|1. A consumer at a rehabilitative psychosocial program says to the nurse, “People are not cleaning up behind themselves in the bathrooms. The building is dirty and cluttered.” How should the nurse respond? a. Encourage the consumer to discuss it at a meeting with everyone. b. Hire a professional cleaning service to clean the restrooms. c. Address the complaint at the next staff meeting. d. Tell the consumer, “That’s not my problem.”.
2. A nurse documents: “Patient is mute despite repeated efforts to elicit speech. Makes no eye contact. Inattentive to staff. Gazes off to the side or looks upward rather than at speaker.” Which nursing diagnosis should be considered? a. Defensive coping b. Decisional conflict c. Risk for other-directed violence d. Impaired verbal communication.
3. A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional intervention? a. Conduct mental health assessments. b. Prescribe psychotropic medication. c. Establish therapeutic relationships. d. Individualize nursing care plans.
4. A hospitalized patient diagnosed with schizophrenia has a history of multiple relapses. The patient usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply first as the patient transitions from hospital to community? a. Administer a second-generation antipsychotic to help negative symptoms. b. Use a quick-dissolving medication formulation to reduce “cheeking.” c. Prescribe a long-acting intramuscular antipsychotic medication. d. Involve the patient in decisions about which medication is best.
5. A nurse assesses an older adult patient brought to the emergency department by a family member. The patient was wandering outside saying, “I can’t find my way home.” The patient is confused and unable to answer questions. Select the nurse’s best action. a. Record the patient’s answers to questions on the nursing assessment form. b. Ask an advanced practice nurse to perform the assessment interview. c. Call for a mental health advocate to maintain the patient’s rights. d. Obtain important information from the family member.
6. 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 disturbances.
7. A patient diagnosed with a SMI died suddenly at age 52. The patient lived in the community for 5 years without relapse and held supported employment the past 6 months. The distressed family asks, “How could this happen?” Which response by the nurse accurately reflects research and addresses the family’s question? a. “A certain number of people die young from undetected diseases, and it’s just one of those sad things that sometimes happen.” b. “Mentally ill people tend to die much younger than others, perhaps because they do not take as good care of their health, smoke more, or are overweight.” c. “We will have to wait for the autopsy to know what happened. There were some medical problems, but we were not expecting death.” d. “We are all surprised. The patient had been doing so well and saw the nurse every other week.”.
8. What information is conveyed by nursing diagnoses? (Select all that apply.) a. Medical judgments about the disorder b. Unmet patient needs currently present c. Goals and outcomes for the plan of care d. Supporting data that validate the diagnoses e. Probable causes that will be targets for nursing interventions.
9. 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 HCL 2.5 mg po 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 I’m ready to blow up.’ O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol 2 mg po. I: Haloperidol 2 mg po given 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 2 mg po 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 2 mg po administered at 0900 with calming effect in 30 minutes. Stated, ‘I’m no longer bothered by the voices.’”.
10. Which service would be expected to provide resources 24 hours a day, 7 days a week if needed for persons with SMI? a. Clubhouse model b. Cognitive-behavioral therapy (CBT) c. Assertive community treatment (ACT) d. Cognitive enhancement therapy (CET).
11. A homeless patient diagnosed with a SMI became suspicious and delusional. Depot antipsychotic medication began and housing was obtained in a local shelter. One month later, which statement by the patient indicates significant improvement? a. “They will not let me drink. They have many rules in the shelter.” b. “I feel comfortable here. Nobody bothers me.” c. “Those shots make my arm very sore.” d. “Those people watch me a lot.”.
12. A patient states, “I’m 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-esteem–building activities b. Anxiety self-control measures c. Sleep enhancement activities d. Suicide precautions.
13. The parent of an adolescent diagnosed with mental illness asks the nurse, “Why do you want to do a family assessment? My teenager is the patient, not the rest of us.” Select the nurse’s best response. a. “Family dysfunction might have caused the mental illness.” b. “Family members provide more accurate information than the patient.” c. “Family assessment is part of the protocol for care of all patients with mental illness.” d. “Every family member’s perception of events is different and adds to the total picture.”.
14. Which scenario best illustrates scapegoating within a family? a. The identified patient sends messages of aggression to selected family members. b. Family members project problems of the family onto one particular family member. c. The identified patient threatens separation from the family to induce feelings of isolation and despair. d. Family members give the identified patient nonverbal messages that conflict with verbal messages.
15. A consumer at a rehabilitative psychosocial program says to the nurse, “People are not cleaning up behind themselves in the bathrooms. The building is dirty and cluttered.” How should the nurse respond? a. Encourage the consumer to discuss it at a meeting with everyone. b. Hire a professional cleaning service to clean the restrooms. c. Address the complaint at the next staff meeting. d. Tell the consumer, “That’s not my problem.”.
16. An adult, recently diagnosed with AIDS, is hospitalized with pneumonia. The patient and family are very anxious. Select the best outcome to add to the plan of care for this family. a. Describe the stages of the anticipatory grieving process. b. Identify and describe effective methods for coping with anxiety. c. Recognize ways dysfunctional communication is expressed in the family. d. Examine previously unexpressed feelings related to the patient’s sexuality.
17. Which documentation of family assessment indicates a healthy and functional family? a. Members provide mutual support. b. Power is distributed equally among all members. c. Members believe there are specific causes for events. d. Under stress, members turn inward and become enmeshed.
18. A hospitalized patient diagnosed with schizophrenia has a history of multiple relapses. The patient usually responds quickly to antipsychotic medication but soon discontinues the medication. Discharge plans include follow-up at the mental health center, group home placement, and a psychosocial day program. Which strategy should apply first as the patient transitions from hospital to community? a. Administer a second-generation antipsychotic to help negative symptoms. b. Use a quick-dissolving medication formulation to reduce “cheeking.” c. Prescribe a long-acting intramuscular antipsychotic medication. d. Involve the patient in decisions about which medication is best.
19. An adult diagnosed with schizophrenia lives with elderly parents. The patient was recently hospitalized with acute psychosis. One parent is very anxious, and the other is ill because of the stress. Which nursing diagnosis is most applicable to this scenario? a. Ineffective family coping related to parental role conflict b. Caregiver role strain related to the stress of chronic illness c. Impaired parenting related to patient’s repeated hospitalizations d. Interrupted family processes related to relapse of acute psychosis.
20. A 16-year-old wants to drive, but the parents will not allow it. A 14-year-old sibling was invited to several sleepovers, but the parents found reasons to deny permission. Both teens are annoyed because the parents buy clothes for them that are more suitable for younger children. The parents say, “We don’t want our kids to grow up too fast.” Which term best describes this family’s boundaries? a. Rigid b. Clear c. Enmeshed d. Differentiated.
21. A voluntarily hospitalized patient tells the nurse, “Get me the forms for discharge. I want to leave now.” Select the nurse’s best response. a. “I will get the forms for you right now and bring them to your room.” b. “Since you signed your consent for treatment, you may leave if you desire.” c. “I will get them for you, but let’s talk about your decision to leave treatment.” d. “I cannot give you those forms without your health care provider’s permission.”.
22. A nurse introduces 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.
23. A community mental health nurse has worked with a patient for 3 years but is moving out of the city and terminates the relationship. When a novice nurse begins work with this patient, what is the starting point for the relationship? a. Begin at the orientation phase. b. Resume the working relationship. c. Initially establish a social relationship. d. Return to the emotional catharsis phase.
24. A patient comes to the crisis center saying, “I’m in a terrible situation. I don’t know what to do.” The triage nurse can initially assume that the patient is a. suicidal. b. anxious and fearful. c. misperceiving reality. d. potentially homicidal.
25. Which communication technique will the nurse use more in crisis intervention than traditional counseling? a. Role modeling b. Giving direction c. Information giving d. Empathic listening.
26. A nurse wants to enhance growth of a patient by showing positive regard. The nurse’s action most likely to achieve this goal is a. making rounds daily. b. staying with a tearful patient. c. administering medication as prescribed. d. examining personal feelings about a patient.
27. Which scenario is an example of a situational crisis? a. The death of a child from sudden infant death syndrome b. Development of a heroin addiction c. Retirement of a 55-year-old person d. A riot at a rock concert.
28. During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patient’s hand. Select the correct analysis of the nurse’s behavior. a. It shows empathy and compassion. It will encourage the patient to continue to express feelings. b. The gesture is premature. The patient’s 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. Psychiatric patients should not be touched.
29. A student falsely accused a college professor of sexual intimidation. The professor tells the nurse, “I cannot teach nor do any research. My mind is totally preoccupied with these false accusations.” What is the priority nursing diagnosis? a. Ineffective denial related to threats to professional identity b. Deficient knowledge related to sexual harassment protocols c. Impaired social interaction related to loss of teaching abilities d. Ineffective coping related to distress from false accusations.
30. During the initial interview at the crisis center, a patient says, “I’ve been served with divorce papers. I’m so upset and anxious that I can’t think clearly.” Which comment should the nurse use to assess personal coping skills? a. “In the past, how have you handled difficult or stressful situations?” b. “What would you like us to do to help you feel more relaxed?” c. “Tell me more about how it feels to be anxious and upset.” d. “Can you describe your role in the marital relationship?”.
31. Which situation demonstrates use of primary intervention related to crisis? a. Implementation of suicide precautions for a depressed patient b. Teaching stress-reduction techniques to a first-year college student c. Assessing coping strategies used by a patient who attempted suicide d. Referring a patient diagnosed with schizophrenia to a partial hospitalization program.
32. While talking with a patient diagnosed with major depressive disorder, a nurse notices the patient is unable to maintain eye contact. The patient’s chin lowers to the chest. 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 skills.
33. The patient says, “My marriage is just great. My spouse and I always agree.” The nurse observes the patient’s foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patient’s communication is a. clear. b. distorted. c. incongruous. d. inadequate.
34. A patient with acute depression states, “God is punishing me for my past sins.” What is the nurse’s most therapeutic response? a. “You sound very upset about this.” b. “God always forgives us for our sins.” c. “Why do you think you are being punished?” d. “If you feel this way, you should talk to your minister.”.
35. A patient tells the nurse, “I don’t think I’ll ever get out of here.” Select the nurse’s most therapeutic response. a. “Don’t talk that way. Of course you will leave here!” b. “Keep up the good work, and you certainly will.” c. “You don’t think you’re making progress?” d. “Everyone feels that way sometimes.”.
36. After leaving work, a nurse realizes documentation of administration of a prn medication was omitted. This off-duty nurse phones the nurse on duty and says, “Please document administration of the medication for me. My password is alpha1.” The nurse receiving the call should a. fulfill the request promptly. b. document the caller’s password. c. refer the matter to the charge nurse to resolve. d. report the request to the patient’s health care provider.
37. Which individual diagnosed with a mental illness may need involuntary hospitalization? An individual a. who has a panic attack after her child gets lost in a shopping mall. b. with visions of demons emerging from cemetery plots throughout the community. c. who takes 38 acetaminophen tablets after the person’s stock portfolio becomes worthless. d. diagnosed with major depression who stops taking prescribed antidepressant medication.
38. A nurse finds a psychiatric advance directive in the medical record of a patient currently experiencing psychosis. The directive was executed during a period when the patient was stable and competent. The nurse should a. review the directive with the patient to ensure it is current. b. ensure that the directive is respected in treatment planning. c. consider the directive only if there is a cardiac or respiratory arrest. d. encourage the patient to revise the directive in light of the current health problem.
39. A new antidepressant is prescribed for an elderly patient diagnosed with major depressive disorder, but the dose is more than the usual geriatric dose. The nurse should a. consult a reliable drug reference. b. teach the patient about possible side effects and adverse effects. c. withhold the medication and confer with the health care provider. d. encourage the patient to increase oral fluids to reduce drug concentration.
40. An aide in a psychiatric hospital says to the nurse, “We don’t have time every day to help each patient complete a menu selection. Let’s tell dietary to prepare popular choices and send them to our unit.” Select the nurse’s best response. a. “Thanks for the suggestion, but that idea may not work because so many patients take MAOI (monoamine oxidase inhibitor) antidepressants.” b. “Thanks for the idea, but it’s important to treat patients as individuals. Giving choices is one way we can respect patients’ individuality.” c. “Thank you for the suggestion, but the patients’ bill of rights requires us to allow patients to select their own diet.” d. “Thank you. That is a very good idea. It will make meal preparation easier for the dietary department.”.
41. Which documentation of a patient’s behavior best demonstrates a nurse’s observations? a. Isolates self from others. Frequently fell asleep during group. Vital signs stable. b. Calmer; more cooperative. Participated actively in group. No evidence of psychotic thinking. c. Appeared to hallucinate. Frequently increased volume on television, causing conflict with others. d. Wore four layers of clothing. States, “I need protection from evil bacteria trying to pierce my skin.”.
42. A Filipino American patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were applied to increase the patient’s self-esteem but after 3 weeks, the patient’s eye contact did not improve. What is the most accurate analysis of this scenario? a. The patient’s 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 patient’s poor eye contact is indicative of anger and hostility that were unaddressed. d. The nurse should have assessed the patient’s culture before making this diagnosis and plan.
43. An advanced practice nurse observes a novice nurse expressing irritability regarding a patient with a long history of alcoholism and suspects the new nurse is experiencing countertransference. Which comment by the new nurse confirms this suspicion? a. “This patient continues to deny problems resulting from drinking.” b. “My parents were alcoholics and often neglected our family.” c. “The patient cannot identify any goals for improvement.” d. “The patient said I have many traits like her mother.”.
44. A nurse explains to the family of a mentally ill patient how a 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 shared openly.” d. “The focus is creation of a partnership in which each member is concerned with growth and satisfaction of the other.”.
45. A 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 gland.
46. A patient says, “I’m still on restriction, but I want to attend some off-unit activities. Would you ask the doctor to change my privileges?” What is the nurse’s best response? a. “Why are you asking me when you’re able to speak for yourself?” b. “I will be glad to address it when I see your doctor later today.” c. “That’s a good topic for you to discuss with your doctor.” d. “Do you think you can’t speak to a doctor?”.
47. A recent immigrant from Honduras comes to the clinic with a family member who has been a U.S. resident for 10 years. The family member says, “The immigration to America has been very difficult.” Considering cultural background, which expression of stress by this patient would the nurse expect? a. Motor restlessness b. Somatic complaints c. Memory deficiencies d. Sensory perceptual alterations.
48. A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent 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.” The nurse should a. invite the interrupting patient to join in the session with the current patient. b. say to the interrupting patient, “I am not available to talk with you at the present time.” c. end the unproductive session with the current patient and spend time with the interrupting patient. d. tell the interrupting patient, “This session is 5 more minutes; then I will talk with you.”.
49. The adult child of a patient diagnosed with major depressive disorder asks, “Do you think depression and physical illness are connected? Since my father’s death, my mother has had shingles and the flu, but she’s usually not one who gets sick.” Which answer by the nurse best reflects current knowledge? a. “It is probably a coincidence. Emotions and physical responses travel on different tracts of the nervous system.” b. “You may be paying more attention to your mother since your father died and noticing more things such as minor illnesses.” c. “So far, research on emotions or stress and becoming ill more easily is unclear. We do not know for sure if there is a link.” d. “Negative emotions and prolonged stress interfere with the body’s ability to protect itself and can increase the likelihood of illness.”.
50. A patient tells the nurse, “I will never be happy until I’m as successful as my older sister.” The nurse asks the patient to reassess this statement and reframe it. Which reframed statement by the patient is most likely to promote coping? a. “People should treat me as well as they treat my sister.” b. “I can find contentment in succeeding at my own job level.” c. “I won’t be happy until I make as much money as my sister.” d. “Being as smart or clever as my sister isn’t really important.”.
51. Which comments by a nurse are likely to help a patient cope by addressing the mediators of the stress response? (Select all that apply.) a. “A divorce, while stressful, can be the beginning of a new, better phase of life.” b. “You mentioned your spirituality. Are there aspects of your faith that could be helpful to you at this time?” c. “Journaling often promotes awareness of how experiences have affected people.” d. “It seems to me you are overreacting to this change in your life.” e. “There is a support group for newly divorced persons in your neighborhood.”.