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A new staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional interventions?
a. Conduct mental health assessments
b. Establish therapeutic relationships
c. Individualize nursing care plans
d. Prescribe psychotropic medication
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Terms in this set (636)
A new staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional interventions?
a. Conduct mental health assessments
b. Establish therapeutic relationships
c. Individualize nursing care plans
d. Prescribe psychotropic medication
d. Prescribe psychotropic medication
Two nursing students discuss their career plans after graduation. One student wants to enter psychiatric nursing. The other asks, "Why would you want to be a psychiatric nurse? The only thing they do is talk. You'll lose all your skills." Select the best response.
a. "Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of the patients' problems."
b. "Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations."
c. "I think I will be good in the mental health field. I did not like clinical rotations in school, so I do not want to continue them after I graduate."
d. "Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That appeals to me."
b. "Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations."
A new bill introduced in Congress would reduce funding for care of persons with mental illness. Groups of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled?
a. Advocacy
b. Attending
c. Recovery
d. Evidence-based practice
a. Advocacy
An informal group of patients discusses their perceptions of nursing care. Which comment best indicates a patient perceived the nurse was caring? "My nurse:
a. always asks me which type of juice I want to help me swallow my medication."
b. explained my treatment plan to me and asked for my ideas about how to make it better."
c. told me that if I take all the medicines the doctor prescribes, then I will get discharged soon."
d. spends time listening to me talk about my problems. That helps me feel like I'm not alone."
d. spends time listening to me talk about my problems. That helps me feel like I'm not alone."
Which finding best indicates that a patient has a mental illness? The patient:
a.responds to rules, routines, and customs of a group.
b. reports mood is consistently sad, discouraged, and hopeless.
c. performs tasks attempted within the limits set by own abilities.
d. is able to see the difference between the "as if" and the "for real."
b. reports mood is consistently sad, discouraged, and hopeless.
Which finding best indicates that the goal "Demonstrate mentally healthy behavior" was achieved? A patient:
a. sees self as approaching ideals and capable of meeting demands.
b. seeks others to assume responsibility for major areas of own life.
c. behaves without considering the consequences of personal actions.
d. aggressively meets own needs without considering the rights of others.
a. sees self as approaching ideals and capable of meeting demands.
A nurse encounters an unfamiliar psychiatric disorder on a new patient's admission form. To determine criteria used to establish this diagnosis, the nurse should consult which resource?
a. Diagnostic and Statistical Manual of Mental Disorders
b. A nursing diagnosis handbook
c. A psychiatric nursing textbook
d. A behavioral health reference manual
a. Diagnostic and Statistical Manual of Mental Disorders
Which documentation of diagnosis would a nurse expect in a psychiatric treatment setting?
a. I Acute renal failure
II 75
III Bipolar disorder I, mixed
IV Loss of disability benefits 2 months ago
V None
b. I Schizophrenia, paranoid type
II Death of spouse last year
III 60
IV None
V Diabetes, type 2
c. I Polysubstance dependence
II Narcissistic Personality Disorder
III 90
IV Hyperlipidemia
V Charges pending for assault
d. I Major Depression
II Avoidant Personality Disorder
III Hypertension
IV Home destroyed by hurricane last year
V 80
d. I Major Depression
II Avoidant Personality Disorder
III Hypertension
IV Home destroyed by hurricane last year
V 80
A nurse explains the multiaxial DSM-IV-TR to a psychiatric technician and includes information that it:
a. focuses on plans for treatment.
b. includes nursing and medical diagnoses.
c. classifies problems in multiple areas of functioning.
d. uses the framework of a specific biopsychosocial theory.
c. classifies problems in multiple areas of functioning.
A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information?
a. The ICD-10
b. Nursing Outcomes Classification
c. Diagnostic and Statistical Manual of Mental Disorders
d. The ANA Psychiatric-Mental Health Nursing Scope and Standards of Practice
c. Diagnostic and Statistical Manual of Mental Disorders
Which comment most clearly shows a speaker views mental illness with stigma? a. "Some mental illnesses are inherited." b. "Most people with mental illness are unmotivated." c. "Severe environmental stress sometimes causes mental illness." d. "Some mental illnesses are brain disorders resulting from changes in how impulses are transmitted."b. "Most people with mental illness are unmotivated."A newly admitted patient is uncommunicative about recent life events. The nurse suspects marital and economic problems, but the social worker's assessment is not yet available. Select the nurse's best action. a. Focus assessment questions on these two topics. b. Ask another patient who shares a room with this patient. c. Avoid seeking information on these topics at this time. d. Refer to axis IV of the DSM-IV-TR in the medical record.d. Refer to axis IV of the DSM-IV-TR in the medical record.The Diagnostic and Statistical Manual of Mental Disorders classifies: a. deviant behaviors. b. people with mental disorders. c. present disability or distress. d. mental disorders people have.d. mental disorders people have.A nurse participating in a community health fair is asked, "What is the most prevalent mental disorder in the United States?" Select the nurse's best response. a. Schizophrenia b. "Why do you ask?" c. Bipolar disorder d. Alzheimer's diseased. Alzheimer's diseaseIn the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill? One who: a. describes hearing God's voice speaking. b. is usually pessimistic but strives to meet personal goals. c. is wealthy and gives away $20 bills to needy individuals. d. always has an optimistic viewpoint about life and having own needs met.a. describes hearing God's voice speaking.A patient's relationships are intense and unstable. The patient initially idealizes the significant other and then devalues them, resulting in frequent feelings of emptiness. This patient will benefit from interventions to develop which aspect of mental health? a. Effectiveness in work b. Communication skills c. Productive activities d. Fulfilling relationshipsd. Fulfilling relationshipsWhich belief will best support a nurse's efforts to provide patient advocacy during a multidisciplinary patient 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 disorders reflect a person's cultural patterns.d. Assessment findings in mental disorders reflect a person's cultural patterns.A nurse is part of a multidisciplinary team working with groups of depressed patients. Half the patients receive supportive interventions and antidepressant medication. The other half receives only medication. The team measures outcomes for each group. Which type of study is evident? a. Prevalence b. Clinical epidemiology c. Descriptive epidemiology d. Experimental epidemiologyb. Clinical epidemiologyThe spouse of a patient with schizophrenia says, "I don't understand how nurturing or toilet training in childhood has anything to do with this incredibly disabling illness." Which response by the nurse will best help the spouse understand this disorder? a. "This illness is the result of genetic factors." b. "Psychological stress is at the root of most mental disorders." c. "It must be frustrating for you that your spouse is sick so much of the time." d. "New findings show that this condition more likely has biological rather than psychological origins."d. "New findings show that this condition more likely has biological rather than psychological origins."A 40-year-old who lives with parents and works at an unchallenging job says, "I'm as happy as anyone else, even though I don't socialize much outside of work. My work is routine, but when new things come up, my boss explains things a few times to make sure I catch on. At home, my parents make decisions for me, and I go along with their ideas." The nurse should identify interventions to improve this patient's: a. self-concept. b. overall happiness. c. appraisal of reality. d. control over behavior.a. self-concept.Select the best response for the nurse who receives a query from another mental health professional seeking to understand the difference between a DSM-IV-TR diagnosis and a nursing diagnosis. a. "There is no functional difference between the two. Both identify human disorders." b. "The DSM-IV-TR diagnosis disregards culture, whereas the nursing diagnosis takes culture into account." c. "The DSM-IV-TR diagnosis is associated with present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems." d. "The DSM-IV-TR diagnosis affects the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for phenomena a patient is experiencing."d. "The DSM-IV-TR diagnosis affects the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for phenomena a patient is experiencing."An experienced nurse says to a new graduate, "When you've practiced as long as I have, you'll instantly know how to take care of psychotic patients." Which information should the new graduate consider when analyzing this comment? You may select more than one answer. a. The experienced nurse may have lost sight of patients' 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 patients through trial and error. e. An intuitive sense of patients' needs guides effective psychiatric nurses.a. The experienced nurse may have lost sight of patients' 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.A patient asks the nurse, "I read an article online about psychosocial factors that influence depression. What are psychosocial factors?" Examples a nurse could cite to support the premise that a patient's depression may be influenced by psychosocial factors include: (Select all that apply) a. having a hostile and over involved family. b. having two first-degree relatives with bipolar disorder. c. feeling strong guilt over having an abortion when one's religion forbids it. d. experiencing the death of a parent a month before the onset of depression. e. experiencing symptom remission when treated with antidepressant medication.a. having a hostile and over involved family. c. feeling strong guilt over having an abortion when one's religion forbids it. d. experiencing the death of a parent a month before the onset of depression.A patient in the emergency department says, "The 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 aspect(s) of mental health should be of greatest 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-conceptb. Appraisal of reality c. Control over behavior e.Healthy self-conceptA 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."c. "I will make some changes in my behavior for the good of the family."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-10b. DSM-VWhich individual is demonstrating the highest level of resilience? One who a. is able to repress stressors. b. becomes depressed after the death of a spouse. c. lives in a shelter for 2 years after the home is destroyed by fire. d. takes a temporary job to maintain financial stability after loss of a permanent job.d. takes a temporary job to maintain financial stability after loss of a permanent job.Which disorder is an example of a culture-bound syndrome? a. Epilepsy b. Schizophrenia c. Running amok d. Major depressive disorderC. Running amokA 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. ParityC. IncidenceWhich 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 patient. c. Healthy development is vital to mental health. d. Recovery occurs on a continuum from illness to health.B. Care is centered on the patient.Select the best response for the nurse 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 patient is experiencing."d. "The DSM-V diagnosis guides medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for issues a patient is experiencing."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. Psychotherapyd. PsychotherapyWhich 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.a. Says, "I have some weaknesses, but I feel I'm important to my family and friends." d. Considers past experiences when deciding about the future. e. Experiences feelings of conflict related to changing jobs.The mental health status of a particular client can best be assessed by considering ...placement on a continuum from health to illnessWhich of the following best demonstrates party related to mental health care?A client's mental health coverage is equal to his medical/surgical coverageA nursing diagnosis for a client with a psychiatric disorder serves the purpose of....providing a framework for selecting appropriate interventionsAn individual is found to consistently wear only a bathrobe and neglect the cleanliness of his apartment. When neighbors ask him to stop his frequent outbursts of operatic arias, he acts outraged and tells them he must sing daily and will not promise to be quieter. This behavior supports that he is .....not demonstrating any definitive signs of mental illnessIn order to best differentiate whether an Asian client is demonstrating a mental illness when attempting suicide is to A. ask the client whether he views himself as being depressed. B. identify his culture's view regarding suicide. C. explain to him that suicide is often regarded as a desperate act. D. assess the client for other examples of depressive behaviors.B. identify his culture's view regarding suicideThe nurse planning care for a mentally ill client bases interventions on the concept that the client ....has areas of strength on which to buildA 14-year-old belongs to a neighborhood gang, engages in sexually promiscuous behavior, and has a history of school truancy but reports that her parents are just old- fashioned and don't understand her. The assessment data supports that the client A. is displaying deviant behavior. B. cannot accurately appraise reality. C. is seriously and persistently mentally ill. D. should be considered for group home placement.A. is displaying deviant behaviorA client tells the mental health nurse "I am terribly frightened! I hear whispering that someone is going to kill me." Which criterion of mental health can the nurse assess as lacking?Appraisal of realityWhich branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)? A. experimental B. descriptive C. clinical D. analyticC. ClinicalThese severe mental illnesses are recognized across cultures: A antisocial and borderline personality disorders. B schizophrenia and bipolar disorder. C bulimia and anorexia nervosa. D amok and social phobia.B. schizophrenia & bipolar disorderThe prevalence rate over a 12-month period for major depressive disorder is...greater than the prevalence rate for generalized anxietyWhich statement about diagnosis of a mental disorder is true?Culture may cause variations in symptoms for each clinical disorder.A nurse's identification badge includes the term, "Psychiatric Mental Health Nurse." A client with a history of paranoia asks, "What does that title mean?" The nurse responds best by answering: A. "Don't be afraid; it means I'm here to help, not hurt, you." B. "Psychiatric mental health nurses care for people with mental illnesses." C. "We have the specialized skills needed to care for those with mental illnesses." D. "The nurses who work in mental health facilities have that title."C. "We have the specialized skills needed to care for those mental illnesses."Current information suggests that the most disabling mental disorders are the result of: A) biological influences. B) psychological trauma. C) learned ways of behaving. D) faulty patterns of early nurturance.A. biological influencesWhich statement best describes the DSM-5?It is a medical psychiatric assessment system.The quantitative study of the distribution of mental disorders in human populations is calledepidemiologyA parent says, "My 2-year-old child refuses toilet training and shouts 'No!' when given directions. What do you think is wrong?" Select 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."b. "This is normal for your child's age. The child is striving for independence."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)d. Substance Abuse and Mental Health Services Administration (SAMHSA)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 doubtd. Autonomy versus shame and doubtA 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. Preconsciousa. IdThe 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. Preconsciousc. SuperegoA 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-esteemd. Self-esteemAn 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-absorptionc. Autonomy versus shame and doubtWhich statement by a patient 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."b. "I do not allow other people to truly get to know me."A patient is suspicious and frequently manipulates others. To which psychosexual stage do these traits relate? a. Oral b. Anal c. Phallic d. Genitala. OralA patient 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 patient's needs? a. Latency b. Phallic c. Anal d. Orald. OralA 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? a. Trust and mistrust b. Intimacy and isolation c. Industry and inferiority d. Generativity and self-absorptiond. Generativity and self-absorptionAn 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 behavior by our sibling."c. "This death was unfair but I hope we can plan a service that everyone feels is a celebration of life."A student nurse says, "I don't need to interact with my patients. 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 responding: a. "Interactions are required in order to help you develop therapeutic communication skills." b. "Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills." c. "Observing patient interactions will help you formulate priority nursing diagnoses and appropriate interventions." d. "It is important to pay attention to patients' behavioral changes, because these signify adjustments in personality."b. "Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills."A nurse consistently encourages patient to do his or her own activities of daily living. If the patient is unable to complete an activity, the nurse helps until the patient 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 Travelbeec. Dorothea OremA nurse uses Maslow's hierarchy of needs to plan care for a patient diagnosed with mental illness. Which problem will receive priority? The patient a. refuses to eat or bathe. b. reports feelings of alienation from family. c. is reluctant to participate in unit social activities. d. is unaware of medication action and side effects.a. refuses to eat or bathe.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.c. Give the child a small treat for speaking.The parent of a child diagnosed with schizophrenia tearfully asks the nurse, "What could I have done differently to prevent this illness?" Select 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."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."A nurse influenced by Peplau's interpersonal theory works with an anxious, withdrawn patient. Interventions should focus on a. rewarding desired behaviors. b. use of assertive communication. c. changing the patient's self-concept. d. administering medications to relieve anxiety.b. use of assertive communication.A patient participated in psychotherapy weekly for 5 months. The therapist used free association, dream analysis, and facilitated transference to help the patient understand conflicts and foster change. Select the term that applies to this method. a. Rational-emotive behavior therapy b. Psychodynamic psychotherapy c. Cognitive-behavioral therapy d. Operant conditioningb. Psychodynamic psychotherapyConsider this comment from a therapist: "The patient is homosexual but has kept this preference secret. Severe anxiety and depression occur when the patient 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 theorya. Theory of interpersonal relationshipsA psychotherapist works with an anxious, dependent patient. Which strategy is most consistent with psychoanalytic psychotherapy? a. Identifying the patient's strengths and assets b. Praising the patient for describing feelings of isolation c. Focusing on feelings developed by the patient toward the therapist d. Providing psychoeducation and emphasizing medication adherencec. Focusing on feelings developed by the patient toward the therapistA 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 psychotherapyd. Interpersonal psychotherapyWhich technique is most applicable to aversion therapy? a. Punishment b. Desensitization c. Role modeling d. Positive reinforcementa. PunishmentA patient 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 patient's comment? a. Superego b. Transference c. Reality testing d. Counter-transferenceb. TransferenceA 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 patient? a. Psychoanalysis b. Aversion therapy c. Systematic desensitization d. Short-term dynamic therapyc. Systematic desensitizationA patient repeatedly stated, "I'm stupid." Which statement by that patient would show progress resulting from cognitive-behavioral therapy? a. "Sometimes I do stupid things." b. "Things always go wrong for me." c. "I always fail when I try new things." d. "I'm disappointed in my lack of ability."a. "Sometimes I do stupid things."A patient says, "All my life I've been surrounded by stupidity. Everything I buy breaks because the entire American workforce is incompetent." This patient is experiencing a a. self-esteem deficit. b. cognitive distortion. c. deficit in motivation. d. deficit in love and belonging.b. cognitive distortion.A patient is fearful of riding on elevators. The therapist first rides an escalator with the patient. The therapist and patient 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. Biofeedbackb. Systematic desensitizationA patient 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. Personalizationb. OvergeneralizationWhich comment best indicates a patient 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."d. "My favorite leisure is walking on the beach, hearing soft sounds of rolling waves."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."c. "My friend has had bipolar disorder for years and many problems have resulted. It's not her fault."Which patient 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 nervosaa. An accountant with a loving family and successful career who was involved in a short extramarital affairA patient 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."a. "The therapist will be active and questioning." b. "You will be given some homework assignments." d. "The therapist will help you look at your ideas and beliefs about yourself."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."a. "I am proud of my children's successes in life." d. "My experiences in the war helped me appreciate the meaning of life."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."a. "I am content with a good book." 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."Which activities represent the art of nursing? (Select all that apply.) a. Administering medications on time to a group of patients b. Listening to a new widow grieve her husband's death c. Helping a patient obtain groceries from a food bank d. Teaching a patient about a new medication e. Holding the hand of a frightened patientb. Listening to a new widow grieve her husband's death c. Helping a patient obtain groceries from a food bank e. Holding the hand of a frightened patientWhich 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)d. Electroconvulsive therapy (ECT) e. Transcranial magnetic stimulation (TMS)An important difference between the developmental theories of Freud and Erikson is ...Erikson viewed individual growth in terms of social setting.Maslow's theory of humanistic psychology has provided nursing with a framework for...holistic assessmentThe premise underlying behavioral therapy is a. Behavior is learned and can be modified. b. Behavior is a product of unconscious drives. c. Motives must change before behavior changes. d. Behavior is determined by cognitions; change in cognitions produces new behavior.A. Behavior is learned and can be modified.The nurse planning care for a 14-year-old needs to take into account that the developmental task of adolescence is to: a. establish trust. b. gain autonomy. c. achieve identity. d. develop a sense of industry.C. achieve identitySullivan viewed anxiety as: A) emotional experience felt after the age of 5 years. B) a sign of guilt in adults. C) any painful feeling or emotion arising from social insecurity. D) adults trying to go beyond experiences of guilt and pain.C. Any painful feeling or emotion arising from social insecurityWhich statement best clarifies the difference between the art and the science of nursing?The art is the care, compassion, and advocacy component, and the science is the applied knowledge base.Which client problem would be most suited to the use of interpersonal therapy? a. Disturbed sensory perception b. Impaired social interaction c. Medication noncompliance d. Dysfunctional grievingD. Dysfunctional grievingA cognitive therapist would help a client restructure the thought "I am stupid!" to..."What I did was stupid."The nurse providing anticipatory guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by a. giving the child what he is asking for. b. scolding the child when he displays tantrum behaviors. c. spanking the child at the onset of the tantrum behaviors. d. ignoring the tantrum and giving attention when the child acts appropriately.D. ignoring the tantrum and giving attention when the child acts appropriatelyFreud believed that individuals cope with anxiety by using ...defense mechanismsOne implication of Freud's theory of the unconscious on psychiatric mental health nursing is related to the consideration that conscious and unconscious influences can help nurses better understand a. the root causes of client suffering. b. the client's immature behavior. c. the client's interpersonal interactions. d. the client's psychological ability to reason.A. the root causes of client sufferingAccording to Freud, the nurse recognizes that a client experiencing dysfunction of the conscious as part of the mind will have problems with...all material that the person is aware of at any one timeWhen asked, the nurse explains that a client's id is a. the control over the emotional frustration he feels over the loss of his job. b. the source of his instincts to save himself from hurting himself. c. not in place since he was abused after the age of 5 months. d. able to differentiate his believed experiences and reality.B. the source of his instincts to save himself from hurting himselfAs a result of Harry Stack Sullivan's work, the mental health nurse is involved in providing clients with a. security operations. b. psychoanalysis. c. analysis of behavior patterns. d. a psychotherapeutic environment.D. a psychotherapeutic environmentThe nurse is working with a client experiencing both post-partum depression and very low self-esteem. The client is distrustful of unit staff and "just wants to go home." Initially, the nurse's priority is to...establish trust with the clientUsing Maslow's model of needs, the nurse providing care for an anxious client identifies the priority intervention to be a. assessing the client's success at fulfilling her appropriate developmental level tasks. b. assessing the client for her strengths upon which a nurse-client relationship can be based. c. planning one-on-one time with the client to assist in identifying the fears behind her anxiety. d. evaluating the client's ability to learn and retain essential information regarding her condition.B. assessing the client for her strengths upon which a nurse-client relationship can be basedA suspicious client who smokes several packs of cigarettes daily and drinks large quantities of coffee and soda as he is able to afford reacts to every nursing intervention with sarcasm. When asking for advice, the nurse manager's most helpful response is a. "You are dealing with a very difficult and resistant client; just keep with your plan." b. "If you haven't been able to establish client trust by now, ask for a change of assignment." c. "Remember that sarcasm represents the oral-stage fixation of development." d. "You are attempting to work with a client who likes to keep others off-balance."C. "Remember that sarcasm represents the oral-stage fixation of development"A client with a history of three failed engagements is concerned about being "too possessive." This concern supports a need for which type of therapy?InterpersonalAn 86-year-old, previously healthy and independent, falls after an episode of vertigo. Which behavior by this patient best demonstrates resilience? The patient: a. says, "I knew this would happen eventually." b. stops attending her weekly water aerobics class. c. refuses to use a walker and says, "I don't need that silly thing." d. says, "Maybe some physical therapy will help me with my balance."d. says, "Maybe some physical therapy will help me with my balance."Which organization actively seeks to reduce the stigma associated with mental illness through public presentations such as "In Our Own Voice" (IOOV)? a. American Psychiatric Association (APA) b. National Alliance on Mental Illness (NAMI) c. United States Department of Health and Human Services (USDHHS) d. North American Nursing Diagnosis Association International (NANDA-I)b. National Alliance on Mental Illness (NAMI)A patient is admitted to the psychiatric hospital. Which assessment finding best indicates that the patient has a mental illness? The patient: a. describes coping and relaxation strategies used when feeling anxious. b. describes mood as consistently sad, discouraged, and hopeless. c. can perform tasks attempted within the limits of own abilities. d. reports occasional problems with insomnia.b. describes mood as consistently sad, discouraged, and hopeless.The goal for a patient is to increase resiliency. Which outcome should a nurse add to the plan of care? Within 3 days, the patient will: a. describe feelings associated with loss and stress. b. meet own needs without considering the rights of others. c. identify healthy coping behaviors in response to stressful events. d. allow others to assume responsibility for major areas of own life.c. identify healthy coping behaviors in response to stressful events.A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a patient's insurance form. Which resource should the nurse consult to discern the criteria used to establish this diagnosis? a. A psychiatric nursing textbook b. NANDA International (NANDA-I ) c. A behavioral health reference manual d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)A nurse must assess several new patients at a community mental health center. Conclusions concerning current functioning should be made on the basis of: a. the degree of conformity of the individual to society's norms. b. the degree to which an individual is logical and rational. c. a continuum from mentally healthy to unhealthy. d. the rate of intellectual and emotional growth.c. a continuum from mentally healthy to unhealthy.A 40-year-old adult living with parents states, "I'm happy but I don't socialize much. My work is routine. When new things come up, my boss explains them a few times to make sure I understand. At home, my parents make decisions for me, and I go along with them." A nurse should identify interventions to improve this patient's: a. self-concept. b. overall happiness. c. appraisal of reality. d. control over behavior.a. self-concept.A patient tells a nurse, "I have psychiatric problems and am in and out of hospitals all the time. Not one of my friends or relatives has these problems." Select the nurse's best response. a. "Comparing yourself with others has no real advantages." b. "Why do you blame yourself for having a psychiatric illness?" c. "Mental illness affects 50% of the adult population in any given year." d. "It sounds like you are concerned that others don't experience the same challenges as you."d. "It sounds like you are concerned that others don't experience the same challenges as you."A critical care nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and a nursing diagnosis. Select the psychiatric nurse's best response. a. "No functional difference exists between the two diagnoses. Both serve to identify a human deviance." b. "The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis includes cultural variables." c. "The DSM-5 diagnosis profiles present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems." d. "The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience."d. "The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience."The spouse of a patient diagnosed with schizophrenia says, "I don't understand why childhood experiences have anything to do with this disabling illness." Select the nurse's response that will best help the spouse understand this condition. a. "Psychological stress is actually at the root of most mental disorders." b. "We now know that all mental illnesses are the result of genetic factors." c. "It must be frustrating for you that your spouse is sick so much of the time." d. "Although this disorder more likely has a biological rather than psychological origin, the support and involvement of caregivers is very important."d. "Although this disorder more likely has a biological rather than psychological origin, the support and involvement of caregivers is very important."Which belief by a nurse supports the highest degree of patient advocacy during a multidisciplinary patient 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 constant from culture to culture. d. Some symptoms of mental disorders may reflect a person's cultural patterns.d. Some symptoms of mental disorders may reflect a person's cultural patterns.A patient's history shows intense and unstable relationships with others. The patient initially idealizes an individual and then devalues the person when the patient's needs are not met. Which aspect of mental health is a problem? a. Effectiveness in work b. Communication skills c. Productive activities d. Fulfilling relationshipsd. Fulfilling relationshipsIn the majority culture of the United States, which individual is at greatest risk to be incorrectly labeled mentally ill? a. Person who is usually pessimistic but strives to meet personal goals b. Wealthy person who gives $20 bills to needy individuals in the community c. Person with an optimistic viewpoint about life and getting his or her own needs met d. Person who attends a charismatic church and describes hearing God's voiced. Person who attends a charismatic church and describes hearing God's voiceA participant at a community education conference asks, "What is the most prevalent type of mental disorder in the United States?" Select the nurse's best response. a. "Why do you ask?" b. "Schizophrenia" c. "Affective disorders" d. "Anxiety disorders"d. "Anxiety disorders"A nurse wants to find a description of diagnostic criteria for a person diagnosed with schizophrenia. Which resource should the nurse consult? a. U.S. Department of Health and Human Services b. Journal of the American Psychiatric Association c. North American Nursing Diagnosis Association International (NANDA-I) d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)A patient in the emergency department reports, "I hear voices saying someone is stalking me. They want to kill me because I found the cure for cancer. I will stab anyone that threatens me." Which aspects of mental health have the greatest immediate concern to a nurse? Select all that apply. a. Happiness b. Appraisal of reality c. Control over behavior d. Effectiveness in work e. Healthy self-conceptb. Appraisal of reality c. Control over behavior e. Healthy self-conceptWhich statements most clearly reflect the stigma of mental illness? Select all that apply. a. "Many mental illnesses are hereditary." b. "Mental illness can be evidence of a brain disorder." c. "People claim mental illness so they can get disability checks." d. "If people with mental illness went to church, they would be fine." e. "Mental illness is a result of the breakdown of the American family."c. "People claim mental illness so they can get disability checks." d. "If people with mental illness went to church, they would be fine." e. "Mental illness is a result of the breakdown of the American family."Planning for patients with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for patients who: a. present a clear danger to self or others. b. are noncompliant with medications at home. c. have no support systems in the community. d. develop new symptoms during the course of an illness.a. present a clear danger to self or others.A patient is hospitalized for a reaction to a psychotropic medication and then is closely monitored for 24 hours. During a predischarge visit, the case manager learns the patient received a notice of eviction on the day of admission. The most appropriate intervention for the case manager is to: a. cancel the patients discharge from the hospital. b. contact the landlord who evicted the patient to discuss the situation. c. arrange a temporary place for the patient to stay until new housing can be arranged. d. document that the adverse medication reaction was feigned because the patient had nowhere to live.c. arrange a temporary place for the patient to stay until new housing can be arranged.A multidisciplinary health care team meets 12 hours after an adolescent is hospitalized after a suicide attempt. Members of the team report their assessments. What outcome can be expected from this meeting? a. A treatment plan will be formulated. b. The health care provider will order neuroimaging studies. c. The team will request a court-appointed advocate for the patient. d. Assessment of the patients need for placement outside the home will be undertaken.a. A treatment plan will be formulated.The relapse of a patient diagnosed with schizophrenia is related to medication noncompliance. The patient is hospitalized for 5 days, medication is restarted, and the patients thoughts are now more organized. The patients family members are upset and say, Its too soon for discharge. Hospitalization is needed for at least a month. The nurse should: a. call the psychiatrist to come explain the discharge rationale. b. explain that health insurance will not pay for a longer stay for the patient. c. call security to handle the disturbance and escort the family off the unit. d. explain that the patient will continue to improve if medication is taken regularly.d. explain that the patient will continue to improve if medication is taken regularly.A nurse assesses an inpatient psychiatric unit, noting that exits are free from obstruction, no one is smoking, the janitors closet is locked, and all sharp objects are being used under staff supervision. These observations relate to: a. management of milieu safety. b. coordinating care of patients. c. management of the interpersonal climate. d. use of therapeutic intervention strategies.a. management of milieu safety.The following patients are seen in the emergency department. The psychiatric unit has one bed available. Which patient should the admitting officer recommend for admission to the hospital? The patient who: a. is experiencing dry mouth and tremor related to side effects of haloperidol (Haldol). b. is experiencing anxiety and a sad mood after a separation from a spouse of 10 years. c. self-inflicted a superficial cut on the forearm after a family argument. d. is a single parent and hears voices saying, Smother your infant.d. is a single parent and hears voices saying, Smother your infant.A student nurse prepares to administer oral medications to a patient diagnosed with major depressive disorder, but the patient refuses the medication. The student nurse should: a. tell the patient, Ill get an unsatisfactory grade if I dont give you the medication. b. tell the patient, Refusing your medication is not permitted. You are required to take it. c. discuss the patients concerns about the medication, and report to the staff nurse. d. document the patients refusal of the medication without further comment.c. discuss the patients concerns about the medication, and report to the staff nurse.A nurse surveys the medical records for violations of patients rights. Which finding signals a violation? a. No treatment plan is present in record. b. Patient belongings are searched at admission. c. Physical restraint is used to prevent harm to self. d. Patient is placed on one-to-one continuous observation.a. No treatment plan is present in record.Which principle takes priority for the psychiatric inpatient staff when addressing behavioral crises? a. Resolve behavioral crises using the least restrictive intervention possible. b. Rights of the majority of patients supersede the rights of individual patients. c. Swift intervention is justified to maintain the integrity of the therapeutic milieu. d. Allow patients opportunities to regain control without intervention if the safety of other patients is not compromised.a. Resolve behavioral crises using the least restrictive intervention possible.To provide comprehensive care to patients, which competency is more important for a nurse who works in a community mental health center than a psychiatric nurse who works in an inpatient unit? a. Problem-solving skills b. Calm and caring manner c. Ability to cross service systems d. Knowledge of psychopharmacologyc. Ability to cross service systemsA suspicious and socially isolated patient lives alone, eats one meal a day at a nearby shelter, and spends the remaining daily food allowance on cigarettes. Select the community psychiatric nurses best initial action. a. Report the situation to the manager of the shelter. b. Tell the patient, You must stop smoking to save money. c. Assess the patients weight; determine the foods and amounts eaten. d. Seek hospitalization for the patient while a new plan is being formulated.c. Assess the patients weight; determine the foods and amounts eaten.A patient diagnosed with schizophrenia has been stable in the community. Today, the spouse reports the patient is expressing delusional thoughts. The patient says, Im willing to take my medicine, but I forgot to get my prescription refilled. Which outcome should the nurse add to the plan of care? a. Nurse will obtain prescription refills every 90 days and deliver them to the patient. b. Patients spouse will mark dates for prescription refills on the family calendar. c. Patient will report to the hospital for medication follow-up every week. d. Patient will call the nurse weekly to discuss medication-related issues.b. Patients spouse will mark dates for prescription refills on the family calendar.A community mental health nurse has worked for 6 months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and stopped taking medications because of inadequate money. The patient says, Only a traitor would make me go to the hospital. Which solution is best? a. Arrange a bed in a local homeless shelter with nightly onsite supervision. b. Negotiate a way to provide medication so the patient can remain at home. c. Hospitalize the patient until the symptoms have stabilized. d. Seek inpatient hospitalization for up to 1 week.b. Negotiate a way to provide medication so the patient can remain at home.A community psychiatric nurse facilitates medication compliance for a patient by having the health care provider prescribe depot medications by injection every 3 weeks at the clinic. For this plan to be successful, which factor will be of critical importance? a. Attitude of significant others toward the patient b. Nutritional services in the patients neighborhood c. Level of trust between the patient and the nurse d. Availability of transportation to the clinicd. Availability of transportation to the clinicWhich assessment finding for a patient living in the community requires priority intervention by the nurse? The patient: a. receives Social Security disability income plus a small check from a trust fund. b. lives in an apartment with two patients who attend day hospital programs. c. has a sibling who is interested and active in care planning. d. purchases and uses marijuana on a frequent basis.d. purchases and uses marijuana on a frequent basis.A patient tells the nurse at the clinic, I havent been taking my antidepressant medication as directed. I leave out the midday dose. I have lunch with friends and dont want them to ask me about the pills. Select the nurses most appropriate intervention. a. Investigate the possibility of once-daily dosing of the antidepressant. b. Suggest to the patient to take the medication when no one is watching. c. Explain how taking each dose of medication on time relates to health maintenance. d. Add the following nursing diagnosis to the plan of care: Ineffective therapeutic regimen management, related to lack of knowledge.a. Investigate the possibility of once-daily dosing of the antidepressant.A community psychiatric nurse assesses that a patient diagnosed with a mood disorder is more depressed than on the previous visit a month ago; however, the patient says, I feel the same. Which intervention supports the nurses assessment while preserving the patients autonomy? a. Arrange for a short hospitalization. b. Schedule weekly clinic appointments. c. Refer the patient to the crisis intervention clinic. d. Call the family and ask them to observe the patient closely.b. Schedule weekly clinic appointments.A patient hurriedly tells the community mental health nurse, Everythings a disaster! I cant concentrate. My disability check didnt come. My roommate moved out, and I cant afford the rent. My therapist is moving away. I feel like Im coming apart. Which nursing diagnosis applies? a. Decisional conflict, related to challenges to personal values b. Spiritual distress, related to ethical implications of treatment regimen c. Anxiety, related to changes perceived as threatening to psychological equilibrium d. Impaired environmental interpretation syndrome, related to solving multiple problems affecting security needsc. Anxiety, related to changes perceived as threatening to psychological equilibriumWhich patient would a nurse refer to partial hospitalization? An individual who: a. spent yesterday in the 24-hour supervised crisis care center and continues to be actively suicidal. b. because of agoraphobia and panic episodes needs psychoeducation for relaxation therapy. c. has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up. d. states, Im not sure I can avoid using alcohol when my spouse goes to work every morning.d. states, Im not sure I can avoid using alcohol when my spouse goes to work every morning.Which employers health plan is required to include parity provisions related to mental illnesses? a. Employer with more than 50 employees b. Cancer thrift shop staffed by volunteers c. Daycare center that employs 7 teachers d. Church that employs 15 peoplea. Employer with more than 50 employeesA nurse can best address factors of critical importance to successful community treatment for persons with mental illness by including assessments related to which of the following? Select all that apply. a. Housing adequacy and stability b. Income adequacy and stability c. Family and other support systems d. Early psychosocial development e. Substance abuse history and current usea. Housing adequacy and stability b. Income adequacy and stability c. Family and other support systems e. Substance abuse history and current useA community member asks a nurse, People diagnosed with mental illnesses used to go to a state hospital. Why has that changed? Select the nurses accurate responses. Select all that apply. a. Science has made significant improvements in drugs for mental illness, so now many people may live in their communities. b. A better selection of less restrictive settings is now available in communities to care for individuals with mental illness. c. National rates of mental illness have declined significantly. The need for state institutions is actually no longer present. d. Most psychiatric institutions were closed because of serious violations of patients rights and unsafe conditions. e. Federal legislation and payment for treatment of mental illness have shifted the focus to community rather than institutional settings.a. Science has made significant improvements in drugs for mental illness, so now many people may live in their communities. b. A better selection of less restrictive settings is now available in communities to care for individuals with mental illness. e. Federal legislation and payment for treatment of mental illness have shifted the focus to community rather than institutional settings.A psychiatric nurse best implements the ethical principle of autonomy when he or she: a. intervenes when a self-mutilating patient attempts to harm self. b. stays with a patient who is demonstrating a high level of anxiety. c. suggests that two patients who are fighting be restricted to the unit. d. explores alternative solutions with a patient, who then makes a choice.d. explores alternative solutions with a patient, who then makes a choice.Which action by a psychiatric nurse best supports a patients right to be treated with dignity and respect? a. Consistently addressing a patient by title and surname. b. Strongly encouraging a patient to participate in the unit milieu. c. Discussing a patients condition with another health care provider in the elevator. d. Informing a treatment team that a patient is too drowsy to participate in care planning.a. Consistently addressing a patient by title and surname.Two hospitalized patients fight when they are in the same room. During a team meeting, a nurse asserts that safety is of paramount importance and therefore the treatment plans should call for both patients to be secluded to prevent them from injuring each other. This assertion: a. reveals that the nurse values the principle of justice. b. reinforces the autonomy of the two patients. c. violates the civil rights of the two patients. d. represents the intentional tort of battery.c. violates the civil rights of the two patients.In a team meeting a nurse says, Im concerned whether we are behaving ethically by using restraint to prevent one patient from self-mutilation while the care plan for another patient who has also self-mutilated calls for one-on-one supervision. Which ethical principle most clearly applies to this situation? a. Beneficence b. Autonomy c. Fidelity d. Justiced. JusticeWhich scenario is an example of a tort?a. The primary nurse does not complete the plan of care for a patient within 24 hours of the patients admission. b. An advanced practice nurse recommends that a patient who is dangerous to self and others be voluntarily hospitalized. c. A patients admission status is changed from involuntary to voluntary after the patients hallucinations subside. d. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent violence because a unit is short staffed.d. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent violence because a unit is short staffed.A nurses neighbor asks, Why arent people with mental illness kept in state institutions anymore? What is the nurses best response? a. Many people are still in psychiatric institutions. Inpatient care is needed because many people who are mentally ill are violent. b. Less restrictive settings are now available to care for individuals with mental illness. c. Our nation has fewer persons with mental illness; therefore fewer hospital beds are needed. d. Psychiatric institutions are no longer popular as a consequence of negative stories in the press.b. Less restrictive settings are now available to care for individuals with mental illness.Which nursing intervention demonstrates false imprisonment? a. A confused and combative patient says, Im getting out of here and no one can stop me. The nurse restrains this patient without a health care providers order and then promptly obtains an order. b. A patient has been irritating, seeking the attention of nurses most of the day. Now a nurse escorts the patient down the hall, saying, Stay in your room or youll be put in seclusion. c. An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. A nurse rushes after the patient and convinces the patient to return to the unit. d. An involuntarily hospitalized patient with suicidal ideation attempts to leave the unit. A nurse calls the security team and uses established protocols to prevent the patient from leaving.b. A patient has been irritating, seeking the attention of nurses most of the day. Now a nurse escorts the patient down the hall, saying, Stay in your room or youll be put in seclusion.A patient should be considered for involuntary commitment for psychiatric care when he or she: a. is noncompliant with the treatment regimen. b. sells and distributes illegal drugs. c. threatens to harm self and others. d. fraudulently files for bankruptcy.c. threatens to harm self and others.A nurse at the mental health center prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot) to a patient with schizophrenia. As the nurse swabs the site, the patient shouts, Stop! I dont want to take that medicine anymore. I hate the side effects. Select the nurses best initial action. a. Stop the medication administration procedure and say to the patient, Tell me more about the side effects youve been having. b. Say to the patient, Since Ive already drawn the medication in the syringe, Im required to give it, but lets talk to the doctor about skipping next months dose. c. Proceed with the injection but explain to the patient that other medications are available that may help reduce the unpleasant side effects. d. Notify other staff members to report to the room for a show of force and proceed with the injection, using restraint if necessary.a. Stop the medication administration procedure and say to the patient, Tell me more about the side effects youve been having.Several nurses are concerned that agency policies related to restraint and seclusion are inadequate. Which statement about the relationship of substandard institutional policies and individual nursing practice should guide nursing practice? a. The policies do not absolve an individual nurse of the responsibility to practice according to the professional standards of nursing care. b. Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care. c. In an institution with substandard policies, the nurse has a responsibility to inform the supervisor and leave the premises. d. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.a. The policies do not absolve an individual nurse of the responsibility to practice according to the professional standards of nursing care.A newly admitted patient who is acutely psychotic is a private patient of the senior psychiatrist. To whom does the psychiatric nurse who is assigned to this patient owe the duty of care? a. Health care provider b. Profession c. Hospital d. Patientd. PatientAn example of a breach of a patients right to privacy occurs when a nurse: a. asks a family to share information about a patients prehospitalization behavior. b. discusses the patients history with other staff members during care planning. c. documents the patients daily behaviors during hospitalization. d. releases information to the patients employer without consent.d. releases information to the patients employer without consent.An adolescent hospitalized after a violent physical outburst tells the nurse, Im going to kill my father, but you cant tell anyone. Select the nurses best response. a. Youre right. Federal law requires me to keep that information private. b. Those kinds of thoughts will make your hospitalization longer. c. You really should share this thought with your psychiatrist. d. I am required to share information with the treatment team.d. I am required to share information with the treatment team.A voluntarily hospitalized patient tells the nurse, Get me the forms for discharge against medical advice so I can leave now. What is the nurses best initial response? a. I cant give you those forms without your health care providers knowledge. b. I will get them for you, but lets talk about your decision to leave treatment. c. Since you signed your consent for treatment, you may leave if you desire. d. Ill get the forms for you right now and bring them to your room.b. I will get them for you, but lets talk about your decision to leave treatment.The family of a patient whose insurance will not pay for continuing hospitalization considers transferring the patient to a public psychiatric hospital. The family expresses concern that the patient will never get any treatment. Which reply by the nurse would be most helpful? a. Under the law, treatment must be provided. Hospitalization without treatment violates patients rights. b. Thats a justifiable concern because the right to treatment extends only to the provision of food, shelter, and safety. c. Much will depend on other patients, because the right to treatment for a psychotic patient takes precedence over the right to treatment of a patient who is stable. d. All patients in public hospitals have the right to choose both a primary therapist and a primary nurse.a. Under the law, treatment must be provided. Hospitalization without treatment violates patients rights.Which individual with a mental illness may need emergency or involuntary hospitalization for mental illness? The individual who: a. resumes using heroin while still taking methadone. b. reports hearing angels playing harps during thunderstorms. c. throws a heavy plate at a waiter at the direction of command hallucinations. d. does not show up for an outpatient appointment with the mental health nurse.c. throws a heavy plate at a waiter at the direction of command hallucinations.A patient being treated in an alcohol rehabilitation unit reveals to the nurse, I feel terrible guilt for sexually abusing my 6-year-old child before I was admitted. Based on state and federal law, the best action for the nurse to take is to: a. anonymously report the abuse by telephone to the local child abuse hotline. b. reply, Im glad you feel comfortable talking to me about it. c. respect the nurse-patient relationship of confidentiality. d. file a written report on the agency letterhead.a. anonymously report the abuse by telephone to the local child abuse hotline.The spouse of a patient who has delusions asks the nurse, Are there any circumstances under which the treatment team is justified in violating the patients right to confidentiality? The nurse must reply that confidentiality may be breached: a. under no circumstances. b. at the discretion of the psychiatrist. c. when questions are asked by law enforcement. d. if the patient threatens the life of another person.d. if the patient threatens the life of another person.A nurse cares for an older adult patient admitted for treatment of depression. The health care provider prescribes an antidepressant medication, but the dose is more than the usual adult dose. The nurse should: a. implement the order. b. consult a drug reference. c. give the usual geriatric dosage. d. hold the medication and consult the health care provider.d. hold the medication and consult the health care provider.A patient diagnosed with schizophrenia believes evil spirits are being summoned by a local minister and verbally threatens to bomb a local church. The psychiatrist notifies the minister. The psychiatrist has: a. released information without proper authorization. b. demonstrated the duty to warn and protect. c. violated the patients confidentiality. d. avoided charges of malpractice.b. demonstrated the duty to warn and protect.After leaving work, a staff nurse realizes that documentation of the administration of a medication to a patient was omitted. This off-duty nurse telephones the unit and tells the nurse, Please document the administration of the medication I forgot to do. My password is alpha1. The nurse should: a. fulfill the request. b. refer the matter to the charge nurse to resolve. c. access the record and document the information. d. report the request to the patients health care provider.b. refer the matter to the charge nurse to resolve.A patient diagnosed with mental illness asks a psychiatric technician, Whats the matter with me? The technician replies, Your wing nuts need tightening. The nurse who overheard the exchange should take action based on: a. violation of the patients right to be treated with dignity and respect. b. the nurses obligation to report caregiver negligence. c. preventing defamation of the patients character. d. supervisory liability.a. violation of the patients right to be treated with dignity and respect.Which documentation of a patients behavior best demonstrates a nurses observations? a. Isolates self from others. Frequently fell asleep during group. Vital signs stable. b. Calmer and more cooperative. Participated actively in group. No evidence of psychotic thinking. c. Appeared to hallucinate. Patient frequently increased volume on television, causing conflict with others d. Wears four layers of clothing. States, I need protection from dangerous bacteria trying to penetrate my skin.d. Wears four layers of clothing. States, I need protection from dangerous bacteria trying to penetrate my skin.A nurse volunteers for a committee that must revise the hospital policies and procedures for suicide precautions. Which resources would provide the best guidance? Select all that apply. a. Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5) b. States nurse practice act c. State and federal regulations that govern hospitals d. Summary of common practices of several local hospitals e. American Nurses Association Scope and Standards of Practice for PsychiatricMental Health Nursingc. State and federal regulations that govern hospitals e. American Nurses Association Scope and Standards of Practice for PsychiatricMental Health NursingIn which situations does a nurse have a duty to intervene and report? Select all that apply. a. A peer is unable to write behavioral outcomes. b. A health care provider consults the Physicians Desk Reference. c. A peer tries to provide patient care in an alcohol-impaired state. d. A team member has violated the boundaries of a vulnerable patient. e. A patient refuses a medication prescribed by a licensed health care provider.c. A peer tries to provide patient care in an alcohol-impaired state. d. A team member has violated the boundaries of a vulnerable patient.Which situations qualify as abandonment on the part of a nurse? (Select all that apply.) The nurse: a. allows a patient with acute mania to refuse hospitalization without taking further action. b. terminates employment without referring a seriously mentally ill for aftercare. c. calls police to bring a suicidal patient to the hospital after a suicide attempt. d. refers a patient with persistent paranoid schizophrenia to community treatment. e. asks another nurse to provide a patients care because of concerns about countertransference.a. allows a patient with acute mania to refuse hospitalization without taking further action. b. terminates employment without referring a seriously mentally ill for aftercare.A patient asks a nurse, What are neurotransmitters? My doctor says mine are out of balance. The best reply would be: a. You must feel relieved to know that your problem has a physical basis. b. Neurotransmitters are chemicals that pass messages between brain cells. c. It is a high-level concept to explain. You should ask the doctor to tell you more. d. Neurotransmitters are substances we eat daily that influence memory and mood.b. Neurotransmitters are chemicals that pass messages between brain cells.The parent of an adolescent diagnosed with schizophrenia asks a nurse, My childs doctor ordered a positron- emission tomography (PET) scan. What is that? Select the nurses best reply. a. PET uses a magnetic field and gamma waves to identify problems areas in the brain. Does your teenager have any metal implants? b. Its a special type of x-ray image that shows structures of the brain and whether a brain injury has ever occurred. c. PET is a scan that passes an electrical current through the brain and shows brain wave activity. PET can help diagnose seizures. d. PET is a special scan that shows blood flow and activity in the brain.d. PET is a special scan that shows blood flow and activity in the brain.A patient has dementia. The health care provider wants to make a differential diagnosis between Alzheimer disease and multiple infarctions. Which diagnostic procedure should a nurse expect to prepare the patient for first? a. Computed tomography (CT) scan b. Positron emission tomography (PET) scan c. Functional magnetic resonance imaging (fMRI) d. Single-photon emission computed tomography (SPECT) scana. Computed tomography (CT) scanA patient has delusions and hallucinations. Before beginning treatment with a psychotropic medication, the health care provider wants to rule out the presence of a brain tumor. For which test will a nurse need to prepare the patient? a. Cerebral arteriogram b. Functional magnetic resonance imaging (fMRI) c. Computed tomography (CT) scan or magnetic resonance imaging (MRI) d. Positron emission tomography (PET) or single-photon emission computed tomography (SPECT)c. Computed tomography (CT) scan or magnetic resonance imaging (MRI)The nurse wants to assess for disturbances in circadian rhythms in a patient admitted for major depressive disorder. Which question best implements this assessment? a. Do you ever see or hear things that others do not? b. Do you have problems with short-term memory? c. What are your worst and best times of day? d. How would you describe your thinking?c. What are your worst and best times of day?A nurse administers a medication that potentiates the action of gamma-aminobutyric acid (GABA). Which finding would be expected? a. Reduced anxiety b. Improved memory c. More organized thinking d. Fewer sensory perceptual alterationsa. Reduced anxietyOn the basis of current knowledge of neurotransmitter effects, a nurse anticipates that the treatment plan for a patient with memory difficulties may include medications designed to: a. inhibit GABA production. b. increase dopamine sensitivity. c. decrease dopamine at receptor sites. d. prevent destruction of acetylcholine.d. prevent destruction of acetylcholine.A patient has disorganized thinking associated with schizophrenia. Neuroimaging would most likely show dysfunction in which part of the brain? a. Brainstem b. Cerebellum c. Temporal lobe d. Prefrontal cortexd. Prefrontal cortexA nurse should assess a patient taking a medication with anticholinergic properties for inhibited function of the: a. parasympathetic nervous system. b. sympathetic nervous system. c. reticular activating system. d. medulla oblongata.a. parasympathetic nervous system.The therapeutic action of monoamine oxidase inhibitors (MAOIs) blocks neurotransmitter reuptake, causing: a. increased concentration of neurotransmitters in the synaptic gap. b. decreased concentration of neurotransmitters in serum. c. destruction of receptor sites. d. limbic system stimulation.a. increased concentration of neurotransmitters in the synaptic gap.A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. A nurse can correctly analyze that these symptoms are related to which drug action? a. Anticholinergic effects b. Dopamine-blocking effects c. Endocrine-stimulating effects d. Ability to stimulate spinal nervesb. Dopamine-blocking effectsA patient has anxiety, increased heart rate, and fear. The nurse would suspect the presence of a high concentration of which neurotransmitter? a. GABA b. Histamine c. Acetylcholine d. Norepinephrined. NorepinephrineA patient has symptoms of acute anxiety related to the death of a parent in an automobile accident 2 hours earlier. The nurse should anticipate administering a medication from which group? a. Tricyclic antidepressants b. Atypical antipsychotics c. Anticonvulsants d. Benzodiazepinesd. BenzodiazepinesA patient is hospitalized for major depressive disorder. Of the medications listed, a nurse can expect to provide the patient with teaching about: a. chlordiazepoxide (Librium). b. fluoxetine (Prozac). c. clozapine (Clozaril). d. tacrine (Cognex).b. fluoxetine (Prozac).A patient hospitalized with a mood disorder has aggression, agitation, talkativeness, and irritability. A nurse begins the care plan based on the expectation that the health care provider is most likely to prescribe a medication classified as a(n): a. anticholinergic. b. mood stabilizer. c. psychostimulant. d. tricyclic antidepressant.b. mood stabilizer.A drug causes muscarinic-receptor blockade. A nurse will assess the patient for: a. dry mouth. b. gynecomastia. c. pseudoparkinsonism. d. orthostatic hypotension.a. dry mouth.A patient begins therapy with a phenothiazine medication. What teaching should a nurse provide related to the drugs strong dopaminergic effect? a. Chew sugarless gum. b. Increase dietary fiber. c. Arise slowly from bed. d. Report muscle stiffness.d. Report muscle stiffness.A nurse can anticipate anticholinergic side effects are likely to occur when a patient is taking: a. lithium (Lithobid). b. buspirone (BuSpar). c. risperidone (Risperdal). d. fluphenazine (Prolixin).d. fluphenazine (Prolixin).Priority teaching for a patient taking clozapine (Clozaril) should include which instruction? a. Report sore throat and fever immediately. b. Avoid foods high in polyunsaturated fat. c. Use water-based lotions for rashes. d. Avoid unprotected sex.a. Report sore throat and fever immediately.A nurse cares for patients taking various medications, including buspirone (BuSpar), haloperidol (Haldol), trazodone (Desyrel), and phenelzine (Nardil). The nurse will order a special diet for the patient taking: a. buspirone. b. haloperidol. c. trazodone. d. phenelzine.d. phenelzine.A nurse caring for a patient taking a serotonin reuptake inhibitor (SSRI) will develop outcome criteria related to: a. mood improvement. b. logical thought processes. c. reduced levels of motor activity. d. decreased extrapyramidal symptoms.a. mood improvement.A patients spouse, who is a chemist, asks a nurse how serotonin reuptake inhibitors (SSRIs) lift depression. The nurse should explain that SSRIs: a. destroy increased amounts of neurotransmitters. b. make more serotonin available at the synaptic gap. c. increase production of acetylcholine and dopamine. d. block muscarinic and alpha1-norepinephrine receptors.b. make more serotonin available at the synaptic gap.A patient has taken many conventional antipsychotic drugs over years. The health care provider, who is concerned about early signs of tardive dyskinesia, prescribes risperidone (Risperdal). A nurse planning care for this patient understands that atypical antipsychotics: a. are less costly. b. have higher potency. c. are more readily available. d. produce fewer motor side effects.d. produce fewer motor side effects.The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3 and a granulocyte count of 1500 mm3. The nurse should: a. report the laboratory results to the health care provider. b. give the next dose as prescribed. c. administer aspirin and force fluids. d. repeat the laboratory tests.a. report the laboratory results to the health care provider.A nurse administering psychotropic medications should be prepared to intervene when giving a drug that blocks the attachment of norepinephrine to alpha1 receptors because the patient may experience: a. increased psychotic symptoms. b. severe appetite disturbance. c. orthostatic hypotension. d. hypertensive crisis.c. orthostatic hypotension.A nurse prepares to administer an antipsychotic medication to a patient diagnosed with schizophrenia. Additional monitoring of the medications effects and side effects will be most important if the patient is also diagnosed with which health problem? Select all that apply. a. Parkinson disease b. Graves disease c. Osteoarthritis d. Epilepsy e. Diabetesa. Parkinson disease d. Epilepsy e. DiabetesThe spouse of a patient diagnosed with schizophrenia asks, Which neurotransmitters are more active when a person has schizophrenia? The nurse should state, The current thinking is that the thought disturbances are related to increased activity of: (Select all that apply.) a. GABA. b. substance P. c. histamine. d. dopamine. e. norepinephrine.d. dopamine. e. norepinephrine.An individual is experiencing problems associated with memory. Which cerebral structures are most likely to be involved in this deficit? Select all that apply. a. Prefrontal cortex b. Occipital lobe c. Temporal lobe d. Parietal lobe e. Basal gangliaa. Prefrontal cortex c. Temporal lobe d. Parietal lobeA new staff nurse completes orientation to the psychiatric unit. This nurse will expect to ask an advanced practice nurse to perform which action for patients? a. Perform mental health assessment interviews. b. Establish therapeutic relationships. c. Prescribe psychotropic medications. d. Individualize nursing care plans.c. Prescribe psychotropic medications.A newly admitted patient with major depressive disorder has lost 20 pounds over the past month and has suicidal ideation. The patient has taken an antidepressant medication for 1 week without remission of symptoms. Select the priority nursing diagnosis. a. Imbalanced nutrition: Less than body requirements b. Chronic low self-esteem c. Risk for suicide d. Hopelessnessc. Risk for suicideA patient with major depressive disorder has lost 20 pounds in one month has chronic low self-esteem and a plan for suicide. The patient has taken an antidepressant medication for 1 week. Which nursing intervention is most directly related to this outcome: Patient will refrain from gestures and attempts to harm self? a. Implement suicide precautions. b. Frequently offer high-calorie snacks and fluids. c. Assist the patient to identify three personal strengths. d. Observe patient for therapeutic effects of antidepressant medication.a. Implement suicide precautions.A patients nursing diagnosis is Insomnia. The desired outcome is: Patient will sleep for a minimum of 5 hours nightly by October 31. On November 1, a review of the sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. Which evaluation should be documented? a. Consistently demonstrated b. Often demonstrated c. Sometimes demonstrated d. Never demonstratedd. Never demonstratedA patients nursing diagnosis is Insomnia. The desired outcome is: Patient will sleep for a minimum of 5 hours nightly by October 31. On November 1, a review of the sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. What is the nurses next action? a. Continue the current plan without changes. b. Remove this nursing diagnosis from the plan of care. c. Write a new nursing diagnosis that better reflects the problem. d. Revise the outcome target date and interventions.d. Revise the outcome target date and interventions.A patient begins a new program to assist with building social skills. In which part of the plan of care should a nurse record the item Encourage patient to attend one psychoeducational group daily? a. Assessment b. Analysis c. Planning d. Implementation e. Evaluationd. ImplementationBefore assessing a new patient, a nurse is told by another health care worker, I know that patient. No matter how hard we work, there isnt much improvement by the time of discharge. The nurses responsibility is to: a. document the other workers assessment of the patient. b. assess the patient based on data collected from all sources. c. validate the workers impression by contacting the patients significant other. d. discuss the workers impression with the patient during the assessment interview.b. assess the patient based on data collected from all sources.A nurse works with a patient to establish outcomes. The nurse believes that one outcome suggested by the patient is not in the patients best interest. What is the nurses best action? a. Remain silent. b. Educate the patient that the outcome is not realistic. c. Explore with the patient possible consequences of the outcome. d. Formulate a more appropriate outcome without the patients input.c. Explore with the patient possible consequences of the outcome.A patient states, Im not worth anything. I have negative thoughts about myself. I feel anxious and shaky all the time. Sometimes I feel so sad that I want to go to sleep and never wake up. Which nursing intervention should have the highest priority? a. Self-esteembuilding activities b. Anxiety self-control measures c. Sleep enhancement activities d. Suicide precautionsd. Suicide precautionsSelect the best outcome for a patient with this nursing diagnosis: Impaired social interaction, related to sociocultural dissonance as evidenced by stating, Although Id like to, I dont join in because I dont speak the language very well. The patient will: a. demonstrate improved social skills. b. express a desire to interact with others. c. become more independent in decision making. d. select and participate in one group activity per day.d. select and participate in one group activity per day.Nursing behaviors associated with the implementation phase of the nursing process are concerned with: a. participating in the mutual identification of patient outcomes. b. gathering accurate and sufficient patient-centered data. c. comparing patient responses and expected outcomes. d. carrying out interventions and coordinating care.d. carrying out interventions and coordinating care.Which statement made by a patient during an initial assessment interview should serve as the priority focus for the plan of care? a. I can always trust my family. b. It seems like I always have bad luck. c. You never know who will turn against you. d. I hear evil voices that tell me to do bad things.d. I hear evil voices that tell me to do bad things.Which entry in the medical record best meets the requirement for problem-oriented charting? a. A: Pacing and muttering to self. P: Sensory perceptual alteration, related to internal auditory stimulation. I: Given fluphenazine (Prolixin) 2.5 mg at 0900, and went to room to lie down. E: Calmer by 0930. Returned to lounge to watch TV. b. S: States, I feel like Im ready to blow up. O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol (Haldol) 2 mg. I: (Haldol) 2 mg at 0900. E: Returned to lounge at 0930 and quietly watched TV. c. Agitated behavior. D: Patient muttering to self as though answering an unseen person. A: Given haloperidol (Haldol) 2 mg and went to room to lie down. E: Patient calmer. Returned to lounge to watch TV. d. Pacing hall and muttering to self as though answering an unseen person. haloperidol (Haldol) 2 mg administered at 0900 with calming effect in 30 minutes. Stated, Im no longer bothered by the voices.b. S: States, I feel like Im ready to blow up. O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol (Haldol) 2 mg. I: (Haldol) 2 mg at 0900. E: Returned to lounge at 0930 and quietly watched TV.A nurse assesses an older adult patient brought to the emergency department by a family member. The patient was wandering outside, saying, I cant find my way home. The patient is confused and unable to answer questions. Select the nurses best action. a. Document the patients mental status. Obtain other assessment data from the family member. b. Record the patients answers to questions on the nursing assessment form. c. Ask an advanced practice nurse to perform the assessment interview. d. Call for a mental health advocate to maintain the patients rights.a. Document the patients mental status. Obtain other assessment data from the family member.A nurse asks a patient, If you had fever and vomiting for 3 days, what would you do? Which aspect of the mental status examination is the nurse assessing? a. Behavior b. Cognition c. Affect and mood d. Perceptual disturbancesb. CognitionAn adolescent asks a nurse conducting an assessment interview, Why should I tell you anything? Youll just tell my parents whatever you find out. Select the nurses best reply. a. That is not true. What you tell us is private and held in strict confidence. Your parents have no right to know. b. Yes, your parents may find out what you say, but it is important that they know about your problems. c. What you say about feelings is private, but some things, like suicidal thinking, must be reported to the treatment team. d. It sounds as though you are not really ready to work on your problems and make changes.c. What you say about feelings is private, but some things, like suicidal thinking, must be reported to the treatment team.A nurse assessing a new patient asks, What is meant by the saying, You cant judge a book by its cover? Which aspect of cognition is the nurse assessing? a. Mood b. Attention c. Orientation d. Abstractiond. AbstractionWhen a nurse assesses an older adult patient, the patients answers seem vague or unrelated to the questions. The patient also leans forward and frowns, listening intently to the nurse. An appropriate question for the nurse to ask would be: a. Are you having difficulty hearing when I speak? b. How can I make this assessment interview easier for you?c. I notice you are frowning. Are you feeling annoyed with me? d. Youre having trouble focusing on what Im saying. What is distracting you?a. Are you having difficulty hearing when I speak?At one point in an assessment interview a nurse asks, How does your faith help you in stressful situations? This question would be asked during the assessment of: a. childhood growth and development. b. substance use and abuse. c. educational background. d. coping strategies.d. coping strategies.When a new patient is hospitalized, a nurse takes the patient on a tour, explains the rules of the unit, and discusses the daily schedule. The nurse is engaged in: a. counseling. b. health teaching. c. milieu management. d. psychobiologic intervention.c. milieu management.After formulating the nursing diagnoses for a new patient, what is the next action a nurse should take? a. Design interventions to include in the plan of care. b. Determine the goals and outcome criteria. c. Implement the nursing plan of care. d. Complete the spiritual assessment.b. Determine the goals and outcome criteria.Select the most appropriate label to complete this nursing diagnosis: ___________, related to feelings of shyness and poorly developed social skills as evidenced by watching television alone at home every evening. a. Deficient knowledge b. Ineffective coping c. Powerlessness d. Social isolationd. Social isolationThe acronym QSEN refers to: a. Qualitative Standardized Excellence in Nursing. b. Quality and Safety Education for Nurses. c. Quantitative Effectiveness in Nursing. d. Quick Standards Essential for Nurses.b. Quality and Safety Education for Nurses.A nurse documents: Patient is mute, despite repeated efforts to elicit speech. Makes no eye contact. Is inattentive to staff. Gazes off to the side or looks upward rather than at the speaker. Which nursing diagnosis should be considered? a. Defensive coping b. Decisional conflict c. Risk for other-directed violence d. Impaired verbal communicationd. Impaired verbal communicationA nurse assesses a patient who reluctantly participates in activities, answers questions with minimal responses, and rarely makes eye contact. What information should be included when documenting the assessment? Select all that apply. a. Uncooperative patient b. Patients subjective responses c. Only data obtained from the patients verbal responses d. Description of the patients behavior during the interview e. Analysis of why the patient is unresponsive during the interviewb. Patients subjective responses d. Description of the patients behavior during the interviewA nurse performing an assessment interview for a patient with a substance abuse disorder decides to use a standardized rating scale. Which scales are appropriate? Select all that apply. a. Addiction Severity Index (ASI) b. Brief Drug Abuse Screen Test (B-DAST) c. Abnormal Involuntary Movement Scale (AIMS) d. Cognitive Capacity Screening Examination (CCSE) e. Recovery Attitude and Treatment Evaluator (RAATE)a. Addiction Severity Index (ASI) b. Brief Drug Abuse Screen Test (B-DAST) e. Recovery Attitude and Treatment Evaluator (RAATE)What information is conveyed by nursing diagnoses? Select all that apply. a. Medical judgments about the disorder b. Goals and outcomes for the plan of care c. Unmet patient needs currently present d. Supporting data that validate the diagnoses e. Probable causes that will be targets for nursing interventionsc. Unmet patient needs currently present d. Supporting data that validate the diagnoses e. Probable causes that will be targets for nursing interventionsA patient is very suspicious and states, The FBI has me under surveillance. Which strategies should a nurse use when gathering initial assessment data about this patient? Select all that apply. a. Tell the patient that medication will help this type of thinking. b. Ask the patient, Tell me about the problem as you see it. c. Seek information about when the problem began. d. Tell the patient, Your ideas are not realistic. e. Reassure the patient, You are safe here.b. Ask the patient, Tell me about the problem as you see it. c. Seek information about when the problem began. e. Reassure the patient, You are safe here.A patient says to the nurse, I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadnt rested well. Which comment would be appropriate if the nurse seeks clarification? a. It sounds as though you were uncomfortable with the content of your dream. b. I understand what youre saying. Bad dreams leave me feeling tired, too. c. So, all in all, you feel as though you had a rather poor nights sleep? d. Can you give me an example of what you mean by stoned?d. Can you give me an example of what you mean by stoned?A patient diagnosed with schizophrenia tells the nurse, The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say. Which response by the nurse would be most therapeutic? a. Lets talk about something other than the CIA. b. It sounds like youre concerned about your privacy. c. The CIA is prohibited from operating in health care facilities. d. You have lost touch with reality, which is a symptom of your illness.b. It sounds like youre concerned about your privacy.The patient says, My marriage is just great. My spouse and I usually agree on everything. The nurse observes the patients foot moving continuously as the patient twirls a shirt button. What conclusion can the nurse draw? The patients communication is: a. clear. b. mixed. c. precise. d. inadequate.b. mixed.A nurse interacts with a newly hospitalized patient. Select the nurses comment that applies the communication technique of offering self. a. Ive also had traumatic life experiences. Maybe it would help if I told you about them. b. Why do you think you had so much difficulty adjusting to this change in your life? c. I hope you will feel better after getting accustomed to how this unit operates. d. Id like to sit with you for a while to help you get comfortable talking to me.d. Id like to sit with you for a while to help you get comfortable talking to me.Which technique will best communicate to a patient that the nurse is interested in listening? a. Restate a feeling or thought the patient has expressed. b. Ask a direct question, such as, Did you feel angry? c. Make a judgment about the patients problem. d. Say, I understand what youre saying.a. Restate a feeling or thought the patient has expressed.A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate? a. What are the common elements here? b. Tell me again about your experiences. c. Am I correct in understanding that? d. Tell me everything from the beginning.c. Am I correct in understanding that?A patient tells the nurse, I dont think I will ever get out of here. Select the nurses most therapeutic response. a. Dont talk that way. Of course you will leave here! b. Keep up the good work and you certainly will. c. You dont think youre making progress? d. Everyone feels that way sometimes.c. You dont think youre making progress?Documentation in a patients chart shows, Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, I enjoy spending time with you. Which analysis is most accurate? a. Patient is giving positive feedback about the nurses communication techniques. b. Nurse is viewing the patients behavior through a cultural filter. c. Patients verbal and nonverbal messages are incongruent. d. Patient is demonstrating psychotic behaviors.c. Patients verbal and nonverbal messages are incongruent.While talking with a patient with severe depression, a nurse notices the patient is unable to maintain eye contact. The patients chin lowers to the chest while the patient looks at the floor. Which aspect of communication has the nurse assessed? a. Nonverbal communication b. A message filter c. A cultural barrier d. Social skillsa. Nonverbal communicationDuring the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patients hand. Select the correct analysis of the nurses behavior. a. It shows empathy and compassion. It will encourage the patient to continue to express feelings. b. The gesture is premature. The patients cultural and individual interpretation of touch is unknown. c. The patient will perceive the gesture as intrusive and overstepping boundaries. d. The action is inappropriate. Patients in a psychiatric setting should not be touched.b. The gesture is premature. The patients cultural and individual interpretation of touch is unknown.A Mexican-American patient puts a picture of the Virgin Mary on the bedside table. Under which section of the assessment should the nurse document this behavior? a. Culture b. Ethnicity c. Verbal communication d. Nonverbal communicationa. CultureAn African-American patient says to a Caucasian nurse, Theres no sense talking. You wouldnt understand because you live in a white world. The nurses best action would be to: a. explain, Yes, I do understand. Everyone goes through the same experiences. b. say, Please give an example of something you think I wouldnt understand. c. reassure the patient that nurses interact with people from all cultures. d. change the subject to one that is less emotionally disturbing.b. say, Please give an example of something you think I wouldnt understand.A Filipino-American patient had this nursing diagnosis: Situational low self-esteem, related to poor social skills as evidenced by lack of eye contact. Interventions were used to raise the patients self-esteem; however, after 3 weeks, the patients eye contact did not improve. What is the most accurate analysis of this scenario? a. The patients eye contact should have been directly addressed by role-playing to increase comfort with eye contact. b. The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient. c. The patients poor eye contact is indicative of anger and hostility that remain unaddressed. d. The nurse should have assessed the patients culture before making this diagnosis and plan.d. The nurse should have assessed the patients culture before making this diagnosis and plan.When a female Mexican-American patient and a female nurse sit together, the patient often holds the nurses hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behavior and thinks the patient is homosexual. Which alternative is a more accurate assessment? a. The patient is accustomed to touch during conversations, as are members of many Hispanic subcultures. b. The patient understands that touch makes the nurse uncomfortable and controls the relationship based on that factor. c. The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted. d. The nurse is homophobic.a. The patient is accustomed to touch during conversations, as are members of many Hispanic subcultures.A Puerto Rican American patient uses dramatic body language when describing emotional discomfort. Which analysis most likely explains the patients behavior? The patient: a. likely has a histrionic personality disorder. b. believes dramatic body language is sexually appealing. c. wishes to impress staff with the degree of emotional pain. d. belongs to a culture in which dramatic body language is the norm.d. belongs to a culture in which dramatic body language is the norm.During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. The nurse should respond by saying: a. Youve turned the tables on me. b. Nurses direct the interviews with patients. c. Do not ask questions about my personal life. d. The time we spend together is to discuss your concerns.d. The time we spend together is to discuss your concerns.Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions? a. Nurses are responsible for breaking silences. b. Patients withdraw if silences are prolonged. c. Silence can provide meaningful moments for reflection. d. Silence helps patients know that what they said is understood.c. Silence can provide meaningful moments for reflection.A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies? Giving advice: a. is rarely helpful. b. fosters independence. c. lifts the burden of personal decision making. d. helps the patient develop feelings of personal adequacy.a. is rarely helpful.The relationship between a nurse and patient as it relates to status and power is best described by which term? a. Symmetric b. Complementary c. Incongruent d. Paralinguisticb. ComplementaryA patient with severe depression states, God is punishing me for my past sins. What is the nurses best response? a. Why do you think that? b. You sound very upset about this. c. You believe God is punishing you for your sins? d. If you feel this way, you should talk to a member of your clergy.b. You sound very upset about this.A patient cries as the nurse explores the patients relationship with a deceased parent. The patient says, I shouldnt be crying like this. It happened a long time ago. Which responses by the nurse will facilitate communication? Select all that apply. a. Why do you think you are so upset? b. I can see that you feel sad about this situation. c. The loss of your parent is very painful for you. d. Crying is a way of expressing the hurt youre experiencing. e. Lets talk about something else because this subject is upsetting you.b. I can see that you feel sad about this situation. c. The loss of your parent is very painful for you. d. Crying is a way of expressing the hurt youre experiencing.Which benefits are most associated with the use of telehealth? Select all that apply. a. Cost savings for patients b. Maximization of care management c. Access to services for patients in rural areas d. Prompt reimbursement by third-party payers e. Rapid development of trusting relationships with patientsa. Cost savings for patients b. Maximization of care management c. Access to services for patients in rural areasA nurse assesses a confused older adult. The nurse experiences sadness and reflects, The patient is like one of my grandparents . . . so helpless. What feelings does the nurse describe? a. Transference b. Countertransference c. Catastrophic reaction d. Defensive coping reactionb. CountertransferenceWhich statement shows a nurse has empathy for a patient who made a suicide attempt? a. You must have been very upset when you tried to hurt yourself. b. It makes me sad to see you going through such a difficult experience. c. If you tell me what is troubling you, I can help you solve your problems. d. Suicide is a drastic solution to a problem that may not be such a serious matter.a. You must have been very upset when you tried to hurt yourself.After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference? a. The patients reactions toward the nurse seem realistic and appropriate. b. The patient states, Talking to you feels like talking to my parents. c. The nurse feels unusually happy when the patients mood begins to lift. d. The nurse develops a trusting relationship with the patient.c. The nurse feels unusually happy when the patients mood begins to lift.A patient says, Please dont share information about me with the other people. How should the nurse respond? a. I wont share information with others without your permission, but I will share information about you with other staff members. b. A therapeutic relationship is just between the nurse and the patient. Its up to you to tell others what you want them to know. c. It really depends on what you choose to tell me. I will be glad to disclose at the end of each session what I will report to others. d. I cannot tell anyone about you. It will be as though I am talking about my own problems, and we can help each other by keeping it between us.a. I wont share information with others without your permission, but I will share information about you with other staff members.A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent for most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, I really need to talk to you right now. The nurse should: a. say to the interrupting patient, I am not available to talk with you at the present time. b. end the unproductive session with the current patient and spend time with the patient who has just interrupted. c. invite the interrupting patient to join in the session with the current patient. d. tell the patient who interrupted, This session is 5 more minutes; then, I will talk with you.d. tell the patient who interrupted, This session is 5 more minutes; then, I will talk with you.Termination of a therapeutic nurse-patient relationship with a patient has been successful when the nurse: a. avoids upsetting the patient by shifting focus to other patients before the discharge. b. gives the patient a personal telephone number and permission to call after discharge. c. discusses with the patient changes that have happened during the relationship and evaluates the outcomes. d. offers to meet the patient for coffee and conversation three times a week after discharge.c. discusses with the patient changes that have happened during the relationship and evaluates the outcomes.What is the desirable outcome for the orientation stage of a nurse-patient relationship? The patient will demonstrate behaviors that indicate: a. great sense of independence. b. rapport and trust with the nurse. c. self-responsibility and autonomy. d. resolution of feelings of transference.b. rapport and trust with the nurse.During which phase of the nurse-patient relationship can the nurse anticipate that identified patient issues will be explored and resolved? a. Preorientation b. Orientation c. Working d. Terminationc. WorkingAt what point in the nurse-patient relationship should a nurse plan to first address termination? a. In the orientation phase b. During the working phase c. In the termination phase d. When the patient initially brings up the topica. In the orientation phaseA nurse should introduce the matter of a contract during the first session with a new patient because contracts: a. specify what the nurse will do for the patient. b. spell out the participation and responsibilities of each party. c. indicate the feeling tone established between the participants. d. are binding and prevent either party from prematurely ending the relationship.b. spell out the participation and responsibilities of each party.As a nurse escorts a patient being discharged after treatment for major depressive disorder, the patient gives the nurse a gold necklace with a heart pendant and says, Thank you for helping mend my broken heart. Which is the nurses best response? a. Accepting gifts violates the policies and procedures of the facility. b. Im glad you feel so much better now. Thank you for the beautiful necklace. c. Im glad I could help you, but I cant accept the gift. My reward is seeing you with a renewed sense of hope. d. Helping people is what nursing is all about. Its rewarding to me when patients recognize how hard we work.c. Im glad I could help you, but I cant accept the gift. My reward is seeing you with a renewed sense of hope.Which remark by a patient indicates passage from the orientation phase to the working phase of a nurse- patient relationship? a. I dont have any problems. b. It is so difficult for me to talk about my problems. c. I dont know how talking about things twice a week can help. d. I want to find a way to deal with my anger without becoming violent.d. I want to find a way to deal with my anger without becoming violent.A nurse explains to the family of a patient who is mentally ill how the nurse-patient relationship differs from social relationships. Which is the best explanation? a. The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient. b. The focus shifts from nurse to patient as the relationship develops. Advice is given by both, and solutions are implemented. c. The focus of the relationship is socialization. Mutual needs are met, and feelings are openly shared. d. The focus is the creation of a partnership in which each member is concerned with the growth and satisfaction of the other.a. The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient.A nurse wants to demonstrate genuineness with a patient diagnosed with schizophrenia. The nurse should: a. restate what the patient says. b. use congruent communication strategies. c. use self-disclosure in patient interactions. d. consistently interpret the patients behaviors.b. use congruent communication strategies.A nurse caring for a withdrawn, suspicious patient recognizes the development of feelings of anger toward the patient. The nurse should: a. suppress the angry feelings. b. express the anger openly and directly with the patient. c. tell the nurse manager to assign the patient to another nurse. d. discuss the anger with a clinician during a supervisory session.d. discuss the anger with a clinician during a supervisory session.A nurse wants to enhance the growth of a patient by showing positive regard. The action consistent with this wish is: a. making rounds daily. b. staying with a tearful patient. c. administering daily medication as prescribed. d. examining personal feelings about a patient.b. staying with a tearful patient.A patient says, Ive done a lot of cheating and manipulating in my relationships. Select a nonjudgmental response by the nurse. a. How do you feel about that? b. Its good that you realize this. c. Thats not a good way to behave. d. Have you outgrown that type of behavior?a. How do you feel about that?A patient says, People should be allowed to commit suicide without interference from others. A nurse replies, Youre wrong. Nothing is bad enough to justify death. What is the best analysis of this interchange? a. The patient is correct. b. The nurse is correct. c. Neither person is totally correct. d. Differing values are reflected in the two statements.d. Differing values are reflected in the two statements.Which issues should a nurse address during the first interview with a patient diagnosed with a psychiatric disorder? a. Trust, congruence, attitudes, and boundaries b. Goals, resistance, unconscious motivations, and diversion c. Relationship parameters, the contract, confidentiality, and termination d. Transference, countertransference, intimacy, and developing resourcesc. Relationship parameters, the contract, confidentiality, and terminationDuring the first interview, a nurse notices that the patient does not make eye contact. The nurse can correctly analyze that: a. the patient is not truthful. b. the patient is feeling sad. c. the patient has a poor self-concept. d. more information is needed to draw a conclusion.d. more information is needed to draw a conclusion.Which behavior shows that a nurse values autonomy? The nurse: a. sets limits on a patients romantic overtures toward the nurse. b. suggests one-on-one supervision for a patient who is suicidal. c. informs a patient that the spouse will not be in during visiting hours. d. discusses available alternatives and helps the patient weigh the consequences.d. discusses available alternatives and helps the patient weigh the consequences.As a nurse discharges a patient, the patient gives the nurse a card of appreciation made in an arts and crafts group. What is the nurses best action? a. Recognize the effectiveness of the relationship and patients thoughtfulness. Accept the card. b. Inform the patient that accepting gifts violates the policies of the facility. Decline the card. c. Acknowledge the patients transition through the termination phase but decline the card. d. Accept the card and invite the patient to return to participate in other arts and crafts groups.a. Recognize the effectiveness of the relationship and patients thoughtfulness. Accept the card.A patient says, Im still on restriction, but I want to attend some off-unit activities. Would you ask the doctor to change my privileges? What is the nurses best response? a. Why are you asking me when youre able to speak for yourself? b. I will be glad to address it when I see your doctor later today. c. Thats a good topic for you to take up with your doctor. d. Do you think you cant speak to a doctor?c. Thats a good topic for you to take up with your doctor.A community mental health nurse has worked with a patient for 3 years but is moving out of the city and terminates the relationship. A new nurse who begins work with this patient will: a. begin at the orientation phase. b. resume the working relationship. c. enter into a social relationship. d. return to the emotional catharsis phase.a. begin at the orientation phase.As a patient diagnosed with mental illness is being discharged from a facility, a nurse invites the patient to the annual staff picnic. What is the best analysis of this scenario? a. The invitation facilitates dependency on the nurse. b. The nurses action blurs the boundaries of the therapeutic relationship. c. The invitation is therapeutic for the patients diversional activity deficit. d. The nurses action assists the patients integration into community living.b. The nurses action blurs the boundaries of the therapeutic relationship.A nurse says, I am the only one who truly understands this patient. Other staff members are too critical. The nurses statement indicates: a. boundary blurring. b. sexual harassment. c. positive regard. d. advocacy.a. boundary blurring.Which descriptors exemplify consistency regarding therapeutic nurse-patient relationships? Select all that apply. a. Having the same nurse care for a patient on a daily basis b. Encouraging a patient to share initial impressions of staff c. Providing a schedule of daily activities to a patient d. Setting a time for regular sessions with a patient e. Offering solutions to a patients problemsa. Having the same nurse care for a patient on a daily basis c. Providing a schedule of daily activities to a patient d. Setting a time for regular sessions with a patientA nurse ends a relationship with a patient. Which actions by the nurse should be included in the termination phase? Select all that apply. a. Focus dialog with the patient on problems that may occur in the future. b. Help the patient express feelings about the relationship with the nurse. c. Help the patient prioritize and modify socially unacceptable behaviors. d. Reinforce expectations regarding the parameters of the relationship. e. Help the patient identify strengths, limitations, and problems.a. Focus dialog with the patient on problems that may occur in the future. b. Help the patient express feelings about the relationship with the nurse.A new psychiatric nurse has a parent diagnosed with bipolar disorder. This nurse angrily recalls embarrassing events concerning the parents behavior in the community. Select the best ways for this nurse to cope with these feelings. Select all that apply. a. Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses. b. Recognize that these feelings are unhealthy, and try to suppress them when working with patients. c. Recognize that psychiatric nursing is not an appropriate career choice, and explore other nursing specialties. d. Begin new patient relationships by saying, My own parent had mental illness, so I accept it without stigma. e. Recognize that the feelings may add sensitivity to the nurses practice, but supervision is important.a. Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses. e. Recognize that the feelings may add sensitivity to the nurses practice, but supervision is important.A new nurse tells a mentor, I want to convey to my patients that I am interested in them and that I want to listen to what they have to say. Which behaviors are helpful in meeting the nurses goal? Select all that apply. a. Sitting behind a desk, facing the patient. b. Introducing self to a patient and identifying own role. c. Using facial expressions that convey interest and encouragement. d. Assuming an open body posture and sometimes mirror imaging. e. Maintaining control of the topic under discussion by asking direct questions.b. Introducing self to a patient and identifying own role. c. Using facial expressions that convey interest and encouragement. d. Assuming an open body posture and sometimes mirror imaging.Which scenario best demonstrates an example of eustress? An individual: a. loses a beloved family pet. b. prepares to take a 1 week vacation to a tropical island with a group of close friends. c. receives a bank notice there were insufficient funds in their account for a recent rent payment. d. receives notification that their current employer is experiencing financial problems and some workers will be terminated.b. prepares to take a 1 week vacation to a tropical island with a group of close friends.A patient diagnosed with liver failure has been on the transplant waiting list 8 months. The patient says, Why is it taking so long to have the surgery? Maybe Im meant to die for all the bad things Ive done. The nurse should document the patients comment in which section of the assessment? a. Physical b. Spiritual c. Financial d. Psychologicalb. SpiritualA person with a fear of heights drives across a high bridge. Which structure will stimulate a response from the autonomic nervous system? a. Thalamus b. Parietal lobe c. Hypothalamus d. Pituitary glandc. HypothalamusA person with a fear of heights drives across a high bridge. Which division of the autonomic nervous system is stimulated in response to this experience? a. Limbic system b. Peripheral nervous system c. Sympathetic nervous system d. Parasympathetic nervous systemc. Sympathetic nervous systemA patient is brought to the emergency department after a motorcycle accident. The patient is alert, responsive, and diagnosed with a broken leg. The patients vital signs are temperature (T), 98.6 F; pulse (P), 72 beats per minute (bpm); and respirations (R), 16 breaths per minute. After being informed that surgery is required for the broken leg, which vital sign readings would be expected? a. T, 98.6; P, 64; R, 14 b. T, 98.6; P, 68; R, 12 c. T, 98.6; P, 62; R, 16 d. T, 98.6; P, 84; R, 22d. T, 98.6; P, 84; R, 22As part of the stress response, the HPA axis is stimulated. Which structures make up this system? a. Hippocampus, parietal lobe, and amygdala b. Hypothalamus, pituitary gland, and adrenal glands c. Hind brain, pyramidal nervous system, and anterior cerebrum d. Hepatic artery, parasympathetic nervous system, and acoustic nerveb. Hypothalamus, pituitary gland, and adrenal glandsCortisol is released in response to a patients prolonged stress. Which initial effect would the nurse expect to result from the increased cortisol level? a. Diuresis and electrolyte imbalance b. Focused and alert mental status c. Drowsiness and lethargy d. Restlessness and anxietyb. Focused and alert mental statusA soldier returns to the United States from active duty in a combat zone in Afghanistan. The soldier is diagnosed with post-traumatic stress disorder (PTSD). The nurses highest priority is to screen this soldier for which problem? a. Major depressive disorder b. Bipolar disorder c. Schizophrenia d. Dementiaa. Major depressive disorderA soldier returns to the United States from active duty in a combat zone in Afghanistan. The soldier is diagnosed with post-traumatic stress disorder (PTSD). Which comment by the soldier requires the nurses immediate attention? a. Its good to be home. I missed my family and friends. b. I saw my best friend get killed by a roadside bomb. It should have been me instead. c. Sometimes I think I hear bombs exploding, but its just the noise of traffic in my hometown. d. I want to continue my education but Im not sure how I will fit in with other college students.b. I saw my best friend get killed by a roadside bomb. It should have been me instead.A soldier returned home from active duty in a combat zone in Afghanistan and was diagnosed with post- traumatic stress disorder (PTSD). The soldier says, If theres a loud noise at night, I get under my bed because I think were getting bombed. What type of experience has the soldier described? a. Illusion b. Flashback c. Nightmare d. Auditory hallucinationb. FlashbackA soldier returned 3 months ago from Afghanistan and was diagnosed with post-traumatic stress disorder (PTSD). Which social event would most likely be disturbing for this soldier?a. Halloween festival with neighborhood children b. Singing carols around a Christmas tree c. Family outing to the seashore d. Fireworks display on July 4thd. Fireworks display on July 4thA soldier served in combat zones in Iraq in 2010 and was deployed to Afghanistan in 2013. When is it most important for the nurse to screen for signs and symptoms of post-traumatic stress disorder (PTSD)? a. Immediately upon return to the United States from Afghanistan b. Before departing Afghanistan to return to the United States c. One year after returning from Afghanistan d. Screening should be ongoingd. Screening should be ongoingA nurse assesses soldiers in a combat zone in Afghanistan. When is it most important for the nurse to screen for signs and symptoms of traumatic brain injury (TBI)? a. After a fall, vehicle crash, or exposure to a blast b. Before departing Afghanistan to return to the United States c. One year after returning to the United States from Afghanistan d. Immediately upon return to the United States from Afghanistana. After a fall, vehicle crash, or exposure to a blastA soldier in a combat zone tells the nurse, I saw a child get blown up over a year ago, and now I keep seeing bits of flesh everywhere. I see something red and the visions race back to my mind. Which phenomenon associated with post-traumatic stress disorder (PTSD) is this soldier describing? a. Re-experiencing b. Hyperarousal c. Avoidance d. Psychosisa. Re-experiencingA soldier who served in a combat zone returned to the United States. The soldiers spouse complains to the nurse, We had planned to start a family, but now he wont talk about it. He wont even look at children. The spouse is describing which symptom associated with post-traumatic stress disorder (PTSD)? a. Reexperiencing b. Hyperarousal c. Avoidance d. Psychosisc. AvoidanceA soldier returned home last year after deployment to a war zone. The soldiers spouse complains, We were going to start a family but now he wont talk about it. He will not look at children. I wonder if were going to make it as a couple. Select the nurses best response. a. Post-traumatic stress disorder often changes a persons sexual functioning. b. I encourage you to continue to participate in social activities where children are present. c. Have you talked with your spouse about these reactions? Sometimes we just need to confront behavior. d. Post-traumatic stress disorder often strains relationships. I will suggest some community resources for help and support.d. Post-traumatic stress disorder often strains relationships. I will suggest some community resources for help and support.A nurse talks with the caregiver of a combat veteran diagnosed with severe traumatic brain injuries. The caregiver says, I dont know how much longer I can do it. My whole life is consumed with taking care of my partner. Select the nurses best response. a. How are you taking care of yourself? b. Lets review your partners diagnostic results. c. I have some web-based programs for you to visit. d. Your partner is lucky to have someone so devoted.a. How are you taking care of yourself?A professors 4-year-old child has a fever of 101.6 F, diarrhea, and complains of stomach pain. The professor is scheduled to teach three classes today. Which nursing diagnosis best applies to this scenario? a. Decisional conflict b. Unilateral neglect c. Disabled family coping d. Ineffective management of the therapeutic regimena. Decisional conflictAn individual says to the nurse, I feel so stressed out lately. I think the stress is affecting my body also. Which somatic complaints are most likely to accompany this feeling? Select all that apply. a. Headache b. Neck pain c. Insomnia d. Anorexia e. Myopiaa. Headache b. Neck pain c. Insomnia d. AnorexiaWhich experiences are most likely to precipitate post-traumatic stress disorder (PTSD)? Select all that apply. a. An 8-year-old child watches an R-rated movie with both parents. b. A young adult jumps from a bridge with a bungee cord with a best friend. c. An adolescent is kidnapped and held for 2 years in the home of a sexual predator. d. A passenger is in a bus that overturns on a sharp curve in the road, tumbling down an embankment. e. An adult is trapped for 3 hours at an angle in an elevator after a portion of the supporting cable breaks.c. An adolescent is kidnapped and held for 2 years in the home of a sexual predator. d. A passenger is in a bus that overturns on a sharp curve in the road, tumbling down an embankment. e. An adult is trapped for 3 hours at an angle in an elevator after a portion of the supporting cable breaks.A nurse assesses the health status of soldiers returning from Afghanistan. Screening will be a priority for signs and symptoms of which health problems? Select all that apply. a. Schizophrenia b. Eating disorder c. Traumatic brain injury d. Seasonal affective disorder e. Post-traumatic stress disorderc. Traumatic brain injury e. Post-traumatic stress disorderA professors 4-year-old child has a temperature of 101.6 F, diarrhea, and complains of stomach pain. The professor is scheduled to teach three classes today. Which actions by the professor demonstrate effective parenting? Select all that apply. a. Telephoning a grandparent to stay with the child at home for the day. b. Telephoning a colleague to teach his classes and staying home with the sick child. c. Taking the child to the university and keeping the child in a private office for the day. d. Taking the child to a daycare center and hoping daycare workers will not notice the child is sick. e. Giving the child one dose of ibuprofen (Motrin) and taking the child to the daycare center.a. Telephoning a grandparent to stay with the child at home for the day. b. Telephoning a colleague to teach his classes and staying home with the sick child.A nurse wishes to teach alternative coping strategies to a patient experiencing severe anxiety. The nurse will first need to: a. Verify the patients learning style. b. Create outcomes and a teaching plan. c. Lower the patients current anxiety level. d. Assess how the patient uses defense mechanisms.c. Lower the patients current anxiety level.A patient approaches the nurse and impatiently blurts out, Youve got to help me! Something terrible is happening. My heart is pounding. The nurse responds, Its almost time for visiting hours. Lets get your hair combed. Which approach has the nurse used? a. Bringing up an irrelevant topic b. Responding to physical needs c. Addressing false cognitions d. Focusinga. Bringing up an irrelevant topicA patient experiencing moderate anxiety says, I feel undone. An appropriate response for the nurse would be: a. Why do you suppose you are feeling anxious? b. What would you like me to do to help you? c. Im not sure I understand. Give me an example. d. You must get your feelings under control before we can continue.c. Im not sure I understand. Give me an example.A patient with a high level of motor activity runs from chair to chair and cries, Theyre coming! Theyre coming! The patient does not follow instructions or respond to verbal interventions from staff. The initial nursing intervention of highest priority is to: a. provide for patient safety. b. increase environmental stimuli. c. respect the patients personal space. d. encourage the clarification of feelings.a. provide for patient safety.A patient with a high level of motor activity runs from chair to chair and cries, Theyre coming! Theyre coming! The patient is unable to follow instructions or respond to verbal interventions from staff. Which nursing diagnosis has the highest priority? a. Risk for injury b. Self-care deficit c. Disturbed energy field d. Disturbed thought processesa. Risk for injuryA supervisor assigns a worker a new project. The worker initially agrees but feels resentful. The next day, when asked about the project, the worker says, Ive been working on other things. When asked 4 hours later, the worker says, Someone else was using the copier, so I couldnt finish it. The workers behavior demonstrates: a. acting out. b. projection. c. suppression. d. passive aggression.d. passive aggression.A patient is undergoing diagnostic tests. The patient says, Nothing is wrong with me except a stubborn chest cold. The spouse reports that the patient smokes, coughs daily, has recently lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using? a. Displacement b. Regression c. Projection d. Deniald. DenialA patient with a mass in the left upper lobe of the lung is scheduled for a biopsy. The patient has difficulty understanding the nurses comments and asks, What are they going to do? Assessment findings include a tremulous voice, respirations 28 breaths per minute, and pulse rate 110 beats per minute. What is the patients level of anxiety? a. Mild b. Moderate c. Severe d. Panicb. ModerateA patient who is preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is appropriate? a. Reassure the patient that all nurses are skilled in providing postoperative care. b. Describe the procedure again in a calm manner, using simple language. c. Tell the patient that the staff is prepared to promote recovery. d. Encourage the patient to express feelings to his or her family.b. Describe the procedure again in a calm manner, using simple language.A nurse encourages an anxious patient to talk about feelings and concerns. What is the rationale for this intervention? a. Offering hope allays and defuses the patients anxiety. b. Concerns stated aloud become less overwhelming and help problem solving to begin. c. Anxiety is reduced by focusing on and validating what is occurring in the environment. d. Encouraging patients to explore alternatives increases the sense of control and lessens anxiety.b. Concerns stated aloud become less overwhelming and help problem solving to begin.Which assessment question would be most appropriate for the nurse to ask a patient who has possible generalized anxiety disorder (GAD)? a. Have you been a victim of a crime or seen someone badly injured or killed? b. Do you feel especially uncomfortable in social situations involving people? c. Do you repeatedly do certain things over and over again? d. Do you find it difficult to control your worrying?d. Do you find it difficult to control your worrying?A patient in the emergency department has no physical injuries but exhibits disorganized behavior and incoherence after minor traffic accident. In which room should the nurse place the patient? a. Interview room furnished with a desk and two chairs b. Small, empty storage room with no windows or furniture c. Room with an examining table, instrument cabinets, desk, and chair d. Nurses office, furnished with chairs, files, magazines, and bookcasesa. Interview room furnished with a desk and two chairsA person has minor physical injuries after an automobile accident. The person is unable to focus and says, I feel like something awful is going to happen. This person has nausea, dizziness, tachycardia, and hyperventilation. What is this persons level of anxiety? a. Mild b. Moderate c. Severe d. Panicc. SevereTwo staff nurses applied for a charge nurse position. After the promotion was announced, the nurse who was not promoted said, The nurse manager had a headache the day I was interviewed. Which defense mechanism is evident? a. Introjection b. Conversion c. Projection d. Splittingc. ProjectionA patient tells a nurse, My new friend is the most perfect person one could imaginekind, considerate, and good looking. I cant find a single flaw. This patient is demonstrating: a. denial. b. projection. c. idealization. d. compensation.c. idealization.A patient experiences an episode of severe anxiety. Of these medications in the patients medical record, which is most appropriate to administer as an as-needed (PRN) anxiolytic medication? a. buspirone (BuSpar) b. lorazepam (Ativan) c. amitriptyline (Elavil) d. desipramine (Norpramin)b. lorazepam (Ativan)Two staff nurses applied for promotion to nurse manager. Initially, the nurse not promoted had feelings of loss but then became supportive of the new manager by helping make the transition smooth and encouraging others. Which term best describes the nurses response? a. Altruism b. Sublimation c. Suppression d. Passive aggressiona. AltruismA person who feels unattractive repeatedly says, Although Im not beautiful, I am smart. This is an example of: a. repression. b. devaluation. c. identification. d. compensation.d. compensation.A person who is speaking about a contender for a significant others affection says in a gushy, syrupy voice, What a lovely person. Thats someone I simply adore. The individual is demonstrating: a. reaction formation. b. repression. c. projection. d. denial.a. reaction formation.An individual experiences sexual dysfunction and blames it on a partner by calling the person unattractive and unromantic. Which defense mechanism is evident? a. Rationalization b. Compensation c. Introjection d. Regressiona. RationalizationA student says, Before taking a test, I feel a heightened sense of awareness and restlessness. The nurse can correctly assess the students experience as: a. culturally influenced. b. displacement. c. trait anxiety. d. mild anxiety.d. mild anxiety.A student says, Before taking a test, I feel a heightened sense of awareness and restlessness. The nursing intervention most suitable for assisting the student is to: a. explain that the symptoms are the result of mild anxiety, and discuss the helpful aspects. b. advise the student to discuss this experience with a health care provider. c. encourage the student to begin antioxidant vitamin supplements. d. listen without comment.a. explain that the symptoms are the result of mild anxiety, and discuss the helpful aspects.If a cruel and abusive person rationalizes this behavior, which comment is most characteristic of this person? a. I dont know why it happens. b. I have always had poor impulse control. c. That person should not have provoked me. d. Inside I am a coward who is afraid of being hurt.c. That person should not have provoked me.A patient experiencing severe anxiety suddenly begins running and shouting, Im going to explode! The nurse should: a. say, Im not sure what you mean. Give me an example. b. chase after the patient, and give instructions to stop running. c. capture the patient in a basket-hold to increase feelings of control. d. assemble several staff members and state, We will help you regain control.d. assemble several staff members and state, We will help you regain control.A person who has been unable to leave home for more than a week because of severe anxiety says, I know it does not make sense, but I just cant bring myself to leave my apartment alone. Which nursing intervention is appropriate? a. Teach the person to use positive self-talk. b. Assist the person to apply for disability benefits. c. Ask the person to explain why the fear is so disabling. d. Advise the person to accept the situation and use a companion.a. Teach the person to use positive self-talk.Which comment by a person experiencing severe anxiety indicates the possibility of obsessive-compulsive disorder? a. I check where my car keys are eight times. b. My legs often feel weak and spastic. c. Im embarrassed to go out in public. d. I keep reliving the car accident.a. I check where my car keys are eight times.Alprazolam (Xanax) is prescribed for a patient experiencing acute anxiety. Health teaching should include instructions to: a. report drowsiness. b. eat a tyramine-free diet. c. avoid alcoholic beverages. d. adjust dose and frequency based on anxiety level.c. avoid alcoholic beverages.Which statement is mostly likely to be made by a patient diagnosed with agoraphobia? a. Being afraid to go out seems ridiculous, but I cant go out the door. b. Im sure Ill get over not wanting to leave home soon. It takes time. c. When I have a good incentive to go out, I can do it. d. My family says they like it now that I stay home.a. Being afraid to go out seems ridiculous, but I cant go out the door.A patient has the nursing diagnosis Anxiety, related to __________, as evidenced by an inability to control compulsive cleaning. Which phrase correctly completes the etiologic portion of the diagnosis? a. ensuring the health of household members b. attempting to avoid interactions with others c. having persistent thoughts about bacteria, germs, and dirt d. needing approval for cleanliness from friends and familyc. having persistent thoughts about bacteria, germs, and dirtA patient performs ritualistic hand washing. What should the nurse do to help the patient develop more effective coping strategies? a. Allow the patient to set a hand-washing schedule. b. Encourage the patient to participate in social activities. c. Encourage the patient to discuss hand-washing routines. d. Focus on the patients symptoms rather than on the patient.b. Encourage the patient to participate in social activities.For a patient experiencing panic, which nursing intervention should be implemented first? a. Teach relaxation techniques. b. Administer an anxiolytic medication. c. Provide calm, brief, directive communication. d. Gather a show of force in preparation for gaining physical control.c. Provide calm, brief, directive communication.Which finding indicates that a patient with moderate-to-severe anxiety has successfully lowered the anxiety level to mild? The patient: a. asks, Whats the matter with me? b. stays in a room alone and paces rapidly. c. can concentrate on what the nurse is saying. d. states, I dont want anything to eat. My stomach is upset.c. can concentrate on what the nurse is saying.A patient tells the nurse, I dont go to restaurants because people might laugh at the way I eat, or I could spill food and be laughed at. The nurse assesses this behavior as consistent with: a. acrophobia. b. agoraphobia. c. social anxiety disorder (social phobia). d. Post-traumatic stress disorder (PTSD).c. social anxiety disorder (social phobia).A patient checks and rechecks electrical cords related to an obsessive thought that the house may burn down. The nurse and patient explore the likelihood of an actual fire. The patient states that a house fire is not likely. This counseling demonstrates the principles of: a. flooding. b. desensitization. c. relaxation technique. d. cognitive restructuring.d. cognitive restructuring.A patient has a fear of public speaking. The nurse should be aware that social anxiety disorders (social phobias) are often treated with which type of medication? a. Beta-blockers b. Antipsychotic medications c. Tricyclic antidepressant agents d. Monoamine oxidase inhibitorsa. Beta-blockersA patient tells the nurse, I wanted my health care provider to prescribe diazepam (Valium) for my anxiety disorder, but buspirone (BuSpar) was prescribed instead. Why? The nurses reply should be based on the knowledge that buspirone: a. does not produce blood dyscrasias. b. does not cause dependence. c. can be administered as needed. d. is faster acting than diazepam.b. does not cause dependence.A child is placed in a foster home after being removed from parental contact because of abuse. The child is apprehensive and overreacts to environmental stimuli. The foster parents ask the nurse how to help the child. What should the nurse recommend? Select all that apply. a. Use a calm manner and low voice. b. Maintain simplicity in the environment. c. Avoid repetition in what is said to the child. d. Minimize opportunities for exercise and play. e. Explain and reinforce reality to avoid distortions.a. Use a calm manner and low voice. b. Maintain simplicity in the environment. e. Explain and reinforce reality to avoid distortions.A nurse plans health teaching for a patient diagnosed with generalized anxiety disorder (GAD) who takes lorazepam (Ativan). What information should be included? Select all that apply. a. Use caution when operating machinery. b. Allow only tyramine-free foods in diet. c. Restrict intake of caffeine. d. Avoid using alcohol and other sedatives. e. Take the medication on an empty stomach.a. Use caution when operating machinery. c. Restrict intake of caffeine. d. Avoid using alcohol and other sedatives.Which assessment questions are most appropriate to ask a patient with possible obsessive-compulsive disorder? Select all that apply. a. Have you been a victim of a crime or seen someone badly injured or killed? b. Are there certain social situations that cause you to feel especially uncomfortable? c. Do you have to do things in a certain way to feel comfortable? d. Is it difficult to keep certain thoughts out of awareness? e. Do you do certain things over and over again?c. Do you have to do things in a certain way to feel comfortable? d. Is it difficult to keep certain thoughts out of awareness? e. Do you do certain things over and over again?A medical-surgical nurse works with a patient diagnosed with a somatic system disorder. Care planning is facilitated by understanding that the patient will probably: a. readily seek psychiatric counseling. b. be resistant to accepting psychiatric help. c. attend psychotherapy sessions without encouragement. d. be eager to discover the true reasons for physical symptoms.b. be resistant to accepting psychiatric help.A patient has blindness related to a functional neurological (conversion) disorder but is unconcerned about this problem. Which understanding should guide the nurses planning for this patient? The patient is: a. suppressing accurate feelings regarding the problem. b. relieving anxiety through the physical symptom. c. meeting needs through hospitalization. d. refusing to disclose genuine fears.b. relieving anxiety through the physical symptom.A patient has blindness related to a functional neurological (conversion) disorder. To help the patient eat, the nurse should: a. establish a buddy system with other patients who can feed the patient at each meal. b. expect the patient to feed himself or herself after explaining the arrangement of the food on the tray. c. direct the patient to locate items on the tray independently and feed himself or herself unassisted. d. address the needs of other patients in the dining room, and then feed this patient.b. expect the patient to feed himself or herself after explaining the arrangement of the food on the tray.A patient with blindness related to a functional neurological (conversion) disorder says, All the doctors and nurses in this hospital stop by often to check on me. Too bad people outside the hospital dont find me interesting. Which nursing diagnosis is most relevant? a. Social isolation b. Chronic low self-esteem c. Interrupted family processes d. Ineffective health maintenanceb. Chronic low self-esteemTo assist a patient diagnosed with a somatic system disorder, a nursing intervention of high priority is to: a. imply that somatic symptoms are not real. b. help the patient suppress feelings of anger. c. shift the focus from somatic symptoms to feelings. d. investigate each physical symptom as soon as it is reported.c. shift the focus from somatic symptoms to feelings.A patient who fears serious heart disease was referred to the mental health center by a cardiologist after diagnostic evaluation showed no physical illness. The patient says, My heart misses beats. Im frequently absent from work. I dont go out much because I need to rest. Which health problem is most likely? a. Body dysmorphic disorder b. Antisocial personality disorder c. Illness anxiety disorder (hypochondriasis) d. Persistent depressive disorder (dysthymia)c. Illness anxiety disorder (hypochondriasis)A nurse assessing a patient diagnosed with a somatic system disorder is most likely to note that the patient: a. readily sees a relationship between symptoms and interpersonal conflicts. b. rarely derives personal benefit from the symptoms. c. has little difficulty communicating emotional needs. d. has unmet needs related to comfort and activity.d. has unmet needs related to comfort and activity.To plan effective care for patients diagnosed with somatic system disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms: a. are generally chronic in nature. b. have a physiological basis. c. can be voluntarily controlled. d. provide relief from health anxiety.d. provide relief from health anxiety.A patient diagnosed with a somatic symptom disorder has the nursing diagnosis: Interrupted family processes, related to patients disabling symptoms as evidenced by the spouse and children assuming roles and tasks that previously belonged to patient. An appropriate outcome is that the patient will: a. assume roles and functions of the other family members. b. demonstrate a resumption of former roles and tasks. c. focus energy on problems occurring in the family. d. rely on family members to meet his or her personal needs.b. demonstrate a resumption of former roles and tasks.A woman wears a size 7 shoe. She says, My feet are huge. Ive asked three orthopedists to surgically reduce my feet. The patient tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely? a. Dissociative amnesia with fugue b. Illness anxiety disorder c. Body dysmorphic disorder d. Dissociative identity disorderc. Body dysmorphic disorderWhich assessment finding best supports the diagnosis of dissociative amnesia with fugue? The patient states: a. I cannot recall why Im living in this town. b. I feel as if Im living in a fuzzy dream state. c. I feel like different parts of my body are at war. d. I feel very anxious and worried about my problems.a. I cannot recall why Im living in this town.A college student observes a roommate going out wearing uncharacteristically seductive clothing, returning 12 to 24 hours later, and then sleeping for 8 to 12 hours. At other times, the roommate sits on the floor speaking like a young child. Which health problem should be considered? a. Functional neurological (conversion) disorder b. Dissociative identity disorder c. Dissociative amnesia d. Body dysmorphic disorderb. Dissociative identity disorderA nurse assesses a patient diagnosed with functional neurological (conversion) disorder. Which comment is most likely from this patient? a. Since my father died, Ive been short of breath and had sharp pains that go down my left arm, but I think its just indigestion. b. I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry and I think Im getting seriously dehydrated. c. Sexual intercourse is painful. I pretend as if Im asleep so I can avoid it. I think its starting to cause problems with my marriage. d. I get choked very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus.a. Since my father died, Ive been short of breath and had sharp pains that go down my left arm, but I think its just indigestion.A nurse counsels a patient diagnosed with body dysmorphic disorder. Which nursing diagnosis would be a priority for the plan of care? a. Anxiety b. Risk for suicide c. Disturbed body image d. Ineffective role performanceb. Risk for suicideSelect the correct etiology to complete this nursing diagnosis for a patient diagnosed with dissociative identity disorder: Disturbed personal identity, related to: a. obsessive fears of harming self or others. b. poor impulse control and lack of self-confidence. c. depressed mood secondary to nightmares and intrusive thoughts. d. cognitive distortions associated with unresolved childhood abuse issues.d. cognitive distortions associated with unresolved childhood abuse issues.For a patient diagnosed with dissociative amnesia, complete this outcome: Within 4 weeks, the patient will demonstrate an ability to execute complex mental processes by: a. functioning independently. b. verbalizing feelings of safety. c. regularly attending diversional activities. d. describing previously forgotten experiences.b. verbalizing feelings of safety.A person comes to the clinic reporting, I wear a scarf across my lower face when I go out but because of my ugly appearance. Assessment reveals an average appearance with no actual disfigurement. Which problem is most likely? a. Dissociative identity disorder b. Body dysmorphic disorder c. Pseudocyesis d. Malingeringb. Body dysmorphic disorderA nurse counseling a patient diagnosed with dissociative identity disorder (DID) should understand that the assessment of highest priority is: a. risk for self-harm b. cognitive functioning c. identification of drug abuse d. readiness to reestablish identity or memorya. risk for self-harmA patient says, I feel detached and weird all the time, like Im looking at life through a cloudy window. Everything seems unreal. These feelings really interfere with my work and study. Which term should the nurse use to document this complaint? a. Depersonalization b. Hypochondriasis c. Dissociation d. Malingeringa. DepersonalizationA patient reports fears of having cervical cancer and says to the nurse, Ive had Pap smears by six different doctors. The results are normal, but Im sure thats because of errors in the laboratory. Which disorder would the nurse suspect? a. Functional neurologic (conversion) disorder b. Illness anxiety disorder (hypochondriasis) c. Body dysmorphic disorder d. Dissociative amnesia with fugueb. Illness anxiety disorder (hypochondriasis)A patient diagnosed with somatic symptom disorder says, I have pain from an undiagnosed injury. I cant take care of myself. I need pain medicine six or seven times a day. I feel like a baby because my family has to help me so much. It is important for the nurse to assess: a. mood. b. cognitive style. c. secondary gains. d. identity and memory.c. secondary gains.The causes of somatic system disorders may be related to: a. faulty perceptions of body sensations. b. traumatic childhood events. c. culture-bound phenomena. d. mood instability.a. faulty perceptions of body sensations.What is the primary difference between somatic system disorders and dissociative disorders? a. Somatic system disorders are under voluntary control, whereas dissociative disorders are unconscious and automatic. b. Dissociative disorders are precipitated by psychological factors, whereas somatic system disorders are related to stress. c. Dissociative disorders are individually determined and related to childhood sexual abuse, whereas somatic system disorders are culture bound. d. Dissociative disorders entail stress-related disruptions of memory, consciousness, or identity, whereas somatic system disorders involve the expression of psychological stress through somatic symptoms.d. Dissociative disorders entail stress-related disruptions of memory, consciousness, or identity, whereas somatic system disorders involve the expression of psychological stress through somatic symptoms.A patient says, I know I have a brain tumor despite the results of the magnetic resonance image (MRI). The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day. Which response by the nurse fosters cognitive restructuring? a. You do not have a brain tumor. The more you talk about it, the more it reinforces your illogical thinking. b. Lets see whether any other explanations for your vomiting are possible. c. You seem so worried. Lets talk about how youre feeling. d. We should talk about something else.b. Lets see whether any other explanations for your vomiting are possible.Which treatment modality should a nurse recommend to help a patient diagnosed with somatic symptom disorder cope more effectively? a. Flooding b. Relaxation c. Response prevention d. Systematic desensitizationb. RelaxationA patient diagnosed with depersonalization disorder tells the nurse, Its starting again. I feel as though Im going to float away. The nurse should help the patient by: a. encouraging meditation. b. administering an anxiolytic medication. c. helping the patient visualize a pleasant scene. d. helping the patient focus on the here and now.d. helping the patient focus on the here and now.A patient diagnosed with somatic symptom disorder has been in treatment for 4 weeks. The patient says, Although Im still having pain, I notice it less and am able to perform more activities. The nurse should evaluate the treatment plan as: a. unsuccessful. b. minimally successful. c. partially successful. d. totally achieved.c. partially successful.A patient diagnosed with somatic symptom disorder says, Why has God chosen me to be sick all the time and unable to provide for my family? The burden on my family is worse than the pain I bear. Which nursing diagnoses apply to this patient? Select all that apply. a. Spiritual distress b. Decisional conflict c. Adult failure to thrive d. Impaired social interaction e. Ineffective role performancea. Spiritual distress e. Ineffective role performanceA nurse assesses a patient suspected to have somatic system disorder. Which findings support the diagnosis? Select all that apply. a. Female b. Reports frequent syncope c. Complains of heavy menstrual bleeding d. First diagnosed with psoriasis at 12 years of age e. Reports of back pain, painful urination, frequent diarrhea, and hemorrhoidsa. Female b. Reports frequent syncope c. Complains of heavy menstrual bleeding e. Reports of back pain, painful urination, frequent diarrhea, and hemorrhoidsA patients roommate has observed the patient behaving in uncharacteristic ways, but the patient cannot remember the episodes. Dissociative identity disorder (DID) is suspected. Which questions are most relevant to the assessment of this patient? Select all that apply. a. Are you sexually promiscuous? b. Do you think you need an antidepressant medication? c. Have you ever found yourself someplace and did not know how you got there? d. Are your memories of childhood clear and complete, or do you have blank spots? e. Have you ever found new things in your belongings that you cant remember buying?c. Have you ever found yourself someplace and did not know how you got there? d. Are your memories of childhood clear and complete, or do you have blank spots? e. Have you ever found new things in your belongings that you cant remember buying?A client is diagnosed with dysthymic disorder. Which should a nurse classify as an affective symptom of this disorder? A. Social isolation with a focus on self B. Low energy level C. Difficulty concentrating D. Gloomy and pessimistic outlook on lifeD. Gloomy and pessimistic outlook on lifeA client is diagnosed with major depressive disorder. Which nursing diagnosis should a nurse assign to this client to address a behavioral symptom of this disorder? A. Altered communication R/T feelings of worthlessness AEB anhedonia B. Social isolation R/T poor self-esteem AEB secluding self in room C. Altered thought processes R/T hopelessness AEB persecutory delusions D. Altered nutrition: less than body requirements R/T high anxiety AEB anorexiaB. Social isolation R/T poor self-esteem AEB secluding self in roomA nurse assesses a client suspected of having major depressive disorder. Which client symptom would eliminate this diagnosis? A. The client is disheveled and malodorous. B. The client refuses to interact with others. C. The client is unable to feel any pleasure. D. The client has maxed-out charge cards and exhibits promiscuous behaviors.D. The client has maxed-out charge cards and exhibits promiscuous behaviors.A nurse reviews the laboratory data of a client suspected of having major depressive disorder. Which laboratory value would potentially rule out this diagnosis? A. Thyroid-stimulating hormone (TSH) level of 6.2 U/mL B. Potassium (K+) level of 4.2 mEq/L C. Sodium (Na+) level of 140 mEq/L D. Calcium (Ca2+) level of 9.5 mg/dLA. Thyroid-stimulating hormone (TSH) level of 6.2 U/mLA depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. Which theoretical principle best explains the etiology of this client's depressive symptoms? A. According to psychoanalytic theory, depression is a result of anger turned inward. B. According to object-loss theory, depression is a result of abandonment. C. According to learning theory, depression is a result of repeated failures. D. According to cognitive theory, depression is a result of negative perceptions.C. According to learning theory, depression is a result of repeated failures.What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive disorder? A. The attention during the assessment is beneficial in decreasing social isolation. B. Depression can generate somatic symptoms that can mask actual physical disorders. C. Physical health complications are likely to arise from antidepressant therapy. D. Depressed clients avoid addressing physical health and ignore medical problems.B. Depression can generate somatic symptoms that can mask actual physical disorders.A nurse is planning care for a child who is experiencing depression. Which medication is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents? A. Paroxetine (Paxil) B. Sertraline (Zoloft) C. Citalopram (Celexa) D. Fluoxetine (Prozac)D. Fluoxetine (Prozac)A nurse admits an older client who is experiencing memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a mini-mental status exam? A. To rule out bipolar disorder B. To rule out schizophrenia C. To rule out senile dementia D. To rule out a personality disorderC. To rule out senile dementiaA confused client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). The client presents with restlessness, tachycardia, diaphoresis, and tremors. What complication does a nurse suspect and what could be its possible cause? A. Neuroleptic malignant syndrome caused by ingestion of two different seratonin reuptake inhibitors (SSRIs) B. Neuroleptic malignant syndrome caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) C. Serotonin syndrome caused by ingestion of an SSRI and an MAOI D. Serotonin syndrome caused by ingestion of two different SSRIsD. Serotonin syndrome caused by ingestion of two different SSRIsA client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, "I heard about something called a monoamine oxidase inhibitor (MAOI). Can't my doctor add that to my medications?" Which is an appropriate nursing reply? A. "This combination of drugs can lead to delirium tremens." B. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis." C. "That's a good idea. There have been good results with the combination of these two drugs." D. "The only disadvantage would be the exorbitant cost of the MAOI."B. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis."A psychiatrist prescribes a monoamine oxidase inhibitor (MAOI) for a client. Which foods should the nurse teach the client to avoid? A. Pepperoni pizza and red wine B. Bagels with cream cheese and tea C. Apple pie and coffee D. Potato chips and diet colaA. Pepperoni pizza and red wineA client who has been taking buspirone (BuSpar) as prescribed for 2 days is close to discharge. Which statement indicates to the nurse that the client has an understanding of important discharge teaching? A. "I cannot drink any alcohol with this medication." B. "It is going to take 2 to 3 weeks in order for me to begin to feel better." C. "This drug causes physical dependence and I need to strictly follow doctor's orders." D. "I can't take this medication with food. It needs to be taken on an empty stomach."B. "It is going to take 2 to 3 weeks in order for me to begin to feel better."A client is admitted to the psychiatric unit with a diagnosis of major depression. The client is unable to concentrate, has no appetite, and is experiencing insomnia. Which should be included in this client's plan of care? A. A simple, structured daily schedule with limited choices of activities B. A daily schedule filled with activities to promote socialization C. A flexible schedule that allows the client opportunities for decision making D. A schedule that includes mandatory activities to decrease social isolationA. A simple, structured daily schedule with limited choices of activitiesAn isolative client was admitted 4 days ago with a diagnosis of major depressive disorder. Which nursing statement would best motivate this client to attend a therapeutic group being held in the milieu? A. "We'll go to the day room when you are ready for group." B. "I'll walk with you to the day room. Group is about to start." C. "It must be difficult for you to attend group when you feel so bad." D. "Let me tell you about the benefits of attending this group."B. "I'll walk with you to the day room. Group is about to start."Sertraline (Zoloft) has been prescribed for a client complaining of poor appetite, fatigue, and anhedonia. Which consideration should the nurse recognize as influencing this prescriptive choice? A. Zoloft is less expensive for the client. B. Zoloft is extremely sedating and will help with sleep disturbances. C. Zoloft has less adverse side effects than other antidepressants. D. Zoloft begins to improve depressive symptoms quickly.C. Zoloft has less adverse side effects than other antidepressants.What client information does a nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)? A. The client's understanding of the need for regular blood work B. The client's mood and affect score, using the facility's mood scale C. The client's cognitive ability to understand information about the medication D. The client's access to a support network willing to participate in treatmentC. The client's cognitive ability to understand information about the medicationA client diagnosed with seasonal affective disorder (SAD) states, "I've been feeling 'down' for 3 months. Will I ever feel like myself again?" Which reply by the nurse will best assess this client's symptoms. A. "Have you been diagnosed with any physical disorder within the last 3 months?" B. "Have you experienced any traumatic events that triggered this mood change?" C. "People who have seasonal mood changes often feel better when spring comes." D. "Help me understand what you mean when you say, 'feeling down'?"D. "Help me understand what you mean when you say, 'feeling down'?"A nurse is implementing a one-on-one suicide observation level with a client diagnosed with major depressive disorder. The client states, "I'm feeling a lot better so you can stop watching me. I have taken up too much of your time already." Which is the best nursing reply? A. "I really appreciate your concern but I have been ordered to continue to watch you." B. "Because we are concerned about your safety, we will continue to observe you." C. "I am glad you are feeling better. The treatment team will consider your request." D. "I will forward you request to your psychiatrist because it is his decision."B. "Because we are concerned about your safety, we will continue to observe you."A newly admitted client is diagnosed with major depressive disorder with suicidal ideations. Which would be the priority nursing intervention for this client? A. Teach about the effective of suicide on family dynamics. B. Carefully and unobtrusively observe based on assessed data, at varied intervals around the clock. C. Encourage the client to spend a portion of each day interacting within the milieu. D. Set realistic achievable goals to increase self esteem.B. Carefully and unobtrusively observe based on assessed data, at varied intervals around the clock.The nurse is providing counseling to clients diagnosed with major depressive disorder. The nurse chooses to assess and attempt to modify the negative thought patterns of these clients. The nurse is functioning under which theoretical framework? A. Psychoanalytic theory B. Interpersonal theory C. Cognitive theory D. Behavioral theoryC. Cognitive theoryWhich client statement expresses a typical underlying feeling of clients diagnosed with major depressive disorder? A. "It's just a matter of time and I will be well." B. "If I ignore these feelings, they will go away." C. "I can fight these feelings and overcome this disorder." D. "I deserve to feel this way."D. "I deserve to feel this way."A 75-year-old client diagnosed with a long history of depression is currently on doxepin (Sinequan) 100 mg daily. The client takes a daily diuretic for hypertension and is recovering from the flu. Which nursing diagnosis should the nurse assign highest priority? A. Risk for ineffective thermoregulation R/T anhidrosis B. Risk for constipation R/T excessive fluid loss C. Risk for injury R/T orthostatic hypotension D. Risk for infection R/T suppressed white blood cell countC. Risk for injury R/T orthostatic hypotensionA client is admitted with a diagnosis of depression NOS (not otherwise specified). Which client statement would describe a somatic symptom that can occur with this diagnosis? A. "I am extremely sad, but I don't know why." B. "Sometimes I just don't want to eat because I ache all over." C. "I feel like I can't ever make the right decision." D. "I can't seem to leave the house without someone with me."B. "Sometimes I just don't want to eat because I ache all over."A client diagnosed with major depressive disorder was raised in an excessively religiously based household. Which nursing intervention would be most appropriate to address this client's underlying problem? A. Encourage the client to bring into awareness underlying sources of guilt. B. Teach the client that religious beliefs should be put into perspective throughout the life span. C. Confront the client with the irrational nature of the belief system. D. Assist the client to modify his or her belief system in order to improve coping skills.A. Encourage the client to bring into awareness underlying sources of guilt.A nurse is caring for four clients taking various medications including imipramine (Tofranil), doxepine (Sinequan), ziprasidone (Geodon), and tranylcypromine (Parnate). The nurse orders a special diet for the client receiving which medication? A. Tofranil B. Senequan C. Geodon D. ParnateD. ParnateA client admitted to the psychiatric unit following a suicide attempt is diagnosed with major depressive disorder. Which behavioral symptoms should the nurse expect to assess? A. Anxiety and unconscious anger B. Lack of attention to grooming and hygiene C. Guilt and indecisiveness D. Expressions of poor self-esteemB. Lack of attention to grooming and hygieneA newly admitted client diagnosed with major depressive disorder states, "I have never considered suicide." Later the client confides to the nurse about plans to end it all by medication overdose. What is the most helpful nursing reply? A. "I'm glad you shared this. There is nothing to worry about. We will handle it together." B. "Bringing this up is a very positive action on your part." C. "We need to talk about the things you have to live for." D. "I think you should consider all your options prior to taking this action."B. "Bringing this up is a very positive action on your part."A nursing home resident has a diagnosis of dysthymic disorder. When planning care for this client, which of the following symptoms should a nurse expect the client to exhibit? (Select all that apply.) A. Sad mood on most days B. Mood rating of 2/10 for the past 6 months C. Labile mood D. Sad mood for the past 3 years after spouse's death E. Pressured speech when communicatingA. Sad mood on most days D. Sad mood for the past 3 years after spouse's deathAn individual experiences sadness and melancholia in September continuing through November. Which of the following factors should a nurse identify as most likely to contribute to the etiology of these symptoms? (Select all that apply.) A. Gender differences in social opportunities that occur with age B. Drastic temperature and barometric pressure changes C. Increased levels of melatonin D. Variations in serotonergic functioning E. Inaccessibility of resources for dealing with life stressorsB. Drastic temperature and barometric pressure changes C. Increased levels of melatonin D. Variations in serotonergic functioningA client is prescribed phenelzine (Nardil). Which of the following client statements should indicate to a nurse that discharge teaching about this medication has been successful? (Select all that apply.) A. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." B. "Guess I will have to give up my glass of red wine with dinner." C. "I'll have to be very careful about reading food and medication labels." D. "I'm going to miss my caffeinated coffee in the morning." E. "I'll be sure not to stop this medication abruptly."A. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." B. "Guess I will have to give up my glass of red wine with dinner." C. "I'll have to be very careful about reading food and medication labels." E. "I'll be sure not to stop this medication abruptly."A person is directing traffic on a busy street while shouting and making obscene gestures at passing cars. The person has not slept or eaten for 3 days. What features of mania are evident? a. Increased muscle tension and anxiety b. Vegetative signs and poor grooming c. Poor judgment and hyperactivity d. Cognitive deficit and sad moodc. Poor judgment and hyperactivityA patient diagnosed with bipolar disorder is dressed in a red leotard and brightly colored scarves. The patient says, Ill punch you, munch you, crunch you, while twirling and shadowboxing. Then the patient says gaily, Do you like my scarves? Herethey are my gift to you. How should the nurse document the patients mood? a. Labile and euphoric b. Irritable and belligerent c. Highly suspicious and arrogant d. Excessively happy and confidenta. Labile and euphoricA patient experiencing mania has not eaten or slept for 3 days. Which nursing diagnosis has priority? a. Risk for injury b. Ineffective coping c. Impaired social interaction d. Ineffective therapeutic regimen managementa. Risk for injuryA patient diagnosed with bipolar disorder is hyperactive and manic after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate? a. Stop that! No one did anything to provoke an attack by you. b. If you do that one more time, you will be secluded immediately. c. Do not hit anyone. If you are unable to control yourself, we will help you. d. You know we will not let you hit anyone. Why do you continue this behavior?c. Do not hit anyone. If you are unable to control yourself, we will help you.This nursing diagnosis applies to a patient experiencing mania: Imbalanced nutrition: less than body requirements, related to insufficient caloric intake and hyperactivity as evidenced by 5-pound weight loss in 4 days. Select the most appropriate outcome. The patient will: a. ask staff for assistance with feeding within 4 days. b. drink six servings of a high-calorie, high-protein drink each day. c. consistently sit with others for at least 30 minutes at mealtime within 1 week. d. consistently wear appropriate attire for age and sex within 1 week while in the psychiatric unit.b. drink six servings of a high-calorie, high-protein drink each day.A patient develops mania after discontinuing lithium. New prescriptions are written to resume lithium twice daily and begin olanzapine (Zyprexa). The addition of olanzapine to the medication regimen will: a. minimize the side effects of lithium. b. bring hyperactivity under rapid control. c. enhance the antimanic actions of lithium. d. provide long-term control of hyperactivity.b. bring hyperactivity under rapid control.A patient diagnosed with bipolar disorder has rapid cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed? a. phenytoin (Dilantin) b. clonidine (Catapres) c. carbamazepine (Tegretol) d. chlorpromazine (Thorazine)c. carbamazepine (Tegretol)The cause of bipolar disorder has not been determined, but: a. several factors, including genetics, are implicated. b. brain structures were altered by stresses early in life. c. excess norepinephrine is probably a major factor. d. excess sensitivity in dopamine receptors may exist.a. several factors, including genetics, are implicated.The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Select the nurses best response. a. A high proportion of patients diagnosed with bipolar disorders are found among creative writers. b. A higher rate of relatives diagnosed with bipolar disorder is found among patients with bipolar disorder. c. Patients diagnosed with bipolar disorder have higher rates of relatives who respond in an exaggerated way to daily stresses. d. More individuals diagnosed with bipolar disorder come from high socioeconomic and educational backgrounds.b. A higher rate of relatives diagnosed with bipolar disorder is found among patients with bipolar disorder.A patient diagnosed with bipolar disorder commands other patients, Get me a book. Take this stuff out of here, and other similar demands. The nurse wants to interrupt this behavior without entering into a power struggle. Select the best initial approach by the nurse. a. Distraction: Lets go to the dining room for a snack. b. Humor: How much are you paying servants these days? c. Limit setting: You must stop ordering other patients around. d. Honest feedback: Your controlling behavior is annoying others.a. Distraction: Lets go to the dining room for a snack.A nurse receives this laboratory result for a patient diagnosed with bipolar disorder: lithium level 1 mEq/L. This result is: a. within therapeutic limits b. below therapeutic limits c. above therapeutic limits d. incorrect because of inaccurate testinga. within therapeutic limitsConsider these three drugs: divalproex (Depakote), carbamazepine (Tegretol), and gabapentin (Neurontin). Which drug also belongs to this group? a. clonazepam (Klonopin) b. risperidone (Risperdal) c. lamotrigine (Lamictal) d. aripiprazole (Abilify)c. lamotrigine (Lamictal)When a hyperactive patient experiencing acute mania is hospitalized, what initial nursing intervention is a priority? a. Allow the patient to act out his or her feelings. b. Set limits on the patients behavior as necessary. c. Provide verbal instructions to the patient to remain calm. d. Restrain the patient to reduce hyperactivity and aggression.b. Set limits on the patients behavior as necessary.At a unit meeting, staff members discuss the decor for a special room for patients experiencing mania. Select the best option. a. Extra-large window with a view of the street b. Neutral walls with pale, simple accessories c. Brightly colored walls and print drapes d. Deep colors for walls and upholsteryb. Neutral walls with pale, simple accessoriesA patient experiencing acute mania has exhausted the staff members by noon. The patient has joked, manipulated, insulted, and fought all morning. Staff members are feeling defensive and fatigued. Which is the best action? a. Confer with the health care provider regarding use of seclusion for this patient. b. Hold a staff meeting to discuss consistency and limit-setting approaches. c. Conduct a meeting with all patients to discuss the behavior. d. Explain to the patient that the behavior is unacceptable.b. Hold a staff meeting to discuss consistency and limit-setting approaches.A patient experiencing acute mania undresses in the group room and dances. The nurses first intervention would be to: a. quietly ask the patient, Why dont you put on your clothes? b. firmly tell the patient, Stop dancing, and put on your clothing. c. put a blanket around the patient, and walk with the patient to a quiet room. d. allow the patient stay in the group room. Move the other patients to a different area.c. put a blanket around the patient, and walk with the patient to a quiet room.A patient experiencing acute mania waves a newspaper and says, I must have my credit card and use the computer right now. A store is having a big sale and I need to order 10 dresses and four pairs of shoes. Select the nurses most appropriate intervention. a. Suggest to the patient to ask a friend do the shopping and bring purchases to the unit. b. Invite the patient to sit with the nurse and look at new fashion magazines. c. Tell the patient that computer use is not allowed until self-control improves. d. Ask whether the patient has enough money to pay for the purchases.b. Invite the patient to sit with the nurse and look at new fashion magazines.A patient diagnosed with bipolar disorder is being treated on an outpatient basis with lithium carbonate 300 mg three times daily. The patient complains of nausea. To reduce the nausea, the nurse can suggest that the lithium be taken with: a. meals. b. an antacid. c. a large glass of juice. d. an antiemetic medication.a. meals.A health teaching plan for a patient taking lithium should include instructions to: a. maintain normal salt and fluids in the diet. b. drink twice the usual daily amount of fluids. c. double the lithium dose if diarrhea or vomiting occurs. d. avoid eating aged cheese, processed meats, and red wine.a. maintain normal salt and fluids in the diet.Which nursing diagnosis would most likely apply to both a patient diagnosed with major depressive disorder (MDD) as well as one experiencing acute mania? a. Deficient diversional activity b. Disturbed sleep pattern c. Fluid volume excess d. Defensive copingb. Disturbed sleep patternWhich dinner menu is best suited for the patient diagnosed with bipolar disorder experiencing acute mania? a. Spaghetti and meatballs, salad, a banana b. Beef and vegetable stew, a roll, chocolate pudding c. Broiled chicken breast on a roll, an ear of corn, apple d. Chicken casserole, green beans, flavored gelatin with whipped creamc. Broiled chicken breast on a roll, an ear of corn, appleOutcome identification for the treatment plan of a patient with grandiose thinking associated with acute mania focuses on: a. maintaining an interest in the environment. b. developing an optimistic outlook. c. self-control of distorted thinking. d. stabilizing the sleep pattern.c. self-control of distorted thinking.Which documentation indicates that the treatment plan for a patient experiencing acute mania has been effective? a. Converses without interrupting; clothing matches; participates in activities. b. Irritable, suggestible, distractible; napped for 10 minutes in afternoon. c. Attention span short; writing copious notes; intrudes in conversations. d. Heavy makeup; seductive toward staff; pressured speech.a. Converses without interrupting; clothing matches; participates in activities.A patient experiencing mania dances around the unit, seldom sits, monopolizes conversations, interrupts, and intrudes. Which nursing intervention will best assist the patient with energy conservation?a. Monitor physiologic functioning b. Provide a subdued environment c. Supervise personal hygiene d. Observe for mood changesb. Provide a subdued environmentA patient diagnosed with bipolar disorder has been hospitalized for 7 days and has taken lithium 600 mg three times daily. Staff members observe increased agitation, pressured speech, poor personal hygiene, hyperactivity, and bizarre clothing. What is the nurses best intervention? a. Educate the patient about the proper ways to perform personal hygiene and coordinate clothing. b. Continue to monitor and document the patients speech patterns and motor activity. c. Ask the health care provider to prescribe an increased dose and frequency of lithium. d. Consider the need to check the lithium level. The patient may not be swallowing medications.d. Consider the need to check the lithium level. The patient may not be swallowing medications.A patient experiencing acute mania has disrobed in the hall three times in 2 hours. The nurse should: a. direct the patient to wear clothes at all times. b. ask if the patient finds clothes bothersome. c. tell the patient that others feel embarrassed. d. arrange for one-on-one supervision.d. arrange for one-on-one supervision.A patient experiencing acute mania is dancing atop the pool table in the recreation room. The patient waves a cue in one hand and says, Ill throw the pool balls if anyone comes near me. The nurses first intervention is to: a. tell the patient, You need to be secluded. b. help the patient down from the table. c. clear the room of all other patients. d. assemble a show of force.c. clear the room of all other patients.A patient receiving lithium should be assessed for which evidence of complications? a. Pharyngitis, mydriasis, and dystonia b. Alopecia, purpura, and drowsiness c. Diaphoresis, weakness, and nausea d. Ascites, dyspnea, and edemac. Diaphoresis, weakness, and nauseaAfter hospital discharge, what is the priority intervention for a patient diagnosed with bipolar disorder who is taking antimanic medication, as well as for the patients family? a. Decreasing physical activity b. Increasing food and fluids c. Meeting self-care needs d. Psychoeducationd. PsychoeducationA patient diagnosed with bipolar disorder is in the maintenance phase of treatment. The patient asks, Do I have to keep taking this lithium even though my mood is stable now? Select the nurses most appropriate response. a. You will be able to stop the medication in approximately 1 month. b. Taking the medication every day helps prevent relapses and recurrences. c. Usually patients take this medication for approximately 6 months after discharge. d. Its unusual that the health care provider has not already stopped your medication.b. Taking the medication every day helps prevent relapses and recurrences.A patient diagnosed with bipolar disorder and who takes lithium telephones the nurse at the clinic to say, Ive had severe diarrhea 4 days. I feel very weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do? The nurse should advise the patient: a. Restrict oral fluids for 24 hours and stay in bed. b. Have someone bring you to the clinic immediately. c. Drink a large glass of water with 1 teaspoon of salt added. d. Take an over-the-counter antidiarrheal medication hourly until the diarrhea subsides.b. Have someone bring you to the clinic immediately.Lithium is prescribed for a new patient. Which information from the patients history indicates that monitoring serum concentrations of the drug will be especially challenging and critical? a. Arthritis b. Epilepsy c. Psoriasis d. Congestive heart failured. Congestive heart failureA patient diagnosed with bipolar disorder is being treated as an outpatient during a hypomanic episode. Which suggestions should the nurse provide to the family? Select all that apply. a. Provide structure b. Limit credit card access c. Encourage group social interaction d. Limit work to half days e. Monitor the patients sleep patternsa. Provide structure b. Limit credit card access e. Monitor the patients sleep patternsA nurse prepares the plan of care for a patient having a manic episode. Which nursing diagnoses are most likely? Select all that apply. a. Imbalanced nutrition: more than body requirements b. Disturbed thought processes c. Sleep deprivation d. Chronic confusion e. Social isolationb. Disturbed thought processes c. Sleep deprivationA patient tells the nurse, I am so ashamed of being bipolar. When Im manic, my behavior embarrasses my family. Even if I take my medication, theres no guarantee I wont have a relapse. I am such a burden to my family. These statements support which nursing diagnoses? Select all that apply. a. Powerlessness b. Defensive coping c. Chronic low self-esteem d. Impaired social interaction e. Risk-prone health behaviora. Powerlessness c. Chronic low self-esteemA person diagnosed with schizophrenia has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today the person shouts, Theyre all plotting to destroy me. Select the nurses most therapeutic response. a. Everyone here is trying to help you. No one wants to harm you. b. Feeling that people want to destroy you must be very frightening. c. That is not true. People here are trying to help if you will let them. d. Staff members are health care professionals who are qualified to help you.b. Feeling that people want to destroy you must be very frightening.A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, I saw two doctors talking in the hall. They were plotting to kill me. The nurse may correctly assess this behavior as: a. echolalia. b. an idea of reference. c. a delusion of infidelity. d. an auditory hallucination.b. an idea of reference.A patient diagnosed with schizophrenia says, My co-workers are out to get me. I also saw two doctors plotting to overdose me. How does this patient perceive the environment? a. Disorganized b. Unpredictable c. Dangerous d. Bizarrec. DangerousWhen a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol (Haldol) was prescribed. The patient now says, I stopped taking those pills. They made me feel like a robot. What common side effects should the nurse validate with the patient? a. Sedation and muscle stiffness b. Sweating, nausea, and diarrhea c. Mild fever, sore throat, and skin rash d. Headache, watery eyes, and runny nosea. Sedation and muscle stiffnessA nurse works with a patient diagnosed with schizophrenia regarding the importance of medication management. The patient repeatedly says, I dont like taking pills. Which treatment strategy should the nurse discuss with the health care provider? a. Use of a long-acting antipsychotic injections b. Addition of a benzodiazepine, such as lorazepam (Ativan) c. Adjunctive use of an antidepressant, such as amitriptyline (Elavil) d. Inpatient hospitalization because of the high risk for exacerbation of symptomsa. Use of a long-acting antipsychotic injectionsA patients care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating? a. Aloofness, haughtiness, suspicion b. Darting eyes, tilted head, mumbling to self c. Elevated mood, hyperactivity, distractibility d. Performing rituals, avoiding open placesb. Darting eyes, tilted head, mumbling to selfA health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social functioning. The patient is also overweight and has hypertension. Which drug should the nurse advocate? a. clozapine (Clozaril) b. ziprasidone (Geodon) c. olanzapine (Zyprexa) d. aripiprazole (Abilify)d. aripiprazole (Abilify)A patient diagnosed with schizophrenia tells the nurse, I eat skiller. Tend to end. Easter. It blows away. Get it? Select the nurses best response. a. Nothing you are saying is clear. b. Your thoughts are very disconnected. c. Try to organize your thoughts, and then tell me again. d. I am having difficulty understanding what you are saying.d. I am having difficulty understanding what you are saying.A patient diagnosed with schizophrenia has catatonia. The patient has little spontaneous movement and waxy flexibility. Which patient needs are of priority importance? a. Psychosocial b. Physiologic c. Self-actualization d. Safety and securityb. PhysiologicA patient diagnosed with schizophrenia has catatonia. The patient is stuporous, demonstrates little spontaneous movement, and has waxy flexibility. The patients activities of daily living are severely compromised. An appropriate outcome is that the patient will: a. demonstrate increased interest in the environment by the end of week 1. b. perform self-care activities with coaching by the end of day 3. c. gradually take the initiative for self-care by the end of week 2. d. voluntarily accept tube feeding by day 2.b. perform self-care activities with coaching by the end of day 3.A nurse observes a patient who is diagnosed with schizophrenia. The patient is standing immobile, facing the wall with one arm extended in a salute. The patient remains immobile in this position for 15 minutes, moving only when the nurse gently lowers the arm. What is the name of this phenomenon? a. Echolalia b. Waxy flexibility c. Depersonalization d. Thought withdrawalb. Waxy flexibilityWhich patient diagnosed with schizophrenia would be expected to have the lowest level of overall functioning? a. 39 years old; paranoid ideation since age 35 years b. 32 years old; isolated episodes of catatonia since age 24 years; stable for 3 years c. 19 years old; diagnosed with schizophreniform disorder 6 months ago d. 40 years old; frequent relapses since age 18; often does not take medication as prescribedd. 40 years old; frequent relapses since age 18; often does not take medication as prescribedA patient with delusions of persecution about being poisoned has refused all hospital meals for 3 days. Which intervention is most likely to be acceptable to the patient? a. Allow the patient to have supervised access to food vending machines b. Allow the patient to telephone a local restaurant to deliver meals c. Offer to taste each portion on the tray for the patient d. Begin tube feedings or total parenteral nutritiona. Allow the patient to have supervised access to food vending machinesA community mental health nurse wants to establish a relationship with a very withdrawn patient diagnosed with schizophrenia. The patient lives at home with a supportive family. Select the nurses best plan. a. Visit daily for 4 days, then visit every other day for 1 week; stay with the patient for 20 minutes; accept silence; state when the nurse will return. b. Arrange to spend 1 hour each day with the patient; focus on asking questions about what the patient is thinking or experiencing; avoid silences. c. Visit twice daily; sit beside the patient with a hand on the patients arm; leave if the patient does not respond within 10 minutes. d. Visit every other day; remind the patient of the nurses identity; encourage the patient to talk while the nurse works on reports.a. Visit daily for 4 days, then visit every other day for 1 week; stay with the patient for 20 minutes; accept silence; state when the nurse will return.Patients diagnosed with schizophrenia who are suspicious and withdrawn: a. universally fear sexual involvement with therapists. b. are socially disabled by the positive symptoms of schizophrenia. c. exhibit a high degree of hostility as evidenced by rejecting behavior. d. avoid relationships because they become anxious with emotional closeness.d. avoid relationships because they become anxious with emotional closeness.A newly admitted patient diagnosed with schizophrenia says, The voices are bothering me. They yell and tell me Im bad. I have got to get away from them. Select the nurses most helpful reply. a. Do you hear the voices often? b. Do you have a plan for getting away from the voices? c. I will stay with you. Focus on what we are talking about, not the voices. d. Forget the voices. Ask some other patients to sit and talk with you.c. I will stay with you. Focus on what we are talking about, not the voices.A patient diagnosed with schizophrenia has taken fluphenazine (Prolixin) 5 mg orally twice daily for 3 weeks. The nurse now assesses a shuffling, propulsive gait; a masklike face; and drooling. Which term applies to these symptoms? a. Neuroleptic malignant syndrome b. Hepatocellular effects c. Pseudoparkinsonism d. Akathisiac. PseudoparkinsonismA patient diagnosed with schizophrenia is acutely disturbed and violent. After several doses of haloperidol (Haldol), the patient is calm. Two hours later the nurse sees the patients head rotated to one side in a stiff position; the lower jaw is thrust forward, and the patient is drooling. Which problem is most likely? a. Acute dystonic reaction b. Tardive dyskinesia c. Waxy flexibility d. Akathisiaa. Acute dystonic reactionAn acutely violent patient diagnosed with schizophrenia receives several doses of haloperidol (Haldol). Two hours later the nurse notices the patients head rotated to one side in a stiffly fixed position; the lower jaw is thrust forward, and the patient is drooling. Which intervention by the nurse is indicated? a. Administer diphenhydramine (Benadryl) 50 mg IM from the PRN medication administration record. b. Reassure the patient that the symptoms will subside. Practice relaxation exercises with the patient. c. Give trihexyphenidyl (Artane) 5 mg orally at the next regularly scheduled medication administration time. d. Administer atropine sulfate 2 mg subcutaneously from the PRN medication administration record.a. Administer diphenhydramine (Benadryl) 50 mg IM from the PRN medication administration record.A patient has taken trifluoperazine (Stelazine) 30 mg/day orally for 3 years. The clinic nurse notes that the patient grimaces and constantly smacks both lips. The patients neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect? a. Agranulocytosis b. Tardive dyskinesia c. Tourette syndrome d. Anticholinergic effectsb. Tardive dyskinesiaA nurse sits with a patient diagnosed with schizophrenia. The patient starts to laugh uncontrollably, although the nurse has not said anything funny. Select the nurses best response. a. Why are you laughing? b. Please share the joke with me. c. I dont think I said anything funny. d. You are laughing. Tell me whats happening.d. You are laughing. Tell me whats happening.Which symptoms are expected for a patient diagnosed with schizophrenia who has disorganization? a. Extremes of motor activity, from excitement to stupor b. Social withdrawal and ineffective communication c. Severe anxiety with ritualistic behavior d. Highly suspicious, delusional behaviorb. Social withdrawal and ineffective communicationWhat assessment findings mark the prodromal stage of schizophrenia? a. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion b. Auditory hallucinations, ideas of reference, thought insertion, and broadcasting c. Stereotyped behavior, echopraxia, echolalia, and waxy flexibility d. Loose associations, concrete thinking, and echolalia neologismsa. Withdrawal, misinterpreting, poor concentration, and preoccupation with religionA patient diagnosed with schizophrenia says, Everyone has skin lice that jump on you and contaminate your blood. Which problem is evident? a. Poverty of content b. Concrete thinking c. Neologisms d. Paranoiad. ParanoiaA patient diagnosed with schizophrenia has paranoid thinking. The patient angrily tells a nurse, You are mean and nasty. No one trusts you or wants to be around you. Select the most likely analysis. The patient: a. is trying to manipulate the nurse by using negative comments. b. is likely to experience disorganization and catatonia in the near future. c. is jealous of the nurses position of power in the relationship. d. may be identifying another persons shortcomings in order to preserve his or her own self-esteem.d. may be identifying another persons shortcomings in order to preserve his or her own self-esteem.A patient diagnosed with schizophrenia says, High heat. Last time here. Did you get a coat? What type of verbalization is evident? a. Neologism b. Idea of reference c. Thought broadcasting d. Associative loosenessd. Associative loosenessA patient diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive but the patient continues to have apathy, poverty of thought, and social isolation. The nurse expects a change to which medication? a. haloperidol (Haldol) b. olanzapine (Zyprexa) c. chlorpromazine (Thorazine) d. diphenhydramine (Benadryl)b. olanzapine (Zyprexa)The family of a patient diagnosed with schizophrenia is unfamiliar with the illness and the familys role in recovery. Which type of therapy should the nurse recommend? a. Psychoeducational b. Psychoanalytic c. Transactional d. Familya. PsychoeducationalA patient diagnosed with schizophrenia has been stable for a year; however, the family now reports the patient is tense, sleeps 3 to 4 hours per night, and has difficulty concentrating. The patient says, Demons are in the basement and they can come through the floor. The nurse can correctly assess this information as an indication of: a. need for psychoeducation b. medication noncompliance c. chronic deterioration d. relapsed. relapseA patient diagnosed with schizophrenia begins to talks about cracklomers in the local shopping mall. The term cracklomers should be documented as: a. neologism. b. concrete thinking. c. thought insertion. d. an idea of reference.a. neologism.A patient diagnosed with schizophrenia anxiously says, I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror. While listening, the nurse should: a. sit close to the patient. b. place an arm protectively around the patients shoulders. c. place a hand on the patients arm and exert light pressure. d. maintain a normal social interaction distance from the patient.d. maintain a normal social interaction distance from the patient.A patient diagnosed with schizophrenia has auditory hallucinations. The patient anxiously tells the nurse, The voice is telling me to do things. Select the nurses priority assessment question. a. How long has the voice been directing your behavior? b. Do the messages from the voice frighten you? c. Do you recognize the voice speaking to you? d. What is the voice telling you to do?d. What is the voice telling you to do?A patient receiving risperidone (Risperdal) reports severe muscle stiffness at 10:30 AM. By noon, the patient is diaphoretic, drooling, and has difficulty swallowing. By 4:00 PM, vital signs are body temperature, 102.8 F; pulse, 110 beats per minute; respirations, 26 breaths per minute; and blood pressure, 150/90 mm Hg. Select the nurses best analysis and action. a. Agranulocytosis. Institute reverse isolation. b. Tardive dyskinesia. Withhold the next dose of medication. c. Cholestatic jaundice. Begin a high-protein, low fat diet. d. Neuroleptic malignant syndrome. Immediately notify the health care provider.d. Neuroleptic malignant syndrome. Immediately notify the health care provider.A patient diagnosed with schizophrenia begins a new prescription for lurasidone HCl (Latuda). The patient is 5?26?3? tall and currently weighs 204 pounds. Which topic is most important for the nurse to include in the teaching plan related to this medication? a. How to recognize tardive dyskinesia b. Weight management strategies c. Ways to manage constipation d. Sleep hygiene measuresb. Weight management strategiesA patient diagnosed with schizophrenia has auditory hallucinations, delusions of grandeur, poor personal hygiene, and motor agitation. Which assessment finding would the nurse regard as a negative symptom of schizophrenia? a. Auditory hallucinations b. Delusions of grandeur c. Poor personal hygiene d. Motor agitationc. Poor personal hygieneThe family members of a patient newly diagnosed with schizophrenia state that they do not understand what has caused the illness. The nurses response should be based on which models? Select all that apply. a. Neurobiological b. Environmental c. Family theory d. Genetic e. Stressa. Neurobiological d. GeneticA nurse at the mental health clinic plans a series of psychoeducational groups for persons diagnosed with schizophrenia. Which two topics would take priority? a. How to complete an application for employment b. The importance of correctly taking your medication c. How to dress when attending community events d. How to give and receive compliments e. Ways to quit smokingb. The importance of correctly taking your medication e. Ways to quit smokingA patient diagnosed with schizophrenia is hospitalized after arguing with co-workers and threatening to harm them. The patient is aloof and suspicious and says, Two staff members I saw talking were plotting to assault me. Based on data gathered at this point, which nursing diagnoses relate? Select all that apply. a. Risk for other-directed violence b. Disturbed thought processes c. Risk for loneliness d. Spiritual distress e. Social isolationa. Risk for other-directed violence b. Disturbed thought processesWhich changes in brain biochemical function is most associated with suicidal behavior? a. Dopamine excess b. Serotonin deficiency c. Acetylcholine excess d. Gamma-aminobutyric acid deficiencyb. Serotonin deficiencyA college student failed two tests. Afterward, the student cried for hours and then tried to telephone a parent but got no answer. The student then gave several expensive sweaters to a roommate. Which behavior provides the strongest clue of an impending suicide attempt? a. Calling parents b. Excessive crying c. Giving away sweaters d. Staying alone in a dorm roomc. Giving away sweatersA nurse uses the SAD PERSONS scale to interview a patient. This tool provides data relevant to: a. current stress level. b. mood disturbance. c. suicide potential. d. level of anxiety.c. suicide potential.A person intentionally overdoses on antidepressant drugs. Which nursing diagnosis has the highest priority? a. Powerlessness b. Social isolation c. Risk for suicide d. Ineffective management of the therapeutic regimenc. Risk for suicideA person attempts suicide by overdose, is treated in the emergency department, and then hospitalized. What is the best initial outcome? The patient will: a. verbalize a will to live by the end of the second hospital day. b. describe two new coping mechanisms by the end of the third hospital day. c. accurately delineate personal strengths by the end of first week of hospitalization. d. exercise suicide self-restraint by refraining from gestures or attempts to kill self for 24 hours.d. exercise suicide self-restraint by refraining from gestures or attempts to kill self for 24 hours.A college student who attempted suicide by overdose is hospitalized. When the parents are contacted, they respond, There must be a mistake. This could not have happened. Weve given our child everything. The parents reaction reflects: a. denial. b. anger. c. anxiety. d. rescue feelings.a. denial.An adolescent tells the school nurse, My friend threatened to take an overdose of pills. The nurse talks to the friend who verbalized the suicide threat. The most critical question for the nurse to ask would be: a. Why do you want to kill yourself? b. Do you have access to medications? c. Have you been taking drugs and alcohol? d. Did something happen with your parents?b. Do you have access to medications?An adult attempts suicide after declaring bankruptcy. The patient is hospitalized and takes an antidepressant medication for five days. The patient is now more talkative and shows increased energy. Select the highest priority nursing intervention. a. Supervise the patient 24 hours a day. b. Begin discharge planning for the patient. c. Refer the patient to art and music therapists. d. Consider the discontinuation of suicide precautions.a. Supervise the patient 24 hours a day.A nurse and patient construct a no-suicide contract. Select the preferable wording for the contract. a. I will not try to harm myself during the next 24 hours. b. I will not make a suicide attempt while I am hospitalized. c. For the next 24 hours, I will not kill or harm myself in any way. d. I will not kill myself until I call my primary nurse or a member of the staff.c. For the next 24 hours, I will not kill or harm myself in any way.A tearful, anxious patient at the outpatient clinic reports, I should be dead. The initial task of the nurse conducting the assessment interview is to: a. assess the lethality of a suicide plan. b. encourage expression of anger. c. establish a rapport with the patient. d. determine risk factors for suicide.c. establish a rapport with the patient.Select the most helpful response for a nurse to make when a patient being treated as an outpatient states, I am considering suicide. a. Im glad you shared this. Please do not worry. We will handle it together. b. I think you should admit yourself to the hospital to get help. c. We need to talk about the good things you have to live for. d. Bringing this up is a very positive action on your part.d. Bringing this up is a very positive action on your part.Which intervention should a nurse recommend for the distressed family and friends of someone who has committed suicide? a. Participating in reminiscence therapy b. Attending a self-help group for survivors c. Contracting for two sessions of group therapy d. Completing a psychological postmortem assessmentb. Attending a self-help group for survivorsWhich statement provides the best rationale for why a nurse should closely monitor a severely depressed patient during antidepressant medication therapy? a. As depression lifts, physical energy becomes available to carry out suicide. b. Suicide may be precipitated by a variety of internal and external events. c. Suicidal patients have difficulty using social supports. d. Suicide is an impulsive act.a. As depression lifts, physical energy becomes available to carry out suicide.A nurse assesses a patient who reports a 3-week history of depression and crying spells. The patient says, My business is bankrupt, and I was served with divorce papers. Which subsequent statement by the patient alerts the nurse to a concealed suicidal message? a. I wish I were dead. b. Life is not worth living. c. I have a plan that will fix everything. d. My family will be better off without me.c. I have a plan that will fix everything.A depressed patient says, Nothing matters anymore. What is the most appropriate response by the nurse? a. Are you having thoughts of suicide? b. I am not sure I understand what you are trying to say. c. Try to stay hopeful. Things have a way of working out. d. Tell me more about what interested you before you began feeling depressed.a. Are you having thoughts of suicide?A nurse counsels a patient with recent suicidal ideation. Which is the nurses most therapeutic comment? a. Lets make a list of all your problems and think of solutions for each one. b. Im happy youre taking control of your problems and trying to find solutions. c. When you have bad feelings, try to focus on positive experiences from your life. d. Lets consider which problems are most important and which are less important.d. Lets consider which problems are most important and which are less important.When assessing a patients plan for suicide, what aspect has priority? a. Patients financial and educational status b. Patients insight into suicidal motivation c. Availability of means and lethality of method d. Quality and availability of patients social supportc. Availability of means and lethality of methodWhich understanding about individuals who attempt suicide will help a nurse plan the care for a suicidal patient? Every suicidal person should be considered: a. mentally ill. b. intent on dying. c. cognitively impaired. d. experiencing hopelessness.d. experiencing hopelessness.Which statement by a patient during an assessment interview should alert the nurse to the patients need for immediate, active intervention? a. I am mixed up, but I know I need help. b. I have no one for help or support. c. It is worse when you are a person of color. d. I tried to get attention before I shot myself.b. I have no one for help or support.The feeling experienced by a patient that should be assessed by the nurse as most predictive of elevated suicide risk is: a. hopelessness. b. sadness. c. elation. d. anger.a. hopelessness.Four individuals have given information about their suicide plans. Which plan evidences the highest suicide risk? a. Jumping from a 100-foot-high railroad bridge located in a deserted area late at night b. Turning on the oven and letting gas escape into the apartment during the night c. Cutting the wrists in the bathroom while the spouse reads in the next room d. Overdosing on aspirin with codeine while the spouse is out with friendsa. Jumping from a 100-foot-high railroad bridge located in a deserted area late at nightWhich individual in the emergency department should be considered at the highest risk for completing suicide? a. An adolescent Asian-American girl with superior athletic and academic skills who has asthma b. A 38-year-old single African-American female church member with fibrocystic breast disease c. A 60-year-old married Hispanic man with 12 grandchildren who has type 2 diabetes d. A 79-year-old single white man with cancer of the prostate glandd. A 79-year-old single white man with cancer of the prostate glandA nurse answers a suicide crisis line. A caller says, I live alone in a home several miles from my nearest neighbors. I have been considering suicide for 2 months. I have had several drinks and now my gun is loaded. Im going to shoot myself in the heart. How would the nurse assess the lethality of this plan? a. No risk b. Low level c. Moderate level d. High leveld. High levelA staff nurse tells another nurse, I evaluated a new patient using the SAD PERSONS scale and got a score of 10. Im wondering if I should send the patient home. Select the best reply by the second nurse. a. That action would seem appropriate. b. A score over 8 requires immediate hospitalization. c. I think you should strongly consider hospitalization for this patient. d. Give the patient a follow-up appointment. Hospitalization may be needed soon.b. A score over 8 requires immediate hospitalization.A patient recently hospitalized for two weeks committed suicide during the night. Which initial measure will be most helpful for staff members and other patients regarding this event? a. Request the public information officer to make an announcement to the local media. b. Hold a staff meeting to express feelings and plan the care for other patients. c. Ask the patients roommate not to discuss the event with other patients. d. Quickly discharge as many patients as possible to prevent panic.b. Hold a staff meeting to express feelings and plan the care for other patients.A severely depressed patient who has been on suicide precautions tells the nurse, I am feeling a lot better, so you can stop watching me. I have taken too much of your time already. Which is the nurses best response? a. I wonder what this sudden change is all about. Please tell me more. b. I am glad you are feeling better. The team will consider your request. c. You should not try to direct your care. Leave that to the treatment team. d. Because we are concerned about your safety, we will continue with our plan.d. Because we are concerned about your safety, we will continue with our plan.A new nurse says to a peer, My newest patient is diagnosed with schizophrenia. At least I wont have to worry about suicide risk. Which response by the peer would be most helpful? a. Lets reconsider your plan. Suicide risk is high in patients diagnosed with schizophrenia. b. Suicide is a risk for any patient diagnosed with schizophrenia who uses alcohol or drugs. c. Patients diagnosed with schizophrenia are usually too disorganized to attempt suicide. d. Visual hallucinations often prompt suicide among patients diagnosed with schizophrenia.a. Lets reconsider your plan. Suicide risk is high in patients diagnosed with schizophrenia.The parents of identical twins ask a nurse for advice. One twin committed suicide a month ago. Now the parents are concerned that the other twin may also have suicidal tendencies. Which comment by the nurse is accurate? a. Genetics are associated with suicide risk. Monitoring and support are important. b. Apathy underlies suicide. Instilling motivation is the key to health maintenance. c. Your child is unlikely to act out suicide when identifying with a suicide victim. d. Fraternal twins are at higher risk for suicide than identical twins.a. Genetics are associated with suicide risk. Monitoring and support are important.A college student failed two examinations. The student cried for hours and then tried to call a parent but got no answer. The student then suspended access to his social networking web site. Which suicide risk factors are present? Select all that apply. a. History of earlier suicide attempt b. Co-occurring medical illness c. Recent stressful life event d. Self-imposed isolation e. Shame or humiliationc. Recent stressful life event d. Self-imposed isolation e. Shame or humiliationA patient with suicidal impulses is on the highest level of suicide precautions. Which measures should the nurse incorporate into the patients plan of care? Select all that apply. a. Allow no glass or metal on meal trays. b. Remove all potentially harmful objects from the patients possession. c. Maintain arms length, one-on-one nursing observation around the clock. d. Check the patients whereabouts every hour. Make verbal contact at least three times each shift. e. Check the patients whereabouts every 15 minutes, and make frequent verbal contacts. f. Keep the patient within visual range while he or she is awake. Check every 15 to 30 minutes while the patient is sleeping.a. Allow no glass or metal on meal trays. b. Remove all potentially harmful objects from the patients possession. c. Maintain arms length, one-on-one nursing observation around the clock.A nurse assesses five newly hospitalized patients. Which patients have the highest suicide risk? Select all that apply. a. 82-year-old white man b. 17-year-old white female adolescent c. 39-year-old African-American man d. 29-year-old African-American woman e. 22-year-old man with traumatic brain injurya. 82-year-old white man b. 17-year-old white female adolescent e. 22-year-old man with traumatic brain injuryA nurse assesses the health status of soldiers returning from Afghanistan. Screening for which health problems will be a priority? Select all that apply. a. Schizophrenia b. Eating disorder c. Traumatic brain injury d. Oppositional defiant disorder e. Post-traumatic stress disorderc. Traumatic brain injury e. Post-traumatic stress disorder1. A health care provider recently convicted of Medicare fraud says to a nurse, "Sure I overbilled. Everyone takes advantage of the government. There are too many rules to follow and I should get the money." These statements show: a. shame. b. suspiciousness. c. superficial remorse. d. lack of guilt feelings.d. lack of guilt feelings.2. Which intervention is appropriate for an individual diagnosed with an antisocial personality disorder who frequently manipulates others? a. Refer requests and questions related to care to the case manager. b. Encourage the patient to discuss feelings of fear and inferiority. c. Provide negative reinforcement for acting-out behavior. d. Ignore, rather than confront, inappropriate behavior.a. Refer requests and questions related to care to the case manager.3. As a nurse prepares to administer medication to a patient diagnosed with a borderline personality disorder, the patient says, "Just leave it on the table. I'll take it when I finish combing my hair." What is the nurse's best response? a. Reinforce this assertive action by the patient. Leave the medication on the table as requested. b. Respond to the patient, "I'm worried that you might not take it. I'll come back later." c. Say to the patient, "I must watch you take the medication. Please take it now." d. Ask the patient, "Why don't you want to take your medication now?"c. Say to the patient, "I must watch you take the medication. Please take it now."4. What is an appropriate initial outcome for a patient diagnosed with a personality disorder who frequently manipulates others? The patient will: a. identify when feeling angry. b. use manipulation only to get legitimate needs met. c. acknowledge manipulative behavior when it is called to his or her attention. d. accept fulfillment of his or her requests within an hour rather than immediately.c. acknowledge manipulative behavior when it is called to his or her attention.5. Consider this comment to three different nurses by a patient diagnosed with an antisocial personality disorder, "Another nurse said you don't do your job right." Collectively, these interactions can be assessed as: a. seductive. b. detached. c. manipulative. d. guilt-producing.c. manipulative.9. What is the priority nursing diagnosis for a patient diagnosed with antisocial personality disorder who has made threats against staff, ripped art off the walls, and thrown objects? a. Risk for other-directed violence b. Risk for self-directed violence c. Impaired social interaction d. Ineffective deniala. Risk for other-directed violence6. A nurse reports to the treatment team that a patient diagnosed with an antisocial personality disorder has displayed the behaviors below. This patient is detached and superficial during counseling sessions. Which behavior by the patient most clearly warrants limit setting? a. Flattering the nurse b. Lying to other patients c. Verbal abuse of another patient d. Detached superficiality during counselingc. Verbal abuse of another patient10. When a patient diagnosed with a personality disorder uses manipulation to get needs met, the staff applies limit-setting interventions. What is the correct rationale for this action? a. It provides an outlet for feelings of anger and frustration. b. It respects the patient's wishes, so assertiveness will develop. c. External controls are necessary due to failure of internal control. d. Anxiety is reduced when staff assumes responsibility for the patient's behavior.c. External controls are necessary due to failure of internal control.7. A patient diagnosed with borderline personality disorder has a history of self-mutilation and suicide attempts. The patient reveals feelings of depression and anger with life. Which type of medication would the nurse expect to be prescribed? a. Benzodiazepine b. Mood stabilizing medication c. Monoamine oxidase inhibitor (MAOI) d. Serotonin norepinephrine reuptake inhibitor (SNRI)b. Mood stabilizing medication11. One month ago, a patient diagnosed with borderline personality disorder and a history of self-mutilation began dialectical behavior therapy. Today the patient phones to say, "I feel empty and want to hurt myself." The nurse should: a. arrange for emergency inpatient hospitalization. b. send the patient to the crisis intervention unit for 8 to 12 hours. c. assist the patient to choose coping strategies for triggering situations. d. advise the patient to take an anti-anxiety medication to decrease the anxiety level.c. assist the patient to choose coping strategies for triggering situations.8. A patient's spouse filed charges after repeatedly being battered. The patient sarcastically says, "I'm sorry for what I did. I need psychiatric help." Which statement by the patient supports an antisocial personality disorder? a. "I have a quick temper, but I can usually keep it under control." b. "I've done some stupid things in my life, but I've learned a lesson." c. "I'm feeling terrible about the way my behavior has hurt my family." d. "I hit because I am tired of being nagged. My spouse deserves the beating."d. "I hit because I am tired of being nagged. My spouse deserves the beating."12. What is the most challenging nursing intervention with patients diagnosed with personality disorders who use manipulation? a. Supporting behavioral change suicide attempts b. Maintaining consistent limits c. Monitoring d. Using aversive therapyb. Maintaining consistent limits13. The history shows that a newly admitted patient is impulsive. The nurse would expect behavior characterized by: a. adherence to a strict moral code. b. manipulative, controlling strategies. c. acting without thought on urges or desires. d. postponing gratification to an appropriate time.b. manipulative, controlling strategies.14. A patient says, "I get in trouble sometimes because I make quick decisions and act on them." Select the nurse's most therapeutic response. a. "Let's consider the advantages of being able to stop and think before acting." b. "It sounds as though you've developed some insight into your situation." c. "I bet you have some interesting stories to share about overreacting." d. "It's good that you're showing readiness for behavioral change."a. "Let's consider the advantages of being able to stop and think before acting."15. A patient diagnosed with borderline personality disorder was hospitalized several times after self-mutilating episodes. The patient remains impulsive. Which nursing diagnosis is the initial focus of this therapy? a. Risk for self-directed violence b. Impaired skin integrity c. Risk for injury d. Powerlessnessa. Risk for self-directed violence16. Which statement made by a patient diagnosed with borderline personality disorder indicates the treatment plan is effective? a. "I think you are the best nurse on the unit." b. "I'm never going to get high on drugs again." c. "I felt empty and wanted to hurt myself, so I called you." d. "I hate my mother. I called her today, and she wasn't home."c. "I felt empty and wanted to hurt myself, so I called you."17. When preparing to interview a patient diagnosed with narcissistic personality disorder, a nurse can anticipate the assessment findings will include: a. preoccupation with minute details; perfectionist. b. charm, drama, seductiveness; seeking admiration. c. difficulty being alone; indecisive, submissiveness. d. grandiosity, self-importance, and a sense of entitlement.d. grandiosity, self-importance, and a sense of entitlement.18. For which behavior would limit setting be most essential? The patient who: a. clings to the nurse and asks for advice about inconsequential matters. b. is flirtatious and provocative with staff members of the opposite sex. c. is hypervigilant and refuses to attend unit activities. d. urges a suspicious patient to hit anyone who stares.d. urges a suspicious patient to hit anyone who stares.19. The nurse caring for an individual demonstrating symptoms of schizotypal personality disorder would expect assessment findings to include: a. arrogant, grandiose, and a sense of self-importance. b. attention seeking, melodramatic, and flirtatious. c. impulsive, restless, socially aggressive behavior. d. socially anxious, rambling stories, peculiar ideas.d. socially anxious, rambling stories, peculiar ideas.20. Others describe a worker as very shy and lacking in self-confidence. This worker stays in an office cubicle all day, never coming out for breaks or lunch. Which term best describes this behavior? a. Narcissistic b. Histrionic c. Avoidant d. Paranoidc. Avoidant21. What is the priority intervention for a nurse beginning to work with a patient diagnosed with a schizotypal personality disorder? a. Respect the patient's need for periods of social isolation. b. Prevent the patient from violating the nurse's rights. c. Teach the patient how to select clothing for outings. d. Engage the patient in community activities.a. Respect the patient's need for periods of social isolation.22. A patient diagnosed with borderline personality disorder self-inflicted wrist lacerations after gaining new privileges on the unit. In this case, the self-mutilation may have been due to: a. an inherited disorder that manifests itself as an incapacity to tolerate stress. b. use of projective identification and splitting to bring anxiety to manageable levels. c. a constitutional inability to regulate affect, predisposing to psychic disorganization. d. fear of abandonment associated with progress toward autonomy and independence.d. fear of abandonment associated with progress toward autonomy and independence.26. A nursing diagnosis appropriate to consider for a patient diagnosed with any of the personality disorders is: a. noncompliance. b. impaired social interaction. c. disturbed personal identity. d. diversional activity deficit.b. impaired social interaction.23. A patient diagnosed with borderline personality disorder has self-inflicted wrist lacerations. The health care provider prescribes daily dressing changes. The nurse performing this care should: a. maintain a stern and authoritarian affect. b. provide care in a matter-of-fact manner. c. encourage the patient to express anger. d. be very rigid and challenging.b. provide care in a matter-of-fact manner.27. A new psychiatric technician says, "Schizophrenia...schizotypal! What's the difference?" The nurse's response should include which information? a. A patient diagnosed with schizophrenia is not usually overtly psychotic. b. In schizotypal personality disorder, the patient remains psychotic much longer. c. With schizotypal personality disorder, the person can be made aware of misinterpretations of reality. d. Schizotypal personality disorder causes more frequent and more prolonged hospitalizations than schizophrenia.c. With schizotypal personality disorder, the person can be made aware of misinterpretations of reality.24. A nurse set limits while interacting with a patient demonstrating behaviors associated with borderline personality disorder. The patient tells the nurse, "You used to care about me. I thought you were wonderful. Now I can see I was wrong. You're evil." This outburst can be assessed as: a. denial. b. splitting. c. defensive. d. reaction formation.b. splitting.28. Personality traits most likely to be documented regarding a patient demonstrating characteristics of an obsessive-compulsive personality disorder are: a. affable, generous. b. perfectionist, inflexible. c. suspicious, holds grudges. d. dramatic speech, impulsive.b. perfectionist, inflexible.25. Which characteristic of personality disorders makes it most necessary for staff to schedule frequent team meetings in order to address the patient's needs and maintain a therapeutic milieu? a. Ability to achieve true intimacy b. Flexibility and adaptability to stress c. Ability to provoke interpersonal conflict d. Inability to develop trusting relationshipsc. Ability to provoke interpersonal conflict29. A nurse determines desired outcomes for a patient diagnosed with schizotypal personality disorder. Select the best outcome. The patient will: a. adhere willingly to unit norms. b. report decreased incidence of self-mutilative thoughts. c. demonstrate fewer attempts at splitting or manipulating staff. d. demonstrate ability to introduce self to a stranger in a social situation.d. demonstrate ability to introduce self to a stranger in a social situation.30. A patient says, "The other nurses won't give me my medication early, but you know what it's like to be in pain and don't let your patients suffer. Could you get me my pill now? I won't tell anyone." Which response by the nurse would be most therapeutic? a. "I'm not comfortable doing that," and then ignore subsequent requests for early medication. b. "I understand that you have pain, but giving medicine too soon would not be safe." c. "I'll have to check with your doctor about that; I will get back to you after I do." d. "It would be unsafe to give the medicine early; none of us will do that."b. "I understand that you have pain, but giving medicine too soon would not be safe."MULTIPLE RESPONSE 1. A nurse plans care for an individual diagnosed with antisocial personality disorder. Which characteristic behaviors will the nurse expect? Select all that apply. a. Reclusive behavior b. Callous attitude c. Perfectionism d. Aggression e. Clinginess f. Anxietyb. Callous attitude d. Aggression2. For which patients diagnosed with personality disorders would a family history of similar problems be most likely? Select all that apply. a. Obsessive-compulsive b. Antisocial c. Borderline d. Schizotypal e. Narcissistica. Obsessive-compulsive b. Antisocial c. Borderline d. SchizotypalJosie, a 27 year old patient complains that the most of the staff do not like her or care what happens to her, but you are special and she can tell you that you are a caring person. She talks with you about being unsure of what she want to do with her life and her "mix-up feelings" about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it "makes the numbness stops." Given the presentation, which personality disorder would you suspect? a. obsessive compulsive b. borderline c. antisocial d. schizotypalb. borderlineWhich statement about persons with personality disorders is accurate? a. they, unlike those with mood or psychotic disorders, are at very low risk of suicide b. they tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them c. they are believed to be purely psychological disorders, that is, disorders arising from psychological rather than neurological or other other physiological abnormalities d. their symptoms are not as disabling as most other mental disorders, therefore their care tends to be less challenging and complicated for staffb. they tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward themLacey, a 19 year old, shows you multiple fresh, serious (but non life threatening) self-inflicted cuts on her forearms. Which response would bet he most therapeutic? a. im so sorry you felt so bad that you cut yourself lets discuss what led up to this action while i take care of your wounds b. i will take care of your wounds first then you will have to be searched for anything else you could injure yourself with c. i can give you some bandaids for you to put on your cuts, but you need to stop this attention seeking behavior d. after i care for your wounds i would like you to write down what you were feeling and thinking before you cut yourself. then we will discuss it.d. after i care for your wounds i would like you to write down what you were feeling and thinking before you cut yourself. then we will discuss it.Alicia, a 31 year old patient, is flirting with a peer. She is overheard asking him to convince staff to give her privileges to leave the inpatient mental health unit. Later she offers you a back rub in exchange receiving her 10:00 pm Xanax an hour early. Which responses to such behaviors would be themes therapeutic? Select all that apply. a. label the behavior as undesirable, and explore with alicia more effective ways to meet her needs. b. by role playing, demo other approaches alicia could use to meet her needs c. advise the other patients that alicia is being manipulative and that they should ignore her when she behaves this way d. bargain with alicia to determine a reasonable compromise regarding how much of such behavior is acceptable before she crosses the line e. explain that such behavior is unacceptable, and give alicia specific examples of consequences that will be enacted if the behavior continues f. ignore the behavior for the time being so alicia will find it unrewarding and in turn seek other, and hopefully more adaptive, ways to meet her needsa. label the behavior as undesirable, and explore with alicia more effective ways to meet her needs. b. by role playing, demo other approaches alicia could use to meet her needs e. explain that such behavior is unacceptable, and give alicia specific examples of consequences that will be enacted if the behavior continuesA patient becomes frustrated and angry and when trying to get hi MP3 player and headset to function properly and angrily throws it across the room, nearly hitting a peer with it. Which interventions would be the most therapeutic. Select all that apply. a. place the pt in seclusion for an hour to allow him to deescalate b. tell the pt that any further outbursts will result in a loss of privileges c. offer to help the pt learn how to operate his music player and headset d. explore with the pt how he was feeling as he worked with the music player e. point out the consequences of such behavior and note that it cannot be tolerated f. limit the pts exposure to frustrating experiences until he attains improved coping skills g. encourage the pt to recognize signs of escalating tension and seek assistancea. place the pt in seclusion for an hour to allow him to deescalate d. explore with the pt how he was feeling as he worked with the music player e. point out the consequences of such behavior and note that it cannot be tolerated g. encourage the pt to recognize signs of escalating tension and seek assistanceMary Alice is a 37-year-old patient referred to the mental health clinic with a suspected personality disorder. She is withdrawn and suspicious and states she has always preferred to be alone. She describes herself as having "special powers" and states that she is thinking of opening a business where she gives "readings" to people about their future. She states, "I believe we can all read each other's thoughts at times." Based on this presentation, you suspect: a. obsessive-compulsive personality disorder. b. narcissistic personality disorder. c. avoidant personality disorder. d. schizotypal personality disorder (STPD).d. schizotypal personality disorder (STPD).Which of the following are true of antisocial personality disorder (APD)? (select all that apply): a. It is the least studied of the personality disorders. b. It is characterized by rigidity and inflexible standards of self and others. c. Persons with APD display magical thinking. d. Persons with APD are concerned with personal pleasure and power. e. It is characterized by deceitfulness, disregard for others, and manipulation. f. Persons with APD usually present for treatment because of awareness of how their behavior is affecting others. g. Frontal lobe dysfunction is a brain change identified in APD.d. Persons with APD are concerned with personal pleasure and power. e. It is characterized by deceitfulness, disregard for others, and manipulation. g. Frontal lobe dysfunction is a brain change identified in APD.Patients with borderline personality disorder (BPD) exhibit negative effect, which includes emotional _____________, described as rapidly moving from one emotional extreme to another.LabilityWhich is true of pharmacological therapies for treatment of personality disorders? a. Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. b. Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. c. Patients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. d. Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients.a. Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident.Belinda is a 24-year-old patient with borderline personality disorder (BPD). She is admitted to the inpatient psychiatric unit following a suicide attempt. You are caring for Belinda. Which of the following statements by Belinda illustrates a primary coping style of persons with BPD? a. "My provider says I might get out of here tomorrow. Do you think I'm ready to go?" b. "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." c. "I will never again speak to any of my messed up family members. I know that this will help me be more functional." d. "I promise I am not feeling suicidal. I won't hurt myself."b. "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here."1. Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. She wears layered, loose clothing and now has amenorrhea. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely? a. Binge eating disorder b. Anorexia nervosa c. Bulimia nervosa d. Picab. Anorexia nervosa2. Disturbed body image is the nursing diagnosis for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor? a. Weight, muscle, and fat are congruent with height, frame, age, and sex. b. Calorie intake is within the required parameters of the treatment plan. c. Weight reaches the established normal range for the patient. d. Patient expresses satisfaction with body appearance.d. Patient expresses satisfaction with body appearance3. A patient who is referred to the eating disorders clinic has lost 35 pounds in the past 3 months. To assess the patient's oral intake, the nurse should ask: a. "Do you often feel fat?" b. "Who plans the family meals?" c. "What do you eat in a typical day?" d. "What do you think about your present weight?"c. "What do you eat in a typical day?"4. A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and has lost 25% of body weight. A nurse asks, "Describe what you think about your present weight and how you look." Which response by the patient is most consistent with the diagnosis? a. "I am fat and ugly." b. "What I think about myself is my business." c. "I am grossly underweight, but that's what I want." d. "I am a few pounds overweight, but I can live with it."a. "I am fat and ugly."5. A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and has lost 25% of body weight. The patient's current serum potassium is 2.7 mg/dl. Which nursing diagnosis applies? a. Adult failure to thrive, related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss b. Disturbed energy field, related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia c. Ineffective health maintenance, related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia d. Imbalanced nutrition: less than body requirements, related to malnutrition as evidenced by loss of 25% of body weight and hypokalemiad. Imbalance nutrition: less than body requirements, related to malnutrition as evidenced by loss of 25% of body weight and hypokalemia6. Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important outcome related to the nursing diagnosis: Imbalanced nutrition: less than body requirements. Within 1 week, the patient will: a. weigh self accurately using balanced scales. b. limit exercise to less than 2 hours daily. c. select clothing that fits properly. d. gain 1 to 2 pounds.d. gain 1 to 2 pounds7. Which nursing intervention has priority as a patient diagnosed with anorexia nervosa begins to gain weight? a. Assess for depression and anxiety. b. Observe for adverse effects of re-feeding. c. Communicate empathy for the patient's feelings. d. Help the patient balance energy expenditure and caloric intake.b. Observe for adverse effects of re-feeding8. A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain? a. Because severe anxiety concerning eating is expected, objective and subjective data must be routinely collected. b. Patient involvement in decision-making increases a sense of control and promotes compliance with the treatment. c. A team approach to planning the diet ensures that physical and emotional needs of the patient are met. d. Because of increased risk for physical problems with re-feeding, obtaining patient permission is required.b. Patient involvement in decision-making increases a sense of control and promotes compliance with the treatment9. The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention "Monitor for complications of re-feeding." Which body system should a nurse closely monitor for dysfunction? a. Renal b. Endocrine c. Central nervous d. Cardiovasculard. Cardiovascular10. A psychiatric clinical nurse specialist uses cognitive therapy techniques with a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy? a. "What are your feelings about not eating the food that you prepare?" b. "You seem to feel much better about yourself when you eat something." c. "It must be difficult to talk about private matters to someone you just met." d. "Being thin does not seem to solve your problems. You are thin now but still unhappy."d. "Being thin does not seem to solve your problems. You are thin but now still unhappy."11. An appropriate intervention for a patient diagnosed with bulimia nervosa who binges and purges is to teach the patient to: a. eat a small meal after purging. b. avoid skipping meals or restricting food. c. concentrate oral intake after 4 PM daily. d. understand the value of reading journal entries aloud to others.b. avoid skipping meals or restricting food.12. What behavior by a nurse caring for a patient diagnosed with an eating disorder indicates the nurse needs supervision? a. The nurse's comments are nonjudgmental. b. The nurse uses an authoritarian manner when interacting with the patient. c. The nurse teaches the patient to recognize signs of increasing anxiety and ways to intervene. d. The nurse refers the patient to a self-help group for individuals with eating disorders.b. The nurse uses an authoritarian manner when interacting with the patient.13. A nursing diagnosis for a patient diagnosed with bulimia nervosa is: Ineffective coping, related to feelings of loneliness as evidenced by overeating to comfort self, followed by self-induced vomiting. The best outcome related to this diagnosis is, "Within 2 weeks the patient will: a. appropriately express angry feelings." b. verbalize two positive things about self." c. verbalize the importance of eating a balanced diet." d. identify two alternative methods of coping with loneliness."d. identify two alternative methods of coping with loneliness."14. Which nursing intervention has the highest priority for a patient diagnosed with bulimia nervosa? a. Assist the patient to identify triggers to binge eating. b. Provide corrective consequences for weight loss. c. Explore patient needs for health teaching. d. Assess for signs of impulsive eating.a. Assist the patient to identify triggers to binge eating.15. One bed is available on the inpatient eating disorders unit. Which patient should be admitted? The patient whose weight dropped from: a. 150 to 100 pounds over a 4-month period. Vital signs: temperature, 35.9° C; pulse, 38 beats/min; blood pressure, 60/40 mm Hg b. 120 to 90 pounds over a 3-month period. Vital signs: temperature, 36° C; pulse, 50 beats/min; blood pressure, 70/50 mm Hg c. 110 to 70 pounds over a 4-month period. Vital signs: temperature, 36.5° C; pulse, 60 beats/min; blood pressure, 80/66 mm Hg d. 90 to 78 pounds over a 5-month period. Vital signs: temperature, 36.7° C; pulse, 62 beats/min; blood pressure, 74/48 mm Hga. 150 to 100 pounds over a 4-month period. Vital signs: temperature, 35.9 C; pulse, 38 beats/min; blood pressure, 60/40 mm Hg16. While providing health teaching for a patient diagnosed with bulimia nervosa, a nurse should emphasize information about: a. self-monitoring of daily food and fluid intake. b. establishing the desired daily weight gain. c. recognizing symptoms of hypokalemia. d. self-esteem maintenance.c. recognizing symptoms of hypokalemia17. As a patient admitted to the eating disorders unit undresses, a nurse observes that the patient's body is covered by fine, downy hair. The patient weighs 70 pounds and is 5 feet, 4 inches tall. Which condition should be documented? a. Amenorrhea b. Alopecia c. Lanugo d. Stuporc. Lanugo18. A patient being admitted to the eating disorders unit has a yellow cast to the skin and fine, downy hair covering the body. The patient weighs 70 pounds; height is 5 feet, 4 inches. The patient is quiet and says only, "I won't eat until I look thin." What is the priority initial nursing diagnosis? a. Anxiety, related to fear of weight gain b. Disturbed body image, related to weight loss c. Ineffective coping, related to lack of conflict resolution skills d. Imbalanced nutrition: less than body requirements, related to self-starvationd. Imbalance nutrition: less than body requirements, related to self-starvation19. A nurse conducting group therapy on the eating disorders unit schedules the sessions immediately after meals for the primary purpose of: a. maintaining patients' concentration and attention. b. shifting the patients' focus from food to psychotherapy. c. focusing on weight control mechanisms and food preparation. d. processing the heightened anxiety associated with eating.d. processing the heightened anxiety associated with eating20. Physical assessment of a patient diagnosed with bulimia nervosa often reveals: a. prominent parotid glands. b. peripheral edema. c. thin, brittle hair. d. amenorrhea.a. prominent parotid glands21. Which personality characteristic is a nurse most likely to assess in a patient diagnosed with anorexia nervosa? a. Carefree flexibility b. Rigidity, perfectionism c. Open displays of emotion d. High spirits and optimismb. Rigidity, perfectionism22. Which assessment finding for a patient diagnosed with an eating disorder meets a criterion for hospitalization? a. Urine output: 40 ml/hr b. Pulse rate: 58 beats/min c. Serum potassium: 3.4 mEq/L d. Systolic blood pressure: 62 mm Hgd. Systolic blood pressure: 62 mm Hg23. Which statement is a nurse most likely to hear from a patient diagnosed with anorexia nervosa? a. "I would be happy if I could lose 20 more pounds." b. "My parents don't pay much attention to me." c. "I'm thin for my height." d. "I have nice eyes."a. "I would be happy if I could lose 20 more pounds."24. Which nursing diagnosis is more applicable for a patient diagnosed with anorexia nervosa who restricts intake and is 20% below normal weight than for a 130-pound patient diagnosed with bulimia nervosa who purges? a. Powerlessness b. Ineffective coping c. Disturbed body image d. Imbalanced nutrition: less than body requirementsd. Imbalanced nutrition: less than body requirements25. An outpatient diagnosed with anorexia nervosa has begun re-feeding. Between the first and second appointments, the patient gained 8 pounds. The nurse should: a. assess lung sounds and extremities. b. suggest the use of an aerobic exercise program. c. positively reinforce the patient for the weight gain. d. establish a higher goal for weight gain the next week.a. assess lung sounds and extremities.26. When a nurse finds a patient diagnosed with anorexia nervosa vigorously exercising before gaining the agreed-upon weekly weight, the nurse should state: a. "You and I will have to sit down and discuss this problem." b. "It bothers me to see you exercising. You'll lose more weight." c. "Let's discuss the relationship between exercise and weight loss and how that affects your body." d. "According to our agreement, no exercising is permitted until you have gained a specific amount of weight."d. "According to our agreement, no exercising is permitted until you have gained a specific amount of weight."27. A patient diagnosed with anorexia nervosa has a body mass index (BMI) of 14.8 kg/m2. Which assessment finding is most likely to accompany this value? a. Cachexia b. Leukocytosis c. Hyperthermia d. Hypertensiona. Cachexia28. A patient referred to the eating disorders clinic has lost 35 pounds in 3 months and has developed amenorrhea. For which physical manifestations of anorexia nervosa should a nurse assess? Select all that apply. a. Peripheral edema b. Parotid swelling c. Constipation d. Hypotension e. Dental caries f. Lanugoa. Peripheral edema c. Constipation d. Hypotension f. Lanugo29. A patient diagnosed with anorexia nervosa is hospitalized for treatment. What features should the milieu provide? Select all that apply. a. Flexible mealtimes b. Unscheduled weight checks c. Adherence to a selected menu d. Observation during and after meals e. Monitoring during bathroom trips f. Privileges correlated with emotional expressionc. Adherence to a selected menu d. Observation during and after meals e. Monitoring during bathroom trips1. A patient diagnosed with alcoholism asks, "How will Alcoholics Anonymous (AA) help me?" Select the nurse's best response. a. "The goal of AA is for members to learn controlled drinking with the support of a higher power." b. "An individual is supported by peers while striving for abstinence one day at a time." c. "You must make a commitment to permanently abstain from alcohol and other drugs." d. "You will be assigned a sponsor who will plan your treatment program."b. "An individual is supported by peers while striving for abstinence one day at a time."2. A nurse reviews vital signs for a patient admitted with an injury sustained while intoxicated. The medical record shows these blood pressure and pulse readings at the times listed: 0200: 118/78 mm Hg and 72 beats/min 0400: 126/80 mm Hg and 76 beats/min 0600: 128/82 mm Hg and 72 beats/min 0800: 132/88 mm Hg and 80 beats/min 1000: 148/94 mm Hg and 96 beats/min What is the nurse's priority action? a. Force fluids. b. Consult the health care provider. c. Obtain a clean-catch urine sample. d. Place the patient in a vest-type restraint.b. Consult the health care provider.3. A nurse cares for a patient diagnosed with an opioid overdose. Which focused assessment has the highest priority? a. Cardiovascular b. Respiratory c. Neurologic d. Hepaticb. Respiratory4. A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours. The patient is now shaky, irritable, anxious, diaphoretic, and reports nightmares. The pulse rate is 130 beats/min. The patient shouts, "Bugs are crawling on my bed. I've got to get out of here." Select the most accurate assessment of this situation. The patient: a. is attempting to obtain attention by manipulating staff. b. may have sustained a head injury before admission. c. has symptoms of alcohol-withdrawal delirium. d. is having an acute psychosis.c. has symptoms of alcohol-withdrawal delirium.5. A patient admitted yesterday for injuries sustained while intoxicated believes bugs are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis? a. Disturbed sensory perception b. Ineffective coping c. Ineffective denial d. Risk for injuryd. Risk for injury6. A hospitalized patient diagnosed with an alcohol abuse disorder believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe a(n): a. narcotic analgesic, such as hydromorphone (Dilaudid). b. sedative, such as lorazepam (Ativan) or chlordiazepoxide (Librium). c. antipsychotic, such as olanzapine (Zyprexa) or thioridazine (Mellaril). d. monoamine oxidase inhibitor antidepressant, such as phenelzine (Nardil).b. sedative, such as lorazepam (Ativan) or chlordiazepoxide (Librium).7. A hospitalized patient diagnosed with an alcohol abuse disorder believes spiders are spinning entrapping webs in the room. The patient is fearful, agitated, and diaphoretic. Which nursing intervention is indicated? a. Check the patient every 15 minutes b. One-on-one supervision c. Keep the room dimly lit d. Force fluidsb. One-on-one supervision8. A patient diagnosed with an alcohol abuse disorder says, "Drinking helps me cope with being a single parent." Which therapeutic response by the nurse would help the patient conceptualize the drinking objectively? a. "Sooner or later, alcohol will kill you. Then what will happen to your children?" b. "I hear a lot of defensiveness in your voice. Do you really believe this?" c. "If you were coping so well, why were you hospitalized again?" d. "Tell me what happened the last time you drank."d. "Tell me what happened the last time you drank."9. A patient asks for information about Alcoholics Anonymous. Select the nurse's best response. "Alcoholics Anonymous is a: a. form of group therapy led by a psychiatrist." b. self-help group for which the goal is sobriety." c. group that learns about drinking from a group leader." d. network that advocates strong punishment for drunk drivers."b. self-help group for which the goal is sobriety."10. Police bring a patient to the emergency department after an automobile accident. The patient demonstrates ataxia and slurred speech. The blood alcohol level is 500 mg%. Considering the relationship between the behavior and blood alcohol level, which conclusion is most probable? The patient: a. rarely drinks alcohol. b. has a high tolerance to alcohol. c. has been treated with disulfiram (Antabuse). d. has ingested both alcohol and sedative drugs recently.b. has a high tolerance to alcohol.11. A patient admitted to an alcoholism rehabilitation program tells the nurse, "I'm actually just a social drinker. I usually have a drink at lunch, two in the afternoon, wine with dinner, and a few drinks during the evening." The patient is using which defense mechanism? a. Denial b. Projection c. Introjection d. Rationalizationa. Denial12. Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids? a. Bromocriptine (Parlodel) b. Methadone (Dolophine) c. Disulfiram (Antabuse) d. Naltrexone (ReVia)d. Naltrexone (ReVia)13. During the third week of treatment, the spouse of a patient in a rehabilitation program for substance abuse says, "After this treatment program, I think everything will be all right." Which remark by the nurse will be most helpful to the spouse? a. "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol." b. "It will be important for you to structure life to avoid as much stress as you can and provide social protection." c. "Addiction is a lifelong disease of self-destruction. You will need to observe your spouse's behavior carefully." d. "It is good that you are supportive of your spouse's sobriety and want to help maintain it."a. "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol."14. The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, the team should: a. provide long-term care for the patient in a residential facility. b. withdraw the patient from cannabis, then treat the schizophrenia. c. consider each diagnosis primary and provide simultaneous treatment. d. first treat the schizophrenia, then establish goals for substance abuse treatment.c. consider each diagnosis primary and provide simultaneous treatment.15. Select the most therapeutic manner for a nurse working with a patient beginning treatment for alcohol addiction. a. Empathetic, supportive b. Skeptical, guarded c. Cool, distant d. Confrontationala. Empathetic, supportive16. Which features should be present in a therapeutic milieu for a patient with a hallucinogen overdose? a. Simple and safe b. Active and bright c. Stimulating and colorful d. Confrontational and challenginga. Simple and safe17. When a patient first began using alcohol, two drinks produced relaxation and drowsiness. After 1 year, four drinks are needed to achieve the same response. Why has this change occurred? a. Tolerance has developed. b. Antagonistic effects are evident. c. Metabolism of the alcohol is now delayed. d. Pharmacokinetics of the alcohol have changed.a. Tolerance has developed.18. At a meeting for family members of alcoholics, a spouse says, "I did everything I could to help. I even requested sick leave when my partner was too drunk to go to work." The nurse assesses these comments as: a. codependence. b. assertiveness c. role reversal d. homeostasis.a. codependence.19. In the emergency department, a patient's vital signs are BP 66/40 mm Hg; pulse 140 beats/min; respirations 8 breaths/min and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to narcotic intoxication. Select the priority outcome. a. The patient will demonstrate effective coping skills and identify community resources for treatment of substance abuse within 1 week of hospitalization. b. Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min. c. The patient will correctly describe a plan for home care and achieving a drug-free state before release from the emergency department. d. Within 6 hours, the patient's breath sounds will be clear bilaterally and throughout lung fields.b. Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min.20. Family members of an individual undergoing a residential alcohol rehabilitation program ask, "How can we help?" Select the nurse's best response. a. "Alcoholism is a lifelong disease. Relapses are expected." b. "Use search and destroy tactics to keep the home alcohol free." c. "It's important that you visit your family member on a regular basis." d. "Make your loved one responsible for the consequences of behavior."d. "Make your loved one responsible for the consequences of behavior."21. Which goal for treatment of alcoholism should the nurse address first? a. Learn about addiction and recovery. b. Develop alternate coping strategies. c. Develop a peer support system. d. Achieve physiologic stability.d. Achieve physiologic stability.22. A patient with an antisocial personality disorder was treated several times for substance abuse, but each time the patient relapsed. Which treatment approach is most appropriate? a. 1-week detoxification program b. Long-term outpatient therapy c. 12-step self-help program d. Residential programd. Residential program23. Select the priority nursing intervention when caring for a patient after an overdose of amphetamines. a. Monitor vital signs. b. Observe for depression. c. Awaken the patient every 15 minutes. d. Use warmers to maintain body temperature.a. Monitor vital signs.24. Symptoms of withdrawal from opioids for which the nurse should assess include: a. dilated pupils, tachycardia, elevated blood pressure, and elation. b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia. c. mood lability, incoordination, fever, and drowsiness. d. excessive eating, constipation, and headache.b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia.25. A patient has smoked two packs of cigarettes daily for many years. When the patient tries to reduce smoking, anxiety, craving, poor concentration, and headache occur. This scenario describes: a. cross-tolerance. b. substance abuse c. substance addiction. d. substance intoxication.c. substance addiction.26. Which assessment findings are likely for an individual who recently injected heroin? a. Anxiety, restlessness, paranoid delusions b. Muscle aching, dilated pupils, tachycardia c. Heightened sexuality, insomnia, euphoria d. Drowsiness, constricted pupils, slurred speechd. Drowsiness, constricted pupils, slurred speech27. An adult in the emergency department states, "Everything I see appears to be waving. I am outside my body looking at myself. I think I'm losing my mind." Vital signs are slightly elevated. The nurse should suspect: a. a schizophrenic episode. b. hallucinogen ingestion. c. opium intoxication. d. cocaine overdose.b. hallucinogen ingestion.28. A nurse wants to research epidemiology, assessment techniques, and best practices regarding persons with addictions. Which resource will provide the most comprehensive information? a. Substance Abuse and Mental Health Services Administration (SAMHSA) b. Institute of Medicine - National Research Council (IOM) c. National Council of State Boards of Nursing (NCSBN) d. American Society of Addictions Medicinea. Substance Abuse and Mental Health Services Administration (SAMHSA)29. A patient is thin, tense, jittery, and has dilated pupils. The patient says, "My heart is pounding in my chest. I need help." The patient allows vital signs to be taken but then becomes suspicious and says, "You could be trying to kill me." The patient refuses further examination. Abuse of which substance is most likely? a. PCP b. Heroin c. Barbiturates d. Amphetaminesd. Amphetamines30. Select the priority outcome for a patient completing the fourth alcohol-detoxification program in the past year. Prior to discharge, the patient will: a. state, "I know I need long-term treatment." b. use denial and rationalization in healthy ways. c. identify constructive outlets for expression of anger. d. develop a trusting relationship with one staff member.a. state, "I know I need long-term treatment."31. A nurse prepares for an initial interaction with a patient with a long history of methamphetamine abuse. Which is the nurse's best first action? a. Perform a thorough assessment of the patient. b. Verify that security services are immediately available. c. Self-assess personal attitude, values, and beliefs about this health problem. d. Obtain a face shield because oral hygiene is poor in methamphetamine abusers.c. Self-assess personal attitude, values, and beliefs about this health problem.1. A patient undergoing alcohol rehabilitation decides to begin disulfiram (Antabuse) therapy. Patient teaching should include the need to: (select all that apply) a. avoid aged cheeses. b. avoid alcohol-based skin products. c. read labels of all liquid medications. d. wear sunscreen and avoid bright sunlight. e. maintain an adequate dietary intake of sodium. f. avoid breathing fumes of paints, stains, and stripping compounds.b. avoid alcohol-based skin products. c. read labels of all liquid medications. f. avoid breathing fumes of paints, stains, and stripping compounds.2. The nurse can assist a patient to prevent substance abuse relapse by: (select all that apply) a. rehearsing techniques to handle anticipated stressful situations. b. advising the patient to accept residential treatment if relapse occurs. c. assisting the patient to identify life skills needed for effective coping. d. advising isolating self from significant others until sobriety is established. e. informing the patient of physical changes to expect as the body adapts to functioning without substances.a. rehearsing techniques to handle anticipated stressful situations. c. assisting the patient to identify life skills needed for effective coping. e. informing the patient of physical changes to expect as the body adapts to functioning without substances.3. A patient took a large quantity of bath salts. Priority nursing and medical measures include: (select all that apply) a. administration of naloxone (Narcan). b. vitamin B12 and folate supplements. c. restoring nutritional integrity. d. management of heart rate. e. environmental safety.d. management of heart rate. e. environmental safety.4. A new patient beginning an alcoholism rehabilitation program says, "I'm just a social drinker. I usually have one drink at lunch, two in the afternoon, wine at dinner, and a few drinks during the evening." Select the nurse's most therapeutic responses. Select all that apply. a. "I see," and use interested silence. b. "I think you are drinking more than you report." c. "Social drinkers have one or two drinks, once or twice a week." d. "You describe drinking steadily throughout the day and evening." e. "Your comments show denial of the seriousness of your problem."c. "Social drinkers have one or two drinks, once or twice a week." d. "You describe drinking steadily throughout the day and evening."A 5-year-old child moves and talks constantly, is easily distracted, and does not listen to the parents. The child awakens before the parents every morning. The child attended kindergarten, but the teacher could not handle the behavior. What is this childs most likely problem? a. Tic disorder b. Oppositional defiant disorder (ODD) c. Intellectual development disorder (IDD) d. Attention deficit hyperactivity disorder (ADHD)d. Attention deficit hyperactivity disorder (ADHD)A child diagnosed with attention deficit hyperactivity disorder (ADHD) has hyperactivity, distractibility, and impaired play. The health care provider prescribed methylphenidate (Concerta). The desired behavior for which the nurse should monitor is: a. increased expressiveness in communicating with others. b. improved ability to participate in play with other children. c. ability to identify anxiety and implement self-control strategies. d. improved socialization skills with other children and authority figures.b. improved ability to participate in play with other children.A 5-year-old child diagnosed with attention deficit hyperactivity disorder (ADHD) bounces out of a chair in the waiting room, runs across the room, and begins to slap another child. What is the nurses best action? a. Call for emergency assistance from another staff member. b. Instruct the parents to take the child home immediately. c. Direct this child to stop, and then comfort the other child. d. Take the child into another room with toys to act out feelings.d. Take the child into another room with toys to act out feelings.A 16-year-old adolescent diagnosed with conduct disorder (CD) has been in a residential program for three months. Which outcome should occur before discharge? a. The teen and parents create and consent to a behavioral contract with rules, rewards, and consequences. b. The teen completes an application to enter a military academy for continued structure and discipline. c. The teen is temporarily placed with a foster family until the parents complete a parenting skills class. d. The teen has an absence of anger and frustration for 1 week.a. The teen and parents create and consent to a behavioral contract with rules, rewards, and consequences.A child diagnosed with attention deficit hyperactivity disorder (ADHD) is going to begin medication therapy. The nurse should plan to teach the family about which classification of medications? a. Central nervous system stimulants b. Monoamine oxidase inhibitors (MAOIs) c. Antipsychotic medications d. Anxiolytic medicationsa. Central nervous system stimulantsShortly after an adolescents parents announce a plan to divorce, the teen stops participating in sports, sits alone at lunch, and avoids former friends. The adolescent says, If my parents loved me, then they would work out their problems. What nursing diagnosis is most applicable? a. Ineffective coping b. Decisional conflict c. Chronic low self-esteem d. Disturbed personal identitya. Ineffective copingShortly after a 15-year-olds parents announce a plan to divorce, the adolescent stops participating in sports, sits alone at lunch, and avoids former friends. The adolescent says, All the other kids have families. If my parents loved me, then they would stay together. Which nursing intervention is most appropriate? a. Develop a plan for activities of daily living. b. Communicate disbelief relative to the adolescents feelings. c. Assist the adolescent to differentiate reality from perceptions. d. Assess and document the adolescents level of depression daily.c. Assist the adolescent to differentiate reality from perceptions.When group therapy is to be used as a treatment modality, the nurse should suggest placing a 9-year-old in a group that uses: a. play activities exclusively. b. group discussion exclusively. c. talk focused on a specific issue. d. play then talk about the play activity.d. play then talk about the play activity.When assessing a 2-year-old diagnosed with autism spectrum disorder, a nurse expects: a. hyperactivity and attention deficits. b. failure to develop interpersonal skills. c. history of disobedience and destructive acts. d. high levels of anxiety when separated from a parent.b. failure to develop interpersonal skills.A 4-year-old child cries and screams from the time the parents leave the child at preschool until the child is picked up 4 hours later. The child is calm and relaxed when the parents are present. The parents ask, What should we do? What is the nurses best recommendation? a. Send a picture of yourself to school to keep with the child. b. Arrange with the teacher to let the child call home at playtime. c. Talk with the school about withdrawing the child until maturity increases. d. Talk with your health care provider about a referral to a mental health professional.d. Talk with your health care provider about a referral to a mental health professional.A 15-year-old adolescent has run away from home six times. After the adolescent was arrested for prostitution, the parents told the court, We cant manage our teenager. The adolescent is physically abusive to the mother and defiant with the father. The adolescents problem is most consistent with criteria for: a. attention deficit hyperactivity disorder (ADHD). b. childhood depression. c. conduct disorder (CD). d. autism spectrum disorder (ASD).c. conduct disorder (CD).A 15-year-old adolescent is referred to a residential program after an arrest for theft and running away from home. At the program, the adolescent refuses to participate in scheduled activities and pushes a staff member, causing a fall. Which approach by the nursing staff would be most therapeutic? a. Neutrally permit refusals b. Coax to gain compliance c. Offer rewards in advance d. Establish firm limitsd. Establish firm limitsAn adolescent was arrested for prostitution and assault on a parent. The adolescent says, I hate my parents. They focus all their attention on my brother, whos perfect in their eyes. Which type of therapy might promote the greatest change in this adolescents behavior? a. Bibliotherapy b. Play therapy c. Family therapy d. Art therapyc. Family therapyAn adolescent is arrested for prostitution and assault on a parent. The adolescent says, I hate my parents. They focus all their attention on my brother, whos perfect in their eyes. Which nursing diagnosis is most applicable? a. Ineffective impulse control, related to seeking parental attention as evidenced by acting out b. Disturbed personal identity, related to acting out as evidenced by prostitution c. Impaired parenting, related to showing preference for one child over another d. Hopelessness, related to feeling unloved by parentsa. Ineffective impulse control, related to seeking parental attention as evidenced by acting outWhich assessment finding would cause the nurse to consider an 8-year-old child to be most at risk for the development of a psychiatric disorder? a. Being raised by a parent with chronic major depressive disorder b. Moving to three new homes over a 2-year period c. Not being promoted to the next grade d. Having an imaginary frienda. Being raised by a parent with chronic major depressive disorderWhich child shows behaviors indicative of mental illness? a. 4-year-old who stuttered for 3 weeks after the birth of a sibling b. 9-month-old who does not eat vegetables and likes to be rocked c. 3-month-old who cries after feeding until burped and sucks a thumb d. 3-year-old who is mute, passive toward adults, and twirls while walkingd. 3-year-old who is mute, passive toward adults, and twirls while walkingThe child most likely to receive propranolol (Inderal) to control aggression, deliberate self-injury, and temper tantrums is one diagnosed with: a. attention deficit hyperactivity disorder (ADHD). b. post-traumatic stress disorder (PTSD). c. autism spectrum disorder (ASD). d. separation anxiety.c. autism spectrum disorder (ASD).A 12-year-old child has been the neighborhood bully for several years. The parents say, We cant believe anything our child says. Recently, the child shot a dog with a pellet gun and set fire to a trash bin outside a store. The childs behaviors are most consistent with: a. conduct disorder (CD). b. defiance of authority. c. anxiety over separation from a parent. d. attention deficit hyperactivity disorder (ADHD).a. conduct disorder (CD).The parent of a child diagnosed with Tourettes disorder says to the nurse, I think my child is faking the tics because they come and go. Which response by the nurse is accurate? a. Perhaps your child was misdiagnosed. b. Your observation indicates the medication is effective. c. Tics often change frequency or severity. That does not mean they arent real. d. This finding is unexpected. How have you been administering your childs medication?c. Tics often change frequency or severity. That does not mean they arent real.An 11-year-old child, who has been diagnosed with oppositional defiant disorder (ODD), becomes angry over the rules at a residential treatment program and begins shouting at the nurse. Select the best method to defuse the situation. a. Assign the child to a short time-out. b. Administer an antipsychotic medication. c. Place the child in a therapeutic hold. d. Call a staff member to seclude the child.a. Assign the child to a short time-out.When a 5-year-old child is disruptive, the nurse says, You must take a time-out. The expectation is that the child will: a. go to a quiet room until called for the next meal. b. slowly count to 20 before returning to the group activity. c. sit on the edge of the activity until able to regain self-control. d. sit quietly on the lap of a staff member until able to apologize for the behavior.c. sit on the edge of the activity until able to regain self-control.A child blurts out answers to questions before the questions are complete, demonstrates an inability to take turns, and persistently interrupts and intrudes in the conversations of others. Assessment data show these behaviors relate primarily to: a. intelligence. b. impulsivity. c. inattention. d. defiance.b. impulsivity.A parent diagnosed with schizophrenia and her 13-year-old child live in a homeless shelter. The child has formed a trusting relationship with a shelter volunteer. The child says, My three friends and I got an A on our school science project. The nurse can assess that the child: a. displays resiliency. b. has a difficult temperament. c. is at risk for post-traumatic stress disorder. d. uses intellectualization to deal with problems.a. displays resiliency.A parent diagnosed with schizophrenia and 13-year-old child live in a homeless shelter. The child has formed a trusting relationship with a volunteer. The teen says, I have three good friends at school. We talk and sit together at lunch. What is the nurses best suggestion to the treatment team? a. Suggest foster home placement. b. Seek assistance from an intimate partner violence program. c. Make referrals for existing and emerging developmental problems. d. Foster healthy characteristics and existing environmental supports.d. Foster healthy characteristics and existing environmental supports.Which behavior indicates that the treatment plan for a child diagnosed with autism spectrum disorder was effective? The child: a. plays with one toy for 30 minutes. b. repeats words spoken by a parent. c. holds the parents hand while walking. d. spins around and claps hands while walking.c. holds the parents hand while walking.What are the primary distinguishing factors between the behavior of children diagnosed with oppositional defiant disorder (ODD) and those diagnosed with conduct disorder (CD)? (Select all that apply.) The child diagnosed with: a. ODD relives traumatic events by acting them out. b. ODD tests limits and disobeys authority figures. c. ODD has difficulty separating from the parents. d. CD uses stereotypical or repetitive language. e. CD often violates the rights of others.b. ODD tests limits and disobeys authority figures. e. CD often violates the rights of others.A nurse prepares the plan of care for a 15-year-old adolescent diagnosed with moderate intellectual developmental disorder (IDD). What are the highest outcomes that are realistic for this person? (Select all that apply.) Within 5 years, the person will: a. live unaided in an apartment. b. complete high school or earn a general equivalency diploma (GED). c. independently perform his or her own personal hygiene. d. obtain employment in a local sheltered workshop. e. correctly use public buses to travel in the community.c. independently perform his or her own personal hygiene. d. obtain employment in a local sheltered workshop. e. correctly use public buses to travel in the community.