Mental Health Final - Questions

A patient needs supportive care for the maintenance treatment of bipolar disorder. The new nurse demonstrates an understanding of the services provided by the various members of the patient's mental healthcare team when he makes which statement:
a "Your social worker will help you learn to budget your money effectively."
b "Your counselor asked me to remind you of the group session on critical thinking at 2:00 today."
c "The mental health technician on staff today will administer the medication that you require."
d "Remember to ask the occupational therapist about sources of financial help that you are qualified for."
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A patient needs supportive care for the maintenance treatment of bipolar disorder. The new nurse demonstrates an understanding of the services provided by the various members of the patient's mental healthcare team when he makes which statement:
a "Your social worker will help you learn to budget your money effectively."
b "Your counselor asked me to remind you of the group session on critical thinking at 2:00 today."
c "The mental health technician on staff today will administer the medication that you require."
d "Remember to ask the occupational therapist about sources of financial help that you are qualified for."
b "Your counselor asked me to remind you of the group session on critical thinking at 2:00 today."
A patient has been voluntarily admitted to a mental health facility after an unsuccessful attempt to harm himself. Which statement demonstrates a need to better educate the patient on his patient's rights?
a. "I understand why I was restrained when I was out of control."
b. "You can't tell my boss about the suicide attempt without my permission."
c. "I have a right to know what all of you are planning to do to me."
d. "I can hurt myself if I want to. It's none of your business."
d. "I can hurt myself if I want to. It's none of your business."
Which intervention demonstrates an attempt by nursing staff to meet the goals identified by The Joint Commission as National Patient Safety Goals? Select all that apply.
a. Identifying patients using both name and date of birth before drawing blood.
b. Sitting with the patient diagnosed with an eating disorder during meals.
c. Administering the Beck Scale on each patient at the time of admission.
d. Performing a medication history assessment on each new patient.
e. Using appropriate hand washing technique at all times.
a. Identifying patients using both name and date of birth before drawing blood.
c. Administering the Beck Scale on each patient at the time of admission.
d. Performing a medication history assessment on each new patient.
e. Using appropriate hand washing technique at all times.
4. The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.
a. "Is the patient expressing suicidal thoughts?"
b. "Does the patient have intact judgment and insight into his situation?"
c. "Does the patient have experiences with either community or inpatient mental healthcare facilities?"
d. "Does the patient require a therapeutic environment to support the management of psychotic symptoms?"
e. "Does the patient require the regular involvement of their family/significant other in planning and executing the plan of care?"
A, B, D, E.
The nurse frequently includes daily sessions involving relaxation techniques. Which assessment data would most indicate a need for this intervention to be included in the initial plan of care for a patient?
a. Family history of anxiety and symptoms of anxiety
b. Significant other has a chronic health issue
c. Hopes to retire in 6 months
d. Recently adopted infant twins
A. Family history of anxiety and symptoms of anxiety
A newly divorced 36-year-old mother of three has difficulty sleeping. When she shares this information to her gynecologist, she suggests which of the following services as appropriate for her patient's needs?
a. Assertive community treatment
b. Patient-centered medical home
c. Psychiatric home care
d. Primary care provide
D. Primary care provider
An Afghanistan Conflict veteran has been homeless since being discharged from military service. He is now diagnosed with schizophrenia. The nurse practitioner recognizes that assertive community treatment (ACT) is a good option for this patient since ACT provides:
a. Psychiatric home care
b. Care for hard-to-engage, seriously ill patients
c. Outpatient community mental health center care
d. A comprehensive emergency service model
b. Care for hard-to-engage, seriously ill patients
An adolescent female is readmitted for inpatient care after a suicide attempt. What is the most important nursing intervention to accomplish upon admission?
a. Allowing the patient to return to her previous room so that she will feel safe
b. Orienting the patient to the unit and introducing her to patients and staff
c. Building trust through therapeutic communication
d. Checking the patient's belongings for dangerous items
d. Checking the patient's belongings for dangerous items
Emma is a 40-year-old married female who has found it increasingly difficult to leave her home due to agoraphobia. Emma's family is appropriately concerned and suggests that she seek psychiatric care. After investigating her options, Emma decides to try:
a. Telepsychiatry
b. Assertive community treatment
c. Psychiatric home care
d. Outpatient psychiatric care
a. Telepsychiatry
Pablo is a homeless adult who has no family connection. Pablo passed out on the street and emergency medical services took him to the hospital, where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select all that apply.
a. Intermittent supervision is available in inpatient settings.
b. He requires stabilization of multiple symptoms.
c. He has nutritional and self-care needs.
d. Medication adherence will be mandated.
e. He is in imminent danger of harming himself.
b. He requires stabilization of multiple symptoms.
c. He has nutritional and self-care needs.
e. He is in imminent danger of harming himself.
Which statement made by the nurse concerning ethics demonstrates the best understanding of the concept? a. "It isn't right to deny someone healthcare because they can't pay for it." b. "I never discuss my patient's refusal of treatment." c. "The hospital needs to buy more respirators so we always have one available." d. "Not all ICU patients have the right to unbiased attention from the staff."a. "It isn't right to deny someone healthcare because they can't pay for it."Which nursing intervention demonstrates the ethical principle of beneficence? a. Refusing to administer a placebo to a patient. b. Attending an in-service on the operation of the new IV infusion pumps c. Providing frequent updates to the family of a patient currently in surgery d. Respecting the right of the patient to make decisions about whether or not to have electroconvulsive therapyc. Providing frequent updates to the family of a patient currently in surgeryHow can a newly hired nurse best attain information concerning the state's mental health laws and statutes? a. Discuss the issue with the facility's compliance officer b. Conduct an internet search using the keywords "mental + health + statutes + (your state)" c. Consult the ANA's Code of Ethics for Nurses d. Review the facility's latest edition of the policies manualb. Conduct an internet search using the keywords "mental + health + statutes + (your state)"When considering facility admissions for mental healthcare, what characteristic is unique to a voluntary admission? a. The patient poses no substantial threat to themselves or to others b. The patient has the right to seek legal counsel c. A request in writing is required before admission d. A mental illness has been previously diagnosedc. A request in writing is required before admissionWhich situations demonstrate liable behavior on the part of the staff? Select all that apply. a. Forgetting to obtain consent for electroconvulsive therapy for a cognitively impaired patient b. Leaving a patient with suicidal thoughts alone in the bathroom to shower c. Promising to restrain a patient who stole from another patient on the unit d. Reassuring a patient with paranoia that his antipsychotic medication was not tampered witha. Forgetting to obtain consent for electroconvulsive therapy for a cognitively impaired patient b. Leaving a patient with suicidal thoughts alone in the bathroom to shower c. Promising to restrain a patient who stole from another patient on the unitA nurse makes a post on a social media page about his peer taking care of a patient with a crime-related gunshot wound in the emergency department. He does not use the name of the patient. The nurse: a. Has not violated confidentiality laws because he did not use the patient's name. b. Cannot be held liable for violating confidentiality laws because he was not the primary nurse for the patient. c. Has violated confidentiality laws and can be held liable. d. Cannot be held liable because postings on a social media site are excluded from confidentiality lawsc. Has violated confidentiality laws and can be held liable.In providing care for patients of a mental health unit, Li recognizes the importance of standards of care. When Li notices that some policies fall short of the state licensing laws, which of the following statements represents the most appropriate standard of care pathway? a. Professional association, customary care, facility policy b. State board of nursing, facility policy, customary care c. Facility policy, professional associations, state board of nursing d. State board of nursing, professional association, facility policyd. State board of nursing, professional association, facility policyLucas has completed his inpatient psychiatric treatment, which was ordered by the court system. Which statement reveals that Lucas does not understand the concept of conditional release? a. "I will continue treatment in an outpatient treatment center." b. "My nurse practitioner has recommended group therapy." c. "I am finally free, no more therapy." d. "Attending therapy and taking my meds are a part of this conditional release."c. "I am finally free, no more therapy."Implied consent occurs when no verbal or written agreement takes place prior to a caregiver delivering treatment. Which of the following examples represents implied consent? a. The mother of an unconscious patient saying okay to surgery b. Care given to a heroin overdose victim c. Immobilizing a patient who has refused to take medication d. Signing general intake paperwork with specific parametersb. Care given to a heroin overdose victimBased on Maslow's hierarchy of needs, physiological needs for a restrained patient include: Select all that apply. a. Private toileting, oral hydration b. Checking the tightness of the restraints c. Therapeutic communication d. Maintaining a patent airwaya. Private toileting, oral hydration b. Checking the tightness of the restraints d. Maintaining a patent airwayWhich statement made by either the nurse or the patient demonstrates an ineffective patient-nurse relationship? a. "I've given a lot of thought about what triggers me to be so angry." b. "Why do you think it's acceptable for you to be so disrespectful to staff?" c. "Will your spouse be available to attend tomorrow's family group session?" d. "I wanted you to know that the medication seems to be helping me feel less anxious."a. "I've given a lot of thought about what triggers me to be so angry."The patient expresses sadness at "being all alone with no one to share my life with." Which response by the nurse demonstrates the existence of a therapeutic relationship? a. "Loneliness can be a very painful and difficult emotion." b. "Let's talk and see if you and I have any interests in common." c. "I use Facebook to find people who share my love of cooking." d. "Loneliness is managed by getting involved with people.c. "I use Facebook to find people who share my love of cooking."Which patient outcome is directly associated with the goals of a therapeutic nurse-patient relationship? a. Patient will be respectful of other patients on the unit. b. Patient will identify suicidal feelings to staff whenever they occur. c. Patient will engage in at least one social interaction with the unit population daily. d. Patient will consume a daily diet to meet both nutritional and hydration needs.b. Patient will identify suicidal feelings to staff whenever they occur.What is the greatest trigger for the development of a patient's nurse-focused transference? a. The similarity between the nurse and someone the patient already dislikes b. The nature of the patient's diagnosed mental illness c. The history the patient has with the patient's parents d. The degree of authority the nurse has over the patientc. The history the patient has with the patient's parentsWhich patient statement demonstrates a value held regarding children? a. "Nothing is more important to me than the safety of my children." b. "I believe my spouse wants to leave both me and our children." c. "I don't think my child's success depends on going to college." d. "I know my children will help me through my hard times."a. "Nothing is more important to me than the safety of my children." b. "I believe my spouse wants to leave both me and our children." c. "I don't think my child's success depends on going to college."Mary is a 39-year-old attending a psychiatric outpatient clinic. Mary believes that her husband, sister, and son cause her problems. Listening to Mary describe the problems, the nurse displays therapeutic communication in which response? a. "I understand you are in a difficult situation." b. "Thinking about being wronged repeatedly does more harm than good." c. "I feel bad about your situation, and I am so sorry it is happening to you and your family." d. "It must be so difficult to live with uncaring people."c. "I feel bad about your situation, and I am so sorry it is happening to you and your family."A registered nurse is caring for an older male who reports depressive symptoms since his wife of 54 years died suddenly. He cries, maintains closed body posture, and avoids eye contact. Which nursing action describes attending behavior? a. Reminding the patient gently that he will "feel better over time" b. Using a soft tone of voice for questioning c. Sitting with the patient and taking cues for when to talk or when to remain silent d. Offering medication and bereavement servicesd. Offering medication and bereavement servicesA male patient frequently inquires about the female student nurse's boyfriend, social activities, and school experiences. Which is the best initial response by the student? a. The student requests assignment to a patient of the same gender as the student. b. She limits sharing personal information and stresses the patient-centered focus of the conversation. c. The student shares information to make the therapeutic relationship more equal. d. She explains that if he persists in focusing on her, she cannot work with him.c. The student shares information to make the therapeutic relationship more equal.Morgan is a third-year nursing student in her psychiatric clinical rotation. She is assigned to an 80-year-old widow admitted for major depressive disorder. The patient describes many losses and sadness. Morgan becomes teary and says meaningfully, "I am so sorry for you." Morgan's instructor overhears the conversation and says, "I understand that getting tearful is a human response. Yet, sympathy isn't helpful in this field." The instructor urges Morgan to focus on: a. "Adopting the patient's sorrow as your own" b. "Maintaining pure objectivity" c. "Using empathy to demonstrate respect and validation of the patient's feelings" d. "Using touch to let her know that everything is going to be alright"b. "Maintaining pure objectivity"Emily is a 28-year-old nurse who works on a psychiatric unit. She is assigned to work with Jenna, a 27-year-old who was admitted with major depressive disorder. Emily and Jenna realize that they graduated from the same high school and each has a 2-year-old daughter. Emily and Jenna discuss getting together for a play date with their daughters after Jenna is discharged. This situation reflects: a. Successful termination b. Promoting interdependence c. Boundary blurring d. A strong therapeutic relationshipa. Successful termination b. Promoting interdependence d. A strong therapeutic relationshipWhich statement made by the nurse demonstrates the best understanding of nonverbal communication? a. "The patient's verbal and nonverbal communication is often different." b. "When my patient responds to my question, I check for congruence between verbal and nonverbal communication to help validate the response." c. "If a patient is slumped in the chair, I can be sure he's angry or depressed." d. "It's easier to interpret verbal communication than to interpret nonverbal communication."b. "When my patient responds to my question, I check for congruence between verbal and nonverbal communication to help validate the response."Which nursing statement is an example of reflection? a. "I think this feeling will pass." b. "So you are saying that life has no meaning." c. "I'm not sure I understand what you mean." d. "You look sad."d. "You look sad."When should a nurse be most alert to the possibility of communication errors resulting in harm to the patient? a. Change of shift report b. Admission interviews c. One-on-one conversations with patients d. Conversations with patients' familiesa. Change of shift reportDuring an admission assessment and interview, which channels of information communication should the nurse be monitoring? Select all that apply. a. Auditory b. Visual c. Written d. Tactile e. Olfactorya. Auditory b. Visual d. Tactile e. OlfactoryWhat principle about nurse-patient communication should guide a nurse's fear about "saying the wrong thing" to a patient? a. Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation. b. The patient is more interested in talking to you than listening to what you have to say and so is not likely to be offended. c. Considering the patient's history, there is little chance that the comment will do any actual harm. d. Most people with a mental illness have by necessity developed a high tolerance of forgiveness.a. Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.You have been working closely with a patient for the past month. Today, he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic? a. "A new psychiatrist is a chance to start fresh; I'm sure it will go well for you." b. "You say you look forward to the meeting, but you appear anxious or unhappy." c. "I notice that you frowned and avoided eye contact just now. Don't you feel well?" d. "I get the impression you don't really want to see your psychiatrist—can you tell me why?"b. "You say you look forward to the meeting, but you appear anxious or unhappy."Which student behavior is consistent with therapeutic communication? a. Offering your opinion when asked to convey support. b. Summarizing the essence of the patient's comments in your own words. c. Interrupting periods of silence before they become awkward for the patient. d. Telling the patient he did well when you approve of his statements or actions.b. Summarizing the essence of the patient's comments in your own words.James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for your day shift and anxiously reports, "Last night, demons came to my room and tried to rape me." Which response would be most therapeutic? a. "There are no such things as demons. What you saw were hallucinations." b. "It is not possible for anyone to enter your room at night. You are safe here." c. "You seem upset. Please tell me more about what you experienced last night." d. "That must have been frightening, but we'll check on you at night and you'll be safe."c. "You seem upset. Please tell me more about what you experienced last night."Therapeutic communication is the foundation of a patient-centered interview. Which of the following techniques is not considered therapeutic? a. Restating b. Encouraging description of perception c. Summarizing d. Asking "why" questionsd. Asking "why" questionsCarolina is surprised when her patient does not show up for a regularly scheduled appointment. When contacted, the patient states, "I don't need to come see you anymore. I have found a therapy app on my phone that I love." How should Carolina respond to this news? a. "That sounds exciting, would you be willing to visit and show me the app?" b. "At this time, there is no real evidence that the app can replace our therapy." c. "I am not sure that is a good idea right now; we are so close to progress." d. "Why would you think that is a better option than meeting with me?"a. "That sounds exciting, would you be willing to visit and show me the app?"What assessment question is focused on identifying a long-term consequence of chronic stress on physical health? a. "Do you have any problems with sleeping well?" b. "How many infections have you experienced in the past 6 months?" c. "How much moderate exercise do you engage in on a regular basis?" d. "What management techniques do you regularly use to manage your stress?"b. "How many infections have you experienced in the past 6 months?"Which nursing assessments are directed at monitoring a patient's fight-or-flight response? Select all that apply. a. Blood pressure b. Heart rate c. Respiratory rate d. Abdominal pain e. Dilated pupilsa. Blood pressure b. Heart rate c. Respiratory rate e. Dilated pupilsThe patient you are assigned unexpectedly suffers a cardiac arrest. During this emergency situation, your body will produce a large amount of: a. Carbon dioxide b. Growth hormone c. Epinephrine d. Aldosteronec. EpinephrineWhich question is focused on the assessment of an individual's personal ability to manage stress? Select all that apply. a. "Have you ever been diagnosed with cancer?" b. "Do you engage in any hobbies now that you have retired?" c. "Have you been taking your antihypertensive medication as it is prescribed?" d. "Who can you rely on if you need help after you're discharged from the hospital?" e. "What do you do to help manage the demands of parenting a 4-year-old and a newborn?"b. "Do you engage in any hobbies now that you have retired?" d. "Who can you rely on if you need help after you're discharged from the hospital?" e. "What do you do to help manage the demands of parenting a 4-year-old and a newborn?"When considering stress, what is the primary goal of making daily entries into a personal journal? a. Providing a distraction from the daily stress b. Expressing emotions to manage stress c. Identifying stress triggers d. Focusing on one's stressc. Identifying stress triggersJackson has suffered from migraine headaches all of his life. Fatima, his nurse practitioner, suspects muscle tension as a trigger for his headaches. Fatima teaches him a technique that promotes relaxation by using: a. Biofeedback b. Guided imagery c. Deep breathing d. Progressive muscle relaxationd. Progressive muscle relaxationHugo is 21 and diagnosed with schizophrenia. His history includes significant turmoil as a child and adolescent. Hugo reports his father was abusive and routinely beat him, all of his siblings, and his mother. Hugo's early exposure to stress most likely: a. Made him resilient to stressful situations b. Increased his future vulnerability to psychiatric disorders c. Developed strong survival skills d. Shaped his nurturing natureb. Increased his future vulnerability to psychiatric disordersHugo has a fraternal twin named Franco who is unaffected by mental illness, even though they were raised in the same dysfunctional household. Franco asks the nurse, "Why Hugo and not me?" The nurse replies: a. "Your father was probably less abusive to you." b. "Hugo likely has a genetic vulnerability." c. "You probably ignored the situation." d. "Hugo responded to perceived threats by focusing on an internal world."b. "Hugo likely has a genetic vulnerability."First responders and emergency department healthcare providers often use dark humor in an effort to: a. Reduce stress and anxiety b. Relive the experience c. Rectify moral distress d. Alert others to the stressa. Reduce stress and anxietyYour 39-year-old patient Samantha, who was admitted with anxiety, asks you what the stress-relieving technique of mindfulness is. The best response is: a. Mindfulness is focusing on an object and repeating a word or phrase while deep breathing. b. Mindfulness is progressively tensing, then relaxing, body muscles. c. Mindfulness is focusing on the here and now, not the past or future, and paying attention to what is going on around you. d. Mindfulness is a memory system to assist you in short-term memory recall.c. Mindfulness is focusing on the here and now, not the past or future, and paying attention to what is going on around you.Which characteristics suggest a man is experiencing the prodromal phase of schizophrenia? Select all that apply. a. Always afraid that others will steal his belongings. b. Displays unusual interest in numbers and specific topics. c. Has increasingly unusual thoughts and uses words oddly. d. Demonstrates increasing difficulty with concentration.a. Always afraid that others will steal his belongings. b. Displays unusual interest in numbers and specific topics. c. Has increasingly unusual thoughts and uses words oddly.Which nursing interventions are particularly well chosen for addressing a population at high risk for developing schizophrenia? Select all that apply. a. Screening 15- to 25-year-olds for early symptoms. b. Forming a support group for females aged 25 to 35 who are diagnosed with substance use disorders. c. Teaching ways to cope and build resiliency. d. Educating about the risk of psychosis with marijuana use.a. Screening 15- to 25-year-olds for early symptoms.To provide effective care for the patient who is taking a second-generation antipsychotic, the nurse should frequently assess for a. Alcohol use disorder b. Major depressive disorder c. Stomach cancer d. Polydipsia e. Metabolic syndromee. Metabolic syndromeA female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms? a. Her memory problems will likely decrease. b. Depressive episodes should be less severe. c. She will probably enjoy social interactions more. d. She should experience a reduction in hallucinations.d. She should experience a reduction in hallucinations.Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia? a. Depersonalization b. Pressured speech c. Negative symptoms d. Paranoiad. ParanoiaWhich therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient's nursing diagnosis is hallucinations? Select all that apply. a. "I know you say you hear voices, but I cannot hear them." b. "Stop listening to the voices, they are NOT real." c. "Tell me more about what you hear." d. "Please tell the voices to leave you alone for now."a. "I know you say you hear voices, but I cannot hear them." c. "Tell me more about what you hear."When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that a. The medications provided are ineffective. b. Nurses are trying to control their minds. c. The medications will make them sick. d. They are not actually ill.d. They are not actually ill.Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) a week ago. You find him sitting stiffly and not moving. He is diaphoretic, and when you ask if he is okay, he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply. a. Hold his medication and contact his prescriber stat. b. Wipe him with a washcloth that has been wetted with cold water or alcohol. c. Administer an "as needed" medication such as benztropine intramuscularly to correct his dystonic reaction. d. Reassure him that no treatment is needed and that this reaction will pass. e. Hold his medication for now and consult his prescriber when he comes to the unit later today.a. Hold his medication and contact his prescriber stat. b. Wipe him with a washcloth that has been wetted with cold water or alcohol.Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disorder and can be an effort to: Select all that apply. a. Self-medicate for social discomfort. b. Cope with anxiety. c. Enhance mood. d. Enable Tomas to better express himself.a. Self-medicate for social discomfort. b. Cope with anxiety. c. Enhance mood.A patient reports that "the voices are really bad today." Helpful nursing responses would include a. Giving an additional "as needed" dosage of his antipsychotic medication. b. Telling him that the voices are not real and that he should ignore them. c. Directing him to return to his room and try not to think about the voices. d. Encouraging the patient to use competing auditory stimuli, such as humming or listening to music.d. Encouraging the patient to use competing auditory stimuli, such as humming or listening to music.1. Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar disorder and her support system? Select all that apply. a. "Remember that alcohol and caffeine can trigger a relapse of your symptoms." b. "Due to the risk of a manic episode, antidepressant therapy is never used with bipolar disorder." c. "It's critical to let your healthcare provider know immediately if you aren't sleeping well." d. "It will be helpful for your family to understand the management of this disorder." e. "The symptoms tend to come and go and so you need to be able to recognize the early signs."a. "Remember that alcohol and caffeine can trigger a relapse of your symptoms." c. "It's critical to let your healthcare provider know immediately if you aren't sleeping well." d. "It will be helpful for your family to understand the management of this disorder." e. "The symptoms tend to come and go and so you need to be able to recognize the early signs."Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply. a. "I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day." b. "I discussed the diuretic my cardiologist prescribed with my psychiatric care provider." c. "Lithium may help me lose the few extra pounds I tend to carry around." d. "I take my lithium on an empty stomach to help with absorption." e. "I've already made arrangements for outpatient lithium level monitoring."a. "I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day." b. "I discussed the diuretic my cardiologist prescribed with my psychiatric care provider." e. "I've already made arrangements for outpatient lithium level monitoring."The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply. a. Increased attentiveness b. Getting up at night to urinate c. Improved vision d. An upset stomach for no apparent reason e. Shaky hands that make holding a cup difficultd. An upset stomach for no apparent reason e. Shaky hands that make holding a cup difficultA male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially? a. Reinforce that the level is considered therapeutic. b. Instruct the patient to hold the next dose of medication and contact the prescriber. c. Have the patient go to the hospital emergency department immediately. d. Alert the patient to the possibility of seizures and appropriate precautions.b. Instruct the patient to hold the next dose of medication and contact the prescriber.Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply. a. Monitor the patient's vital signs frequently. b. Keep the patient distracted with group-oriented activities. c. Provide the patient with frequent milkshakes and protein drinks. d. Reduce the volume on the television and dim bright lights in the environment. e. Use a firm but calm voice to give specific concise directions to the patient.a. Monitor the patient's vital signs frequently. c. Provide the patient with frequent milkshakes and protein drinks. d. Reduce the volume on the television and dim bright lights in the environment. e. Use a firm but calm voice to give specific concise directions to the patient.Substance use problems or disorders are often present in people diagnosed with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that: a. Anxiety may be present. b. Alcohol ingestion is a form of self-medication. c. The patient is lacking a sufficient number of neurotransmitters. d. The patient is using alcohol because she is depressedb. Alcohol ingestion is a form of self-medication.Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I disorder 8 years ago. Ted has a history of IV drug use, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his blood tests confirm. To reduce Ted's mania, the psychiatric nurse practitioner recommends: a. Clonazepam (Klonopin) b. Fluoxetine (Prozac) c. Electroconvulsive therapy (ECT) d. Lurasidone (Latudac. Electroconvulsive therapy (ECT)A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, "You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing _______": a. A higher dosage b. Once a week dosing c. A lower dosage d. A different drugc. A lower dosageTatiana has been hospitalized for an acute manic episode. On admission, the nurse suspects lithium toxicity. What assessment findings would indicate the nurse's suspicion as correct? a. Shortness of breath, gastrointestinal distress, chronic cough b. Ataxia, severe hypotension, large volume of dilute urine c. Gastrointestinal distress, thirst, nystagmus d. Electroencephalographic changes, chest pain, dizzinessb. Ataxia, severe hypotension, large volume of dilute urineLuc's family comes home one evening to find him extremely agitated and they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting? a. Hypodermic needles b. Fast food wrappers c. Empty soda cans d. Energy drink containersd. Energy drink containersWhich response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder? a. "I'm so restless. I can't seem to sit still." b. "I spend most of my time studying. I have to get into a good college." c. "I'm obsessed with counting telephone poles as I drive by them." d. "I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep."d. "I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep."Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply. a. "Do rules apply to you?" b. "What do you do to manage anxiety?" c. "Do you have a history of disordered eating?" d. "Do you think that you drink too much?" e. "Have you ever been arrested for committing a crime?"b. "What do you do to manage anxiety?" c. "Do you have a history of disordered eating?" d. "Do you think that you drink too much?"Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population? a. Conducting routine suicide screenings at a senior center. b. Identifying depression as a natural, but treatable result of aging. c. Identifying males as being at a greater risk for developing depression. d. Stressing that most individuals experience just a single episode of major depressive disorder in a lifetimea. Conducting routine suicide screenings at a senior center.Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply. a. Female b. 7 years old c. Comorbid autism diagnosis d. Outbursts occur at least once a week e. Temper tantrums occur at home and in schoolb. 7 years old c. Comorbid autism diagnosis e. Temper tantrums occur at home and in schoolWhich chronic medical condition is a common trigger for major depressive disorder? a. Pain b. Hypertension c. Hypothyroidism d. Crohn diseasea. PainTammy, a 28-year-old with major depressive disorder and bulimia nervosa, is ready for discharge from the county hospital after 2 weeks of inpatient therapy. Tammy is taking citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervosa, what is an alternative antidepressant to consider? a. Fluoxetine (Prozac) b. Isocarboxazid (Marplan) c. Amitriptyline d. Duloxetine (Cymbalta)a. Fluoxetine (Prozac)Cabot has multiple symptoms of depression, including mood reactivity, social phobia, anxiety, and overeating. With a history of mild hypertension, which classification of antidepressants dispensed as a transdermal patch would be a safe medication? a. Tricyclic antidepressants b. Selective serotonin reuptake inhibitors c. Serotonin and norepinephrine reuptake inhibitors d. Monoamine oxidase inhibitord. Monoamine oxidase inhibitorWhen a nurse uses therapeutic communication with a withdrawn patient who has major depressive disorder, an effective method of managing the silence is to: a. Meditate in the quiet environment b. Ask simple questions even if the patient will not answer c. Use the technique of making observations d. Simply sit quietly and leave when the patient falls asleepc. Use the technique of making observationsThe biological approach to treating depression with electrodes surgically implanted into specific areas of the brain to stimulate the regions identified to be underactive in depression is: a. Transcranial magnetic stimulation b. Deep brain stimulation c. Vagus nerve stimulation d. Electroconvulsive therapyb. Deep brain stimulationTwo months ago, Natasha's husband died suddenly and she has been overwhelmed with grief. When Natasha is subsequently diagnosed with major depressive disorder, her daughter, Nadia, makes which true statement? a. "Depression often begins after a major loss. Losing dad was a major loss." b. "Bereavement and depression are the same problem." c. "Mourning is pathological and not normal behavior." d. "Antidepressant medications will not help this type of depression."a. "Depression often begins after a major loss. Losing dad was a major loss."The nurse is providing care for a patient demonstrating behaviors associated with moderate levels of anxiety. What question should the nurse ask initially in attempting to help the patient de-escalate the anxiety? a. "Do you know what will help you manage your anxiety?" b. "Do you need help to manage your anxiety?" c. "Can you identify what was happening when your anxiety began to increase?" d. "Are you feeling anxious right now?"c. "Can you identify what was happening when your anxiety began to increase?"Which patient is at increased risk for the development of anxiety and will require frequent assessment by the nurse? Select all that apply. a. Exacerbation of asthma signs and symptoms b. History of peanut and strawberry allergies c. History of chronic obstructive pulmonary disease d. Current treatment for unstable angina pectoris e. History of a traumatic brain injurya. Exacerbation of asthma signs and symptoms c. History of chronic obstructive pulmonary disease d. Current treatment for unstable angina pectoris e. History of a traumatic brain injuryWhich medication should the nurse be prepared to educate patients on when they are prescribed a selective serotonin reuptake inhibitor (SSRI) for panic attacks? a. Alprazolam (Xanax) b. Fluoxetine (Prozac) c. Clonazepam (Klonopin) d. Venlafaxine (Effexor)b. Fluoxetine (Prozac)Which statement or statements made by the nurse demonstrates an understanding of the effective use of relaxation therapy for anxiety management? Select all that apply. a. "Relaxation therapy's main goal is to prevent exhaustion by removing muscle tension." b. "Muscle relaxation promotes the relaxation response." c. "Show me how you learned to deep breathe in yesterday's therapy session." d. "You've said that going to group makes you nervous, so let's start relaxing now." e. "I've given you written descriptions of the various relaxation exercises for you to review."b. "Muscle relaxation promotes the relaxation response." c. "Show me how you learned to deep breathe in yesterday's therapy session." d. "You've said that going to group makes you nervous, so let's start relaxing now." e. "I've given you written descriptions of the various relaxation exercises for you to review."To maximize the therapeutic effect, which lifestyle practice should the nurse discourage for a patient who has recently been prescribed an antianxiety medication? a. Eating high-protein foods. b. Using acetaminophen without first discussing it with a healthcare provider c. Taking medications after eating dinner or while having a bedtime snack d. Buying a large coffee with sugar and extra cream each morning on the way to workd. Buying a large coffee with sugar and extra cream each morning on the way to workIn a parent-teacher conference, the school nurse meets with the parents of a profoundly shy 8-year-old girl. The parents hold hands, speak softly, respond briefly, and have poor eye contact. The nurse recognizes that the child is most likely exposed to parental modeling and a. The inherited shyness trait b. A lack of affection in the home c. Severe punishment by the parents d. Is afraid to say something foolisha. The inherited shyness traitIsabel is a straight-A student, yet she suffers from severe test anxiety and seeks medical attention. The nurse interviews Isabel and develops a plan of care. The nurse recognizes effective teaching about mild anxiety when Isabel states the following: a. "I would like to try a benzodiazepine for my anxiety." b. "If I study harder, my anxiety level will go down." c. "Mild anxiety is okay because it helps me to focus." d. "I have fear that I will fail at college."c. "Mild anxiety is okay because it helps me to focus."The activity of gamma-aminobutyric acid (GABA) contributes to a slowing of neural activity. Which of the following drugs facilitate the action of GABA? a. Benzodiazepines b. Antihistamines c. Anticonvulsants d. Noradrenergicsa. BenzodiazepinesSamantha is a new patient at the mental health clinic and is seeking assistance for what she describes as "severe anxiety." In addition to daily self-medicating with alcohol, Samantha describes long-term use of herbal kava. The nurse practitioner knows that kava is associated with inhibiting P450 and orders which of the following tests? a. Electrocardiogram b. Liver enzymes c. Glomerular filtration rate d. Complete blood countb. Liver enzymesA homebound patient diagnosed with agoraphobia has been receiving therapy at home. The nurse recognizes effective teaching when the patient states the following: a. "I may never leave the house again." b. "Having groceries delivered is very convenient." c. "My risk for agoraphobia is increased by my family history." d. "I will go out again someday, just not today."c. "My risk for agoraphobia is increased by my family history."Nick, a construction worker, is on duty when a nearly completed wall suddenly falls, crushing a number of his co-workers. Although badly shaken initially, he seemed to be coping well. About 2 weeks after the tragedy, he begins to experience tremors, nightmares, and periods during which he feels numb or detached from his environment. He finds himself frequently thinking about the tragedy and feeling guilty that he was spared while many others died. Which statement about this situation is most accurate? a. Nick has acute stress disorder and will benefit from antianxiety medications. b. Nick is experiencing posttraumatic stress disorder (PTSD) and should be referred for outpatient treatment. c. Nick is experiencing anxiety and grief and should be monitored for PTSD symptoms. d. Nick is experiencing mild anxiety and a normal grief reaction; no intervention is needed.a. Nick has acute stress disorder and will benefit from antianxiety medications.You are caring for Susannah, a 29-year-old who has been diagnosed with dissociative identity disorder. She was recently hospitalized after coming to the emergency department with deep cuts on her arms with no memory of how this occurred. The priority nursing intervention for Susannah is: a. Assist in recovering memories of abuse. b. Maintain 1:1 observation. c. Teach coping skills and stress-management strategies. d. Refer for integrative therapyb. Maintain 1:1 observation.You are caring for Connor, an 8-year-old boy who has been diagnosed with reactive attachment disorder. Which of the following nursing outcomes would be the most appropriate to achieve? a. Increases ability to self-control and decreases impulsive behaviors. b. Avoids situations that trigger conflicts. c. Expresses complex thoughts. d. Writes or draws feelings in a journal.d. Writes or draws feelings in a journal.Ashley is a 21-year-old college student who was sexually assaulted at a party. She was seen in the local emergency department and referred for counseling after being diagnosed by the provider on call as having acute stress disorder. Which of the following treatment modalities would you expect to see used in therapy with Ashley? a. Aversion therapy b. Stress-reduction therapy c. Cognitive behavioral therapy d. Short-term classical analysis therapyc. Cognitive behavioral therapyJamie, age 24, has been diagnosed with a dissociative disorder following a traumatic event. Jamie's mother asks you, "Does this mean my daughter is now crazy?" Your best response would be: a. "People with dissociative disorders are out of touch with reality, so in that way, your daughter is now mentally ill. Don't worry. Treatment is available." b. "Jamie will most likely need long-term intensive inpatient treatment to deal with her traumatic memories as well as to work through her delusions." c. "Most mental health providers are skeptical about dissociative disorders and aren't sure they truly exist. Jamie may be making up her symptoms as a cry for help." d. "Jamie is dealing with the anxiety associated with the trauma by separating herself from it. With treatment, she can get back to her previous level of functioning."d. "Jamie is dealing with the anxiety associated with the trauma by separating herself from it. With treatment, she can get back to her previous level of functioning."A young child is found wandering alone at a mall. A male store employee approaches and asks where her parents are. She responds, "I don't know. Maybe you will take me home with you?" This sort of response in children may be due to: a. A lack of bonding as an infant b. A healthy confidence in the child c. Adequate parental bonding d. Normal parentinga. A lack of bonding as an infantDuring a routine health screening, a grieving widow whose husband died 15 months ago reports emptiness, a loss of self, difficulty thinking of the future, and anger at her dead husband. The nurse suggests bereavement counseling. The widow is most likely suffering from: a. Major depression b. Normal grieving c. Adjustment disorder d. Posttraumatic stress disorderc. Adjustment disorderMaggie, a child in protective custody, is found to have an imaginary friend, Holly. The foster family shares this information with the nurse. The nurse teaches the family members about children who have suffered trauma and knows her teaching was effective when the foster mother states: a. "I understand that imaginary friends are abnormal." b. "I understand that imaginary friends are a maladaptive behavior." c. "I understand that imaginary friends are a coping mechanism." d. "I understand that we should tell the child that imaginary friends are unacceptable."c. "I understand that imaginary friends are a coping mechanism."The school nurse has been alerted to the fact that an 8-year-old boy routinely play acts as a police officer, "locking up" other children on the playground to the point where the children get scared. The nurse recognizes that this behavior is most likely an indication of: a. The need to dominate others b. Inventing traumatic events c. A need to develop close relationships d. A potential symptom of traumatizationd. A potential symptom of traumatizationA pregnant woman is in a relationship with a male who routinely abuses her. Her unborn child may engage in high-risk behavior as a teen as a result of: a. Maternal stress b. Parental nurturing c. Appropriate stress responses in the brain d. Memories of the abusea. Maternal stressWhich patient statement acknowledges the characteristic behavior associated with a diagnosis of pica? a. "Nothing could make me drink milk." b. "I'm ashamed of it, but I eat my hair." c. "I haven't eaten a green vegetable since I was 3 years old." d. "I regurgitate and rechew my food after almost every meal."b. "I'm ashamed of it, but I eat my hair."In evaluating an eating disorder, what physical criterion for hospital admission would you consider? a. A daytime heart rate of less than 50 beats per minute b. An oral temperature of 100°F or more c. 90% of ideal body weight d. Systolic blood pressure greater than 130 mm Hga. A daytime heart rate of less than 50 beats per minuteIn considering the need for monitoring, which intervention should the nurse implement for a patient with anorexia nervosa? Select all that apply. a. Provide scheduled portion-controlled meals and snacks. b. Congratulate patients for weight gain and behaviors that promote weight gain. c. Limit time spent in the bathroom during periods when the patient is not under direct supervision. d. Promote exercise as a method to increase appetite. e. Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintained.a. Provide scheduled portion-controlled meals and snacks. c. Limit time spent in the bathroom during periods when the patient is not under direct supervision. e. Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintained.Which intervention will promote independence in a patient being treated for bulimia nervosa? a. Have the patient monitor daily caloric intake and intake and output of fluids. b. Encourage the patient to use behavior modification techniques to promote weight gain behaviors. c. Ask the patient to use a daily log to record feelings and circumstances related to urges to purge. d. Allow the patient to make limited choices about eating and exercise as weight gain progresses.d. Allow the patient to make limited choices about eating and exercise as weight gain progresses.Which patient statement supports the diagnosis of anorexia nervosa? a. "I'm terrified of gaining weight." b. "I wish I had a good friend to talk to." c. "I've been told that I drink way too much alcohol." d. "I don't get much pleasure out of life anymore."a. "I'm terrified of gaining weight."Obesity can be the end result of a binge-eating disorder. The nurse understands that the best treatment option in persons with a binge-eating disorder is a. Bariatric surgery b. Coping strategies c. Avoidance of public eating d. Appetite suppression medicationsb. Coping strategiesTaylor, a psychiatric registered nurse, orients Regina, a patient with anorexia nervosa, to the room where she will be assigned during her stay. After getting Regina settled, the nurse informs Regina of the following: a. "I need to go through the belongings you have brought with you." b. "You can use the scale in the back room when you need to." c. "You will be eating five times a day here." d. "The daily structure is based around your desire to eat."a. "I need to go through the belongings you have brought with you."Safety measures are of concern in treating eating disorders. Patients with anorexia nervosa are supervised closely to monitor the following: Select all that apply. a. Foods that are eaten b. Attempts at self-induced vomiting c. Relationships with other patients d. Weighta. Foods that are eaten b. Attempts at self-induced vomiting d. WeightMalika has been overweight all her life. Now an adult, she has health problems related to excessive weight. Seeking weight-loss assistance at a primary care facility, Malika is surprised when the nurse practitioner suggests the following: a. A trial of SSRI antidepressant therapy b. Mild exercise to start, increasing in intensity over time c. Removing snack foods from the home d. Medication treatment for hypertensiona. A trial of SSRI antidepressant therapyMalika agrees to try losing weight according to the nurse practitioner's outlined plan. Additional teaching is warranted when Malika states that a. "I am willing to admit that I am depressed." b. "Psychotherapy will be a part of my treatment." c. "I prefer to have a gastric bypass rather than use this plan." d. "My comorbid conditions may improve with weight loss."c. "I prefer to have a gastric bypass rather than use this plan."Which patient statement supports a diagnosis of narcolepsy? a. "My wife tells me I snore at night." b. "I sleepwalk several nights a week." c. "I have no control over when I fall asleep." d. "My legs feel funny, and that keeps me awake."c. "I have no control over when I fall asleep."Madelyn, a 29-year-old patient recently diagnosed with major depressive disorder, comes to the mental health clinic complaining of continued difficulty sleeping. One week ago, she was started on a selective serotonin reuptake inhibitor (SSRI), fluoxetine (Prozac), for her depressive symptoms. When educating Madelyn, your response is guided by the knowledge that: a. SSRIs such as fluoxetine more commonly cause hypersomnolence as opposed to difficulty sleeping. b. The sleep problem is caused by the depression and is unrelated to the medication. c. The neurotransmitters involved in sleep and wakefulness are the same neurotransmitters targeted by many psychiatric medications and may be affecting her sleep. d. The medication should be discontinued since sleep is the most important element to her recovery.c. The neurotransmitters involved in sleep and wakefulness are the same neurotransmitters targeted by many psychiatric medications and may be affecting her sleep.Which behaviors will the nurse encourage a patient diagnosed with insomnia disorder to adopt? Select all that apply. a. Avoiding exercising at bedtime b. Avoiding napping during the day c. Eating a hearty snack at bedtime d. Getting up at the same time each day e. Moving the clock so it is not visible from the beda. Avoiding exercising at bedtime b. Avoiding napping during the day d. Getting up at the same time each day e. Moving the clock so it is not visible from the bedWhich treatment is typically prescribed for primary insomnia? Select all that apply. a. Cognitive behavioral therapy-insomnia (CBT-I) b. Intravenous medication for sedation c. Stimulus control d. Sleep restriction e. Sleep hygiene measuresa. Cognitive behavioral therapy-insomnia (CBT-I) c. Stimulus control d. Sleep restriction e. Sleep hygiene measuresLight projected into the retina is believed to trigger changes in sleep patterns and quality of sleep. Therefore, the nurse should suggest: a. Not reading within an hour of bedtime. b. Exercising before bedtime in a darkened environment. c. Limiting use of electronic devices in the hour before bedtime. d. Dimming the screen on cellphones and computers in the evening.c. Limiting use of electronic devices in the hour before bedtime.Sleep disturbances are often overlooked or undiagnosed due to: a. A lack of formal nurse and physician training in sleep disturbances. b. Patients not often accurately describing sleep disturbance patterns. c. The belief that sleep disturbance is a necessary part of hospitalization. d. Patients hiding the fact that they have issues with sleep.a. A lack of formal nurse and physician training in sleep disturbances.Many people allow life circumstances to dictate their amount of sleep instead of recognizing sleep as a priority. Which statement will the nurse recognize as progress in the patient's sleep hygiene program? a. "I go to bed even if I am not sleepy, hoping I will fall asleep." b. "I have one glass of red wine at bedtime each night." c. "I take a nap each day to 'catch up' on my sleep deficit." d. "I have removed the television from my bedroom."d. "I have removed the television from my bedroom."Larry is a 50-year-old man who works about 60 hours per week. He arrives at the clinic seeking assistance with a weight gain of 50 pounds over the past year. Larry admits to sleeping 4 to 5 hours a night. The nurse recognizes that the weight gain may be related to: a. A new onset of diabetes. b. Suspected cardiovascular disease. c. Dysregulation of hormones that influence appetite. d. Comorbidity of depression with obesity.c. Dysregulation of hormones that influence appetite.Sleep deprivation is considered a safety issue that results in loss of life and property. Psychomotor impairments of sleep deprivation are similar to symptoms caused by: a. Sleeping in excess of 10 hours. a. Misuse of caffeine products. c. Alcohol consumption. d. Working more than 40 hours per week.c. Alcohol consumption.The stage of sleep known as rapid eye movement or REM sleep is characterized by atonia and myoclonic twitches in addition to the actual rapid movement of the eyes. Atonia is thought to be a protective mechanism as it: a. Limits physical movements. b. Prevents nightmares. c. Enhances the dream state. d. Regulates the autonomic nervous system.a. Limits physical movements.Natalya, a patient with a history of alcohol use disorder, has been prescribed disulfiram (Antabuse). Which physical effects support the suspicion that the patient has relapsed? Select all that apply. a. Intense nausea b. Diaphoresis c. Acute paranoia d. Confusion e. Dyspneaa. Intense nausea b. Diaphoresis d. Confusion e. DyspneaWhich assessment data confirm the suspicion that a patient is experiencing opioid withdrawal? Select all that apply. a. Pupils are dilated b. Pulse rate is 62 beats/min c. Slow movements d. Extreme anxiety e. Sleepya. Pupils are dilated d. Extreme anxietyThe nursing diagnosis denial is especially useful when working with substance use disorders and gambling. Which statements describe this diagnosis? Select all that apply. a. Reports inability to cope b. Does not perceive the danger of substance use or gambling c. Minimizes symptoms d. Refuses healthcare attention e. Unable to admit the impact of disease on life patternb. Does not perceive the danger of substance use or gambling c. Minimizes symptoms d. Refuses healthcare attention e. Unable to admit the impact of disease on life patternWhat action should you take when a female staff member is demonstrating behaviors associated with a substance use disorder? a. Accompany the staff member when she is giving patient care. b. Offer to attend rehabilitation counseling with her. c. Refer her to a peer assistance program. d. Confront her about your concerns and/or report your concerns to a supervisor immediately.d. Confront her about your concerns and/or report your concerns to a supervisor immediately.A patient diagnosed with opioid use disorder has expressed a desire to enter into a rehabilitation program. What initial nursing intervention during the early days after admission will help ensure the patient's success? a. Restrict visitors to family members only. b. Manage the patient's withdrawal symptoms well. c. Provide the patient a low-stimulus environment. d. Advocate for at least 3 months of treatment.b. Manage the patient's withdrawal symptoms well.Lester and Alene have always enjoyed gambling. Lately, Alene has discovered that their savings account is down by $50,000. Alene insists that Lester undergo therapy for his gambling behavior. The nurse recognizes that Lester is making progress when he states: a. "I understand that I am a bad person for depleting our savings." b. "Gambling activates the reward pathways in my brain." c. "Gambling is the only thing that makes me feel alive." d. "We have always enjoyed gaming. I do not know why Alene is so upset."b. "Gambling activates the reward pathways in my brain."Opioid use disorder is characterized by: a. Lack of withdrawal symptoms b. Intoxication symptoms of pupillary dilation, agitation, and insomnia c. Tolerance d. Requiring smaller amounts of the drug to achieve a high over timec. ToleranceTerry is a young male in a chemical dependency program. Recently, he has become increasingly distracted and disengaged. The nurse concludes that Terry is: a. Bored b. Depressed c. Bipolar d. Not ready to changed. Not ready to changeMax is a 30-year-old male who arrives at the emergency department stating, "I feel like I am having a stroke." During the intake assessment, the nurse discovers that Max has been working for 36 hours straight without eating and has consumed 8 double espresso drinks and 12 caffeinated sodas. The nurse suspects: a. Fluid overload b. Dehydration and caffeine overdose c. Benzodiazepine overdose d. Sleep deprivation syndromeb. Dehydration and caffeine overdoseDonald, a 49-year-old male, is admitted for inpatient alcohol detoxification. The rationale for admission into this program is due to: a. Heavy use of a substance known to cause withdrawal b. A need for rehabilitation c. The potential for relapse d. CNS hypoactivity following cessation of alcohol consumptiona. Heavy use of a substance known to cause withdrawalWhich statement made by the primary caregiver of a person with dementia demonstrates an accurate understanding of providing the person with a safe environment? a. "The local police know that he has wandered off before." b. "I keep the noise level low in the house." c. "We've installed locks on all the outside doors." d. "Our telephone number is always attached to the inside of his shirt pocket."c. "We've installed locks on all the outside doors."Which statement made by a family member tends to support a diagnosis of delirium rather than dementia? a. "She was fine last night but this morning she was confused." b. "Dad doesn't seem to recognize us anymore." c. "She's convinced that snakes come into her room at night." d. "He can't remember when to take his pills or whether he's bathed."a. "She was fine last night but this morning she was confused."In terms of the pathophysiology responsible for both delirium and dementia, which intervention would be appropriate for delirium specifically? a. Assisting with needs related to nutrition, elimination, hydration, and personal hygiene b. Monitoring neurological status on an ongoing basis c. Placing an identification bracelet on patient d. Giving one simple direction at a time in a respectful tone of voiceb. Monitoring neurological status on an ongoing basisWhat side effects should the nurse monitor for while caring for a patient taking donepezil (Aricept)? Select all that apply. a. Insomnia b. Constipation c. Bradycardia d. Signs of dizziness e. Reports of headachea. Insomnia c. Bradycardia d. Signs of dizziness e. Reports of headacheWhat is the rationale for providing a patient diagnosed with dementia easily accessible finger foods thorough the day? a. It increases input throughout the day b. The person may be anorexic c. It helps with the monitoring of food intake d. It helps to prevent constipationa. It increases input throughout the dayOphelia, a 69-year-old retired nurse, attends a reunion of her former coworkers. Ophelia is concerned because she usually knows everyone, and she cannot recognize faces today. A registered nurse colleague recognizes Ophelia's distress and "introduces" Ophelia to those attending. The nurse practitioner understands that Ophelia seems to have a deficit in her a. Lower-level cognitive domain b. Delirium threshold c. Executive function d. Social cognition abilityd. Social cognition abilityAfter talking with her 85-year-old mother, Nancy became concerned enough to drive to her home and check on her. Her mother's appearance was disheveled, her words were nonsensical, she smelled strongly of urine, and there was a stain on her dressing gown. Because she is a nurse, Nancy recognizes that her mother's condition is likely due to a. Early-onset dementia b. A mild cognitive disorder c. A urinary tract infection d. Having skipped breakfastc. A urinary tract infectionLucia, 70 years old, recently underwent a major orthopedic surgical procedure. On postoperative day 3, she responds to the nurse who has been caring for her with affection. At other times, however, she tells the nurse to leave because she does not recognize her and asks to have another nurse care for her, specifically naming the nurse as the "nice one." The most likely reason for Lucia's behavior is that she is a. Attention-seeking and manipulative b. Showing signs of early dementia c. Experiencing an acute delirium d. Playing one staff member off against anotherc. Experiencing an acute deliriumSince his wife's death 2 months earlier, Aaron, 90 years of age and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating, disrupted sleep, and lacks energy. His family has to remind and encourage him to shower, take his medications, and eat, all of which he then does. Which of the following responses would be most appropriate? a. Reorient Mr. Smith by pointing out the day and date each time you have occasion to interact with him. b. Meet with the family and support them to accept, anticipate, and prepare for the progression of his stage 2 dementia. c. Avoid touch and proximity. These are likely to be uncomfortable for Mr. Smith and may provoke aggression when he is disoriented. d. Arrange for an appointment with a mental health professional for the evaluation and treatment of suspected major depressive disorder.d. Arrange for an appointment with a mental health professional for the evaluation and treatment of suspected major depressive disorder.Nurses caring for patients who have neurocognitive disorders are exposed to stress on many levels. Specialized skills training and continuing education are helpful to diffuse stress, as well as which of the following? Select all that apply. a. Expressing emotions by journaling b. Describing stressful events on Facebook c. Engaging in exercise and relaxation activities d. Having realistic patient expectations e. Participating in a happy hour after work to blow off steama. Expressing emotions by journaling c. Engaging in exercise and relaxation activities d. Having realistic patient expectationsWhich patient statement does not demonstrate an understanding of a suicide safety plan? a. "Going for a really long, hard run helps clear my mind and stops the suicidal thoughts." b. "I will take extra medication if I start getting those self-destructive feelings." c. "My sister is always there for me when I start getting suicidal." d. "I keep the suicide prevention phone number in my wallet."b. "I will take extra medication if I start getting those self-destructive feelings."Which interventions will help make the environment on the unit safer for patients with suicidal ideation? Select all that apply. a. All windows are kept locked. b. Every shower has a breakaway shower rod. c. Eating utensils are counted when trays are collected. d. Patient doors are kept open. e. Staying within listening distance of the patient.a. All windows are kept locked. b. Every shower has a breakaway shower rod. c. Eating utensils are counted when trays are collected. d. Patient doors are kept open.What are the nursing responsibilities to a patient expressing suicidal thoughts? Select all that apply. a. Instituting one-to-one observation. b. Documenting the patient's whereabouts and mood every 15 to 30 minutes. c. Ensuring that the patient has no contact with glass or metal utensils. d. Ensuring that patient has swallowed each individual dose of medication. e. Discussing triggers of depression.a. Instituting one-to-one observation. b. Documenting the patient's whereabouts and mood every 15 to 30 minutes. c. Ensuring that the patient has no contact with glass or metal utensils. d. Ensuring that patient has swallowed each individual dose of medication.When considering community suicide prevention programs, what population should the nurse plan to service with regular suicide screenings? Select all that apply. a. 10- to 34-year-olds b. Males c. College-educated adults d. Rural population e. Native Americana. 10- to 34-year-olds b. Males e. Native AmericanResearch supports that which intervention implemented on a long-term basis significantly reduces the incidence of suicide and suicide attempts in a patient diagnosed with bipolar disorder? a. An antipsychotic medication b. Electroconvulsive therapy (ECT) c. One-on-one observation d. Lithiumd. LithiumGladys is seeing a therapist because her husband died by suicide 6 months ago. Gladys tells her therapist, "I know he was in pain, but why didn't he leave me a note?" The therapist's best response would be: a. "He probably acted quickly on his impulse to kill himself." b. "He did not want to think about the pain he would cause you." c. "He was not able to think clearly due to his emotional pain." d. "He thought you may think it was an accident if there was no note."c. "He was not able to think clearly due to his emotional pain."Martin is a 23-year-old male with a new diagnosis of schizophrenia, and his family is receiving information from a home health nurse. The topic of education is suicide prevention, and the nurse recognizes effective teaching when the mother says: a. "Persons with schizophrenia rarely die by suicide." b. "Suicide risk is greatest in the first few years after diagnosis." c. "Suicide is not common in schizophrenia due to confusion." d. "Most persons diagnosed with schizophrenia die of suicide."b. "Suicide risk is greatest in the first few years after diagnosis."Sigmund Freud, Karl Menninger, and Aaron Beck theorized that hopelessness was an integral part of why a person ends one's life by suicide. A more recent theory suggests suicide results from: a. Elevated serotonin levels b. The diathesis-stress model c. Outward aggression turned inward d. A lack of perfectionismb. The diathesis-stress modelWhich person is at the highest risk for suicide? a. A 50-year-old married white male with major depressive disorder who has a plan to overdose if circumstances at work do not improve. b. A 45-year-old married white female who recently lost her parents, suffers from bipolar disorder, and attempted suicide once as a teenager. c. A young single white male who misuses alcohol, is hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden. d. An older Hispanic male who is Catholic, living with a debilitating chronic illness, recently widowed, and who states, "I wish that God would take me too."c. A young single white male who misuses alcohol, is hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden.Kara is a 23-year-old patient admitted with major depressive disorder and suicidal ideation. Which intervention(s) would be therapeutic for Kara? Select all that apply. a. Focus primarily on developing solutions to the problems that lead the patient to feel suicidal. b. Assess the patient thoroughly and reassess the patient at regular intervals as levels of risk fluctuate. c. Avoid talking about the suicidal ideation as this may increase the patient's risk for suicidal behavior. d. Meet regularly with the patient to provide opportunities for the patient to express and explore feelings. e. Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group. f. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic.b. Assess the patient thoroughly and reassess the patient at regular intervals as levels of risk fluctuate. d. Meet regularly with the patient to provide opportunities for the patient to express and explore feelings. e. Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group. f. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic.Which statement made by a new mother should be explored further by the nurse? a. "I have three children, that's enough." b. "I think the baby cries just to make me angry." c. "I wish my husband could help more with the baby." d. "Babies are a blessing, but they are a lot of work."b. "I think the baby cries just to make me angry."Which problem is observed in children who regularly witness acts of violence in their family? Select all that apply. a. Phobias b. Low self-esteem c. Major depressive disorder d. Narcissistic personality disorder e. Posttraumatic stress disordera. Phobias b. Low self-esteem c. Major depressive disorder e. Posttraumatic stress disorderWhat situation associated with a caregiver presents the greatest risk that an older adult will experience abuse by that caregiver? a. The caregiver is a single male relative. b. The caregiver was neglected as a child. c. The caregiver is under the age of 30. d. The caregiver has little experience with older adults.b. The caregiver was neglected as a child.What safety-related responsibility does the nurse have in any situation of suspected abuse? a. Protect the patient from future abuse by the abuser. b. Inform the suspected abuser that the authorities have been notified. c. Arrange for counseling for all involved parties, but especially the patient. d. Report suspected abuse to the proper authorities.d. Report suspected abuse to the proper authorities.The nurse is assisting a patient to identify safety issues that may occur now that she has left an abusive partner. What telephone numbers should be available to the patient? Select all that apply. a. The police department b. An abuse hotline c. A responsible friend or family member d. A domestic violence shelter e. The hospital emergency departmenta. The police department b. An abuse hotline c. A responsible friend or family member d. A domestic violence shelterSecondary effects of abuse often manifest as arrested development in children due to the fact that: a. Coping is easier than emotional growth b. Energy for development is diverted to coping c. Children cannot differentiate love from abuse d. Abuse fosters a sense of belonging, even if dysfunctionalb. Energy for development is diverted to copingThe use of a patient-centered interview technique works well for gathering information about abusive situations. It is a good use of clinical time to sit near the patient and: a. Establish trust and rapport b. Ask lots of questions c. Interrupt the patients' story to allow for decompression d. Utilize closed-ended questionsa. Establish trust and rapportThe abused person is often in a dependent position, relying on the abuser for basic needs. At particular risk are children and older adults due to: a. The love they have for parents or children. b. Their limited options. c. The need to feel safe at home. d. Other relatives do not want them.b. Their limited options.An appropriate expected outcome in individual therapy regarding the perpetrator of abuse would be: a. A decrease in family interaction so there are fewer opportunities for abuse to occur. b. The perpetrator will recognize destructive patterns of behavior and learn alternate responses. c. The perpetrator will no longer live with the family but have supervised contact while undergoing intensive inpatient therapy. d. A triad of treatment modalities, including medication, counseling, and role-playing opportunities.b. The perpetrator will recognize destructive patterns of behavior and learn alternate responses.Perpetrators of domestic violence tend to: Select all that apply. a. Have relatively poor social skills and have grown up with poor role models. b. Believe they, if male, should be dominant and in charge in relationships. c. Force their mates to work and expect them to handle the financial decisions. d. Be controlling and willing to use force to maintain their power in relationships. e. Prevent their mates from having relationships and activities outside the family.a. Have relatively poor social skills and have grown up with poor role models. b. Believe they, if male, should be dominant and in charge in relationships. d. Be controlling and willing to use force to maintain their power in relationships. e. Prevent their mates from having relationships and activities outside the family.Your 24-year-old patient is planning to leave the family to start a new job in a city 400 miles away. Which statement made by the patient best demonstrates a healthy sense of family support? a. "I've always been independent. That's how I was raised." b. "If I get in trouble financially, I know mom and dad will help me out." c. "I don't need anyone's help. Everyone has their own problems to deal with." d. "I'm going to miss everyone terribly, but I know they will support me in this decision."d. "I'm going to miss everyone terribly, but I know they will support me in this decision."A nurse works with patients whose families are attending family therapy. The nurse should recommend psychoeducational family therapy for which family? a. A family whose members have problems establishing and respecting boundaries. b. A family whose teenaged children are routinely making major family decisions. c. A family whose 18-year-old son has been diagnosed with schizophrenia. d. A family who communicates primarily using dysfunctional techniques.c. A family whose 18-year-old son has been diagnosed with schizophrenia.A 10-year-old shares that he doesn't like spending weekends with his father "now that dad's girlfriend moved in." The nurse will discuss the issues with the child and parents based on an understanding of the stresses present in which type of family structure? a. Unmarried biological b. Cohabitating c. Blended d. Otherb. CohabitatingWhich statement is an example of a parent demonstrating the dysfunctional communication technique of generalizing? a. "I want to be a good mother, but my husband just isn't involved with the kids." b. "I keep the peace by seldom asking any of the family to help with chores." c. "My wife's priorities are the kids, her parents, and then her job." d. "The kids never listen to me even when I threaten them."d. "The kids never listen to me even when I threaten them."Just before you escort the Juarez family in for a meeting, their 17-year-old son confides to you that he is gay. He says he has not told any other adult, including his parents. What is your best response to him? a. "Your parents have a right to know about this." b. "How do you think your parents would react if you told them?" c. "That's your decision, but you need to be careful about risky sexual behavior." d. "Lots of famous people are gay. You don't need to worry."b. "How do you think your parents would react if you told them?"When performing an intake assessment on a family, you wish to map the family's structure and information that reflect both the family's history and current functioning. This assessment tool is called a: a. Mini-mental status exam b. Beck depression inventory c. Genogram d. Histogramc. GenogramWhile you are working with a family whose son was admitted due to a psychotic break, you observe the mother say to her son, "What, no hug for your Mom?" As the son embraces his mother, she stiffens, which results in the young man backing away. She responds, "You only care about yourself." What behavior is this mother engaging in? a. Triangulation b. Scapegoating c. Double binding d. Differentiationc. Double bindingWhich of the following family members should you refer to individual therapy rather than family therapy? a. A mother who has anxiety controlled by medication. b. A father who is questioning his sexuality. c. A son who is verbally abusive toward his parents. d. A daughter who has been treated for alcohol use disorder.b. A father who is questioning his sexuality.You are evaluating the family therapy experience. Which behavior would indicate that further family therapy is needed? a. Wife talks to her husband through their children. b. Son's grades have risen from a "D" average to a "C" average. c. Daughter's headaches have subsided. d. Mother has stopped using illicit substances.a. Wife talks to her husband through their children.Emotional support is an important family dynamic because it allows family members to: a. Feel secure enough to explore aspects of their personality. b. Feel isolated and fearful even though family members are near. c. Grow without boundaries within the family unit. d. Have bursts of anger without recourse or shame.a. Feel secure enough to explore aspects of their personality.Which statement made by the patient demonstrates an understanding of the foundational principle of integrative care? a. "My body has the ability to heal itself if we have the knowledge to give it the right tools." b. "The integrative care I'm getting is primarily a combination of complementary, alternative, and mainstream medicines." c. "Much of the knowledge that integrative care is based on comes from Western cultural traditions." d. "The most important focus of my integrative care is the cure of my cardiac illness."a. "My body has the ability to heal itself if we have the knowledge to give it the right tools."When considering the goals of complementary and alternative medicines, which patient would be of particular interest to researchers studying advances in symptom management? a. One who experiences chronic pain related to a neck injury b. A patient diagnosed with an acute gastrointestinal infection c. A pregnant woman diagnosed with gestational diabetes d. A child requiring surgery for a clubbed foota. One who experiences chronic pain related to a neck injuryWhich assessment question regarding a patient's report of pain demonstrates the nurse's attention to the principles of holistic nursing care? a. "When did your pain begin?" b. "Are you taking any herbal supplements for the pain?" c. "Has anyone else in your family ever experienced this kind of pain?" d. "How has the pain affected your daily ability to care for yourself?"b. "Are you taking any herbal supplements for the pain?"What medication education should the nurse provide to a patient who has expressed an interest in taking St. John's wort? a. Allergic reactions to this herb are common. b. Due to liver toxicity, regular liver function test should be conducted while taking it. c. St. John's wort should not be taken in combination with antidepressants. d. This medication results in gastrointestinal symptoms, including bleeding.c. St. John's wort should not be taken in combination with antidepressants.Which factor is likely to attract a patient to complementary and alternative medicine? Select all that apply. a. This nonmainstream approach is always less expensive than conventional medical treatment. b. A desire to choose personal healthcare practices. c. Using these approaches carries a lower risk than many pharmaceuticals. d. Traditional medicine has been unsuccessful in providing effective treatment. e. Integrative medication practices tend to produce desired results more quickly than conventional practices.b. A desire to choose personal healthcare practices. c. Using these approaches carries a lower risk than many pharmaceuticals. d. Traditional medicine has been unsuccessful in providing effective treatment.In contrast to most Western medicine, integrative care takes into consideration: a. The physician's diagnosis and the patient's response b. The nurse's ideas about healing in addition to the physician c. A whole-person perspective: body, mind, and spirit d. The diagnosis before beginning spirit workc. A whole-person perspective: body, mind, and spiritA nursing student is experiencing increasing test anxiety. Her professor suggests the student try some integrative therapies. The student reported successful test anxiety reduction with which of the following therapies? a. Aromatherapy and breathing exercises b. Megavitamin therapy and yoga c. Naturopathy d. Reikia. Aromatherapy and breathing exercisesThe nurse is caring for a patient who has a question about the safety of an herbal supplement. Which nursing response is best? a. "Herbal supplements are regulated by the FDA." b. "Natural ingredients in herbal supplements are harmless." c. "Your primary care provider needs to be aware of any supplements you take." d. "Marketing for herbal supplements demonstrates that all supplements are safe."c. "Your primary care provider needs to be aware of any supplements you take."A patient asks the nurse if exercise and what she eats can impact her mood. The nurse's best response is which of the following? a. "There is no need to be concerned about exercise and nutrition if you take your antidepressant." b. "Limited studies are available on exercise and nutrition and mood." c. "Exercise is helpful, but you don't need to worry about nutrition." d. "Extensive research has shown that exercise and proper nutrition greatly improve mood symptoms."d. "Extensive research has shown that exercise and proper nutrition greatly improve mood symptoms."Reviewing prescription medications in the discharge instructions for a patient with a diagnosis of major depressive disorder, the nurse would caution the patient about which over-the-counter supplement(s)? Select all that apply. a. Fish oil b. SAMe c. St. John's wort d. Melatoninb. SAMe c. St. John's wort