Mental Health - Exam 4

Question 1

A client with which of the following personality disorders lacks empathy, has a sense of entitlement, violates the rights of others and impulsively acts out

a. histrionic personality disorder
b. antisocial personality disorder
c. borderline personality disorder
d. narcissistic personality disorder

Answer 1

b. antisocial personality disorder

Question 2

An appropriate short-term goal for an antisocial client with a nursing diagnosis of Ineffective coping related to use of manipulation would be

a. Client will acknowledge manipulative behavior when it is called to his or her attention.
b. Client will use manipulation only to get his or her needs met.
c. Client will accept staff explanation that a request will be met within an hour rather than immediately.
d. Staff will state fewer negative countertransferences about client.

Answer 2

a. Client will acknowledge manipulative behavior when it is called to his or her attention.

Question 3

The nurse is assigned to perform an assessment of a client diagnosed as having histrionic personality disorder. When the interview is documented, the nurse is most likely to describe the client as

a. superficially charming
b. intense and impulsive
c. guarded and suspicious
d. friendly and open

Answer 3

b. intense and impulsive

Question 4

M, a client with borderline personality disorder, tells Nurse J, “You used to care about me. I thought you were wonderful. Now I can see I was mistaken. You’re hateful.” This outburst can be assessed as use of

a. splitting
b. denial
c. reaction formation
d. separation-individuation strategies

Answer 4

a. splitting

Question 5

Which characteristic in an individual with a personality disorder makes it most necessary for staff to schedule frequent meetings?

a. the client’s flexibility and adaptability to stress
b. the client’s ability to achieve true intimacy
c. the client’s ability to evoke interpersonal conflicts
d. the need for staff to develop strategies to interpret to the client the reasons for his or her behavior

Answer 5

c. the client’s ability to evoke interpersonal conflicts

Question 6

When a client self harms it is best to

a. ignore the act
b. ask the client why they self harmed
c. treat the resulting injury with a “matter of fact” approach
d. Focus on the self harm during group and community meetings

Answer 6

c. treat the resulting injury with a “matter of fact” approach

Question 7

Which of the following is considered a maturational crisis?

a. Tornado
b. Sexual assault
c. Car accident
d. Mid life crisis

Answer 7

d. Mid life crisis

Question 8

A goal of crisis intervention is for the adult client to:

a. Stabilize and return to pre-crisis functioning.
b. Come to terms with childhood sexual abuse.
c. Remain having suicidal ideations.
d. All of the above.

Answer 8

a. Stabilize and return to pre-crisis functioning.

Question 9

A crisis is considered:

a. Chronic and long lasting.
b. Acute and time limited.
c. Labile and fluctuating.
d. Can be all of the above.

Answer 9

b. Acute and time limited.

Question 10

Three policemen brought E to the mental health unit. She had been directing traffic and shouting rhymes on a busy city street. Her husband reported that E had stopped taking her lithium 3 weeks ago and had not slept or eaten for 3 days. Which behaviors listed below will be of priority concern as the nurse begins a care plan for E?

a. bizarre, colorful, inappropriate dress
b. grandiose thinking, poor concentration
c. insulting, provocative behavior directed at staff
d. hyperactivity, ignoring eating and sleeping

Answer 10

d. hyperactivity, ignoring eating and sleeping

Question 11

E is a manic client who became hyperactive after discontinuing her lithium. E’s husband asks what evidence supports the possibility of genetic transmission of bipolar disorders. Which reply is factual?

a. “A higher proportion of clients with bipolar disorders are found among creative writers.”
b. “A higher rate of relatives with bipolar disorder is found among clients with bipolar disorder.”
c. “A higher rate of relatives of clients with bipolar disorder respond in an exaggerated way to daily stress.”
d. “More individuals with bipolar disorder come from higher socioeconomic and educational backgrounds.”

Answer 11

b. “A higher rate of relatives with bipolar disorder is found among clients with bipolar disorder.”

Question 12

When a manic client is admitted to a psychiatric unit, what initial nursing intervention should be planned?

a. allowing client to act out feelings since a safe environment can be provided
b. providing verbal instructions to client to try to remain calmer
c. being accessible to set limits on client behavior as necessary
d. restraining client to reduce hyperactivity and aggression

Answer 12

c. being accessible to set limits on client behavior as necessary

Question 13

Of the dinner menus given below, which one should be served to a hyperactive manic client?

a. broiled chicken pattie on a roll, ear of corn, apple
b. spaghetti and meatballs, salad, banana
c. beef and vegetable stew, roll, chocolate pudding
d. goulash, green beans, jello with whipped cream

Answer 13

a. broiled chicken pattie on a roll, ear of corn, apple

Question 14

During periods of non stop laughter, talkativeness, and banter, a client with manic behavior is noted to abruptly become irritable. Such changes in mood should be assessed as

a. dissociation
b. lability
c. undoing
d. flight of ideas

Answer 14

b. lability

Question 15

A client who lives at home and is on maintenance doses of lithium should be advised to maintain an adequate dietary intake of

a. protein
b. calcium
c. glucose
d. sodium

Answer 15

d. sodium

Question 16

J, age 4, spends much of his day in constant motion. His mother tries to get him interested in playing with his toys, but he is easily distracted and doesn’t seem to listen. He talks appropriately, but excessively. He gets out of bed in the morning before his mother. She reports that one morning he broke the screen on the TV. She enrolled him in preschool, but the teacher was unable to handle him. The suggestion was made that J be evaluated at the mental health clinic. The nurse establishes the nursing diagnosis Altered growth and development related to neurological changes, as evidenced by hyperactivity and distractibility. What goal is related to this nursing diagnosis? Within 6 weeks, with the aid of medication, J will

a. seek out the nurse to talk to him or her
b. express his anger in an acceptable manner
c. sit and play with a toy for 10 minutes
d. not destroy things in his environment

Answer 16

c. sit and play with a toy for 10 minutes

Question 17

When assessing a 2-year-old child with suspected autistic disorder, the nurse should be particularly alert for

a. failure to develop interpersonal skills
b. hyperactivity and attention deficits
c. high levels of anxiety when separated from the mother
d. a history of disobedience and destructive acts

Answer 17

a. failure to develop interpersonal skills

Question 18

When C, age 5, is disruptive, the nurse tells her, “C, you must take a time-out.” What is expected of C? She will

a. go to her room until called for the next meal
b. slowly count to 20 before returning to the milieu
c. sit quietly on the lap of one of the staff members
d. sit on the periphery of the activity until regaining self-control and reviewing the episode

Answer 18

d. sit on the periphery of the activity until regaining self-control and reviewing the episode

Question 19

Side effects of Ritalin include:

a. Sedation, delusions, tactile hallucinations
b. Sedation, lethargy and proteinuria
c. Anxiety, insomnia, decreased appetite
d. Dehydration, tremors and seizures

Answer 19

c. Anxiety, insomnia, decreased appetite

Question 20

Lithium: Early signs of toxicity

Answer 20

Blood level: 1.5 mEq/L

Signs:
N & V
Diarrhea
Thirst
Polyuria
Slurred speech
Muscle weakness

Question 21

Lithium: Advanced signs of toxicity

Answer 21

Blood level: 1.6 mEq/L

Signs:
Coarse hand tremor
Persistent gastrointestinal upset
Mental confusion
Muscle hyperirritability
Incoordination

Question 22

Lithium: Severe Toxicity > 2.5 mEq/L

Answer 22

Signs: 
Hospitalization
Confusion
Incontinence of urine or feces
Coma
Cardiac arrhythmias
Peripheral circulatory collapse
Abdominal pain
Proteinuria
Oliguria
Death

Question 23

Lithium Contraindications

Answer 23

Cardiovascular disease
Brain damage
Renal disease
Thyroid disease
Myasthenia Gravis
Pregnancy
Breastfeeding mothers
Children younger than 12 years

Question 24

Lithium carbonate

therapeutic blood level
maintenance blood level
toxic blood level

Answer 24

therapeutic blood level: 0.8 to 1.4 mEq/L
maintenance blood level: 0.4 to 1.3 mEq/L
toxic blood level: 1.5 to 2.0 mEq/L

Question 25

Bipolar Outcomes Identification

Acute, Continuation and Maintenance phase

Answer 25

Acute-prevention
Continuation-relapse prevention
Maintenance phase-

Question 26

Bipolar Acute phase

Answer 26

Acute-highest priority is always safety

• prevent injury
• medical stabilization
• maintaining safety
• self-care needs (shower, hydration, nutrition and making sure they get rest)

Question 27

Bipolar Continuation phase

Answer 27

Continuation

• relapse prevention
• maintain medication adherence
• psychoeducational teaching
• referrals
• patients often think they are stable so often will stop taking meds, or do not like being stable-they prefer the manic phase

Question 28

Bipolar Maintenance phase

Answer 28

Maintenance

• prevent relapse..with follow up care
• upon relapse symptoms coming back worse than initial episode

Question 29

Anticonvulsant drugs

Answer 29

Valproate (Depakote)-mood stabilization w/o complications
Carbamazepine (Tegretol)-mood stabilization
Lamotrigine (Lamictal)-for acute and maintenance phase
*Lamictal can cause a life threatening rash!!

Question 30

Antianxiety drugs

Answer 30

Clonazepam (Klonopin)
Lorazepam (Ativan)

Atypical Antipsychotics
Olanzapine (Zyprexa)
Risperidone (Risperdal)

Question 31

Bipolar continuation phase

Answer 31

This stage can last forever (focusing on relapse prevention)

Teach the patient about illness and medication maintenance

Question 32

ADHD

Answer 32

stimulants

Question 33

M, a client with borderline personality disorder, has come back from a pass having lacerated her wrists. The physician orders daily dressing changes for the lacerations. The nurse performing this care should

a. encourage M to express anger
b. provide care in a matter-of-fact manner
c. be sympathetic and concerned
d. offer to listen to M’s feelings about cutting

Answer 33

b. provide care in a matter-of-fact manner