MH FINAL EXAM

Question 1

Which of the following may be influential in the predisposition of PTSD?
A. Un satisfactory parent-child relationship
B. Excess of NT serotonin
C. Distorted, negative cognitions

Answer 1

D. Severity of the stressor and availability of support systems

Question 2

Which of the following statement indicates an understanding of personality d/o by the RN?
A. Promote a sense of control by establishing a schedule
B.. Incourage a schizoid personality to increase socialization
C. Practice limit setting to help prevent client manipulation
D. Implement assertivenes training w/ antisocial personality d/o

Answer 2

C

Question 3

Which of the following is expected from a client who has avoidant personality d/o?

Answer 3

“I’m scared you’re going to leave me.”

Question 4

RN is caring for a client experiencing loss, blaming the doctor. Which of the following is an appropriate response?

Answer 4

You sound angry. Anger is a normal feeling associated w/ loss.

Question 5

John is Dx w/ PTSD. Which of the following therapy regimens would be most appropriate?
A. Paroxetine and gorup therapy
B. Dizepam and implosion therapy
C. Alprazolam and behavior therapy
D. Carbamazepine and cognitive therapy

Answer 5

A. Paroxetine and group therapy – want them to talk about it and work through it

Question 6

An order for Sertraline (Zoloft) for a client w/ adjustment d/o w/ depressed mood. This med is used for?

Answer 6

Increased E and elevated mood

Question 7

Which of the following is true regarding the dx of adjustment d/o?
A. LT psychotherapy to achieve relief
B. This is an inherited d/o
C. S/Sx will remit once client has accepted change in their life
D. Higher education will decrease the d/o

Answer 7

C,
RATIONALE: adjustment d/o patients will have difficulties adjusting to a change

Question 8

Which of the following is the priority RN dx for adjustment d/o w/ depressed mood after divorce?
A. Risk-prone health behavior r/t loss of dependency
B.
C. Ineffective communication r/t problems w/ dependency
D. Social isolation related to divorce

Answer 8

B. Complicated grieving related to breakup of marriage

Question 9

Which of the following demonstrates an undertanding of the use of ECT for bipolar disorder?
A. ECT is the recommenede initial tx for bipolar d/o
B. ECT is contraindicated for SI
C. ECT is effective for clients experiencing severe mania
D. ECT is prescribed to prevent relapse of bipolar d/o

Answer 9

C. ECT is effective for clients experiencing severe mania

Initial treatment = Lithium = “Gold standard”
– Will not use for Bipolar 2

Question 10

Priority RN action for client w/ bipolar d/o?
A.Set consistent limits for expected client behavior
B. Adminster prescribed meds as scheduled
C. Provide step-by-step instruction during hygiene

Answer 10

D. Monitor client for escalating behavior

Think: harming self

Question 11

Actions should the RN include in client’s plan of care of anorexia w/ binge and purge?
A. Allow client to select preferred meal times
B. Establish consequences of purging behavior
C. Provide client w/ high-fat diet at start of tx
D. Implement 1-to-1 observation during meal times

Answer 11

D. Implement 1-to-1 observation during meal times

– Eat for 30 minutes, monitor for 1hr after meals

Question 12

Following reponses should the RN make to a hospitalized bulimia client who has fears of gaining weight?

Answer 12

I understand your concerns, lets talk about your recent accomplishments
anorexic = underweight
bulimic = @ weight
binge = OVERweight

Question 13

Statement indicates depersonalization for a schizoaffective d/o?

Answer 13

“I am no one, and everyone is me.”

Question 14

Removes and reapplies makeup is a repetitive behavior is due to

Answer 14

Attempt to reduce anxiety

Question 15

Patient experiencing a panic attack. The RN should take which of the following actions?

Answer 15

Stay with the client and remain quiety

Question 16

Client w/ MDD and anxiety. What is the priority RN action?

Answer 16

1-to-1 observation

think: SAFETY, b/c more likely to do it w/ anxiety

Question 17

Voices saying, “kill your doctor.” Actions should RN take first?

Answer 17

1-to1 observation

Question 18

Example of aggressive communication?

Answer 18

You better listen to me

Question 19

Client is screaming at everyone. Which of the following is a therapeutic response?

Answer 19

Stop screaming and walk outside w/ me

Question 20

Client throws char across the room. RN priority action?
A. Encourage the client to express feelings outload.
B. Maintain eye contact w/ client
C. Move the client away form others
D. Tell the client the behavior is not acceptable.

Answer 20

C. Move the client away from others

Question 21

• Cognitive reframing and stress management: “I will change my negative talk..”
• Insight feel you need tx how will you get money for your needs? governor of state?
  hx of depression and ID of protective factors against suicide
• my 4th child
  crohns dis
  my family hx of suicide

licensed to practice medicine

Question 22

6 RN Processes

Answer 22

think: ADOPIE
Assessment
Diagnosis
Outcomes identification
Planning
Implementation
Evaluation

Question 23

Purpose of psychostimulants

Answer 23

Increasing norepinephrine, serotonin, dopamine release

Question 24

Purpose of benzodiazepines

Answer 24

Facilitate transmission of the inhibitory NT GABA

Question 25

Purpose of antipsychotic medications

Answer 25

Block dopamine receptors, some affect muscarinic cholinergic, histaminergic, α-adrenergic receptors

Question 26

Modalities relevant to treatment of TBI + PTSD

Answer 26

Psychosocial therapies — CBT, prolonged exposure therapy, group/family, eye-movement desensitization, reprocessing
Psychopharmacology — SSRIs = 1st line tx
Complementary therapies
Rehabilitation therapies

Question 27

Antianxiety Agent Interactions

Answer 27

INCREASES — EtOH, barbiturates, narcotics, antipsychotics, antidepressants, antihistamines, cimetidine, disulfiram, herbal depressants
DECREASES effects — cigarette smoking and caffeine consumption

Question 28

Which of the following medications would be an appropriate p r n medication for an individual with anxiety symptoms?
A. Buspirone
B. Alprazolam
C. Fluoxetine
D. Sertraline

Answer 28

B. Alprazolam — Benzodiazepine that works as a CNS depressant to produce quick-acting effects for relaxation

Question 29

Antidepressant MOA

Answer 29

For MDD and dysthymia d/o’s
Increase concentration of norepinephrine, serotonin, and/or dopamine in the body either by blocking their reuptake by the neurons (tricyclics, tetracyclics, S S R I’s, SNRI’s) or by inhibiting the release of monoamine oxidase inhibitors (M A O I’s).

Question 30

Antidepressant Drug Interactions w/ SSRI’s

Answer 30

Serotonin syndrome — Buspirone (BuSpar), TCA (esp. Clomipramine, Selegiline (Eldepryl), Saint John’s Wort
____________
HTN’ive crisis — MAOI’s
Increased risk for bleeding — Warfarin, NSAID’s
_____________
Increased sedation — EtOH, benzos
_____________
Lowered seizure threshold — Antiepileptics

Question 31

Therapeutic levels for Lithium maintenance

Answer 31

For acute mania — 1.0 to 1.5 mEq/L
For maintenance — 0.6 to 1.2 mEq/L
NOTE: considering adequate amount of Na and H2O

Question 32

Mental Status Assessment Criteria

Answer 32

General Description: Appearance, Motor Activity, Speech Patterns, General Attitude
__________
Emotions: Mood + Affect
_________
Thought Process: Form of thought, Content of thought,
Perceptual disturbances
Sensorium + Cognitive Ability
Impulse Control
Judgment — “What are your plans for the future?”
Insight — “Do you think you have a problem?”

Question 33

Which of the following psychosocial therapies has been shown to be helpful for clients with traumatic brain injury (TBI)?
a. Eye movement desensitization
b. Psychoanalysis
c. Reality therapy
d. Cognitive behavioral therapy

Answer 33

D, Cognitive behavioral therapy

Question 34

What are the 5 stages of deployment?

Answer 34

Predeployment
Deployment
Sustainment
Redeployment
Postdeployment

Question 35

Potential indicators for increased risk for maladaptive grief

Answer 35

■Additional financial problems posed by the loss
■Lack of coping skills or lack of experience in responding to loss
■Emotional or physical dependence on the lost person or item
■History of mental illness or substance abuse
■History of trauma, including abuse
■Multiple losses within a short time frame