Psychiatric Nursing Review

During the orientation portion of a psychiatric nursing course, which would the instructor be most likely to tell students?

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?

In 1952, Hildegard Peplau defined the psychiatric nurse’s role as:

A helper who makes important decisionis for a client may be positively affecting the client's autonomy.

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:

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:

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?

The helper and client should sit so that their eyes are level.

Which neurotransmitter is involved in the movement disorders seen in Parkinson disease and in the deficits seen in schizophrenia and other psychoses?

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:

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:

Match the mental illness(es) with the most likely neurotransmitter(s) involved.
Serotonin, norepinephrine

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?

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?

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:

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:

When a patient in crisis intervention therapy alludes to the possibility of self-harm, the nurse should:

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:

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?)

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:

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:

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:

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?

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:

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?

Which statement should indicate to the nurse that a client is experiencing a delusion?

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?

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:

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?

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?

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:

A critical factor for the nurse to determine during crisis intervention is the client's:

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?

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:

While working with a client who is withdrawn and disconnected which of the following is an appropriate short-term goal.

A client is newly prescribed lithium carbonate (lithium.) Which teaching point by the nurse takes priority?

Harry Stack Sullivan, an American psychiatrist, elaborated on the concept of:

Which neurotransmitter is involved in the movement disorders seen in Parkinson disease and in the deficits seen in schizophrenia and other psychoses?

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:

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?

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:

The nurse can best handle the answering of personal questions asked by a client in any phase of the nurse-client relationship by:

The nurse is aware that the phase of the nurse-client relationship in which most of the problem solving occurs is called the:

Which of the following responses by the nurse is the best example of clarifying?

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:

A nurse working with a patient in individual crisis intervention would characterize the approaches used as:

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?

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:

Which situation supports the biologic theory of the development of bipolar affective disorder?

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:

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:

A client is started on ctialopram (Celexa) for depression. Which information should be most important to include when planning teaching for the client?

When working with the client in crisis, which of the following is most important?

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:

When working in a psychiatric setting, it is imperative that the nurse prevent clients from:

A patient with bipolar disorder has rapid cycles. To prepare teaching materials, the nurse anticipates which medication will be prescribed?

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?

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?

A client's family asks about the treatment of schizophrenia. The nurse, before responding, recalls that:

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:

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?

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:

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:

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?

In communicating with a client with a psychiatric diagnosis, the nurse uses silence. When using silence in therapeutic communication, clients should feel:

Laboratory results show a patient’s lithium level is 1.0 mEq/L. Select the correct analysis.

The nurse using Peplau's model for therapy will focus assessment on:

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:

Which group of medications are atypical antipsychotics?

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?

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?

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:

Using specific terms rather than abstract concepts in communication with a client is an example of

A communication technique in which the therapist helps the client put an idea in a more positive or objective view point is called:

While assessing the defense mechanisms used by the client, the nurse recognizes the client use of defense mechanisms as adaptive when the:

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:

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)

Carl Rogers advocated that the therapist treating the client:

An INHIBITORY neurotransmitter is

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?

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?

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?

While working with a client who is having delusions, what nursing intervention would be MOST helpful?

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

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?

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:

When working with the client in crisis, which of the following is most important?

A communication technique that repeats the main thought expressed by the client is

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

Which term is used to describe altered perception through any one of the 5 senses?

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:

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?

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:

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?

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:

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?

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?

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:

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:

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:

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:

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:

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?

What symptoms should a nurse identify to differentiate between a client diagnosed with panic disorder and GAD - generalized anxiety disorder?

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:

A psychiatric patient is experiencing panic-level anxiety. The initial intervention of highest priority is:

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:

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?

A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (BuSpar). Which client statement indicates teaching has been effective?

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

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:

Which long term treatment for GAD - Generalized Anxiety Disorder should a nurse identify as most appropriate?

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:

A nursing diagnosis that is appropriate to consider for a patient with antisocial personality disorder is:

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:

Which behavior would be most characteristic of a young person diagnosed with an antisocial personality disorder?

During the process of self-exploration, it is important for a nurse to convey the message that the patient:

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?

Which thinking about relationships would be most characteristic of a patient with antisocial personality disorder?

Milieu work with patients with personality disorders is most effective when it:

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:

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:

When a nurse plans education for the family of a patient with personality disorder who uses maladaptive social responses, which information can be included?

A patient uses the maladaptive social behavior of manipulation. Staff working to reduce this behavior should first convey the message that:

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:

It will be most helpful for a nurse to transmit to a recovering substance abuser that a relapse is best viewed as:

The nursing intervention of highest priority relative to alcohol withdrawal delirium is:

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:

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?

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:

A nursing diagnosis that would be considered universally appropriate for patients who abuse mood-altering drugs would be:

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.

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: