psych Foundations
A nurse is teaching a client about side effects of medications. Which drug will cause a heightened skin reaction to sunlight?
Chlorpromazine Clients taking chlorpromazine should be instructed to stay out of the sun. Photosensitivity makes the skin more susceptible to burning.
Thirty minutes after administering fluphenazine (Prolixin) to a client, the nurse notes that the client's jaw is rigid, the client is drooling, and her speech is slurred. There are a number of as-needed prescriptions in the client's chart. What should the nurse administer?
Benztropine (Cogentin), 2 mg intramuscularly7
The nurse should first discuss terminating the nurse-client relationship with a client during the:
Orientation phase, when a contract is established
Methylphenidate (Ritalin) is prescribed to treat a 7-year-old child's attention deficit-hyperactivity disorder (ADHD). The nurse understands that methylphenidate is used in the treatment of this disorder in children for its:
Paradoxical effect
A client's hands are raw and bloody from a ritual involving frequent handwashing. Which defense mechanism does the nurse identify?
Undoing
Imipramine (Tofranil), 75 mg three times per day, is prescribed for a client. What nursing action is appropriate when this medication is being administered?
Having the client checked for increased intraocular pressure and teaching about symptoms of glaucoma
A client on the psychiatric unit is undergoing a pretreatment evaluation for electroconvulsive therapy (ECT). Because of the client's profoundly depressed behavior, the nurse doubts that the client can provide informed consent. What should the nurse's initial intervention be?
Having the client verbalize her understanding and the outcomes of the procedure
A nurse understands that when a client is a member of a different ethnic community it is important to:
Offer a therapeutic regimen compatible with the lifestyle of the family
A client is to begin lithium carbonate therapy. The nurse should ensure that before the drug's administration the client has baseline:
Renal studies
A client who is dying jokes about the situation even though the client is becoming sicker and weaker. Which is the most therapeutic response by the nurse?
"Does it help to joke about your illness?"
A practitioner prescribes Alprazolam (Xanax) 0.25 mg by mouth three times a day for a client with anxiety and physical symptoms related to work pressures. For what most common side effect of this drug should the nurse monitor the client?
Drowsiness
An injured child is brought to the emergency department by the parents. While interviewing the parents, the nurse begins to suspect child abuse. Which parental behaviors might support this conclusion? (Select all that apply.)
Focusing on the child's role in sustaining the injury Changing the story of how the child sustained the injury Giving an explanation of how the injury occurred that is not consistent with the injury
A nurse encourages a client to attend Alcoholics Anonymous (AA) meetings after discharge. What do self-help groups such as AA help their members do?
Foster changes in behavior
According to Erikson, a person's adjustment to the period of senescence 노쇠 will depend largely on the adjustment the individual made to the earlier developmental stage of:
Generativity versus stagnation
The mother of an 18-year-old man comes to the local mental health center. She is extremely upset because of her son's behavior since the young man returned from his freshman year at college. He takes his brother's clothing, comes in at all hours, and refuses to get a job. Sometimes he is happy and outgoing, but at other times he is withdrawn. The mother asks why her son is like this. While contemplating this situation, the nurse considers that adolescents are usually:
Impulsive and self-centered
A client with schizophrenia who has type II (negative) symptoms is prescribed risperidone (Risperdal). Which outcomes indicate that the medication has minimized these symptoms? (Select all that apply.)
More interest is shown in unit activities. The client performs activities of daily living independently.
A nurse is teaching clients about dietary restrictions during monoamine oxidase inhibitor (MAOI) therapy. What response does the nurse tell them to anticipate if they do not follow these restrictions?
Occipital headaches
What should a nurse ensure when creating an environment that is conducive to psychological safety?
Realistic limits are set.
A client who is being treated in a mental health clinic is to be discharged after several months of therapy. The client anxiously tells the nurse, "I don't know what I'll do when I can't see you anymore." The nurse determines that the client is:
Reacting to the planned discharge
An older female client is concerned about maintaining her independent living status. What initial intervention strategy is of primary importance?
Reinforcing routines and supporting her usual habits
A client with schizophrenia is taking benztropine (Cogentin) in conjunction with an antipsychotic. The client tells a nurse, "Sometimes I forget to take the Cogentin." What should the nurse teach the client to do if this happens again?
Take a dose as soon as possible, up to 2 hours before the next dose.
A client has been taking prescribed risperidone (Risperdal) 3 mg twice a day for the past 8 days. A friend brings the client to the outpatient clinic. The client reports tremors, shortness of breath, a fever, and sweating. What should the nurse do?
Take the client's vital signs and arrange for immediate transfer to a hospital
What is an initial client objective in relation to anger management?
Taking responsibility for the hostile 적대적인 behavior
An adolescent on the psychiatric unit has an angry outburst toward another client who cut in front of people standing in line to get their mail. Later the nurse conducts a one-on-one therapeutic session with the angry client. What is an appropriate short-term goal for the client to strive for?
Talking about the situation that precipitated the anger
A recently hired nurse is caring for several clients on a mental health unit at a local community hospital. The nurse manager is evaluating the nurse's performance. What situation indicates that the nurse-client boundaries of the recently hired nurse are appropriate?
The nurse shares with the entire treatment team vital information the client disclosed in a private session.
A 2½-year-old child is admitted for treatment of injuries supposedly sustained in a fall down a flight of stairs. Child abuse is suspected. What statements might the nurse expect from a parent who engages in child abuse? (Select all that apply.)
"Every time I turn around the kid is falling over something." "I can't understand it. He didn't have a problem using the stairs without my help before this."
A 17-year-old teenager is found to have leukemia. Which statements by the teenager reflect Piaget's cognitive processes associated with adolescence? (Select all that apply.)
"I'm going to do my best to fight this awful disease." "Now I can't go to the prom because I have this stupid disease." "This illness is serious, but with treatment I think I have a chance to get better."
When talking with a client who has been receiving Paroxetine (Paxil), the nurse determines that more clarification is needed when the client says:
"I've been on the medication for 8 days now, and I don't feel any better."
A client is extremely depressed, and the practitioner prescribes a tricyclic antidepressant, imipramine (Tofranil). The client asks the nurse what the medication will do. The nurse responds:
"It will help increase your appetite and make you feel better."
Certain questions are applicable in determining nursing negligence. (Select all that apply.)
"Was reasonable care provided?" "Was there a breach of nursing duty?" "Was there an act of omission that resulted in harm? "Except for the nurse's action, would the injury have occurred?"
A person mowing a lawn is badly disfigured by the lawnmower blade. According to Erikson's theory, which age at the time of injury will be associated with the greatest risk of long-term psychological effects?
11 years An 11-year-old child is generally in Erikson's stage of industry versus inferiority, which involves the mastery of skills; unfortunately, the child did not master the skill of lawnmowing.
A client on the psychiatric unit asks a nurse about psychiatric advance directives (PADs). What information should form the basis of the nurse's response?
A client is allowed to consent to or refuse potential psychiatric treatments if a future incapacitating mental health crisis occurs.
Oral chlordiazepoxide (Librium) 100 mg/ hr is prescribed for a client with a Clinical Institute Withdrawal Assessment (CIWA) score of 25. The client has had 300 mg in 3 hours but is still displaying acute alcohol withdrawal symptoms. What is the next nursing action?
Administering chlordiazepoxide as indicated by the client's CIWA score
How should a nurse characterize a sudden terrorist act that causes the deaths of thousands of adults and children and negatively affects their families, friends, communities, and the nation?
Adventitious An adventitious crisis is a crisis or disaster that is unplanned and accidental; its subcategories include national disasters and crimes of violence.
In conjunction with which classification of medication are trihexyphenidyl, biperiden (Akineton), and benztropine (Cogentin) often prescribed?
Antipsychotics Antipsychotics are used to control the extrapyramidal (parkinsonian) symptoms that often develop as a side effect of antipsychotic therapy.
The way individuals cope with an unexpected hospitalization depends on many factors. However, the one that is most significant is:
Basic personality
A nurse on the psychiatric unit is assigned to work with a male client who appears reclusive and distrustful of everyone. The nurse can help the client develop trust by:
Being prompt(신속한) for their scheduled meetings
A parent whose daughter is killed in a school bus accident tearfully tells the nurse, "My daughter was just getting over the chickenpox and didn't want to go to school, but I insisted that she go. It's my fault that she's dead." How should the nurse anticipate that perceiving a death as preventable will likely influence the grieving process?
Bereavement may be of greater intensity and duration.
A nurse is speaking with a client who was sexually abused as a child. The client does not know what constitutes inappropriate touch by another person. What issue will have to be addressed with this client?
Boundary violations
How should a nurse at an assisted living facility encourage a client to effectively complete the tasks of older adulthood?
By fostering a sense of contentment when the client looks back on her achievements
What should a nurse recognize that a client who uses the defense mechanism of sublimation is doing?
Channeling unacceptable impulses into socially approved behavior
A nurse suggests a crisis intervention group to a client experiencing a developmental crisis. The nurse knows that these groups are successful because the:
Client is assisted in investigating alternative approaches to solving the identified problem
A recently married 22-year-old woman is brought to the trauma center by the police. She has been robbed, beaten, and sexually assaulted. The client, although anxious and tearful, appears to be in control. The health care provider prescribes alprazolam (Xanax) 0.25 mg for agitation. The nurse should administer this medication when the:
Client requests something to calm her
A client has been prescribed chlorpromazine (Thorazine) for the management of positive symptoms of schizophrenia. When the client reports difficulty sustaining an erection, the nurse:
Consults with his provider regarding alternative medication therapies
A female nurse has been caring for a depressed 75-year-old woman who reminds her of her grandmother. The nurse spends extra time with her every day and brings her home-baked cookies. The nurse's behavior reflects:
Countertransference
In the process of development the individual strives to maintain, protect, and enhance the integrity of the self. The nurse determines that this is usually accomplished through the use of:
Defense mechanisms
The parents of a toddler with recently diagnosed moderate cognitive impairment discuss their child's possibility of future independent function. What should the nurse conclude?
Denial is being used as a defense.
What is the most difficult initial task in the development of a nurse-client relationship?
Developing an awareness of self and the professional role in the relationship
A client who is taking clozapine (Clozaril) calls the nurse in the psychiatric clinic to report the sudden development of a sore throat and a high fever. What should the nurse instruct the client to do?
Discontinue the medication and, if the health care provider is unavailable today, go to the emergency department for evaluation Symptoms of infection are suggestive of agranulocytosis, an adverse effect that can occur with clozapine therapy and can cause death.
A male long-distance jumper improves his distance by 3½ inches (7 cm) and earns the praise of his coach, but on another day, when he does not reach his mark, he forcefully kicks the door of his locker. What defense mechanism does his outburst demonstrate?
Displacement
A psychiatric nurse is hired to work in the psychiatric emergency department of a large teaching hospital. While reviewing the manuals, the nurse reads, "People with mental health emergencies shall be triaged within 5 minutes of entering the emergency department." What does the nurse consider this statement to represent?
Hospital policy
A health care provider refers a 52-year-old man to the mental health clinic. The history reveals that the man lost his wife to colon cancer 6 months ago and that since that time he has seen his health care provider seven times with the concern that he has colon cancer. All tests have had negative results. Recently the client stopped seeing friends, dropped his hobbies, and stayed home to rest. Which disorder should the nurse identify as consistent with the client's preoccupation with the fear of having a serious disease?
Hypochondriac disorder
A nurse in the mental health clinic concludes that a client is using confabulation when:
Imagination is used to fill in memory gaps
When having a conversation with a nurse, an older client states, "I've lived a good life. I don't want to die, but I accept it as a part of life." What developmental stage, according to Erikson, has the client completed?
Integrity
A client with diabetes mellitus is able to discuss in detail the diabetic metabolic process while eating a piece of chocolate cake. What defense mechanism does the nurse identify when evaluating this behavior?
Intellectualization
To provide appropriate psychosocial support to clients, a nurse must understand development across the life span. What theory is the nurse using in considering relationships and resulting behaviors the central factors that influence development?
Interpersonal theory
A client who had to be cut out of a car after a motor vehicle collision has no visible physical effects from the ordeal. The client responds to the emergency department nurse's questions factually in a soft voice with a composed manner. This behavior may indicate that the client:
Is controlling the expression of feelings
A client has become increasingly depressed, and the practitioner prescribes an antidepressant. After 20 days of therapy, the client returns to the clinic. The client appears relaxed and smiles at the nurse. The most significant conclusion that the nurse can draw from this behavior is that the client:
Is responding to the antidepressant therapy
The nurse anticipates that the medication that will be used to prevent symptoms of withdrawal in clients with a long history of alcohol abuse is:
Lorazepam (Ativan)
A client with schizophrenia is started on an antipsychotic/neuroleptic medication. The nurse explains to a family member that this drug primarily is used to:
Make the client more receptive to psychotherapy
A client is receiving doxepin (Sinequan). For which most dangerous side effect of tricyclic antidepressants should a nurse monitor the client?
Mydriasis Mydriatic action causes dilated pupils, which can precipitate an acute attack of glaucoma, resulting in blindness.
A woman who was sexually assaulted by a stranger in the elevator of her apartment building is brought by her husband to the emergency department. What is the priority nursing intervention?
Obtaining information about her perception of the incident
A young client who has become a mother for the first time is anxious about her new parenting role. With the nurse's encouragement, she joins the new mothers' support group at the local YMCA. What kind of prevention does this activity reflect?
Primary prevention Primary prevention is directed toward health promotion and prevention of problems. Tertiary prevention is focused on rehabilitation and the reduction of residual effects of illness. Secondary prevention is related to early detection and treatment of problems.
A 23-year-old woman is admitted to a psychiatric unit after several episodes of uncontrolled rage at her parents' home, and borderline personality disorder is diagnosed. While watching a television newscast describing an incident of violence in the home, the client says, "People like that need to be put away before they kill someone." The nurse concludes that the client is using:
Projection
A neuromuscular blocking agent is administered to a client before electroconvulsive therapy. At this time, the nurse should monitor the client for:
Respiratory difficulties
Doxepin (Sinequan) is prescribed for a 74-year-old man for treatment of a depressive episode that has not responded to several other medications. The nurse in the outpatient clinic reviews with the client the side effects of doxepin. The identification of which side effects by the client as needing to be reported to the health care provider allows the nurse to conclude that the teaching has been effective? (Select all that apply.)
Retention of urine Thoughts of suicide
What is the most appropriate intervention for the nurse to implement after finding a disturbed client in bed in the fetal position?
Sitting down in a chair by the client and saying, "I'm here to spend time with you."
A client with a diagnosis of borderline personality disorder (BPD) has negative feelings toward the other clients on the unit and considers them all "bad." Which defense is the client using when identifying the other clients thusly?
Splitting
A 19 year-old, arrested for assault and robbery, has a history of truancy and prostitution but is unconcerned that her behavior has caused emotional distress to others. The diagnosis of antisocial personality disorder is made. According to psychoanalytical theory, the client's lack of remorse and repetitive behavior probably are related to an underdeveloped:
Superego Lack of remorse 후회 indicates a weak superego, the aspect of personality concerned with prohibitions.
A client with chronic undifferentiated schizophrenia is receiving an antipsychotic medication. For which potentially irreversible extrapyramidal side effect should a nurse monitor the client?
Tardive dyskinesia Tardive dyskinesia occurs as a late and persistent extrapyramidal complication of long-term antipsychotic therapy. It is most often manifested by abnormal movements of the lips, tongue, and mouth.
During a well-baby visit, the parents complain that their 2-year-old daughter soils herself because she is lazy. The parents plan to make her wear her soiled clothing to teach her a lesson. The nurse is concerned about the potential for child neglect and abuse. Which nursing intervention will be most therapeutic at this time?
Teaching the parents developmental milestones in relation to acceptable discipline methods
A nurse on the psychiatric unit of the hospital has been assigned four clients for the shift. The assignment includes an 84-year-old client who is severely depressed, a 73-year-old client who is being discharged, a 53-year-old client who was admitted for lithium toxicity, and a 48-year-old client who has panic attacks. Which client should the nurse evaluate first after receiving report?
The 53-year-old client should be evaluated first because of the severity of adaptations associated with lithium toxicity.
What is the most important information for a nurse to teach to prevent relapse in a client with a psychiatric illness?
The need to follow the prescribed medication regimen
A secretary in a home health agency gossips about coworkers and then writes them notes to tell them how valuable they are to the organization and how much she likes working with them. What defense mechanism is being used by the secretary?
Undoing Undoing is atonement for or an attempt to dissipate unacceptable acts or wishes.
For which adverse effect should the nurse continually observe a client who is receiving valproic acid (Depakene)?
Yellow sclerae
A client with schizophrenia is actively psychotic, and a new medication regimen is prescribed. A student nurse asks the nurse, "Which of the medications will be the most helpful against the psychotic signs and symptoms?" What response should the nurse give?
Ziprasidone (Geodon) Ziprasidone (Geodon) is a neuroleptic, which will reduce psychosis by affecting the action of both dopamine and serotonin. Citalopram (Celexa) is a selective serotonin reuptake inhibitor antidepressant. Benztropine (Cogentin) is an anticholinergic. Acetaminophen with hydrocodone (Lortab) is an analgesic/opioid.
A client with type 1 diabetes is found to have a psychosis and is to receive haloperidol (Haldol). Which response should a nurse anticipate with this drug combination?
Decreased control of the diabetes
A client is admitted for treatment of obsessive-compulsive disorder that is interfering with activities of daily living. Which medication should the nurse anticipate the health care provider will prescribe?
Clomipramine (Anafranil) Clomipramine (Anafranil) potentiates the effects of serotonin (antiobsessional effect) and norepinephrine in the central nervous system; it diminishes obsessive-compulsive behaviors. Benztropine (Cogentin) is an antiparkinsonian agent, not an antianxiety agent. Amantadine (Symmetrel) is an antiparkinsonian agent, not an antianxiety agent. Diphenhydramine (Benadryl) is an antihistamine, not an antianxiety agent.
A nurse is evaluating a young adult for evidence of achievement of the age-related developmental stage set forth in Erikson's developmental theory. What developmental crisis is associated with this age group?
Intimacy versus isolation
Which tool is used to standardize and measure nursing treatments?
Nursing Interventions Classification (NIC)
The nurse is caring for a client experiencing a crisis. What role is most important for the nurse to assume when providing therapeutic crisis intervention?
Active participant
A client is scheduled for a 6-week electroconvulsive therapy (ECT) treatment program. What intervention is important during the course of treatment?
Elimination of benzodiazepines for nighttime sedation
A client with a diagnosis of schizophrenia is discharged from the hospital. At home the client forgets to take the medication, is unable to function, and must be rehospitalized. What medication may be prescribed that can be administered on an outpatient basis every 2 to 3 weeks?
Fluphenazine
Relatives of the victims of a home invasion in which several family members were killed receive crisis intervention services. Which therapy is most beneficial after the immediate event has passed?
Grief
Survivors of a major earthquake are being interviewed on admission to the hospital. The nurse notes that they exhibit a flattened affect, make minimal eye contact, and speak in a monotone. These behaviors are indicative of the defense mechanism known as:
Isolation Isolation is the separation of thought or memory from feeling.
A health care provider prescribes divalproex (Depakote). What does the nurse consider an appropriate indication for the use of this drug?
Management of manic episodes of bipolar disorder
A nurse is caring for clients with a variety of psychiatric illnesses. For which diagnoses is the establishment of a psychiatric advance directive (PAD) most beneficial? (Select all that apply.)
Bipolar disease Paranoid schizophrenia
The nurse explains to a nursing assistant that behavior usually is viewed and accepted as normal if it:
Fits within standards accepted by one's society
A person mowing a lawn is badly disfigured by the lawnmower blade. According to Erikson's theory, which age at the time of injury will be associated with the greatest risk of long-term psychological effects?
11 years An 11-year-old child is generally in Erikson's stage of industry versus inferiority, which involves the mastery of skills; unfortunately, the child did not master the skill of lawnmowing.
An 18 year-old woman is brought to the emergency department by her two roommates after being found unconscious in the bathroom. Laboratory tests are ordered. The nurse reviewing the findings notes that the urinalysis is positive for flunitrazepam (Rohypnol). The nurse knows that flunitrazepam is often used:
As a date rape drug
On the first day of the month a practitioner prescribes an antipsychotic medication for a client with schizophrenia. The initial dosage is 25 mg once a day, to be titrated in increments of 25 mg every other day to a desired dosage of 175 mg daily. On what day of the month will the client reach the desired daily dose of 175 mg?
Day 13 The client will reach the desired dosage of 175 mg on the 13th day of the month; on the first day it is 25 mg, on the third day it is 50 mg, on the fifth day it is 75 mg, on the seventh day it is 100 mg, on the ninth day it is 125 mg, on the 11th day it is 150 mg, and on the 13th day it is 175 mg.
Antipsychotic drugs can cause extrapyramidal side effects. Which responses should the nurse document as indicating pseudoparkinsonism? (Select all that apply.)
Rigidity Tremors Bradykinesia
