "id" is the part of the self that says:

I want what I want (ego = mediator, id = self wanting, superego = morals & standards)

A client recently prescribed haloperidol (Haldol), complains of severe muscle pain. Assessment includes a heart rate of 104, B/P 172/92, oral temp of 101.2 F. Based on the assessment, what is the most appropriate nursing action?

Immediately notify the client's health-care provider of the assessment findings.

A Latino- American client is admitted in an aggravated, disheveled state to the Psych ER. When developing an individual, culturally sensitive care plan, the nurse gives priority to:

Inclusion of family in the client's care plan

A client is taking valproic acid (Depakene) for acute manic symptoms. Which of these manifestations, if identified in the client, would require immediate follow- up be the nurse?

Jaundice

The stage of development most often concerned with " good me - bad me" is:

Latent stage

A nurse is assessing a recently admitted client who is exhibiting agitation that appears to be related to acute mania. Which action should a nurse plan to utilize when caring for a client experiencing agitation related to acute mania?

Maintain a low level of stimuli in the client's environment.

A nurse is educating a client diagnosed with depression who is experiencing insomnia. Which intervention should the nurse recommend to reduce episodes of insomnia?

Maintain regular bedtime hours.

The nurse teaches a client that the level of anxiety that best enhances an individual's power of perception is:

Mild

Omega-3 fatty acids may be important to prevent:

Mood swings in bipolar disorder

A nurse should question an order for a tricyclic antidepressant for a client who was recently diagnosed with:

Myocardial Infarction

In psychiatric nursing, the most important tool the nurse brings to a helping relationship is:

Oneself and the desire to help

An elderly woman comes to the Psych ER in severe crisis after her husband died. After meeting with the nurse the client agrees to join a bereavement group at the hospital. How will this group assist her?

Others will share coping strategies

A psychiatric unit uses a behavioral approach to determine an increase in privileges?

Performing ADLs independently

A client tells you he is worried that his medication is not working. You respond:

Please tell me about your medication concern

The nurse is assessing the client with severe anxiety. What technique shouldn't the nurse use?

Postpone assessment until the client is calmer

Which nursing diagnosis should a nurse give highest priority when caring for a client with major depressive disorder?

Potential for Injury

Which nursing diagnosis should a nurse give highest priority when caring for a client with major depressive disorder?

Potential for injury

The nurse is planning care for a client experiencing the acute phase of mania. Which is the priority intervention?

Prevent injury

A nurse is assessing a client for adverse effects of trazadone (Desyrel). Which is the unique effect to this med?

Priapism

A nurse observes a client who has a history of aggressive behavior toward others swearing & kicking the furniture in the dayroom. Based on the client's behavior, what should be the nurse's immediate priority of care?

Provide for a safe, therapeutic milieu

The statement that best describes psychiatric nursing is:

Provides care for people with present or potential mental health problems

A client exhibits disorganized thinking, hallucinations, & delusions. This presentation is which type of major depressive disorder (MDD)?

Psychotic

The psychiatrist orders Behavioral Restraints PRN for a client who has a history of violent behavior. The nurse should:

Recognize that a PRN orders for behavioral restraints are unacceptable

Which action by a nurse constitutes a breach of a patient's right to privacy?

Releasing information to the patients employer

The nurse identifies that the main goal in planning care for a client in crisis is to:

Restore the client's psychologic equilibrium.

A newly admitted client is very paranoid and fearful. Which of the following aspects of the therapeutic milieu are most important in the first days of treatment?

Safety & structural activities

Light therapy is accepted as first line treatment in:

Seasonal affective disorder

A nurse understands the milieu therapy can be helpful for a client with antisocial personality disorder because it:

Simulates a social community where clients learn to interact with others

A nursing instructor is teaching a new student about establishing therapeutic relationships with mentally ill clients. What intervention should be used to establish this relationship?

Sit with the client in silence

A schizophrenic client since age 17, John 42 years old, on new meds, is finally living alone. He's unsure what to do with his time, about work, about a love life. What type of crisis situation is represented in this case?

Situational

A nurse is assessing a client with a history of aggressive behavior toward others. Which client behavior requires immediate nursing intervention?

Stating "the guy over there needs to shut up and sit down"

A young client is admitted for a severe anxiety disorder. The client is crying and pacing. What should be the first nursing action?

Stay physically close to the client

A client tells you, a student nurse, that he has been hoarding his pills in his drawer instead of swallowing them. He asks him to keep this confidential. You should:

Tell the client that this must be reported to the staff because it concerns safety

Which of the following actions is present during the working phase of the nurse- client relationship?

The client expresses thought and feelings

An Arabic female client rarely makes eye contact with a male nurse when questioned. What is the most likely explanation for this behavior?

The client is demonstrating respect

A nurse observes that a client is diagnosed with major depressive disorder who recently started on an antidepressant is acting differently. Two days ago, the client was sad and remained in bed. Now the client is awake at 4 a.m. and planning a unit party. What is the most likely explanation for the change in behavior?

The client was misdiagnosed and what was thought to be depression is bipolar disorder.

The mother of a client diagnosed with paranoid schizophrenia visiting her son 2 days after admission to the psychiatric unit approaches the nurse and states, "He is still talking about how the government is controlling his thoughts." What is the most accurate nursing appraisal of the mother's statement?

The mother requires further education regarding the client's diagnosis

A client has been involuntarily admitted to a hospital because he has been assessed as being dangerous to himself and others. The client has lost which of the following rights?

The right to leave the hospital against medical advise

A client is suspicious and expresses a fear of sharing and asking for help. Which stage of Erikson's development is being described?

Trust vs mistrust

The client is seen in the clinic with social phobia anxiety. What behavior would the nurse expect the client to exhibit?

Unwillingness to attend the wedding of a close family member

A nurse influenced by Peplau's interpersonal theory works with an anxious, withdrawn patient. Intervention should focus on

Use of assertive communication

For the client taking clozapine (Cloazril), which laboratory value is significant?

WBC of 2,000

A client who is experiencing anxiety disorder asks the nurse, " What will I do if I lose my job?" What is the most therapeutic response by the nurse?

What has happened that is worrying you?

A nurse is caring for a client with acute mania. The nurse observes coarse hand tremors and learns that the client's serum lithium level is 1.8 mEq/L. Which action should be taken by the nurse?

Withhold the medication and notify the physician.

A 22-year-old woman is getting married this weekend comes to the ER with complaints that she thinks she is having a heart attack. You should respond:

Would you like to discuss how the wedding is making you feel?

A client admitted with a bad history of assaults against others. The unit is short staffed and the nurse decides to place the client in seclusion as a preventative action. This is considered:

a tort

A client admitted to the hospital for constant hand washing rituals. The act of hand washing is considered:

compulsion

A nurse is reviewing clients' medications. The client taking which medication should be assessed for EPS (extrapyramidal symptoms) because of highest probability of this side effect?

haloperidol (Haldol)