Psych Midterm
An emergency psychiatric presents with hyperthermia and unexplained loss of appetite. The nurse con concludes that these symptoms are consistent with trauma to which area of the brain?
Hypothalamus
You notice your client has a very tense body posture. What is your best response?
I notice your fists are clenched... what's happening?
Theories are...
Ideas which describe and explain phenomena
the nurse can explain the therapeutic action of MAOIs as blocking neurotransmitter reuptake, causing...
Increased concentration of neurotransmitter in the synaptic gap.
The client says, "I can't tolerate this sadness." What is the best response?
Tell me about your sadness
Linda is a patient who was admitted in an acute manic state as a result of bipolar disorder. She has been on lithium for approximately 14 days and her symptoms are now under control. The maintenance plasma lithium level desired by the treatment team is...
0.6-1.2mEq/L
16 years ago a toddler died in a tragic accident. Once a year, the parents place flowers at the accident site How would the nurse characterize the parent's behavior? a. Mourning b. Bereavement c. Complicated grief d. Disenfranchised grief
A
3 weeks after being assaulted by a patient, a nurse develops headaches, insomnia, and GI problems. The nurse has 4 absences form work over a 2 week period. Which action should the nursing supervisor employ? a. Refer the nurse for counseling and support b. Ask the nurse about current personal problems c. Direct the nurse to take paid vacation for the following week d. Schedule the nurse for administrative tasks rather than patient care
A
A college student has been experiencing significant stress associated with academic demands. Last month, the student began attending yoga sessions 3 times a week. Which outcome indicates this activity has been successful? a. The student reports improved feelings of well-being b. The student increases use of caffeine to improve concentration c. The student reports, "Now I am sleeping about 10 hours every day" d. The student says, "I withdrew from 2 courses to reduce my academic load"
A
A community mental health nurse counsels a group of patients about the upcoming flu season. What instruction does the nurse provide for patients who are prescribed lithium? a. Stop taking your medication and contact me if you have nausea, vomiting, and/or diarrhea b. Remember that lithium reduces your immunity, so you are ore vulnerable to getting the flu c. The flu is contagious. Isolate yourself if you get the flu so that you avoid exposing others to it d. Because you take lithium, you may have flu like symptoms that are not typically experienced by others
A
A day shift nurse contacts a nurse scheduled for night shift at home and says, "our unit is full and there are 8 patients in the ED waiting for a bed". The night shift nurse replies, "thanks for telling me. I am calling in sick". Which type of problem is evident by the night shift nurse's reply? a. Ethical problem of fidelity b. Legal problem of negligence c. Legal problem of intentional tort d. Violation of the patient's right to treatment
A
A distraught 8yo girl tells the nurse, "I had a horrible nightmare and was so scared. I tried to get in bed with my parents but they said no. I think I could have gone back to sleep if I had been with them." Which family dynamic is likely the basis of this child's comment? a. Boundaries in the family are rigid b. The family has poor differentiation of roles c. Girl is enmeshed in part of a family triangle d. Generational boundaries in the family are diffuse
A
A nurse plans a psychoeducational group about physical health in an outpatient program for consumers diagnosed with severe mental illness. Which topic has priority? a. Heart-healthy living b. Living with diabetes c. ABCDEs of skin cancer d. Breast and testicular self-exam
A
A nurse prepares a patient in a rural community for an initial telehealth visit with the HCP. Select the nurse's priority action. a. Ensure that the patient's rights to privacy are respected. b. Ask the patient, "how much do you know about the internet?" c. Inform the patient, "this experience will be like appearing on television." d. Advise the patient, "you will be able to hear but not see your HCP"
A
A patient diagnosed with bipolar disorder lives in the community and is showing early signs of mania. The patient says, "I need to go visit my daughter but she lives across the country. I put some requests on the internet to get a ride. I'm sure someone will take me." What is the nurse's most therapeutic response? a. I'm concerned about your safety when meeting or riding with strangers b. Have you asked friends and family to donate money for your airfare? c. You are not likely to get a ride. Let's consider some other strategies d. Have you asked your daughter if she wants you to come for a visit?
A
A patient diagnosed with schizophrenia says, "I hear the voices every day. They always say bad things about me." Which action by the nurse has the highest priority? a. Assess the patient for suicidal thinking and plan b. Review the patient's medication regime and compliance c. Educate the patient about symptoms associated with schizophrenia d. Suggest distractors for the patient to use when auditory hallucinations occur
A
A patient has been out of work 3 weeks with a major illness and anticipates another month of recovery. The patient tells the nurse, "I'm trying to keep up with my work email from home. They hired a new person in my department but the person has no experience." Select the nurse's therapeutic response. a. It sounds like you're saying you are worried about your job security. b. No one expects you to keep pace with your job while you're recovering c. Your employer is required to hold your job for you while you're on sick leave. d. Don't worry about your job right now. It's more important for you to recover.
A
A patient is diagnosed with an abscess in the cerebellum. Which nursing diagnosis has priority for the plan of care? a. Risk for falls related to loss of balance and equilibrium b. Unilateral neglect related to impairments in perception c. Impaired physical mobility related to spasticity and changes in muscle tone d. Risk for impaired cerebral tissue perfusion related to obstruction secondary to infection
A
A patient who had a stroke 3 days ago tearfully tells the nurse, "What's the use in living? I'm no good to anybody like this." Which action should the nurse employ first when caring for a patient demonstrating hopelessness? a. Implement the institutional protocol for suicide risk b. Support the patient to clarify and express feelings of grief c. Educate the patient about the success of stroke rehab d. Offer the patient to confer with the pastoral counselor
A
A physician informed an adult of the results of recent diagnostic tests that showed lung cancer. Later in the day the patient says to the nurse, "My doctors said I have breathing problems, right?" Which nursing diagnosis is acceptable? a. Denial related to acceptance of new diagnosis b. Chronic sorrow related to unresolved life conflicts c. Situational low self-esteem related to stress of new diagnosis d. Acute confusion related to metastatic changes to cerebral function
A
A veteran of the war in Afghanistan tells the nurse, "Everyday something happens that makes me feel like I'm still there. My family has grown impatient with me. They say it's time for me to move on from that time in my life but I can't." What is the nurse's first priority? a. Assess the veteran for suicide risk b. Refer the veteran for specialized mental health services c. Assess the vet for evidence of TBI d. Refer the vet's family to a PTSD group
A
On the 6th anniversary of her spouse's death, a widow says, "Sometimes life doesn't seem worth living anymore. I wish I could go to sleep and never wake up." Which response by the nurse has priority? a. Are you considering suicide? b. You still have so much to live for c. Grief can sometimes last for many years d. Why do you continue to grieve something from long ago?
A
Which newly hospitalized patient should the nurse monitor closely for development of delirium? a. 48yo who usually drinks a 6 pack of beer daily b. 68yo who takes aspirin 650mg twice daily for arthritic pain c. 72yo who says, "I have a glass of wine every evening to stimulate my appetite" d. 78yo whose blood glucose levels are consistently greater than 250
A
Which scenario best describes empathetic caring? a. Nurse provides comfort to a colleague after an error of medication administration b. Nurse works a 4th extra shift in 1 week to maintain adequate unit staffing c. Nurse identifies a violation of confidentiality and makes a report an agency's privacy officer d. Nurse conscientiously reads current literature to stay aware of new EBP
A
While entering the building, an elementary school nurse observes a person in the distance emerging from the forest and approaching the school. The person is dressed in black from head to toe, wearing a backpack, and carrying a long, narrow, dark object. What action should the nurse take first? a. Move to a secure location b. Observe the intruder's features c. Take note of the intruder's location d. Activate the school code for an intruder
A
The nurse must assess the mental health of several new clients at the mental health clinic. Conclusion about current functioning should be made on the basis of
A continuum from healthy to psychotic
The patient on neuroleptic medication who develops severe spasm of the muscles of the tongue or face, oculogyric crisis, or opisthotonos can be assessed as experiencing...
Acute dystonia
A psychotropic drug causes Michele to retain fluid and gain weight. Michele says, "When I take that medicine, I feel like a fat pig." The nurse can conclude that the side effects are disturbing because they...
Affect body image and self-concept
An appropriate nursing diagnosis for a client with a medical diagnosis of delirium caused by a systemic infection is...
Altered thought processes related to elevated temperature
An 85yo woman says to the nurse, "I raised 3 children, but now 2 of them barely speak to me. I did not do a good job of instilling a family spirit." Which response should the nurse provide? a. Do you think this situation is likely to change? b. If you could relive those earlier years, what would you do differently? c. There's no guidebook to parenting. Your children have made their own choices. d. Your children are likely to regret their behavior. I hope you can find it in your heart to forgive them.
B
A 92yo lives alone but family members assist with transportation and home maintenance. This adult tells the nurse, "They mean well but sometimes my family treats me like I'm a child." What is the nurse's best action? a. Encourage the adult to overlook these behaviors from family members b. Role play with the adult ways to share these feelings with family members c. Contact family members privately and educate them about the harmful effects of ageism d. Reinforce family member's good intentions and say, "It's fortunate your family is so helpful"
B
A female nurse is appointed to a committee with 7 men. At the beginning of the meeting, the chairman asks the nurse to be the secretary. The nurse responds, "No. You're just asking me to be secretary because I'm the only woman here." Which response would have been more effective? a. There are others more qualified than I am to be secretary b. I would be glad to perform another role for the committee c. I'm probably overreacting but I find your request offensive d. Thank you for asking but your request is sexually discriminatory
B
A mature, professional couple plans a large wedding in a city 100 miles from their home. Which response is most likely to be associated with this experience? a. Distress b. Eustress c. Acute stress d. Depersonalization
B
A neighbor telephones the nurse daily, giving lengthy details about multiple somatic complaints and relationship problems. Which limit-setting strategy should the nurse employ? a. Suggest the neighbor call other people in the community b. Say to the neighbor, "I can talk to you for 15 minutes twice a week" c. Use the telephone's caller ID to screen calls from the neighbor d. Tell the neighbor, "You should discuss these concerns with your personal physician rather than me"
B
A nurse leads a milieu meeting in an outpatient program for adults diagnosed with serious mental illness. Four consumers complain that another consumer is always begging us for money. Which comment by the nurse is most therapeutic? a. If you can afford to help eachother, it is reasonable to do so. b. Let's review what we have learned about being assertive with others c. No one needs to bring money to our program. Lunch is provided at no charge. d. Let's show understanding of each other. Money management is a problem for everyone
B
A nurse who has worked for a community hospice organization for 8 years says, "My patients and their families experience overwhelming suffering. No matter how much I do, it's never enough." Which problem should the nursing supervisor suspect? a. The nurse is experiencing spiritual distress b. The nurse is at risk for burnout and compassion fatigue c. The nurse is not receiving adequate recognition from others d. The nurse is at risk for overhelping, which creates dependency
B
A parents tells the nurse about the death of a child 2 years ago. Which comment by this parent warrants the nurse's priority attention? a. I still have some of my child's toys and clothes b. A parent should never live longer than their child c. I never returned to church again after the death of my child d. My child has been dead a long time but it seems like only yesterday
B
A patient asks the psychiatric mental health RN, "I'm having so much anxiety. I think hypnosis would help me. Will you do that for me?" When determining a response, which factor should the nurse consider? a. The patient's current medication regime b. State regulations regarding scope of practice c. Patient's level of participation within the therapeutic milieu d. Plan of the care the multidisciplinary team has developed
B
A patient diagnosed with major depressive disorder was hospitalized for 2 weeks on an acute psych unit. One day after discharge, the patient completed suicide. Recognizing likely reactions among staff, which action should the nursing supervisor implement first? a. Assess each staff member individually for suicidal intent or plans b. Provide a private setting for staff members to talk about feelings associated with the event c. Remind staff members that suicide is a risk for the patient population and that they are not at fault d. Invite a guest speaker to conduct an educational session for staff members about suicide risk factors
B
A patient has been disruptive to the therapeutic milieu for 2 days. A CNA says to the nurse, "We need to seclude this patient because this behavior is upsetting everyone on the unit." Considering patient's rights, the nurse should respond... a. Seclusion is not part of the patient's plan of care b. Let's think of some new ways to help this patient be less disruptive c. Thank you for that suggestion. I will discuss it with the HCP d. Disruptive behavior is expected with mental illness. We must respond therapeutically
B
A patient smiles broadly at the nurse and says, "Look at my clean teeth. I brushed them with scouring powder because the label said it brightens and whitens everything." Which term should the nurse include when documenting this encounter? a. Circumstantiality b. Concrete thinking c. Poverty of speech d. Associative looseness
B
A person diagnosed with severe mental illness has been homeless for 8 years and says, "I don't have any money because I've never had a job. I can't afford a place to live." Which interventions should the outpatient mental health nurse add to the plan of care? a. Requisition of the patient's legal record of arrests and convictions b. Help the patient apply for Supplemental Security Income c. Assist the patient to apply for Social Security Disability Income d. Seek to have the patient adjudicated incompetent
B
A woman experienced a double mastectomy yesterday. Now she cheerfully says to the nurse, "I didn't need those things anyway. No more wet t-shirt contests for me!" How should the nurse interpret this comment? a. The patient is realistically accepting her loss b. The comment is sarcastic, which may reflect anger c. The patient is experiencing distorted body image d. The comment suggests guilt regarding prior behavior
B
An 84yo tells the nurse, "I do 4 or 5 puzzles every day to keep my brain healthy and sharp." When considering a holistic approach to maintaining mental health, the nurse should respond... a. It is more important for you to have physical activities every day b. Let's think of some other activities we can add to your daily routine c. Repetition of the same activity is not helpful for keeping your brain healthy d. There are some herbal preparations that will also help keep your brain sharp
B
Select the completion of this sentence that demonstrates an adult is coping in a healthy way: "I am feeling so angry right now..." a. I am afraid I'm going to cry b. I would like to punch something c. I want to talk to someone about it d. I want to curl up and sleep for a long time
C
An adult experiencing a recent exacerbation of ulcerative colitis tells the nurse, "I had an accident while I was at the grocery store. It was so embarrassing." Select the nurse's therapeutic response. a. Most grocery stores have public restrooms available. b. Tell me more about how you felt when that happened. c. People usually have compassion about those types of events. d. Your disease is now in remission so that is not likely to happen again.
B
An individual lives in a community adjacent to a military base. Loud jets fly overhead multiple times a day. The person tells the nurse, "They're so loud I can't hear myself think." What is the nurse's best first action? a. Direct the individual to report the jet noise to local authorities b. Teach relaxation and stress reduction techniques to the individual c. Assess the individual for sensory impairments, particularly auditory d. Encourage the individual to form a community action group to oppose noise pollution
B
An outpatient nurse has lunch with a group of consumers diagnosed with severe mental illness. The nurse observes an obese adult ask a malnourished adult, "If you aren't going to eat your apple, will you give it to me?" What is the nurse's best action? a. Remind both adults that sharing food with each other is not permitted b. Remind the malnourished adult of treatment goals related to weight gain c. Reseat the consumers at 2 separate tables for the remainder of the meal d. Overlook the remark. Both adults are permitted to make their own decisions
B
Considering Maslow's pyramid, which comment indicates an individual is motivated by the highest level of need? a. Even though I'm 40 years old, I have returned to college so I can get a better job b. I help my community by volunteering at a thrift shop that raises money for the poor c. I recently applied for public assistance in order to feed my family but I hope it's not forever. d. My children tell my I'm a good parent. I feel happy being part of a family that appreciates me.
B
In which scenario is it most urgent for the nurse to act as a patient advocate? a. An adult cries and experiences anxiety after a near-miss auto accident on the way to work b. A homeless adult diagnosed with schizophrenia lives in a community expecting a Category 5 hurricane c. A 14-year old girl's grades decline because she consistently focuses on her appearance and social networking d. A parent allows a prescription to lapse for 1 day for their 8yo child's medication for ADHD
B
Nurse plans a group meeting for adult patients in a therapeutic milieu. Which topic should the nurse include? a. Coping with grief and loss b. Importance of hand washing c. Strategies for money management d. Staffing shortages expected over the next 3 days
B
On an inpatient unit, one patient assaults another patient resulting in a small laceration. Considering the patient's right to confidentiality, how will the nurse effectively document this event? a. Ensure unit safety by documenting the hostile and combative characteristics of the assaulting patient b. Document in each patient's medical record the events and actions taken, using initials of other patients involved c.. Document in both patients' medical records that an incident report was prepared according to agency policy d. Verbally report the events to other team members and minimize written documentation in order to reduce potential legal consequences
B
Systematic measurement of body weight, BMI, waist circumference, and glucose levels would be most important for a patient beginning a new prescription for which med? a. aripiprazole (Abilify) b. olanzapine (Zyprexa) c. ziprasidone (Geodon) d. quetiapine (Seroquel)
B
The nurse asks an 87yo how they are doing. The patient replies, "I have good days and bad days." Select the nurse's therapeutic response. a. How is your sleep? b. Tell me more about that c. Are you feeling depressed? d. We expect that from people your age.
B
The nurse in a high school meets with small groups of students the day after a school bus accident resulted in the death of 5 students. Which comment should the nurse use to begin the session? a. Sometimes life is not fair. Yesterday's tragedy is an example of just how unfair it can be b. We're grateful that you are safe. Our discussion is to talk about feelings associated with yesterday's tragedy. c. We've had a terrible loss. I also feel your pain. You need to talk about your feelings associated with yesterday's tragedy. d. Thank you for coming today. As school leaders, we know it is very important to respond to yesterday's tragedy
B
Which comment by a patient diagnosed with bipolar disorder best indicates the patient is experiencing mania? a. I have been sleeping about 6 hrs each night b. Yesterday I made 487 posts on my social media page c. I am having dreams about my father's death 8 years ago d. My appetite is so robust that I've gained 4 lbs in the past 2 weeks
B
A patient diagnosed with schizophrenia complains to the nurse about persistent feelings of restlessness and says, "I feel like I need to move all the time." What is the nurse's next action? a. Add an activity group to the patient's plan of care b. Assess the patient for EPS c. Perform a full mental status evaluation d. Educate the patient about psychomotor agitation associated with schizophrenia
B- could be akithisia developing
A patient has symptoms of acute anxiety related to the death of a parents in a car accident 2 hours earlier. The nurse should prepare to teach the patient about meds from which group?
Benzodiazepines
3 days after beginning a new regime of haloperidol (Haldol) 10 mg BID, the nurse observes that a hospitalized patient is drooling, has stiff and extended extremities and has skin that is damp and hot to touch. The patient has difficulty responding verbally to the nurse. What is the nurse's correct analysis and action in this situation? a. A seizure is occurring; place patient in lateral recumbent position and monitor b. Serotonin syndrome has developed; place an IV and rapidly infuse D5.5 NS c. Neuroleptic malignant syndrome has developed; prepare the patient for immediate transfer to a medical unit d. An acute dystonic reaction is occurring; promptly administer IM Benadryl
C
A 28yo second grade teacher is diagnosed with major depressive disorder. She grew up in Texas but moved to Alaska 10 years ago to separate from an abusive mother. Her father died by suicide when she was 12yo. Which combination of factors in this scenario best demonstrates the stress-diathesis model? a. Cold climate coupled with history of abuse b. Current age of 28 coupled with family history of depression c. Family history of mental illness coupled with history of abuse d. Female gender coupled with stressful profession of teaching
C
A family member asks the nurse, "I know my uncle's Alzheimer's disease has progressed but is there any medication that can help him now?" Which response by the nurse is correct? a. I'm sorry but there are no medications that help with severe Alzheimer's disease b. Alzheimer's disease sometimes stabilizes. Let's hope that happens in this situation c. There are a few medications that may help. Let's discuss it with the HCP d. It sounds like you're having difficulty accepting that your uncle's disease is irreversible. Would you like to talk about those feelings?
C
A group of nurse's privately discuss patients under their care. Which nurse's comment indicates the need for clinical supervision regarding countertransference? a. My patient is always asking my permission to do something just like a child. b. When our unit is understaffed, it seems like we have more incidents of disruptive behavior c. My patient tries to tell me what to do all the time. I got a divorce because my spouse used to do that. d. Our patients have had so many traumatic life experiences, I find myself feeling sympathetic sometimes
C
A nurse begins a therapeutic relationship with a patient diagnosed with schizophrenia. The patient has severe paranoia. Which comment by the nurse is most appropriate? a. Let's begin by talking about the goals you have for yourself b. I understand that you have problems with fear and suspiciousness of others c. As you get to know me better, I hope you will feel comfortable talking to me. d. I am part of your treatment team. Our goal is to help stabilize your symptoms
C
A nurse participating in a community health fair interviews an adult who has had no interaction with a HCP for more than 10 years. The adult says, "I like to keep to myself. Crowds make me nervous." What action should the nurse employ? a. Refer the adult for a full health assessment b. Explore the adult's family and social relationships c. Ask the adult, "How do you feel about the quality of your life?" d. Explain to the adult, "We can help you feel better about yourself"
C
A nurse working in a county jail assesses 4 new inmates. The nurse should direct guards to place which inmate under suicide watch? Inmate charged with... a. Breaking and entering b. Prostitution c. Lewd and lavicious act on a minor d. Assault and battery on an elderly person
C
A patient begins a new prescription for risperidone (Risperdal). Which intervention should the nurse include in the plan of care? a. Monitor I&O b. Educate patient about foods that contain tyramines c. Assess sitting, standing and lying BP daily d. Administer with food to reduce GI upset
C
A patient experiencing depression says to the nurse, "My HCP said I need talk therapy but I think I need a prescription for an antidepressant. What should I do?" Select the nurse's best response a. Which antidepressant you think would be helpful? b. There are different types of talk therapy. Most patients find it beneficial c. Let's consider ways to address your concerns with your HCP d. Are you willing to give talk therapy a try before starting an antidepressant
C
A patient has a long history of bipolar disorder with frequent episodes of mania secondary to stopping prescribed medication. The patient says, "I will use my whole check next month to buy lottery tickets. Winning will solve my money problems." Select the nurse's best action. a. Educate the patient about the low odds of winning the lottery b. Present reality by saying to the patient, "That is not good use of your money" c. Confer with the treatment team about appointing a legal guardian for the patient d. Tell the patient, "If you buy lottery tickets, your money will run out by the end of the month."
C
A patient tells the community health nurse, "I told my HCP I was having trouble sleeping and he prescribed trazadone 50 mg every night. I read on the internet that drug is an antidepressant but I am not depressed. What should I do?" Which response by the nurse is correct? a. I will help you contact your HCP for clarification regarding this new prescription b. Insomnia and depression go hand in hand. If your depression is relieved, your sleep will improve c. In low doses, trazadone helps relieve insomnia. Higher doses are needed for antidepressant effect to occur d. Information on the internet is often misleading and incorrect. It's more important to trust the judgement of your HCP
C
An 8yo tells a parent, "I like to scare kids at school by showing them pictures of clowns. Some kids are terrified". How should the nurse counsel the parents regarding this behavior? a. Recommend family therapy for the child, siblings, and parents b. Suggest the parents enroll the child in an anger management program c. Educate both parents about bullying, including possible origins and long term effects d. Teach the parents about the developmental phase and tasks for an 8yo child
C
An adult has had long-term serious medical problems resulting in decreased libido and sexual performance. The adult's spouse privately says to the nurse, "I don't feel loved anymore. I feel sexual urges but my partner isn't interested." Select the nurse's therapeutic response. a. Tell me about how your partner shows love for you b. You're describing a situation many couples face c. Let's consider some other ways you can satisfy your needs d. I'm glad you are able to talk about and accept your situation
C
An adult plans to attend an upcoming 10th high school reunion. This person says to the nurse, "I am embarrassed to go. I won't look as good as my classmates. I haven't been successful in my career." Which comment by the nurse addresses this cognitive distortion? a. You look fine to me. Do you think you will have fun at your reunion? b. Everyone ages. Other classmates have had more problems than you. c. Do you think you are the only person who has aged and faced difficulties in life? d. I think you are doing well in the face of the numerous problems you have endured.
C
In a hostile voice, a patient experiencing mania yells at the nurse, "you WILL listen to me and not interrupt. I have some really important stuff to say. I'm tired of you doctors and nurses acting like you have all the answers." To facilitate effective communication, which initial response should the nurse provide? a. You are our patient so we always listen to you b. I can talk with you better if you use a calm voice c. It's our job to help you get through this manic episode d. Patient have an important role in treatment planning
C
In which nurse-patient interaction would it be appropriate for the nurse to consider using touch? a. Comforting a tearful patient of Japanese heritage b. Counseling a child who was physically abused by a parent c. Welcoming a person of Hispanic heritage to a new group session d. Interacting with a Native American who has a hearing impairment
C
Nurse assesses a new patient whose chief concern is "daily crying spells". Which comment from the patient would prompt the nurse to suspect a medical reason is causing the problem rather than depression? a. I usually drink 2 or 3 cups of coffee in the morning. b. I often have headaches, especially when the pollen count is high c. Years ago I had thyroid problems but they cleared up and I stopped the medication d. I recently had 3 moles removed because my doctor thought they were suspicious
C
The nurse cares for a hospitalized adolescent diagnosed with major depressive disorder. The HCP prescribes a low dose antidepressant. In consideration of published warnings about use of antidepressant meds in younger patients, which action should the nurse employ? a. Notify the facility's patient advocate about the new prescription b. Teach the adolescent about Black Box warnings associated with antidepressant meds c. Monitor the adolescent closely for evidence of adverse effects, particularly suicidal thinking or behavior d. Remind the HCP about warnings associated with the use of antidepressants in children and adolescents
C
The nurse interacts with a veteran of WW2. The veteran says, "Veterans of modern wars whine and complain all the time. Back when I was in the service, you kept your feelings to yourself." Select the nurse's best response. a. American society in the 1940s expected World War 2 soldiers to be strong b. World War 2 was fought in a traditional way but the enemy is more difficult to identify in today's wars. c. We now have a better understanding of how trauma affects people and the importance of research-based compassionate care. d. Intermittent explosive devices, which were not in use during World War 2, produce traumatic brain injuries that must be treated.
C
The nurse plans care for a newly hospitalized patient experiencing panic level anxiety after a car accident. The patient has no physical injuries. When selecting goals from NOC classification, the nurse will... a. Select outcomes related to patient learning b. Focus first on long-term goals for the patient c. Individualize outcomes based on the patient's needs d. Confer with the patient about which outcomes the patient wants to achieve
C
Which patient is likely to achieve maximum benefit from CBT? a. Older adult diagnosed with Stage 3 Alzheimer's disease b. Adult diagnosed with schizophrenia and experiencing delusions c. Adult experiencing feelings of failure after losing the 4th job in 2 years d. School-age child diagnosed with ADHD
C
Which scenario presents the most risk factors for suicide? a. 64yo black female whose husband died 3 months ago b. 72yo white female scheduled for hip replacement in 2 weeks c. 82yo widowed white male recently diagnosed with pancreatic cancer d. 92yo black male who recently moved into the home of his adult children
C
While interacting with a 62yo adult diagnosed with a progressive neurocognitive disorder, the nurse observes that the adult has slow responses and difficulty finding the right words. What is the nurse's best initial action? a. Suggest words that the adult may be trying to remember b. Ask the adult, "Are you having problems saying what you mean?" c. Use silence to allow the adult an opportunity to compose responses d. Discontinue the interaction to prevent further frustration with the adult
C
A patient has dementia. The HCP wants to make a differential diagnosis between Alzheimer disease and multiple infarctions. Which diagnostic procedure should a nurse expect to prepare the patient for first?
CT or fMRI ????
Which of the following is an appropriate outcome for a client experiencing an acute episode of delirium?
Client will have decreased confusion as evidenced by orientation to person, place, and time
A nurse consistently strives to demonstrate caring behaviors during interactions with patients. Which reaction by a patient indicates this nurse is effective? A patient reports feeling...
Connected with others
A 55yo lives 100 miles from her parents and mother in law. In the past year, her father had back surgery, her mother broke her hip and her mother in law had a cardiac event. Which nursing diagnosis is most applicable? a. Risk for complicated grieving related to impending deaths of parents b. Risk for injury related to frequent long drives to care for aging parents c. Risk for chronic low self-esteem related to overwhelming responsibilities d. Risk for caregiver role strain related to responsibilities for care of aging parents
D
A colleague tells the nurse, "I have not been able to sleep for the past 3 days. I eel like a robot." What is the nurse's best action? a. Direct the colleague to leave the facility immediately b. Observe the colleague closely for evidence of impaired practice c. Offer to administer meds for patients assigned to the colleague d. Confer with the supervisor about the nurse's ability to safely deliver care
D
A nurse assesses a 78yo patient who lives alone at home and is beginning 3 new prescriptions. Which question by the nurse will provide best for the patient's safety? a. How do you store your medications at home? b. What is your usual bowel elimination pattern? c. Who usually helps you with your medication? d. How much alcohol do you drink on a normal day?
D
A nurse counsels a widow whose husband died 5 years ago. The widow says, "If I'd done more, he would still be alive." Select the nurse's therapeutic response. a. I understand how you feel after a terrible loss b. That was a long time ago. Now it's time to move on with your life. c. You did a very good job of caring for him, especially since he was sick so long d. Your husband was 82yo with severe COPD
D
A nurse leads a bereavement group. Which participant's comment best demonstrates that the work of grief has been successfully completed? a. Our time together was too short. I only wish we had done more things together b. I know our life together was a blessing that I did not deserve. I wish I had said I love you more often c. Other people knew my loved one as a good and helpful person. I hope people see me the same way. d. Our best vacations always involved water. When I see pictures of the ocean, those memories come flooding in.
D
A nurse's sibling happily says, "I want to introduce you to my fiance. We're getting married in 6 months." The nurse has encountered the fiance in a clinical setting and is aware of the fiance's diagnosis of schizophrenia. What is the nurse's best response? a. In private, tell the sibling about the fiance's diagnosis b. Encourage the sibling to postpone the wedding for at least a year c. Ask the fiance, "Have you told my sibling about your mental illness?" d. Say to the sibling and the fiance, "I hope you will be very happy together."
D
A patient has been oppositional, demanding and resistant to working on goals. A mental health nurse tells the nursing supervisor, "We finally had a serious talk. I let the patient know it's time to get right with God and stop this behavior." Recognizing the nurse's actions were not acceptable, select the supervisor's responding action. a. Review the facility policies regarding patient's rights with the nurse b. Ask the nurse about documentation related to this patient interaction c. Schedule the nurse for a staff developmental activity on cultural sensitivity d. Work with the nurse to prepare and analyze a process recording of the interaction
D
A patient on an acute psych unit removed the cap from a ceiling sprinkler, resulting in rapid flooding of the unit. After moving patients to a safe area, which action should the nurse take next? a. Conduct individual sessions with patients regarding the experience b. Increase the volume of overhead music to distract patients from the event c. Implement a psychomotor activity to reduce anxiety associated with the event d. Lead a group session with patients to discuss feelings associated with the event
D
A patient reports to a primary care provider about sleeplessness, constant fatigue and sadness. In our current health care climate, what is the most likely treatment approach that will be offered to the patient? a. Group therapy b. Individual psychotherapy c. Complementary therapy d. Psychopharmacological treatment
D
A patient tells the nurse, "No matter what I do, I feel like there's always a dark cloud following me." Select the nurse's initial action. a. Assess the patient's current sleep and eating patterns b. Explain to the patient, "Everyone feels down from time to time" c. Suggest alternative activities for times when the patient feels depressed d. Say to the patient, "Tell me more about what you mean by a dark cloud"
D
A patient was diagnosed with bipolar disorder many years ago. The patient tells the nurse, "When I have a manic episode, there's always a feeling of gloom behind it and I know I will soon be totally depressed." What is the nurse's best response? a. Most patients diagnosed with bipolar disorder report the same kinds of feelings b. Feelings of gloom associated with depression result from serotonin dysregulation c. If you take your medication as it is prescribed, you will not have hose experiences d. Your comment indicates that you have an understanding and insight about your disorder
D
A recently widowed adult says, "I've bee calling my neighbors often but they act like they don't want to talk to me. I just need to talk about it, you know?" What is the nurse's best action? a. Say to the person, "You may call me any time you need to talk" b. Ask the person, "What do you mean by I just need to talk about it"? c. Educate the person about the importance of finding alternative activities d. Tell the person the location and time of a local bereavement support group
D
A single adults says to the nurse, "Both of my parents died several years ago and my only sibling committed suicide 2 weeks ago. I feel so alone." After determining the patient has no suicidal ideation, the nurse should... a. Explore the adult's feelings of survivor's guilt b. Assess the adults cultural beliefs and spirituality c. Refer the adult for CBT d. Refer the adult to a self-help group for suicide survivors
D
An adult required a heart transplant 5 years ago. Multiple medial complications followed, resulting in persistent irritability, depression, insomnia. The adult's spouse says, "I've walked on eggshells for 5 years, never knowing when something else will go wrong." What is the nurse's priority intervention regarding the spouse? a. Explore the spouse's feelings, showing care and compassion b. Encourage the spouse to attend a community support group c. Teach stress reduction and relaxation techniques to the spouse d. Refer the spouse to the PCP for health assessment
D
In a staff meeting at an inpatient mental health facility, the administrator announces that psych technicians will now be supervised by the milieu director rather than by nurses. What is the nurse's best action? a. Confer with colleagues about their opinions regarding the proposed change b. Volunteer to participate on a committee charged with defining job responsibilities of UAP c. Ask the administrator to delay the implementation of this change until the decision can be reviewed by an interdisciplinary team d. Advise the administrator of regulations in the state nurse practice act regarding the supervision of UAP
D
Over the past 2 months a patient made 8 suicide attempts with increasing lethality. The HCP informs the patient and family that ECT is needed. The family whispers to the nurse, "Isn't this a dangerous treatment?" How should the nurse reply? a. Our facility has an excellent record of safety associated with use of ECT b. Your family member will eventually be successful with suicide if aggressive measures aren't promptly taken c. Yes, there are hazards with ECT. You should discuss these concerns with the HCP d. ECT is very effective when urgent help is needed. Your family member was carefully evaluated for possible risks
D
The nurse prepares outcomes to the plan of care for an adult diagnosed with mental illness. Which strategy recognizes the current focus of treatment services for this population? a. Patient's diagnoses are confirmed using advanced neuroimaging techniques b. Nurse confers with the treatment team to verify the patient's most significant disability c. Nurse prioritizes the patient's problems in accordance with Maslow's hierarchy of needs d. Patient and family participate actively in establishing priorities and selecting interventions
D
Which comment by the nurse would be appropriate to begin a new nurse-patient relationship? a. Which of your problems is most serious? b. I want you to tell me about your problems c. I'm an experienced nurse. You can trust me d. What would you like to tell me about yourself?
D
Which patient would the nurse expect to have the most difficulty with problem solving and decision making? a. 18yo diagnosed with bulimia nervos at age 14; has taken oral doses of Prozac daily for 3 years b. 46yo diagnosed with schizophrenia at age 24; has taken oral doses of Clozaril daily for 18 years c. 62yo diagnosed with bipolar disorder at age 28; has taken oral Depakote daily for 16 years d. 52yo diagnosed with schizophrenia at age 21; has taken monthly injections of Haldol for 12 years
D
Ad adult diagnosed with Stage 2 Alzheimer's disease begins a new prescription for rivastigmine (Exelon). Which nursing diagnosis has the highest priority to add to the plan of care? a. Risk for constipation b. Risk for altered sensory perception c. Risk for impaired oral mucous membranes d. Risk for imbalanced nutrition, less than body requirements
D- side effects are N/V, weight loss, diarrhea, loss of appetite
During long periods of sadness, what happens to neurotransmitters that can lead to depression?
Decrease
Which mental illness is most frequently diagnosed among US adults?
Depression
The nurse is the psych setting must be able to confront personal identity and separate it for the identity of the client. This is known as...
Detached concern
A client with dementia has been admitted to a nursing home. Which of the following nursing actions will help the client maintain optimal cognitive function?
Discuss pictures of children and grandchildren with the client or Provide client with list of tasks to do each day ???
During a mental status exam, which method is used to best assess a patient's judgement?
Discussing hypothetical situations
Antipsychotics are particularly used to block...
Dopamine
The nursing action most likely to be effective in improving the level of orientation of a client experiencing dementia is..
Encouraging the client to discuss memories of being an elementary teacher
Most psychiatric drugs are safe to take in pregnancy. True or False?
False
Tardive dyskinesia and NMA are conditions that only occur after prolonged use of antipsychotic medication. True or Flase
False
Which emotion causes the fastest reaction possible in the body?
Fear
The client is taking the MAOI tranycyromien (Parnate) for depression. What is the most practical intervention to prevent a hypertensive crisis?
Follow diet guidelines
When Jack's neuroleptic-induced parkinsonism is treated with benztopine (Cogentin), the nurse should understand that Jack will continue to take this antiparkinsonian drug...
For a few months and then be reassessed
Which is the most useful way to discuss aging?
Functional age
Operant conditioning will be used to encourage speech in a child who is nearly mute. Which technique would a nurse include in the treatment plan?
Give the child a small treat for speaking.
A middle aged an paid a grocery cashier with WIC vouchers. What might you reasonably conclude?
He had a teenage daughter who was pregnant or had a young child.
Which group of children is probably at most risk for poor health?
Hispanic children living in the inner city
In evaluating the effectiveness of teaching a client with depression about the action of their antidepressant medication, the client demonstrates understanding of depressive symptoms and action of the antidepressant med if the client states the symptoms are a result of...
Insufficient serotonin activity in the CNS
Within the context of the nurse-patient relationship, genuineness on the part of the nurse implies...
Interacting without pretense or assuming roles
When the nurse is analyzing data gathered during a client assessment in order to formulate a nursing diagnosis, the nurse must...
Look for patterns of experienced problems
Why are the numbers of children seen in school health nurse clinics increasing?
Many children lack any other sources of regular health care
When a new client has been admitted to the unit, the nurse takes the client on a tour, tells the client about the rules of the unit, and discusses the daily schedule. In doing this the nurse is engaged in...
Milieu management
The nurse should do which of the following as a primary nursing strategy for dealing effectively with a patient with delirium?
Monitor neurological signs on an ongoing basis
A patient hospitalized with a mood disorder has aggression, agitation, talkativeness, and irritability. A nurse begins the care plan based on the expectation that the HCP is most likely to prescribe a med classified as a...
Mood stabilizer
What is true of older adults and their living situations?
More than 90% of all the elderly live in their own home while fewer than 5% live in care facilities.
An informal group of patients discuss their perceptions of nursing care. Which comment best indicates a patient's perception that their nurse is caring?
My nurse spends time listening to me talk about my problems. That helps me feel like I'm not alone.
How does the US compare with other countries on infant mortality rate?
Near the bottom of the industrialized nations, at a rank of 29th
A client tells the nurse, "I'm a real freak. I'm a psych patient, in and out of hospitals all the time. None of my friends or relatives are crazy like this." The reply that would help the client understand the prevalence of mental illness is...
Nearly 50% of all people aged 15 to 55 years have had a psychiatric disorder at some time in their lives
A nurse uses Maslow's hierarchy of needs to plan care for a psychotic patient. Which problem receives priority?
Patient refuses to eat or bathe
The nurse is particularly concerned about the client's self-care needs. Therefore, careful assessment of which of the following is done?
Physiologic and psychosocial needs
A patient who scores 11 out of 30 on the Mini Mental Status Exam has a high likelihood of
Poor education
A patient has disorganized thinking associated with schizophrenia. Neuroimaging would most likely show dysfunction in which part of the brain?
Prefrontal cortex
A patient underwent psychotherapy for 3 years. The therapist used free association, dream analysis, and facilitated transference to help the patient understand unconscious processes and foster personality changes. Which type of therapy was used?
Psychoanalysis
The following strategy could help the nurse reduce the occurrence of burnout..
Recognizing personal needs as an integral part of professional practice
The primary nursing intervention in working with a client who has a diagnosis of dementia is ensuring that the client...
Remains in a safe and secure environment to prevent injury
An intervention appropriate to use for both clients with delirium and with dementia is...
Reorienting the client to the health care worker with each contact
The teaching plan for a client taking clozapine should include the following instructions...
Report sore throat and fever immediately.
The nursing diagnosis established for a client with fluctuating LOC, disturbed orientation, and visual and tactile hallucinations that should be given priority is...
Risk for injury related to altered cerebral function, as evidenced by sensory, perceptual alterations and unstable gait
You are working with an 82 year old woman who is experiencing dementia. She is oriented to self only. She wanders the halls and is often found in other patients' rooms both lying in their beds and going through their belongings. Many patient have become angry with her and have threatened to hurt her. Based on this data, what is the priority diagnosis?
Risk of injury related to confusional state and disorientation
The nurse supports parental praise of a child who is behaving in a helpful way. When the individual behaves with politeness and helpfulness in adulthood, which feeling will most likely result?
Self-esteem
When some antidepressants are combined with other drugs or supplements that increase serotonin such as St John's Wort or OTC cold meds, the patient can develop a syndrome that can cause restlessness, muscle rigidity and possible seizures. This syndrome is called
Serotonin syndrome
A client explains to a home health nurse that he has not been sleeping, eating or interacting well in usual activities he loved. What should you suggest?
Share that he seem s depressed and they should see his doctor immediately.
A woman roller her wheelchair into the clinic where the nurse greeted her. What should be the nurse's first response?
Sit so the nurse is eye level
A client with marked cognitive impairment is combative and difficult to manage. He has pulled out his NG tube, his IV, and his Foley catheter. He had climbed out of bed over the side rails while the nurse tried to calm and restrain him. The nurse notifies the doctor on call and can anticipate that the physician will order a
Small dose of a high-potency antipsychotic
Cognitive therapy was provided for a patient who frequently said, "I'm stupid." Which statement by the patient indicates the therapy was efective?
Sometimes I do stupid things
If most American students do not plan to leave their local community, which language should be the required foreign language in high school?
Spanish, to improve employment opportunities
A woman confides in you that she and her husband want to become parents as soon as possible. What would be your best response?
Start living as healthy a lifestyle as possible right now
A client lists the following problems: "I have no sense of self-worth. I constantly think negative thoughts about myself, I feel shaky and anxious all the time. Sometimes my mood is so low that I think I want to go to sleep and never wake up." The nursing interventions that should be given highest priority relate to outcomes associated with...
Suicide self-restraint
An older client will most likely do which of the following in conversation?
Take longer to react
Which outcome, focused on recovery, would be expected in the plan of care for a patient living in the community with serious and persistent mental illness. Within 3 months, the patient will...
Take medication as prescribed.
A nurse overheard an adult woman telling her dad that he was being unreasonable and a danger. What is the argument probably about?
The dad wants to keep driving
Planned assessments of critical importance for a client with delirium include...
The emotional state
A nurse says, "When I was in school, I learned to call upset patients by name to get their attention but I read a research study that says this approach doesn't work. I'm going to stop calling patients by name." Which statement is the best appraisal of this nurse's comment?
The nurse misinterpreted the results of the study. Classic tenets of practice do not change.
Why might all family members want their aged relatives to have a living will or advance directive?
To help family members know what their loved one does or does not want if they become incapacitated
What is the single leading cause of death in the US?
Tobacco use
All of the SSRIs inhibit the reuptake of serotonin. True or False?
True
Early signs of lithium toxicity include severe diarrhea, vomiting, blurred vision, ataxia, and tinnitus. True or False?
True
Even though only 40% of patients respond to its use, lithium remains the gold standard treatment for acute mania and maintenance of bipolar disorder. True or false
True
The nurse wants to assess for disturbances in circadian rhythms in a patient admitted for depression. Which question best implements this assessment?
What are your worse and best times of day?
A patient is hospitalized for major depression. Of the medications listed, a nurse can expect to provide the patient with teaching about...
clozapine (Clozaril)
Mr. Vale's wife has bipolar disorder and was treated with lithium, to which she failed to respond. MR. Vale is concerned that his wife will never recover. The nurse should frame her reply to him with the knowledge that patients who fail to respond to lithium or who are no longer able to tolerate the side effects have been treated effectively with...
carbamazepine (Tegetrol) and valproic acid (Depakote)
If the limbic system is disrupted, you expect the client to have difficulty with...
emotional responses
The outcome that should be established for an elderly client with delirium caused by fever and dehydration is that the client will...
return to a premorbid level of functioning.
