MH Final Exam Flashcards
A nursing instructor is teaching about recovery as it applies to mental illness. Which student statement indicates that further teaching is needed?
A. “The goal of recovery is improved health and wellness.”
B. “The goal of recovery is expedient, comprehensive behavioral change.”
C. “The goal of recovery is the ability to live a self-directed life.”
D. “The goal of recovery is the ability to reach full potential.”
B. “The goal of recovery is expedient, comprehensive behavioral change.”
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery from mental health disorders and substance use disorders as a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Change in recovery is not an expedient process. It occurs incrementally over time.
Which situation presents an example of the basic concept of a recovery model?
A. The client’s family is encouraged to make decisions in order to facilitate discharge.
B. A social worker, discovering the client’s income, changes the client’s discharge placement.
C. A psychiatrist prescribes an antipsychotic drug on the basis of observed symptoms.
D. A client diagnosed with schizophrenia schedules follow-up appointments and group therapy.
D. A client diagnosed with schizophrenia schedules follow-up appointments and group therapy.
The basic concept of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care.
A nursing instructor is teaching about the guiding principles of the recovery model, as described by the SAMHSA. Which student statement indicates that further teaching is needed?
A. “Recovery occurs via many pathways.”
B. “Recovery emerges from strong religious affiliations.”
C. “Recovery is supported by peers and allies.”
D. “Recovery is culturally based and influenced.”
B. “Recovery emerges from strong religious affiliations.”
SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope; recovery is person-driven; recovery occurs via many pathways; recovery is holistic; recovery is supported by peers and allies; recovery is supported through relationship and social networks; recovery is culturally based and influenced; recovery is supported by addressing trauma; recovery involves individual, family, and community strengths and responsibility; and recovery is based on respect. Recovery emerges from hope, but affiliation with any particular religion would have little bearing on the recovery process.
A client diagnosed with alcohol abuse disorder is referred to a residential care facility after discharge. According to the SAMHSA, which dimension of recovery is supporting this client?
A. Health
B. Home
C. Purpose
D. Community
B. Home
SAMHSA describes the dimension of Home as a stable and safe place to live.
A client diagnosed with obsessive-compulsive disorder states, “I really think my future will improve because of my successful treatment choices. I’m going to make my life better.” Which guiding principle of recovery has assisted this client?
A. Recovery emerges from hope.
B. Recovery is person-driven.
C. Recovery occurs via many pathways.
D. Recovery is holistic.
A. Recovery emerges from hope.
A nurse maintains a client’s confidentiality, addresses the client appropriately, and does not discriminate on the basis of gender, age, race, or religion. Which guiding principle of recovery has this nurse employed?
A. Recovery is culturally based and influenced.
B. Recovery is based on respect.
C. Recovery involves individual, family, and community strengths and responsibility.
D. Recovery is person-driven.
B. Recovery is based on respect.
The SAMHSA lists the following as guiding principles for the recovery model: recovery emerges from hope; recovery is person-driven; recovery occurs via many pathways; recovery is holistic; recovery is supported by peers and allies; recovery is supported through relationship and social networks; recovery is culturally based and influenced; recovery is supported by addressing trauma; recovery involves individual, family, and community strengths and responsibility; and recovery is based on respect. This nurse accepts and appreciates clients who are affected by mental health and substance use problems. This nurse protects the rights of clients and does not discriminate against them.
A nurse on an inpatient unit helps a client understand the significance of treatments and provides the client with copies of all documents related to the plan of care. This nurse is employing which commitment in the “Tidal Model of Recovery?”
A. Know that Change Is Constant
B. Reveal Personal Wisdom
C. Be Transparent
D. Give the Gift of Time
C. Be Transparent
Barker & Buchanan-Barker developed a set of essential values termed The 10 Tidal Commitments, upon which the Tidal Model is based. They include Value the Voice, Respect the Language, Develop Genuine Curiosity, Become the Apprentice, Use the Available Toolkit, Craft the Step Beyond, Give the Gift of Time, Reveal Personal Wisdom, Know that Change Is Constant, and Be Transparent. This nurse is employing the Be Transparent commitment.
Which is the priority focus of recovery models?
A. Empowerment of the health-care team to bring their expertise to decision-making
B. Empowerment of the client to make decisions related to individual health care
C. Empowerment of the family system to provide supportive care
D. Empowerment of the physician to provide appropriate treatments
B. Empowerment of the client to make decisions related to individual health care
A client experiences an exacerbation of psychiatric symptoms to the point of threatening self-harm. Which action step of the Wellness Recovery Action Plan (WRAP) model should be employed, and what action reflects this step?
A. Step 3: Triggers that cause distress or discomfort are listed.
B. Step 4: Signs indicating relapse are identified and plans for responding are developed.
C. Step 5: A specific plan to help with symptoms is formulated.
D. Step 6: Following client-designed plan, caregivers now become decision-makers.
D. Step 6: Following client-designed plan, caregivers now become decision-makers.
A nursing instructor is teaching about components present in the recovery process, as described by Andresen and associates, which led to the development of the Psychological Recovery Model. Which student statement indicates that further teaching is needed?
A. “A client has a better chance of recovery if he or she truly believes that recovery can occur.”
B. “If a client is willing to give the responsibility of treatment to the health-care team, he or she is likely to recover.”
C. “A client who has a positive sense of self and a positive identity is likely to recover.”
D. “A client has a better chance of recovery if he or she has purpose and meaning in life.”
B. “If a client is willing to give the responsibility of treatment to the health-care team, he or she is likely to recover.”
A client states, “My illness is so devastating, I feel like my life is on hold.” The nurse recognizes that this client is in which stage of the Psychological Recovery Model as described by Andersen and associates?
A. Moratorium
B. Awareness
C. Preparation
D. Rebuilding
A. Moratorium
A client states, “I have come to the conclusion that this disease has not paralyzed me.” The nurse recognizes that this client is in which stage of the Psychological Recovery Model as described by Andersen and associates?
A. Moratorium
B. Awareness
C. Preparation
D. Rebuilding
B. Awareness
A psychiatrist who embraces the Psychological Recovery Model tells the nurse that a client is in the Growth stage. What should the nurse expect to find when assessing this client?
A. A client feeling confident about achieving goals in life.
B. A client who is aware of the need to set goals in life.
C. A client who has mobilized personal and external resources.
D. A client who begins to actively take control of his or her life.
A. A client feeling confident about achieving goals in life.
Which of the following has the SAMHSA described, as major dimensions of support for a life of recovery? Select all that apply.
A. Health B. Community C. Home D. Religious affiliation E. Purpose
A. Health
B. Community
C. Home
E. Purpose
A nurse uses the commitments of the Tidal Model of Recovery in psychiatric nursing practice. Which of the following nursing actions reflect the use of the Develop Genuine Curiosity commitment? Select all that apply.
A. The nurse expresses interest in the client’s story.
B. The nurse asks for clarification of certain points.
C. The nurse encourages the client to speak his own words in his own unique way.
D. The nurse assists the client to unfold the story at his or her own rate.
E. The nurse provides the clients with copies of all documents relevant to care.
A. The nurse expresses interest in the client’s story.
B. The nurse asks for clarification of certain points.
D. The nurse assists the client to unfold the story at his or her own rate.
Order the six steps of The Wellness Recovery Action Plan (WRAP) Model as described by Copeland et al.
A.\_\_\_\_\_\_\_\_ Daily Maintenance List B.\_\_\_\_\_\_\_\_ Things Are Breaking Down or Getting Worse C. \_\_\_\_\_\_\_\_Crisis Planning D.\_\_\_\_\_\_\_\_ Develop a Wellness Toolbox E.\_\_\_\_\_\_\_\_\_Early Warning Signs F. \_\_\_\_\_\_\_\_ Triggers
Step1: Develop a Wellness Toolbox Step2: Daily Maintenance List Step3: Triggers Step4: Early Warning Signs Step5: Things Are Breaking Down or Getting Worse Step6: Crisis Planning
________________________ from mental health disorders and substance use disorders is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
Recovery
A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this clients safety?
A. Assess for medication noncompliance
B. Note escalating behaviors and intervene immediately
C. Interpret attempts at communication
D. Assess triggers for bizarre, inappropriate behaviors
B. Note escalating behaviors and intervene immediately
A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be taught by the nurse?
A. The side effects of medications
B. Deep breathing techniques to decrease stress
C. How to make eye contact when communicating
D. How to be a leader
C. How to make eye contact when communicating
A 16-year-old client diagnosed with schizophrenia experiences command hallucinations to harm others. The clients parents ask a nurse, Where do the voices come from? Which is the appropriate nursing reply?
A. Your child has a chemical imbalance of the brain, which leads to altered thoughts.
B. Your childs hallucinations are caused by medication interactions.
C. Your child has too little serotonin in the brain, causing delusions and hallucinations.
D. Your childs abnormal hormonal changes have precipitated auditory hallucinations.
A. Your child has a chemical imbalance of the brain, which leads to altered thoughts.
Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia spectrum disorder, tells them that voices command him to harm others. Which is the appropriate nursing response?
A. Tell him to stop discussing the voices.
B. Ignore what he is saying, while attempting to discover the underlying cause.
C. Focus on the feelings generated by the hallucinations and present reality.
D. Present objective evidence that the voices are not real.
C. Focus on the feelings generated by the hallucinations and present reality.
A nurse is assessing a client diagnosed with schizophrenia spectrum disorder. The nurse asks the client, Do you receive special messages from certain sources, such as the television or radio? The nurse is assessing which potential symptom of this disorder?
A. Thought insertion
B. Paranoia
C. Magical thinking
D. Delusions of reference
D. Delusions of reference
A client diagnosed with schizophrenia spectrum disorder states, Cant you hear him? Its the devil. Hes telling me Im going to hell. Which is the most appropriate nursing response?
A. Did you take your medicine this morning?
B. You are not going to hell. You are a good person.
C. I’m sure the voices sound scary. I don’t hear any voices speaking.
(The voices must sound scary, but the devil is not talking to you. This is part of your illness)
D. The devil only talks to people who are receptive to his influence.
C. I’m sure the voices sound scary. I don’t hear any voices speaking.
(The voices must sound scary, but the devil is not talking to you. This is part of your illness)
A client diagnosed with schizophrenia spectrum disorder tells a nurse about voices commanding him to kill the president. Which is the priority nursing diagnosis for this client?
- Disturbed sensory perception
- Altered thought processes
- Risk for violence: directed toward others
- Risk for injury
- Risk for violence: directed toward others
Which nursing intervention would be most appropriate when caring for an acutely agitated paranoid client diagnosed with schizophrenia spectrum disorder?
- Provide neon lights and soft music.
- Maintain continual eye contact throughout the interview.
- Use therapeutic touch to increase trust and rapport.
- Provide personal space to respect the client’s boundaries.
- Provide personal space to respect the client’s boundaries.
Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder?
- Establishing personal contact with family members
- Being reliable, honest, and consistent during interactions
- Sharing limited personal information
- Sitting close to the client to establish rapport
- Being reliable, honest, and consistent during interactions
A paranoid client diagnosed with schizophrenia spectrum disorder states, “My psychiatrist is out to get me. I’m sad that the voice is telling me to stop him.” What symptom is the client exhibiting, and what is the nurse’s legal responsibility related to this symptom?
- Magical thinking; administer an antipsychotic medication.
- Persecutory delusions; orient the client to reality.
- Command hallucinations; warn the psychiatrist.
- Altered thought processes; call an emergency treatment team meeting.
- Command hallucinations; warn the psychiatrist.
A client is diagnosed with schizophrenia spectrum disorder. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine?
- Tactile hallucinations
- Tardive dyskinesia
- Restlessness and muscle rigidity
- Reports of hearing disturbing voices
- Restlessness and muscle rigidity
A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client’s positive and negative symptoms of schizophrenia?
- Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia.
- Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia.
- Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia.
- Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia.
- Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia.
A 60-year-old client diagnosed with schizophrenia spectrum disorder presents in an ED with uncontrollable tongue movements, stiff neck, and difficulty swallowing. Which medical diagnosis and treatment should a nurse anticipate when planning care for this client?
- Neuroleptic malignant syndrome treated by discontinuing antipsychotic medications
- Agranulocytosis treated by administration of clozapine (Clozaril)
- Extrapyramidal symptoms treated by administration of benztropine (Cogentin)
- Tardive dyskinesia treated by discontinuing antipsychotic medications
- Tardive dyskinesia treated by discontinuing antipsychotic medications
After taking chlorpromazine (Thorazine) for 1 month, a client presents to an ED with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5°C). Which medical diagnosis and treatment should a nurse anticipate when planning care for this client?
- Neuroleptic malignant syndrome treated by discontinuing Thorazine and administering dantrolene (Dantrium)
- Neuroleptic malignant syndrome treated by increasing Thorazine dosage and administering an antianxiety medication
- Dystonia treated by administering trihexyphenidyl (Artane)
- Dystonia treated by administering bromocriptine (Parlodel)
- Neuroleptic malignant syndrome treated by discontinuing Thorazine and administering dantrolene
A client diagnosed with schizophrenia spectrum disorder takes an antipsychotic agent daily. Which assessment finding should a nurse prioritize?
- Respirations of 22 beats/minute
- Weight gain of 8 pounds in 2 months
- Temperature of 104°F (40°C)
- Excessive salivation
- Temperature of 104°F (40°C)
An aging client diagnosed with schizophrenia spectrum disorder takes an antipsychotic and a beta-adrenergic blocking agent for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate?
- “Make sure you concentrate on taking slow, deep, cleansing breaths.”
- “Watch your diet and try to engage in some regular physical activity.”
- “Rise slowly when you change position from lying to sitting or sitting to standing.”
- “Wear sunscreen and try to avoid midday sun exposure.”
- “Rise slowly when you change position from lying to sitting or sitting to standing.”
A client diagnosed with schizophrenia spectrum disorder is prescribed clozapine (Clozaril). Which client symptoms, related to the side effects of this medication, should prompt a nurse to intervene immediately?
- Sore throat, fever, and malaise
- Akathisia and hypersalivation
- Akinesia and insomnia
- Dry mouth and urinary retention
- Sore throat, fever, and malaise
During an admission assessment, a nurse assesses that a client diagnosed with schizophrenia spectrum disorder has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Based on this assessment data, which antipsychotic medication would be contraindicated?
- Haloperidol (Haldol), because it is used only in older patients
- Clozapine (Clozaril), because it is incompatible with desipramine
- Risperidone (Risperdal), because it exacerbates symptoms of depression
- Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines
- Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines
A client has been assigned an admission diagnosis of brief psychotic disorder. Which assessment information would alert the nurse to question this diagnosis?
- The client has experienced impaired reality testing for a 24-hour period.
- The client has experienced auditory hallucinations for the past 3 hours.
- The client has experienced bizarre behavior for 1 day.
- The client has experienced confusion for 3 weeks.
- The client has experienced auditory hallucinations for the past 3 hours.
A nurse is assessing a client diagnosed with substance induced psychotic disorder (SIPD). What would differentiate this client’s symptoms from the symptoms of a client diagnosed with brief psychotic disorder (BPD)?
- Clients diagnosed with SIPD experience delusions, whereas clients diagnosed with BPD do not.
- Clients diagnosed with BPD experience hallucinations, whereas clients diagnosed with SIPD do not.
- Catatonic features may be associated with SIPD, whereas BPD has no catatonic features.
- Catatonic features may be associated with BPD, whereas SIPD has no catatonic features
- Catatonic features may be associated with SIPD, whereas BPD has no catatonic features.
A nurse prepares to assess a client using the Abnormal Involuntary Movement Scale (AIMS). Which side effect of antipsychotic medications led to the use of this assessment tool?
- Dystonia
- Tardive dyskinesia
- Akinesia
- Akathisia
- Tardive dyskinesia
Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia spectrum disorder? (Select all that apply.)
- Group therapy
- Medication management
- Deterrent therapy
- Supportive family therapy
- Social skills training
- Group therapy
- Medication management
- Deterrent therapy
- Social skills training
A nurse is administering risperidone (Risperdal) to a client diagnosed with schizophrenia spectrum disorder. Which of the following client symptoms would most likely decrease because of the therapeutic effect of this medication? (Select all that apply.)
- Somatic delusions
- Social isolation
- Gustatory hallucinations
- Flat affect
- Clang associations
1 Somatic delusions
3 Gustatory hallucinations
5 Clang associations
Laboratory results reveal decreased levels of prolactin in a client diagnosed with schizophrenia spectrum disorder. Which of the following client symptoms would a nurse expect to observe during assessment? (Select all that apply.)
- Apathy
- Social withdrawal
- Anhedonia
- Auditory hallucinations
- Delusions
- Apathy
- Social withdrawal
- Anhedonia
The diagnosis of catatonic disorder associated with another medical condition is made when the client’s medical history, physical examination, or laboratory findings provide evidence that symptoms are directly attributed to which of the following? (Select all that apply.)
- Hyperthyroidism
- Hypothyroidism
- Hyperadrenalism
- Hypoadrenalism
- Hyperaphia
- Hyperthyroidism
- Hypothyroidism
- Hyperadrenalism
- Hypoadrenalism
___________________________ disorder is manifested by schizophrenic behaviors, with a strong element of symptomatology associated with the mood disorders (depression or mania).
Schizoaffective
___________________________ are false sensory perceptions not associated with real external stimuli and may involve any of the five senses.
Hallucinations
A nursing instructor is teaching about trauma and stressor-related disorders. Which student statement indicates that further instruction is needed?
A. “The trauma that women experience is more likely to be sexual assault and child sexual abuse.”
B. “The trauma that men experience is more likely to be accidents, physical assaults, combat, or viewing death or injury.”
C. “After exposure to a traumatic event, only 10 percent of victims develop post-traumatic stress disorder (PTSD).”
D. “Research shows that PTSD is more common in men than in women.”
D. “Research shows that PTSD is more common in men than in women.”
Which factors differentiate the diagnosis of PTSD from the diagnosis of adjustment disorder (AD)?
A. PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to “normal” daily events.
B. AD results from exposure to an extreme traumatic event, whereas PTSD results from exposure to “normal” daily events.
C. Depressive symptoms occur in PTSD and not in AD.
D. Depressive symptoms occur in AD and not in PTSD.
A. PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to “normal” daily events.
Which client would a nurse recognize as being at highest risk for the development of an AD?
A. A young married woman
B. An elderly unmarried man
C. A young unmarried woman
D. A young unmarried man
C. A young unmarried woman
A nursing instructor is explaining the etiology of trauma-related disorders from a learning theory perspective. Which student statement indicates that learning has occurred?
A. “How clients perceive events and view the world affect their response to trauma.”
B. “The psychic numbing in PTSD is a result of negative reinforcement.”
C. “The individual becomes addicted to the trauma owing to an endogenous opioid response.”
D. “Believing that the world is meaningful and controllable can protect an individual from PTSD.”
B. “The psychic numbing in PTSD is a result of negative reinforcement.”
As the sole survivor of a roadside bombing, a veteran is experiencing extreme guilt. Which nursing diagnosis would address this client’s symptom?
A. Anxiety
B. Altered thought processes
C. Complicated grieving
D. Altered sensory perception
C. Complicated grieving
A client has been assigned a nursing diagnosis of complicated grieving related to the death of multiple family members in a motor vehicle accident. Which intervention should the nurse initially employ?
A. Encourage the journaling of feelings.
B. Assess for the stage of grief in which the client is fixed.
C. Provide community resources to address the client’s concerns.
D. Encourage attending a grief therapy group.
B. Assess for the stage of grief in which the client is fixed.
Which clinical presentation is associated with the most commonly diagnosed adjustment disorder (AD)?
A. Anxiety, feelings of hopelessness, and worry
B. Truancy, vandalism, and fighting
C. Nervousness, worry, and jitteriness
D. Depressed mood, tearfulness, and hopelessness
D. Depressed mood, tearfulness, and hopelessness
Both situational and intrapersonal factors most likely contribute to an individual’s stress response. Which factor would a nurse categorize as intrapersonal?
A. Occupational opportunities
B. Economic conditions
C. Degree of flexibility
D. Availability of social supports
C. Degree of flexibility
A client diagnosed with AD has been assigned the nursing diagnosis of anxiety R/T divorce. Which correctly written outcome addresses this client’s problem?
A. Rates anxiety as 4 out of 10 by discharge.
B. States anxiety level has decreased by day one.
C. Accomplishes activities of daily living independently.
D. Demonstrates ability for adequate social functioning by day three.
A. Rates anxiety as 4 out of 10 by discharge.
Eye movement desensitization and reprocessing (EMDR) has been empirically validated for which disorder?
A. Adjustment disorder
B. Generalized anxiety disorder
C. Panic disorder
D. Post-traumatic stress disorder
D. Post-traumatic stress disorder
After a teaching session about grief, a client says to the nurse, “I seem to be stuck in the anger stage of grieving over the loss of my son.” How would the nurse assess this statement, and in what phase of the nursing process would this occur?
A. Assessment phase; nursing actions have been successful in achieving the objectives of care.
B. Evaluation phase; nursing actions have been successful in achieving the objectives of care.
C. Implementation phase; nursing actions have been successful in achieving the objectives of care.
D. Diagnosis phase; nursing actions have been successful in achieving the objectives of care
B. Evaluation phase; nursing actions have been successful in achieving the objectives of care.
By which biological mechanism does EMDR achieve its therapeutic effect?
A. EMDR achieves its therapeutic effect, but the exact biological mechanism is unknown.
B. EMDR achieves its therapeutic effect by causing a decrease in imagery vividness.
C. EMDR achieves its therapeutic effect by causing an increase in memory access.
D. EMDR achieves its therapeutic effect by decreasing trauma associated anxiety.
A. EMDR achieves its therapeutic effect, but the exact biological mechanism is unknown.
A client receiving EMDR therapy says, “After only two sessions of my therapy, I am feeling great. Now I can stop and get on with my life.” Which of the following nursing responses is most appropriate?
A. “I am thrilled that you have responded so rapidly to EMDR.”
B. “To achieve lasting results, all eight phases of EMDR must be completed.”
C. “If I were you, I would complete the EMDR and comply with doctor’s orders.”
D. “How do you feel about continuing the therapy?”
B. “To achieve lasting results, all eight phases of EMDR must be completed.”
A nurse would recognize which treatment as most commonly used for AD and its appropriate rationale?
A. Psychotherapy; to examine the stressor and confront unresolved issues
B. Fluoxetine (Prozac); to stabilize mood and resolve symptoms
C. Eye movement desensitization therapy; to reprocess traumatic events
D. Lorazepam (Ativan); a first-line treatment to address symptoms of anxiety
A. Psychotherapy; to examine the stressor and confront unresolved issues
