psyco mid term
A patient has been out of work for 3 weeks with a major illness and anticipates another month of recovery. The patient tells the nurse." I am trying to keep up with my work email from home. They hired a new person in my department, but that person has no experience Select the nurse's therapeutic response?
"It sounds like you're saying you are worried about your job security.
A client who has severe anxiety starts to cry while talking with the nurse. The client is so upset that the crying becomes uncontrollable. What is the best response by the nurse?
"You don't need to talk: I'll just stay with you for now"
The doctor order mg of an IV medication that needs to be reconstituted. The Instructions say 50mg of the medication is to reconstitute with normal saline for a solution of 2.5 mg/ml. How many ml will you draw up to achieve this ordered dose ?
10 ml
A primary healthcare provider ordered ceftriance (rocephin) for a 4-year-old child with lower respiratory tract infections. The dose required in 20mg divided twice a day administered per dose via IV. The child weight is 29lbs. The drug comes prediluted in a concentration of 10mg How much of the medication will you administer?
13.2 ml
The doctor writes a order for and IV bolus. The order says to administer 20mg IV BID Your supplied with a vial that is labeled 40 mg/ml. How many ml the patient receive DAILY
1ml
The school nurse assesses four adolescents all of whom outwardly appear healthy. Which adolescent meets one criterion for anorexia nervosa with mild severity?
5"7 tall, weight 110 lbs
Which scenario meets the criteria for "normal" behavior?
A 42-year-old man cries privately for 1 month after the death of his wife.
Which scenario meets the criteria for normal behavior?
A 43-year-old man cries privately for 1 month after the death of his wife
Which patient would the nurse expect to have the most difficulty with problem solving and decision making?
A 52 yr old diagnosed with schizophrenia at age21, has taken monthly injection of haloperidol (haldol decanoate) for 12 yrs.
A mature, professional couple plans a large wedding in a city 100 miles away from their home. Which responses is most likely to be associated with this experience?
A student reports improved feelings of well-being
Which patient is likely to achieve maximum benefit from cognitive behavioral therapy (CBT)?
Adult experiencing feeling of failure after losing the fourth job in 2 years
Which pt. is likely to achieve maximum benefit from cognition behavioral therapy?
Adult experiencing feeling of failure after losing the fourth job in 2 years
A mental health nurse assesses a pt diagnosed with an antisocial personality disorder. Which comorbid problem is most important for the nurse to include in the assessment?
Alcohol us and abuse
A patient begins a new prescription for risperidone (Risperdal). Which intervention should the nurse include in the plan of care?
Assess sitting standing and lying blood pressure daily
A veteran of the war in Afghanistan tells the nurse, "Everyday something happens that makes me feel like I'm still there. My family has grown impatient with me. They say it's time for me to move on from that time in my life but I can't. What is the nurses first priority?
Assess the veteran for suicide risk
A nurse is performing a mental status assessment. What is being assessed when the nurse notes that the client is cooperative?
Attitude
A patient is hospitalized with a diagnosis of anorexia nervosa. The nurse reviews the patients lab results below Sodium 143 potassium 3.1 Chloride 102 Magnesium 2.2 Calcium 8.4 Phosphate 3.0 The nurse should take which action next?
Auscultate the patient's heart rate rhythms and sounds.
An adult experienced a spinal cord injury resulting in quadriplegia 3 years ago and now lives permanently in a skilled care facility. Which comment by this person best demonstrates resiliency?
Being paralyzed has taken things from me but it hasn't kept me from being mentally involved in life.
A distraught 8-year-old girl tells the nurse. "I had a horrible nightmare and was so scared. I tried to get in bed with my parents, but they said. No, I think I could have gone back to sleep if I had been with them? "Which family dynamic is likely the basis of this child's comment?
Boundaries in the family are rigid.
A client receiving tricyclic antidepressant arrives at the mental health clinic. Which observation would indicate the client is following the medication plan correctly?
Client arrives at the clinical n and appropriate appearance.
A nurse assesses a confused older adult. The nurse experiences sadnessan d reflects "The patient is like one of my grandparents, so helpless. "What feelings does the nurse describe?
Countertransference
A hospitalized client is started on a monoamine oxidase inhibitor (MAO) for the treatment of depression. The nurse would instruct the client that which foods are acceptable to consume while taking the medication? Select all that apply
Crackers Tossed Salad
Edwards come back down the hallway with his wife behind him. They each take a seat in what you believe is their own favorite chairs. The phone them rings and Edward's wife states to Edward. " It is okay honey; I will get it I don't want to you get in a hurry and fall again/ "As the RN you pick up on what Edward's wife said about "not to hurry" and "Fall again" What do you do next?
Edward tells you "My wife worries too much I tripped and fell in the hallway last night. I guess I was in a hurry, but I am not for certain what for. Oh well things like that happens. As the RN you pull out your flowsheet that includes a tall risk assessment and start to complete.
Over the past 2 months a patient made eight suicide attempts with increasing lethality. The health care provider informs the patient and family that electroconvulsive therapy (ECT) is needed. The family whispers to the nurse, "Isn't this a dangerous treatment?" How should the nurse reply? a. "Our facility has an excellent record of safety associated with use of electroconvulsive therapy." b. "Your family member will eventually be successful with suicide if aggressive measures are not promptly taken." c. "Yes, there are hazards with electroconvulsive therapy. You should discuss these concerns with the health care provider." d. "Electroconvulsive therapy is very effective when urgent help is needed. Your family member was carefully evaluated for possible risks."
Electroconvulsive therapy
When managing the milieu, client autonomy and the need for therapeutic limit setting are concepts that often are in conflict. Which nursing intervention best minimial this conflict?
Establishing unit rules that are appropriate and explained thoroughly
A 28 years old 2nd grade teacher is diagnosed with major depressive disorder. She grew up in Texas but moved to Alaska 10 years ago to separate from an abusive mother. Her father died by suicide when she was 12 years old. Which combination of factors in this scenario best demonstrates the stress-diathesis model?
Family history of mental illness coupled with history of abuse
Which nursing action align with the mental health recovery model?
Focus on the expectation of recovery. Encourage the patient to learn self regulation. Empower the patient to make decisions.
The nurse employed in a mental health clinic is greeted by a neighbor in a local grocery store. The neighbor says "How is carol doing? Carol is my best friend and is seen at your clinic every week. Which is the most appropriate nursing response?
I cannot discuss any client situation with you
A nurse analyzes report from four adult patients of frightening events they encountered. Which patient's report most clearly indicates that the resulting fear was mentally healthy
I was at home when a storm with heavy thunder and lightning lasted over an hour.
A nurse assesses four adolescents diagnosed with various eating disorders. Which comment would the nurse expect from the adolescent diagnosed with anorexia nervosa?
I've lost 60 lbs but I'm still a size 2. I want to be a size 0
A patient begins a new program to assist with building social skills, In which part of the plan of care should a nurse record the item. "Encourage pt tp attend one psychoeducational group daily>
Implemetation
A patient tells the community mental health nurse. " I told my health care provider I was having trouble sleeping and he prescribed trazodone 50mg every night. "I read on the internet that drug is an antidepressant, but I'[m not depressed. What should I do? Which response by the nurse is correct?
In low doses trazodone helps relieve insomnia. Higher doses are needed for antidepressant effects to occur.
Patient in the ER was seen for the third time in a month with complaints of tremors and paresthesia in the lower extremities Conversion disorders was diagnosed. While preparing for discharge the patient says "Now I'm having chest pain but it's probably nothing how should the nurse respond?
Interrupt the discharge and arrange additional medical evaluation of the patient.
A pt experiencing depression says to the nurse, "My health care provider said I need to talk therapy, but I think i need a prescription for an antidepressant medication. What should I do? Select the Nurses best response.
Let's consider some way to address your concerns with you HCP
A patient at a general medical clinic tells the nurse. "I have so many ailments that I need to see six different doctors. None of them has discovered what is really wrong with me." Which comment should the nurse offer next?
Let's review all of the medications you currently take.
A patient has been disruptive to the therapeutic milieu for 2days. A certified nursing assistant says to the nurse. "We need to seclude this patient because this behavior is upsetting everyone on the unit." Considering patients rights. how should the nurse respond?
Let's think of some new ways to help this patient be less disruptive."
A nurse working in an acute care unit for adolescents diagnosed with mental illness says "Our pt. have so much energy. we need some physical activities for them. In recognition of needs for safety and exercise, which activity could the treatment team approve?
Line dancing to popular music
The nurse is called into the common area by a certified nursing assistant(CNA). The client is found sitting on the common room floor with arms hugging knees and rocking back and forth. The client is having trouble answering questions, and their speech is slow. Health history: Generalized anxiety disorder (GAD) : diagnosed in : panic disorder: diagnosed in 2020. Eating disorder: anorexia from 2018-2019: Physical Exam Data Alert and Oriented x3 (client unaware of where they are). Skin diaphoretic, pale. Muscle tension in the neck and upper extremities. A slight tremor of upper extremities. Coughing dyspnea. Pupils 4+ equal, round reactive to light and accommodation(PERRLA) Flow sheet at 1100 blood pressure110/67 mmhg Oxygen Saturation 24 breath/mins
Move the client to a quieter space Contact the healthcare provider to ask for benzodiazepine on an needed (PRN) basis. State where the client is and who the nurse is Remain with the client
Systematic measurement of body weight, body mass index (BMI), waist circumference, and glucose levels would be most important for a patient beginning a new prescription for which medication?
Olanzapine (Zyprexa)
A patient reports to a primary care provider about sleeplessness, constant fatigue, and sadness. In our current health care climate. What is the most likely treatment approach that will be offered to the patient?
Psychopharmacological treatment
Friends invite an adult diagnosed with type 2 diabetes to go on a mountain hike next week. The adult replies, "I can't go because I don't have any hiking shoes." In actuality, this adult fears difficulty with blood glucose management during strenuous activity. Which defense mechanism is evident?
Rationalization
Many client who call a crisis hotline are extremely anxious. The nurse answering the hotline phone remembers what characteristic as distinguishing posttraumatic stress disorders from other anxiety disorders?
Reexperiencing the trauma in dreams and flashbacks
An adult required a heart transplant 5 years ago. Multiple medical complications followed, resulting in persistent irritability, depression, and insomnia. The adult's spouse says, "I've walked on eggshells for five years, never knowing when something else will go wrong." What is the nurse's priority intervention regarding the spouse?
Refer the spouse to the primary care provider for health assessment.
A neighbor telephones the nurse daily, giving lengthy details about multiple somatic complaints and relationship problems. Which limit setting strategy should the nurse employ?
Say to the neighbor, "I can talk to you for 15 minutes twice a week."
A patient tells the nurse "no matter what I do I feel like there's always this dark cloud following me " Select the nurse initial action?
Say to the patient "Tell me more about what you mean by a dark cloud?
An outpatient psychiatric nurse assesses a patient diagnosed with hoarding disorder. The patient has lost 12 pounds in the past two months, appears disheveled, and is wearing dirty clothing with poor hygiene. What is the nurse's priority action? .
Schedule a home visit to assess the safety of the patient's living conditions.
A hospitalized client has began taking bupropion as an antidepressant agent. The nurse determines that which is an adverse effect. indicating that the client is taking an excessive amount of medication?
Seizure activity
A 30-year-old sales manager tells the nurse. "I am thinking about a job-change. I don't feel like I am living up to my potential. "Which of Maslow's developmental stages in the sales manager attempting to achieve?
Self Actualization
What can a patient do to help problems to not be so overwhelming?
Social phobia Compensation Benzodiazepines (Ativan Xanax etc...)
The nurse present a class about mental health and mental illness to a group of fourth graders. One student asks "Why do people get mentally ill?" Select the nurse's best response.
Sometimes a person's brain does not work correctly because something bad happens or they inherit a brain problem.
An individual lives in a community adjacent to a military base. Loud jets fly overhead multiple times daily. The person tells the nurse, they're so loud I can't hear myself think What is the nurse's best first action?
Teach relaxation and stress reduction techniques to the individual
The nurse would plan whih goals for the termination stage of group development? Select all that apply
The group evaluates the experience The group explores members feeling about eh group and the impeding separation
A nurse plans a group meeting for adult patients in a therapeutic milieu. Which topic should the nurse include?
The importance of hand washing
An adult plans a group meeting for adult patients in a therapeutic Milieu. Which topic should the nurse include?
The importance of hand washing
The nurse prepares outcome to the plan of care for an adult diagnosed with mental illness. Which strategy recognizes the current focus of treatment services for this population?
The patient and family participate actively in establishing priorities and selecting interventions.
A nurse student arrives late for a clinical experience and is not wearing the correct attire When the instructor privately criticizes the behavior the student responds. I'm always the one who gets caught. You're going to cause me to fail> Select the instructors best response?
The requirement for this experience were discussed during our orientation.
After a power outage, a facility must serve a dinner of sandwiches and fruit to patients. Which comment is most likely from a patient diagnosed with a narcissistic personality disorder?
You should have ordered a to-go meal from a local restaurant for me
An adult experienced a spinal cord injury resulting in quadriplegia 3 years ago and now lives permanently in a skilled care facility. Which comment by this person best demonstrates resiliency?
being paralyzed has taken things from me but it hasn't kept me from being mentally involved in life.
In which scenario is it most urgent for the nurse to act as a patient advocate?
A homeless adult diagnosed with schizophrenia lives in a community expecting a category 5 hurricane.
Which scenario best demonstrates empathetic caring?
A nurse provides comfort to a colleague after an error of medication administration.
A mentally ill gunman opens fire in a crowed movie theater, killing six people and injuring others. Which comment about this event by a member of the community most clearly show the stigma of mental illness?
All these people with mental illness are violent and should be locked up
A mentally ill gunman opens fire in a crowded movie theater, killing six people and injuring others. Which comment about this event by a member of the community most clearly shows the stigma of mental illness?
All these people with mental illness are violent and should be locked up.
Select the best example of altruism?
An individual with a long-standing fear of animals volunteers at a community animal shelter.
A person shoplifts merchandise from a community cancer thrift shop. When confronted, the thief replies "All this stuff was donated so I can take it" This comment suggests feature of which personality disorder?
Antisocial
As soon as Edward's wife hangs up the phone she comes back to where you the RN are with Edward her husband Edward fills his wife in that he said that he has only fallen a couple of times and it is to be expected. Edward's wife proceeds to tell you that she is fearful that the next time Edward falls he might break a hip or something. What is the appropriate action to take?
As the Rn you proceed to educate both Edward and his wife the results of the fall risk assessment and state that there is a concern. As RN you educate that having no throw rugs in the hallway would be a fall prevention. Edwards wife gets right up and picks up all the throw rugs from the hallway and states. "thank you."
An adult plan to attend an upcoming tenth high school reunion. This person says to the nurse. "I am embarrassed to go. I will not look as good as my classmates. I haven't been successful in my career? Which comment by the nurse addresses this cognitive distortion?
Do you think you are the only person who has aged and faced difficulties in life?
A nurse designs a plan of exercise for a patient experiencing stress. What rationale should the nurse cite when presenting this plan to the treatment team?
Exercise will stimulate endorphins and improve the patient's feeling of weell-being.
A patient diagnosed with dissociative identify disorder is hospitalized on an acute care psychiatric unit after a suicide attempt. During a team meeting which staff nurse's comment should prompt the nurse supervisor to intervene?
I find myself more fascinated and engaged with this patient than others
Considering Maslow's pyramid, which comment indicates an individual is motivated by the highest level of need?
I help my community by volunteering at a thrift shop that raises money for the poor.
Considering Maslow's pyramid, which comment indicates an individual is motivated by the highest level of need?
I help my community by volunteering at the thrift shop that raises money for the poor.
A nurse plans care for a patient diagnosed with borderline personality disorder. Which nursing diagnosis is most likely to apply to this patient
Ineffective relationships r/t frequent splitting
The emergency department nurse is caring for an adult client who is a victim of family violence. Which priority information would be included in discharged instructions?
Information regarding shelters
UNFOLDING CASE STUDY Edward is a 68-year-old client who has been assigned to you for a home health visit. As the RN, it is important to you to make sure Edward is and will remain safe in his home. What is the most appropriate action to take?
Introduce yourself Edward then stat he is going to go tell his wife you have arrived. AS Edward walks down the hallway so that he does not trip on the when he comes back
The nurse assesses a new patient suspected of having a schizotypal personability disorder. Which assessment question is this patient most likely to answered affirmatively??
Is anyone in your family diagnosed with a mental illness?
A nursing assistant says to the nurse. "The schizophrenic in room 226 has been rabling all day. "When considering the nurse's responsibility to manage the ancillary staff, which response should the nurse provide?
It is more respectful to refer to the patient by name than by diagnosis.
A nursing assistant says to the nurse. "The schizophrenic in room 226 has been rambling all day". When considering the nurse's responsibility to manage the ancillary staff, which response should the nurse provide?
It is more respectful to refer to the patient by name than by diagnosis.
A client with a diagnosisi of depression who has attempted suicide says to the nurse." I should have died I 've always been a failure. Nothing ever goes right for me. Which therapeutic response would the nurse make?
It sound like as if you've been feeling like a failure for a while."
A patient has been out of work for 3 weeks with a major illness and anticipates another month of recovery. the pt tells the nurse "I'm trying to keep up with my work email from home. They hired a new person in my department, but that person has no experience. "select the nurse's therapeutic response?
It sounds like your saying your are worried about your job security
The nurse in the mental health unit plans to use which therapeutic communication techniques when communicating with client? select all that apply?
Maintaining neutral responses Active listening Restating Providing acknowledgment and feedback
The nurse admits a patient experiencing hallucinations and delusional thinking to an inpatient mental health unit. The plan of care will require that which service occur's first?
Medical assessment
The nurse cares for a hospitalized adolescent diagnosed with major depressive disorder. The health care provider prescriber a low-dose antidepressant. In consideration of published warning about use of antidepressant medications in younger pt which action should the nurse employ>
Monitor the adolescent closely for evidence of adverse effects particularly suicidal thing or behavior!
During the first interview, a nurse notices that the patient does not make eye contact. The nurse can correctly analyze that:
More information is needed to draw a conclusion
While weighting patients on an eating disorders unit the nurse overhears a psychiatric technician say. "I wish I had an eating disorder, maybe I'd lose a little weight, what is the nurse best action?
Privately discuss the importance of sensitivity with the technician
The nurse in the mental health unit plans to use which therapeutical communication techiques when communicating with a client? Select all that apply
Restating Active listening Providing acknowledgment and feedback Maintaining neutal responses
A patient is diagnosed with an abscess in the cerebellum. Which nursing diagnosis has priority for the plan of care?
Risk for falls related to loss of balance and equilbrium
A patient is diagnosed with an abscess in the cerebellum. Which nursing diagnosis has priority for the plan of care?
Risk for falls related to loss of balance and equilibrium
Which diet selection by a client who is depressed and taking the MAO inhibitor tranylcypromine sulfate (Parnate) indicates to the nurse that the client understands the dietary restrictions imposed by this medication regimen?
Roast beef, baked potato with butter and Iced tea
The nurse presents a class about mental health and mental illness to a group of fourth graders. One student asks, "Why do people get mentally ill?" Select the nurse's best response?
Sometimes a person's brain does not work correctly because something bad happens or they inherit a brain problem.
A 40-year-old male client diagnosed with schizophrenia and alcohol dependence has not, had any visitors or phone calls since admission. He reports he has no family that cares about him and was living on the street price to this admission. According to Erikson's theory of psychosocial development, which stage is the client in at this time?
Stagnation
Shortly after hospitalization an adolescent diagnosed with anorexia nervosa says to the nurse. Being fat is the worst thing in the world I hope it never happens to me. "Which response by the nurse is appropriate?
Tell me how your world would be different if you were fat
A nurse in an outpatient medical clinic talks to a patient with a long history of malingering and doctor shopping. The patient continuers to expresses complaints of multiple problems. Select the nurse's best comment to the patient?
The treatment team discussed your case and wants to begin a special case management program for you
A combat veteran from two tours of the war in Afghanistan tells the nurse. "Some guys in my unit have PTSD, but I never had any problems other than my hearing is fot as good as it once was Which explanation for this comment should the nurse consider?
The veteran may have amnesia associated with the combat experience
The spouse of a patient who experiences delusions asks the nurse, "Are there any circumstances under which the treatment team is justified in violating the pts right to confidentiality? "What is the nurse best response?
We are not bound if the pt threatens the life of another person
The nurse interacts with a veteran of World War II. The veteran says "Veterans of Modern wars whine and complain all the time. Back when I was in service, you kept your feelings to yourself. "Select the nurse's best response?
We now have a better understanding of how trauma affects people and the importance of research-based compassionate care.
The nurse is conduction an initial assessment of a client in crisis. When assessing the client's perception of the precipitation event that led the to the crisis, which is the most appropriate question?
What leads you to seek help now
A teen who escaped war in his country was diagnosed with posttraumatic stress disorder (PTSD). The teen says, "If there's a loud noise at night, I get under my bed because I think were getting bombed. What type of experience has the teen described?
flashback
