Psychosocial Nursing: Exam 2 Practice Questions
Describe some of the side effects related to circadian rhythm sleep disorder or "shift work disorder":
- GI issues (ulcers, bowel d/o) - Depression exacerbation - Hypertension - Excessive sleepiness and/or insomnia - Lost in productivity - Possibly linked as a behavior "carcinogenic to humans"
The provision of optimal care for patients withdrawing from substances of abuse is facilitated by the nurse's understanding that severe morbidity and mortality are often associated with withdrawal from: A. alcohol and CNS depressants B. CNS stimulants and hallucinogens C. narcotic antagonists and caffeine D. opiates and inhalants
A. alcohol and CNS depressants
Cocaine exerts which of the following effects on a patient? A. Stimulation after 15-20 mins B. Stimulation and anesthetic effects C. Immediate imbalance of emotions D. Paranoia
B. Stimulation and anesthetic effects Cocaine exerts two main effects on the body, both anesthetic and stimulant
A patient who is dependent on alcohol tells the nurse, "alcohol is no problem for me. I can quit anytime i want to." The nurse can assess this statement as indicating A. denial B. projection C. rationalization D. reaction formation
A. denial Believing that one can control drug use, despite addiction to the substance, is based on denial (escaping unpleasant reality by ignoring its existence)
A client arrested for an assault in which he savagely beat a classmate states, "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of A. antisocial personality disorder. B. borderline personality disorder. C. schizotypal personality disorder. D. narcissistic personality disorder.
A Clients with antisocial personality act out feelings without consideration for the rights of others. They feel no remorse for their antisocial acts.
A patient reports frequent sleep disturbances. Which interventions could be considered to help improve the patient's sleep pattern? (Select all that apply.) a.Melatonin b.Chamomile c.Vitamin C d.Valerian e.SAM-e
A, B, & D Melatonin, chamomile, and valerian have relaxant effects that help sleep. SAM-e may help with mild depression. Vitamin C has no effect on sleep.
Characteristics the nurse will assess in the client diagnosed with antisocial personality disorder are A. deceitfulness, impulsiveness, and lack of empathy. B. perfectionism, preoccupation with detail, and verbosity. C. avoidance of interpersonal contact and preoccupation with being criticized. D. a need for others to assume responsibility for decision making and seeking nurture.
A Antisocial clients have no conscience. Their sense of right and wrong is impaired, and they tend to do whatever serves them best without consideration for the rights or feelings of others.
When providing care for a client diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with the client's A. mood shifts, impulsivity, and splitting. B. grief, anger, and social isolation. C. altered sensory perceptions and suspicion. D. perfectionism and preoccupation with detail.
A Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Borderline individuals desperately seek relationships to avoid feeling abandoned, but they often drive others away with excessive demands, impulsive behavior, or uncontrolled anger. Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings.
A nurse who is idealized by a client is at risk for A. becoming overinvolved and being protective and indulgent. B. becoming indecisive about planned interventions. C. developing a prejudicial, blaming orientation. D. stringent enforcement of boundaries and limits.
A Finding an approach for helping clients with personality disorders who have overwhelming needs can be challenging for caregivers. For example, a borderline female client may briefly idealize her male nurse on the inpatient unit, telling staff and clients alike that she is "the luckiest client because she has the best nurse in the hospital." The rest of the team initially realizes that this behavior is an exaggeration, and they have a neutral response. But after days of constant dramatic praise, some members of the team may start to feel inadequate and jealous of the nurse. They begin to make critical remarks about minor events to prove that the nurse is not perfect. Open communication in staff meetings and ongoing clinical supervision are important aspects of self-care for the nurse working with these clients to maintain objectivity.
Inpatient hospitalization for persons with mental illness is generally reserved for patients who: a. present a clear danger to self or others. b. are noncompliant with medication at home. c. have limited support systems in the community. d. develop new symptoms during the course of an illness.
A Hospitalization is justified when the patient is a danger to self or others, has dangerously decompensated, or needs intensive medical treatment. The distracters do not necessarily describe patients who require inpatient treatment.
A client diagnosed with obsessive-compulsive personality disorder takes the nurse aside and mentions, "I've observed you interacting with that new patient. You are not approaching him properly. You should be more forceful with him." The best response for the nurse would be A. "I will be continuing to follow the care plan for the patient." B. "I see you are trying to control that patient's therapy as well as your own." C. "Your eye for perfection extends even to my nursing interventions." D. "That patient's care is really of no concern to you or to other clients."
A Obsessive-compulsive personality disorder has the key factor of perfectionism with a focus on orderliness and control. These individuals get so preoccupied with details and rules that they may not be able to accomplish the tasks. Guard against engaging in power struggles with a client with obsessive-compulsive disorder.
Which statement is descriptive of clients with a personality disorder? A. They are resistant to behavioral change. B. They have an ability to tolerate frustration and pain. C. They usually seek help to change maladaptive behaviors. D. They have little difficulty forming satisfying and intimate relationships.
A Personality disorders are deeply ingrained and pervasive. Clients with personality disorders find it very difficult, if not nearly impossible, to change. Change proceeds very slowly.
The primary goal of milieu therapy for clients diagnosed with personality disorders is: A. to manage the effect the behavior has on the entire group. B. to provide one-on-one therapy for each member of the milieu. C. to help the client remain uninvolved with other patients. D. to promote a laissez-faire attitude among the staff members.
A The primary goal of milieu therapy is affect management in a group context
A patient diagnosed with schizophrenia was hospitalized after arguing with co-workers and threatening to harm them. The patient is aloof, suspicious, and says, "Two staff members I saw talking were plotting to kill me." Based on data gathered at this point, which nursing diagnoses relate? (Select all that apply.) a. Risk for other-directed violence b. Disturbed thought processes c. Risk for loneliness d. Spiritual distresse. Social isolation
A & B Delusions of persecution and ideas of reference support the nursing diagnosis of disturbed thought processes. Risk for other-directed violence is substantiated by the patient's feeling endangered by persecutors. Fearful individuals may strike out at perceived persecutors or attempt self-harm to get away from persecutors. Data are not present to support the other diagnoses.
A nurse at the mental health clinic plans a series of psychoeducational groups for persons newly diagnosed with schizophrenia. Which two topics take priority? (Select all that apply.) a. "The importance of taking your medication correctly" b. "How to complete an application for employment" c. "How to dress when attending community events" d. "How to give and receive compliments" e. "Ways to quit smoking"
A & E Stabilization is maximized by adherence to the antipsychotic medication regimen. Because so many persons with schizophrenia smoke cigarettes, this topic relates directly to the patients' physiological well-being. The other topics are also important but are not priority topics.
The nurse manager of a mental health center wants to improve medication adherence among the seriously mentally ill persons treated there. Which interventions are likely to help achieve this goal? (Select all that apply.) a. Maintain stable and consistent staff. b. Increase the length of medication education groups. c. Stress that without treatment, illnesses will worsen. d. Prescribe drugs in smaller but more frequent dosages. e. Make it easier to access prescribers and pay for drugs. f. Require adherence in order to participate in programming.
A & E Trust in one's providers is a key factor in treatment adherence, and mentally ill persons can sometimes take a very long time to develop such trust; therefore, interventions which stabilize staffing allow patients to have more time with staff to develop these bonds. Ready access to prescribers allows medicine-related concerns to be addressed quickly, reducing obstacles to adherence such as side effects or ineffective dosages. Medication costs can be obstacles to adherence as well. Many SMI patients have anosognosia and do not adhere to treatment because they believe they are not ill, so telling them nonadherence will worsen an illness they do not believe they have is unlikely to be helpful. Increasing medication education is helpful only when the cause of nonadherence is a knowledge deficit. Other issues that reduce adherence, particularly anosognosia and side effects, are seldom helped by longer medication education. Requiring medication adherence to participate in other programs is coercive and unethical. Smaller, more frequent doses do not reduce side effects and make the regimen more difficult for the patient to remember.
When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to implement which intervention? A. Waiting quietly for the client to reply B. Prompting the client if the reply is slow C. Repeating the question if the client does not answer promptly D. Reviewing the client's medical record to support the client's response
A. Waiting quietly for the client to reply. Depressed clients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply.
Symptoms that would signal opioid withdrawal include A. lacrimation, rhinorrhea, dilated pupils and muscle aches B. Illusions, disorientation, tahycardia and tremors C. Fatigue, lethargy, sleepiness and convulsions D. synesthesia, depersonalization and hallucinations
A. lacrimation, rhinorrhea, dilated pupils and muscle aches Symptoms of opioid withdrawal resemble the "fluid" they include runny nose, tearing, diaphoresis and fever
A patient diagnosed with major depression does not interact with others except when addressed, and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Which communication technique will be effective? a. Make observations. b. Ask the patient direct questions. c. Phrase questions to require yes or no answers. d. Frequently reassure the patient to reduce guilt feelings.
A) Making observations about neutral topics such as the environment draws the patient into the reality around him or her but places no burdensome expectations for answers on the patient. Acceptance and support are shown by the nurses presence. Direct questions may make the patient feel that the encounter is an interrogation. Open-ended questions are preferable if the patient is able to participate in dialogue. Platitudes are never acceptable. They minimize patient feelings and can increase feelings of worthlessness.
Select the example of tertiary prevention. a. Helping a person diagnosed with a serious mental illness learn to manage money b. Restraining an agitated patient who has become aggressive and assaultive c. Teaching school-age children about the dangers of drugs and alcohol d. Genetic counseling with a young couple expecting their first child
A) Tertiary prevention involves services that address residual impairments, with a goal of improved independent functioning. Restraint is a secondary prevention. Genetic counseling and teaching school-age children about substance abuse and dependence are examples of primary prevention.
A nurse surveys medical records. Which finding signals a violation of patients' rights? a. A patient was not allowed to have visitors. b. A patient's belongings were searched at admission. c. A patient with suicidal ideation was placed on continuous observation. d. Physical restraint was used after a patient was assaultive toward a staff member.
A) The patient has the right to have visitors. Inspecting patients' belongings is a safety measure. Patients have the right to a safe environment, including the right to be protected against impulses to harm self.
Which principle has the highest priority when addressing a behavioral crisis in an inpatient setting? a. Resolve the crisis with the least restrictive intervention possible. b. Swift intervention is justified to maintain the integrity of a therapeutic milieu. c. Rights of an individual patient are superseded by the rights of the majority of patients. d. Patients should have opportunities to regain control without intervention if the safety of others is not compromised.
A) The rule of using the least restrictive treatment or intervention possible to achieve the desired outcome is the patient's legal right. Planned interventions are nearly always preferable. Intervention may be necessary when the patient threatens harm to self.
Which chronic medical condition is a common trigger for major depressive disorder? a. Pain b. Hypertension c. Hypothyroidism d. Crohn's disease
A) pain
A night shift worker reports, "I'm having trouble getting to sleep after a night's work. I have a hearty breakfast with coffee, read the paper, do my exercises, and then go to bed. However, I just lie awake until it is nearly time to get up to be with my family for dinner." What changes should the nurse suggest? Select all that apply. a. Drink juice with breakfast rather than coffee. b. Exercise after awakening rather than before. c. Turn on the television when going to bed. d. Do not read the paper. e. Eat a light breakfast.
A, B & E Sleep can be disrupted by caffeine, a central nervous system stimulant, exercise performed just before trying to sleep, and eating a heavy meal before retiring. Reading the newspaper is not likely to be so stimulating that it disrupts the patient's ability to sleep. Television will be disruptive to sleep.
Which statements most clearly indicate the speaker views mental illness with stigma? (Select all that apply.) a. "We are all a little bit crazy." b. "If people with mental illness would go to church, their problems would be solved." c. "Many mental illnesses are genetically transmitted. It's no one's fault that the illness occurs." d. "Anyone can have a mental illness. War or natural disasters can be too stressful for healthy people." e. "People with mental illness are lazy. They get government disability checks instead of working."
A, B & E Stigma is represented by judgmental remarks that discount the reality and validity of mental illness. It is evidenced in stereotypical statements, by oversimplification, and by multiple other messages of guilt or shame. See related audience response question.
An adult patient tells the case manager, "I don't have bipolar disorder anymore, so I don't need medicine. After I was in the hospital last year, you helped me get an apartment and disability checks. Now I'm bored and don't have any friends." Where should the nurse refer the patient? (Select all that apply.) a. Psychoeducational classes b. Vocational rehabilitation c. Social skills training d. A homeless shelter e. Crisis intervention
A, B, & C The patient does not understand the illness and need for adherence to the medication regimen. Psychoeducation for the patient (and family) can address this lack of knowledge. The patient, who considers himself friendless, could also profit from social skills training to improve the quality of interpersonal relationships. Many patients with SMI have such poor communication skills that others are uncomfortable interacting with them. Interactional skills can be effectively taught by breaking the skill down into smaller verbal and nonverbal components. Work gives meaning and purpose to life, so vocational rehabilitation can assist with this aspect of care. The nurse case manager will function in the role of crisis stabilizer, so no related referral is needed. The patient presently has a home and does not require a homeless shelter.
patient who emigrated from India is hospitalized. The patient and family use ayurvedic medicine. The nurse wants to adjust this patient's care so that it is more comfortable and familiar. What changes from usual Western practice should be considered? (Select all that apply.) a.In preparation for discharge, include a significant focus on preventive practices. b.Spend time exploring the patient's life overall, focusing on broader issues than health. c.Involve the patient's entire family and treatment team in decisions about treatment options. d.Anticipate that the patient will prefer and value interventions with high technology features. e.Provide relevant health-related information and then encourage the patient to determine which course of action to pursue.
A, B, & E Ayurvedic medicine, an ancient practice that originated in India, stresses individual responsibility for health, is holistic, promotes prevention, recognizes the uniqueness of the individual, and offers natural methods of treatment. Ayurvedic medicine does not require spiritual cleansing or the involvement of family and the treatment team in all decisions.
A patient diagnosed with SMI was living successfully in a group home but wanted an apartment. The prospective landlord said, "People like you have trouble getting along and paying their rent." The patient and nurse meet for a problem-solving session. Which options should the nurse endorse? (Select all that apply.) a. Coach the patient in ways to control symptoms effectively. b. Seek out landlords less affected by the stigma associated with mental illness. c. Threaten the landlord with legal action because of the discriminatory actions. d. Encourage the patient to remain in the group home until the illness is less obvious. e. Suggest that the patient list a false current address in the rental application. f. Have the case manager meet with the landlord to provide education about mental illness.
A, B, & F Managing symptoms so that they are less obvious or socially disruptive can reduce negative reactions and reduce rejection due to stigma. Seeking a more receptive landlord might be the most expeditious route to housing for this patient. Educating the landlord to reduce stigma might make him more receptive and give the case manager an opportunity to address some of his concerns (e.g., the case manager could arrange a payee to assure that the rent is paid each month). However, threatening a lawsuit would increase the landlord's defensiveness and would likely be a long and expensive undertaking. Delaying the patient's efforts to become more independent is not clinically necessary according to the data noted here; the problem is the landlord's bias and response, not the patient's illness. It would be unethical to encourage falsification and poor role modeling to do so; further, if falsification is discovered, it could permit the landlord to refuse or cancel her lease. See related audience response question.
A client diagnosed with major depressive disorder shows vegetative signs of depression. Which nursing actions should be implemented? Select all that apply. A. Offer laxatives as needed. B. Monitor food and fluid intake. C. Provide a quiet sleep environment. D. Eliminate all daily caffeine intake. E. Restrict intake of processed foods.
A, B, C
Which important points should the nurse teach a patient about using herbal preparations? (Select all that apply.) a.Check active and inactive ingredients. b.Discontinue use if side or adverse effects occur. c.Avoid herbals during pregnancy and breast-feeding. d.Buying from online sources is preferable and cheaper. e.Inform your health care provider about the use of herbals.
A, B, C & E All of the instruction is correct except regarding purchase of herbals. Herbals should be purchased from a reputable firm. Internet purchasing might not be the best plan, unless the reputation of the firm can be confirmed.
A patient in good health and without any major health needs says, "I want to try some techniques to improve my mental and physical well-being but I'm overwhelmed by all the suggestions on the Internet." Which techniques would be appropriate for the nurse to suggest? (Select all that apply.) a.Yoga b.Exercise c.Meditation d.Aromatherapy e.Acupuncture f.Spinal manipulation
A, B, C, & D Yoga, exercise, meditation, and aromatherapy are self-help techniques that may have a positive effect on the patient's physical and mental well-being. These techniques are unlikely to cause harm. The patient is in good health; therefore, acupuncture and spinal manipulation are not indicated.
Which interventions will help make the environment on the unit safer for suicidal patients? Select all that apply. a. All windows are kept locked. b. Every shower has a breakaway shower rod. c. Eating utensils are counted when trays are collected. d. Patient doors are kept open. e. Staying within listening distance of the patient.
A, B, C, D a. All windows are kept locked. b. Every shower has a breakaway shower rod. c. Eating utensils are counted when trays are collected. d. Patient doors are kept open.
What are the nursing responsibilities to a patient expressing suicidal thoughts? Select all that apply. a. Instituting one-to-one observation. b. Documenting the patient's whereabouts and mood every 15 to 30 minutes. c. Ensuring that the patient has no contact with glass or metal utensils. d. Ensuring that patient has swallowed each individual dose of medication. e. Discussing triggers of depression
A, B, C, D a. Instituting one-to-one observation. b. Documenting the patient's whereabouts and mood every 15 to 30 minutes. c. Ensuring that the patient has no contact with glass or metal utensils. d. Ensuring that patient has swallowed each individual dose of medication.
Alicia, a 31-year-old patient, is flirting with a peer. She is overheard asking him to convince staff to give her privileges to leave the inpatient mental health unit. Later she offers you a backrub in exchange for receiving her 10:00 p.m. Xanax an hour early. Which response(s) to such behaviors would be most therapeutic? Select all that apply. a) Label the behavior as undesirable, and explore with Alicia more effective ways to meet her needs. b) By role-playing, demonstrate other approaches Alicia could use to meet her needs. c) Advise the other patients that Alicia is being manipulative and that they should ignore her when she behaves this way. d) Bargain with Alicia to determine a reasonable compromise regarding how much of such behavior is acceptable before she crosses the line. e) Explain that such behavior is unacceptable, and give Alicia specific examples of consequences that will be enacted if the behavior continues. f) Ignore the behavior for the time being so Alicia will find it unrewarding and in turn seek other, and hopefully more adaptive, ways to meet her needs.
A, B, E
What is the major reason for the hospitalization of a depressed patient? A. Inability to go to work B. Suicidal ideation C. Loss of appetite D. Psychomotor agitation
B. Suicidal ideation Suicidal thoughts are a major reason for hospitalization for patients with major depression. It is imperative to intervene with such patients to keep them safe from self-harm. The other options describe symptoms of major depression but aren't by themselves the major reason for hospitalization
Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply. a. "I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day." b. "I discussed the diuretic my cardiologist prescribed with my psychiatric care provider." c. "Lithium may help me lose the few extra pounds I tend to carry around." d. "I take my lithium on an empty stomach to help with absorption." e. "I've already made arrangements for my monthly lab work."
A, B, E a. "I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day." b. "I discussed the diuretic my cardiologist prescribed with my psychiatric care provider." e. "I've already made arrangements for my monthly lab work."
When considering community suicide prevention programs, what population should the nurse plan to service with regular suicide screenings? Select all that apply. a. 10- to 34-year-olds b. Males c. College-educated adults d. Rural population e. Native American
A, B, E a. 10- to 34-year-olds b. Males e. Native American
Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar and her support system? Select all that apply. a. "Remember that alcohol and caffeine can trigger a relapse of your symptoms." b. "Due to the risk of a manic episode, antidepressant therapy is never used with bipolar disorder. c. "It's critical to let your healthcare provider know immediately if you aren't sleeping well." d. "Is your family prepared to be actively involved in helping manage this disorder?" e. "The symptoms tend to come and go and so you need to be able to recognize the early signs."
A, C, D, E a. "Remember that alcohol and caffeine can trigger a relapse of your symptoms." c. "It's critical to let your healthcare provider know immediately if you aren't sleeping well." d. "Is your family prepared to be actively involved in helping manage this disorder?" e. "The symptoms tend to come and go and so you need to be able to recognize the early signs."
Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply. a. Monitor the patient's vital signs frequently. b. Keep the patient distracted with group-oriented activities. c. Provide the patient with frequent milkshakes and protein drinks. d. Reduce the volume on the television and dim bright lights in the environment. e. Use a firm but calm voice to give specific concise directions to the patient.
A, C, D, E a. Monitor the patient's vital signs frequently. c. Provide the patient with frequent milkshakes and protein drinks. d. Reduce the volume on the television and dim bright lights in the environment. e. Use a firm but calm voice to give specific concise directions to the patient.
A patient becomes frustrated and angry when trying to get his MP3 player and headset to function properly and angrily throws it across the room, nearly hitting a peer with it. Which intervention(s) would be the most therapeutic? Select all that apply. a. Place the patient in seclusion for 1 hour to allow him to de-escalate. b. Tell the patient that any further outbursts will result in a loss of privileges. c. Offer to help the patient learn how to operate his music player and headset. d. Explore with the patient how he was feeling as he worked with the music player. e. Point out the consequences of such behavior and note that it cannot be tolerated. f. Limit the patient's exposure to frustrating experiences until he attains improved coping skills. g. Encourage the patient to recognize signs of mounting tension and seek assistance.
A, D, E, G
An appropriate long-term goal/outcome for a recovering substance abuser would be that the patient will A. discuss the addiction with significant others b. state an intention to stop using illegal substances C. abstain from the use of mood altering substances D. substitute a less addicting drug for the present drug
C. abstain from the use of mood altering substances Abstinence is highly desirable long-term goal/outcome/ It's a better out come that short term goal because lapses are common in the short term
A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best address this cognitive distortion with which response? A. "Let's look at what you just said, that you can 'never do anything right.'" B. "Tell me what things you think you are not able to do correctly." C. "Is this part of the reason you think no one likes you?" D. "That is the most unrealistic thing I have ever heard."
A. "Let's look at what you just said, that you can 'never do anything right.'" Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the client's willingness to participate. None of the other options examines the underlying cause of the feeling.
Which of the following would the nurse recommend to a patient with sleep difficulties as an aromatherapy? A. Ylang-ylang B. Benadryl C. Rozerem D. Kava-Kava
A. Ylang-ylang This is an essential oil that has anxiolytics and hypnotic effects.-Benadryl should not be used as it causes confusion in older adults-Rozerem is melatonin (a hormone)-Kava kava is an herbal supplement
Which assessment data would be most consistent with a severe opiate overdose? A. BP 80/40 mmHg; HR 120 beats/min; RR 10 breaths/min B. BP 120/80 mmHg; HR 84 beats/min; RR 20 breaths/min C. BP 140/90 mmHG; HR 76 beats/min; RR 24 breaths/min D. BP 180/100 mmHg; HR 72 beats/min; RR 28 breaths/min
A. BP 80/40 mmHg; HR 120 beats/min; RR 10 breaths/min Opiate overdose results in lowered blood pressure with a rise in pulse rate along with respiratory depression
Which of the following is NOT true regarding the REM sleep cycle? A. It occurs during the first 4 stages of the sleep cycle B. It involves vivid dreaming C. There is a loss of muscle tension, causing floppy limbs D. There is an increase in heart rate
A. It occurs during the first 4 stages of the sleep cycle - REM sleep occurs as the 5th stage of the sleep cycle. Non-REM sleep accounts for stages 1-4 of the sleep cycle. A deeper sleep occurs during REM sleep.
Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? A. Onset of action is from 1 to 3 weeks or longer. B. They tend to be more effective for men. C. Recent memory impairment is commonly observed. D. They often cause the client to have diurnal variation.
A. Onset of action is from 1 to 3 weeks or longer. A drawback of antidepressant drugs is that improvement in mood may take 1 to 3 weeks or longer. None of the other options provide correct information regarding antidepressant medications.
The only class of commonly abused drugs that has a specific antidote is the A. Opiates B. hallucinogens C. amphetamines D. benzodiazepines
A. Opiates The effects of opiates can be negated by a narcotic antagonist such as naloxone
Which of the following medications can be given at night time to a schizophrenia patient off-label to also help with sleep? A. Seroquel B. Benadryl C. Ativan D. Sonata
A. Seroquel Discussed that this was an anti-psychotic that may be given to those with schizophrenia to also help with their sleep problem because it causes drowsiness.
The treatment team meets to discuss Cody's plan of care. Which of the following factors will be priorities when planning interventions? A. readiness to change and support system B. current college performance C. financial ability D. availability of immediate family to come to meetings
A. readiness to change and support system The plan will take into account acute safety needs, severity and range of symptoms, motivation or readiness to change, skills and strengths, availability of a support system, and the individual's cultural needs. The other options may be factors but are not the priority factors in planning interventions for the patient as much as the patient's perceived need for change and having others who can lend support outside the hospital.
A client was in an automobile accident and while there is the odor of alcohol on his breath, his speech is clear, and he is alert and answers questions posed to him. His blood alcohol level is determined to be 0.30 mg%. What conclusion can be drawn? A. the patient has a high tolerance to alcohol B. the patient ate a high fat meal before drinking C. the patient has a decreased tolerance to alcohol D. the patient's blood alcohol level is within legal limits
A. the patient has a high tolerance to alcohol A nontolerant drinker would evidence staggering, ataxia, confusion and stupor at this blood alcohol level
Nursing assessment of an alcohol-dependent client 6 to 12 hours after the last drink would most likely reveal the presence of A. tremors B. seizures C. blackouts D. hallucinations
A. tremors Tremors are an early sign of alcohol withdrawal
A terminally ill patient says, "I know I will never get well, but," and the patient's voice trails off. Select the most therapeutic response by the nurse. a. "What do you hope for?" b. "Do you have questions about what is happening?" c. "You are not going to get well. It is healthy that you accept that." d. "When you have questions, it is best to talk to the health care provider."
ANS: A This open-ended response is an example of following the patient's lead. It provides an opportunity for the patient to speak about whatever is on his mind. The distracters are not therapeutic; they block further communication, refocus the conversation, give advice, or suggest the nurse is uncomfortable with the topic.
Which is true of pharmacological therapies for treatment of personality disorders? A. Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. B. Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. C. Patients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. D. Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients.
AAt this time in the United States, there are no specifically FDA-approved medications for treating personality disorders. Prescribers are using the medications "off- label" until evidence-based pharmacotherapies are proven to be safe and effective. There is evidence that mood stabilizers, antidepressants, and atypical antipsychotics are helpful in specific personality disorders. Pharmacologic evidence is lacking for the treatment of persons with narcissistic and obsessive-compulsive personality disorders. Although patients with personality disorders usually do not like taking medicine unless it calms them down and are fearful about taking something over which they have no control, providers do attempt to mediate symptoms with psychotropic agents for improved quality of life.
Family members ask the nurse, "What can we say when our loved one says, 'Death is coming soon?'" To promote communication, which response could the nurse suggest for family members? a. "We feel sad when we think about life without you." b. "We have not given up on getting you well." c. "We think you will be around for a long time yet." d. "Let's talk about the good memories we have."
ANS: A The correct response is emotionally honest. It allows the family opportunities to express emotions, address issues in the relationship, and say farewell. The distracters are evasive.
A wife received news that her husband died of heart failure and called her family to come to the hospital. She angrily tells the nurse who cared for him, "He would still be alive if you had given him your undivided attention." Select the nurse's most therapeutic action. a. Say, "I understand you are feeling upset. I will stay with you until your family comes." b. Say, "Your husband's heart was so severely damaged that it could no longer pump." c. Say, "I will call my supervisor to discuss this matter with you." d. Hold the spouse's hand in silence until the family arrives.
ANS: A When bereaved family behaves in a disturbed manner, the nurse should show patience and tact while offering sympathy and warmth. The distracters are defensive, evasive, or placating. Touch (holding hands) is culturally defined; it may or may not be appropriate in this situation.
A patient with a new diagnosis of cancer says, "My father died of pancreatic cancer. I took care of him during his illness, so I know what is ahead for me." Which nursing diagnosis applies? a. Anticipatory grieving b. Ineffective coping c. Ineffective denial d. Spiritual distress
ANS: A The patient's experience demonstrates anticipatory grieving. The other diagnoses may apply but are not supported by the comment.
Which patients meet criteria for hospice services? (Select all that apply.) a. A 92-year-old diagnosed with acute pneumonia and late-stage Alzheimer's disease b. A 54-year-old diagnosed with glioblastoma and life expectancy of 8 to 10 weeks c. A 16-year-old with type 1 diabetes, multiple infections, and substance abused. d. A 74-year-old newly diagnosed with chronic obstructive pulmonary disease (COPD) and life expectancy of 2 years e. A 36-year-old diagnosed with multiple sclerosis complicated by major depressive disorder and pain associated with muscle spasms
ANS: A, B Hospice services are available to patients with terminal illnesses and a life expectancy of less than 6 months. The patient must choose hospice care, rather than curative treatments. Although patients with other health problems may experience complications, treatments focusing on cure would exclude them from hospice services.
Which actions by a nurse are most appropriate when caring for a hospice patient? (Select all that apply.) a. Giving choices b. Fostering personal control c. Explaining curative options d. Supporting the patient's spirituality e. Offering interventions that convey respect f.Providing answers to the patient's questions about spirituality
ANS: A, B, D, E The correct answers support the rights and choices of the dying individual. Acting on false information robs a patient of the opportunity for honest dialogue and places barriers to achieving end-of-life developmental opportunities. The nurse supports the patient's spirituality but does not have the answers to all questions.
After the death of his wife, a man says, "I can't live without her ... she was my whole life." Select the nurse's most therapeutic reply. a. "Each day will get a little better." b. "Her death is a terrible loss for you." c. "It's important to recognize that she is no longer suffering." d. "Your friends will help you cope with this change in your life."
ANS: B A statement that validates the bereaved person's loss is more helpful than commonplace clichés. It signifies understanding. The other options are clichés.
A woman just received notification that her husband died. She approaches the nurse who cared for him during his last hours and says angrily, "If you had given him your undivided attention, he would still be alive." Which analysis applies? a. The comment warns of a malpractice suit. b. Anger is a phenomenon experienced during grief. c. The wife had conflicted feelings about her husband. d. In some cultures, grief is expressed solely through anger.
ANS: B Anger may be manifested toward the health care system, God, or even the deceased. Anger may protect the bereaved from facing the devastating reality of loss. Anger expressed during mourning is not directed toward the nurse personally, even though accusations and blame may make him/her feel as though it is.
During a psychiatric assessment, the nurse observes a patients facial expression is without emotion. The patient says, Life feels so hopeless to me. Ive been feeling sad for several months. How will the nurse document the patients affect and mood? a. Affect depressed; mood flat b. Affect flat; mood depressed c. Affect labile; mood euphoric d. Affect and mood are incongruent.
ANS: B Mood refers to a persons self-reported emotional feeling state. Affect is the emotional feeling state that is outwardly observable by others. When there is no evidence of emotion in a persons expression, the affect is flat.
Which event is most likely to precipitate grief across a community? a. A local bank is robbed twice in a single month b. An adolescent shoots the principal of a local high school c. The elderly pastor of the town's largest church dies of heart failure d. Concrete pilings crumble in a bridge important to movement of local traffic
ANS: B The correct response identifies an event likely to be perceived as a public tragedy. The distracters are occurrences that are more commonplace. They may precipitate concern but not grief.
Which finding indicates successful completion of an individual's grief and mourning? a. For 2 years after her husband's death, a widow has kept her husband's belongings in their usual places. b. After 15 months, a widower realistically remembers both the pleasures and disappointments of his relationship with his wife. c. Three years after her husband's death, the widow talks about her husband as if he is alive and weeps when others mention his name. d. Eighteen months after a spouse's death, an adult says, "I have never cried or had feelings of loss, even though we were very close."
ANS: B The goals of mourning have evolved from doing the grief work, getting over it, and moving on with life. The work of grieving is over when the bereaved person can remember the individual realistically and acknowledge both the pleasure and disappointments associated with the loved one. The individual is then free to enter into new relationships and activities. The incorrect options suggest maladaptive grief.
A staff nurse asks a hospice nurse, "Who should be referred for hospice care?" Select the best response. a. "Hospice is for terminally ill patients diagnosed with cancer." b. "Patients in the end stage of any disease are eligible for hospice." c. "Hospice is designed to care for patients experiencing end-stage renal disease." d. "Patients diagnosed with degenerative neurological diseases are eligible for hospice after paralysis occurs."
ANS: B A hospice service cares for terminally ill patients regardless of diagnosis.
A patient with pancreatic cancer says, "I know I am dying, but I am still alive. I want to be in control as long as I can." Which reply by the nurse shows active listening? a. "Our staff will do their best to manage your pain." b. "Your mind and spirit are healthy, although your body is frail." c. "It's important for you to let others help you to ease their own pain." d. "Are you saying you want people to stop focusing on your diagnosis?"
ANS: B The patient has strengths and capabilities and is asking for acknowledgment that he/she is not incapacitated, even though the diagnosis is likely terminal. The correct answer provides that acknowledgment. The other responses are tangential.
As death approaches, a patient diagnosed with AIDS says, "I do not have enough energy for many visitors anymore and I am embarrassed about how I look. I only want to see my parents and sister." Which actions should the nurse take? (Select all that apply.) a. Encourage the patient to reconsider this decision so that interested and caring friends can provide support. b. Support the patient to share the request with the parents and sister. c. Assist family to inform the patient's friends of the request. d. Suggest that the patient discuss these wishes with clergy. e. Place a "No Visitors" sign on the patient's door
ANS: B, C The correct responses empower the patient to maintain dignity, control, personal space, and confidentiality. As some patients approach death, they begin to withdraw. In the stage of acceptance, many patients are exhausted and tired, and interactions of a social nature are a burden. Many prefer to have someone present at the bedside who will sit without talking constantly.
A patient diagnosed with depression begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about: a. restricting sodium intake to 1 gram daily. b. minimizing exposure to bright sunlight. c. reporting increased suicidal thoughts. d. maintaining a tyramine-free diet.
ANS: C Some evidence indicates that suicidal ideation may worsen at the beginning of antidepressant therapy; thus, close monitoring is necessary. Avoiding exposure to bright sunlight and restricting sodium intake are unnecessary. Tyramine restriction is associated with monoamine oxidase inhibitor (MAOI) therapy.
A nurse talks with a woman who recently learned that her husband died while jogging. Select the appropriate statement for the nurse. a. "At least your husband did not suffer." b. "It's better to go quickly as your husband did." c. "Your husband's loss must be very painful for you." d. "You will begin to feel better after you get over the shock."
ANS: C The most helpful responses by others validate the bereaved person's experience of loss. Avoid clichés, because they are ineffective
A patient who was widowed 18 months ago says, "I can remember good times we had without getting upset. Sometimes I even think about the disappointments. I am still trying to become accustomed to sleeping in the bed all alone." The work of mourning a. is beginning. b. has not begun. c. is at or near completion. d. is progressing abnormally.
ANS: C The work of mourning has been successfully completed when the bereaved can acknowledge both positive and negative memories about the deceased and when the task of restructuring the relationship with the deceased is completed.
A widow repeatedly tells details of finding her elderly husband not breathing, performing cardiopulmonary resuscitation, and seeing him pronounced dead. Family members are concerned and ask, "What can we do?" The nurse should counsel the family that a. they should express their feelings to the widow and ask her not to retell the story. b. the retelling should be limited to once daily to avoid unnecessary stimulation. c. repeating the story and her feelings is a helpful and necessary part of grieving. d. retelling of memories is expected as part of the aging process.
ANS: C Nurses are encouraged to tell bereaved patients that telling the personal story of loss as many times as needed is acceptable and healthy because repetition is a helpful and necessary part of grieving.
A widower tells friends, "I am taking my neighbor out for dinner. It's time for me to be more sociable again." Considering the stages of grief described by Kübler-Ross, which stage is evident? a. Anger b. Denial c. Depression d. Acceptance
ANS: D As an individual accepts loss, the person renews interest in people and activities. The person is seeking to move into new relationships. The patient's comment demonstrates an attempt to regain control. Bargaining is evidenced by people reviewing what could have been done differently. While the person may also experience occasional anger or sadness, the comment speaks directly to acceptance.
After a spouse's death, an adult repeatedly says, "I should have recognized what was happening and been more helpful." This adult is experiencing a. depression. b. bargaining. c. anger. d. guilt.
ANS: D Guilt is expressed by the bereaved person's self-reproach. Anger, depression, and bargaining cannot be assessed from data given in the scenario.
Four teenagers died in an automobile accident. Six months later, which behavior by the parents best demonstrates acceptance of the tragedy? The parents who: a. isolate themselves at home. b. return immediately to employment. c. forbid other teens in the household to drive a car. d. create a scholarship fund at their child's high school.
ANS: D Loss of a child is among the highest risk situations for maladaptive grieving. The parents who create a scholarship fund are openly expressing their feelings and memorializing their child. The other parents in this question are isolating themselves and/or denying their feelings.
A bystander was killed during a robbery 2 weeks ago. His widow, who is diagnosed with schizoaffective disorder, cries spontaneously when talking about his death. Select the nurse's most therapeutic response. a. "Are you hearing voices at night?" b. "I am worried about how much you are crying. Your grief over your husband's death has gone on too long." c. "This loss is harder to accept because of your mental illness. I will refer you to a partial hospitalization program." d. "The unexpected death of your husband must be very painful. I am glad you are able to talk to me about your feelings."
ANS: D The patient is expressing feelings related to the loss, and this is an expected and healthy behavior. This patient is at risk for dysfunctional grieving because of the history of a serious mental illness, but the nurse's priority intervention is to form a therapeutic alliance and support the patient's expression of feelings. The crying 2 weeks after his death is expected and normal.
An adult says to the nurse, "The cancer in my neck spread in only 2 months. I've been cursed my whole life. Maybe if I had been more generous with others ..." Considering the stages of grief described by Kübler-Ross, which stage is evident? a. Anger b. Denial c. Depression d. Bargaining
ANS: D The patient's comment demonstrates an attempt to regain control. Bargaining is evidenced by people reviewing what could have been done differently. While the person may also be experiencing anger and depression, the comment speaks directly to bargaining. The person shows acceptance of the disease.
A child drowned while swimming in a local lake 2 years ago. Which behavior best indicates the child's parents are mourning in an effective way? The parents a. forbid their other children from going swimming. b. keep a place set for the deceased child at the family dinner table. c. sealed their child's room exactly as the child left it 2 years ago. d. throw flowers on the lake at each anniversary date of the accident.
ANS: D Loss of a child is among the highest risk situations for maladaptive grieving. Depending on many factors, this process can take many months to a number of years. The parents who throw flowers on the lake on each anniversary date of the accident are openly expressing their feelings. The incorrect options indicate the parents are isolating themselves and/or denying their feelings.
A hospice patient tells the nurse, "Life has been good. I am proud of being self-educated. I overcame adversity and always gave my best. I intend to die as I lived." The nurse planning care for this patient would recognize the importance of a. providing aggressive pain and symptom management. b. helping the patient reassess and explore existing conflicts. c. assisting the patient to focus on the meaning in life and death. d. supporting the patient's use of own resources to meet challenges
ANS: D The patient whose intrinsic strength and endurance have been a hallmark often wishes to approach dying by staying optimistic and in control. Helping such patients use their own resources to meet challenges would be appropriate.
Which personality disorder is this describing? Fails to conform to social norms with respect to lawful behaviors Deceitfulness (repeated lying, uses of aliases, or conning others) for personal profit or pleasure Impulsivity Irritability and aggressiveness, repeated physical fights or assault Reckless disregard for safety of self or others Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
Antisocial personality disorder (dramatic/erratic)
Which statement about persons with personality disorders is accurate? a. They, unlike those with mood or psychotic disorders, are at very low risk of suicide. b. They tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them. c. They are believed to be purely psychological disorders, that is, disorders arising from psychological rather than neurological or other physiological abnormalities. d. Their symptoms are not as disabling as most other mental disorders; therefore, their care tends to be less challenging and complicated for staff.
B
What are the 3 anxious/fearful personality disorders?
Avoidant Personality Disorder Dependent Personality Disorder Obsessive-Compulsive Personality Disorder
Josie, a 27-year-old patient, complains that most of the staff do not like her or care what happens to her, but you are special and she can tell that you are a caring person. She talks with you about being unsure of what she wants to do with her life and her "mixed-up feelings" about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it "makes the numbness stop." Given this presentation, which personality disorder would you suspect? a. Obsessive-compulsive b. Borderline c. Antisocial d. Schizotypal
B
Which neurotransmitters are most responsible for wakefulness? Select all that apply. a. Gamma-aminobutyric acid (GABA) b. Norepinephrine c. Acetylcholine d. Dopamine e. Galanin
B, C & D Gamma-aminobutyric acid (GABA) and galanin are sleep-promoting neurotransmitters.
Belinda is a 24-year-old patient with borderline personality disorder (BPD). She is admitted to the inpatient psychiatric unit following a suicide attempt. You are caring for Belinda. Which of the following statements by Belinda illustrates a primary coping style of persons with BPD? A. "My provider says I might get out of here tomorrow. Do you think I'm ready to go?" B. "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." C. "I will never again speak to any of my messed up family members. I know that this will help me be more functional." D. "I promise I am not feeling suicidal. I won't hurt myself."
B A primary coping style used by patients with BPD is called splitting. Splitting is the inability to incorporate positive and negative aspects of oneself or others into a whole image. The individual may tend to idealize another person (friend, lover, health care professional) at the start of a new relationship and hope that this person will meet all of his or her needs. At the first disappointment or frustration, however, the individual quickly shifts to devaluation, despising the other person. The other options do not describe splitting, which is a primary coping style of patients with BPD.
Which level of prevention activities would a nurse in an emergency department employ most often? a. Primary b. Secondary c. Tertiary
B An emergency department nurse would generally see patients in crisis or with acute illness, so secondary prevention is used. Primary prevention involves preventing a health problem from developing, and tertiary prevention applies to rehabilitative activities.
Research has indicated that the antisocial personality may be characterized by A. social isolation. B. lack of remorse. C. learning difficulties. D. difficulty with reality testing.
B Individuals with an antisocial personality exhibit a lack of remorse when confronted with the results of their thoughtless, irresponsible behavior toward others.
Select the example of primary prevention. a. Assisting a person diagnosed with a serious mental illness to fill a pill-minder b. Helping school-age children identify and describe normal emotions c. Leading a psychoeducational group in a community care home d. Medicating an acutely ill patient who assaulted a staff person
B Primary preventions are directed at healthy populations with a goal of preventing health problems from occurring. Helping school-age children describe normal emotions people experience promotes coping, a skill that is needed throughout life. Assisting a person with serious and persistent mental illness to fill a pill-minder is an example of tertiary prevention. Medicating an acutely ill patient who assaulted a staff person is a secondary prevention. Leading a psychoeducational group in a community care home is an example of tertiary prevention.
A newly admitted client has an axis II diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be to A. set firm limits on behavior. B. respect need for social isolation. C. encourage expression of feelings. D. involve in milieu and group activities
B Schizoid personality disorder has the primary feature of emotional detachment. Individuals do not seek out or enjoy close relationships. They are reclusive, avoidant, and uncooperative. They do not do well with resocialization.
Playing one staff member against another is an example of A. devaluation. B. splitting. C. impulsiveness. D. social ineptitude
B Splitting involves setting up individuals or groups to disagree. While the two parties are busy disagreeing, they are too busy to maintain consistent limits for the manipulative client. The client can enjoy the spectacle and do as he or she pleases.
Substance abuse is often present in people diagnosed with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that: a. Anxiety may be present. b. Alcohol ingestion is a form of self-medication. c. The patient is lacking a sufficient number of neurotransmitters. d. The patient is using alcohol because she is depressed.
B b. Alcohol ingestion is a form of self-medication.
A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially? a. Reinforce that the level is considered therapeutic. b. Instruct the patient to hold the next dose of medication and contact the prescriber. c. Have the patient go to the hospital emergency room immediately. d. Alert the patient to the possibility of seizures and appropriate precautions
B b. Instruct the patient to hold the next dose of medication and contact the prescriber.
Which characteristic would be more applicable to a community mental health nurse than to a nurse working in an operating room? a. Kindness b. Autonomy c. Compassion d. Professionalism
B) A community mental health nurse often works autonomously. Kindness, compassion, and professionalism apply to both nurses.
Tatiana has been hospitalized for an acute manic episode. On admission the nurse suspects lithium toxicity. What assessment findings would indicate the nurse's suspicion as correct? a. Shortness of breath, gastrointestinal distress, chronic cough b. Ataxia, severe hypotension, large volume of dilute urine c. Gastrointestinal distress, thirst, nystagmus d. Electroencephalographic changes, chest pain, dizziness
B) Ataxia, severe hypotension, large volume of dilute urine
A nurse receives these three phone calls regarding a newly admitted patient. • The psychiatrist wants to complete an initial assessment. • An internist wants to perform a physical examination. • The patient's attorney wants an appointment with the patient. The nurse schedules the activities for the patient. Which role has the nurse fulfilled? a. Advocate b. Case manager c. Milieu manager d. Provider of care
B) Nurses on psychiatric units routinely coordinate patient services, serving as case managers as described in this scenario. The role of advocate would require the nurse to speak out on the patient's behalf. The role of milieu manager refers to maintaining a therapeutic environment. Provider of care refers to giving direct care to the patient.
A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor's closet is locked. These observations relate to a. coordinating care of patients. b. management of milieu safety. c. management of the interpersonal climate. d. use of therapeutic intervention strategies.
B) Nursing staff are responsible for all aspects of milieu management. The observations mentioned in this question directly relate to the safety of the unit. The other options, although part of the nurse's concerns, are unrelated to the observations cited.
A new patient at the sleep disorders clinic tells the nurse, "I have not slept well in a year, so I never feel good. I do not expect things will ever improve or be any different." Interventions the nurse should consider include: (select all that apply) a. suggesting use of alcohol as a sedative. b. providing instruction in relaxation techniques. c. counseling the patient to address cognitive distortions. d. health teaching regarding factors that influence sleep. e. teaching fatigue-producing activities to become overtired. f. encouraging long daytime naps to compensate for sleep deprivation.
B, C & D Interventions that could be helpful include teaching relaxation techniques, such as meditation or progressive relaxation, to relieve the tension that sometimes prevents initiation of sleep. Reviewing factors that influence sleep can assist the patient to diagnose and remove barriers to sleep. Cognitive therapy could be helpful in combating the hopelessness verbalized by the patient. Alcohol consumption actually disrupts sleep. Becoming overtired may be a barrier to nighttime sleep. Naps may help replace lost sleep, but lengthy daytime sleep will prevent the patient from sleeping well at night.
Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply. a. "Do rules apply to you?" b. "What do you do to manage anxiety?" c. "Do you have a history of disordered eating?" d. "Do you think that you drink too much?" e. "Have you ever been arrested for committing a crime?"
B, C, D b. "What do you do to manage anxiety?" c. "Do you have a history of disordered eating?" d. "Do you think that you drink too much?"
A person diagnosed with SMI has frequent relapses, usually precipitated by situational stressors such as running out of money or the absence of key staff at the mental health center. Which interventions would the nurse suggest to reduce the risk of stressors to cause relapse? (Select all that apply.) a. Discourage potentially stressful activities such as groups or volunteer work. b. Develop written plans that will help the patient remember what to do in a crisis. c. Help the patient identify and anticipate events that are likely to be overwhelming. d. Encourage health-promoting activities such as exercise and getting adequate rest. e. Accompany the patient to a NAMI support group.
B, C, D & E Basic interventions for coping with crises involve anticipating crises where possible and then developing a plan with specific actions to take when faced with an overwhelming stressor. Written plans are helpful; it can be difficult for anyone, especially a person with cognitive or memory impairments, to develop or remember steps to take when under overwhelming stress. Health-promoting activities enhance a person's ability to cope with stress. As the name suggests, support groups help a person develop a support system, and they provide practical guidance from peers who learned from experience how to deal with issues the patient may be facing. Groups and volunteer work may involve a measure of stress but also provide benefits that help persons cope and should not be discouraged unless they are being done to excess.
Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply. a. Female b. 7 years old c. Comorbid autism diagnosis d. Outbursts occur at least once a week e. Temper tantrums occur at home and in school
B, C, E b. 7 years old c. Comorbid autism diagnosis e. Temper tantrums occur at home and in school
Kara is a 23-year-old patient admitted with depression and suicidal ideation. Which intervention(s) would be therapeutic for Kara? Select all that apply. a. Focus primarily on developing solutions to the problems leading the patient to feel suicidal. b. Assess the patient thoroughly and reassess the patient at regular intervals as levels of risk fluctuate. c. Avoid talking about the suicidal ideation as this may increase the patient's risk for suicidal behavior. d. Meet regularly with the patient to provide opportunities for the patient to express and explore feelings. e. Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group. f. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic.
B, D, E, F
One month ago, an adult died from cancer. Family members now gather at the adult's home to dispose of the deceased's belongings. Which comments demonstrate the family member is coping with the loss in an effective way? (Select all that apply.) a. "Her possessions still have her scent. We should dispose of them." b. "Let's take turns selecting items of hers we would each like to have." c. "When I die, I hope someone who loved me goes through my things." d. "This was her favorite jacket. If we donate it to charity, someone else can enjoy it too." e. "We're violating her privacy by looking through her things. Let's call a charity to come pick up everything."
B,C,D b. "Let's take turns selecting items of hers we would each like to have." c. "When I die, I hope someone who loved me goes through my things." d. "This was her favorite jacket. If we donate it to charity, someone else can enjoy it too."
Which statement would best show acceptance of a depressed, mute client? A. "I will be spending time with you each day to try to improve your mood." B. "I would like to sit with you for 15 minutes now and again this afternoon." C. "Each day we will spend time together to talk about things that are bothering you." D. "It is important for you to share your thoughts with someone who can help you evaluate your thinking."
B. "I would like to sit with you for 15 minutes now and again this afternoon." Spending time with the client without making demands is a good way to show acceptance. While not inappropriate, the other options are less
A nurse notices a severely withdrawn client is wearing a new shirt and has neat, clean hair. Which remark by the nurse supports building a positive self-esteem for this client? A. "You look great this morning." B. "You are wearing a new shirt." C. "I like the shirt you are wearing." D. "You must be feeling better today."
B. "You are wearing a new shirt."
This patient comes into the clinic with their wife and the wife states that her husband often wakes seeming afraid during the night in a sweat and his heart racing, but the husband has a very fuzzy memory of what actually happens. This client has A. Insomnia B. Sleep terrors disorder C. Nightmare disorder D. Narcolepsy
B. Sleep terrors disorder This d/o differs from Nightmare d/o in that the person with Sleep terrors wakes up screaming and in fear with signs of increase ANS arousal, unable to remember the details of their dream, and has amnesia about the entire episode. Person with Nightmare d/o can remember their dreams and becomes oriented upon wakening from the dream.
Cody is a 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months. He is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be an appropriate priority outcome for Cody's treatment plan while in the hospital? A. Cody will return to a predrug level of functioning within 1 week B. Cody will be medically stabilized while in the hospital C. Cody will state within 3 days that he will totally abstain from drugs and alcohol D. Cody will take a leave of absence from college to alleviate stress
B. Cody will be medically stabilized while in the hospital If the patient has been abusing substances heavily, he will begin to experience physical symptoms of withdrawal, which can be dangerous if not treated. The priority outcome is for the patient to withdraw from the substances safely with medical support. Substance use disorder outcome measures include immediate stabilization for individuals experiencing withdrawal such as in this instance, as well as eventual abstinence if individuals are actively using, motivation for treatment and engagement in early abstinence, and pursuit of a recovery lifestyle after discharge. The first option is an unrealistic time frame. It is not likely that the patient will make a total commitment to abstinence within this time frame. Although a leave of absence may be an option, the immediate need is to make sure the patient goes through drug and alcohol withdrawal safely.
What statement about the comorbidity of depression is accurate? A. Depression most often exists in an individual as a single entity. B. Depression is commonly seen in individuals with medical disorders. C. Substance abuse and depression are seldom seen as comorbid disorders. D. Depression may coexist with other disorders but is rarely seen with schizophrenia.
B. Depression is commonly seen in individuals with medical disorders. Depression commonly accompanies medical disorders. The other options are false statements.
A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." How should the nurse respond to this statement? A. "That is a good observation. Depression does mostly strike people older than 50 years." B. "Depression is seen in people of all ages, from childhood to old age." C. "Depression is most often seen among the middle adult age group." D. "The age of onset for most depressive episodes is given as 18 years."
B. Depression is seen in people of all ages, from childhood to old age." Depression can occur at any age. Children, adolescents, adults, and the elderly may all experience depression.
A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested A. LAAM B. GHB C. ReVia D. Clonidine
B. GHB The drugs most frequently used to facilitate a sexual assault (rape) are flunitrazepam (Rohypnol, "roofies"), a fast-acting benzodiazepine, and gamma-hydroxybutyrate (GHB) and its congeners. These drugs are odorless, tasteless, and colorless; mix easily with drinks; and can render a person unconscious in a matter of minutes. Perpetrators use these drugs because they rapidly produce disinhibition and relaxation of voluntary muscles; they also cause the victim to have lasting anterograde amnesia for events that occur.
What is one herbal therapy that can be used to help regulate the circadian rhythm and improve sleeping patterns? A. Cymbalta B. Melatonin C. Gabitril D. Lunesta
B. Melatonin An endogenous hormone that reduces transient insomnia
When the nurse asks whether a client is having any thoughts of suicide, the client becomes angry and defensive, shouting, "I'm sick of you people! Are you ever do is ask me the same question over and over. Get out of here!" The nurse's response is based on what fact concerning hostility? A. The client is getting better and is able to be assertive. B. The client may be at high risk for self-harm. C. The client is probably experiencing transference. D. The client may be angry at someone else and projecting that anger to staff.
B. The client may be at high risk for self-harm. Overt hostility is highly correlated with suicide; therefore the patient may be considered high risk, and appropriate precautions should be taken. The other responses are incorrect with no evidence to support them.
Which of the following medications would be least likely to be given to a client with depression who also has insomnia diagnosis, as it decreases sleep: A. Pristiq B. Wellbutrin C. Cymbalta D. trazadone (Desyrel) E. Ambien
B. Wellbutrin
You're caring for Mick, a 32 year old patient with chemical addiction who will soon to be preparing for discharge. A principle of counseling interventions that should be observed when caring for a patient with chemical addiction is to: A. praise the patient for compliant behavior B. communicate that relapses are always possible C. confirm that the patient's recovery is considered complete after discharge D. encourage Mick to resume his former friendships to regain a sense of normalcy
B. communicate that relapses are always possible
A person who covertly supports the substance abusing behavior of another is called a(n) A. patsy B. enabler C. participant D. minimizer
B. enabler An enabler is one who helps a substance-abusing patient avoid facing the consequences of drug use
A client brought to the emergency department after phenylcyclohexylpiperidine (PCP) ingestion is both verbally and physically abusive, and the staff is having difficulty keeping him and themselves safe. The nursing intervention that would be most therapeutic is A. taking him to the gym on the psychiatric unit B. obtaining an order for seclusion and close observation C. assigning a psychiatric technician to "talk him down" D. administering naltrexone as needed per hospital protocol
B. obtaining an order for seclusion and close observation Aggressive, violent behavior is often seen with PCP ingestion. The client will respond best to a safe, low-stimulus environment such as that provided by seclusion until the effects of the drug wear off. Talking down is never advised because of the client's unpredictable violent potential. Naltrexone is an opiate antagonist.
Erik is a 26-year-old patient who abuses heroin. He states to you, "I've been using more heroin lately. I told my provider about it and she said I need more and more heroin to feel the effect I want." You know this describes: A. intoxication B. tolerance C. withdrawal D. addiction
B. tolerance Tolerance is described as needing increasing greater amounts of a substance to receive the desired result to become intoxicated or finding that using the same amount over time results in a much-diminished effect. Intoxication is the effect of the drug. Withdrawal is a set of symptoms patients experience when they stop taking the drug. Addiction is loss of behavioral control with craving and inability to abstain, loss of emotional regulation, and loss of the ability to identify problematic behaviors and relationships.
When intervening with a patient who is intoxicated from alcohol, it's useful to first: A. let the patient sober up B. decide immediately on care goals C. ask what drugs other than alcohol the patient has recently used D. gain adherence by sharing your personal drinking habits with the patient
C. ask what drugs other than alcohol the patine has recently used
Which personality disorder is this describing? Avoids real or imagined abandonment Unstable and intense interpersonal relationships with alternating extremes of idealization and devaluation Identity disturbance, unstable self-image or sense of self Impulsivity in potentially self-damaging areas (ex: spending, sex, substance use, reckless driving, binge eating) Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior Profound reactivity of mood (Ex: intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days) Chronic feelings of emptiness Inappropriate anger that's difficult to control (ex: frequent displays of temper, recurrent physical fights)
Borderline personality disorder (Dramatic/erratic)
A suspicious, socially isolated patient lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. Select a community psychiatric nurse's best initial action. a. Explore ways to help the patient stop smoking. b. Report the situation to the manager of the shelter. c. Assess the patient's weight; determine foods and amounts eaten. d. Arrange hospitalization for the patient in order to formulate a new treatment plan.
C) Assessment of biopsychosocial needs and general ability to live in the community is called for before any other action is taken. Both nutritional status and income adequacy are critical assessment parameters. A patient may be able to maintain adequate nutrition while eating only one meal a day. The rule is to assess before taking action. Hospitalization may not be necessary. Smoking cessation strategies can be pursued later.
A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, "You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing": a. A higher dosage b. Once a week dosing c. A lower dosage d. A different drug
C
Clients demonstrating characteristics of personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. A nursing diagnosis that addresses this sort of interpersonal dysfunction is A. spiritual distress. B. defensive coping. C. impaired social interaction. D. disturbed sensory perception.
C For a client who has difficulty in relationships and is very manipulative, the nursing diagnosis of impaired social interaction would be used
Characteristic behaviors the nurse will assess in the narcissistic client are A. dramatic expression of emotion, being easily led. B. perfectionism and preoccupation with detail. C. grandiose, exploitive, and rage-filled behavior. D. angry, highly suspicious, aloof, withdrawn behavior
C Narcissistic clients give the impression of being invulnerable and superior to others to protect their fragile self-esteem.
The priority nursing intervention for a client diagnosed with borderline personality disorder is to A. protect other clients from manipulation. B. respect the client's need for social isolation. C. assess for suicidal and self-mutilating behaviors. D. provide clear, consistent limits and boundaries.
C One of the primary nursing guidelines/interventions for clients with a personality disorder is to assess for suicidal and self-mutilating behaviors, especially during times of stress.
Splitting is a process in which the client A. unconsciously represses undesirable aspects of self. B. places responsibility for his or her behavior outside the self. C. sees things as divided into "all good" or "all bad." D. evidences lack of personal boundaries.
C Splitting demonstrates the failure to integrate the positive and negative into a cohesive whole. An individual is not seen as a person with good and bad traits, but rather as all good or all bad.
A patient was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the case manager learned that the patient received a notice of eviction immediately prior to admission. Select the case manager's most appropriate action. a. Postpone the patient's discharge from the hospital. b. Contact the landlord who evicted the patient to further discuss the situation. c. Arrange a temporary place for the patient to stay until new housing can be arranged. d. Determine whether the adverse medication reaction was genuine because the patient had nowhere to live.
C The case manager should intervene by arranging temporary shelter for the patient until an apartment can be found. This activity is part of the coordination and delivery of services that falls under the case manager role. None of the other options is a viable alternative.
The unit secretary receives a phone call from the health insurer for a hospitalized patient. The caller seeks information about the patient's projected length of stay. How should the nurse instruct the unit secretary to handle the request? a. Obtain the information from the patient's medical record and relay it to the caller. b. Inform the caller that all information about patients is confidential. c. Refer the request for information to the patient's case manager. d. Refer the request to the health care provider.
C The case manager usually confers with insurers and provides the treatment team with information about available resources. The unit secretary should be mindful of patient confidentiality and should neither confirm that the patient is an inpatient nor disclose other information.
The client diagnosed with a personality disorder who is most likely to be admitted to a psychiatric unit is one who has A. paranoid personality disorder and is suspicious of his neighbors. B. narcissistic personality disorder and is highly self-important. C. borderline personality disorder and is impulsive. D. dependent personality disorder and clings to her husband.
C Clients with borderline disorder can decompensate into psychotic states under stress. Hospitalization is needed at these times.
A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit A. frequent episodes of psychosis. B. constant involvement with the needs of significant others. C. inflexible and maladaptive responses to stress. D. abnormal ego functioning.
C Personality patterns persist unmodified over long periods of time. Inflexible and maladaptive responses to stress are characteristic of individuals with a personality disorder.
Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his blood tests confirm. To reduce Ted's mania the psychiatric nurse practitioner recommends: a. Clonazepam (Klonopin) b. Fluoxetine (Prozac) C. Electroconvulsive Therapy (ECT) d. Lurasidone (Latuda)
C. Electroconvulsive Therapy (ECT)
A patient diagnosed with schizophrenia had an exacerbation related to medication non-adherence and was hospitalized for 5 days. The patient's thoughts are now more organized and discharge is planned. The patient's family says, "It's too soon for discharge. We will just go through all this again." The nurse should a. ask the case manager to arrange a transfer to a long-term care facility. b. notify hospital security to handle the disturbance and escort the family off the unit. c. explain that the patient will continue to improve if the medication is taken regularly. d. contact the health care provider to meet with the family and explain the discharge rationale.
C) Patients do not stay in a hospital until every symptom disappears. The nurse must assume responsibility to advocate for the patient's right to the least restrictive setting as soon as the symptoms are under control and for the right of citizens to control health care costs. The health care provider will use the same rationale. Shifting blame will not change the discharge. Security is unnecessary. The nurse can handle this matter.
The admission note indicates a client diagnosed with major depressive disorder has anergia and anhedonia. A nurse should plan for which of the following measures? Select all that apply. A. Channel excessive energy B. Reduce feelings of guilt C. Instill a sense of hopefulness D. Assist with self-care activities E. Accommodate psychomotor retardation
C, D, E
A person diagnosed with a SMI living in the community was punched, pushed to the ground, and robbed of $7 during the day on a public street. Which statements about violence and SMI in general are accurate? (Select all that apply.) a. Persons with SMI are more likely to be violent. b. SMI persons are more likely to commit crimes than to be the victims of crime. c. Impaired judgment and social skills can provoke hostile or assaultive behavior. d. Lower incomes force SMI persons to live in high-crime areas, increasing risk. e. SMI persons experience higher rates of sexual assault and victimization than others. f. Criminals may believe SMI persons are less likely to resist or testify against them.
C, D, E & F Mentally ill persons are more likely to be victims of crime than perpetrators of criminal acts. They are often victims of criminal behavior, including sexual crimes, at a higher rate than others. When a mentally ill person commits a crime, it is usually nonviolent. Mental illnesses interfere with employment and are associated with poverty, limiting SMI persons to living in inexpensive areas that also tend to be higher-crime areas. SMI persons may inadvertently provoke others because of poor judgment or socially inappropriate behavior, or they may be victimized because they are perceived as passive, less likely to resist, and less likely to be believed as witnesses. See related audience response question.
Which of the following would you most likely expect the young child with night terrors to say: A. "That was such a horrible nightmare I had--it was about scary clowns" B. "My mom held me while I cried and it helped me feel a lot better" C. "I really don't remember much about it, I can't even remember waking up" D. "I bumped into the table and it gave me this bruise when I was sleep"
C. "I really don't remember much about it, I can't even remember waking up" These individuals usually cannot remember the dream, are not easily consoled after waking fearful, and cannot remember having the episode in the middle of the night.
A client prescribed fluoxetine demonstrates an understanding of the medication teaching when making which statement? A. "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." B. "I will not take any over-the-counter medication while on the fluoxetine." C. "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." D. "I will report increased thirst and urination to my provider."
C. "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." "This describes symptoms of serotonin syndrome, a life-threatening complication of SRRI medication. The other options are incorrect because the patient should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the provider, and would not have been educated to report increased thirst and urination as a side effect of fluoxetine.
Which of the drugs used by a polysubstance abuser is most likely to be responsible for withdrawal symptoms requiring both medical intervention and nursing support? A. opiates B. marijuana C. barbiturates D. hallucinogens
C. barbiturates Withdrawal from central nervous system depressants is complicated, requiring carefully titrated detoxification with a similar drug. Abrupt withdrawal can lead to death.
A teaching need is revealed when a patient taking disulfiram (Antabuse) states, A. "I usually treat heartburn with antacids." B. "I take ibuprofen or acetaminophen for headache." C. "Most over the counter cough syrups are safe for me to use." D. "I have had to give up using aftershave lotion."
C. "Most over the counter cough syrups are safe for me to use." The patient taking disulfiram has to avoid hidden sources of alcohol. Many cough syrups contain alcohol
A 38-year-old patient is admitted with major depression. Which statement made by the patient alerts the nurse to a common accompaniment to depression? A. I still pray and read my bible every day B. My mother wants to move in with me, but I want to be independent. C. I still feel bad about my sister dying of cancer. I should have done more for her! D. I've heard others say that depression is a sign of weakness.
C. I still feel bad about my sister dying of cancer. I should have done more for her!" Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible describes a coping mechanism; the other responses do not describe a common accompaniment to depression
A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse should identify this cognitive distortion as what response? A. Self-blame B. Catatonia C. Learned helplessness D. Discounting positive attributes
C. Learned helplessness Learned helplessness results in depression when the client feels no control over the outcome of a situation. None of the other options demonstrate these feelings
Which of the following is CORRECT? A. Infants less than 12 months need roughly 10 hours of sleep per day B. Older adults require fewer hours of sleep than young adults, roughly 6 hours/day C. School aged children need roughly 9 hours of sleep per night D. Young adults require 10 hours of sleep per day, with at least one hour coming from naps
C. School aged children need roughly 9 hours of sleep per night - <12 months: 16-18 hours of sleep per day, sleeping during both day and night hours - Children ages 1-5 need about 9-12 hours of sleep per day (mostly at night) - School age children need 9 hours of sleep/day- Adolescents and young adults require 7-8 hours of sleep -Older adults still need 7-8 hours of sleep (may have an advanced circadian rhythm where they go to bed early and wake up early)
A client was diagnosed with major depressive disorder after their employment was terminated. The client says to the nurse, "I am not worth the time you spend with me. I am the most useless person in the world." Which of the following nursing diagnoses best applies to this statement? A. Powerlessness B. Defensive coping C. Situational low self-esteem D. Disturbed personal identity
C. Situational low self-esteem
Which of the following should the MD suggest to the night-shift nurse who has come into her clinic complaining of excessive sleepiness and fatigue during the day. A. Try to work all of your shifts in succession B. Take at least a 2 hour nap during the day if possible C. Sleep in a dark room with no windows D. Play soft music at night to help you fall asleep
C. Sleep in a dark room with no windows Helping to reduce external stimulation (light, noise) in the sleeping area can improve sleeping patterns at night and reduce feelings of excessive sleepiness during the day. The night-shift nurse should try to avoid working multiple days in a row.
A client with generalized anxiety disorder also suffers from insomnia, as she lies awake at night worrying about the next day's responsibilities. The nurse would expect which of the following medications to only be used short term to help with sleep in this client: A. Lyrica B. Lunesta C. Xanax D. Ambien
C. Xanax This is a benzodiazepine that is used short-term to promote the effects of GABA receptors to induce sleep. The others listed are non-benzodiazepine medications used to help induce sleep.
Which of the following treatments would be best to address a patient with narcolepsy? A. Avoid naps during the daytime hours B.Eating 3 heavy meals per day with no snacking C. a stimulant medication such as Ritalin D. Daily doses of benzodiazepine, such as Ativan
C. a stimulant medication such as Ritalin Treatment includes: -Light or vegetarian meals -Having planned naps throughout the day -Antidepressants (SSRI, TCA) -Stimulants (Dexedrine and Ritalin) -Anticonvulsants (Nuvigil)
Which of the following is true regarding substance addiction and medical comorbidity? A. most substance abusers don't have medical comorbidities B. there has been little research done regarding substance addiction disorders and medial comorbidity C. conditions such as hep C, diabetes, and HIV infection are common comorbidities D. Cormorbid conditions are thought to positively affect those with substance addiction in that these patients seek help for symptoms earlier
C. conditions such as hep C, diabetes, and HIV infection are common comorbidities The more common co-occurring medical conditions are hepatitis C, diabetes, cardiovascular disease, HIV infection, and pulmonary disorders. The high comorbidity appears to be the result of shared risk factors, high symptom burden, physiological response to licit and illicit drugs, and the complications from the route of administration of substances. Most substance abusers do have medical comorbidities. There is research such as the 2001-2003 National Comorbidity Survey Replication (NCS-R) showing the correlation between medical comorbidities and psychiatric disorders. It is more likely that medical comorbidities negatively affect substance addiction in that they cause added symptoms, stress, and burden.
Which of the following is NOT an appropriate nursing intervention to implement the role of rest for patients? A. consolidate patient services and tasks for the evening into one hour B. keeping the patient active and occupied during the day hours C. encouraging multiple short naps throughout the day D. simulating day time by opening the blinds to improve circadian rhythm patterns
C. encouraging multiple short naps throughout the day You want to help the patient to limit the number of naps taken during the day, as long/frequent naps decrease rest and sleep at night time.
The most helpful message to transmit about relapse to the recovering alcoholic patient is that lapses A. are an indicator of treatment failure B. are caused by physiological changes C. result from lack of good situational support D. can be learning situations to prolong sobriety
C. result from lack of good situational support Relapses can point out problems to be resolved and can result in renewed efforts for change
In helping an addicted individual plan for ongoing treatment, which intervention is the first priority or a safe recovery? A. ongoing support from at least two family members must be secured B. the patient needs to be employed C. the patient must strive to maintain abstinence D. a regular schedule of appointments with a primary care provider must be set up
C. the patient must strive to maintain abstinence Abstinence is the safest treatment goal for all addicts. Abstinence is strongly related to good work adjustments, positive health status, comfortable interpersonal relationships, and general social stability.
Which of the following is NOT a common side effect related to sleep deprivation? A. weakened immune system B. worsening of depression symptoms C. weight loss D. decreased hand-eye coordination
C. weight loss The common side effects of sleep deprivation include: - weight GAIN - weakened immune system - worsening of depression symptoms and other mental illnesses - increase in pain perception - decreased hand-eye coordination - memory problems - cardiac diseases
Lacey, a 19-year-old patient, shows you multiple fresh, serious (but non-life-threatening) self-inflicted cuts on her forearm. Which response would be most therapeutic? a. "I'm so sorry you felt so bad that you cut yourself! Let's discuss what led up to this action while I take care of your wounds. "b. "I will take care of the wounds first, then you will have to be searched for anything else you could injure yourself with." c. "I can give you some Band-Aids for you to put on your cuts, but you need to stop this attention-seeking behavior." d. "After I care for your wounds, I'd like you to write down what you were thinking and feeling before you cut yourself; then we will discuss it."
D
Which behavior would be inconsistent with defining characteristics for the nursing diagnosis of ineffective coping? A. Difficulty in relationships B. High levels of anxiety C. Manipulation D. Interdependence
D The characteristics for the diagnosis of ineffective coping include crisis, high levels of anxiety, anger, and aggression; child, elder, or spouse abuse; and difficulty in relationships and manipulation. Interdependence would not be considered a symptom for ineffective coping
Mary Alice is a 37-year-old patient referred to the mental health clinic with a suspected personality disorder. She is withdrawn and suspicious and states she has always preferred to be alone. She describes herself as having "special powers" and states that she is thinking of opening a business where she gives "readings" to people about their future. She states, "I believe we can all read each other's thoughts at times." Based on this presentation, you suspect: A. obsessive-compulsive personality disorder. B. narcissistic personality disorder. C. avoidant personality disorder. D. schizotypal personality disorder (STPD).
D The main traits that describe STPD are psychoticism such as eccentricity, odd or unusual beliefs and thought processes, and social detachment by preferring to be socially isolated, as well as being overly suspicious or anxious. In obsessive-compulsive personality disorder the main pathological personality traits are rigidity and inflexible standards of self and others, along with persistence of goals long after they are necessary, even if they are self-defeating or negatively affect relationships. People with narcissistic personality disorder come across as arrogant, with an inflated view of their self-importance. They have a need for constant admiration, along with a lack of empathy for others, a factor that strains most relationships over time. Traits of avoidant personality disorder include low self-esteem, feelings of inferiority compared with peers, and a reluctance to engage in unfamiliar activities involving new people.
Which patient would be most appropriate to refer for assertive community treatment (ACT)? A patient diagnosed with a. a phobic fear of crowded places. b. a single episode of major depressive disorder. c. a catastrophic reaction to a tornado in the community. d. schizophrenia and four hospitalizations in the past year.
D) ACT provides intensive case management for persons with serious persistent mental illness who live in the community. Repeated hospitalization is a frequent reason for this intervention. The distracters identify mental health problems of a more episodic nature.
The patients below were evaluated in the emergency department. The psychiatric unit has one bed available. Which patient should be admitted? The patient: a. feeling anxiety and a sad mood after separation from a spouse of 10 years. b. who self-inflicted a superficial cut on the forearm after a family argument. c. experiencing dry mouth and tremor related to taking antipsychotic medication. d. who is a new parent and hears voices saying, "Smother your baby."
D) Admission to the hospital would be justified by the risk of patient danger to self or others. The other patients have issues that can be handled with less restrictive alternatives than hospitalization.
Which aspect of direct care is an experienced, inpatient psychiatric nurse most likely to provide for a patient? a. Hygiene assistance b. Diversional activities c. Assistance with job hunting d. Building assertiveness skills
D) Assertiveness training relies on the counseling and psychoeducational skills of the nurse. Assistance with personal hygiene would usually be accomplished by a psychiatric technician or nursing assistant. Diversional activities are usually the province of recreational therapists. The patient would probably be assisted in job hunting by a social worker or vocational therapist.
Clinical pathways are used in managed care settings to: a. stabilize aggressive patients. b. identify obstacles to effective care. c. relieve nurses of planning responsibilities. d. streamline the care process and reduce costs.
D) Clinical pathways provide guidelines for assessments, interventions, treatments, and outcomes as well as a designated timeline for accomplishment. Deviations from the timeline must be reported and investigated. Clinical pathways streamline the care process and save money. Care pathways do not identify obstacles or stabilize aggressive patients. Staff are responsible for the necessary interventions. Care pathways do not relieve nurses of the responsibility of planning; pathways may, however, make the task easier.
The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply. a. Increased attentiveness b. Getting up at night to urinate c. Improved vision d. An upset stomach for no apparent reason e. Shaky hands that make holding a cup difficult
D, E d. An upset stomach for no apparent reason e. Shaky hands that make holding a cup difficult
Which of the following are true of antisocial personality disorder (APD)? (select all that apply): A. It is the least studied of the personality disorders. B. It is characterized by rigidity and inflexible standards of self and others .C. Persons with APD display magical thinking. D. Persons with APD are concerned with personal pleasure and power. E. It is characterized by deceitfulness, disregard for others, and manipulation. F. Persons with APD usually present for treatment because of awareness of how their behavior is affecting others. G. Frontal lobe dysfunction is a brain change identified in APD.
D, E, G APD is the most studied and researched personality disorder. Rigidity and inflexible standards describe obsessive-compulsive personality disorder. Magical thinking describes schizotypal personality disorder. People with APD usually present with depression or because of the consequences of their behaviors, not because they care about the effects of their actions on others.
Cody is preparing for discharge. He tells you, "Dr. Jacobson is putting me on some medication called naltrexone. How will that help me?" Which response is appropriate teaching regarding naltrexone? A. "It helps your mood so that you don't feel the need to do drugs." B. "It will keep you from experiencing flashbacks." C. "It's a sedative that will help you sleep at night so you are more alert and able to make good decisions." D. "It helps prevent relapse by reducing drug cravings."
D. "It helps prevent relapse by reducing drug cravings." Naltrexone is used for withdrawal and also to prevent relapse by reducing the craving for the drug. The other options do not accurately describe the action of naltrexone
When would an REM sleep behavior disorder generally take place? A. During first 10 minutes when sleep is the lightest B. Right before the patient awakens in the morning after 6 hours of sleep C. About 30 minutes into sleep D. About 90 minutes into sleep
D. About 90 minutes into sleep REM sleep generally occurs about 90 minutes into a persons sleep
Which of the following is least likely to be used in the treatment of sleep terrors? A. Developing a consistent bedtime schedule B. Psychotherapy C. Attempting to awaken the individual before the night terror occurs if possible D. Administration of high dose Valium
D. Administration of high dose Valium Benzodiazepines are rarely used for sleep terrors as they have high abuse potential. The other options listed were all options discussed in lecture as treatment options.
A client admitted with major depression and suicidal ideation with a plan to overdose is preparing for discharge and asks you, "Why did I get a prescription for only 7 days of amitriptyline?" The nurse's response is based on what fact? A. Amitriptyline is very expensive, so the patient may have to buy fewer at a time. B. The goal is to see how the client responds to the first week of medication to evaluate its effectiveness. C. The health care provider wants to see whether any side effects occur within the first week of administration. D. Amitriptyline is lethal in overdose.
D. Amitriptyline is lethal in overdose. Amitriptyline is a tricyclic antidepressant (TCA); these drugs are known to be lethal in smaller doses than other antidepressants. Because the patient had a plan of overdose, the best course of action is to give a small prescription requiring her to visit her provider's office more often for monitoring of suicidal ideation and plan. Tricyclics are not known to be expensive. Antidepressant therapy usually takes several weeks to produce full results, so the patient would not be evaluated after only 1 week. Side effects are always a consideration but not the most important consideration with TCAs
A client prescribed a selective serotonin reuptake inhibitor mentions taking the medication along with the St. John's wort daily. The nurse should provide the client with what information regarding this practice? A. Agreeing that this will help the client to remember the medications. B. Caution the client to drink several glasses of water daily. C. Suggest that the client also use a sun lamp daily. D. Explain the high possibility of an adverse reaction.
D. Explain the high possibility of an adverse reaction. Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants. None of the other options are relevant to the situation.
When educating a client with bipolar disorder about the importance of adequate sleep, which is most vital for the nurse to include in the teaching? A. Adequate sleep of at least 7-8 hours per night will help your cure your mental illness B. Contact your primary care provider if you have an improvement in your sleep pattern C. Anti-depressants can worsen your insomnia, so please stop taking those right away D. Lack of sleep can trigger a mania episode, so be sure to try to get at least 7-8 hours of sleep each night
D. Lack of sleep can trigger a mania episode, so be sure to try to get at least 7-8 hours of sleep each night It is anti-psychotic medications (such as Risperdal) that can worsen sleep-related movement disorder in bipolar disorder (i.e. can make restless leg syndrome worse if on an anti-psychotic)
Which of the following is NOT true regarding Restless Leg Syndrome? A. The sensation can occur as an itching, burning, or tingling B. Movement of the legs helps to relieve the sensation C. There is no test to confirm restless leg syndrome D. The symptoms of restless leg syndrome will improve during rest and sleep
D. The symptoms of restless leg syndrome will improve during rest and sleep The sensations associated with restless leg syndrome with get worse with sleep or decreased activity and will be relieved with movement.
Benzodiazepines are useful for treating alcohol withdrawal because they A. block cortisol secretion B. increase dopamine release C. decease serotonin availability D. exert a calming effect
D. exert a calming effect Benzodiazepines act by binding to a-aminobutyric acid-benzodiazepine receptor sites, producing a calming effect
A client has been using cocaine intranasally for 4 years. When brought to the hospital in an unconscious state, nursing measures should include A. induction of vomiting B. administration of ammonium chloride C. monitoring of opiate withdrawal symptoms D. observation for hyperpyrexia and seizures
D. observation for hyperpyrexia and seizures Hyperpyrexia and convulsions are dangerous symptoms seen in central nervous system stimulate overdose
As you evaluate a patient's progress, which treatment outcome would indicate a poor general prognosis for long term recovery from substance abuse? A. patient demonstrates improved self-esteem B. patient demonstrates enhanced coping abilities C. patient demonstrates improved relationships with others D. patient demonstrates positive expectations for ongoing drug use
D. patient demonstrates positive expectations for ongoing drug use
You are caring for Leah, a 26 year old patient who has been abusing CNS stimulants. Which statement provides a basis for planning care for a patient who abuses CNS stimulants? A. symptoms of intoxication include dilation of the pups, dryness of the oronasal cavity B. medical management focuses on removing the drugs from the body C. withdrawal is simple and barely complicated D. post-withdrawal symptoms include fatigue and depression
D. post withdrawal symptoms include fatigue and depression
What is the ethical obligation of the nurse who sees a peer divert a narcotic, compared with the ethical obligation when the nurse observes a peer who is under the influence of alcohol? A. the nurse should immediately report the peer who is diverting narcotics and should defer reporting the alcohol using nurse until a second incident takes place B. neither should be reported until the nurse has collected factual evidence C. no report should be made until suspicions are confirmed by a second staff member D. supervisory staff should be informed as soon as possible in both cases
D. supervisory staff should be informed as soon as possible in both cases If indicators of impaired practice are observed, the observations need to be reported to the nurse manager. Intervention is the responsibility of the nurse manager and other nursing administrators. However, clear documentation (specific dates, times, events, consequences) by co-workers is crucial. The nurse manager's major concerns are with job performance and client safety. Reporting an impaired colleague is not easy, even though it is our responsibility. To not "see" what is going on, nurses may deny or rationalize, thus enabling the impaired nurse to potentially endanger lives while becoming sicker and more isolated. Impairment can occur whether the nurse is under the influence of alcohol or a narcotic drug.
The term "tolerance" as it relates to substance abuse, refers to A. the use of a substance beyond acceptable societal norms B. the additive effects achieved by taking two drugs with similar actions C. the signs and symptoms that occur when an addictive substance is withheld D. the need to take larger amounts of a substance to achieve the same effects
D. the need to take larger amounts of a substance to achieve the same effects With regard to substance abuse, tolerance is defined as the need to take higher and higher doses of a drug to achieve the desired effect
A syndrome that occurs after stopping the long term use of a drug is called A. amnesia B. tolerance C. Enabling D. withdrawal
D. withdrawal Withdrawal is a condition marked by physical and psychological symptoms that occur when a drug that has been taken for a long time is stopped or drastically reduced in dosage
A patient diagnosed with schizophrenia says, "Contagious bacteria are everywhere. When they get in your body, you will be locked up with other infected people." Which problem is evident? a. Poverty of content b. Concrete thinking c. Neologisms d. Paranoia
d. Paranoia The patient's unrealistic fear of harm indicates paranoia. Neologisms are invented words. Concrete thinking involves literal interpretation. Poverty of content refers to an inadequate fund of information.
Which personality disorder is this describing? Uncomfortable in situations in which he or she is not the center of attention Interaction with others is characterized by inappropriate sexually seductive or provocative behavior Rapidly shifting and shallow expression of emotions Uses physical appearance to draw attention to self Style of speech is excessively impressionistic and lacking in detail Self-dramatization, theatricality, and exaggerated expression of emotion Easily influenced by others Considers relationships to be more intimate than they actually are
Histrionic personality disorder (dramatic/erratic)
Patients with borderline personality disorder (BPD) exhibit negative effect, which includes emotional _____________, described as rapidly moving from one emotional extreme to another.
LABILITY One of pathological personality traits seen in persons with BPD is negative effect, which is characterized by emotional lability, that is, rapidly shifting emotions from one extreme to another. Patients exhibiting this trait are often documented as being "labile."
What are the 3 types of odd/eccentric personality disorders?
Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder
Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population? a. Conducting routine suicide screenings at a senior center. b. Identifying depression as a natural, but treatable result of aging. c. Identifying males as being at a greater risk for developing depression. d. Stressing that most individuals experience just a single episode of major depression in a lifetime.
a. Conducting routine suicide screenings at a senior center.
A patient experiencing primary insomnia asks the nurse, "I take a nap during the day. Doesn't that make up for a lost night's sleep?" Select the nurse's best reply. a. "Circadian drives give daytime naps a structure different from nighttime sleep." b. "The body clock operates on a 24-hour cycle, making nap effectiveness unpredictable." c. "It is a matter of habit and expectation. We expect to be more refreshed from a night's sleep." d. "Sleep restores homeostasis but works more efficiently when aided by melaton
a. "Circadian drives give daytime naps a structure different from nighttime sleep." Regular sleep cycles occur with nighttime sleep, with progression through two distinct physiological states: four stages of non-rapid eye movement and a period of REM sleep. Naps often contain different amounts of REM sleep, thus changing the physiology of sleep as well as the psychological and behavioral effects of sleep.
Two months ago, Natasha's husband died suddenly and she has been overwhelmed with grief. When Natasha is subsequently diagnosed with major depressive disorder, her daughter, Nadia, makes which true statement? a. "Depression often begins after a major loss. Losing dad was a major loss." b. "Bereavement and depression are the same problem." c. "Mourning is pathological and not normal behavior." d. "Antidepressant medications will not help this type of depression."
a. "Depression often begins after a major loss. Losing dad was a major loss."
The nurse provides health education for an adult experiencing sleep deprivation. Which instruction has the highest priority? a. "It's important to limit your driving to short periods. Sleep deprivation increases your risks for serious accidents." b. "Sleep deprivation is usually self-limiting. See your health care provider if it lasts more than a year." c. "Turn the radio on with a soft volume as you prepare for bed each evening. It will help you relax." d. "Three glasses of wine each evening help many patients who suffer from sleep deprivation."
a. "It's important to limit your driving to short periods. Sleep deprivation increases your risks for serious accidents." Safety is the highest priority for this patient. Sleep deprivation causes psychomotor deficits. Driver drowsiness and fatigue lead to many automobile injuries and fatalities. Alcohol compounds problems associated with sleep deprivation. Sleep deprivation should be evaluated and treated; a 1-year delay is too long.
A nurse's neighbor says, "My sister has been diagnosed with bipolar disorder but will not take her medication. I have tried to help her for over 20 years, but it seems like everything I do fails. Do you have any suggestions?" Select the nurse's best response. a. "NAMI offers a family education series that you might find helpful." b. "Since your sister is noncompliant, perhaps it's time for her to be changed to injectable medication." c. "You have done all you can. Now it's time to put yourself first and move on with your life." d. "You cannot help her. Would it be better for you to discontinue your relationship?"
a. "NAMI offers a family education series that you might find helpful." NAMI offers a family education series that assists with the stress caregivers and other family members often experience. The nurse should not give advice about injectable medication or encourage the family member to give up on the patient.
A nurse asks a patient diagnosed with schizophrenia, "What is meant by the old saying 'You can't judge a book by looking at the cover.'?" Which response by the patient indicates concrete thinking? a. "The table of contents tells what a book is about." b. "You can't judge a book by looking at the cover." c. "Things are not always as they first appear." d. "Why are you asking me about books?"
a. "The table of contents tells what a book is about." Concrete thinking refers to an impaired ability to think abstractly. Concreteness is often assessed through the patient's interpretation of proverbs. Concreteness reduces one's ability to understand and address abstract concepts such as love or the passage of time. The incorrect options illustrate echolalia, an unrelated question, and abstract thinking.
An acutely violent patient diagnosed with schizophrenia received several doses of haloperidol. Two hours later the nurse notices the patient's head rotated to one side in a stiffly fixed position, the lower jaw thrust forward, and drooling. Which intervention by the nurse is indicated? a. Administer diphenhydramine 50 mg IM from the prn medication administration record. b. Reassure the patient that the symptoms will subside. Practice relaxation exercises with the patient. c. Give trihexyphenidyl 5 mg orally at the next regularly scheduled medication administration time. d. Administer atropine sulfate 2 mg subcut from the prn medication administration record.
a. Administer diphenhydramine 50 mg IM from the prn medication administration record. Diphenhydramine, trihexyphenidyl, benztropine, and other anticholinergic medications may be used to treat dystonias. Swallowing will be difficult or impossible; therefore, oral medication is not an option. Medication should be administered immediately, so the intramuscular route is best. In this case, the best option given is diphenhydramine.
A patient diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol, the patient is calm. Two hours later the nurse sees the patient's head rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is most likely? a. An acute dystonic reaction b. Tardive dyskinesia c. Waxy flexibility d. Akathisia
a. An acute dystonic reaction Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back. Opisthotonos and oculogyric crisis may be observed. Dystonic reactions are considered emergencies requiring immediate intervention. Tardive dyskinesia involves involuntary spasmodic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or pelvis. It appears after prolonged treatment. Waxy flexibility is a symptom seen in catatonic schizophrenia. Internal and external restlessness, pacing, and fidgeting are characteristics of akathisia.
Which person would be most likely to experience sleep fragmentation? a. An obese adult b. A toddler who attends day care c. A person diagnosed with mild osteoarthritis d. An adolescent diagnosed with anorexia nervosa
a. An obese adult Obese adults experience more disruption of sleep stages, resulting in fragmentation. Obesity is the leading factor for obstructive sleep apnea, which causes sleep fragmentation. These changes are also associated with illness and some medications. The changes are evident on a hypnogram. An adolescent with anorexia nervosa would have a low body weight and therefore decreased risk for sleep fragmentation. Persons with arthritis have pain that may sometimes interrupt sleep, but it would not have as high risk as would obesity. Toddlers do not generally experience sleep fragmentation.
A consumer at a rehabilitative psychosocial program says to the nurse, "People are not cleaning up behind themselves in the bathrooms. The building is dirty and cluttered." How should the nurse respond? a. Encourage the consumer to discuss it at a meeting with everyone. b. Hire a professional cleaning service to clean the restrooms. c. Address the complaint at the next staff meeting. d. Tell the consumer, "That's not my problem."
a. Encourage the consumer to discuss it at a meeting with everyone. Consumer-run programs range from informal "clubhouses," which offer socialization and recreation, to competitive businesses, such as snack bars or janitorial services, which provide needed services and consumer employment while encouraging independence and building vocational skills. Consumers engage in problem solving under the leadership of staff. See related audience response question.
Tammy, a 28-year-old with major depressive disorder and bulimia nervosa, is ready for discharge from the county hospital after 2 weeks of inpatient therapy. Tammy is taking citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervosa, what is an alternative antidepressant to consider? a. Fluoxetine (Prozac) b. Isocarboxazid (Marplan) c. Amitriptyline d. Duloxetine (Cymbalta)
a. Fluoxetine (Prozac)
A patient reports, "The medicine prescribed to help me get to sleep worked well for about a month, but I don't have any more of those pills, and now my insomnia is worse than ever. I had nightmares the last 2 nights." Which type of medication did the health care provider most likely prescribe? a. Hypnotic b. Tricyclic antidepressant c. Conventional antipsychotic d. Central nervous system stimulant
a. Hypnotic Hypnotics can worsen existing sleep disturbances when they induce drug-dependency insomnia. Once the drug is discontinued, the individual may have rebound insomnia and nightmares. CNS stimulants worsen insomnia while they are in use. Tricyclic antidepressants and atypical antipsychotics may help insomnia but would not be used for initial therapy.
A patient diagnosed with a SMI lives independently and attends a psychosocial rehabilitation program. The patient presents at the emergency department seeking hospitalization. The patient has no acute symptoms but says, "I have no money to pay my rent or refill my prescription." Select the nurse's best action. a. Involve the patient's case manager to provide crisis intervention. b. Send the patient to a homeless shelter until housing can be arranged. c. Arrange for a short in-patient admission and begin discharge planning. d. Explain that one must have active psychiatric symptoms to be admitted.
a. Involve the patient's case manager to provide crisis intervention. Impaired stress tolerance and problem-solving abilities can cause persons with SMI to experience relatively minor stressors as crises. This patient has run out of money, and this has overwhelmed her ability to cope, resulting in a crisis for which crisis intervention would be an appropriate response. Inpatient care is not clinically indicated nor is the patient homeless (although she may fear she is). Telling the patient that she is not symptomatic enough to be admitted may prompt malingering.
The family of a patient diagnosed with schizophrenia is unfamiliar with the illness and family's role in recovery. Which type of therapy should the nurse recommend? a. Psychoeducational b. Psychoanalytic c. Transactional d. Family
a. Psychoeducational A psychoeducational group explores the causes of schizophrenia, the role of medication, the importance of medication compliance, support for the ill member, and hints for living with a person with schizophrenia. Such a group can be of immeasurable practical assistance to the family. The other types of therapy do not focus on psychoeducation.
Which personality disorder is this describing? Avoids occupational activities that involve significant interpersonal contact Unwilling to get involved with people unless certain of being liked Shows restraint within intimate relationships because of the fear of being charmed or ridiculed Preoccupied with being criticized or rejected in social situations Inhibited in new interpersonal situations Views self inferior to others Reluctant to take risks or engage in any new activities because of embarrassment
avoidant personality disorder (anxious/fearful)
When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol was prescribed. The patient now says, "I stopped taking those pills. They made me feel like a robot." What are common side effects the nurse should validate with the patient? a. Sedation and muscle stiffness b. Sweating, nausea, and diarrhea c. Mild fever, sore throat, and skin rash d. Headache, watery eyes, and runny nose
a. Sedation and muscle stiffness Typical antipsychotic drugs often produce sedation and extrapyramidal side effects such as stiffness and gait disturbance, effects the patient might describe as making him or her feel like a "robot." The side effects mentioned in the other options are usually not associated with typical antipsychotic therapy or would not have the effect described by the patient.
Which season would be most associated with increased periods of wakefulness in the general population? a. Summer b. Winter c. Spring d. Fall
a. Summer Circadian drive is associated with physiology. Light is the main exogenous factor that drives wakefulness. Days are longest in summer.
Normally, most people sleep at night. What is the physiological rationale? a. The master biological clock responds to darkness with sleep. b. Darkness stimulates histamine release, which promotes sleep. c. Cooler environmental temperatures stimulate retinal messages. d. Stimulation of the sympathetic nervous system promotes sleep.
a. The master biological clock responds to darkness with sleep. The master biological clock in the suprachiasmatic nucleus (SCN) of the hypothalamus regulates sleep as well as other physiological processes. Darkness cues the clock for sleep. Light cues it for wakefulness. Light stimulates retinal messages. Histamine release is associated with wakefulness. Stimulation of the sympathetic nervous system promotes alertness.
What assessment findings mark the prodromal stage of schizophrenia? a. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion b. Auditory hallucinations, ideas of reference, thought insertion, and broadcasting c. Stereotyped behavior, echopraxia, echolalia, and waxy flexibility d. Loose associations, concrete thinking, and echolalia neologisms
a. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion Withdrawal, misinterpreting, poor concentration, and preoccupation with religion are prodromal symptoms, the symptoms that are present before the development of florid symptoms. The incorrect options each list the positive symptoms of schizophrenia that might be apparent during the acute stage of the illness
A newly hospitalized patient experiencing psychosis says, "Red chair out town board." Which term should the nurse use to document this finding? a. Word salad b. Neologism c. Anhedonia d. Echolalia
a. Word salad Word salad is a jumble of words that is meaningless to the listener and perhaps to the speaker as well, because of an extreme level of disorganization.
A patient diagnosed with schizophrenia begins to talks about "macnabs" hiding in the warehouse at work. The term "macnabs" should be documented as a. a neologism. b. concrete thinking. c. thought insertion. d. an idea of reference.
a. a neologism. A neologism is a newly coined word having special meaning to the patient. "Macnabs" is not a known common word. Concrete thinking refers to the inability to think abstractly. Thought insertion refers to thoughts of others are implanted in one's mind. Ideas of reference are a type of delusion in which trivial events are given personal significance.
A patient says, "I have trouble falling asleep at night and might lie awake until 3 or 4 AM before falling sleep." Which medication would the nurse expect a health care provider to prescribe for this patient? a. zolpidem (Ambien) b. flurazepam (Dalmane) c. risperidone (Risperdal) d. methylphenidate (Ritalin)
a. zolpidem (Ambien) Zolpidem is a short-acting hypnotic that will help the patient initiate sleep and awaken without untoward symptoms of drowsiness. Methylphenidate is a central nervous system stimulant. Flurazepam is a long-acting hypnotic that will produce hangover drowsiness during the next day. Risperidone is an antipsychotic and not likely to be useful in this scenario. See relationship to audience response question.
A patient reports good results from taking an herb to manage migraine headache pain. The nurse confirms there are no hazardous interactions between the herb and the patient's current prescription drugs. Select the nurse's best comment to the patient. a."Thanks for telling me. I'll make a note in your medical record that you take it." b."You are experiencing a placebo effect. When we believe something will help, it usually does." c."Self-management of health problems can be dangerous. You should have notified me sooner." d."Research studies show that herbals actually increase migraine pain by inflaming nerve cells in the brain."
a."Thanks for telling me. I'll make a note in your medical record that you take it." The nurse should reinforce the patient for reporting use of the herb. Many patients keep secrets about use of alternative therapies. If it poses no danger, the nurse can document the use. The patient may also get placebo effect from the herb, but it is not necessary for the nurse to point out that information. The distracters are judgmental and may discourage the patient from openly sharing in the future.
A patient diagnosed with major depressive disorder tells the nurse, "I want to try supplementing my selective serotonin reuptake inhibitor (SSRI) with St. John's wort." Which action should the nurse take first?a.Advise the patient of the danger of serotonin syndrome. b.Suggest that aromatherapy may produce better results. c.Assess the patient for depression and risk for suicide. d.Suggest the patient decrease the antidepressant dose.
a.Advise the patient of the danger of serotonin syndrome. Research has suggested that St. John's wort is a mild inhibitor of serotonin reuptake and could lead to serotonin syndrome; this risk is increased if the patient is taking other medications that increase serotonin activity. Assessing the depression would be a secondary intervention. Aromatherapy has not been shown to be an effective adjunct or treatment for depression. Although a dosage reduction in her SSRI medication might reduce the risk of serotonin syndrome, this intervention is not in the nurse's scope of practice.
A nurse plans health education for a patient who will be receiving warfarin for several weeks after knee-replacement surgery. Which substance should the nurse caution the patient to avoid? a.Fish oil b.Black cohosh c.Lavender d.Mandarin
a.Fish oil Fish oil may increase bleeding time and therefore has a potentially hazardous interaction with the anticoagulant warfarin. Black cohosh is an herbal treatment for hot flashes. Mandarin and lavender may have calming effects, which may be helpful, but would not cause increased risk of bleeding.
For which patient would it be most important for the nurse to urge immediate discontinuation of kava? A patient with a comorbid diagnosis of a.cirrhosis. b.osteoarthritis. c.multiple sclerosis. d.chronic back pain.
a.cirrhosis. Kava should be used with caution in patients with liver disease because of its potentially hepatotoxic effects. The other health problems do not pose immediate dangers.
A patient asks, "What is the major difference between conventional health care and complementary and alternative medicine (CAM)?" The nurse's best reply is that conventional health care a.focuses on what is done to the patient, whereas CAM focuses on body-mind interaction with an actively involved patient. b.has been tested by research so less regulation is needed, but CAM is religiously based and highly regulated. c.is controlled by the health care industry, but CAM is the people's medicine and not motivated by profit. d.is holistic and focused on health promotion, whereas CAM treats illnesses and is symptom-specific.
a.focuses on what is done to the patient, whereas CAM focuses on body-mind interaction with an actively involved patient. Conventional health care focuses primarily on curative actions implemented on a mostly passive patient, whereas CAM focuses more on the mind-body aspects of health, along with the active involvement of the patient. Conventional health care is largely grounded in scientific research, and its various components are heavily regulated; the opposite tends to be true of CAM. Some forms of CAM have their roots in religious or cultural practices, but this is not characteristic of CAM as a whole. Both conventional health care and CAM can focus on health promotion and treatment of illness. Although critics express concern about the role of profit in conventional health care, the profit motive can also apply in CAM.
During an assessment interview, a patient diagnosed with inflammatory bowel disease accompanied by frequent episodes of diarrhea says, "I've been using probiotics in small doses for about a week." When the nurse assesses mental status, expected findings would be a.intact cognitive function. b.slow verbal responses. c.paranoid thinking. d.slurred speech.
a.intact cognitive function. Probiotics may reduce inflammation and heal the gut. No effect on cognitive function would be associated with use of microbiomes, including probiotics. The patient has taken small doses, so response times would be normal. It does not usually produce the effects cited in the distracters.
The sibling of a patient who was diagnosed with a SMI asks why a case manager has been assigned. The nurse's reply should cite the major advantage of the use of case management as: a. "The case manager can modify traditional psychotherapy for homeless patients so that it is more flexible." b. "Case managers coordinate services and help with accessing them, making sure the patient's needs are met." c. "The case manager can focus on social skills training and esteem building in the real world where the patient lives." d. "Having a case manager has been shown to reduce hospitalizations, which prevents disruption and saves money."
b. "Case managers coordinate services and help with accessing them, making sure the patient's needs are met." The case manager helps the patient gain entrance into the system of care, can coordinate multiple referrals that so often confuse the seriously mentally ill person and his family, and can help overcome obstacles to access and treatment participation. Case managers do not usually possess the credentials needed to provide psychotherapy or function as therapists. Case management promotes efficient use of services in general, but only ACT programming has been shown to reduce hospitalization (which the sibling might see as a disadvantage). Case managers operate in the community, but this is not the primary advantage of their services.
A patient has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today this patient shouts, "They're all plotting to destroy me. Isn't that true?" Select the nurse's most therapeutic response. a. "Everyone here is trying to help you. No one wants to harm you." b. "Feeling that people want to destroy you must be very frightening." c. "That is not true. People here are trying to help you if you will let them." d. "Staff members are health care professionals who are qualified to help you."
b. "Feeling that people want to destroy you must be very frightening." Resist focusing on content; instead, focus on the feelings the patient is expressing. This strategy prevents arguing about the reality of delusional beliefs. Such arguments increase patient anxiety and the tenacity with which the patient holds to the delusion. The other options focus on content and provide opportunity for argument.
Which patient statement does not demonstrate an understanding of a suicide safety plan? a. "I know that when I start thinking about my dad, I'm going to start thinking about killing myself." b. "Going for a really long, hard run helps clear my mind and stops the suicidal thoughts." c. "My sister is always there for me when I start getting suicidal." d. "I keep the suicide prevention phone number in my wallet."
b. "Going for a really long, hard run helps clear my mind and stops the suicidal thoughts."
A nurse who works night shift says, "I am exhausted most of the time. I sleep through my alarm. Sometimes my brain does not seem to work right. I am worried that I might make a practice error." Which question should the nursing supervisor ask first? a. "What stress are you experiencing in your life?" b. "How much sleep do you get in a 24-hour period?" c. "Would it help if you do some exercises just before going to bed?" d. "Have you considered using a hypnotic medication to help you sleep?"
b. "How much sleep do you get in a 24-hour period?" Total sleep hours should be ascertained before seeking to correct a sleep disorder. In this case, the patient describes sleep deprivation symptoms rather than a sleep disorder. The correct response is the only option that addresses total sleep hours.
A homeless patient diagnosed with a SMI became suspicious and delusional. Depot antipsychotic medication began and housing was obtained in a local shelter. One month later, which statement by the patient indicates significant improvement? a. "They will not let me drink. They have many rules in the shelter." b. "I feel comfortable here. Nobody bothers me." c. "Those shots make my arm very sore." d. "Those people watch me a lot."
b. "I feel comfortable here. Nobody bothers me." Evaluation of a patient's progress is made based on patient satisfaction with the new health status and the health care team's estimation of improvement. For a formerly delusional patient to admit to feeling comfortable and free of being "bothered" by others denotes improvement in the patient's condition. The other options suggest that the patient is in danger of relapse.
Which comment is most likely from a patient with chronic sleep deprivation? a. "I turn on the television every night to get to sleep. I set the timer so it goes off in 30 minutes." b. "I have diarrhea frequently and not much energy, so I stay at home most of the time." c. "I only sleep about 7 hours a night, but I know I should sleep 8 or 9 hours." d. "When my alarm clock goes off every morning, it seems like I am dreaming."
b. "I have diarrhea frequently and not much energy, so I stay at home most of the time." A discrepancy between hours of sleep obtained and hours required leads to sleep deprivation. Adults with less than 6 hours of sleep per night often suffer from chronic sleep deprivation. Common complaints include poor general health, physical and mental distress, limitations in ADLs, depressive or anxious symptoms, and pain. One distracter indicates a problem with sleep hygiene [television]. The remaining distracters do not indicate a problem
A home care nurse assesses a very demanding patient with chronic obstructive pulmonary disease (COPD). Afterward, the nurse talks with the spouse who has provided this patient's care for 6 years. The spouse says, "I don't need much sleep anymore. I might need to help him during the night." Select the nurse's most therapeutic response. a. "It sounds like you are very devoted to your spouse." b. "I noticed you fell asleep while I was assessing your spouse. I'm concerned about you." c. "Your spouse is lucky to have you to provide care rather than being placed in a nursing home." d. "If you keep going like this, your health will be impaired also. Then who will take care of both of you?"
b. "I noticed you fell asleep while I was assessing your spouse. I'm concerned about you." Sleep deprivation can cause accidents. The correct answer makes an observation, gives important information about safety, and communicates care and compassion for the spouse. The distracters do not invite further dialogue with the spouse.
A nurse cares for these four patients. Which patient has the highest risk for problems with sleep physiology? a. Retiree who volunteers twice a week at Habitat for Humanity b. Corporate accountant who travels frequently c. Parent with three teenagers d. Lawn care worker
b. Corporate accountant who travels frequently The corporate accountant is likely to work long hours and have significant stress associated with work demands. Compounded by travel, these factors are likely to precipitate unstable sleep patterns and inadequate sleep time. The retiree and lawn care worker engage in physical activity during the day, which will promote natural fatigue and sleep. The parent's sleep is unlikely to be disturbed; teenagers sleep through the night.
A patient diagnosed with a SMI died suddenly at age 52. The patient lived in the community for 5 years without relapse and held supported employment the past 6 months. The distressed family asks, "How could this happen?" Which response by the nurse accurately reflects research and addresses the family's question? a. "A certain number of people die young from undetected diseases, and it's just one of those sad things that sometimes happen." b. "Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, smoke more, or are overweight." c. "We will have to wait for the autopsy to know what happened. There were some medical problems, but we were not expecting death." d. "We are all surprised. The patient had been doing so well and saw the nurse every other week."
b. "Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, smoke more, or are overweight." The family is in distress. Because they do not understand his death, they are less able to accept it and seek specific information to help them understand what happened. Persons with SMI die an average of 25 years prematurely. Contributing factors include failing to provide for their own health needs (e.g., forgetting to take medicine), inability to access or pay for care, higher rates of smoking, poor diet, criminal victimization, and stigma. The most accurate answer indicates that seriously mentally ill people are at much higher risk of premature death for a variety of reasons. Staff would not have been surprised that the patient died prematurely, and they would not attribute his death to random, undetected medical problems. Although the cause of death will not be reliably established until the autopsy, this response fails to address the family's need for information.
Many persons brought before a criminal court have mental illness, have committed minor offenses, and are off medications. The judge consults the nurse at the local community mental health center for guidance about how to respond when handling such cases. Which advice from the nurse would be most appropriate? a. "Sometimes a little time in jail makes a person rethink what they've been doing and puts them back on the right track." b. "Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses." c. "Arresting these people helps them in the long run. Sometimes we cannot hospitalize them, but in jail they will get their medication." d. "Research suggests that special mental health courts do not make much difference so far, but outpatient commitment does seem to help."
b. "Sentencing such persons to participate in treatment instead of incarcerating them has been shown to reduce repeat offenses." Research supports the use of special mental health courts that can sentence mentally ill persons to treatment instead of jail. Jail exposes vulnerable mentally ill persons to criminals, victimization, and high levels of stimulation and stress. Incarceration can also interrupt eligibility for benefits or lead to the loss of housing and often provides lower-quality mental health treatment in other settings. Recidivism rates for both mentally ill and non-mentally ill offenders are relatively high, so it does not appear that incarceration necessarily leads people to behave more appropriately. In addition, a criminal record can leave them more desperate and with fewer options after release. Research indicates that outpatient commitment is less effective at improving the mental health of mentally ill persons than was expected.
Which hallucination necessitates the nurse to implement safety measures? The patient says, a. "I hear angels playing harps." b. "The voices say everyone is trying to kill me." c. "My dead father tells me I am a good person." d. "The voices talk only at night when I'm trying to sleep."
b. "The voices say everyone is trying to kill me." The correct response indicates the patient is experiencing paranoia. Paranoia often leads to fearfulness, and the patient may attempt to strike out at others to protect self. The distracters are comforting hallucinations or do not indicate paranoia.
A nurse counsels a patient on ways to determine the person's total sleep requirement. Which instruction would produce the most accurate results? a. "For 1 full week, record what you remember about your dream content and related feelings as soon as you wake up. Bring the record to your next appointment." b. "While off work for 1 week, go to bed at your usual time and wake up without an alarm. Record how many hours you sleep and then average the findings." c. "For 2 full weeks, record how much time you sleep each night and rate your daytime alertness on a scale of 1 to 10. Calculate your average alertness score." d. "All adults need 7 or 8 hours of sleep to function properly. Let's design ways to help you reach that goal."
b. "While off work for 1 week, go to bed at your usual time and wake up without an alarm. Record how many hours you sleep and then average the findings." Sleep requirements are most accurately determined by going to bed at the usual time and waking up without an alarm for several nights, ideally on vacation. The average of these findings indicates the estimated requirements. Two distracters relate to dream content and daytime alertness. Some adults are long sleepers or short sleepers with different requirements for sleep from the general population.
A patient diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive, but the patient continues to have apathy, poverty of thought, and social isolation. The nurse would expect a change to which medication? a. Haloperidol b. Olanzapine c. Chlorpromazine d. Diphenhydramine
b. Olanzapine Olanzapine is a second-generation atypical antipsychotic that targets both positive and negative symptoms of schizophrenia. Haloperidol and chlorpromazine are conventional antipsychotics that target only positive symptoms. Diphenhydramine is an antihistamine. See relationship to audience response question.
A person says, "I often feel like I have been dreaming just before I awake in the morning." Which rationale correctly explains the comment? a. Sleep architecture changes during the sleep period, resulting in increased slow-wave sleep at the end of the cycle. b. Cycles of rapid eye movement sleep increase in the second half of sleep and occupy longer periods. c. Dreams occur more frequently when a person is experiencing unresolved conflicts or depression. d. Dream content relates directly to developmental tasks. The person is likely feeling autonomous.
b. Cycles of rapid eye movement sleep increase in the second half of sleep and occupy longer periods. Cycles of rapid eye movement sleep increase in the second half of sleep and occupy longer periods, up to 1 hour. Dreaming occurs during REM sleep. The question relates to sleep architecture rather than dream content.
A patient diagnosed with schizophrenia says, "My co-workers are out to get me. I also saw two doctors plotting to kill me." How does this patient perceive the environment? a. Disorganized b. Dangerous c. Supportive d. Bizarre
b. Dangerous The patient sees the world as hostile and dangerous. This assessment is important because the nurse can be more effective by using empathy to respond to the patient. Data are not present to support any of the other options.
A patient's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating? a. Detachment and overconfidence b. Darting eyes, tilted head, mumbling to self c. Euphoric mood, hyperactivity, distractibility d. Foot tapping and repeatedly writing the same phrase
b. Darting eyes, tilted head, mumbling to self Clues to hallucinations include eyes looking around the room as though to find the speaker, tilting the head to one side as though listening intently, and grimacing, mumbling, or talking aloud as though responding conversationally to someone.
A person diagnosed with a SMI enters a shelter for the homeless. Which intervention should be the nurse's initial priority? a. Find supported employment. b. Develop a trusting relationship. c. Administer prescribed medication. d. Teach appropriate health care practices.
b. Develop a trusting relationship. Basic psychosocial needs do not change because a person is homeless. The first step in caring for health care needs is establishing rapport. Once a trusting relationship is established, the nurse pursues other interventions.
A patient needs diagnostic evaluation of sleep problems. Which test will evaluate the patient for possible sleep-related problems? a. Skull x-rays b. Electroencephalogram (EEG) c. Positron emission tomography (PET) d. Single-photon emission computed tomography (SPECT)
b. Electroencephalogram (EEG) Electroencephalogram (EEG) measures NREM and REM sleep. The distracters represent ways to diagnose structural and metabolic problems.
A nurse leads a psychoeducational group about first-generation antipsychotic medications with six adult men diagnosed with schizophrenia. The nurse will monitor for concerns regarding body image with respect to which potential side effect of these medications? a. Constipation b. Gynecomastia c. Visual changes d. Photosensitivity
b. Gynecomastia FGAs (first-generation antipsychotic) stimulate release of prolactin, which can result in gynecomastia (enlargement of the breasts) as well as other changes in sexual function. Men may experience disturbances in body image as a result of gynecomastia. Other side effects of FGAs may be disturbing to other aspects of the patient's physical health but are not likely to bother body image.
A patient insistently states, "I can decipher codes of DNA just by looking at someone." Which problem is evident? a. Visual hallucinations b. Magical thinking c. Idea of reference d. Thought insertion
b. Magical thinking Magical thinking is evident in the patient's appraisal of his own abilities. There is no evidence of the distracters.
A patient reports, "Nearly every night I awaken feeling frightened after a bad dream. The dream usually involves being hunted by people trying to hurt me. It usually happens between 4 and 5 AM." The nurse assesses this disorder as most consistent with criteria for which problem? a. Sleep deprivation b. Nightmare disorder c. Night terror disorder d. REM sleep behavior disorder
b. Nightmare disorder Nightmares are long, frightening dreams from which people awaken in a frightened state. They occur during REM sleep late in the night. Night terror disorder occurs as arousal in the first third of the night during non-REM sleep and is accompanied by feelings of panic. REM sleep behavior disorder involves acting out a violent dream during REM sleep. Nightmare disorder may lead to sleep deprivation.
A patient living independently had command hallucinations to shout warnings to neighbors. After a short hospitalization, the patient was prohibited from returning to the apartment. The landlord said, "You cause too much trouble." What problem is the patient experiencing? a. Grief b. Stigma c. Homelessness d. Nonadherence
b. Stigma The inability to obtain shelter because of negative attitudes about mental illness is an example of stigma. Stigma is defined as damage to reputation, shame, and ridicule society places on mental illness. Data are not present to identify grief as a patient problem. Data do not suggest that the patient is actually homeless. See relationship to audience response question.
A patient diagnosed with schizophrenia has received fluphenazine decanoate twice a month for 3 years. The clinic nurse notes that the patient grimaces and constantly smacks both lips. The patient's neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect? a. Agranulocytosis b. Tardive dyskinesia c. Tourette's syndrome d. Anticholinergic effects
b. Tardive dyskinesia Fluphenazine decanoate is a first-generation antipsychotic medication. Tardive dyskinesia is a condition involving the face, trunk, and limbs that occurs more frequently with first-generation antipsychotics than second or third generation. Involuntary movements, such as tongue thrusting; licking; blowing; irregular movements of the arms, neck, and shoulders; rocking; hip jerks; and pelvic thrusts, are seen. These symptoms are frequently not reversible even when the drug is discontinued. The scenario does not present evidence consistent with the other disorders mentioned. Agranulocytosis is a blood disorder. Tourette's syndrome is a condition in which tics are present. Anticholinergic effects include dry mouth, blurred vision, flushing, constipation, and dry eyes.
A client says, "Facebook has a new tracking capacity. If I use the Internet, Homeland Security will detain me as a terrorist." Select the nurse's best initial action. a. Tell the client, "Facebook is a safe website. You don't need to worry about Homeland Security." b. Tell the client, "You are in a safe place where you will be helped." c. Administer a prn dose of an antipsychotic medication. d. Tell the client, "You don't need to worry about that."
b. Tell the client, "You are in a safe place where you will be helped." The patient is experiencing paranoia and delusional thinking, which leads to fear. Explaining that the patient is in a safe place will help relieve the fear. It is not therapeutic to disagree or give advice. Medication will not relieve the immediate concern.
Sigmund Freud, Karl Menninger, and Aaron Beck theorized that hopelessness was an integral part of why a person commits suicide. A more recent theory suggest suicide results from: a. Elevated serotonin levels b. The diathesis-stress model c. Outward aggression turned inward d. A lack of perfectionism
b. The diathesis-stress model
A nurse observes a catatonic patient standing immobile, facing the wall with one arm extended in a salute. The patient remains immobile in this position for 15 minutes, moving only when the nurse gently lowers the arm. What is the name of this phenomenon? a. Echolalia b. Waxy flexibility c. Depersonalization d. Thought withdrawal
b. Waxy flexibility Waxy flexibility is the ability to hold distorted postures for extended periods of time, as though the patient were molded in wax. Echolalia is a speech pattern. Depersonalization refers to a feeling state. Thought withdrawal refers to an alteration in thinking.
For patients diagnosed with SMI, what is the major advantage of case management? a. The case manager can modify traditional psychotherapy. b. With one coordinator of services, resources can be more efficiently used. c. The case manager can focus on social skills training and esteem building. d. Case managers bring groups of patients together to discuss common problems.
b. With one coordinator of services, resources can be more efficiently used. The case manager coordinates the care and multiple referrals that so often confuse the seriously mentally ill patient and the patient's family. Case management promotes efficient use of services. The other options are lesser advantages or are irrelevant.
SMI is characterized as a. any mental illness of more than 2 weeks' duration. b. a major long-term mental illness marked by significant functional impairments. c. a mental illness accompanied by physical impairment and severe social problems. d. a major mental illness that cannot be treated to prevent deterioration of cognitive and social abilities.
b. a major long-term mental illness marked by significant functional impairments. "Serious mental illness" has replaced the term "chronic mental illness." Global impairments in function are evident, particularly social. Physical impairments may be present. SMI can be treated, but remissions and exacerbations are part of the course of the illness
A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, "I saw two doctors talking in the hall. They were plotting to kill me." The nurse may correctly assess this behavior as a. echolalia. b. an idea of reference. c. a delusion of infidelity. d. an auditory hallucination.
b. an idea of reference. Ideas of reference are misinterpretations of the verbalizations or actions of others that give special personal meanings to these behaviors; for example, when seeing two people talking, the individual assumes they are talking about him or her. The other terms do not correspond with the scenario.
After 5 years in a state hospital, an adult diagnosed with schizophrenia was discharged to the community. This patient now requires continual direction to accomplish activities of daily living and expects others to provide meals and do laundry. The nurse assesses this behavior as the probable result of a. side effects of antipsychotic medications. b. dependency caused by institutionalization. c. cognitive deterioration from schizophrenia. d. stress associated with acclimation to the community.
b. dependency caused by institutionalization. Institutions tend to impede independent functioning; for example, daily activities are planned and directed by staff; others provide meals and only at set times. Over time, patients become dependent on the institution to meet their needs and adapt to being cared for rather than caring for themselves. When these patients return to the community, many continue to demonstrate passive behaviors despite efforts to promote. Cognitive dysfunction and antipsychotic side effects can make planning and carrying out activities more difficult, but the question is more suggestive of adjustment to institutional care and difficulty readjusting to independence instead.
A person is prescribed lorazepam (Ativan) 2 mg po bid prn for anxiety. When the person takes this medication, which change in sleep is anticipated? The patient will: a. have fewer dreams. b. have less slow-wave sleep. c. experience extended sleep latency. d. enter sleep through rapid eye movement (REM) sleep.
b. have less slow-wave sleep. Lorazepam is a benzodiazepine, which reduces slow-wave sleep. REM sleep would likely increase. Persons with narcolepsy often enter sleep through REM.
A patient diagnosed with schizophrenia demonstrates little spontaneous movement and has waxy flexibility. The patient's activities of daily living are severely compromised. An appropriate outcome would be that the patient will a. demonstrate increased interest in the environment by the end of week 1. b. perform self-care activities with coaching by the end of day 3. c. gradually take the initiative for self-care by the end of week 2. d. accept tube feeding without objection by day 2.
b. perform self-care activities with coaching by the end of day 3. Outcomes related to self-care deficit nursing diagnoses should deal with increasing ability to perform self-care tasks independently, such as feeding, bathing, dressing, and toileting. Performing the tasks with coaching by nursing staff denotes improvement over the complete inability to perform the tasks. The incorrect options are not directly related to self-care activities, difficult to measure, and unrelated to maintenance of nutrition.
A patient tells the nurse, "I've been having problems getting a good night's sleep. I read some information on the Internet and started taking kava kava." Select the nurse's priority response. a."The Internet does not have reliable health information for consumers." b."The Food and Drug Administration warned against using it due to the link to severe liver damage." c."Melatonin has been shown to have better effects for treating sleep disturbances." d."Your sleep disturbances are related to your problems with anxiety. Herbs will not help."
b."The Food and Drug Administration warned against using it due to the link to severe liver damage." The Food and Drug Administration (FDA) warned against using kava kava due to the link to severe liver damage. The nurse has responsibilities to educate patients regarding safe use of complementary therapies. Melatonin may be useful for sleep disturbances, but the patient's safety is a higher priority. The other distracters are misleading.
A patient says, "I have taken mega doses of vitamins for 3 months to improve my circulation, but I think I feel worse." Which action should the nurse take first? a.Explain to the patient that vitamin mega doses may be harmful and advise caution. b.Assess the patient for symptoms and signs of toxicity from excess vitamin exposure. c.Assess for signs of circulatory integrity to determine whether improvement has occurred. d.Educate the patient that research has not shown that megadoses of vitamins produce benefits.
b.Assess the patient for symptoms and signs of toxicity from excess vitamin exposure. Mega doses of many vitamins, especially when taken over long periods, may produce dangerous side effects or toxicity. The priority for the nurse is to assess for signs of any dangerous consequences of the patient's use of such a regimen. Secondary interventions would include patient education about research findings related to the practice, along with any benefits and undesired effects associated with the practice. A health care provider should also assess the patient for cardiovascular concerns.
A patient had a venous thrombosis 3 weeks ago and is now taking warfarin. When visiting the laboratory to have a prothrombin time drawn, the patient reports drinking ginseng tea to stimulate the immune system. Which nursing diagnosis applies? a.Impaired memory related to neurological changes b.Deficient knowledge related to potentially harmful drug interactions c.Ineffective denial related to consequences of mismanagement of therapeutic regime d.Effective management of the therapeutic regime related to augmentation of anti-coagulant therapy
b.Deficient knowledge related to potentially harmful drug interactions Ginseng tea is amongst the top 10 herbal products used in the United States and believed to have multiple beneficial properties. Because it antagonizes platelet-activating factor, it should not be taken by patients who are receiving anticoagulants or who have other potential bleeding problems. Thus, deficient knowledge is an appropriate nursing diagnosis.
Which CAM method is associated with using allergy injections of small amounts of an allergen in solution? a.Naturopathy b.Homeopathy c.Chiropractic d.Shiatsu
b.Homeopathy Homeopathy uses small doses of a substance to stimulate the body's defenses and healing mechanisms to treat illness. Naturopathy emphasizes health restoration rather than disease. Chiropractic uses manipulation of the body to restore health. Shiatsu is a type of massage.
An older male patient has suffered with episodic pruritus and skin eruptions for over 2 years. This patient tells the nurse, "When my skin gets better for a few days, I start worrying that it's going to start itching again soon. I think my worry may actually trigger the problems to start all over again." Which self-help technique should the nurse consider suggesting for this patient? a.Melatonin b.Meditation c.Purification d.Acupuncture
b.Meditation The patient's comment suggests an element of anxiety accompanies the skin problem. Meditation is a popular self-help method recommended to reduce physical and emotional stress and to promote wellness. Purification, associated with ayurvedic practices, may or may not appeal to this patient. Acupuncture is performed by a professional practitioner, so it is not a self-help technique. The scenario does not indicate the patient is experiencing insomnia, so melatonin is not indicated.
A patient tells the nurse, "I get sick so much, so I started taking ginseng to boost my immune system." The patient's only other medication is warfarin daily. Which potential complication should be included in the nursing assessment? a.Gastrointestinal distress b.Spontaneous bleeding c.Thromboembolism d.Drowsiness
b.Spontaneous bleeding Ginseng may interact with anticoagulants and cause spontaneous bleeding. Warfarin is such an agent and can predispose the patient to spontaneous bleeding. It would not increase the risk of thromboembolism. Drowsiness and gastrointestinal complaints are common side effects.
A patient report, "Last night I had several mixed drinks at a party. When I got home, I had difficulty falling sleep. I made two cups of herbal tea with lavender. This morning, I feel very groggy and have a headache." The nurse should explain that a.lavender should be delayed at least 1 hour after using alcohol to avoid side effects. b.lavender may increase sedation from other central nervous system depressants. c.herbal teas often cause nervous system side effects such as headaches. d.these feelings are actually a hangover from excessive alcohol intake.
b.lavender may increase sedation from other central nervous system depressants. Lavender has sedative properties that are potentiated when used in combination with other central nervous system depressants. Headaches are another possible side effect of this herbal medicine. The nurse should advise caution in ingesting alcohol and lavender for these reasons. Taking lavender an hour after alcohol will not prevent these interactions, and it is likely that the lavender played a role in her feeling perhaps worse than usual after this episode of drinking. Herbal teas cause headaches in some cases, but it is not characteristic of this group of herbal remedies.
A patient has tried a variety of CAM approaches to manage health concerns. The nurse asks, "How is going to CAM practitioners different from seeing your medical doctors?" The patient is most likely to respond, "The CAM practitioners a.usually prescribe a course of invasive and sometimes painful treatments." b.spend more time talking with me and not just about my symptoms." c.say I need to become much more spiritual to be well." d.order many tests to determine my diagnoses."
b.spend more time talking with me and not just about my symptoms." CAM practitioners often spend considerable time assessing the person in a holistic way. Visits typically involve lengthy discussions, in contrast to traditional physician visits, where contact is often brief. CAM remedies can sometimes be invasive or slightly painful, but usually they are noninvasive and well-tolerated. Some CAM practices are very spiritually focused, but most do not have overt religious elements. Conventional health care involves more diagnostic testing than CAM.
Select the best desired outcome for a patient who uses valerian. The patient will report a.stress level is lower. b.undisturbed sleep throughout the night. c.increased interest in recreational activities. d.early morning waking without an alarm clock.
b.undisturbed sleep throughout the night. Valerian decreases sleep latency, nocturnal waking, and leads to a subjective sense of good sleep. Sleeping through the night is the best indicator the herb was effective. Although the patient's stress level may be lowered by use of valerian, the problem is insomnia; outcomes should relate to the problem. Early morning waking is indicative of depression or anxiety.
What are the 4 types of dramatic/erratic personality disorders?
borderline, histrionic, narcissistic, antisocial
Gladys is seeing a therapist because her husband committed suicide 6 months ago. Gladys tells her therapist, "I know he was in pain, but why didn't he leave me a note?" The therapist's best response would be: a. "He probably acted quickly on his impulse to kill himself." b. "He did not want to think about the pain he would cause you." c. "He was not able to think clearly due to his emotional pain." d. "He thought you may think it was an accident if there was no note."
c. "He was not able to think clearly due to his emotional pain."
A newly admitted patient diagnosed with schizophrenia says, "The voices are bothering me. They yell and tell me I am bad. I have got to get away from them." Select the nurse's most helpful reply. a. "Do you hear the voices often?" b. "Do you have a plan for getting away from the voices?" c. "I'll stay with you. Focus on what we are talking about, not the voices. " d. "Forget the voices and ask some other patients to play cards with you."
c. "I'll stay with you. Focus on what we are talking about, not the voices. " Staying with a distraught patient who is hearing voices serves several purposes: ongoing observation, the opportunity to provide reality orientation, a means of helping dismiss the voices, the opportunity of forestalling an action that would result in self-injury, and general support to reduce anxiety. Asking if the patient hears voices is not particularly relevant at this point. Asking if the patient plans to "get away from the voices" is relevant for assessment purposes but is less helpful than offering to stay with the patient while encouraging a focus on their discussion. Suggesting playing cards with other patients shifts responsibility for intervention from the nurse to the patient and other patients.
A nurse educates a patient about the antipsychotic medication regime. Afterward, which comment by the patient indicates the teaching was effective? a. "I will need higher and higher doses of my medication as time goes on." b. "I need to store my medication in a cool dark place, such as the refrigerator." c. "Taking this medication regularly will reduce the severity of my symptoms." d. "If I run out or stop taking my medication, I will experience withdrawal symptoms."
c. "Taking this medication regularly will reduce the severity of my symptoms." Antipsychotic drugs provide symptom control and allow most patients diagnosed with schizophrenia to live and be treated in the community. Dosing is individually determined. Antipsychotics are not addictive; however, they should be discontinued gradually to minimize a discontinuation syndrome.
Which person is at the highest risk for suicide? a. A 50-year-old married white male with depression who has a plan to overdose if circumstances at work do not improve. b. A 45-year-old married white female who recently lost her parents, suffers from bipolar disorder, and attempted suicide once as a teenager. c. A young single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden. d. An older Hispanic male who is Catholic, is living with a debilitating chronic illness, is recently widowed, and who states, "I wish that God would take me too."
c. A young single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden.
Which service would be expected to provide resources 24 hours a day, 7 days a week if needed for persons with SMI? a. Clubhouse model b. Cognitive-behavioral therapy (CBT) c. Assertive community treatment (ACT) d. Cognitive enhancement therapy (CET)
c. Assertive community treatment (ACT) ACT involves consumers working with a multidisciplinary team that provides a comprehensive array of services. At least one member of the team is available 24 hours a day for crisis needs, and the emphasis is on treating the patient within his own environment.
Which nursing diagnosis is likely to apply to an individual diagnosed with a SMI who is homeless? a. Insomnia b. Substance abuse c. Chronic low self-esteem d. Impaired environmental interpretation syndrome
c. Chronic low self-esteem Many individuals with SMI do not live with their families and become homeless. Life on the street or in a shelter has a negative influence on the individual's self-esteem, making this nursing diagnosis one that should be considered. Substance abuse is not an approved North American Nursing Diagnosis Association (NANDA)-International diagnosis. Insomnia may be noted in some patients but is not a universal problem. Impaired environmental interpretation syndrome refers to persistent disorientation, which is not seen in a majority of the homeless.
The nurse wants to enroll a patient with poor social skills in a training program for patients diagnosed with schizophrenia. Which description accurately describes social skills training? a. Patients learn to improve their attention and concentration. b. Group leaders provide support without challenging patients to change. c. Complex interpersonal skills are taught by breaking them into simpler behaviors. d. Patients learn social skills by practicing them in a supported employment setting.
c. Complex interpersonal skills are taught by breaking them into simpler behaviors. In social skills training, complex interpersonal skills are taught by breaking them down into component behaviors that are covered in a stepwise fashion. Social skills training is not based in employment settings, although such skills can be addressed as part of supported employment services. The other distracters are less relevant to social skills training.
A patient diagnosed with schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which patient needs are of priority importance? a. Self-esteem b. Psychosocial c. Physiological d. Self-actualization
c. Physiological Physiological needs must be met to preserve life. A patient with waxy flexibility must be fed by hand or tube, toileted, given range-of-motion exercises, and so forth to preserve physiological integrity. Waxy flexibility may also precipitate a risk for falls; therefore, safety is a concern. Higher level needs are of lesser concern.
The nurse assesses a patient diagnosed with schizophrenia. Which assessment finding would the nurse regard as a negative symptom of schizophrenia? a. Auditory hallucinations b. Delusions of grandeur c. Poor personal hygiene d. Psychomotor agitation
c. Poor personal hygiene Negative symptoms include apathy, anhedonia, poor social functioning, and poverty of thought. Poor personal hygiene is an example of poor social functioning. The distracters are positive symptoms of schizophrenia. See relationship to audience response question.
Which finding constitutes a negative symptom associated with schizophrenia? a. Hostility b. Bizarre behavior c. Poverty of thought d. Auditory hallucinations
c. Poverty of thought Negative symptoms include apathy, anhedonia, poor social functioning, and poverty of thought. Poor personal hygiene is an example of poor social functioning. The distracters are positive symptoms of schizophrenia. See relationship to audience response question.
A patient diagnosed with schizophrenia has taken fluphenazine 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term applies to these symptoms? a. Neuroleptic malignant syndrome b. Hepatocellular effects c. Pseudoparkinsonism d. Akathisia
c. Pseudoparkinsonism Pseudoparkinsonism induced by antipsychotic medication mimics the symptoms of Parkinson's disease. It frequently appears within the first month of treatment and is more common with first-generation antipsychotic drugs. Hepatocellular effects would produce abnormal liver test results. Neuroleptic malignant syndrome is characterized by autonomic instability. Akathisia produces motor restlessness.
A patient diagnosed with schizophrenia begins a new prescription for ziprasidone. The patient is 5'6'' and currently weighs 204 lbs. The patient has dry flaky skin, headaches about twice a month, and a family history of colon cancer. Which intervention has the highest priority for the nurse to include in the patient's plan of care? a. Skin care techniques b. Scheduling a colonoscopy c. Weight management strategies d. Teaching to limit caffeine intake
c. Weight management strategies Ziprasidone is a second-generation antipsychotic medication. The incidence of weight gain, diabetes, and high cholesterol is high with second-generation antipsychotic medications. The patient is overweight now, so weight management will be especially important. The other interventions may occur in time, but do not have the priority of weight management.
An adult diagnosed with a serious mental illness (SMI) says, "I do not need help with money management. I have excellent ideas about investments." This patient usually does not have money to buy groceries by the middle of the month. The nurse assesses the patient as demonstrating a. rationalization. b. identification. c. anosognosia. d. projection.
c. anosognosia. The patient scenario describes anosognosia, the inability to recognize one's deficits due to one's illness. The patient is not projecting an undesirable thought or emotion from himself onto others. He is not justifying his behavior via rationalization and is not identifying with another
A nurse provides health education for an adult with sleep deprivation. It is most important for the nurse to encourage caution when the patient engages in: a. using a vacuum cleaner. b. cooking a meal. c. driving a car. d. bathing.
c. driving a car. Safety is the highest priority for this patient. Sleep deprivation causes psychomotor deficits. Driver drowsiness and fatigue lead to many automobile injuries and fatalities. The distracters are less likely to be associated with serious injury.
A patient says, "It takes me about 15 minutes to go to sleep each night." This comment describes: a. delta sleep. b. parasomnia. c. sleep latency. d. rapid eye movement sleep.
c. sleep latency. Sleep latency refers to the amount of time it takes a person to fall asleep. The distracters represent other phases of the sleep cycle.
A patient shows a nurse this advertisement: "Our product is a scientific breakthrough helpful for depression, anxiety, and sleeplessness. Made from an ancient formula, it stimulates circulation and excretes toxins. Satisfaction guaranteed or your money back." Select the nurse's best response. a."Over-the-counter products for sleep problems are ineffective." b."Do not take anything unless it's prescribed by your doctor." c."Let's do some additional investigation of that product." d."It sounds like you are trying to self-medicate."
c."Let's do some additional investigation of that product." Helping consumers actively evaluate the quality of information available to them is important. It is important for the nurse to work with the patient and include the patient's preferences regarding management of health. Advertisements indicating scientific breakthroughs or promising miracles for multiple ailments are usually for products that are useless and being fraudulently marketed. Some may even be harmful. Some over-the-counter products can be useful, and patients do not need a prescription for these products. The broader issue is safety and efficacy, rather than whether the patient is trying to self-medicate.
A patient tells the nurse, "I prefer to treat my physical problems with herbs and vitamins. They are natural substances, and natural products are safe." Which response by the nurse would be most appropriate? a."Natural substances tend to be safer than conventional medical remedies." b."Natural remedies give you the idea that you are controlling your treatment." c."The word natural can be a marketing term used to imply a product is healthy, but that's not always true." d."You should not treat your own physical problems. You should see your health care provider for these problems."
c."The word natural can be a marketing term used to imply a product is healthy, but that's not always true." CAM remedies are usually natural substances, but it is a fallacy that products labeled natural are safer than conventional medicines. Some natural products contain powerful ingredients that can cause illness and damage to the body if taken inappropriately and, for some persons, can be dangerous even when used as directed. This is the most important message for the nurse to convey to the patient. So-called natural substances can have a number of significant side effects. Natural substances may give one the belief that he is controlling his own treatment, but that is not the message that most needs to be communicated here. Many patients can safely self-manage minor physical problems.
A patient diagnosed with depression confidently tells the nurse, "I've been supplementing my paroxetine with St. John's wort. It has helped a great deal." What is the nurse's priority action? a.Assess changes in the patient's level of depression. b.Remind the patient to use a secondary form of birth control. c.Educate the patient about the risks of selective serotonin syndrome. d.Suggest adding valerian to the treatment regimen to further improve results.
c.Educate the patient about the risks of selective serotonin syndrome. St. John's wort inhibits serotonin reuptake by elevating extracellular sodium; thus, it may interact with medication, particularly selective serotonin reuptake inhibitors, to produce serotonin syndrome. Discussing the patient's birth control method is a secondary priority.
Which complementary and alternative therapy may be safely combined with traditional Western medicine in the treatment of anxiety disorder? a.Electroconvulsive therapy b.Mega doses of vitamins c.Meditative practices d.Herbal therapy
c.Meditative practices Yoga, meditation, and prayer are considered to be beneficial adjuncts to treatment for anxiety disorder. Research supports this with findings of lower catecholamine levels following meditation. Patient self-reports suggest patient satisfaction, with increased ability to relax. Meditation and spiritual practices have no associated untoward side effects. Herbal therapy and megadoses of vitamins have potential associated side effects and interactions. Electroconvulsive therapy is not CAM.
Acupuncture is a traditional Chinese medical treatment based on the belief that a.insertion of needles in key locations will drain toxic energies. b.pressure on meridian points will correct problems in energy flow. c.insertion of needles modulates the flow of energy along body meridians. d.taking small doses of noxious substances will alleviate specific symptoms.
c.insertion of needles modulates the flow of energy along body meridians. Acupuncture involves the insertion of needles to modulate the flow of body energy (qi) along specific body pathways called meridians. Acupressure uses pressure to affect energy flow. Homeopathy involves the use of microdosages of specific substances to effect health improvement. Traditional Chinese medicine (TCM) is more concerned with energy and life force balance, and acupuncture is not predicated on the removal of toxic energies.
Which patient would most likely benefit from taking St. John's wort? A patient with a.mood swings. b.hypomanic symptoms. c.mild depressive symptoms. d.panic disorder with agoraphobia.
c.mild depressive symptoms. St. John's wort may be effective in treating mild to moderate depression. St John's wort has not been found to be effective in treatment of cyclothymic, bipolar, or anxiety disorders.
A patient with rheumatoid arthritis reports, "For the past month I've been having a lot of trouble falling asleep. When I finally get to sleep, I wake up several times during the night." Which information should the nurse seek initially? a. "What have you done to try to improve your sleep?" b. "What would be a good sleep pattern for you?" c. "How much exercise are you getting?" d. "Do you have pain at night?"
d. "Do you have pain at night?" Patients with diseases such as arthritis may have sleep disturbance related to nightly pain. Because the pain is chronic, the patient may fail to realize it is the reason for the inability to sleep. The other options do not follow the patient's lead or begin problem solving without an adequate baseline.
A young adult says to the nurse, "I go to sleep without any problem, but I often wake up during the night because it feels like there are rubber bands in my legs." Which assessment question should the nurse ask to assess for restless legs syndrome (RLS)? a. "What type of birth control do you use?" b. "How much caffeine do you use every day?" c. "How much exercise do you get in a typical day?" d. "Does anyone else in your family have this problem?"
d. "Does anyone else in your family have this problem?" Restless legs syndrome (RLS) is a sensory and movement disorder characterized by an unpleasant, uncomfortable sensation in the legs accompanied by an urge to move. Symptoms begin or worsen during periods of inactivity, such as sleep. Symptoms can have a significant impact on the individual's ability to fall asleep and stay asleep. There is likely to be a strong genetic component, especially when seen in individuals less than 40 years old.
A patient diagnosed with schizophrenia tells the nurse, "I eat skiller. Tend to end. Easter. It blows away. Get it?" Select the nurse's most therapeutic response. a. "Nothing you are saying is clear." b. "Your thoughts are very disconnected." c. "Try to organize your thoughts and then tell me again." d. "I am having difficulty understanding what you are saying."
d. "I am having difficulty understanding what you are saying." When a patient's speech is loosely associated, confused, and disorganized, pretending to understand is useless. The nurse should tell the patient that he or she is having difficulty understanding what the patient is saying. If a theme is discernible, ask the patient to talk about the theme. The incorrect options tend to place blame for the poor communication with the patient. The correct response places the difficulty with the nurse rather than being accusatory.
Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder? a. "I'm so restless. I can't seem to sit still." b. "I spend most of my time studying. I have to get into a good college." c. "I'm not trying to diet, but I've lost about 5 pounds in the past 5 months." d. "I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep."
d. "I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep."
A patient receiving risperidone (Risperdal) reports severe muscle stiffness at 1030. By 1200, the patient has difficulty swallowing and is drooling. By 1600, vital signs are 102.8° F; pulse 110; respirations 26; 150/90. The patient is diaphoretic. Select the nurse's best analysis and action. a. Agranulocytosis; institute reverse isolation. b. Tardive dyskinesia; withhold the next dose of medication. c. Cholestatic jaundice; begin a high-protein, high-cholesterol diet. d. Neuroleptic malignant syndrome; notify health care provider stat
d. Neuroleptic malignant syndrome; notify health care provider stat Taking an antipsychotic medication coupled with the presence of extrapyramidal symptoms, such as severe muscle stiffness and difficulty swallowing, hyperpyrexia, and autonomic symptoms (pulse elevation), suggest neuroleptic malignant syndrome, a medical emergency. The symptoms given in the scenario are not consistent with the medical problems listed in the incorrect options.
An outpatient diagnosed with schizophrenia attends programming at a community mental health center. The patient says, "I threw away the pills because they keep me from hearing God." Which response by the nurse would most likely to benefit this patient? a. "You need your medicine. Your schizophrenia will get worse without it." b. "Do you want to be hospitalized again? You must take your medication." c. "I would like you to come to the medication education group every Thursday." d. "I noticed that when you take the medicine, you are able to keep the job you wanted."
d. "I noticed that when you take the medicine, you are able to keep the job you wanted." The patient appears not to understand that he has an illness. He has stopped his medication because it interferes with a symptom that he finds desirable (auditory hallucinations—the voice of God). Connecting medication adherence to one of the patient's goals (the job) can serve to motivate the patient to take the medication and override concerns about losing the hallucinations. Exhorting a patient to take medication because it is needed to control his illness is unlikely to be successful; he does not believe he has an illness. Medication psychoeducation would be appropriate if the cause of nonadherence was a knowledge deficit.
A patient tells the nurse, "Everyone says we should sleep 8 hours a night. I can only sleep 6 hours, no matter how hard I try. Am I doing harm to my body?" Select the nurse's best response. a. "Tell me about strategies you have tried to increase your total sleep hours." b. "Lack of sleep acts as a stressor on the body and can cause physical changes." c. "If you have really tried to sleep more, maybe you should consult your health care provider." d. "If you function well with 6 hours of sleep, you are a short sleeper. That's normal for some people."
d. "If you function well with 6 hours of sleep, you are a short sleeper. That's normal for some people." Some individuals require less sleep than others do. Those who need less are called "short sleepers," compared with "long sleepers," who require more than 8 hours. The distracters do not provide information the patient is seeking or are untrue.
The parent of a seriously mentally ill adult asks the nurse, "Why are you making a referral to a vocational rehabilitation program? My child won't ever be able to hold a job." Which is the nurse's best reply? a. "We make this referral to continue eligibility for federal funding." b. "Are you concerned that we're trying to make your child too independent?" c. "If you think the program would be detrimental, we can postpone it for a time." d. "Most patients are capable of employment at some level, competitive or supported."
d. "Most patients are capable of employment at some level, competitive or supported." Studies have shown that most patients who complete vocational rehabilitation programs are capable of some level of employment. They also demonstrate significant improvement in assertiveness and work behaviors as well as decreased depression.
A patient diagnosed with schizophrenia anxiously tells the nurse, "The voice is telling me to do things." Select the nurse's priority assessment question. a. "How long has the voice been directing your behavior?" b. "Does what the voice tell you to do frighten you?" c. "Do you recognize the voice speaking to you?' d. "What is the voice telling you to do?"
d. "What is the voice telling you to do?" Learning what a command hallucination is telling the patient to do is important because the command often places the patient or others at risk for harm. Command hallucinations can be terrifying and may pose a psychiatric emergency. The incorrect questions are of lesser importance than identifying the command.
A nurse sits with a patient diagnosed with schizophrenia. The patient starts to laugh uncontrollably, although the nurse has not said anything funny. Select the nurse's most therapeutic response. a. "Why are you laughing?" b. "Please share the joke with me." c. "I don't think I said anything funny." d. "You're laughing. Tell me what's happening."
d. "You're laughing. Tell me what's happening." The patient is likely laughing in response to inner stimuli, such as hallucinations or fantasy. Focus on the hallucinatory clue (the patient's laughter) and then elicit the patient's observation. The incorrect options are less useful in eliciting a response: no joke may be involved, "why" questions are difficult to answer, and the patient is probably not focusing on what the nurse said in the first place.
A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social function. The patient is also overweight and hypertensive. Which drug should the nurse advocate? a. Clozapine b. Ziprasidone c. Olanzapine d. Aripiprazole
d. Aripiprazole Aripiprazole is a third-generation atypical antipsychotic effective against both positive and negative symptoms of schizophrenia. It causes little or no weight gain and no increase in glucose, high- or low-density lipoprotein cholesterol, or triglycerides, making it a reasonable choice for a patient with obesity or heart disease. Clozapine may produce agranulocytosis, making it a poor choice as a first-line agent. Ziprasidone may prolong the QT interval, making it a poor choice for a patient with cardiac disease. Olanzapine fosters weight gain.
A patient diagnosed with schizophrenia says, "It's beat. Time to eat. No room for the cat." What type of verbalization is evident? a. Neologism b. Idea of reference c. Thought broadcasting d. Associative looseness
d. Associative looseness Looseness of association refers to jumbled thoughts incoherently expressed to the listener. Neologisms are newly coined words. Ideas of reference are a type of delusion. Thought broadcasting is the belief that others can hear one's thoughts.
A family discusses the impact of a seriously mental ill member. Insurance partially covers treatment expenses, but the family spends much of their savings for care. The patient's sibling says, "My parents have no time for me." The parents are concerned that when they are older, there will be no one to care for the patient. Which response by the nurse would be most helpful? a. Acknowledge their concerns and consult with the treatment team about ways to bring the patient's symptoms under better control. b. Give them names of financial advisors that could help them save or borrow sufficient funds to leave a trust fund to care for their loved one. c. Refer them to crisis intervention services to learn ways to manage caregiver stress and provide titles of some helpful books for families. d. Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the patient become more independent.
d. Discuss benefits of participating in National Alliance on Mental Illness (NAMI) programs and ways to help the patient become more independent. The family has raised a number of concerns, but the major issues appear to be the effects caregiving has had on the family and their concerns about the patient's future. NAMI offers support, education, resources, and access to other families who have experience with the issues now facing this family. NAMI can help address caregiver burden and planning for the future needs of SMI persons. Improving the patient's symptom control and general functioning can help reduce caregiver burden but would likely be a slow process, whereas NAMI involvement could benefit them on a number of fronts, possibly in a shorter time period. The family will need more than financial planning; their issues go beyond financial. The family is distressed but not in crisis. Crisis intervention is not an appropriate resource for the longer-term issues and needs affecting this family.
Luc's family comes home one evening to find him extremely agitated and they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting? a. Hypodermic needles b. Fast food wrappers c. Empty soda cans d. Energy drink containers
d. Energy drink containers
A homeless individual diagnosed with SMI and a history of persistent treatment nonadherence plans to begin attending the day program at a community mental health center. Which intervention should be the team's initial focus? a. Teach appropriate health maintenance and prevention practices. b. Educate the patient about the importance of treatment adherence. c. Help the patient obtain employment in a local sheltered workshop. d. Interact regularly and supportively without trying to change the patient.
d. Interact regularly and supportively without trying to change the patient. Given the history of treatment nonadherence and the difficulty achieving other goals until psychiatrically stable and adherent, getting the patient to accept and adhere to treatment is the fundamental goal to address. The intervention most likely to help meet that goal at this stage is developing a trusting relationship with the patient. Interacting regularly, supportively, and without demands is likely to build the necessary trust and relationships that will be the foundation for all other interventions later on. No data here suggest the patient is in crisis, so it is possible to proceed slowly and build this foundation of trust.
A nurse leads a psychoeducational group about problem solving with six adults diagnosed with schizophrenia. Which teaching strategy is likely to be most effective? a. Suggest analogies that might apply to a common daily problem. b. Assign each participant a problem to solve independently and present to the group. c. Ask each patient to read aloud a short segment from a book about problem solving. d. Invite participants to come up with solution to getting incorrect change for a purchase.
d. Invite participants to come up with solution to getting incorrect change for a purchase. Concrete thinking, an impaired ability to think abstractly resulting in interpreting or perceiving things in a literal manner, is evident in many patients diagnosed with schizophrenia. People who think concretely benefit from concrete situations during education. Finding a solution in order to get incorrect change for a purchase is an example of a concrete situation. Analogies require abstract thinking and insight. Independently solving a problem and presenting it to the group may be intimidating. All participants may or may not be literate.
A hospitalized patient diagnosed with schizophrenia has a history of multiple relapses. The patient usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply first as the patient transitions from hospital to community? a. Administer a second-generation antipsychotic to help negative symptoms. b. Use a quick-dissolving medication formulation to reduce "cheeking." c. Prescribe a long-acting intramuscular antipsychotic medication. d. Involve the patient in decisions about which medication is best.
d. Involve the patient in decisions about which medication is best. Persons with schizophrenia are at high risk for treatment nonadherence, so the strategy needs primarily to address that risk. Of the options here, involving the patient in the decision is best because it will build trust and help establish a therapeutic alliance with care providers, an essential foundation to adherence. Intramuscular depot medications can be helpful for promoting adherence if other alternatives have been unsuccessful, but IM medications are painful and may jeopardize the patient's acceptance. All of the other strategies also apply but are secondary to trust and bonding with providers.
Research supports which intervention implemented on a long-term basis significantly reduces the incidence of suicide and suicide attempts in a patient diagnosed with bipolar disorder? a. A selective serotonin reuptake inhibitor (SSRI) b. Electroconvulsive therapy (ECT) c. One-on-one observation d. Lithium
d. Lithium
Cabot has multiple symptoms of depression including mood reactivity, social phobia, anxiety, and overeating. With a history of mild hypertension, which classification of antidepressants dispensed as a transdermal patch would be a safe medication? a. Tricyclic antidepressants b. Selective serotonin reuptake inhibitors c. Serotonin and norepinephrine reuptake inhibitors d. Monoamine oxidase inhibitor
d. Monoamine oxidase inhibitor
A 76-year-old man tells the nurse at the sleep disorder clinic, "I awaken almost nightly in the midst of violent dreams in which I am defending myself against multiple attackers. Then I realize I have been hitting and kicking my wife. She has bruises." Which health problem is most likely? a. Sleep Paralysis b. Night Terror Disorder c. Sleep-Related Bruxism d. Rapid Eye Movement (REM) Sleep Behavior Disorder
d. Rapid Eye Movement (REM) Sleep Behavior Disorder The scenario describes REM sleep behavior disorder in which the patient engages in violent and complex behaviors during REM sleep as though acting out his dreams. Older men have a higher incidence of this problem. Sleep paralysis refers to the sudden inability to perform voluntary movement at either sleep onset or awakening from sleep. Bruxism refers to grinding teeth during stage 2 sleep. Night terror disorder occurs as arousal in the first third of the night during non-REM sleep, accompanied by feelings of panic.
The nurse is developing a plan for psychoeducational sessions for a small group of adults diagnosed with schizophrenia. Which goal is best for this group? Members will a. gain insight into unconscious factors that contribute to their illness. b. explore situations that trigger hostility and anger. c. learn to manage delusional thinking. d. demonstrate improved social skills.
d. demonstrate improved social skills. Improved social skills help patients maintain relationships with others. These relationships are important to management of the disorder. Most patients with schizophrenia think concretely, so insight development is unlikely. Not all patients with schizophrenia experience delusions.
A patient diagnosed with schizophrenia tells the community mental health nurse, "I threw away my pills because they interfere with God's voice." The nurse identifies the etiology of the patient's ineffective management of the medication regime as a. inadequate discharge planning. b. poor therapeutic alliance with clinicians. c. dislike of antipsychotic medication side effects. d. impaired reasoning secondary to the schizophrenia.
d. impaired reasoning secondary to the schizophrenia. The patient's ineffective management of the medication regime is most closely related to impaired reasoning associated with the thought disturbances of schizophrenia. The patient believes in being an exalted personage who hears God's voice, rather than an individual with a serious mental disorder who needs medication to control symptoms. Data do not suggest any of the other factors often related to medication nonadherence.
person is prescribed sertraline (Zoloft) 100 mg PO daily. Which change in sleep is likely secondary to this medication? The patient will have: a. more dreams. b. excessive sleepiness. c. less slow-wave sleep. d. less rapid eye movement (REM) sleep.
d. less rapid eye movement (REM) sleep. Sertraline (Zoloft) is an SSRI antidepressant medication, which suppresses REM sleep. Dreams would decrease because they occur during REM. Benzodiazepines reduce slow-wave sleep. SSRIs have a side effect of insomnia
A patient diagnosed with schizophrenia anxiously says, "I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror." While listening, the nurse should a. sit close to the patient. b. place an arm protectively around the patient's shoulders. c. place a hand on the patient's arm and exert light pressure. d. maintain a normal social interaction distance from the patient
d. maintain a normal social interaction distance from the patient The patient is describing phenomena that indicate personal boundary difficulties and depersonalization. The nurse should maintain appropriate social distance and not touch the patient because the patient is anxious about the inability to maintain ego boundaries and merging or being swallowed by the environment. Physical closeness or touch could precipitate panic.
A patient diagnosed with schizophrenia has been stable for a year; however, the family now reports the patient is tense, sleeps 3 to 4 hours per night, and has difficulty concentrating. The patient says, "My computer is sending out infected radiation beams." The nurse can correctly assess this information as an indication of a. the need for psychoeducation. b. medication nonadherence. c. chronic deterioration. d. relapse.
d. relapse. Signs of potential relapse include feeling tense, difficulty concentrating, trouble sleeping, increased withdrawal, and increased bizarre or magical thinking. Medication nonadherence may not be implicated. Relapse can occur even when the patient is taking medication regularly. Psychoeducation is more effective when the patient's symptoms are stable. Chronic deterioration is not the best explanation.
An outpatient diagnosed with schizophrenia tells the nurse, "I am here to save the world. I threw away the pills because they make God go away." The nurse identifies the patient's reason for medication nonadherence as a. poor alliance with clinicians. b. inadequate discharge planning. c. dislike of medication side effects. d. thought disturbances associated with the illness.
d. thought disturbances associated with the illness. The patient's nonadherence is most closely related to thought disturbances associated with the illness. The patient believes he is an exalted personage who hears God's voice rather than an individual with a serious mental disorder who needs medication to control his symptoms. While the distracters may play a part in the patient's nonadherence, the correct response is most likely.
An immigrant from China needs a colonic resection but is anxious and reluctant about surgery. This patient usually follows traditional Chinese health practices. Which comment by the nurse would most likely reduce the patient's anxiety and reluctance? a."Surgery will help rebalance the yin and yang forces and return you to harmony." b."The surgery we are recommending will help you achieve final transformation." c."I know this is new to you, but you can trust us to take very good care of you." d."If you would like, we could investigate using acupuncture to help control pain."
d."If you would like, we could investigate using acupuncture to help control pain." It would be helpful to incorporate elements of TCM as appropriate; such as acupuncture for pain control. TCM has the goal of healing in harmony with one's environment and all of creation in mind, body, and spirit, as well as balance of yin and yang energies and a state of transition. However, it would not be helpful to suggest that surgery will balance the yin and the yang, since this is not how balance is achieved in TCM. Transformation is recognized as a stage of healing occurring when mutual, creative, active participation occurs between healers and the patient toward changes in the mind, body, and spirit; but "final transformation" could imply the end of corporeal life and might be perceived as hastening his demise. Appealing to him to trust persons whose practices are foreign to him conflicts with the patient's values and would not likely be effective.
A patient wants to learn more about integrative therapies. Which resource should the nurse suggest for the most reliable information?a.Internet b.American Nurses Association (ANA) c.Food and Drug Administration (FDA) d.National Center for Complementary and Integrative Health (NCCIH)
d.National Center for Complementary and Integrative Health (NCCIH) The NCCIH provides reliable, objective, and scientific information to help in making decisions about use of these practices. NCCIH supports not only research, but also the development and sharing of this kind of information. The FDA has information, but it is not as extensive as NCCIH. The Internet has many resources but some are unreliable. The ANA does not provide extensive information about this topic.
A patient with a history of asthma says, "I've been very nervous lately. I think aromatherapy will help. I am ordering $250 worth of oils from an Internet site that promised swift results." Select the nurse's best action. a.Support the patient's efforts to become informed and to find health solutions. b.Suggest the patient check with friends who have tried aromatherapy for treatment of anxiety. c.Remind the patient, "If you spend that much on oils, you may not be able to buy your prescribed medication." d.Tell the patient, "Aromatherapy can complicate respiratory problems such as asthma. Let's consider some other options."
d.Tell the patient, "Aromatherapy can complicate respiratory problems such as asthma. Let's consider some other options." Safety is paramount, and aromatherapy may cause complications for a patient with asthma. The nurse should view alternative treatments with an open mind and try to recognize the importance of the treatment to the patient while trying to give the patient accurate, reliable information about the treatment. Although efforts to become health literate should be supported, educating the patient about the pitfalls of relying on the Internet is essential. The opinions of others, whether they are positive or negative, lack a scientific basis and are subject to confounding variables such as the placebo effect and individual factors such as age and health history. Admonishing the patient may jeopardize the relationship.
Which personality disorder is this describing? Difficulty making everyday decisions without an excessive amount of advice and reassurance from others Needs others to assume responsibility for most major areas of life Difficulty doing things on their own (because of a lack of self-confidence in judgment or abilities rather than a lack of motivation or energy) Goes to excessive lengths to obtain nurturance and support from others Feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for themselves Immediately seeks another relationship as a source of care and support when a close relationship ends Unrealistically preoccupied with fears of being left to take care of themselves.
dependent personality disorder (anxious/fearful)
Which personality disorder is this describing? Sense of self-importance (ex: exaggerates achievements and talents) Preoccupied with fantasies of unlimited success, power, brilliance, beauty Believes they are special and unique and can only be understood by, or should associate with, other special or high-status people Requires excessive admiration Sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations) Is interpersonally exploitative (i.e., takes advantage of others) Unwilling to recognize or identify with the feelings and needs of others Envious of others or believes that others are envious of him or her Demonstrates arrogant, haughty behaviors or attitudes
narcissistic personality disorder (Dramatic/erratic)
Which personality disorder is this describing? Preoccupation with rules, lists, organization that interferes with activities Perfectionism interferes with task completion Excessively devoted to work and productivity Overconscientious and inflexible about values and ethics Unable to discard objects, even when they have no sentimental value Reluctance in delegating tasks Money is hoarded for future emergencies Rigidity, stubbornness
obsessive-compulsive personality disorder (anxious/fearful)
Which personality disorder is this describing? Suspects, without basis, that others are exploiting, harming, or deceiving Preoccupied with unjustified doubts about loyalty or trustworthiness of others Reluctant to confide in others because of unwarranted fear that the information will be used maliciously Reads hidden demeaning or threatening meanings into remarks or events Bears grudges (unforgiving of insults, injuries, or slights) Perceives attacks on their character or reputation that are not apparent to others, quick to react angrily or counterattack Recurrent suspicions, without justification, regarding fidelity of spouse or sexual partner
paranoid personality disorder (odd/eccentric)
Which personality disorder is this describing? Does not desire or enjoy close relationships Almost always chooses solitary activities Has little, if any, interest in having sexual relations with another person Takes pleasure in few, if any, activities Lacks close friends or confidants other than first-degree relatives Appears indifferent to the praise or criticism of others Shows emotional coldness, detachment, or flattened activity
schizoid personality disorder (odd/eccentric)
Which personality disorder is this describing? Ideas of reference (personal significance to trivial events) Odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (ex: "sixth sense") Unusual perceptual experiences, including bodily illusions Odd thinking and speech Suspiciousness or paranoid ideation Inappropriate or constricted affect Behavior or appearance that is odd, eccentric, or peculiar lack of close friends or confidants other than first-degree relatives Excessive social anxiety that does not diminish with familiarity, tends to be associated with paranoid fears
schizotypal personality disorder (odd/eccentric)
