During the orientation portion of a psychiatric nursing course, which would the instructor be most likely to tell students?
"The psychiatric nursing patient may be an individual, a family, a group, an organization, or a community."
"There is one approved theoretical framework for psychiatric nursing practice."
"Psychiatric nursing has yet to be recognized as a core mental health discipline."
"Contemporary practice of psychiatric nursing is primarily focused on inpatient care."
Patient: "I wish my parents would stop treating me like an irresponsible child." Nurse: "You say you want your parents to treat you like an adult, but you skip school, stay out after your curfew, and come home stoned. How does that fit?" Which action dimension does the nurse use in this interaction?
Confrontation
Immediacy
Emotional catharsis
Nurse self-disclosure
In 1952, Hildegard Peplau defined the psychiatric nurse’s role as:
professional who helps patients with attitude adjustment needs.
a nurse who is extensively trained to care for psychiatric patients.
a resource person, a teacher, a leader, and a counselor to patients.
a nurturer, a provider of psychiatric care, and a leader in nursing.
A helper who makes important decisionis for a client may be positively affecting the client's autonomy.
True
False
A client's problems can be solved by another person.
A patient says to a nurse, "My spouse and I get along just fine. We usually agree on everything." While speaking, the patient frowns, continuously moves one foot, and twirls a shirt button. The nurse can assess this communication as:
inefficient
inadequate
incongruent
inappropriate
It is important to listen for themes in a client's conversation.
Being unafraid to admit a mistake is a mark of genuineness.
A new nurse has the following thoughts: "How will I handle things if my patient walks away from me? How will I react if the patient is sexually provocative? How will I cope with a patient who cries?" These thoughts indicate that the nurse is engaged in:
role modeling.
self-exploration.
altruistic thinking.
value clarification.
Warmth comes from within and does not need to be conveyed to another
A nurse who has considered what he or she has to offer a patient, reviewed the general goals of a therapeutic relationship, and planned for the first interaction with the patient has engaged in the tasks appropriate to which phase of the nurse-patient relationship?
Working phase
Orientation phase
Termination phase
Preinteraction phase
The helper and client should sit so that their eyes are level.
A person can get clues to a clent's affective state by observation.
A shift in topics is due to client deception.
Listening to a client is one of the most challenging parts of a helping interview.
Which neurotransmitter is involved in the movement disorders seen in Parkinson disease and in the deficits seen in schizophrenia and other psychoses?
acetylcholine
dopamine
GABA
norepinephrine
A patient demonstrates disoriented thinking and irrational ideas. A nurse can anticipate that a PET scan would most likely show dysfunction in the brain’s:
frontal lobe
occipital lobe
cerebellum
temporal lobe
Pharmacogenetics will eventually allow researchers to design custom drugs.
The spouse of a patient who has just been diagnosed with cancer asks, "What do you think about the relationship of stress and the development of cancer? My spouse has been under a huge amount of stress at work, and now they’ve diagnosed cancer." The answer that best reflects the current thinking about psychoneuroimmunology is:
"The literature doesn’t say much, but it is believed that the mental state and the physical state affect each other to some degree."
"It’s thought that the immune system is negatively affected by high stress."
"Stress does not impact cancer risk."
"Your husband's development of cancer was most likely due to his habits in response to stress, such as smoking or poor diet."
Match the mental illness(es) with the most likely neurotransmitter(s) involved. Serotonin, norepinephrine
depression and anxiety
anxiety disorders
psychosis or thought disorders
Alzheimers
Match the mental illness(es) with the most likely neurotransmitter(s) involved. GABA
Match the mental illness(es) with the most likely neurotransmitter(s) involved. dopamine
Match the mental illness(es) with the most likely neurotransmitter(s) involved. acetylcholine
A patient is about to receive electroconvulsive therapy (ECT) when a nurse sees that a consent form for treatment has not been signed. Which fact should determine the nurse’s immediate action?
Failure to obtain the patient’s written consent can result in a lawsuit.
Failure to obtain the patient's written consent can result in patient injury.
Consent forms don't need to be signed by psychiatric patients for ECT.
A patient scheduled for an early-morning ECT (electroconvulsive therapy) treatment asks a nurse, “Am I going to be able to eat breakfast before I go for ECT?” Which response by the nurse is most appropriate?
“No, but we’ll see about getting you breakfast when you get back to the unit.”
"Yes, but it not within one hour before the procedure."
"Yes, you will need a light snack with your medications."
"No, and you cannot eat the night before either."
An individual accompanied by a sibling was brought by ambulance to the emergency room with suspected impaired cognitive function. The patient’s aggressive behavior and attempts to get out of bed present a safety issue. The nurse should first consider:
using a calm tone to orient the patient.
place the patient in restraints
administering haldol
ask the sibling to control the patient
When a crisis clinic nurse asks a patient, "Who takes care of you when you are sick?" the nurse is exploring the balancing factors of:
situational support
emotional support
environmental support
physical support
When a patient in crisis intervention therapy alludes to the possibility of self-harm, the nurse should:
take all steps necessary to ensure the patient’s safety.
refer the patient to counseling
restrain the patient.
put the patient in seclusion.
A patient comes to the mental health clinic with insomnia, irritability, increased tension, and headaches. The symptoms began 1 week ago after the patient was laid off from work. The patient expresses concern that this will result in a relocation that will be hard on the entire family. The patient is most likely experiencing a situational crisis.
A patient comes to the mental health center and relates feeling very anxious since graduating from high school 1 week ago. The patient is having difficulty concentrating and feels shaky. This typifies a situational crisis.
CBT works by using which of the following strategies? (check all that apply)
Cognitive restructuring
Learning new behaviors
Anxiety reduction
Eliminate painful memories
Cope with depression
A jet plane carrying 140 passengers crashes in a nearby community. One can reliably predict that the survivors, families, and community will experience an adventitious crisis or a situational crisis.
A patient comes to the mental health center after being held hostage during a bank robbery 2 days ago. The patient relates a number of symptoms, including intrusive thoughts, nightmares, and feelings of helplessness. The nurse should consider the possibility that the patient is experiencing a maturational crisis.
The outcome of crisis intervention therapy that should be identified for a patient who has been apathetic, fatigued, and feeling helpless since the recent birth of her baby is that she will:
return to the precrisis level of functioning
assess for self-harm
patient no longer feels helpless
A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol) 2.5 mg bid, benzotropine (Cogentin) 1mg prn, and zolpidem (Ambien) 10mg H.S. Which client behavior would warrant the nurse to administer benzotropine (Cogentin?)
Restlessness and muscle rigidity
command hallucinations
aggression
difficulty sleeping
A patient diagnosed with schizophrenia has difficulty completing tasks and seems forgetful and disinterested in unit activities. A nurse can best select successful strategies by understanding that these behaviors are due to:
problems in cognitive functioning
patient is not trying
the medications
patient is developing alzheimer's too
A patient diagnosed with schizophrenia approaches the nurse and says, “Cats eat birds. East now. Job is new. You father.” This speech pattern can be assessed as:
loose associations
clang associations
tangential
delusions
A nurse observes a patient who is sitting alone in a room put hands over both ears and vigorously shake her head as though saying, “No.” Later the patient cries and mutters, “You don’t know what you’re talking about! Leave me alone.” The nurse should attempt to validate that the patient is angry with a peer.
A nurse observes a patient diagnosed with schizophrenia tapping both feet, smacking both lips, and making contorted faces while speaking to another patient. These behaviors prompt the nurse to suspect the patient is experiencing:
Akathisia
Tardive dyskinesia
Dystonia
Parkinsonianism
Which medication would the nurse expect to administer when observing that a patient is fidgety, demonstrates motor restlessness, and jiggles both legs when asked to sit down?
Benzotropin (Cogentin)
Fluphenazine (prolixin)
Ativan
Prozac
A patient tells the nurse, “I can’t go to any unit meetings because when I get in that room, everyone can hear my thoughts.” The nurse can correctly assess this symptom as:
Thought broadcasting
Thought control
Thought insertion
Thought withdrawal
The physician prescribes a medication for a patient diagnosed with schizophrenia. The order for the medication is "PRN for EPS." When should the nurse give the medication?
When the patient exhibits tremors and shuffling gait.
When the patient has increased HR and body temperature.
When the patient has hallucinations.
When the patient does not eat.
Which statement should indicate to the nurse that a client is experiencing a delusion?
There is an alien growing in my liver.
The IRS is going to audit all of us.
I can see the bomb in the corner.
They told me to cut myself.
For the past year a client has received haloperidol (Haldol). The nurse administering the client's next dose notes a twitch on the right side of the client's face and tongue movements. Which nursing intervention takes priority?
Hold the haloperidol (Haldol) and call the physician.
Give the haldol dose.
Administer Congentin.
Assess for other symptoms.
An adult is admitted with a diagnosis of catatonic schizophrenia, excited phase. She shouts and paces continuously and seems to be responding to internal stimuli. A realistic short term goal for the nurse to formulate is:
the client will sleep 8 hours per night
the client will maintain adequate nutrition
The client will attend all groups
The client will sit down for 15 minutes out of every hour
A client with a diagnosis of paranoid schizophrenia reports to the nurse that he hears a voice that says: "Don't take those poisoned pills from that nurse!" Which one of the following nursing diagnoses would be appropriate for the nurse to make during this statement?
Disturbed sensory perception: auditory, related to anxiety as evidenced by auditory hallucination
Disturbed sensory perception: visual, related to anxiety as evidenced by visual hallucination
Delusion, related to anxiety as evidenced by believing pills are poisioned.
Non-compliance related compulsive lying as evidenced by refusal to medications
An older female adult patient who has been treated with clozapine (Clozaril) for 9 months calls to cancel a clinic appointment because of flulike symptoms, including a sore throat, fever, and tiredness. Which statement shows the best understanding regarding the management of the patient’s symptoms?
"I want you to please keep the appointment, and I will arrange for some blood work to be done while you are here."
"Make sure to drink lots of fluids, and get adequate rest."
"We can reschedule for when you feel better."
"Clorazil can cause agranulocytosis so you cannot take it while you are sick."
Forty-eight hours after starting on haloperidol (Haldol), a male client is observed standing by the nurse's station with his head arched sharply backward. The nurse should recognize that the client:
needs to have the dosage increased as his psychotic behavior is not lessening.
is experiencing temporary side effects that usually disappear after several days.
is having pseudoparkinson side effects and needs to have his medication adjusted.
needs immediate treatment because he is experiencing an acute dystonic reaction to the drug.
A critical factor for the nurse to determine during crisis intervention is the client's:
Available situational supports.
Development history.
Restoration of the original functioning level.
Reorganization and reordering of the personality.
A student nurse working with a depressed patient finds herself becoming angry with the patient when he responds slowly or not at all to her efforts to improve his mood. Which explanation most likely explains her emotional response?
The majority of depressed persons respond only partially to treatment interventions.
Staff can have unrealistic expectations, believing depressed people should “cheer up.”
Depressed patients are often resistant to treatment and a source of frustration to staff.
This depressed patient is responding more slowly than most, leading to frustration.
Following a traumatic event a client is extremely upset and exhibits pressured and rambling speech. A therapeutic technique that the nurse can use when a client's communication rambles is:
Touch
Silence
Focusing
Summarizing
While working with a client who is withdrawn and disconnected which of the following is an appropriate short-term goal.
The client will attend one group meeting accompanied by a staff member within one week.
The client will voluntarily lead the unit community meeting by discharge from the hospital.
The client will be more connected to the unit in 3 days.
The client will attend many of the unit group meetings by discharge from the hospital.
A client is newly prescribed lithium carbonate (lithium.) Which teaching point by the nurse takes priority?
Limit your flu9id intake to 2000mL/day.
Monitor your caloric intake because of potential weight gain.
Get yourself in a daily routine to assist in avoiding relapse.
Make sure your salt intake is consistent.
Harry Stack Sullivan, an American psychiatrist, elaborated on the concept of:
interpersonal relations.
harmony between the individual and society.
collective unconscious.
repression of natural desires.
Dopamine
Melatonin
Serotonin
Norepinephrine
The nurse is using cognitive therapy with a client who visits the mental health center. The nurse should explain to the client that cognitive therapy is aimed at:
changing the client's ways of viewing experiences
solving the client's problems for him
reinforcing desired behaviors on a daily basis
educating clients about their disorders and emotional experiences
A client is recently prescribed haloperidol (Haldol) complains of severe muscle pain. Assessment findings include a heart rate of 104 beats per minute, blood pressure of 172/92mm HG and an oral temperature of 101.2 F Based on the assessment findings, what is the most appropriate nursing action?
Immediately notify the clients health care provider of the assessment findings and complaints
Question the client concerning known cadriovascular status
Assure the client that the symptoms are unrelated to the new medication
Gather information concerning the client's possible exposure to a bacterial infection
Prior to admission, a patient was directing traffic, shouting “to work, you jerk, for perks,” and making obscene gestures at cars. The patient’s spouse reports noncompliance with lithium therapy for 3 weeks and not sleeping for 3 days, saying, “I’m too busy.” Features characteristic of bipolar disorder the nurse can identify are:
poor judgment and hyperactivity.
increased muscle tension and anxiety
vegetative signs and poor grooming
cognitive deficits and low mood.
The nurse can best handle the answering of personal questions asked by a client in any phase of the nurse-client relationship by:
Providing brief, truthful answers and redirecting the focus of conversation.
Reviewing the positive and negative aspects of the subject.
Offering an honest, brief expression of personal views on the subject raised.
Clearly remind the client that the nurse's feelings are not the client's concern or business.
The nurse is aware that the phase of the nurse-client relationship in which most of the problem solving occurs is called the:
Working stage
Initial stage
Planning stage
Evaluation/termination stage
Which of the following responses by the nurse is the best example of clarifying?
"I'm having difficulty understanding. Could you explain that to me?"
"Tell me about what you were thinking before you went to talk to him."
"When did you first notice these feelings?"
"Instead of talking about your mother, I want to know how you feel."
The nurse observes a patient who is sitting alone in her room, put her hands over her ears, and vigorously shake her head as though saying, "No." Later the patient cries and mutters, "You don't know what you've talking about! Leave me alone." What assessment should the nurse attempt to validate? The patient is:
experiencing auditory hallucinations.
seeking the attention of staff.
inappropriately expressing emotion.
displaying negative symptoms of schizophrenia.
A nurse working with a patient in individual crisis intervention would characterize the approaches used as:
active, focused, and explorative.
open-ended.
passive and indirect.
psychoanalytic-based techniques.
A nurse is developing a plan of care for a client prescribed the traditional antipsychotic drug haloperidol(Haldol) for the treatment of schizophrenia. Which medication should the nurse expect to administer if extrapyramidal side effects develop?
Benzotropine (Cogentin)
Olanzapine (Zyprexa)
Chlorpromaxzine (Thorazine)
Escitalopram oxalate (Lexapro)
The nurse is caring for a client who exhibits intense and frequently shifting emotional extremes. The nurse should document the client's behaviors and expressions as a:
labile affect
full affect
constricted affect
balanced affect
Which situation supports the biologic theory of the development of bipolar affective disorder?
A client is prescribed a selective serotonin reuptake inhibitor and then exhibits impulsive behaviors, expansive mood, and flight of ideas
A client has 3 jobs which require increased amounts of energy and the abiity to multitask.
A client experiences thoughts of negative self-image and then expresses grandiosity when discussing abilities at work.
A client has been raised in a very chaotic household where there was a lack of impulse control related to excessive spending.
Marcos tells the nurse, "I can't go to community meeting. When I get in that room with all those people, they can hear my thoughts." The nurse can correctly assess this symptom as:
thought broadcasting.
concrete thinking.
auditory hallucinations.
loose associations.
A hospitalized client who has been taking an antipsychotic medication for 2 weeks begins pacing and walking throughout the unit. He tells the nurse that "he cannot sit still". The nurse should document the client's:
akathisia.
mania.
dystonia
hyperactivity
A client is started on ctialopram (Celexa) for depression. Which information should be most important to include when planning teaching for the client?
Sexual side effects may occur. It thry become unbearable consult your health care provider
Activity levels should not be increased
Avoid processed meats, red wine and Swiss cheese
Monitor blood pressure regularly and report any significant change
When working with the client in crisis, which of the following is most important?
Remaining focused on the immediate problem.
Obtaining a complete assessment of the client's past history.
Determining whether the client may have had a part in the emergence of the crisis.
Assisting the client to identify what is similar about this crisis to other crises in the client's life.
A client with a mental disorder has been prescribed an antipsychotic medication. The nurse should explain to the client and his family that antipsychotic medications act by blocking the effects of:
epinephrine
When working in a psychiatric setting, it is imperative that the nurse prevent clients from:
harming themselves or others.
breaking contracts.
using delusional thinking.
increasing hallucinatory behaviors.
A patient with bipolar disorder has rapid cycles. To prepare teaching materials, the nurse anticipates which medication will be prescribed?
Carbamazepine (Tegretol)
Clonidine (Catapres)
Chlorpromazine (Thorazine)
Phenytoin (Dilantin)
A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which neurotransmitter should a nurse expect to be elevated in the client? GABA
A client diagnosed with schizophrenia refuses to take medication, citing the right of autonomy. Under which circumstance would a nurse have the right to medicate the client against the client’s wishes?
When a client physically attacks another client after being confronted in group therapy.
When a client makes inappropriate sexual innuendos to a staff member.
When a client constantly demands attention from the nurse by begging, “ Help me get better.”
When a client refuses to bathe or perform hygienic activities.
A client who will be receiving electroconvulsive therapy (ECT) must provide informed consent. Which situation should cause a nurse to question the validity of the informed consent?
The client relies on his or her spouse to interpret the information.
The client is paranoid.
The client is 87 years old.
The client incorrectly reports his or her spouse’s name, date and time of day.
A client's family asks about the treatment of schizophrenia. The nurse, before responding, recalls that:
Drug therapy, while not eliminating the underlying problem, reduces the symptoms of acute schizophrenia.
Electroconvulsive therapy is more effective in treating schizophrenia than mood disorders.
Family therapy has not proven to be effective in the treatment of clients with schizophrenia.
Insight therapy has proven to be highly successful in the treatment of clients with schizophrenia.
During the initial interview with a client, the nurse begins to feel uncomfortable and realizes the client behaviors and mannerisms remind the nurse of her abusive mother. The nurse realizes this phenomena is known as:
countertransference
transference
denial
reaction formation
For the past year, a client has received haloperidol (Haldol). The nurse administering the client's next dose notes a twitch on the right side of the client's face and tongue movements. Which nursing intervention takes priority?
Administer haloperidol (Haldol) along with benztropine (Cogentin) 1mg IM PRN per order
Assess for other signs of hyperglycemia resulting from the use of the haloperidol (Haldol.)
Check the client's vital signs and assess mental status.
A female client is placed on one to one observation and as the nurse follows her into the bathroom she objects strongly, yelling, "I'm sick of being followed around and watched like a small child who can't be trusted." The best response for the nurse would be:
'I understand you are angry, but I must be able to see you at all times to make sure you are safe."
"Stop yelling at me! I can't change the rules for clients who talk about suicide as you have done."
"Well, you are better; I'll wait outside the bathroom and you can close the door until you are finished."
"You should stop being angry and uncooperative and focus on happy things."
Tim, 22, has schizophrenia. The nurse notes that he is often forgetful and seems uninterested in activities. Further he has difficulty completing tasks. The nurse planning care for Tim will select successful strategies if he or she understands these behaviors are due to:
problems in cognitive functioning.
a lack of self-esteem.
manipulative tendencies.
shyness and embarrassment.
The nurse hands a client who is psychotic and exhibiting concrete thinking the medication cup and tells the client to take his medicine. The client takes the cup, holds it in his hand, and stares at it. Which of the following would the nurse do NEXT?
Tell the client to put the medicine in his mouth and swallow it with some water.
Say nothing and wait for the client to put the medication in his mouth and swallow it.
Instruct the client to sit in the dayroom and wait for the nurse to assist him.
Ask another staff member to stay with the client until he takes the medication.
In communicating with a client with a psychiatric diagnosis, the nurse uses silence. When using silence in therapeutic communication, clients should feel:
unhurried to answer.
it is their turn to talk.
the nurse is thinking.
there is nothing more to say.
Laboratory results show a patient’s lithium level is 1.0 mEq/L. Select the correct analysis.
Within therapeutic limits
Above therapeutic limits
Incorrect. Lithium levels are reported as mEq/dL
Below therapeutic limits
The nurse using Peplau's model for therapy will focus assessment on:
identifying interpersonal problems.
making interpretations about patient behavior
considering the way the social environment has affected the patient
comparing patient symptoms with DSM-IV descriptions.
A male client on the unit has a diagnosis of paranoid-type schizophrenia. The new mental health care worker on this unit approaches the nurse and asks about the best way to work with this client. The nurse replies:
Avoid touching this client and invading personal space.
Offer back rubs at bedtime to decrease the client's anxiety.
Greet this client with a firm handshake.
Place you hand on the client very softly when you speak to him.
Which group of medications are atypical antipsychotics?
Geodon, Abilify, Clozaril
Ritalin, Concerta, Dexadrine
Wellbutrin, Effexor, Remeron
Xanax, Ativan, Klonopin
A nurse is reviewing diet restrictions with a client taking a monoamine oxidase inhibitor (MAOI). Which symptom could occur with nonadherence to diet restrictions while taking a MAOI?
Explosive occipital headache
Agranulocytosis
Severe hypotension
Akathesia
A client has been taking buproprion (Wellbutrin) for more than 1 year. The client has been in a car accident with loss of consciouness and is brought to the emergency department. For which reason would the nurse question the continued use of this medication?
The client is at risk for seizures from a potential closed head injury.
The client may have a possible injury to the gastrointestinal system
The client is at increased risk of bleeding while taking bupropion.
The client may experience sedation from bupropion making assessmemt difficult.
One of the main reasons a client with a mental disorder may change the topic during a conversation with the nurse is that the client is:
uncomfortable with the topic being discussed
not listening to what the nurse has to say.
using the nurse to obtain advice.
not able to establish rapport with the nurse.
Which of the following are SSRIs? Choose all that apply.
Prozac (fluoxetine)
Celexa (citalopram)
Zoloft (sertraline)
Zyprexa or Zydis (olanzapine)
Using specific terms rather than abstract concepts in communication with a client is an example of
concreteness
empathy
immediacy
values clarification
A communication technique in which the therapist helps the client put an idea in a more positive or objective view point is called:
reframing
reflection
restatement
recapturing
While assessing the defense mechanisms used by the client, the nurse recognizes the client use of defense mechanisms as adaptive when the:
Mechanism used decreases anxiety.
Client seeks isolation to avoid stress.
Anxiety is expressed in behaviors.
Client can identify the stressor.
John was the driver of a car that struck and killed a child who darted into the street. He tells the nurse, "I killed a child! I'm haunted by the sight of his body being thrown into the air. If I hadn't been drinking I might have been able to stop. I don't know how I can go on living with myself!" An avenue the crisis nurse should be sure to explore is:
suicidal risk
hallucinations
recent drug use.
the patient's physical condition.
When developing the plan of care for a client receiving haloperidol (Haldol), which of the following medications would the nurse anticipate administering if the client developed extrapyramidal side effects? (EPS)
Benzotropine mesylate (Cogentin).
Lorazepam (Ativan).
Paroxetine (Paxil).
Olanzapine (Zyprexa).
Carl Rogers advocated that the therapist treating the client:
develop unconditional positive regard for the client.
have consensual validation of the terminology used during the session.
focus on the client's instinctual drives.
develop an understanding of the client's basic needs.
An INHIBITORY neurotransmitter is
Substance P
glutamate
Being open sometimes subjects the helper to unsettling information.
As a result of the effects of managed care, hospitalization is often reserved for emergency care. Which of the following situations would the nurse recognize as having the least priority for admission?
Decline in functioning at work.
Potential for self-harm.
Potential for harm to others.
Grave disability (unable to care for self.)
A patient states, "Sometimes I hear voices when no one else is in the room. This makes me wonder who is plotting against me to drive me crazy." Which criterion of mental health can the nurse assess as lacking?
reality perception.
autonomy
integration.
environmental mastery.
The client with schizophrenia has been started on medication therapy with clozapine (Clozaril). The nurse assess the results of which laboratory study to monitor for adverse effects from this medication?
White blood cell count
Platelet count
Blood glucose
Liver function studies.
While working with a client who is having delusions, what nursing intervention would be MOST helpful?
Avoid arguing about the content of the client's delusion.
Promise the client that antipsychotic meds will improve thought processes.
Challenge the content of the client's delusions.
Seclude the client in his room to decrease stimulation.
A woman has remained close to the nurse all day. When the nurse talked with other clients during dinner, the client tried to regain the nurse's attention and then began to shout, "You're just like my mother. You pay attention to everyone but me!" The best interpretation of this behavuor is that
She is demonstrating transference.
She is exhibiting resistance
She has been spoiled by her family
The nurse has failed to meet her needs.
A student in the Mood Disorders Clinic states that everything he does is wrong and that nothing he tries ever works. Although he has never failed an exam, he believes he will fail the next one. Based on evidence-based research, which of the following interventions would best address a presentation of this type?
Cognitive-behavioral therapy
Alternative and complementary therapies
Desensitization therapy
Psychoanalytic therapy
A client admitted to the psychiatric inpatient unit following expressed suicidal ideations tells the nurse the next day that she feels fine, is at peace, and wants to go home now. The nurse understands that the client:
Remains at risk, may have sufficient psychic energy to act out on the suicidal ideation, and requires further assessment.
Has resolved her feelings and is no longer at risk for self harm.
Is probably ready to be discharged to home since the suicidal intent has been resolved.
Has reached a realistic self-appraisal of the serious nature of her suicidal intentions.
A communication technique that repeats the main thought expressed by the client is
restating
clarification
focusing
The nurse is beginning to establish a nurse-client relationship with a woman who was referred for help in managing her children. The woman arrives loate for appointments and focuses on her busy schedule, the difficulty in parking and other reasons for being late. The nurse best interprets this behavior as
resistance
counter-transference
identification
Which term is used to describe altered perception through any one of the 5 senses?
Hallucination
delusion
suspiciousness
thought insertion
A patient who is currently unemployed was arrested for writing thousands of dollars of worthless checks. After acting out sexually in court, the patient explained in rapid-fire speech to the judge, "I’m going to expand my outlook, shape-up, sail away, and be a bird in paradise." The patient was referred for psychiatric evaluation. These behaviors are consistent with a DSM5 diagnosis of:
mania
hypomania
poor behavior
A patient will be starting on fluoxetine hydrochloride (Prozac) therapy and taking 20 mg PO every morning. Which nursing intervention would be most therapeutic for the nurse to teach the patient?
"Try taking your medication with breakfast if you begin experiencing nausea."
"If you experience nausea, just take you medication at night."
"If you experience side effects, skip your next dose."
"You should see improvement from the medication immediately."
During discharge planning, a patient whose symptoms of manic disorder are remitting asks, "Do I have to take lithium even though I’m not high any longer?" The most appropriate response is:
"Taking the medication daily will help you avoid relapses and recurrences."
"There is no need to continue lithium, because you are no longer manic."
"Yes, but you'll only need to take half the dose."
"No, but you'll need to taper off of the drug gradually."
A patient who has been taking an antidepressant for 2 months shares with the nurse, "Since my depression is over, I’ve stopped the Prozac and I won’t need to see you any longer." Which response by a nurse would be most therapeutic?
"Do you recall that we discussed the need for you to take the medication for up to 1 year before trying to taper off the drug? It is not uncommon for some patients to require antidepressant medication over their lifetime."
"It is unsafe to stop taking the Prozac, because it is a medication that you must taper off of."
"I would like to schedule one last appointment with you, to see how you are doing without the Prozac."
"Prozac must be continued for a minimum of one-year. Please consider taking it again."
A patient displaying symptoms of mania has been in constant motion for 1 hour, running in the halls, exercising vigorously, and pushing furniture around the solarium. Finally, he approaches a frail man and orders him to do push-ups or be pushed down. The man looks fearful but gets down on the floor. The nurse should:
gather several staff members to provide an escort to take the patient with mania to his room
administer PRN e-med
place the patient in seclusion
When a patient is originally prescribed fluoxetine (Prozac), which of the following should be included in the plan for patient education? The onset of action is 1 to 4 weeks.
The emergency department calls to say a patient experiencing symptoms of mania is being admitted. Which room placement should a nurse choose for the patient? A single room near the nurse’s station
The nurse is evaluating lab test results for a client prescribed lithium carbonate. The client's lithium level is 1.9 mEq/L. Which nursing intervention takes priority?
Notify the physician and hold the dose until instructed further
Administer the dose
Hold the dose and administer cogentin.
A patient who is taking lithium shares with the nurse, “I’m planning to breast-feed my baby who is due to be born in 2 months.” Which statement shows the best understanding of the effect of lithium on breast-feeding?
“Your medication would be excreted in your breast milk, so breast-feeding isn’t a safe option for your baby.”
"Lithium is not excreted in breast milk, so breast feeding you baby will be safe."
"Lithium will be excreted in your breast milk for up to three hours after taking your dose. Do not breast feed you child during these times."
"Lithium is excreted in breast milk, but if you pump and then filter your breast milk it will be safe to give to your baby."
The care plan for a patient with mania who is displaying elation, hyperactivity, grandiosity, verbosity, disturbed sleep pattern, and poor judgment should take into consideration the need to:
maintain physiological equilibrium
maintain psychological equilibrium
keep the patient in seclusion
remind the patient of reality
A patient who was admitted to the unit 3 weeks ago with major depressive disorder presented with suicidal ideations but had no suicide plan. Sertraline (Zoloft) was prescribed, and the patient now reports that the feelings of depression have somewhat lessened. A factor of importance for the nurse to consider when planning care for this patient is that:
There is an increased risk for suicide as the depression lifts
The medication is effective.
The patient is ready for discharge.
There is a decreased risk for suicide as the depression lifts.
A physician who has evaluated a patient at a mood disorders clinic shares with a nurse that the patient is hypomanic. The nurse can expect to assess:
clinical symptoms less severe than those of a manic state.
clinical symptoms more severe than those of a manic state
clinical symptoms of depression
A patient shares, "My mood is really low, and even though I get plenty of sleep, I’m tired all the time. I’ve gained weight because I eat too many sweets. It seems like it happens every fall and winter." This patient is most likely experiencing:
seasonal affective disorder.
depression
binge-eating
what all people feel around the holidays
A patient who is hospitalized for depression demonstrates dysfunctional thinking as evidenced by persistent pessimism and predictions of disastrous outcomes. A nurse using Cognitive Behavior Therapy will focus on:
patient recognition and replacement of automatic negative evaluations.
the patient's depression
making the patient feel better
determining the best medication for the patient
A patient with severe depression, somatic delusions, and suicidal ideation has not improved after trials with selective serotonin reuptake inhibitor (SSRI) medications,Abilify and tricyclic antidepressants. Which treatment option can a nurse assume the psychiatrist will now consider?
Light therapy
Electroconvulsive therapy
Place the patient on neuroleptics.
Place the patient on lorazepam (ativan).
What symptoms should a nurse identify to differentiate between a client diagnosed with panic disorder and GAD - generalized anxiety disorder?
A fear of dying or going crazy is common to panic disorder and not prevalent in GAD.
A fear of dying is common to GAD and not to panic disorder.
GAD can be treated with medication, but panic disorder cannot.
Panic disorder can be treated with medication, but GAD cannot.
A patient has greatly increased non–goal-directed motor activity, seems terror stricken, and experiences both distorted perceptions and disordered thoughts. When the nursing staff attempts to calm the patient, the patient does not respond. The level of patient anxiety can be assessed as:
panic
mild
moderate
severe
A client who is a veteran of the Gulf War is being assessed by a nurse for post-traumatic stress disorder (PTSD). Which client symptoms would support this diagnosis? (Select all that apply.)
The client fears a physical integrity threat to self.
The client feels detached and estranged from others.
The client experiences fear and helplessness.
The client reports intrusive thoughts about the event.
A psychiatric patient is experiencing panic-level anxiety. The initial intervention of highest priority is:
reduce all environmental stimuli.
provide for the patient’s safety
give the patient a hug
encourage the client to go to a support group that is taking place at the time of the event
A patient calls the community mental health center and shares, "For the past 6 months, whenever I even think about leaving my house, my heart pounds, my body shakes, and I cry and feel dizzy. There’s no reason for me to feel this way, but I do." These symptoms can be assessed as being most consistent with:
panic disorder with agoraphobia.
panic disorder
OCD
agoraphobia
A patient is experiencing panic-level anxiety. Of the medications listed on the patient’s medication administration sheet, which can be given as a prn anxiolytic?
Lorazepam (Ativan)
Diphenhydramine (Benadryl)
Chlopromazine (Thorazine)
Paroxetine (Paxil)
In order to effectively assess a patient who is experiencing anxiety, a nurse understands that the physiological responses associated with anxiety are modulated by the brain through the autonomic nervous system.
A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (BuSpar). Which client statement indicates teaching has been effective?
The client verbalizes that clonazepam (Klonopin) is to be used short term until the buspiron (BuSpar) takes full effect.
The client verbalizes that buspiron (BuSpar) is to be used short term until the clonazepam (Klonopin) takes full effect.
The client verbalizes that she will take the klonopin every day, and use the buspar PRN.
A client rates anxiety at 8 out of 10 on a 1-10 scale, is restless, and has narrowed perceptions. Which of the following medications would appropriately be prescribed to address these symptoms. Select all that apply.
Chlordiazepoxide (Librium)
Clonazepam (Klonipin)
Lithium Carbonate (Lithium)
Diazepam (Valium)
Citalopram (Celexa)
Ted, who watched his wheelchair-bound mother die in Hurricane Katrina, now suffers from an anxiety disorder. Based on causative factors, this disorder would most likely be
Panic disorder with agoraphobia
PTSD (post traumatic stress disorder)
OCD (obsessive compulsive disorder)
GAD (generalized anxiety disorder)
Several months after being trapped in a collapsed building for several hours before being rescued, a patient admits to currently feeling "numb" and being unable to relate well with people. The patient sometimes reexperiences the terror associated with being trapped. The data collected about the patient are consistent with the symptoms of:
posttraumatic stress disorder.
GAD
Which long term treatment for GAD - Generalized Anxiety Disorder should a nurse identify as most appropriate?
Long term treatment with Buspirone (BuSpar)
Long term treatment with Clonazepam (Klonopin)
Clozapine (Clorazil)
Zolpidem (Ambien)
A patient with a personality disorder has revealed to unit staff that family members have acted cruelly. At the same time the patient has told the family about receiving indifferent care from staff members who are neglectful. The patient’s goal is to:
create family-staff conflict, thus diverting focus from the patient’s need for self-examination.
ask for help
share true inner feelings
The relationships of patients with borderline and narcissistic personality disorders are said to move through predictable stages. Initially there are idealization and overvaluation of the object and then disappointment when unrealistic needs are not met. The nurse can predict that the final stages will be: devaluation and rejection of the object.
A nursing diagnosis that is appropriate to consider for a patient with antisocial personality disorder is:
risk for self-directed injury.
impaired social interaction.
impaired cognition
Readiness for enhanced self-concept
A nurse is assigned to work with a patient diagnosed with borderline personality disorder. The nurse will need to consider therapeutic strategies for which possible patient behaviors?
clinging
acting out
mood shifts
impulsivity
telling the truth
hyposensitivity
A patient reports feeling detached and says, “It feels as though I’m watching a movie as life unfolds. I’m isolated, on the outside, a pawn and not a player, untouched. I really don’t feel anything. I don’t know if I’m alive or dead, awake or sleeping.” The nurse can determine that the patient is describing:
depersonalization.
dessociative amnesia
dissociative fugue
dissociative identity
Which behavior would be most characteristic of a young person diagnosed with an antisocial personality disorder?
After committing a crime, the individual persuades the judge to suspend the sentence but later violates probation.
Very persuasive, but very honest.
Attempted suicide and other methods of self-harm.
Impulsivity, especially in sexual situations
During the process of self-exploration, it is important for a nurse to convey the message that the patient:
is responsible for his or her own behavior, including maladaptive coping responses.
cannot control their coping responses because they are a result of their personality.
is responsible for his or her own behavior, but not for coping responses.
is childish and needs to grow up.
Before the community meeting, a patient with antisocial personality disorder was overheard coaching other patients to strongly object to the unit’s "no smoking" policy. Which response would be most characteristic of this patient when approached by staff members who wish to discuss the behavior?
"I think the patients and staff should talk about the rules and negotiate some changes."
"Hey, it’s not my fault. They object to you people running this place like a jail."
"I'm sorry. Can we talk about this in my therapy session later?"
"I know. I just really want to smoke and thought that if everybody wanted the same thing, then we might get smoking back."
Which thinking about relationships would be most characteristic of a patient with antisocial personality disorder?
"The only reason for relating is to take advantage of others."
"Other people want to help me."
"I feel bad when I take advantage of others, but I can't help it."
"Relationships are a waste of time."
Milieu work with patients with personality disorders is most effective when it:
provides strict structure to compensate for a lack of personal boundaries.
focuses on interactional behaviors in the here and now.
provide a loosely structured milieu to allow patients to deal with their disorders freely
An admission note describes a patient as being "lively, excessively emotional, attention seeking, and superficial." The patient’s history reveals stormy relationships with friends and lovers. The nurse notes that the patient only seems comfortable when the focus of attention. The patient becomes anxious when the focus changes. The nurse anticipates that the DSM5 diagnosis that is being considered is:
histrionic personality disorder.
borderline personality disorder.
schizoid personality disorder.
narcissistic personality disorder
The nurse is caring for a patient diagnosed with borderline personality disorder who cut both forearms after learning that the psychiatrist was going on vacation. While changing the dressing daily, it would be advisable for the nurse to:
encourage discussion of the self-mutilation.
maintain a matter-of-fact attitude.
scold the patient for harming himself.
tell the patient how sorry you are for him that he hurt himself.
Which behavior would be most characteristic of an individual with narcissistic personality disorder? Belief in entitlement to special privileges that others may not have
When a nurse plans education for the family of a patient with personality disorder who uses maladaptive social responses, which information can be included?
The patient has enduring ways of relating that provoke others’ negative reactions.
Always engage in the patient's maladaptive behaviors.
Give the patient what he wants at all times.
A patient uses the maladaptive social behavior of manipulation. Staff working to reduce this behavior should first convey the message that:
the patient is accepted, but manipulative behavior may be rejected as inappropriate.
the patient is inappropriate
the patient will only be accepted if she or he has better behavior.
A patient sustained a fractured femur in an automobile accident while driving under the influence of drugs. During the physical assessment "tracks" are noted on both arms and family members indicate that the patient has "dabbled in drugs" for years. The nurse notes that the patient obtains little to no relief from the prescribed dose of narcotic analgesic. The failure to experience pain relief is most likely related to:
drug tolerance to the narcotic prescribed.
withdrawal
insufficient analgesic dosage
The spouse of a patient with alcoholism asks a nurse how to respond in a helpful way even though the patient is disruptive to family life. The best response would be: "Make your spouse responsible for the consequences of the disruptive behavior."
It will be most helpful for a nurse to transmit to a recovering substance abuser that a relapse is best viewed as:
an error from which to learn
failure
downfall
not the patient's fault
A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order? history of alcohol dependence
The nursing intervention of highest priority relative to alcohol withdrawal delirium is:
maintenance of fluid and electrolyte balance.
psychological support
provide food every hour
Whenever possible, physical exercise and meditation should be a daily component of the ongoing program of treatment for a person with an addiction. The basis for these aspects of treatment is to make use of the body’s natural:
endorphins
hormones
antibodies
When designing a teaching plan for a patient taking disulfiram (Antabuse), a nurse should include an explanation on the inadvisability of using certain over-the-counter substances. With the appropriate instruction, which substance could the patient identify as being safe to use?
Antacids
Cold medicine
Alcohol
Cough medicine
A patient addicted to both alcohol and benzodiazepines tells a nurse, "I can control my drug use any time I want to." This statement is an example of the patient’s use of:
Denial
Rationalization
Honesty
A nursing diagnosis that would be considered universally appropriate for patients who abuse mood-altering drugs would be:
ineffective coping
inadequate nutrition
The following are goals for a patient being treated for alcoholism. Select the order in which these goals should be approached: A: developing alternative coping skills; B: attaining physiological stabilization; C: learning about dependence and recovery; D abstinence and development of a support system.
B, D, C, A
C, D, A, B
B, C, A, D
D, A, B, C
An individual who is admitted to an alcohol detoxification unit has had no alcohol intake for 3 days. On admission the patient is noted to have tremors, anxiety, visual hallucinations, insomnia, suspiciousness, and disorientation accompanied by vomiting, temperature elevation, tachycardia, and diaphoresis. These signs and symptoms are characteristic of the syndrome known as:
alcohol withdrawal delirium.
neuroepileptic malignant syndrome
