exam 1 Flashcards
The scope of practiced for an advanced nurse practitioner would include which intervention?
a. Conducting a mental health assessment.
b. Prescribing psychotropic medication.
c. Establishing a therapeutic relationship.
d. Individualizing a nursing care plan.
ANS: B
In most states, prescriptive privileges are granted to master’s-prepared nurse practitioners and clinical nurse specialists who have taken special courses on prescribing medication. The nurse prepared at the basic level is permitted to perform mental health assessments, establish relationships, and provide individualized care planning.
A nursing student expresses concerns that mental health nurses “lose all their clinical nursing skills.” Select the best response by the mental health nurse.
a. “Psychiatric nurses practice in safer environments than other specialties. Nurse-to client ratios must be better because of the nature of the clients’ problems.”
b. “Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations.”
c. “That’s a misconception. Psychiatric nurses frequently use high technology monitoring equipment and manage complex intravenous therapies.”
d. “Psychiatric nurses do not have to deal with as much pain and suffering as medical–surgical nurses do. That appeals to me.”
ANS: B
The practice of psychiatric nursing requires a different set of skills than medical–surgical nursing, though there is substantial overlap. Psychiatric nurses must be able to help clients with medical as well as mental health problems, reflecting the holistic perspective these nurses must have. Nurse–client ratios and workloads in psychiatric settings have increased, just like other specialties. Psychiatric nursing involves clinical practice, not just documentation. Psychosocial pain and suffering are as real as physical pain and suffering.
When a new bill introduced in Congress reduces funding for care of persons diagnosed with mental illness, a group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled?
a. Recovery
b. Attending
c. Advocacy
d. Evidence-based practice
ANS: C
An advocate defends or asserts another’s cause, particularly when the other person lacks the ability to do that for self. Examples of individual advocacy include helping clients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the human condition. Since funding is necessary to deliver quality programming for persons with mental illness, the letter-writing campaign advocates for that cause on behalf of clients who are unable to articulate their own needs.
A family has a long history of conflicted relationships among the members. Which family member’s comment best reflects a mentally healthy perspective?
a. “I’ve made mistakes but everyone else in this family has also.”
b. “I remember joy and mutual respect from our early years together.”
c. “I will make some changes in my behavior for the good of the family.”
d. “It’s best for me to move away from my family. Things will never change.”
ANS: C
The correct response demonstrates the best evidence of a healthy recognition of the importance of relationships. Mental health includes rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem. Recalling joy from earlier in life may be healthy, but the correct response shows a higher level of mental health. The other incorrect responses show blaming and avoidance.
Which assessment finding most clearly indicates that a client may be experiencing a mental illness?
a. reporting occasional sleeplessness and anxiety.
b. reporting a consistently sad, discouraged, and hopeless mood.
c. being able to describe the difference between “as if” and “for real.”
d. experiencing difficulty making a decision about whether to change jobs.
ANS: B
The correct response describes a mood alteration, which reflects mental illness. The distracters describe behaviors that are mentally healthy or within the usual scope of human experience.
A nurse encounters an unfamiliar psychiatric disorder on a new client’s admission form. Which resource should the nurse consult to determine criteria used to establish this diagnosis?
a. International Statistical Classification of Diseases and Related Health Problems (ICD-10)
b. The ANA’s Psychiatric-Mental Health Nursing Scope and Standards of Practice c. Diagnostic and Statistical Manual of Mental Disorders (DSM-V)
d. A behavioral health reference manual
The DSM-V gives the criteria used to diagnose each mental disorder. It is the official guideline for diagnosing psychiatric disorders. The distracters may not contain diagnostic criteria for a psychiatric illness.
A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information?
a. Nursing Outcomes Classification (NOC)
b. DSM-V
c. The ANA’s Psychiatric-Mental Health Nursing Scope and Standards of Practice d. ICD-10
ANS: B
The DSM-V details the diagnostic criteria for psychiatric clinical conditions. It is the official guideline for diagnosing psychiatric disorders. The other references are good resources but do not define the diagnostic criteria.
Which individual behavior demonstrates resilience?
a. Repress stressors associated with a divorce.
b. Continuing to grieve the death of a spouse for 5 years.
c. Continuing to live in a shelter for 2 years after the home is destroyed by fire. d. Taking a temporary job to maintain financial stability after loss of a permanent job.
ANS: D
Resilience is closely associated with the process of adapting and helps people facing tragedies, loss, trauma, and severe stress. It is the ability and capacity for people to secure the resources they need to support their well-being. Repression and protracted grief are unhealthy. Living in a shelter for 2 years shows a failure to move forward after a tragedy. See related audience response question.
The relationship of the North American Nursing Diagnosis Association (NANDA) is to clinical judgment as Nursing Interventions Classification (NIC) is to what?
a. client outcomes.
b. nursing actions.
c. diagnosis.
d. symptoms.
ANS: B
Analogies show parallel relationships. NANDA, the North American Nursing Diagnosis Association, identifies diagnostic statements regarding human responses to actual or potential health problems. These statements represent clinical judgments. NIC (Nursing Interventions Classification) identifies actions provided by nurses that enhance client outcomes. Nursing care activities may be direct or indirect.
An adult says, “Most of the time I’m happy and feel good about myself. I have learned that what I get out of something is proportional to the effort I put into it.” Which number on this mental health continuum should the nurse select?
Mental Illness Mental Health
1 2 3 4 5
a. 1
b. 2
c. 3
d. 4
e. 5
ANS: E
The adult is generally happy and has an adequate self-concept. The statement indicates the adult is reality-oriented, works effectively, and has control over own behavior. Mental health does not mean that a person is always happy.
Which disorder is an example of a culture-bound syndrome?
a. Epilepsy
b. Schizophrenia
c. Running amok
d. Major depressive disorder
ANS: C
Culture-bound syndromes occur in specific sociocultural contexts and are easily recognized by people in those cultures. A syndrome recognized in parts of Southeast Asia is running amok, in which a person (usually a male) runs around engaging in furious, almost indiscriminate violent behavior.
What does the DSM-V classify?
a. deviant behaviors
b. present disability or distress
c. people with mental disorders
d. mental disorders
ANS: D
The DSM-V classifies disorders people have rather than people themselves. The terminology of the tool reflects this distinction by referring to individuals with a disorder rather than as a “schizophrenic” or “alcoholic,” for example. Deviant behavior is not generally considered a mental disorder. Present disability or distress is only one aspect of the diagnosis.
A citizen at a community health fair asks the nurse, “What is the most prevalent mental disorder in the United States?” Select the nurse’s correct response.
a. Schizophrenia
b. Bipolar disorder
c. Dissociative fugue
d. Alzheimer’s disease
ANS: D
The 12-month prevalence for Alzheimer’s disease is 10% for persons older than 65% and 50% for persons older than 85. The prevalence of schizophrenia is 1.1% per year. The prevalence of bipolar disorder is 2.6%. Dissociative fugue is a rare disorder.
In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill?
a. One who describes hearing God’s voice speaking.
b. One who is usually pessimistic but strives to meet personal goals.
c. One who is wealthy and gives away $20 bills to needy individuals.
d. One who always has an optimistic viewpoint about life
ANS: A
The question asks about risk. Hearing voices is generally associated with mental illness, but in charismatic religious groups, hearing the voice of God or a prophet is a desirable event. Cultural norms vary, which makes it more difficult to make an accurate diagnosis. The individuals described in the other options are less likely to be labeled mentally ill.
A client’s relationships are intense and unstable. The client initially idealizes the significant other and then devalues him or her, resulting in frequent feelings of emptiness. This client will benefit from interventions to develop which aspect of mental health?
a. Effectiveness in work
b. Communication skills
c. Productive activities
d. Fulfilling relationships
ANS: D
The information given centers on relationships with others that are described as intense and unstable. The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are not present to describe work effectiveness, communication skills, or activities.
Which belief will best support a nurse’s efforts to provide client advocacy during a multidisciplinary client care planning session?
a. All mental illnesses are culturally determined.
b. Schizophrenia and bipolar disorder are cross-cultural disorders.
c. Symptoms of mental disorders are unchanged from culture to culture.
d. Assessment findings in mental illness reflect a person’s cultural patterns.
ANS: D
Symptoms must be understood in terms of a person’s cultural background. A nurse who understands that a client’s symptoms are influenced by culture will be able to advocate for the client to a greater degree than a nurse who believes that culture is of little relevance. The distracters are untrue statements.
A nurse is part of a multidisciplinary team working with groups of depressed clients. One group of clients receives supportive interventions and antidepressant medication. The other group receives only medication. The team measures outcomes for each group. Which type of study is evident?
a. Incidence
b. Prevalence
c. Comorbidity
d. Clinical epidemiology
ANS: D
Clinical epidemiology is a broad field that addresses studies of the natural history (or what happens if there is no treatment and the problem is left to run its course) of an illness, studies of diagnostic screening tests, and observational and experimental studies of interventions used to treat people with the illness or symptoms. Prevalence refers to numbers of new cases. Comorbidity refers to having more than one mental disorder at a time. Incidence refers to the number of new cases of mental disorders in a healthy population within a given period. See related audience response question.
- The spouse of a client diagnosed with schizophrenia says, “I don’t understand how events from childhood have anything to do with this disabling illness.” Which response by the nurse will best help the spouse understand the cause of this disorder?
a. “Psychological stress is the basis of most mental disorders.”
b. “This illness results from developmental factors rather than stress.”
c. “Research shows that this condition more likely has a biological basis.”
d. “It must be frustrating for you that your spouse is sick so much of the time.”
ANS: C
Many of the most prevalent and disabling mental disorders have strong biological influences. Genetics are only one part of biological factors. Empathy does not address increasing the spouse’s level of knowledge about the cause of the disorder. The other distracters are not established facts.
A category 5 tornado occurred in a community of 400 people. Many homes and businesses were destroyed. In the 2 years following the disaster, 140 individuals were diagnosed with posttraumatic stress disorder (PTSD). Which term best applies to these newly diagnosed cases? a. Prevalence
b. Comorbidity
c. Incidence
d. Parity
ANS: C
Incidence refers to the number of new cases of mental disorders in a healthy population within a given period of time. Prevalence describes the total number of cases, new and existing, in a given population during a specific period of time, regardless of when they became ill. Parity refers to equivalence, and legislation required insurers that provide mental health coverage to offer annual and lifetime benefits at the same level provided for medical–surgical coverage. Comorbidity refers to having more than one mental disorder at a time.
Which component of treatment of mental illness is specifically recognized by Quality and Safety Education for Nurses (QSEN)?
a. All genomes are unique.
b. Care is centered on the client.
c. Healthy development is vital to mental health.
d. Recovery occurs on a continuum from illness to health.
ANS: B
The key areas of care promoted by QSEN are client-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.
What is the best response for the nurse to provide to a question from another health professional regarding the difference between a diagnosis in DSM-V and a nursing diagnosis. a. “There is no functional difference between the two. Both identify human
disorders.”
b. “The DSM-V diagnosis disregards culture, whereas the nursing diagnosis takes culture into account.”
c. “The DSM-V diagnosis describes causes of disorders whereas a nursing diagnosis does not explore etiology.”
d. “The DSM-V diagnosis guides medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for issues a client is
experiencing.”
ANS: D
The medical diagnosis is concerned with the client’s disease state, causes, and cures, whereas the nursing diagnosis focuses on the client’s response to stress and possible caring interventions. Both tools consider culture. The DSM-V is multiaxial. Nursing diagnoses also consider potential problems.
Which nursing intervention below is part of the scope of an advanced practice psychiatric/mental health nurse rather than a basic level registered nurse?
a. Coordination of care
b. Health teaching
c. Milieu therapy
d. Psychotherapy
ANS: D
Psychotherapy is part of the scope of practice of an advanced practice nurse. The distracters are within a basic level registered nurse’s scope of practice
MULTIPLE RESPONSE
1. An experienced nurse says to a new graduate, “When you’ve practiced as long as I have, you automatically know how to take care of clients experiencing psychosis.” Which factors should the new graduate consider when analyzing this comment? (Select all that apply.) a. The experienced nurse may have lost sight of clients’ individuality, which may compromise the integrity of practice.
b. New research findings should be integrated continuously into a nurse’s practice to provide the most effective care.
c. Experience provides mental health nurses with the essential tools and skills needed for effective professional practice.
d. Experienced psychiatric nurses have learned the best ways to care for mentally ill clients through trial and error.
e. An intuitive sense of clients’ needs guides effective psychiatric nurses.
ANS: A, B
Evidence-based practice involves using research findings and standards of care to provide the most effective nursing care. Evidence is continuously emerging, so nurses cannot rely solely on experience. The effective nurse also maintains respect for each client as an individual. Overgeneralization compromises that perspective. Intuition and trial and error are unsystematic approaches to care
MULTIPLE RESPONSE
Which findings are signs of a person who is mentally healthy? (Select all that apply.) a. Says, “I have some weaknesses, but I feel I’m important to my family and friends.” b. Adheres strictly to religious beliefs of parents and family of origin.
c. Spends all holidays alone watching old movies on television.
d. Considers past experiences when deciding about the future.
e. Experiences feelings of conflict related to changing jobs.
ANS: A, D, E
Mental health is a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively, and make a contribution to the community. Mental health provides people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem.
A client in the emergency department says, “Voices say someone is stalking me. They want to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a threat.” Which aspects of the client’s mental health have the greatest and most immediate concern to the nurse? (Select all that apply.)
a. Happiness
b. Appraisal of reality
c. Control over behavior
d. Effectiveness in work
e. Healthy self-concept
ANS: B, C, E
The aspects of mental health of greatest concern are the client’s appraisal of and control over behavior. The appraisal of reality is inaccurate. There are auditory hallucinations, delusions of persecution, and delusions of grandeur. In addition, the client’s control over behavior is tenuous, as evidenced by the plan to stab anyone who seems threatening. A healthy self-concept is lacking, as evidenced by the delusion of grandeur. Data are not present to suggest that the other aspects of mental health (happiness and effectiveness in work) are of immediate concern.
A parent says, “My 2-year-old child refuses toilet training and shouts ‘No!’ when given directions. What do you think is wrong?” What is the nurse’s best reply?
a. “Your child needs firmer control. It is important to set limits now.”
b. “This is normal for your child’s age. The child is striving for independence.”
c. “There may be developmental problems. Most children are toilet trained by age 2.” d. “Some undesirable attitudes are developing. A child psychologist can help you develop a plan.”
ANS: B
This behavior is conventional of a child around the age of 2 years, whose developmental task is to develop autonomy. The distracters indicate the child’s behavior is abnormal.
A nurse wants to find information on current evidence-based research, programs, and practices regarding mental illness and addictions. Which resource should the nurse consult?
a. American Psychiatric Association
b. American Psychological Association (APA)
c. Clinician’s Quick Guide to Interpersonal Psychotherapy
d. Substance Abuse and Mental Health Services Administration (SAMHSA)
ANS: D
The SAMHSA maintains a National Registry of Evidence-based Practices and Programs. New therapies are entered into the database on a regular basis. The incorrect responses are resources but do not focus on evidence-based information.
- Which finding best indicates that the goal “Demonstrate mentally healthy behavior” was achieved for an adult client?
a. being willing to work towards achieving ideals and meeting demands.
b. behaving without considering the consequences of personal actions.
c. aggressively meeting personal needs without considering the rights of others.
d. seeking help from others to avoid assuming responsibility for major areas of own life.
ANS: A
Mental health is a state of well-being in which individuals reach their own potential, cope with the normal stresses of life, work productively, and contribute to the community. Mental health provides people with the capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem. The correct response describes an adaptive, healthy behavior. The distracters describe maladaptive behaviors.
A 26-month-old displays negative behavior, refuses toilet training, and often says, “No!” Which psychosocial crisis is evident?
a. Trust versus mistrust
b. Initiative versus guilt
c. Industry versus inferiority
d. Autonomy versus shame and doubt
ANS: D
The crisis of autonomy versus shame and doubt relates to the developmental task of gaining control of self and environment, as exemplified by toilet training. This psychosocial crisis occurs during the period of early childhood. Trust versus mistrust is the crisis of the infant. Initiative versus guilt is the crisis of the preschool and early-school-aged child. Industry versus inferiority is the crisis of the 6- to 12-year-old child.
A 4-year-old grabs toys from other children and says, “I want that now!” From a psychoanalytic perspective, this behavior is a product of impulses originating in which system of the personality?
a. Id
b. Ego
c. Superego
d. Preconscious
ANS: A
The id operates on the pleasure principle, seeking immediate gratification of impulses. The ego acts as a mediator of behavior and weighs the consequences of the action, perhaps determining that taking the toy is not worth the mother’s wrath. The superego would oppose the impulsive behavior as “not nice.” The preconscious is a level of awareness rather than an aspect of personality
The parent of a 4-year-old rewards and praises the child for helping a sibling, being polite, and using good manners. These qualities are likely to be internalized and become part of which system of the personality?
a. Id
b. Ego
c. Superego
d. Preconscious
ANS: C
The superego contains the “shoulds,” or moral standards internalized from interactions with significant others. Praise fosters internalization of desirable behaviors. The id is the center of basic instinctual drives, and the ego is the mediator. The ego is the problem-solving and reality testing portion of the personality that negotiates solutions with the outside world. The preconscious is a level of awareness from which material can be retrieved easily with conscious effort. This item relates to an audience response question.
A nurse supports a parent for praising a child who behaves in helpful ways to others. When this child behaves with politeness and helpfulness in adulthood, which feeling will most likely result? a. Guilt
b. Anxiety
c. Humility
d. Self-esteem
ANS: D
The individual will be living up to the ego ideal, which will result in positive feelings about self. The other options are incorrect because each represents a negative feeling.
An adult says, “I never know the answers,” and “My opinion does not count.” Which psychosocial crisis was unsuccessfully resolved for this adult?
a. Initiative versus guilt
b. Trust versus mistrust
c. Autonomy versus shame and doubt
d. Generativity versus self-absorption
ANS: C
These statements show severe self-doubt, indicating that the crisis of gaining control over the environment was not met successfully. Unsuccessful resolution of the crisis of initiative versus guilt results in feelings of guilt. Unsuccessful resolution of the crisis of trust versus mistrust results in poor interpersonal relationships and suspicion of others. Unsuccessful resolution of the crisis of generativity versus self-absorption results in self-absorption that limits the ability to grow as a person.
Which statement by a client would lead the nurse to suspect unsuccessful completion of the psychosocial developmental task of infancy?
a. “I know how to do things right, so I prefer jobs where I work alone rather than on a team.”
b. “I do not allow other people to truly get to know me.”
c. “I depend on frequent praise from others to feel good about myself.”
d. “I usually need to do things several times before I get them right.”
ANS: B
According to Erikson, the developmental task of infancy is the development of trust. The correct response is the only statement clearly showing lack of ability to trust others. An inability to work with others, coupled with a sense of superiority, suggests unsuccessful completion of the task of intimacy versus isolation. Relying on praise from others suggests unsuccessful completion of the
task of identity versus role confusion. Shame suggests failure to resolve the crisis of initiative versus guilt.
A client is suspicious and is frequently sarcastic toward others. To which psychosexual stage do these traits relate?
a. Oral
b. Anal
c. Phallic
d. Genital
ANS: A
The behaviors in the stem develop as the result of attitudes formed during the oral stage, when an infant first learns to relate to the environment. Anal-stage traits include stinginess, stubbornness, orderliness, or their opposites. Phallic-stage traits include flirtatiousness, pride, vanity, difficulty with authority figures, and difficulties with sexual identity. Genital-stage traits include the ability to form satisfying sexual and emotional relationships with members of the opposite sex, emancipation from parents, a strong sense of personal identity, or the opposites of these traits.
A client expresses a desire to be cared for by others and often behaves in a helpless fashion. Which stage of psychosexual development is most relevant to the client’s needs?
a. Latency
b. Phallic
c. Anal
d. Oral
ANS: D
Fixation at the oral stage sometimes produces dependent infantile behaviors in adults. Latency fixations often result in difficulty identifying with others and developing social skills, resulting in a sense of inadequacy and inferiority. Phallic fixations result in having difficulty with authority figures and poor sexual identity. Anal fixation sometimes results in retentiveness, rigidity, messiness, destructiveness, and cruelty. This item relates to an audience response question.
A nurse listens to a group of recent retirees. One says, “I volunteer with Meals on Wheels, coach teen sports, and do church visitation.” Another laughs and says, “I’m too busy taking care of myself to volunteer to help others.” Which psychosocial developmental task do these statements contrast
O Industry and inferiority
O Generativity and self-absorption
O Trust and mistrust
O Intimacy and isolation
ANS: D
Both retirees are in middle adulthood, when the developmental crisis to be resolved is generativity versus self-absorption. One exemplifies generativity; the other embodies self absorption. This developmental crisis would show a contrast between relating to others in a trusting fashion and being suspicious and lacking trust. Failure to negotiate this developmental crisis would result in a sense of inferiority or difficulty learning and working as opposed to the ability to work competently. Behaviors that would be contrasted would be emotional isolation and the ability to love and commit oneself.
. An adult dies in a tragic accident. Afterward, the siblings plan a funeral service. Which statement by a sibling best indicates a sense of self-actualization?
a. “Of all of us, I am the most experienced with planning these types of events.”
b. “Funerals are supposed to be conducted quietly, respectfully, and according to a social protocol.”
c. “This death was unfair, but I hope we can plan a service that everyone feels is a celebration of life.”
d. “This death was probably the consequence of years of selfish and inconsiderate.
ANS: C
The correct response shows an accurate perception of reality as well as a focus on solving the problem in a way that involves others. These factors are characteristic of self-actualization. The incorrect responses demonstrate self-centeredness, rigidity, and blaming which are characteristic of a failure to achieve self-actualization.
A student nurse says, “I don’t need to interact with my clients. I learn what I need to know by observation.” An instructor can best interpret the nursing implications of Sullivan’s theory to this student by providing what response?
a. “Interactions are required in order to help you develop therapeutic communication skills.”
b. “Nurses cannot be isolated. We must interact to provide clients with opportunities to practice interpersonal skills.”
c. “Observing client interactions will help you formulate priority nursing diagnoses and appropriate interventions.”
d. “It is important to pay attention to clients’ behavioral changes, because these signify adjustments in personality.”
ANS: B
The nurse’s role includes educating clients and assisting them in developing effective interpersonal relationships. Mutuality, respect for the client, unconditional acceptance, and empathy are cornerstones of Sullivan’s theory. The nurse who does not interact with the client cannot demonstrate these cornerstones. Observations provide only objective data. Priority nursing diagnoses usually cannot be accurately established without subjective data from the client. The other distracters relate to Maslow and behavioral theory. This item relates to an audience response question.
A nurse consistently encourages client to do his or her own activities of daily living. If the client is unable to complete an activity, the nurse helps until the client is once again independent. This nurse’s practice is most influenced by which theorist?
a. Betty Neuman
b. Patricia Benner
c. Dorothea Orem
d. Joyce Travelbee
ANS: C
Orem emphasizes the role of the nurse in promoting self-care activities of the client; this has relevance to the seriously and persistently mentally ill client.
A nurse uses Maslow’s hierarchy of needs to plan care for a client diagnosed with mental illness. Which problem will receive priority?
a. Refusal to eat or bathe.
b. Reporting feelings of alienation from family.
c. Reluctance to participate in unit social activities.
d. Being unaware of medication action and side effects.
ANS: A
The need for food and hygiene are physiological and therefore take priority over psychological or meta-needs in care planning.
Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly mute. Which technique applies?
a. Encourage the child to observe others talking.
b. Include the child in small group activities.
c. Give the child a small treat for speaking.
d. Teach the child relaxation techniques.
ANS: C
Operant conditioning involves giving positive reinforcement for a desired behavior. Treats are rewards and reinforce speech through positive reinforcement.
. The parent of a child diagnosed with schizophrenia tearfully asks the nurse, “What could I have done differently to prevent this illness?” What is the nurse’s best response?
a. “Although schizophrenia results from impaired family relationships, try not to feel guilty. No one can predict how a child will respond to parental guidance.”
b. “Schizophrenia is a biological illness resulting from changes in how the brain and nervous system function. You are not to blame for your child’s illness.”
c. “There is still hope. Changing your parenting style can help your child learn to cope effectively with the environment.”
d. “Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting.”
ANS: B
The parent’s comment suggests feelings of guilt or inadequacy. The nurse’s response should address these feelings as well as provide information. Clients and families need reassurance that the major mental disorders are biological in origin and are not the “fault” of parents. One distracter places the burden of having faulty genes on the shoulders of the parents. The other distracters are neither wholly accurate nor reassuring.
A nurse influenced by Peplau’s interpersonal theory works with an anxious, withdrawn client. What principle will the interventions be focused on?
a. Rewarding desired behaviors.
b. Using assertive communication.
c. Changing the client’s self-concept.
d. Administering medications to relieve anxiety.
ANS: B
The nurse–client relationship is structured to provide a model for adaptive interpersonal relationships that can be generalized to others. Helping the client learn to use assertive communication will improve the client’s interpersonal relationships. The distracters apply to theories of cognitive, behavioral, and biological therapy
A client participated in psychotherapy weekly for 5 months. The therapist used free association, dream analysis, and facilitated transference to help the client understand conflicts and foster change. What is the term that applies to this method?
a. Rational-emotive behavior therapy
b. Psychodynamic psychotherapy
c. Cognitive-behavioral therapy
d. Operant conditioning
ANS: B
The techniques are aspects of psychodynamic psychotherapy. The distracters use other techniques.
Consider this comment from a therapist: “The client is homosexual but has kept this preference secret. Severe anxiety and depression occur when the client anticipates family reactions to this sexual orientation.” Which perspective is evident in the speaker?
a. Theory of interpersonal relationships
b. Classical conditioning theory
c. Psychosexual theory
d. Behaviorism theory
ANS: A
The theory of interpersonal relationships recognizes the anxiety and depression as resulting from unmet interpersonal security needs. Behaviorism and classical conditioning theories do not apply. A psychosexual formulation would focus on uncovering unconscious material that relates to the client problem.
A psychotherapist works with an anxious, dependent client. Which strategy is most consistent with psychoanalytic psychotherapy?
a. Identifying the client’s strengths and assets
b. Praising the client for describing feelings of isolation
c. Focusing on feelings developed by the client toward the therapist
d. Providing psychoeducation and emphasizing medication adherence
ANS: C
Positive or negative feelings of the client toward the therapist indicate transference. Transference is a psychoanalytic concept that can be used to explore previously unresolved conflicts. The distracters relate to biological therapy and supportive psychotherapy. Use of psychoeducational materials is a common “homework” assignment used in cognitive therapy
A person says, “I was the only survivor in a small plane crash. Three business associates died. I got depressed and saw a counselor twice a week for 4 weeks. We talked about my feelings related to being a survivor, and I’m better now.” Which type of therapy was used?
a. Systematic desensitization
b. Psychoanalysis
c. Behavior modification
d. Interpersonal psychotherapy
ANS: D
Interpersonal psychotherapy returned the client to his former level of functioning by helping him come to terms with the loss of friends and guilt over being a survivor. Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying. Psychoanalysis would call for a long period of exploration of unconscious material. Behavior modification would focus on changing a behavior rather than helping the client understand what is going on in his life.
Which technique is most applicable to aversion therapy?
a. Punishment
b. Desensitization
c. Role modeling
d. Positive reinforcement
ANS: A
Aversion therapy is akin to punishment. Aversive techniques include pairing of a maladaptive behavior with a noxious stimulus, punishment, and avoidance training.
A client says to the nurse, “My father has been dead for over 10 years but talking to you is almost as comforting as the talks he and I had when I was a child.” Which term applies to the client’s comment?
a. Superego
b. Transference
c. Reality testing
d. Countertransference
ANS: B
Transference refers to feelings a client has toward the health care workers that were originally held toward significant others in his or her life. Countertransference refers to unconscious feelings that the health care worker has toward the client. The superego represents the moral component of personality; it seeks perfection.
A college student received an invitation to attend the wedding of a close friend who lives across the country. The student is afraid of flying. Which type of therapy would be most helpful for this client?
a. Psychoanalysis
b. Aversion therapy
c. Systematic desensitization
d. Short-term dynamic therapy
ANS: C
Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying. Psychoanalysis and short-term dynamic therapy seek to uncover conflicts. Aversion therapy involves use of a noxious stimulus, punishment, and avoidance.
A client is fearful of riding on elevators. The therapist first rides an escalator with the client. The therapist and client then stand in an elevator with the door open for 5 minutes and later with the elevator door closed for 5 minutes. Which technique has the therapist used?
a. Classic psychoanalytic therapy
b. Systematic desensitization
c. Rational emotive therapy
d. Biofeedback .
ANS: b
Systematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear of flying. Psychoanalysis and short-term dynamic therapy seek to uncover conflicts. Aversion therapy involves use of a noxious stimulus, punishment, and avoidance.
A client says, “All my life I’ve been surrounded by stupidity. Everything I buy breaks because the entire American workforce is incompetent.” This client is experiencing what type of reaction?
a. self-esteem deficit.
b. cognitive distortion.
c. deficit in motivation.
d. deficit in love and b
ANS: B
Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations. See related audience response question.
A client is fearful of riding on elevators. The therapist first rides an escalator with the client. The therapist and client then stand in an elevator with the door open for 5 minutes and later with the elevator door closed for 5 minutes. Which technique has the therapist used?
a. Classic psychoanalytic therapy
b. Systematic desensitization
c. Rational emotive therapy
d. Biofeedback
ANS: B
Systematic desensitization is a form of behavior modification therapy that involves the development of behavior tasks customized to the client’s specific fears. These tasks are presented to the client while using learned relaxation techniques. The client is incrementally exposed to the fear.
A client says, “I always feel good when I wear a size 2 petite.” Which type of cognitive distortion is evident?
a. Disqualifying the positive
b. Overgeneralization
c. Catastrophizing
d. Personalization
ANS: B
Automatic thoughts, or cognitive distortions, are irrational and lead to false assumptions and misinterpretations. The stem offers an example of overgeneralization. See related audience response question.
Which comment best indicates a client is self-actualized?
a. “I have succeeded despite a world filled with evil.”
b. “I have a plan for my life. If I follow it, everything will be fine.”
c. “I’m successful because I work hard. No one has ever given me anything.” d. “My favorite leisure is walking on the beach, hearing soft sounds of rolling waves.”
ANS: D
The self-actualized personality is associated with high productivity and enjoyment of life. Self actualized persons experience pleasure in being alone and an ability to reflect on events.
A nurse presents a community education program about mental illness. Which comment by a participant best demonstrates a correct understanding of mental illness from a biological perspective?
a. “Some people experience life events so traumatic that they cannot be overcome.” b. “Disturbed and conflicted family relationships are usually a starting place for mental illness.”
c. “My friend has had bipolar disorder for years and many problems have resulted. It’s not her fault.”
d. “Mental illness is the result of developmental complications that cause a person not to grow to their full potential.”
ANS: C
Which client is the best candidate for brief psychodynamic therapy?
a. An accountant with a loving family and successful career who was involved in a short extramarital affair
b. An adult with a long history of major depression who was charged with driving under the influence
c. A woman with a history of borderline personality disorder who recently cut both wrists
d. An adult male recently diagnosed with anorexia nervosa
A
A client states, “I’m starting cognitive-behavioral therapy. What can I expect from the sessions?” Which responses by the nurse would be appropriate? (Select all that apply.)
a. “The therapist will be active and questioning.”
b. “You will be given some homework assignments.”
c. “The therapist will ask you to describe your dreams.”
d. “The therapist will help you look at your ideas and beliefs about yourself.”
e. “The goal is to increase subjectivity about thoughts that govern your behavior.”
ANS: A, B, D
Cognitive therapists are active rather than passive during therapy sessions because they help client’s reality-test their thinking. Homework assignments are given and completed outside the therapy sessions. Homework is usually discussed at the next therapy session. The goal of cognitive therapy is to assist the client in identifying inaccurate cognitions and in reality-testing and formulating new, accurate cognitions. One distracter applies to psychoanalysis. Increasing subjectivity is not desirable.
Which comments by an adult best indicate self-actualization? (Select all that apply.)
a. “I am content with a good book.”
b. “I often wonder if I chose the right career.”
c. “Sometimes I think about how my parents would have handled problems.” d. “It’s important for our country to provide basic health care services for everyone.”
e. “When I was lost at sea for 2 days, I gained an understanding of what is
important.”
ANS: A, D, E
Self-actualized persons enjoy privacy, have a sense of democracy, and show positive outcomes associated with peak experiences. Self-doubt, defensiveness, and blaming are not consistent with self-actualization.
Which comments by an elderly person best indicate successful completion of the individual’s psychosocial developmental task? (Select all that apply.)
a. “I am proud of my children’s successes in life.”
b. “I should have given to community charities more often.”
c. “My relationship with my father made life more difficult for me.”
d. “My experiences in the war helped me appreciate the meaning of life.”
e. “I often wonder what would have happened if I had chosen a different career
ANS: A, D
The developmental crisis for an elderly person relates to integrity versus despair. Pride in one’s offspring indicates a sense of fulfillment. Recognition of the wisdom gained from difficult experiences (such as being in a war) indicates a sense of integrity. Blaming and regret indicate despair and unsuccessful resolution of the crisis.
Which activities represent the caring foundation of nursing? (Select all that apply.) a. Administering medications on time to a group of clients
b. Listening to a new widow grieve her husband’s death
c. Helping a client obtain groceries from a food bank
d. Teaching a client about a new medication
e. Holding the hand of a frightened client
ANS: B, C, E
Patricia Benner described caring as the foundation professional nursing practice. Benner encourages nurses to provide caring and comforting interventions. She emphasizes the importance of the nurse-client relationship and the importance of teaching and coaching the client and bearing witness to suffering as the client deals with illness.
Which therapies involve electrical brain stimulation for treatment of mental illness? (Select all that apply.)
a. Aversion therapy
b. Operant conditioning
c. Systematic desensitization
d. Electroconvulsive therapy (ECT)
e. Transcranial magnetic stimulation (TMS)
ANS: D, E
ECT and TMS are therapies that use electrical stimulation of the brain as a form of treatment for mental illness. The incorrect responses are therapies that are interpersonal in nature.
A client asks, “What are neurotransmitters? My doctor said mine are imbalanced.” What is the nurse’s best response?
a. “How do you feel about having imbalanced neurotransmitters?”
b. “Neurotransmitters protect us from harmful effects of free radicals.”
c. “Neurotransmitters are substances we consume that influence memory and mood.”
d. “Neurotransmitters are natural chemicals that pass messages between brain cells
ANS: D
The client asked for information, and the correct response is most accurate. Neurotransmitters are chemical substances that function as messengers in the central nervous system. They are released from the axon terminal, diffuse across the synapse, and attach to specialized receptors on the postsynaptic neuron. The distracters either do not answer the client’s question or provide untrue, misleading information.
. The parent of an adolescent diagnosed with schizophrenia asks the nurse, “My child’s doctor ordered a PET. What kind of test is that?” What is the nurse’s best reply?
a. “This test uses a magnetic field and gamma waves to identify problem areas in the brain. Does your teenager have any metal implants?”
b. “PET means positron-emission tomography. It is a special type of scan that shows blood flow and activity in the brain.”
c. “A PET scan passes an electrical current through the brain and shows brain-wave activity. It can help diagnose seizures.”
d. “It’s a special x-ray that shows structures of the brain and whether there has ever been a brain injury.”
ANS: B
The parent is seeking information about PET scans. It is important to use terms the parent can understand, so the nurse should identify what the initials mean. The correct response is the only option that provides information relevant to PET scans. The distracters describe magnetic resonance image (MRI), computed tomography (CT) scans, and EEG. See relationship to audience response questio
A client with a long history of hypertension and diabetes now develops confusion. The health care provider wants to make a differential diagnosis between Alzheimer’s disease and multiple cerebral infarcts. Which diagnostic procedure should the nurse expect to prepare the client for first?
a. Skull x-rays
b. Computerized axial tomography (CT) scan
c. Positron-emission tomography (PET)
d. Single photon emission computed tomography (SPECT)
ANS: B
A CT scan shows the presence or absence of structural changes, including cortical atrophy, ventricular enlargement, and areas of infarct, information that would be helpful to the health care provider. PET and SPECT show brain activity rather than structure and may occur later. See relationship to audience response question.
PTS: 1 DIF: Cognitive Level: Apply (Application)
TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity
The nurse prepares to assess a client diagnosed with major depressive disorder for disturbances in circadian rhythms. Which question should the nurse ask this client?
a. “Have you ever seen or heard things that others do not?”
b. “What are your worst and best times of the day?”
c. “How would you describe your thinking?”
d. “Do you think your memory is failing?”
ANS: B
Mood changes throughout the day may be related to circadian rhythm disturbances. Questions about sleep pattern are also relevant to circadian rhythms. The distracters apply to assessment for illusions and hallucinations, thought processes, and memory.
A client’s history shows drinking 4 to 6 L of fluid and eating more than 6,000 calories per day. Which part of the central nervous system is most likely dysfunctional for this client? a. Amygdala
b. Parietal lobe
c. Hippocampus
d. Hypothalamus
ANS: D
The hypothalamus, a small area in the ventral superior portion of the brainstem, plays a vital role in such basic drives as hunger, thirst, and sex. See relationship to audience response question.
The nurse administers a medication that potentiates the action of ã-aminobutyric acid (GABA). Which effect would be expected?
a. Reduced anxiety
b. Improved memory
c. More organized thinking
d. Fewer sensory perceptual alterations
ANS: A
Increased levels of GABA reduce anxiety. Acetylcholine and substance P are associated with memory enhancement. Thought disorganization is associated with dopamine. GABA is not associated with sensory perceptual alterations. See relationship to audience response question.
A nurse would anticipate that treatment for a client with memory difficulties might include medications designed to do what?
a. inhibit GABA.
b. prevent destruction of acetylcholine.
c. reduce serotonin metabolism.
d. increase dopamine activity.
.
ANS: B
Increased acetylcholine plays a role in learning and memory. Preventing destruction of acetylcholine by acetylcholinesterase would result in higher levels of acetylcholine, with the potential for improved memory. GABA affects anxiety rather than memory. Increased dopamine would cause symptoms associated with schizophrenia or mania rather than improve memory. Decreasing dopamine at receptor sites is associated with Parkinson’s disease rather than improving memory
. A client has disorganized thinking associated with schizophrenia. Neuroimaging would likely show dysfunction in which part of the brain?
a. Hippocampus
b. Frontal lobe
c. Cerebellum
d. Brainstem
ANS: B
The frontal lobe is responsible for intellectual functioning. The hippocampus is involved in emotions and learning. The cerebellum regulates skeletal muscle coordination and equilibrium. The brainstem regulates internal organs.
The nurse should assess a client taking a drug with anticholinergic properties for inhibited function of which system or structure?
a. parasympathetic
b. sympathetic
c. reticular activating
d. medulla oblongata.
ANS: A
Acetylcholine is the neurotransmitter found in high concentration in the parasympathetic nervous system. When anticholinergic drugs inhibit acetylcholine action, blurred vision, dry mouth, constipation, and urinary retention commonly occur.
The therapeutic action of neurotransmitter inhibitors that block reuptake bring about what response?
a. decreased concentration of the blocked neurotransmitter in the central nervous
system.
b. increased concentration of the blocked neurotransmitter in the synaptic gap. c. destruction of receptor sites specific to the blocked neurotransmitter.
d. limbic system stimulation.
ANS: B
If the reuptake of a substance is inhibited, it accumulates in the synaptic gap, and its concentration increases, permitting ease of transmission of impulses across the synaptic gap. Normal transmission of impulses across synaptic gaps is consistent with normal rather than depressed mood. The other options are not associated with blocking neurotransmitter reuptake.
A client taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. Which drug action causes these symptoms to develop?
a. Anticholinergic effects
b. Dopamine-blocking effects
c. Endocrine-stimulating effects
d. Ability to stimulate spinal nerves
ANS: B
Medication that blocks dopamine often produces disturbances of movement, such as akathisia, because dopamine affects neurons involved in both thought processes and movement regulation. Anticholinergic effects include dry mouth, blurred vision, urinary retention, and constipation. Akathisia is not caused by endocrine stimulation or spinal nerve stimulation
A fearful client has an increased heart rate and blood pressure. The nurse suspects increased activity of which neurotransmitter?
a. GABA
b. Norepinephrine
c. Acetylcholine
d. Histamine
ANS: B
Norepinephrine is the neurotransmitter associated with sympathetic nervous system stimulation, preparing the individual for “fight or flight.” GABA is a mediator of anxiety level. A high concentration of histamine is associated with an inflammatory response. A high concentration of acetylcholine is associated with parasympathetic nervous system stimulation.
A client has acute anxiety related to an automobile accident 2 hours ago. The nurse should teach the client about medication from which group?
a. Tricyclic antidepressants
b. Antipsychotic drugs
c. Mood stabilizers
d. Benzodiazepine
ANS: D
Benzodiazepines provide anxiety relief. Tricyclic antidepressants are used to treat symptoms of depression. Mood stabilizers are used to treat bipolar disorder. Antipsychotic drugs are used to treat psychosis.
A client is hospitalized for severe major depressive disorder. The nurse can expect to provide the client with teaching about what medication?
a. chlordiazepoxide.
b. clozapine.
c. sertraline.
d. tacrine.
ANS: C
Sertraline is a selective serotonin reuptake inhibitor (SSRI). This antidepressant blocks the reuptake of serotonin, with few anticholinergic and sedating side effects. Clozapine is an antipsychotic. Chlordiazepoxide is an anxiolytic. Tacrine treats Alzheimer’s disease.
. A client diagnosed with bipolar disorder displays aggressiveness, agitation, talkativeness, and irritability. The nurse expects the health care provider to prescribe a medication from which group?
a. Psychostimulants
b. Mood stabilizers
c. Anticholinergics
d. Antidepressants
ANS: B
The symptoms describe mania, which is effectively treated by mood stabilizers, such as lithium, and selected anticonvulsants (carbamazepine, valproic acid, and lamotrigine). Drugs from the other classifications listed are not effective in the treatment of mania.
A drug causes muscarinic receptor blockade. The nurse will assess the client for what side effect?
a. dry mouth.
b. gynecomastia.
c.pseudoparkinsonim.
d. orthostatic hypotension.
ANS: A
Muscarinic receptor blockade includes atropine-like side effects, such as dry mouth, blurred vision, and constipation. Gynecomastia is associated with decreased prolactin levels. Movement defects are associated with dopamine blockade. Orthostatic hypotension is associated with á1 antagonism.
A client begins therapy with a phenothiazine medication. What teaching should the nurse provide related to the drug’s strong dopaminergic effect?
a. Chew sugarless gum.
b. Increase dietary fiber.
c. Arise slowly from bed.
d. Report changes in muscle movement.
ANS: D
Phenothiazines block dopamine receptors in both the limbic system and basal ganglia. Movement disorders and motor abnormalities (extrapyramidal side effects), such as parkinsonism, akinesia, akathisia, dyskinesia, and tardive dyskinesia, are likely to occur early in the course of treatment. They are often heralded by sensations of muscle stiffness. Early intervention with antiparkinsonism medication can increase the client’s comfort and prevent dystonic reactions. The distracters are related to anticholinergic effects.
A client tells the nurse, “My doctor prescribed paroxetine for my depression. I assume I’ll have side effects like I had when I was taking imipramine.” The nurse’s reply should be based on the knowledge that paroxetine is included in what class of medication?
a. selective norepinephrine reuptake inhibitor (SNRI).
b. tricyclic antidepressant.
c. monoamine oxidase (MAO) inhibitor.
d. selective serotonin reuptake inhibitors (SSRIs)
ANS: D
Paroxetine is an SSRI and will not produce the same side effects as imipramine, a tricyclic antidepressant. The client will probably not experience dry mouth, constipation, or orthostatic hypotension.
A nurse can anticipate anticholinergic side effects are likely when a client is prescribed which medication?
a. lithium.
b. buspirone.
c. imipramine.
d. risperidone.
ANS: C
Imipramine is a tricyclic antidepressant with strong anticholinergic properties, resulting in dry mouth, blurred vision, constipation, and urinary retention. Lithium therapy is more often associated with fluid-balance problems, including polydipsia, polyuria, and edema. Risperidone therapy is more often associated with movement disorders, orthostatic hypotension, and sedation. Buspirone is associated with anxiety reduction without major side effects.
Which instruction has priority when teaching a client about clozapine?
a. “Avoid unprotected sex.”
b. “Report sore throat and fever immediately.”
c. “Reduce foods high in polyunsaturated fats.”
d. “Use over-the-counter preparations for rashes.
ANS: B
Clozapine therapy may produce neutropenia; therefore, signs of infection should be immediately reported to the health care provider. In addition, the client should have white blood cell levels measured weekly. The other options are not relevant to clozapine.
The nurse will order a special diet for the client who is prescribed which medication? a. carbamazepine.
b. haloperidol.
c. phenelzine.
d. trazodone.
ANS: C
Clients taking phenelzine, a monoamine oxidase (MAO) inhibitor, must be on a low tyramine diet to prevent hypertensive crisis. There are no specific dietary precautions associated with the distracters.
. A nurse instructs a client taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of
a. cardiac dysrhythmia.
b. hypotensive shock.
c. hypertensive crisis.
d. hypoglycemia.
ANS: C
Clients taking MAO-inhibiting drugs must be on a low tyramine diet to prevent hypertensive crisis. In the presence of MAO inhibitors, tyramine is not destroyed by the liver and in high levels produces intense vasoconstriction, resulting in elevated blood pressure.
A nurse caring for a client taking a selective serotonin reuptake inhibitors (SSRIs) will develop outcome criteria related to what?
a. coherent thought processes.
b. improvement in depression.
c. reduced levels of motor activity.
d. decreased extrapyramidal symptoms.
ANS: B
SSRIs affect mood, relieving depression in many cases. SSRIs do not act to reduce thought disorders. SSRIs reduce depression but have little effect on motor hyperactivity. SSRIs do not produce extrapyramidal symptoms.
By which mechanism do selective serotonin reuptake inhibitors (SSRIs) medications improve depression?
a. Destroying increased amounts of serotonin
b. Making more serotonin available at the synaptic gap
c. Increasing production of acetylcholine and dopamine
d. Blocking muscarinic and á1 norepinephrine receptors
ANS: B
Depression is thought to be related to lowered availability of the neurotransmitter serotonin. SSRIs act by blocking reuptake of serotonin, leaving a higher concentration available at the synaptic cleft. SSRIs prevent destruction of serotonin. SSRIs have little or no effect on acetylcholine and dopamine production. SSRIs do not produce muscarinic or á1 norepinephrine blockade.
The laboratory report for a client taking clozapine shows a white blood cell count of 3000 mm3. What is the nurse’s best action?
a. Report the results to the health care provider immediately.
b. Administer the next dose as prescribed.
c. Give aspirin and force fluids.
d. Repeat the laboratory test.
ANS: A
These laboratory values indicate the possibility of agranulocytosis, a serious side effect of clozapine therapy. These results must be immediately reported to the health care provider, and the drug should be withheld. The health care provider may repeat the test, but in the meantime, the drug should be withheld. (Note: This question requires students to apply previous learning regarding normal and abnormal values of white blood cell counts.)
When a drug blocks the attachment of norepinephrine to a1 receptors, the client may experience what side effect?
a. hypertensive crisis.
b. orthostatic hypotension.
c. severe appetite disturbance.
d. an increase in psychotic symptoms.
ANS: B
Sympathetic-mediated vasoconstriction is essential for maintaining normal blood pressure in the upright position. Blockage of a1 receptors leads to vasodilation and orthostatic hypotension. Orthostatic hypotension may cause fainting and falls. Teach clients ways of minimizing this phenomenon.
The nurse should be most alert for problems associated with fluid and electrolyte imbalance when a client is prescribed which medication?
a. lithium.
b. clozapine.
c. fluoxetine.
d. venlafaxine.
ANS: A
Lithium is a salt and known to alter fluid and electrolyte balance, producing polyuria, edema, and other symptoms of imbalance. Clients receiving clozapine should be monitored for agranulocytosis. Clients receiving fluoxetine should be monitored for acetylcholine block. Clients receiving venlafaxine should be monitored for heightened feelings of anxiety.
- Medications that block which receptors would contribute to further weight gain?
a. H1
b. 5 HT2
c. Acetylcholine
d. GABA
ANS: A
H1 receptor blockade results in weight gain. Blocking of the other receptors would have little or no effect on the client’s weight.
An individual hiking in the forest encounters a large poisonous snake on the path. Which change in this individual’s vital signs is most likely?
a. Pulse rate changes from 90 to 72.
b. Respiratory rate changes from 22 to 18.
c. Complaints of intestinal cramping begin.
d. Blood pressure changes from 114/62 to 136/78.
ANS: D
This frightening experience would stimulate the sympathetic nervous system, causing a release of norepinephrine, an excitatory neurotransmitter. It prepares the body for fight or flight. Increased blood pressure, pupil size, respiratory rate, and pulse rate signify release of norepinephrine. Intestinal cramping would be associated with stimulation of the parasympathetic nervous system.
Consider these medications: carbamazepine, lamotrigine, gabapentin. Which medication below also belongs to this group?
a. Galantamine
b. Valproate
c. Buspirone
d. Tacrine
ANS: B
The medications listed in the stem are mood stabilizers, anticonvulsant types. Valproate (Depakote) is also a member of this group. The distracters are drugs for treatment of Alzheimer’s disease and anxiety.
A professional football player is seen in the emergency department after losing consciousness from an illegal block. Prior to discharge, the nurse assists the client to schedule an outclient computed tomography (CT) scan for the next day. Which strategy should the nurse use to ensure the client remembers the appointment?
a. Write the appointment day, time, and location on a piece of paper and give it to the player.
b. Log the appointment day, time, and location into the player’s cell phone calendar feature.
c. Ask the health care provider to admit the client to the hospital overnight.
d. Verbally inform the client of the appointment day, time, and location.
ANS: B
This player may have suffered repeated head injuries with damage to the hippocampus. The hippocampus has significant role in maintaining memory. Logging the appointment into the player’s cell phone calendar will remind him of the appointment the next day. Paper will be lost, and the client is unlikely to remember verbal instruction. Hospitalization is unnecessary. See relationship to audience response question. Caution: This question requires students to apply previous learning regarding central nervous system anatomy and physiology.
. A nurse prepares to administer a second-generation antipsychotic medication to a client diagnosed with schizophrenia. Additional monitoring for adverse effects will be most important if the client has which co-morbid health problems? (Select all that apply.)
a. Parkinson’s disease
b. Grave’s disease
c. Hyperlipidemia
d. Osteoarthritis
e. Diabetes
ANS: A, C, E
Antipsychotic medications may produce weight gain, which would complicate care of a client with diabetes, and increase serum triglycerides, which would complicate care of a client with hyperlipidemia. Parkinson’s disease involves changes in transmission of dopamine and acetylcholine, so these drugs would also complicate care of this client. Osteoarthritis and Grave’s disease should have no synergistic effect with this medication.
Which questions asked by the nurse in a nonjudgmental manner would be most helpful when obtaining information about a client’s use of complementary and herbal remedies? (Select all that apply)
a. “You don’t regularly take herbal remedies, do you?”
b. “What herbal medicines have you used to relieve your symptoms?”
c. “What over-the-counter medicines, vitamins, and nutritional supplements do you use?”
d. “What differences in your symptoms do you notice when you take herbal
supplements?”
e. “Have you experienced problems from using herbal and prescription drugs at the same time?
ANS: B, C, D, E
The correct responses are neutral in tone and do not express bias for or against the use of complementary or herbal medicines. The distracter, worded in a negative way, makes the nurse’s bias evident.
An individual is experiencing problems with memory. Which of these structures are most likely to be involved in this deficit? (Select all that apply.)
a. Amygdala
b. Hippocampus
c. Occipital lobe
d. Temporal lobe
e. Basal ganglia
ANS: A, B, D
The frontal and temporal lobes of the cerebrum play a key role in the storage and processing of memories. The amygdala and hippocampus also play roles in memory. The occipital lobe is predominantly involved with vision. The basal ganglia influence integration of physical movement, as well as some thoughts and emotions.
A client’s sibling says, “My brother has a mental illness, but the doctor ordered a functional magnetic resonance image (fMRI) test. That test is too expensive and will just increase the hospital bill.” What are the nurse’s appropriate responses? (Select all that apply.)
a. “Sometimes there are physical causes for psychiatric symptoms. This test will help us understand whether that is the situation.”
b. “Some mental illnesses are evident on fMRIs. This test will give information to help us plan the best care for your brother.”
c. “This test will indicate whether your brother has been taking his psychotropic medications as prescribed.”
d. “It sounds like you do not truly believe your brother had a mental illness.” e. “It would be better for you to discuss your concerns with the health care provider.
ANS: A, B
The correct responses provide information to the sibling. Modern imaging techniques are important tools in assessing molecular changes in mental disease and marking the receptor sites of drug action, which can help in treatment planning. Psychiatric symptoms can be caused by anatomical or physiologic abnormalities. There is no evidence of denial in the sibling’s comment. The nurse can answer this question rather than referring it to the physician/health care provider. An fMRI does not demonstrate adherence to the medication regime.
In-client hospitalization for persons with mental illness is generally reserved for clients who demonstrate which characteristic?
a. present a clear danger to self or others.
b. are noncompliant with medication at home.
c. have limited support systems in the community.
d. develop new symptoms during the course of an illness.
ANS: A
Hospitalization is justified when the client is a danger to self or others, has dangerously decompensated, or needs intensive medical treatment. The distracters do not necessarily describe clients who require inpatient treatment.
A client was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the case manager learned that the client received a notice of eviction immediately prior to admission. What is the case manager’s most appropriate action? a. Postpone the client’s discharge from the hospital.
b. Contact the landlord who evicted the client to further discuss the situation. c. Arrange a temporary place for the client to stay until new housing can be arranged. d. Determine whether the adverse medication reaction was genuine because the client had nowhere to live.
ANS: C
The case manager should intervene by arranging temporary shelter for the client until an apartment can be found. This activity is part of the coordination and delivery of services that falls under the case manager role. None of the other options is a viable alternative.
What action is an example of tertiary prevention?
a. Helping a person diagnosed with a serious mental illness learn to manage money b. Restraining an agitated client who has become aggressive and assaultive
c. Teaching school-age children about the dangers of drugs and alcohol
d. Genetic counseling with a young couple expecting their first child
ANS: A
Tertiary prevention involves services that address residual impairments, with a goal of improved independent functioning. Restraint is a secondary prevention. Genetic counseling and teaching school-age children about substance abuse and dependence are examples of primary prevention.
A client diagnosed with schizophrenia had an exacerbation related to medication non-adherence and was hospitalized for 5 days. The client’s thoughts are now more organized, and discharge is planned. The client’s family says, “It’s too soon for discharge. We will just go through all this again.” What action should the nurse take?
a. ask the case manager to arrange a transfer to a long-term care facility.
b. notify hospital security to handle the disturbance and escort the family off the unit.
c. explain that the client will continue to improve if the medication is taken regularly.
d. contact the health care provider to meet with the family and explain the discharge rationale.
ANS: C
Clients do not stay in a hospital until every symptom disappears. The nurse must assume responsibility to advocate for the client’s right to the least restrictive setting as soon as the symptoms are under control and for the right of citizens to control health care costs. The health care provider will use the same rationale. Shifting blame will not change the discharge. Security is unnecessary. The nurse can handle this matter.
A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor’s closet is locked. What do these observations relate to? a. coordinating care of clients.
b. management of milieu safety.
c. management of the interpersonal climate.
d. use of therapeutic intervention strategies.
ANS: B
Nursing staff are responsible for all aspects of milieu management. The observations mentioned in this question directly relate to the safety of the unit. The other options, although part of the nurse’s concerns, are unrelated to the observations cited.
The psychiatric unit has one bed available. Which client should be admitted from the emergency department? The client
a. The client feeling anxiety and a sad mood after separation from a spouse of 10 years.
b. The client who self-inflicted a superficial cut on the forearm after a family argument.
c. The client experiencing dry mouth and tremor related to taking antipsychotic medication.
d. The client who is a new parent and hears voices saying, “Smother your baby.”
ANS: D
Admission to the hospital would be justified by the risk of client danger to self or others. The other clients have issues that can be handled with less restrictive alternatives than hospitalization.
A suspicious, socially isolated client lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. What is the community psychiatric nurse’s best initial action?
a. Exploring ways to help the client stop smoking.
b. Reporting the situation to the manager of the shelter.
c. Assessing the client’s weight; determine foods and amounts eaten.
d. Arranging hospitalization for the client in order to formulate a new treatment plan.
NS: C
Assessment of biopsychosocial needs and general ability to live in the community is called for before any other action is taken. Both nutritional status and income adequacy are critical assessment parameters. A client may be able to maintain adequate nutrition while eating only one meal a day. The rule is to assess before taking action. Hospitalization may not be necessary. Smoking cessation strategies can be pursued later.
A nurse surveying medical records would find evidence suggesting which client’s rights have been violated?
a. A client was not allowed to have visitors.
b. A client’s belongings were searched at admission.
c. A client with suicidal ideation was placed on continuous observation.
d. Physical restraint was used after a client was assaultive toward a staff member.
ANS: A
The client has the right to have visitors. Inspecting clients’ belongings is a safety measure. Clients have the right to a safe environment, including the right to be protected against impulses to harm self.
Which principle has the highest priority when addressing a behavioral crisis in an inpatient setting?
a. Resolve the crisis with the least restrictive intervention possible.
b. Swift intervention is justified to maintain the integrity of a therapeutic milieu.
c. Rights of an individual client are superseded by the rights of the majority of clients.
d. Clients should have opportunities to regain control without intervention if the safety of others is not compromised.
ANS: A
The rule of using the least restrictive treatment or intervention possible to achieve the desired outcome is the client’s legal right. Planned interventions are nearly always preferable. Intervention may be necessary when the client threatens harm to self.
Clinical pathways are used in managed care settings to accomplish what?
a. stabilization of aggressive clients.
b. identifying obstacles to effective care.
c. relieving nurses of planning responsibilities.
d. streamlining the care process to reduce costs.
ANS: D
Clinical pathways provide guidelines for assessments, interventions, treatments, and outcomes as well as a designated timeline for accomplishment. Deviations from the timeline must be reported and investigated. Clinical pathways streamline the care process and save money. Care pathways do not identify obstacles or stabilize aggressive clients. Staff are responsible for the necessary interventions. Care pathways do not relieve nurses of the responsibility of planning; pathways may, however, make the task easier.
A nurse receives these three phone calls regarding a newly admitted client. · The psychiatrist wants to complete an initial assessment.
· An internist wants to perform a physical examination.
· The client’s attorney wants an appointment with the client.
The nurse schedules the activities for the client. Which role has the nurse fulfilled? a. Advocate
b. Case manager
c. Milieu manager
d. Provider of care
ANS: B
Nurses on psychiatric units routinely coordinate client services, serving as case managers as described in this scenario. The role of advocate would require the nurse to speak out on the client’s behalf. The role of milieu manager refers to maintaining a therapeutic environment. Provider of care refers to giving direct care to the client.
Which aspect of direct care is an experienced, inpatient psychiatric nurse most likely to provide for a client?
a. Hygiene assistance
b. Diversional activities
c. Assistance with job hunting
d. Building assertiveness skills
ANS: D
Assertiveness training relies on the counseling and psychoeducational skills of the nurse. Assistance with personal hygiene would usually be accomplished by a psychiatric technician or nursing assistant. Diversional activities are usually the province of recreational therapists. The client would probably be assisted in job hunting by a social worker or vocational therapist.
Which characteristic would be more applicable to a community mental health nurse than to a nurse working in an operating room?
a. Kindness
b. Autonomy
c. Compassion
d. Professionalism
ANS: B
A community mental health nurse often works autonomously. Kindness, compassion, and professionalism apply to both nurses.
Which client would be most appropriate to refer for assertive community treatment (ACT)? a. One diagnosed with a phobic fear of crowded places.
b. One who experienced a single episode of major depressive disorder.
c. One who experienced a catastrophic reaction to a tornado in the community. d. One diagnosed with schizophrenia who had four hospitalizations in the past year.
ANS: D
ACT provides intensive case management for persons with serious persistent mental illness who live in the community. Repeated hospitalization is a frequent reason for this intervention. The distracters identify mental health problems of a more episodic nature.
The unit secretary receives a phone call from the health insurer for a hospitalized client. The caller seeks information about the client’s projected length of stay. How should the nurse instruct the unit secretary to handle the request?
a. Obtain the information from the client’s medical record and relay it to the caller. b. Inform the caller that all information about clients is confidential.
c. Refer the request for information to the client’s case manager.
d. Refer the request to the health care provider.
ANS: C
The case manager usually confers with insurers and provides the treatment team with information about available resources. The unit secretary should be mindful of client confidentiality and should neither confirm that the client is an inpatient nor disclose other information.
What is an example of primary prevention?
a. Assisting a person diagnosed with a serious mental illness to fill a pill-minder b. Helping school-age children identify and describe normal emotions
c. Leading a psychoeducational group in a community care home
d. Medicating an acutely ill client who assaulted a staff person
ANS: B
Primary preventions are directed at healthy populations with a goal of preventing health problems from occurring. Helping school-age children describe normal emotions people experience promotes coping, a skill that is needed throughout life. Assisting a person with serious and persistent mental illness to fill a pill-minder is an example of tertiary prevention. Medicating an acutely ill client who assaulted a staff person is a secondary prevention. Leading a psychoeducational group in a community care home is an example of tertiary prevention.
Which level of prevention activities would a nurse in an emergency department employ most often?
a. Primary
b. Secondary
c. Tertiary
ANS: B
An emergency department nurse would generally see clients in crisis or with acute illness, so secondary prevention is used. Primary prevention involves preventing a health problem from developing, and tertiary prevention applies to rehabilitative activities.
How would the nurse assigned to ACT best explain the program’s treatment goal?
a. assisting clients to maintain abstinence from alcohol and other substances of abuse.
b. providing structure and a therapeutic milieu for mentally ill clients whose symptoms require stabilization.
c. maintaining medications and stable psychiatric status for incarcerated inmates who have a history of mental illness.
d. providing services for mentally ill individuals who require intensive treatment to continue to live in the community.
ANS: D
An ACT program provides intensive community services to persons with serious, persistent mental illness who live in the community but require aggressive services to prevent repeated hospitalizations.
Which scenario best depicts a behavioral crisis?
a. A client is waving fists, cursing, and shouting threats at a nurse.
b. A client is curled up in a corner of the bathroom, wrapped in a towel.
c. A client is crying hysterically after receiving a phone call from a family member.
d. A client is performing push-ups in the middle of the hall, forcing others to walk around.
ANS: A
This behavior constitutes a behavioral crisis because the client is threatening harm to another individual. Intervention is called for to defuse the situation. The other options speak of behaviors that may require intervention of a less urgent nature because the clients in question are not threatening harm to self or others.
What is the initial action of a case manager who plans to discuss the treatment plan with a client’s family?
a. Determine an appropriate location for the conference.
b. Support the discussion with examples of the client’s behavior.
c. Obtain the client’s permission for the exchange of information.
d. Determine which family members should participate in the conference.
ANS: C
The case manager must respect the client’s right to privacy, which extends to discussions with family. Talking to family members is part of the case manager’s role. Actions identified in the distracters occur after the client has given permission.
A client usually watches television all day, seldom going out in the community or socializing with others. The client says, “I don’t know what to do with my free time.” Which member of the treatment team would be most helpful to this client?
a. Psychologist
b. Social worker
c. Recreational therapist
d. Occupational therapist
ANS: C
Recreational therapists help clients use leisure time to benefit their mental health. Occupational therapists assist with a broad range of skills, including those for employment. Psychologists conduct testing and provide other client services. Social workers focus on the client’s support system.
