Psych Exam #1 Saunders 8th ed. Questions

811. Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? Select all that apply. 1. Communicate expected behaviors to the client 2. Ensure that the client knows that they are not in charge of the nursing unit 3. Assist the client in identifying ways of setting limits on personal behaviors 4. Follow through about the consequences of behavior in a nonpunitive manner 5. Enforce rules by informing the client that he/she will not be allowed to attend therapy groups 6. Have the client state the consequences for behaving in ways that are viewed as unacceptable

1. Communicate expected behaviors to the client 3. Assist the client in identifying ways of setting limits on personal behaviors 4. Follow through about the consequences of behavior in a nonpunitive manner 6. Have the client state the consequences for behaving in ways that are viewed as unacceptable Interventions for dealing with the client exhibiting manipulative behavior include setting clear, consistent, and enforceable limits on manipulative behaviors; being clear with the client regarding the consequences of exceeding the limits set; following through with the consequences in a nonpunitive manner; and assisting the client in identifying a means of setting limits on personal behaviors. Ensuring that the client knows that he or she is not in charge of the nursing unit is inappropriate; power struggles need to be avoided. Enforcing rules and informing the client that he or she will not be allowed to attend therapy groups is a violation of a client's rights.

797. The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbor says to the nurse, "How is Carol doing? She is my best friend and is seen at your clinic every week." Which is the most appropriate nursing response? 1. I cannot discuss any client situation with you. 2. If you want to know about Carol, you would need to ask her yourself. 3. Only because you're worried about a friend, I'll tell you that she is improving. 4. Being her friend, you know she is having a difficult time and deserves her privacy.

1. I cannot discuss any client situation with you. The nurse is required to maintain confidentiality regarding the client and the client's care. Confidentiality is basic to the therapeutic relationship and is a client's right. The most appropriate response to the neighbor is the statement of that responsibility in a direct, but polite manner. A blunt statement that does not acknowledge why the nurse cannot reveal client information may be taken as disrespectful and uncaring. The remaining options identify statements that do not maintain client confidentiality.

801. A client is participating in a therapy group and focuses on viewing all team members as equally important in helping the clients meet their goals. The nurse is implementing which therapeutic approach? 1. Milieu therapy 2. Interpersonal therapy 3. Behavior modification 4. Support group therapy

1. Milieu therapy All treatment team members are viewed as significant and valuable to the client's successful treatment outcomes in milieu therapy.

812. The nurse observes that a client is pacing, agitated, and presenting aggressive gestures. The client's speech pattern is rapid, and affect is belligerent. Based on these observations, what is the nurse's immediate priority of care? 1. Provide safety for the client and other clients on the unit 2. Provide the clients on the unit with a sense of comfort and safety 3. Assist the staff in caring for the client in a controlled environment 4. Offer the client a less stimulating area in which to calm down and gain control

1. Provide safety for the client and other clients on the unit Safety of the client and other clients is the immediate priority. The correct option is the only one that addresses the safety needs of the client as well as those of the other clients.

799. The nurse in the mental health unit plans to use which therapeutic communication techniques when communicating with a client? 1. Restating 2. Active listening 3. Asking the client "why" 4. Maintaining neutral responses 5. Providing acknowledgement and feedback 6. Giving advice and approval or disapproval

1. Restating 2. Active listening 4. Maintaining neutral responses 5. Providing acknowledgement and feedback Therapeutic communication techniques include listening, maintaining silence, maintaining neutral responses, using broad openings and open-ended questions, focusing and refocusing, restating, clarifying and validating, sharing perceptions, reflecting, providing acknowledgement and feedback, giving information, presenting reality, encouraging formulation of a plan of action, providing nonverbal encouragement, and summarizing. Asking "why" is often interpreted as being accusatory by the client and should also be avoided. Providing advice or giving approval or disapproval are barriers to communication.

808. the nurse is conducting a group therapy session. During the session, a client diagnosed with mania consistently disrupts the group's interactions. Which intervention should the nurse initially implement? 1. Setting limits on the client's behavior 2. Asking the client to leave the group session 3. Asking another nurse to escort the client out of the group session 4. Telling the client that they will not be able to attend any future group sessions

1. Setting limits on the client's behavior Manic clients may be talkative and can dominate group meetings or therapy sessions by their excessive talking. If this occurs, the nurse initially would set limits on the client's behavior. Initially, asking the client to leave the session or asking another person to escort the client out of the session is inappropriate. This may agitate the client and escalate the client's behavior further. Barring the client from group session is also inappropriate because it violates the client's right to receive treatment and is a threatening action.

790. The nurse should plan which goals of the termination stage of group development? Select all that apply. 1. The group evaluates the experience. 2. The real work of the group is accomplished. 3. Group interaction involves superficial conversation. 4. Group members become acquainted with one another. 5. Some structuring of group norms, roles, and responsibilities takes place. 6. The group explores members' feelings about the group and the impending separation.

1. The group evaluates the experience. 6. The group explores members' feelings about the group and the impending separation. The stages of group development include the initial stage, the working stage, and the termination stage. During the initial stage, the group members become acquainted with one another, and some structuring of the group norms, roles, and responsibilities takes place. During the working stage, the real work of the group is accomplished. During the termination stage, the group evaluates the experience and explores members' feelings about the group and the impending separation.

852. A client taking lithium reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is 2.5 mEq/L. The nurse plans care based on which representation of this level? 1. Toxic 2. Normal 3. Slightly above normal 4. Excessively below normal

1. Toxic Maintenance serum levels of lithium are 0.6-1.2 mEq/L. Symptoms of toxicity begin to appear at levels of 1.5 mEq/L. Lithium toxicity requires immediate medical attention and the primary health care provider is notified if symptoms of toxicity occur.

789. A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat? 1. Using open-ended questions and silence. 2. Sharing personal preference regarding food choices 3. Documenting reasons why the client does not want to eat 4. Offering opinions about the necessity of adequate nutrition

1. Using open-ended questions and silence Open-ended questions and silence are strategies used to encourage clients to discuss their problems. Sharing personal food preferences is not a client-centered intervention. The remaining options are not helpful to the client because they do not encourage the client to express feelings. The nurse should not offer opinions and should encourage the client to identify the reasons for the behavior.

842. A client's medication sheet contains a prescription for sertraline. To ensure safe administration of the medication, how should the nurse administer the dose? 1. On an empty stomach 2. At the same time each evening 3. Evenly spaced around the clock 4. As needed when the client complains of depression

2. At the same time each evening Sertraline is classified as an antidepressant. Sertraline is generally administered once every 24 hours. It may be administered in the morning or evening, but evening administration may be preferable because drowsiness is a side effect. The medication may adminstered without food or with food if GI distress occurs. Sertraline is not prescribed PRN.

850. The nurse is performing a followup teaching session with a client discharged 1 month ago. The client is taking fluoxetine. Which information would be important for the nurse to obtain during this client visit regarding the side and adverse effects of the medication? 1. Cardiovascular symptoms 2. Gastrointestinal dysfunctions 3. Problems with mouth dryness 4. Problems with excessive sweating

2. Gastrointestinal dysfunctions The most common side and adverse effects related to fluoxetine include CNS and GI system dysfunction. Fluoxetine affects the GI system by causing nausea and vomiting, cramping, and diarrhea. Cardiovascular symptoms, dry mouth, and excessive sweating are not side and adverse effects associated with this medication.

847. The nurse is teaching a client who is being started on imipramine about the medication. The nurse should inform the client to expect maximum desired effects at which time period following initiation of the medication? 1. In 2 months 2. In 2-3 weeks 3. During the first week 4. During the sixth week of administraiton

2. In 2-3 weeks The maximum therapeutic effects of imipramine may not occur for 2-3 weeks after the antidepressant therapy has been initiated.

845. The nurse is describing the medication side and adverse effects to a client who is taking amitriptyline. Which information should the nurse incorporate into the discussion? 1. Consume a low fiber diet 2. Increase fluids and bulk in the diet 3. Rest if the heart begins to beat rapidly 4. Walk if you have difficulty urinating because this is a normal side effect

2. Increase fluids and bulk in the diet Amitriptyline causes constipation, and the client is instructed to increase fluid intake and bulk (high fiber) in the diet. If the heart begins to beat fast, the the health provider is notified, because this could indicate an adverse effect. Difficulty urinating is an adverse effect and indicates urinary retention; this should also be reported.

851. A client who has been taking buspirone for 1 month returns to the clinic for a followup assessment. The nurse determines that the medication is effective if the absence of which manifestation has occurred? 1. Paranoid thought process 2. Rapid heartbeat or anxiety 3. Alcohol withdrawal symptoms 4. Thought broadcasting or delusions

2. Rapid heartbeat or anxiety Buspirone is not recommended for the treatment of paranoid thought disorders, drug or alcohol withdrawal, or schizophrenia. Buspirone most often is indicated for the treatment of anxiety.

854. A hospitalized client has begin taking bupropion as an antidepressant agent. The nurse determines that which is an adverse effect, indicating that the client is taking an excessive amount of medication? 1. Constipation 2. Seizure activity 3. Increased weight 4. Dizziness when getting upright

2. Seizure activity can occur in clients taking bupropion dosages greater than 450 mg daily. Weight gain is an occasional side effect, whereas constipation is a common side effect of this medication. This medication does not cause significant orthostatic blood pressure changes.

849. The nurse notes that a client with schizophrenia and receiving an antipsychotic medication is moving her mouth, protruding her tongue, and grimacing as she watches television. The nurse determines that the client is experiencing which medication complication? 1. Parkinsonism 2. Tardive dyskinesia 3. Hypertensive crisis 4. Neuroleptic malignant syndrome

2. Tardive dyskinesia TD is a reaction that can occur from antipsychotic meds. It is characterized by uncontrollable involuntary movements of the body and extremities, particularly the tongue. Parkinsonism is characterized by tremors, mask-like faces, rigidity, and a shuffling gait. Hypertensive crisis can occur from the use of MAOIs and is characterized by HTN, occipital headache radiating frontally, neck stiffness and soreness, nausea, and vomiting. Neuroleptic malignant syndrome is a potentially fatal syndrome that may occur at any time during therapy with neuroleptic (antipsychotic) meds. It is characterized by dyspnea or tachypnea, tachycardia or irregular pulse rate, fever, blood pressure changes, increased sweating, loss of bladder control, and skeletal muscle rigidity.

816. The nurse is planning activities for a client diagnosed with bipolar disorder with aggressive social behavior. Which activity would be most appropriate for this client? 1. Chess 2. Writing 3. Board games 4. Group exercise

2. Writing Solitary activities that require a short attention span with mild physical exertion are the most appropriate activities for a client who is exhibiting aggressive behavior. Writing (journaling), walks with staff,and finger painting are activities that minimize stimuli and provide a constructive release for tension. The remaining options have a competitive element to them or are group activities and should be avoided because they can stimulate aggression and increase psychomotor activity.

855. A client receiving TCAs arrives at the mental health clinic. Which observation would indicate that the client is following the medication plan correctly? 1. Client reports not going to work for the past week 2. Client complains of not being able to "do anything" anymore 3. Client arrives at the clinic neat and appropriate in appearance 4. Client reports sleeping 12 hours per night and 3-4 hours during the day

3. Client arrives at the clinic neat and appropriate in appearance Depressed individuals sleep for long periods, are unable to go to work, and feel as if they cannot "do anything." When these clients have had some therapeutic effect from their medication, they report resolution of many of these complaints and exhibit an improvement in their appearance. Options 1, 2, and 4 identify continued depression.

848. A hospitalized client is started on a monoamine oxidase inhibitor (MAOI) for the treatment of depression. The nurse should instruct the client that which foods are acceptable to consume while taking this medication? 1. Figs 2. Yogurt 3. Crackers 4. Aged cheese 5. Tossed salad 6. Oatmeal raisin cookies

3. Crackers 5. Tossed salad With MAOIs the client should avoid ingesting foods that are high in tyramine. Ingestion of these foods could trigger a potentially fatal hypertensive crisis. Foods to avoid include yogurt, aged cheeses, smoked or processed meats, red wines, and fruits such as avocados, raisins and figs.

803. A client says to the nurse, "The federal guards were sent to kill me." Which is the best response by the nurse to the client's concern? 1. I don't believe this is true 2. The guards are not out to kill you. 3. Do you feel afraid that people are trying to hurt you? 4. What makes you think the guards were sent to hurt you?

3. Do you feel afraid that people are trying to hurt you? It is most therapeutic for the nurse to empathize with the client's experience. The remaining options lack this connection with the client. Disagreeing with delusions may make the client more defensive, and the client may cling to the delusions even more. Encouraging discussion regarding the delusion is inappropriate.

810. A manic client begins to make sexual advances toward visitors in the day room. When the nurse firmly states that this is inappropriate and will not be allowed, the client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, which intervention should the nurse implement? 1. Place the client in seclusion for 30 minutes 2. Tell the client that the behavior is inappropriate 3. Escort the client to their room, with the assistance of other staff 4. Tell the client that their telephone privileges are revoked for 24 hours

3. Escort the client to their room, with the assistance of other staff The client is at risk for injury to self and others and should be escorted out of the day room. Seclusion is premature in this situation. Telling the client that the behavior is inappropriate has already been attempted by the nurse. Denying privileges may increase the agitation that already exists in this client.

813. The nurse is preparing a client with schizophrenia a history of command hallucinations for discharge by providing instructions on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggests to the nurse that the client has a need for additional information? 1. My medications will help my anxious feelings 2. I'll go to support group and talk about what I am feeling 3. When I have command hallucinations, I'll call a friend for help 4. I need to get enough sleep and eat well to help prevent feeling anxious

3. When I have command hallucinations, I'll call a friend for help The risk for impulsive and aggressive behavior may increase if a client is receiving command hallucinations to harm self or others. If the client is experiencing a hallucination, the nurse or health care counselor - not a friend - should be contacted to see whether the client has intentions to hurt herself or himself or others. Talking about auditory hallucinations can interfere with subvocal muscular activity associated with a hallucination. The client statements in the remaining options will aid in wellness but are not specific interventions for hallucinations, if they occur.

791. A client diagnosed with terminal cancer says to the nurse, "I'm going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's dying." Which response by the nurse is therapeutic? 1. Have you shared your feelings with your family? 2. I think we should talk more about your anger with your family. 3. You're feeling angry that your family continues to hope for you to be cured? 4. You are probably very depressed, which is understandable with such a diagnosis.

3. You're feeling angry that your family continues to hope for you to be cured? Restating is a therapeutic communication technique in which the nurse repeats what the client says to show understanding and to review what was said. Although it is appropriate for the nurse to attempt to assess the client's ability to discuss feelings openly with family members, it does not help the client discuss the feelings causing the anger. The nurse's direct attempt to expect the client to talk more about the anger is premature. The nurse would never make a judgment regarding the reason for the client's feeling; this is non-therapeutic in the one-to-one relationship.

788. The nurse visits a client at home. The client states, "I haven't slept at all the last couple of nights." Which response by the nurse demonstrates therapeutic communication? 1. "I see" 2. "Really?" 3. "You're having difficulty sleeping?" 4. "Sometimes I have trouble sleeping too."

3. You're having difficulty sleeping? The correct option uses the therapeutic communication technique of restatement. Although restatement is a technique that has a prompting component to it, it repeats the client's major theme, which assists the nurse to obtain a more specific perception of the problem from the client. The remaining options are not therapeutic responses because none of them encourages the client to expand on the problem. Offering personal experience moves the focus away from the client and onto the nurse

787. A client with a diagnosis of 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 by the nurse demonstrates therapeutic communication? 1. "You have everything to live for." 2. "Why do you see yourself as a failure?" 3. "Feeling like this is all part of being depressed." 4. "You've been feeling like a failure for a while?"

4. "You've been feeling like a failure for a while?" Responding to feelings expressed by a client is an effective therapeutic communication technique. The correct option is an example of the use of restating. The remaining options block communication because they minimize the client's experience and do not facilitate exploration of the client's expressed feelings. In addition, use of the word "why" is no therapeutic because clients frequently interpret why questions as accusations. Why questions can cause resentment, insecurity and mistrust.

805. A client is admitted to the mental health unit with a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention? 1. Encouraging quiet reading and writing for the first few days. 2. Identification of physical activities that will provide exercise. 3. No socializing activities until the client asks to participate in milieu. 4. A structured program of activities in which the client can participate.

4. A structured program of activities in which the client can participate A client with depression often is withdrawn while experiencing difficulty concentrating, loss of interest or pleasure, low energy, fatigue, and feelings of worthlessness and poor self-esteem. The plan of care needs to provide successful experiences in a stimulating yet structured environment. The remaining options are either too "restrictive" or offer little or no structure and stimulation.

795. When a client is admitted to an inpatient mental health unit with the diagnosis of anorexia nervosa, a cognitive behavioral approach is used as part of the treatment plan. The nurse plans care based on which purpose of this approach? 1. Providing a supportive environment 2. Examining intro psychic conflicts and past issues 3. Emphasizing social interaction with clients who withdraw 4. Helping the client to examine dysfunctional thoughts and beliefs

4. Helping the client to examine dysfunctional thoughts and beliefs CBT is used to help the client identify and examine dysfunctional thoughts and to identify and examine values and beliefs that maintain these thoughts. The remaining options, while therapeutic in certain situations, are not the focus of CBT.

802. The nurse is working with a client who, despite making a heroic effort, was unable to rescue a neighbor trapped in a house fire. Which client-focused action should the nurse engage in during the working phase of the nurse-client relationship? 1. Exploring the client's ability to function 2. Exploring the client's potential for self-harm 3. Inquiring about the client's perception or appraisal of why the rescue was unsuccessful 4. Inquiring about and examining the client's feelings for any that may block adaptive coping

4. Inquiring about and examining the client's feelings for any that may block adaptive coping The client must first deal with feelings and negative responses before the client can work through the meaning of the crisis. The correct option pertains directly to the client's feelings and is client-focused. The remaining options do not directly focus on or address the client's feelings.

800. What is the most appropriate nursing action to help manage a manic client who is monopolizing a group therapy session? 1. Ask the client to leave the group for this session only 2. Refer the client to another group that includes other manic clients 3. Tell the client to stop monopolizing in a firm but compassionate manner 4. Thank the client for the input, but inform the client that others need a chance to contribute

4. Thank the client for the input, but inform the client that others need a chance to contribute If a client is monopolizing the group, the nurse must be direct and decisive. The best action is to thank the client and suggest that the client stop talking and try listening to others. Although telling the client to stop monopolizing in a firm but compassionate manner may be a direct response, the correct option is more specific and provides more direction for the client. The remaining options are inappropriate because they are not directed toward helping the client in a therapeutic manner.