Exam 1 NCLEX Flashcards
Which understanding is the basis for the nursing actions focused on minimizing mental health promotion of families with chronically mentally ill members?
a. Family members are at an increased risk for mental illness.
b. The mental health care system is not prepared to deal with family crises.
c. Family members are seldom prepared to cope with a chronically ill individual.
d. The chronically mentally ill receive care best when delivered in a formal setting.
A
When families live with a dominant member who has a persistent and severe mental disorder the outcomes are often expressed as family members who are at increased risk for physical and mental illnesses. The remaining options are not necessarily true.
Which nursing activity shows the nurse actively engaged in the primary prevention of mental disorders?
a. Providing a patient, whose depression is well managed, with medication on time
b. Making regular follow-up visits to a new mother at risk for post-partum depression
c. Providing the family of a patient, diagnosed with depression, information on suicide prevention
d. Assisting a patient who has obsessive compulsive tendencies prepare and practice for a job interview
B
Primary prevention helps to reduce the occurrence of mental disorders by staying involved with a patient. Providing medication and information on existing illnesses are examples of secondary prevention which helps to reduce the prevalence of mental disorders. Assisting a mentally ill patient with preparation for a job interview is tertiary prevention since it involves rehabilitation
What is the best explanation to offer when the mother of a chronically ill teenage patient asks, “Under what circumstances would he be considered incompetent?”
a. “When you can provide the court with enough evidence to show that he is not able to care for himself safely.”
b. “It is not likely that someone his age would be determined to be incompetent regardless of his mental condition.”
c. “He would have to engage in behavior that would result in harm to himself or to someone else; like you or his siblings.”
d. “If the illness becomes so severe that his judgment is impaired to the point where the decisions he makes are harmful to himself or to others.”
D
When a person is unable to cognitively process information or to make decisions about his or her own welfare, the person may be determined to be mentally incompetent. Providing self-care is not the only criteria considered. Age is not a factor considered. The decision is often based on the potential for such behavior.
Which psychiatric nursing intervention shows an understanding of integrated care?
a. A chronically abused woman is assessed for anxiety.
b. A manic patient is taken to the gym to use the exercise equipment.
c. The older adult diagnosed with depression is monitored for suicidal ideations.
d. A teenager who refuses to obey the unit’s rules is not allow to play video games.
A
The majority of health disciplines now recognize that mental disorders and physical illnesses are closely linked. The presence of a mental disorder increases the risk for the development of physical illnesses and vice versa. Assessing a chronically abused individual for anxiety call should attention to the psychiatric disorder that could develop from the abuse. The remaining options show interventions that are appropriate for the mental disorder.
Which nursing activities represent the tertiary level of mental health care? Select all that apply.
a. Providing a depression screening at a local college
b. Helping a mental-challenged patient learn to make correct change
c. Reporting an incidence of possible elder abuse to the appropriate legal agency
d. Regularly assessing a patient’s understanding of their prescribed antidepressants
e. Providing a 6-week parenting class to teenage parents through a local high school
B, D
Tertiary prevention reduces the residual effects of the disorder such as depression and mental retardation. There is no quaternary level of prevention. Primary prevention reduces occurrences of mental disorders such as screenings and parenting classes, and secondary prevention reduces the prevalence of disorders as evidenced by assessing knowledge.
Which assessment findings describe risk factors that increase the potential risk for mental illness? Select all that apply.
a. Possesses high tolerance for stress
b. Is very curious about ‘how things work’
c. Admits to being a member of an ethnic gang
d. Only practicing Jew among school classmates
e. Has a younger sibling who is mentally challenged
C, D, E
Risk factors are internal predisposing characteristics and external influences that increase a person’s vulnerability and potential for developing mental disorders. Types of risk factors and examples include the following: having a mentally-challenged family member in the home; belonging to a punitive gang; and being the object of reject or bullying. The remaining options are protective factors.
Which activity shows that a therapeutic alliance has been established between the nurse and patient?
a. The nurse respects the patient’s right to privacy when visitors are spending time with the patient.
b. The patient is eagerly attending all group sessions and working independently on identifying their personal stressors.
c. The patient is freely describing their feelings related to the physical and emotional trauma they experienced as a child with the nurse.
d. The nurse dutifully administers the patient’s medications on time and with appropriate knowledge of the potential side effects.
C
A primary aspect of working with patients in any setting and particularly in the psychiatric setting is the development of a therapeutic alliance with the patient. Such an alliance is established on trust. It is a professional bond between the nurse and the patient that serves as a vehicle for patients to freely discuss their needs and problems in the absence of the nurse’s criticism or judgment. Any nurse has an obligation to respect the patient’s rights and administer care effectively. The patient’s willingness to participate in the plan of care reflects self motivation.
The nurse demonstrates objective patient care when:
a. Being sympathetic to the patient’s recent loss of a spouse
b. Protecting the anxious patient by eliminating stressors in the milieu
c. Responding to the patient by stating, “I know exactly how you feel.”
d. Facilitating the patient’s exploration of various stress reduction techniques
D
The nurse demonstrates objectivity by helping the patient to process and organize thoughts that are directed toward the solving of his or her own problems. With sympathy, the nurse loses objectivity and moves into his or her own personal feelings. Removing all stress does not allow the patient to develop necessary coping skills.
Which nursing intervention would be appropriately addressed during the orientation phase of the nurse–patient relationship?
a. Self reflection by the nurse regarding personal biases and prejudices regarding the patient
b. Patient works at prioritizing personal needs and develops realistic expected outcomes
c. Establishing the contract between the nurse and the patient regarding mutual needs and expectations
d. Patient commits to the reinforcement of positive personal characteristics while working on problems and concerns
C
A contract or agreement is established during the orientation phase of the relationship. The contract defines limits and expectations of both the patient and the nurse. Self Reflection occurs during the pre-orientation phase while the remaining options are addressed during the working phase of the relationship.
The nurse is effectively facilitating the nurse-patient relationship when:
a. Sharing with an angry patient who is verbally abusive that, “Although I can accept that you are angry, I cannot and will not accept your verbal abuse.”
b. Focusing on the patient’s life experience without relating to the similarities of one’s own experiences
c. Objectively providing constructive criticism that is directed to helping the patient identify inappropriate behaviors
d. Refraining from abandoning the patient regardless of the frustration the interaction causes
A
Accepting the patient’s feelings is essential; however, it is not necessary to accept all of the patient’s behaviors. Assist the patient by setting limits on patient behaviors that are self-defeating or that threaten the patient or others in any way. Setting these limits allows for mutual respect in the therapeutic alliance. The remaining options enhance the patient’s clinical experience rather than the nurse-patient relationship.
Which action on the part of a novice mental health nurse will best minimize fear related to effectively working with the psychotic patient?
a. Be knowledgeable about psychotropic medications and their affect on psychosis.
b. Always arrange for staff support when working one-on-one with a psychotic patient.
c. Take advantage of opportunities to attend workshops devoted to the care of the psychotic patient.
d. Recognize that the psychotic patient is not in control of their behaviors due to their altered though processes.
C
Fear breeds avoidance, but knowledge and preparation diminish fear and bring confidence. Being prepared before entering the psychiatric setting includes having knowledge and understanding of mental disorders. The remaining options do not provide confidence but rather means of controlling or avoiding the psychotic patient.
The greatest negative outcome resulting from a nurse’s fear of a mentally ill patient is that the:
a. Nurse will reinforce negative stereotyping of the mentally ill.
b. Patient will experience increased bias against the nursing staff.
c. Public’s fearfulness of the mentally ill will continue to be exaggerated.
d. Therapeutic alliance between the nurse and patient will not develop effectively.
D
Unrealistic preconceived images, stereotyping, and biases have an effect on nurses that, when resulting in fear, will negatively impact the therapeutic effectiveness of the nurse and the care provided. The remaining options do not have the priority that providing quality patient care has.
Which response by the nurse manager to a novice mental health nurse is most effective when the nurse asks, “How do I justify not keeping a patient’s secret?”
a. “Never promise the patient that you will keep a secret for them.”
b. “Always stop the patient from telling you something as a secret.”
c. “Let the patient know that you will not keep a secret that could ultimately cause harm or affect their treatment.”
d. “Keep reminding yourself that you are not the patient’s friend but rather a professional mental health provider.”
C
Nurses and other healthcare professionals do not keep secrets or make promises to patients when the secret may interfere with the patient’s treatment or put them or others at risk for harm. The remaining options offer appropriate nursing actions but do not effectively answer the nurse’s question.
Which interactions are likely outcomes of a well-established therapeutic alliance? Select all that apply.
a. The nurse states, “I’m not here to judge but rather to help.”
b. The patient states, “I really think I can handle this problem now.”
c. The patient asks his abusive father to attend counseling with him.
d. The nurse sets boundaries for a patient who has few social skills.
e. The patient with anger issues voluntarily goes into the seclusion room.
A, B, C, E
The alliance serves as a vehicle that provides patients with an opportunity to freely discuss their needs and problems in the absence of judgment and criticism, to gain insight into their abilities, to practice new coping skills, and to heal emotional wounds. Setting boundaries is not an outcome of such an alliance.
Which nursing interventions are directly related to the principles on which a therapeutic alliance is based? Select all that apply.
a. Graciously declining to, “Come visit when I get discharged.”
b. Establishing the topic to be discussed at each group session
c. Explaining to the patient the purpose of terminating the alliance
d. Sharing how the nurse also has experienced the same problems
e. Providing subjective feedback to the patient’s efforts at therapy
A, B, C
The principles that focus on the development and maintenance of a healthy alliance include: the relationship is therapeutic rather than social; the focus remains on the patient’s needs and problems rather than on the nurse; the relationship is purposeful and goal directed; the relationship is objective rather than subjective in quality; and the relationship is time-limited rather than open-ended. The sharing of experiencing is not patient centered.
The nurse is attempting to minimize the group’s display of resistance during a therapy session. Which patients are at risk for displaying such behavior? Select all that apply
a. The patient who is cognitively impaired
b. The patient who is older and well educated
c. The patient who is aggressive and attention seeking
d. The patient who has attended similar therapy groups in the past
e. The patient who has been diagnosed with paranoid schizophrenia
A, D, E
A patient who redirects the focus away from himself or herself by changing the subject is engaging in resistance behavior. Patients divert the topic for one or more of several reasons: a fear of being judged; avoiding the repetition of material that has been previously discussed; or the inability to stay cognitively focused. The attention-seeking patient may attempt to monopolize the discussion but not necessarily be at risk for resisting the topic. Age and education are not risk factors.
Which nursing action is a reflection of Hildegard Peplau’s theoretic framework regarding psychiatric mental health nursing?
a. Basing patient outcomes on expected instinctual responses
b. Discussing a patient’s feelings regarding parents and siblings
c. Providing the patient with clean clothes and wholesome food
d. Centering professional practice in a state run psychiatric facility
B
Peplau’s pioneering endeavors and contributions were largely influenced by interpersonal psychotherapy. She believed that disorders evolved in the social context of interpersonal interactions. (i.e., what went on between people). Instinctual responses are more related to intrapersonal interactions. Florence Nightingale was instrumental in the holistic approach to nursing care, whereas Linda Richards’ practice was centered on institutional care of the mental ill.
The nurse is attempting to provide a safe environment for a patient at great risk for self-harm. Which intervention shows an understanding of evidence-based practice (EBP)?
a. Using physical restraints only after all other options have been proven ineffective
b. Referring to the facility’s policies manual for guidelines for applying physical restraints
c. Collecting data regarding the short-term effects of using physical restraints on an aggressive patient
d. Requiring constant monitoring of a patient whose inability to self-regulate anger has required the use of physical restraints
B
Health care systems are participating in the shift in nursing practice by encouraging research in their facilities and by implementing interventions that increase nurses’ knowledge about EBP. Nurses are participating to make evidence-based nursing practices available for their use, and they are helping to determine the outcomes that will benefit patients. The remaining options are examples of long-standing practice related to the use of physical restraints
When a patient asks the nurse, “How can jolting me with an electrical shock possibly do me any good?” the answer most reflective of current biologic theory would be:
a. “ECT must sound like a very frightening treatment alternative to you.”
b. “ECT produces a change in brain chemistry that results in improved mood.”
c. “ECT interrupts brain impulses that are causing hallucinations and delusions.”
d. “ECT provides you with external punishment so you can stop punishing yourself.”
B
Current theory regarding use of ECT is that the electrical stimulus causes electrochemical changes within the brain, resulting in increased availability of neurotransmitters at the synapses and improvement of mood. To suggest that the treatment is frightening does not answer the patient’s question. The treatment is not appropriate for hallucinations or delusions. The remaining option is not appropriate or founded in psychiatric therapy.
Which statement made by a patient just prior to being transported for a scheduled ECT treatment would result in cancellation of the treatment?
a. “I’ll be so glad when this treatment is over.”
b. “Will I remember having this treatment?”
c. “Did eating some crackers cause any problems?”
d. “I’m so tired of being depressed; I don’t think I can go on.”
C
Because the patient is to receive general anesthesia and has orders to remain without food or liquids (NPO), the nurse should notify the physician immediately. The introduction of food into the stomach could result in aspiration of stomach contents during treatment. An expression of hopelessness related to depression would be reason to continue with the treatment. The other options offer no contraindication to treatment.
Which statement by a patient who has given informed consent for ECT confirms that the patient understands the side effects of this treatment?
a. “I won’t remember the pain.”
b. “It will take several weeks before I feel good again.”
c. “My short-term memory loss will be only temporary.”
d. “I will be at increased risk for developing epilepsy later.”
C
Temporary impairment of recent memory is an expected side effect that occurs to some degree during the course of ECT. The other options suggest the patient’s understanding of treatment and side effects is flawed.
A novice nurse who will be assessing a patient after electroconvulsive therapy (ECT) asks her mentor, “What sort of memory impairment is present after several ECT treatments?” The best response for the mentor would be:
a. “It’s hard to say. Treatment affects everyone differently.”
b. “Usually the patient has severe difficulty remembering remote events.”
c. “Patients have mild difficulty remembering recent events, like what was eaten for breakfast.”
d. “Both recent and remote memory is affected, producing profound confused, cognitive states.”
C
Most patients experience transient recent memory impairment after electroconvulsive therapy (ECT). The cognitive deficit becomes more pronounced as the number of treatments increases. When the course of treatments is completed, cognitive deficit generally improves to the pretreatment level. The other options are incorrect.
About an hour after the patient has ECT, he complains of having a headache. The nurse should:
a. Notify the physician stat.
b. Administer an as needed (prn) dose of acetaminophen.
c. Take the patient through a progressive relaxation sequence.
d. Advise going to activities to expend energy and relieve tension.
B.
Post-ECT headache is common. Most physicians routinely write an as needed (prn) order for a headache remedy. Notifying the physician is unnecessary, because this is an expected side effect. Options c and d would not be as useful as medication in this instance.
For which patient is the nurse most likely to need to schedule a pre-ECT workup and teaching?
a. Patient A, who is newly diagnosed with dysthymic disorder
b. Patient B, who has melancholic depression that responded well to ECT 2 years ago
c. Patient C, who was unresponsive to a 6-week trial of SSRI antidepressant therapy
d. Patient D, who has depression associated with diagnosis of inoperable brain tumor
B
Indications for ECT include patients with major mood disorders; patients who have responded to ECT in the past; patients who are unresponsive to antidepressants or unable to tolerate their side effects; and patients who are acutely suicidal or in danger of fluid and electrolyte imbalance related to inability to eat due to depression, severe mania, or severe catatonia. Patients with dysthymia are not candidates for ECT. The patient has not run out of medication options when prescribed only an SSRI. Patients with space-occupying lesions of the brain are not candidates for ECT.
What milieu factor would need most attention from the nurse who is caring for a patient who has received six ECT treatments and has two more scheduled?
a. Safety
b. Trust attainment
c. Therapeutic activities
d. Boundary maintenance
A
To feel safe, patients need to know what is expected of them in their role as patients. The patient receiving ECT often has impaired recent memory and may become confused about the milieu and expectations. The nurse will need to reorient and reteach the patient with cognitive deficit. Options b, c, and d will require attention but not to the same extent as safety
A patient asks the nurse manager to help resolve a situation between her and another patient. Which action would best support the patient’s feelings of safety when experimenting with new ways of being?
a. Encouraging the patient to report the incident to the other patient’s physician
b. Intervening on the patient’s behalf and sorting out the incident with the other patient
c. Suggesting that the patient ignore the situation since the other patient was probably not aware of her behavior
d. Offering to be present and help the patient discusses her feelings about the incident with the other patient
D
Offering to be with the patient affords her a safe nonthreatening opportunity to assume responsibility for meeting her own needs assertively by encouraging skills that affect positive communication. Intervening removes the responsibility from the patient. Ignoring supports passive behavior. There is no need to bring in another person. The patient is capable of addressing the problem herself.
A nurse and patient are entering the termination phase in the group experience. An important nursing intervention will be to:
a. Encourage the group to describe goals for change.
b. Inquire whether the group needs more time to accomplish goals.
c. Assist the group to explore alternative coping strategies for problems.
d. Discuss feelings about leaving the group and the support found with the group.
D
Healthy termination is facilitated when the group and nurse express reactions to termination. The nurse serves as a role model by being open and genuine as the feelings about the losses incurred with ending are discussed. On a positive note, accomplishments and growth are acknowledged and the transfer of safety and trust to the group members is accomplished. Describing goals is accomplished in the orientation phase. Accomplishing goals is part of the working phase in a relationship that does not have a strict time limit. Exploring alternative coping strategies would be part of the working stage.
A novice mental health nurse shares that, “I’ll never get used to playing cards or other games with patients. It seems like a poor use of scarce nursing time.” The best response for the nurse’s mentor would be:
a. “Perhaps you’ll want to rethink your transfer to this unit if you’re really uncomfortable.”
b. “Your comments make a point about scarce resources. I’ll ask the treatment team to review our position on activities.”
c. “Activity co-leadership puts us in a position to help patients develop social skills and support them as they take small risks.”
d. “Managed care has cost us activities therapists. Activities are necessary to give patients something to do, so we have to fill in.”
C
Nurses who engage in co-leadership of therapeutic activities recognize that each activity contributes to outcome attainment. During activities, patients practice skills needed in life situations, process emotions, and give and receive validation and feedback. Suggesting a rethink is not supportive of the nurse. The remaining options do not acknowledge the value of activities therapy.
A patient is scheduled to attend an occupational therapy group to work on the identified goal of “recognizing and using more effective coping techniques.” What measure can the nurse use to continue to support the patient’s attainment of this goal after he returns to the unit?
a. Isolating him from more seriously ill patients
b. Praising him for positive behavioral changes
c. Avoiding setting limits that would increase his anxiety level
d. Permitting him to make mistakes prior to intervening on his behalf
B
Recognizing and pointing out positive changes provides encouragement to continue pursuing change. The remaining option would not achieve the nurse’s goal of supporting the patient’s use of effective coping techniques.
Which intervention best reflects the nursing role regarding effective implementation of behavioral therapy goals?
a. Administering the prescribed medications accurately
b. Interacting effectively with members of the health care team
c. Being aware of all the patient related therapeutic modalities
d. Evaluating patient behaviors to reward economic tokens appropriately
D
The primary role of the nurse who is involved in behavioral therapy is to assess and identify the patient’s problem behaviors in collaboration with the multidisciplinary team. A token economy is a system of behavior reinforcements in which patients earn tokens by performing predetermined desired behaviors. The remaining options are generalized responsibilities that are relevant to any therapy format.
To plan care for a patient with a psychiatric disorder, the nurse keeps in mind that the primary nursing role related to therapeutic activities is:
a. Assisting the patient in accomplishing the activity
b. Ensuring that the patient will comply with the rules of the activity
c. Ensuring that the patient can accomplish the activity in a timely manner
d. Providing a support system for the patient if they fail to complete the activity
A
The nurse’s role in therapeutic activities is that of a professional observer and participant who works with the therapist to enhance the patient’s capabilities and functioning within the parameters of the assigned activity. Assuring accomplishment, compliance, or providing failure support are not nursing roles
Which statement best defines the nurse’s initial role as the patient’s source of help in addressing interpersonal problems?
a. “I’ll work with your doctor to help you get better.”
b. “I’ll be working with you to help solve your marital troubles.”
c. “Your medications will help you feel better as soon as they take effect.”
d. “You will be expected to attend the group activities while you are here.”
B
This statement clearly specifies the nurse’s purpose as a helping professional, and establishes the relationship as therapeutic, rather than social. The nurse has independent functions and does not work exclusively with the doctor. Identifying only medication overlooks the contributions of staff and the therapeutic milieu. Giving information is appropriate, but this statement does not define the nurse’s role as resource
Which statement would the nurse use to describe the primary purpose of boundaries?
a. Boundaries define responsibilities and duties to one’s self in relation to others.
b. Boundaries determine objectives of the various working stage of the relationship.
c. Boundaries differentiate the assumed roles of both the nurse and of the patient.
d. Boundaries prevent undesired material from emerging during the interaction.
A
Boundaries are the social, physical, and emotional limits of the interaction. As such, they serve to define the responsibilities and duties of the nurse in relation to the patient. Objectives and roles are determined during the orientation stage. Emergence of undesired material may be a significant issue for the patient.
A patient tells the nurse, “I really like you. You’re the only true friend I have.” The patient’s remarks call for the nurse to revisit the issue of:
a. Trust
b. Safety
c. Boundaries
d. Countertransference
C
The patient’s remarks call for the nurse to remind the patient of the parameters of the nurse-patient relationship. The remark would also give the nurse the opening to go on to discuss the matter of friendship. The patient’s remarks do not suggest the need to deal with trust, safety, or countertransference.
Which assessment findings suggest to the nurse that this patient has characteristics seen in an individual who has reached self-actualization? Select all that apply.
a. Reports to have, “found peace and security in my religious faith”
b. Effectively “changed occupations” when a chronic vision problem worsened
c. Has consistently earned a six-figure salary as an architect for the last 10 years
d. Has been in a supportive, loving relationship with the same individual for 15 years
e. Provides free literacy tutoring help at the local homeless shelter 3 evenings a week
A, B, D, E
Characteristics of self actualization would include: spiritual well-being, open and flexible, relationally fulfilled, and generosity toward others. Salary doesn’t necessarily reflect self-actualization.
Which action will best facilitate the development of trust between a nurse and patient?
a. Responding positively to the patient’s demands
b. Following through with whatever was promised
c. Clarifying with the patient whenever there is doubt
d. Staying available to the patient for the entire shift
B
Being consistent in keeping one’s word implies that the nurse is trustworthy and does what is agreed upon. Being responsive to demands may not be therapeutic. Instead, the patient will need to learn new techniques for meeting needs. Clarification is important but is not the best method for promoting trust. Trust is better served by shorter contacts at agreed-upon intervals
