Psych Test Questions 1

On the sixth anniversary of her spouse's death a widow says, "sometimes life does not 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 someone from long ago?"

A. "Are you considering suicide?" The nurse should always take an individual very seriously if he or she mentions some form of suicidal ideation and ask directly about suicide

As election day nears, a mental health nurse studies the position statements of various candidates for federal offices. Which candidate's commentary would the nurse interpret as supportive of services for persons diagnosed with mental illness? A. "Full parity insurance coverage for mental illness" B. "Coverage for biologically based mental illnesses" C. "Reimbursement for initial treatment of addictions" D. "Managed care oversight for mental illness services"

A. "Full parity insurance coverage for mental illness" Mental health parity refers to third=party (insurance) coverage of care for mental illness and addictions similarly to care of physical illness. Federal and state legislation apply, but coverage varies by state. Some states offer full parity for mental illness insurance coverage

A nursing assistant says to the nurse, "The schizophrenic in room 226 has been rambling all day." When considering the nurses responsibility to manage the ancillary staff, which response should the nurse provide? A. "It is more respectful to refer to the pt by name than by diagnosis" B. "Thank you for informing me about that. I will document the behavior" C. "It is not unusual for schizophrenics to do that. It's just part of their illness" D. "You have a difficult job. I'm glad you are so accepting of our pt's behavior"

A. "It is more respectful to refer to the pt by name than by diagnosis" Diagnoses classify disorders that people have, not the person. For this reason, it is important to avoid use of expressions such as "a schizophrenic" or "an alcoholic." The nurse has a responsibility to educate the coworker

Which client statement reflects resiliency associated with a situational crisis he or she is experiencing? A. "Losing my son is so hard but when my father died, grief counseling really helped." B. "Retirement is something I had always dreaded but so far it's been pretty enjoyable." C. "I wasn't planning on another pregnancy but I would never consider an abortion." D. "When my son died in the flood, I depended on my family and friends for support."

A. "Losing my son is so hard but when my father died, grief counseling really helped." Situational crises are somewhat common, and at least some of them, like experiencing a loss through death, will be experienced by all individuals during their lifetime. Response to the situation depends in part upon the degree of support available. The existence of caring friends, family members, and groups as well as previous success in navigating life events (resiliency), and the overall physical and emotional health of the individual all contribute to an individual's resiliency. The correct option represents both a situational crisis and resiliency based in a past experience. Retirement is a maturational crisis, and the option demonstrates acceptance but not resiliency. While the pregnancy is a situational crisis the option demonstrates a value but not resilience. The death of a loved one in a flood is an example of an adventitious crisis and the option doesn't demonstrate a past experience upon which to rely.DIF: Cognitive Level: Analysis (Analyzing)REF: Page 20-7, 20-8TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity THE CAPACITY TO BOUCNE BACK QUICKLY FROM A SITUATION

Which scenario best demonstrates empathetic caring? A. A nurse provides comfort to a colleague after an error of medication administration B. A nurse works a fourth extra shift in one week to maintain adequate unit staffing C. A nurse identifies a violation of confidentiality and makes a report to an agency's privacy officer D. A nurse conscientiously reads current literature to stay aware of new evidence - based practices

A. A nurse provides comfort to a colleague after an error of medication administration Caring is evidenced by empathic understanding ,actions, and patience on another's behalf; actions, words, and presence that lead to happiness and touch the heart; and giving of self while preserving the importance of self. Comforting is a part of caring, which includes social, emotional, physical, and spiritual support.

When considering prevalence, the nurse will focus on which disorder(s) when identifying the focus of a community mental health screening? A. Anxiety disorders B. Affective disorders C. Alcohol dependence D. Any substance abuse

A. Anxiety disorders Over a 12-month period, anxiety disorders have an 18.1% prevalence affecting an estimated 57 million people. Affective disorders 9.5% (30 million); alcohol dependence 6.3% (16.5 million); any substance abuse 9.4% (24.6 million).DIF: Cognitive Level: Application (Applying)REF: Page 13 (Table 2-2)TOP: Nursing Process: PlanningMSC: NCLEX: Health Promotion and Maintenance

In order to demonstrate the integration of evidence-based practice (EBP) into the care of a client who has been hospitalized for severe depression and prescribed a selective serotonin reuptake inhibitor (SSRI), the novice nurse will include which action into the plan of care? A. Assess the client for the presence of suicidal ideations with a plausible plan B. Ask the health provider to prescribe the medication to be administered orally C. Acquire the advice of a proficient nurse about implementing suicide precautions D. Apply restraints when the client repeatedly attempts to cut his or her wrists with a plastic knife

A. Assess the client for the presence of suicidal ideations with a plausible plan A simple method to state the process of integrating EBP into clinical practice is referred to as the 5 A's: Ask the question; Acquire the literature; Appraise the literature; Apply the evidence; Assess the performance. By assessing the client for suicidal ideations and a plausible plan the nurse is assessing the performance of the SSRI.DIF: Cognitive Level: Application (Applying)REF: Page 3TOP: Nursing Process: PlanningMSC: NCLEX: Safe, Effective Care Environment

The nurse, striving to minimize the bias of a Western view on what is considered acceptable behavior, will consult which mental health associated resource? A. Cultural Formulation Interview (CFI) B. Glossary of Cultural Concepts of Distress C. The client's past and present mental health assessment D. The Diagnostic and Statistical Manual of Mental Disorders

A. Cultural Formulation Interview (CFI)

A day shift nurse contacts a nurse scheduled for night shift at home and says, "Our unit is full and there are eight pts in the emergency department 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 an intentional tort D. Violation of the pt's right to treatment

A. Ethical problem of fidelity Fidelity is an ethical principle that involves maintaining loyalty and commitment to pts

A pt 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 pt demonstrating hopelessness? A. Implement the institutional protocol for suicide risk B. Support the pt to clarify and express feelings of grief C. Educate the pt about the success of stroke rehabilitation D. Offer the pt an opportunity to confer with the pastoral counselor

A. Implement the institutional protocol for suicide risk The pt's comment suggests hopelessness, helplessness, and worthlessness. Physical illnesses play a role in increasing suicide risk Suicide precautions should be initiated

When discussing the current trend to treat mental health clients in community care environments, the nurse identifies which treatment-related event as the trigger for the shift away from traditional hospitalization? A. Increase in availability of psychopharmacological agents B. Increased availability of community resources for treating the mentally ill C. Decreased voluntary commitments being made to traditional hospital settings D. Decrease in the number of clients being diagnosed as being chronically mentally ill

A. Increase in availability of psychopharmacological agents Related to the shift from hospital to community care were the pharmacological breakthroughs in the latter half of the twentieth century that led to dramatic changes in the provision of psychiatric care. Gradually, more psychopharmacological agents were added to treat psychosis, depression, anxiety, and other disorders, and treatment could be provided not only from specialists in psychiatry but also from general practitioners. None of the remaining options are true and so were not factors in that shift.DIF: Cognitive Level: Comprehension (Understanding)REF: Page 53TOP: Nursing Process: AssessmentMSC: NCLEX: Safe, Effective Care Environment

Three weeks after being assaulted by a pt, a nurse develops headaches, insomnia, and gastrointestinal problems. The nurse has four absences from 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 pt care

A. Refer the nurse for counseling and support Nurses need to monitor their thoughts and feelings and learn to recognize when they need self care, support or professional help. Which is especially true in the aftermath of violence. Nurses often suppress their own feelings in order to efficiently handle the immediate situation and react later with anxiety

A pt diagnosed with major depressive disorder tells the community mental health nurse, " I usually spend all day watching television. If there's nothing good to watch, I just sleep or think about my problems." What is the nurse's best action? A. Refer the pt for counseling with a recreational therapist. B. Ask the pt, "What kinds of program do you like to watch?" C. Suggest to the pt, "Are there some friends you could call instead? D. Advise the pt, "Watching television and thinking about problems makes depression worse."

A. Refer the pt for counseling with a recreational therapist. The pt's comments indicated problems with use of leisure time. Recreational activities improve emotional, physical, cognitive, and social well being. A recreational therapist is the best member of the treatment team to provide these services.

A pt 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 to perception C. Im[aired physical mobility related to spasticity and changes in musical tone D. Risk for impaired cerebral tissue perfusion related to obstruction secondary to infection

A. Risk for falls related to loss of balance and equilibrium The cerebellum is critical in both motor and cognitive functions. Alternations in cerebello-thalamo-cortical circuits may manifest as disturbances of coordination, balance, and gait. Safety is the nurse's first concern

The nurse recognizes the influence of a dysfunctional hypothalamus when including which intervention for a specific client? A. Sleep hygiene measures for a 40-year-old diagnosed with acute depression B. Limit setting for a 14-year-old diagnosed with oppositional defiance disorder (ODD) C. Staff to accompany a 30-year-old diagnosed with anorexia nervosa to the bathroom D. Frequent re-orientation to time and place for a 79-year-old diagnosed with dementia

A. Sleep hygiene measures for a 40-year-old diagnosed with acute depression hypothal - homeostasis

A client has made a successful suicide attempt while hospitalized on a unit that specializes on the treatment of depression. When considering both milieu control and crisis management, which intervention will the nursing staff implement? A. Suicide precautions for a full 24 hours will be implemented for all clients B. All group therapy sessions will be held on the unit for at least a 72-hour period C. A client focused psychological postmortem assessment will be conducted immediately D. Every client will be questioned concerning the impact the suicide had on him or her personally

A. Suicide precautions for a full 24 hours will be implemented for all clients A successful suicide attempt is a crisis situation for the unit. The safety of the milieu and of the individual clients are of primary importance. Since the unit focuses on clients diagnosed with depression all the patients on the unit need to be closely monitored for suicidal ideations. The first 24 hours after inpatient suicide is crucial for both safety and crisis management reasons. A postmortem assessment is conducted by staff and administrators to review policies and procedures that would be relevant to preventing such an occurrence. The remaining options are not therapeutic in this situation.DIF: Cognitive Level: Analysis (Analyzing)REF: Page 370TOP: Nursing Process: ImplementationMSC: NCLEX: Safe, Effective Care Environment

The nurse recognizes that the greatest barrier to successful mental health treatment and recovery is demonstrated by which client? A. The teenager who fears being rejected by his peers B. The young homeless adult who cannot keep clinic appointments C. The elderly Syrian immigrant who speaks only minimal English D. The middle-aged adult who cannot afford prescription medication

A. The teenager who fears being rejected by his peers

A parent 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 only like yesterday"

B. "A parent should never live longer than their child" The correct response represents a covert message and suggests possible suicidal thinking by the parent. The nurse should further assess the meaning of the comment

A client is currently expressing suicidal ideations. Which statement made by the client demonstrates knowledge of appropriate crisis management techniques that are focused on safety? A. "I trust the staff here to help." B. "I need you to stay with me." C. "I know the thoughts will likely go away." D. "I have survived the urge to kill myself before."

B. "I need you to stay with me." During a suicidal crisis, it is important that the client understand that the crisis is temporary; unbearable pain can be survived; that help is available; and he or she is not alone. The knowledge most relevant to the client's safety is that he or she is not alone. Being attended to by another demonstrates that he or she is important and cared about. These are the feelings necessary to resist following through on his or her suicidal ideations.DIF: Cognitive Level: Analysis (Analyzing)REF: Page 367TOP: Nursing Process: EvaluationMSC: NCLEX: Psychosocial Integrity

The nurse in a high school meets with small groups of students the day after a school bus accident resulted in the death of five 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 the event" D. "Thank you for coming today. As school leaders, we know it is very important to respond to yesterday's tragedy"

B. "We're grateful that you are safe. Our discussion is to talk about feelings associated with yesterday's tragedy" In phase 1 of a crisis, a person faces a conflict or problem that threatens the self concept and responds with increased feelings of anxiety. The nurse should first assure students that they are safe and then specify the reason for the session

In which scenario is it most urgent for the nurse to act asa pt advocate? A. An adult cries and experiences anxiety after a near - miss automobile 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 yr old girl's grades decline because she consistently focuses on her appearance and social networking D.A parent allows the prescription to lapse for 1 day for their 8 yr old chil's medication for ADHD

B. A homeless adult diagnosed with schizophrenia lives in a community expecting a category 5 hurricane While all of the scenarios present opportunities for a nurse to intervene, the correct response presents an imminent dancer to the pt's safety and well being

The decision to intervene as a patient advocate is clearly identified by the American Nurses Association's (ANA) code of ethics in which situation? A. A client's need for assistance while ambulating post-surgery B. A suspicion that a staff member is unfit to provide client care C. Working with a client to identify triggers for aggressive behavior D. Providing emotional support to a client experiencing a loss of a parent

B. A suspicion that a staff member is unfit to provide client care A nurse advocate speaks up for a client when he or she is unable to do so for him- or herself. The ANA's Code of Ethics for Nurses clearly states the nurse's responsibility to take appropriate actions to safeguard the client from incompetent or impaired practices of any member of the health team. The other options are examples of providing care to meet a specific client need.DIF: Cognitive Level: Application (Applying)REF: Page 3, 4TOP: Nursing Process: PlanningMSC: NCLEX: Safe, Effective Care Environment

When considering the civil rights of a mentally ill client, which circumstance may affect the autonomy of the client regarding decisions associated with his or her care? A.Being accused of a felony B. Judged to be legally incompetent C. Recent immigrant to the United States D. Being treated for a chronic mental illness

B. Judged to be legally incompetent autonomy - self govern

Systematic measurement of body weight, body mass index (BMI), waist circumference, and glucose levels would be most important for a pt beginning a new prescription for which medication? A. Aripirazole (Abilify) B. Olanzapine (Zyprexa) C. Ziprasidone (Geodon) D. Quetiapine (Seroquel)

B. Olanzapine (Zyprexa) Olanzapine (Zyprexa) has metabolic side effects, particularly weight gain. Metabolic monitoring for all pts receiving atypicals is recommended, although riperidone (Risperdal) and quetiapine (Seroquel) have lower weight gain. Ziprasidone (Geodon) and aripiprasole (Abilify) are considered weight neutral. Metabolic monitoring usually includes measurements of body weight, body mass index (BMI), waist circumference, fasting plasma glucose level, and fasting lipid profile

A pt diagnosed with major depressive disorder was hospitalized for 2 weeks on an acute psychiatric unit. One day after discharge, the pt completed suicide. Recognizing likely reactions among staff, which action should the nursing supervisor implement first? A. Assess each staff member individually for suicidal intent and 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 pt population and they are not at fault D. Invite a guest speaker to conduct an education session for staff members about suicide risk factors

B. Provide a private setting for staff members to talk about feelings associated with the event All health care members who provided care for a suicide victim, include medial staff, nursing staff, and ancillary staff, are at risk for being traumatized by suicide. Staff also ay experience symptoms of posttraumatic stress disorder with guilt, shock, anger, shame, and decreased self esteem . To reduce the trauma associated with the sudden loss, posttrauma loss debriefing can help to initiate an adaptive grief process and prevent self defeating behaviors

A community mental health nurse is preparing to address a national parent-teachers' organization. Which statement concerning the availability of residential treatment centers for emotionally disturbed children in the United States should the nurse include? A. Such centers have increased, but only marginally since 2004 B. The number of centers grew substantially between 2004 and 2008 C. Availability of these centers has declined steadily over the last decade D. Availability of such treatment beds has remained stagnant over the last decade

B. The number of centers grew substantially between 2004 and 2008 The number of residential treatment centers for emotionally disturbed children increased from 33,835 to 50,063 with available beds per 100,000 civilian population increasing from 11.4 to 16.5 for the years between 2004 and 2008.DIF: Cognitive Level: Comprehension (Understanding)REF: Page 55 (Table 5-1)TOP: Nursing Process: ImplementationMSC: NCLEX: Management of Care

A mentally ill gunman opens fire in a crowded movie theater, killing six people and injuring others. Which comment about this event by a member of the community most clearly shows the stigma of mental illness? A. "Gun control laws are inadequate in our country" B. "It's frightening to feel that is not safe to go to a movie theater" C. "All these people with mental illness are violent and should be locked up" D. "These events happen because american families no longer go to church together

C. "All these people with mental illness are violent and should be locked up" Stigma refers to the array of negative attitudes and beliefs regarding mental illness. Bias, prejudice, fear, and misinformation contribute to stigma

Which assessment question will provide the nurse with information concerning the client's perception of the situational crisis of losing their job? A. "Have you ever been out of a job before?" B. "Who can you rely upon for help while you are looking for a job?" C. "How much will being unemployed for several months affect your life?" D. "Do you have a plan for meeting your financial obligations while unemployed?"

C. "How much will being unemployed for several months affect your life?" Whether an event is perceived as a crisis is, in part, dependent on the outlook and strengths of the patient. Therefore it is important to view the event through the eyes of the patient. The nurse's initial task is to assess the individual's and possibly the family's perception of the problem. The correct option directly assesses the client's perception of the crisis. While the other options are not inappropriate, they don't focus on perception.DIF: Cognitive Level: Analysis (Analyzing)REF: Page 20-12TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

Which client statement supports the nurse's assessment that the client has demonstrated resiliency? A. "Losing a parent is a natural part of life." B. "I know I'm not the first person to lose a loved one." C. "I've learned from experiencing other losses that I'll be okay." D. "Losing my mother is the hardest thing I've ever experienced."

C. "I've learned from experiencing other losses that I'll be okay."

A pt tells the community mental health nurse, "I told my health care provider I was having trouble sleeping and he prescribed trazodone 50 mg every night. I read on the internet that the drug is an antidepressant, but I'm not depressed. What should I do?" Which response by the nurse is correct? A. "I will help you contact your health care provider for clarification regarding this new prescription" B. " Insomnia and depression usually go hand in hand. If your depression is relieved, your sleep with improve" C. "In low doses, trazodone helps relieve insomnia. Higher doses are needed for antidepressant effects to occur" D. "Information on the internet is often misleading and incorrect. It's more important to trust the judgment of your health care provider"

C. "In low doses, trazodone helps relieve insomnia. Higher doses are needed for antidepressant effects to occur" At lower doses, trazodone loses its antidepressant action while retaining hypnotic effects through histamine receptor antagonism; therefore it is useful for insomnia. Fifty miligrams is a low dose. High doses of trazodone are required for the serotonergic action to relieve depression

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 is not interested." select the nurse's therapeutic response. A. "Tell me about how your partner shows love for you" B. "You're describing a scenario that 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. "Let's consider some other ways you can satisfy your needs" The scenario presents a maturational crisis. Helping the spouse to consider other options is the nurse's most therapeutic action

Which statement by the nurse addresses the fundamental issue associated with an ethical dilemma? A. "Have you ever resolved an ethical dilemma before?" B. "What are your beliefs regarding treatment for chronic illnesses?" C. "Let's discuss the pros and cons of the three available treatment plans." D. "The problem poses an ethical question that complicates the decision process."

C. "Let's discuss the pros and cons of the three available treatment plans."

The nurse presents a class about mental health and mental illness to a group of fourth graders. One student asks, " why do people get mentally ill?" Select the nurses best response. A. "There are many reasons why mental illness occurs" B. "The cause of mental illness is complicated and very hard to understand" C. "Sometimes a person's brain does not work correctly because something bad happens or they inherit a brain problem" D. " Most mental illnesses result from genetically transmitted abnormalities in cerebral structure; however, some are a consequence of traumatic life experiences"

C. "Sometimes a person's brain does not work correctly because something bad happens or they inherit a brain problem" In the correct response, the nurse answers rather than evades the question, provides accurate information and uses terminology a 9 or 10 yr old child can understand. Many of the most prevalent and disabling mental disorders have been found to have strong biological influences, including genetic transmission

A pt has been disruptive to the therapeutic milieu for two days. A certified nursing assistant says to the nurse, " We need to seclude this pt because this behavior is upsetting everyone on the unit." Considering pt's rights, the nurse should respond, A. "Seclusion is not part of this pt's plan of care." B. "Let's think of some new ways to help this pt be less disruptive." C. "Thank you for that suggestion. I will discuss it with the health care provider." D. "Disruptive behavior is expected with mental illness. We must respond therapeutically."

C. "Thank you for that suggestion. I will discuss it with the health care provider." The scenario offers not indication the the pt is dangerous or out of control' therefore less restrictive interventions should be employed. The nurse has a responsibility to provide guidance to the CNA

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 service, you kept your feelings to yourself." Select the nurse's best response. A. "American society in the 1940s expected WW@ 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 (IEDs), which were not in use during WW2, produce traumatic brain injuries that must be treated"

C. "We now have a better understanding of how trauma affects people and the importance of research based, compassionate care Trauma occurs in many forms, including physical, sexual, and emotional abuse; war; natural disasters; and other harmful experiences. Trauma informed care provides guidelines for integrating an understanding of how trauma affects pts into clinical programming

A client diagnosed with major depression is reluctant to agree to the medication therapy stating, "I don't see how medication that affects my brain is going to make me less depressed." Which statement by the nurse best addresses the client's concern? A. "While the brain is a very complex organ, it does respond very well to this medication." B. "Are you afraid of taking the medication because of what your friends and family may think?" C. "Your brain controls your emotions; this medication will help the brain do that more effectively." D. "The staff has your best interests in mind and knows that this medication is very effective in treating depression."

C. "Your brain controls your emotions; this medication will help the brain do that more effectively."

Which scenario meets the criteria for "normal" behavior? A. An 8 yr old child's only verbalization is "no no no" B. A 16 yr old usually sleeps for 3 - 4 hours per night C. A 43 yr old man cries privately for 1 month after the death of his wife D. A 64 yr old woman has difficulty remembering the names of her grandchildren

C. A 43 yr old man cries privately for 1 month after the death of his wife Many biological, cultural, and environmental factors influence mental health. Persons who are normal also may experience dysfunction during their lives. The death of a spouse is a difficult experience, so crying is expected.

How will the nurse best assess a client for the current presence of suicidal ideations? A. Carefully observe the client's nonverbal behaviors B. Place the client on one-on-one suicide observation C. Ask the client directly, "Are you thinking of killing yourself?" D. Determine whether the client has ever acknowledged suicidal ideations

C. Ask the client directly, "Are you thinking of killing yourself?" If suicidal ideations are suspected, always ask directly, "Are you thinking of killing yourself?" None of the other options effectively assess the client for currently suicidal thoughts/ideations.DIF: Cognitive Level: Analysis (Analyzing)REF: Page 362, 363TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

A pt begins a new prescription for risperidone (Risperdal). Which intervention should the nurse include in the plan of care? A. Monitor intake and output daily B. Educate pt about foods that contain tyramines C. Assess sitting, standing and lying blood pressure daily D. Administer with food to reduce gastro intestinal irritation

C. Assess sitting, standing and lying blood pressure daily Risperidone blocks a1 and H1 receptors. It can cause orthostatic hypotension and sedation, which can lead to falls

An experienced nurse in a major medical center requests a transfer from a general medical unit to an acute care psychiatric unit, Which organizational feature would best support this nurse's successful transition? A. Assignment to medication administration for the first 6 months B. Working with a seasoned mental health technician for the first month C. Co-assignment with a knowledgeable psychiatric nurse for an extended orientation D. Staff development activities focused on developing therapeutic communication skills

C. Co-assignment with a knowledgeable psychiatric nurse for an extended orientation The nurse's skills from the medical unity will be valuable, but this nurse will need to expand his or her skill set to effectively care for a psychiatric population. Working with an experienced psychiatric nurse will provide opportunities for learning.

Considering the administration of medications, the nurse applying evidence-based nursing practice will engage in which nursing activity? A. Educating the client regarding the side effects of a newly prescribed antidepressant B. Confirming the client's identity prior to administering a prescribed PRN medication C. Determining the client's preference about when a medication prescribed once daily is administered D. Assessing the client for allergies prior to the administration of a newly prescribed mood stabilizing medication

C. Determining the client's preference about when a medication prescribed once daily is administered A noteworthy concept of EBP is that the approach utilized in nursing incorporates more than clinical research. Evidence is not limited to what is found in research studies, but also incorporates the nurse's clinical knowledge and experience, as well as the patient's preferences and desires. EBP is associated in this case with determining the client's preference regarding the administration of the medication. Confirming the client's identity and identifying possible allergies is associated with client safety. Medication education is considered important to client safety as well as a client right.DIF: Cognitive Level: Application (Applying)REF: Page 3TOP: Nursing Process: ImplementationMSC: NCLEX: Safe, Effective Care Environment

The nurse is determining discharge living arrangements for a mental health client. Which behavior demonstrated by the client would qualify him or her for financial reimbursement for placement into a psychiatric home care environment? A. Engages in numerous compulsive rituals B. Expresses paranoia regarding police persons C. Experiences panic attacks when among strangers D. Experiences both auditory and visual hallucinations

C. Experiences panic attacks when among strangers To qualify for reimbursement, patients must have a psychiatric diagnosis, be under the care of a PCP, and be homebound. The designation of homebound generally is given when patients cannot safely leave home, if leaving home causes undue stress, if the nature of the illness results in a refusal to leave home, or if they cannot leave home unaided. None of the other options meet the qualification of being homebound. DIF: Cognitive Level: Application (Applying)REF: Page 54TOP: Nursing Process: EvaluationMSC: NCLEX: Safe, Effective Care Environment

When considering the lethality of a client's suicide plan, what is the basic principle the nurse will consider? A. A gun can easily deliver a fatal wound B. Ingesting pills is a slow method of self-harm C. If the action is reversible, the plan is less lethal D. Any suicide plan has the potential to be lethal

C. If the action is reversible, the plan is less lethal A plan that doesn't allow for a last minute reversal of the action is consider more lethal. While all suicide plans should be taken seriously, not all plans are considered lethal. The remaining options are true statements but not the guiding principle concerning determining a plan's lethality.DIF: Cognitive Level: Analysis (Analyzing)REF: Page 367TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

What is the fundamental rule when considering the need for securing informed consent from a client for a treatment? A. The primary provider determines the need for informed consent B. Involuntary commitment negates the need for informed consent C. If the procedure intrudes into the body or poses a health risk consent is needed D. If the client is incompetent, informed consent is provided by an appointed surrogate

C. If the procedure intrudes into the body or poses a health risk consent is needed

Which intervention implemented by a community mental health nurse demonstrates the unique skills required of that position? A. Prescribing medications B. Advocating for a community clinic C. Making a referral to a neighborhood food bank D. Providing spiritual counseling for client and their family

C. Making a referral to a neighborhood food bank Community mental health nurses need to be very knowledgeable about community resources such as shelters for abused women, food banks for people with severe financial limitations, and agencies that can provide various other forms of support. Prescriptive privileges are not required. Advocacy is a generalized nursing responsibility while spiritual counseling is not viewed as within the scope of general nursing practice.DIF: Cognitive Level: Application (Applying)REF: Page 54TOP: Nursing Process: ImplementationMSC: NCLEX: Safe, Effective Care Environment

The nurse admits a pt experiencing hallucinations and delusional thinking to an inpatient mental health unit. The plan of care will require which service occurs first? A. Social history B. Psychiatric history C. Medical assessment D. Psychological evaluation

C. Medical assessment Begins with a medical assessment to rule out or consider co-occurring/comorbid conditions

The nurse who holds very strong beliefs about the right to life issue is asked by a client to provide information about the procedures associated with an abortion. When considering the principle of veracity, what action should the nurse take when responding to the client's educational needs? A. Refer the request to the primary health care provider B. Explain to the client that the nurse's view on abortion is biased C. Present the information in a matter-of-fact, non-emotional manner D. Delay the discuss until another nurse is available to provide the information

C. Present the information in a matter-of-fact, non-emotional manner

A client has recently lost all his or her possessions in a fire a month ago. Which assessment data suggests that hospitalization should be considered? A. Drinks a six pack of beer daily B. Has gained 10 pounds since the fire C. States, "The fire made my life so hopeless." D. Reports, "I really do need someone to talk to."

C. States, "The fire made my life so hopeless." In crisis situations it is important to evaluate the person's level of anxiety. Common coping mechanisms may be overeating, drinking, smoking, withdrawing, seeking out someone to talk to, crying, yelling, sleeping too much, praying, or engaging in other physical activity. The potential for suicide or homicide must be assessed. If the patient is thinking of harming themself or someone else, or is unable to take care of personal needs, hospitalization should be considered. The correct option demonstrates a potential risk for suicide.DIF: Cognitive Level: Analysis (Analyzing)REF: Page 20-16TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

What is the primary factor considered when determining the need for an involuntary mental health commitment? A. The cognitive status of the client B. The behaviors being demonstrated C. The danger posed by the behaviors D. The criminal nature of the behaviors

C. The danger posed by the behaviors Involuntary admission is made without the patient's consent. Generally, involuntary admission is necessary when a person is in need of psychiatric treatment, presents a danger to self or others, or is unable to meet his or her own basic needs. None of the other options, standing alone, is a relevant factor when considering the need for an involuntary commitment.DIF: Cognitive Level: Comprehension (Understanding)REF: Page 63TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

When considering an individual's risk for suicide, which client will the nurse consider the priority? A. The older transgender female who has been repeatedly assaulted B. The resent Middle Eastern immigrant from a war torn country C. The teenager recovering from a self-inflicted gunshot wound D. The gay male who has been diagnosed with HIV

C. The teenager recovering from a self-inflicted gunshot wound By far the strongest risk factor for suicide is a previous suicide attempt but there is growing concern over the high suicide rates globally among vulnerable groups who experience discrimination, such as refugees and migrants; indigenous peoples; and lesbian, gay, bisexual, transgender, and intersex (LGBTI) persons. Higher suicide rates are also seen among those who are incarcerated and those who live through war.DIF: Cognitive Level: Application (Applying)REF: Page 365TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

Which anticonvulsant mood stabilizer often prescribed for bipolar disorder carries a Black Box warning that includes pancreatitis? A. Ramelteon B. Lamotrigine C. Valproic acid D. Carbamazepine

C. Valproic acid Anticonvulsant mood stabilizers

An adult experienced a spinal cord injury resulting in quadriplegia 3 years ago and now lives permanently in a skilled care facility. Which comment by this person best demonstrates resiliency? A. "I often pray for a miracle that will heal my paralysis so I will be whole again." B. " I don't know what I did to deserve this fate or whether I am tough enough to endure it" C. " My accident was a twist of fate. I suppose there are worse things than being paralyzed" D. "Being paralyzed has taken things from me but it hasn't kept me from being mentally involved in life"

D. "Being paralyzed has taken things from me but it hasn't kept me from being mentally involved in life" Resiliency is the ability to recover from or adjust successfully to trauma or change. A successful transition through a crisis builds resiliency for the next difficult trial. In the correct response, the the person demonstrates acceptance of the paralysis and a focus on his or her abilities and assets

Which question will the nurse ask in order to assess a client's ability to think clearly? A. "Are you employed full time?" B. "Do you feel guilty about your recent divorce?" C. "How do you plan to afford getting your own apartment?" D. "What do you think is your most valuable personal characteristic?"

D. "How do you plan to afford getting your own apartment?" Clear thinking is demonstrated by the ability to problem solve using good judgment and logically reasoning to arrive at an insightful conclusion. Clear thinking would be demonstrated by arriving at a plan to live independently that demonstrates those qualities. Employment demonstrates productivity; identifying valuable personal characteristics is associated with a healthy sense of self-value; undue guilt reflects ability to manage anxiety and fear.DIF: Cognitive Level: Analyze (Analysis)REF: Page 11 (Figure 2-1)TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

Grief therapy was prescribed for a client who recently experienced tremendous grief upon the death of a parent. Which statement best demonstrates that a client is moving toward the healthy resolution of that grief? A. "I'm considering it's time to go back to work." B. "I've enjoyed going to the book club my sister suggested." C. "My mother would want me to get back to living my life again." D. "I'm going to stop being sad and rely on my faith to support me."

D. "I'm going to stop being sad and rely on my faith to support me." Ongoing evaluation will be performed until the crisis has resolved sufficiently to allow a return to normal pre-crisis functioning. As the patient's anxiety level reduces from severe to moderate to mild through successful interventions, the patient will need less support and return to independence. The correct option demonstrates independence, social engagement, and a return of enjoyment to one's life. The remaining options demonstrate consideration associated with returning to the familiar life situations (work, faith based comfort).DIF: Cognitive Level: Analysis (Analyzing)REF: Page 20-25TOP: Nursing Process: EvaluationMSC: NCLEX: Psychosocial Integrity

Which statement best demonstrates a client's understanding of how years of addiction have affected their ability to mature normally? A. "I don't think I've ever had to think like an adult before." B. "Taking on grown up responsibilities is certainly a challenge." C. "My years of addiction allowed me to avoid being a mature person." D. "I've got to learn how to address my problems like an adult would."

D. "I've got to learn how to address my problems like an adult would." Alcohol and drug addiction will interrupt an individual's progression through the maturational stages. As the patient escapes from stressors through the use of substances, he or she is not practicing communication and coping skills that contribute to maturity. When the individual gets clean and sober, he or she will discover that his or her maturation has been halted at about the age he or she began using drugs or alcohol. The good news is that the developmental process can resume and progress through supportive treatment. The correct option demonstrates an understanding of personal deficits and a need to address them, while the other options are statements of facts.DIF: Cognitive Level: Analysis (Analyzing)REF: Page 20-6TOP: Nursing Process: EvaluationMSC: NCLEX: Psychosocial Integrity

Which statement by the nurse best demonstrates a dilemma associated with the utilization of evidence-based practice (EBP) in the mental health clinical setting? A. "The client can't afford the cost of the medication he's being prescribed." B. "The client doesn't see the benefit of changing to this new form of therapy." C. "I really hated that the in-service on that new therapy modality was filled up." D. "It's hard to review the literature about this new treatment when we are so short staffed."

D. "It's hard to review the literature about this new treatment when we are so short staffed." There are dilemmas associated with the utilization of EBP including the practical issue of nursing environments that are short staffed and dealing with budgetary constraints making it difficult to spend time and money on the evaluation of the literature in order to make decisions of clinical practice based on best evidence. There is a need for higher-level nursing research to address the issues associated with psychiatric nursing interventions, and more education needs to be made available to nurses on the subject of the EBP and its implementation. The client issues of cost and compliance are not related to EBP.DIF: Cognitive Level: Analysis (Analyzing)REF: Page 3TOP: Nursing Process: ImplementationMSC: NCLEX: Safe, Effective Care Environment

A client has demonstrated behaviors suggestive of schizophrenia. As a part of the diagnostic process, the nurse is preparing the client for a magnetic resonance imaging study (MRI). Which statement by the nurse best addresses the client's concern about why the test is being done? A. "It's a painless way to see inside the brain and view its structures." B. "It's a series of cross-sectional pictures of the structure of your brain." C. "This method reduces the brain's exposure to x-rays and radioactive isotopes." D. "The study will show how well the blood is flowing to the ventricles of your brain."

D. "The study will show how well the blood is flowing to the ventricles of your brain." An MRI is capable of providing a high-resolution, 3D-like cross section of the brain. Such a view would allow an evaluation of the blood flow to the ventricles that are usually impaired in clients diagnosed with schizophrenia. The remaining options are correct statements but fail to provide an explanation regarding the value of an MRI to the diagnosis of schizophrenia.DIF: Cognitive Level: Analyze (Analysis)REF: Page 38 (Table 4-1)TOP: Nursing Process: ImplementationMSC: NCLEX: Teaching and Learning

A client prescribed a second-generation antipsychotic (SGA) asks why the medication is referred to with that term. What is the nurse's best response? A. "It's used to identify the newer form of antipsychotic medications." B. "SGAs are capable of treating a larger variety of mental illnesses." C. "SGAs produce fewer side effects than the first generation formulation does." D. "They contain a higher ratio of serotonin to dopamine than first generation forms do."

D. "They contain a higher ratio of serotonin to dopamine than first generation forms do." A SGA has a higher ratio of serotonin (5-HT2) to dopamine D2-receptor blockade than do first-generation forms. The remaining options are true statements but fail to provide an explanation as to the reason for the difference in terms but rather identify differences in use and action.DIF: Cognitive Level: Comprehension (Understanding)REF: Page 48TOP: Nursing Process: ImplementationMSC: NCLEX: Teaching and Learning

Which pt would the nurse expect to have the most difficulty with problem solving and decision making? A. An 18 yr old diagnosed with bulimia nervosa at age 14; has taken oral doses of luoxetine (Prozac) daily for 3 years B. A 46 yr old diagnosed with schizophrenia at age 24; has taken oral doses of clozapine (Clozaril) daily for 18 years C. A 62 yr old diagnosed with bipolar disorder at age 28; has taken oral divalproex sodium (Depakote) daily for 16 years D. A 52 yr old diagnosed with schizophrenia at age 21; has taken monthly injection of halperidol (haldol decanoate) for 12 years

D. A 52 yr old diagnosed with schizophrenia at age 21; has taken monthly injection of halperidol (haldol decanoate) for 12 years Executive functions occur in the cerebrum. Loss of cortical tissue has been associated with schizophrenia as well as with treatment involving haloperidol and other typical anti psychotics. In contrast, newer atypical antipsychotics and antidepressants have been found to increase brain volume and structural synaptic/neuronal plasticity.

While entering the building, an elementary school nurse observes a person in the distance emerging from a 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. Which action should the nurse take first? A. Move to a secure location B. Observe the intruder's features C. Take not of the intruder's location D. Activate the schools code for an intruder

D. Activate the schools code for an intruder This scenario presents a potential adventitious crisis in phase one. The nurse must first consider safety. After moving to a secure location, the nurse can activate the school's code for an intruder and describe the intruder to law enforcement

In a staff meeting at an inpatient mental health facility for persons, the administrator announces that psychiatric 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 unlicensed assistive personnel C. Ask the administrator to delay 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 supervision of unlicensed assistive personnel

D. Advise the administrator of regulations in the state nurse practice act regarding supervision of unlicensed assistive personnel Institutional policies and practices do not absolve an individual nurse of responsibility to practice on the basis of professional standards of nursing care. State nurse practice acts specify that UAP work under a nurse's supervision

A colleague tells the nurse, "I have not been able to sleep for the past three days. I feel 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 to pts assigned to the colleague D. Confer with the supervisor about the nurse's ability to safely deliver care

D. Confer with the supervisor about the nurse's ability to safely deliver care Sleep deprivation causes impaired practice, which jeopardizes pt safety. The colleague's comments indicate that impairment is likely. The nurse should confer with the supervisor to determine the appropriate action

Which institution specific clinical practice resource will the nurse use to integrate evidence-based practice (EBP) into the care of a client hospitalized for the purpose of the evaluation of his or her current therapy plan? A. Researching current medication options using Internet resources B. Reviewing decision points for therapy planning provided by clinical practice guidelines C. Using a clinical algorithm in the form of a decision tree to review treatment approaches D. Implementing a clinical pathway to provide expected outcomes using a measurable format

D. Implementing a clinical pathway to provide expected outcomes using a measurable format Clinical practice resources for the implementation of EBP include Internet resources, clinical practice guidelines, clinical algorithms, and clinical pathways. Clinical pathways are the only resource that is specific to the institution using them.DIF: Cognitive Level: Application (Applying)REF: Page 3TOP: Nursing Process: ImplementationMSC: NCLEX: Safe, Effective Care Environment

A pt on an acute psychiatric unit removed the cap form the ceiling sprinkler, resulting in rapid flooding of the unit. After moving pts to a safe area, which action should the nurse take next? A. Conduct individual sessions with pts regarding the experience B. Increase the volume of overhead music to distract pts from the event C. Implement a psychomotor activity to reduce anxiety associated with the event D. Lead a group session with pts to discuss feelings associated with the event

D. Lead a group session with pts to discuss feelings associated with the event After addressing safety concerns, the nurse should take steps to help tps feel safe and lower anxiety, such as providing a quiet environment, building rapport and acknowledging their crisis experience. A group session will allow pts who are unable to articulate their feelings to hear from pts who are able to discuss it

A nurse working in an acute care unit for adolescents diagnosed with mental illness says, "Our pts have so much energy. We need some physical activities for them." In recognition of needs for safety and exercise, which activity could the treatment team approve? A. Badminton tournament B. competitive soccer matches C. Intramural basketball games D. Line dancing to popular music

D. Line dancing to popular music Safety is a key consideration in selection of activities. The correct response identifies an activity likely to appeal to the population but without physical contact between pts or equipment, which may be associated with injury

The treatment goal is for the hospitalized mental health client to be discharged to a residential treatment environment. The nurse includes which experience into the client's plan of care as a priority intervention? A. Art therapy to reduce the effects of the client's illness B. Recreational therapy to improve the client's social well-being C. Physical therapy to address any existing musculoskeletal disabilities D. Occupational therapy to assist in assuming skills needed to regain independence

D. Occupational therapy to assist in assuming skills needed to regain independence

A pt 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 pt? A. Group therapy B. Individual psychotherapy C. Complementary therapy D. Psychopharmacological treatment

D. Psychopharmacological treatment The pt's report suggests that depression is occurring. With the increased understanding of biology of psychiatric illnesses, treatment approaches have evolved rapidly into more scientifically grounded methods, particularly psychopharmocology

A single adult says the the nurse, "Both of my parents dies several years ago and my only sibling committed suicide 2 weeks ago. I feel so alone." After determining that the adult has no suicidal ideation, the nurse should: A. Explore the adult's feelings of survivor's guilt B. Assess the adult's cultural beliefs and spirituality C. Refer the adult for cognitive behavioral therapy (CBT) D. Refer the adult to a self - help group for suicide survivors

D. Refer the adult to a self - help group for suicide survivors Referrals need to be made available to family members and friends to assist them in dealing with and addressing the many emotional reactions and problems that easily may develop after suicide of a family member or friend. Self help groups are extremely beneficial for survivors

A nurse's sibling happily says, " I want to introduce you to my fiance. We're getting married in six months." The nurse has encountered the finace in a clinical setting and is aware of the finace's diagnosis of schizophrenia What is the nurse's best response? A. In private, tell the sibling about the finace'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 fiance, "I hope you will be very happy together."

D. Say to the sibling and fiance, "I hope you will be very happy together." Despite personal misgivings, the nurse must maintain the fiance's confidentiality

The nurse prepares outcomes to the plan of care for an adult diagnosed with mental illness. Which strategy recognizes the currently focus of treatment services for this population? A. The pt's diagnoses are confirmed using advanced neuroimaging techniques B. The nurse confers with the treatment team to verify the pt's most significant disability C. The nurse prioritizes the pt's problems in accordance with Maslow's hierarchy of needs D. The pt and family participate actively in establishing priorities and selecting interventions

D. The pt and family participate actively in establishing priorities and selecting interventions The correct response recognizes the recovery model, which has the following tenets: Mental health care is consumer and family driven, with pts being partners in all aspects of care; care must focus on increasing the consumer's success in coping with life's challenges and building resilience; and an individualized care plan is at the core of consumer - centered recovery