1. 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 relation d. Individualize nursing care plans.
A nursing student expresses concerns that mental health nurses “lose all their clinical nursing
skills.” Select the best response by the mental health nurse. a. “Psychiatric nurses practice in safer environments than other specialties. Nurse-topatient
ratios must be better because of the nature of the patients’ problems.” b. “Psychiatric nurses use complex communication skills as well as critical thinking
to solve multidimensional problems. I am challenged by those situations.” c. “That’s a misconception. Psychiatric nurses frequently use high technology
monitoring equipment and manage complex intravenous therapies.” d. “Psychiatric nurses do not have to deal with as much pain and suffering as
medical–surgical nurses do. That appeals to me.”.
When a new bill introduced in Congress reduces funding for care of persons diagnosed with
mental illness, a group of nurses write letters to their elected representatives in opposition to
the legislation. Which role have the nurses fulfilled? a. Recovery b. Attending
c. Advocacy d. Evidence-based practice.
A family has a long history of conflicted relationships among the members. Which family
member’s comment best reflects a mentally healthy perspective? a. “I’ve made mistakes but everyone else in this family has also.” b. “I remember joy and mutual respect from our early years together c. “I will make some changes in my behavior for the good of the family.” d. “It’s best for me to move away from my family. Things will never change.”.
Which assessment finding most clearly indicates that a patient may be experiencing a mental
illness? The patient a. reports occasional sleeplessness and anxiety. b. reports a consistently sad, discouraged, and hopeless mood. c. is able to describe the difference between “as if” and “for real.” d. perceives difficulty making a decision about whether to change jobs.
Which finding best indicates that the goal “Demonstrate mentally healthy behavior” was
achieved for an adult patient? The patient a. sees self as capable of achieving ideals and meeting demands. b. behaves without considering the consequences of personal actions. c. aggressively meets own needs without considering the rights of others. d. seeks help from others when assuming responsibility for major areas of own life.
7. A nurse encounters an unfamiliar psychiatric disorder on a new patient’s admission form.
Which resource should the nurse consult to determine criteria used to establish this diagnosis? a. International Statistical Classification of Diseases and Related Health Problems
b. The ANA’s Psychiatric-Mental Health Nursing Scope and Standards of Practice
c. Diagnostic and Statistical Manual of Mental Disorders (DSM-V d. A behavioral health reference manual.
A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource
would have the most complete information? a. Nursing Outcomes Classification (NOC) b. DSM-V
c. The ANA’s Psychiatric-Mental Health Nursing Scope and Standards of Practice
d. ICD-10.
Which individual is demonstrating the highest level of resilience? One who a. is able to repress stressors.
b. becomes depressed after the death of a spouse.
c. lives in a shelter for 2 years after the home is destroyed by fire.
d. takes a temporary job to maintain financial stability after loss of a permanent job.
10. Complete this analogy. NANDA: clinical judgment: NIC: _________________ a. patient outcomes.
b. nursing actions.
c. diagnosis.
d. symptoms.
An adult says, “Most of the time I’m happy and feel good about myself. I have learned that
what I get out of something is proportional to the effort I put into it.” Which number on this
mental health continuum should the nurse select?
Mental Illness Mental Health
1 2 3 4 5 1 2 3 4 5.
Which disorder is an example of a culture-bound syndrome? a. Epilepsy b. Schizophrenia c. Running amok d. Major depressive disorder.
The DSM-V classifies: a. deviant behaviors.
b. present disability or distress.
c. people with mental disorders.
d. mental disorders people have.
A citizen at a community health fair asks the nurse, “What is the most prevalent mental
disorder in the United States?” Select the nurse’s correct response. a. Schizophrenia
b. Bipolar disorder
c. Dissociative fugue
d. Alzheimer’s disease.
In the majority culture of the United States, which individual has the greatest risk to be
labeled mentally ill? One who a. describes hearing God’s voice speaking.
b. is usually pessimistic but strives to meet personal goals.
c. is wealthy and gives away $20 bills to needy individuals. d. always has an optimistic viewpoint about life and having own needs met.
A patient’s relationships are intense and unstable. The patient initially idealizes the significant
other and then devalues him or her, resulting in frequent feelings of emptiness. This patient
will benefit from interventions to develop which aspect of mental health? a. Effectiveness in work
b. Communication skills
c. Productive activities
d. Fulfilling relationships.
Which belief will best support a nurse’s efforts to provide patient advocacy during a
multidisciplinary patient care planning session? a. All mental illnesses are culturally determined.
b. Schizophrenia and bipolar disorder are cross-cultural disorders.
c. Symptoms of mental disorders are unchanged from culture to culture.
d. Assessment findings in mental illness reflect a person’s cultural patterns.
A nurse is part of a multidisciplinary team working with groups of depressed patients. One
group of patients receives supportive interventions and antidepressant medication. The other
group receives only medication. The team measures outcomes for each group. Which type of
study is evident? a. Incidence b. Prevalence
c. Comorbidity
d. Clinical epidemiology.
The spouse of a patient diagnosed with schizophrenia says, “I don’t understand how events
from childhood have anything to do with this disabling illness.” Which response by the nurse
will best help the spouse understand the cause of this disorder? a. “Psychological stress is the basis of most mental disorders.” b. “This illness results from developmental factors rather than stress.”
c. “Research shows that this condition more likely has a biological basis.”
d. “It must be frustrating for you that your spouse is sick so much of the time.”.
A category 5 tornado occurred in a community of 400 people. Many homes and businesses
were destroyed. In the 2 years following the disaster, 140 individuals were diagnosed with
posttraumatic stress disorder (PTSD). Which term best applies to these newly diagnosed
cases? a. Prevalence
b. Comorbidity
c. Incidence
d. Parity.
Which component of treatment of mental illness is specifically recognized by Quality and
Safety Education for Nurses (QSEN)? a. All genomes are unique.
b. Care is centered on the patient.
c. Healthy development is vital to mental health
d. Recovery occurs on a continuum from illness to health.
Select the best response for the nurse to a question from another health professional regarding
the difference between a diagnosis in DSM-V and a nursing diagnosis. a. “There is no functional difference between the two. Both identify human
disorders.” b. “The DSM-V diagnosis disregards culture, whereas the nursing diagnosis takes
culture into account.” c. “The DSM-V diagnosis describes causes of disorders whereas a nursing diagnosis
does not explore etiology.”
d. “The DSM-V diagnosis guides medical treatment, whereas the nursing diagnosis
offers a framework for identifying interventions for issues a patient is
experiencing.”.
Which nursing intervention below is part of the scope of an advanced practice
psychiatric/mental health nurse rather than a basic level registered nurse? a. Coordination of care
b. Health teaching
c. Milieu therapy
d. Psychotherapy.
An experienced nurse says to a new graduate, “When you’ve practiced as long as I have, you
automatically know how to take care of patients experiencing psychosis.” Which factors
should the new graduate consider when analyzing this comment? (Select all that apply.) a. The experienced nurse may have lost sight of patients’ individuality, which may
compromise the integrity of practice b. New research findings should be integrated continuously into a nurse’s practice to
provide the most effective care. c. Experience provides mental health nurses with the essential tools and skills needed
for effective professional practice.
d. Experienced psychiatric nurses have learned the best ways to care for mentally ill
patients through trial and error
e. An intuitive sense of patients’ needs guides effective psychiatric nurses.
Which findings are signs of a person who is mentally healthy? (Select all that apply.) a. Says, “I have some weaknesses, but I feel I’m important to my family and friends.”
b. Adheres strictly to religious beliefs of parents and family of origin. c. Spends all holidays alone watching old movies on television. d. Considers past experiences when deciding about the future. e. Experiences feelings of conflict related to changing jobs.
A patient in the emergency department says, “Voices say someone is stalking me. They want
to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a
threat.” Which aspects of the patient’s mental health have the greatest and most immediate
concern to the nurse? (Select all that apply.) a. Happiness
b. Appraisal of reality
c. Control over behavior d. Effectiveness in work
e. Healthy self-concept.
A parent says, “My 2-year-old child refuses toilet training and shouts ‘No!’ when given
directions. What do you think is wrong?” Select the nurse’s best reply. a. “Your child needs firmer control. It is important to set limits now.”
b. “This is normal for your child’s age. The child is striving for independence.”
c. “There may be developmental problems. Most children are toilet trained by age 2.” d. “Some undesirable attitudes are developing. A child psychologist can help you
develop a plan.”.
A nurse wants to find information on current evidence-based research, programs, and
practices regarding mental illness and addictions. Which resource should the nurse consult? a. American Psychiatric Association
b. American Psychological Association (APA)
c. Clinician’s Quick Guide to Interpersonal Psychotherapy
d. Substance Abuse and Mental Health Services Administration (SAMHSA).
A 26-month-old displays negative behavior, refuses toilet training, and often says, “No!”
Which psychosocial crisis is evident? a. Trust versus mistrust b. Initiative versus guilt c. Industry versus inferiority d. Autonomy versus shame and doubt.
A 4-year-old grabs toys from other children and says, “I want that now!” From a
psychoanalytic perspective, this behavior is a product of impulses originating in which
system of the personality? a. Id
b. Ego
c. Superego
d. Preconscious.
The parent of a 4-year-old rewards and praises the child for helping a sibling, being polite,
and using good manners. These qualities are likely to be internalized and become part of
which system of the personality? a. Id
b. Ego
c. Superego
d. Preconscious.
A nurse supports a parent for praising a child who behaves in helpful ways to others. When
this child behaves with politeness and helpfulness in adulthood, which feeling will most
likely result? a. Guilt
b. Anxiety
c. Humility
d. Self-esteem.
An adult says, “I never know the answers,” and “My opinion does not count.” Which
psychosocial crisis was unsuccessfully resolved for this adult? a. Initiative versus gu
b. Trust versus mistrust c. Autonomy versus shame and doubt
d. Generativity versus self-absorption.
Which statement by a patient would lead the nurse to suspect unsuccessful completion of the
psychosocial developmental task of infancy? a. “I know how to do things right, so I prefer jobs where I work alone rather than on a
team.”
b. “I do not allow other people to truly get to know me.” c. “I depend on frequent praise from others to feel good about myself.”
d. “I usually need to do things several times before I get them right.”.
A patient is suspicious and frequently manipulates others. To which psychosexual stage do
these traits relate? a. Oral
b. Anal
c. Phallic
d. Genital.
A patient expresses a desire to be cared for by others and often behaves in a helpless
fashion. Which stage of psychosexual development is most relevant to the patient’s needs? a. Latency
b. Phallic
c. Anal
d. Oral.
A nurse listens to a group of recent retirees. One says, “I volunteer with Meals on Wheels,
coach teen sports, and do church visitation.” Another laughs and says, “I’m too busy taking
care of myself to volunteer to help others.” Which psychosocial developmental task do these
statements contrast? a. Trust and mistrust
b. Intimacy and isolation c. Industry and inferior
d. Generativity and self-absorption.
An adult dies in a tragic accident. Afterward, the siblings plan a funeral service. Which
statement by a sibling best indicates a sense of self-actualization? “Of all of us, I am the most experienced with planning these types of events.” “Funerals are supposed to be conducted quietly, respectfully, and according to a social protocol.” “This death was unfair but I hope we can plan a service that everyone feels is a
celebration of life.”
“This death was probably the consequence of years of selfish and inconsiderate
behavior by our sibling.”.
A student nurse says, “I don’t need to interact with my patients. I learn what I need to know
by observation.” An instructor can best interpret the nursing implications of Sullivan’s
theory to this student by responding: a. “Interactions are required in order to help you develop therapeutic communication
skills.”
b. “Nurses cannot be isolated. We must interact to provide patients with opportunities
to practice interpersonal skills.” c. “Observing patient interactions will help you formulate priority nursing diagnoses
and appropriate interventions.
d. “It is important to pay attention to patients’ behavioral changes, because these
signify adjustments in personality.”.
A nurse consistently encourages patient to do his or her own activities of daily living. If the
patient is unable to complete an activity, the nurse helps until the patient is once again
independent. This nurse’s practice is most influenced by which theorist? Betty Neuman b. Patricia Benner
c. Dorothea Orem
d. Joyce Travelbee.
A nurse uses Maslow’s hierarchy of needs to plan care for a patient diagnosed with mental
illness. Which problem will receive priority? The patient refuses to eat or bathe.
reports feelings of alienation from family.
is reluctant to participate in unit social activities
is unaware of medication action and side effects.
Operant conditioning is part of the treatment plan to encourage speech in a child who is
nearly mute. Which technique applies? a. Encourage the child to observe others talking.
b. Include the child in small group activities.
c. Give the child a small treat for speakin
d. Teach the child relaxation techniques.
The parent of a child diagnosed with schizophrenia tearfully asks the nurse, “What could I
have done differently to prevent this illness?” Select the nurse’s best response. “Although schizophrenia results from impaired family relationships, try not to feel
guilty. No one can predict how a child will respond to parental guidance.” “Schizophrenia is a biological illness resulting from changes in how the brain and
nervous system function. You are not to blame for your child’s illness.” “There is still hope. Changing your parenting style can help your child learn to
cope effectively with the environment.” “Most mental illnesses result from genetic inheritance. Your genes are more at
fault than your parenting.”.
A nurse influenced by Peplau’s interpersonal theory works with an anxious, withdrawn
patient. Interventions should focus on rewarding desired behaviors.
use of assertive communication.
changing the patient’s self-concept
administering medications to relieve anxiety.
A patient participated in psychotherapy weekly for 5 months. The therapist used free
association, dream analysis, and facilitated transference to help the patient understand
conflicts and foster change. Select the term that applies to this method. Rational-emotive behavior therapy
Psychodynamic psychotherapy
Cognitive-behavioral therapy
Operant conditioning.
Consider this comment from a therapist: “The patient is homosexual but has kept this
preference secret. Severe anxiety and depression occur when the patient anticipates family
reactions to this sexual orientation.” Which perspective is evident in the speaker? Theory of interpersonal relationships
Classical conditioning theory
Psychosexual theory
Behaviorism theory.
A psychotherapist works with an anxious, dependent patient. Which strategy is most
consistent with psychoanalytic psychotherapy? Identifying the patient’s strengths and assets Praising the patient for describing feelings of isolation Focusing on feelings developed by the patient toward the therapist
Providing psychoeducation and emphasizing medication adherence.
A person says, “I was the only survivor in a small plane crash. Three business associates
died. I got depressed and saw a counselor twice a week for 4 weeks. We talked about my
feelings related to being a survivor, and I’m better now.” Which type of therapy was used? Systematic desensitization
Psychoanalysis Behavior modification
Interpersonal psychotherapy.
Which technique is most applicable to aversion therapy? Punishment Desensitization Role modeling Positive reinforcement.
A patient says to the nurse, “My father has been dead for over 10 years, but talking to you is
almost as comforting as the talks he and I had when I was a child.” Which term applies to
the patient’s comment? Superego
Transference
Reality testing
Counter-transference.
A college student received an invitation to attend the wedding of a close friend who lives
across the country. The student is afraid of flying. Which type of therapy would be most
helpful for this patient? Psychoanalysis
Aversion therapy
Systematic desensitization
Short-term dynamic therapy.
A patient repeatedly stated, “I’m stupid.” Which statement by that patient would show
progress resulting from cognitive-behavioral therapy? “Sometimes I do stupid things.” Things always go wrong for me.” “I always fail when I try new things.” “I’m disappointed in my lack of ability.”.
A patient says, “All my life I’ve been surrounded by stupidity. Everything I buy breaks
because the entire American workforce is incompetent.” This patient is experiencing a self-esteem deficit.
cognitive distortion. deficit in motivation.
deficit in love and belonging.
A patient is fearful of riding on elevators. The therapist first rides an escalator with the
patient. The therapist and patient then stand in an elevator with the door open for 5 minutes
and later with the elevator door closed for 5 minutes. Which technique has the therapist
used? Classic psychoanalytic therapy
Systematic desensitization Rational emotive therapy
d. Biofeedback.
A patient says, “I always feel good when I wear a size 2 petite.” Which type of cognitive
distortion is evident? Disqualifying the positive
Overgeneralization
Catastrophizing
d. Personalization.
Which comment best indicates a patient is self-actualized? “I have succeeded despite a world filled with evil.” “I have a plan for my life. If I follow it, everything will be fine.” “I’m successful because I work hard. No one has ever given me anything.”
“My favorite leisure is walking on the beach, hearing soft sounds of rolling.
A nurse presents a community education program about mental illness. Which comment by
a participant best demonstrates a correct understanding of mental illness from a biological
perspective? “Some people experience life events so traumatic that they cannot be overcome.”
“Disturbed and conflicted family relationships are usually a starting place for
mental illness.” “My friend has had bipolar disorder for years and many problems have resulted.
It’s not her fault.”
“Mental illness is the result of developmental complications that cause a person
not to grow to their full potential.”.
Which patient is the best candidate for brief psychodynamic therapy? An accountant with a loving family and successful career who was involved in a
short extramarital affair An adult with a long history of major depression who was charged with driving
under the influence A woman with a history of borderline personality disorder who recently cut both
wrists
An adult male recently diagnosed with anorexia nervosa.
A patient states, “I’m starting cognitive-behavioral therapy. What can I expect from the
sessions?” Which responses by the nurse would be appropriate? (Select all that apply.) “The therapist will be active and questioning.” “You will be given some homework assignments.”
“The therapist will ask you to describe your dreams. “The therapist will help you look at your ideas and beliefs about yourself.”
“The goal is to increase subjectivity about thoughts that govern your behavior.”.
Which comments by an elderly person best indicate successful completion of the
individual’s psychosocial developmental task? (Select all that apply.) “I am proud of my children’s successes in life.”
“I should have given to community charities more often.” “My relationship with my father made life more difficult for me.”
“My experiences in the war helped me appreciate the meaning of life.”
“I often wonder what would have happened if I had chosen a different career.”.
Which comments by an adult best indicate self-actualization? (Select all that apply.) “I am content with a good book.”
“I often wonder if I chose the right career.” “Sometimes I think about how my parents would have handled problems.”
“It’s important for our country to provide basic health care services for everyone.”
When I was lost at sea for 2 days, I gained an understanding of what is
important.”.
Which activities represent the art of nursing? (Select all that apply.) Administering medications on time to a group of patients
Listening to a new widow grieve her husband’s death Helping a patient obtain groceries from a food bank
d. Teaching a patient about a new medication
e. Holding the hand of a frightened patient.
Which therapies involve electrical brain stimulation for treatment of mental illness? (Select
all that apply.) Aversion therapy
Operant conditioning Systematic desensitization
Electroconvulsive therapy (ECT)
Transcranial magnetic stimulation (TMS).
A patient asks, “What are neurotransmitters? My doctor said mine are imbalanced.” Select
the nurse’s best response. “How do you feel about having imbalanced neurotransmitters?”
“Neurotransmitters protect us from harmful effects of free radicals.” “Neurotransmitters are substances we consume that influence memory and mood.”
“Neurotransmitters are natural chemicals that pass messages between brain cells.”.
The parent of an adolescent diagnosed with schizophrenia asks the nurse, “My child’s
doctor ordered a PET. What kind of test is that?” Select the nurse’s best reply. “This test uses a magnetic field and gamma waves to identify problem areas in the
brain. Does your teenager have any metal implants?” “PET means positron-emission tomography. It is a special type of scan that shows
blood flow and activity in the brain.” “A PET scan passes an electrical current through the brain and shows brain-wave
activity. It can help diagnose seizures.” “It’s a special x-ray that shows structures of the brain and whether there has ever
been a brain injury.”.
A patient with a long history of hypertension and diabetes now develops confusion. The
health care provider wants to make a differential diagnosis between Alzheimer’s disease and
multiple infarcts. Which diagnostic procedure should the nurse expect to prepare the patient
for first? skull x rays CT scan
PET
Single photon emission computed tomography (SPECT).
A patient’s history shows drinking 4 to 6 L of fluid and eating more than 6,000 calories per
day. Which part of the central nervous system is most likely dysfunctional for this patient? Amygdala Parietal lobe Hippocampus
Hypothalamus.
The nurse prepares to assess a patient diagnosed with major depressive disorder for
disturbances in circadian rhythms. Which question should the nurse ask this patient? “Have you ever seen or heard things that others do not?”
“What are your worst and best times of the day?” “How would you describe your thinking?”
“Do you think your memory is failing?”.
The nurse administers a medication that potentiates the action of ã-aminobutyric acid
(GABA). Which effect would be expected? Reduced anxiety
Improved memory More organized thinking
Fewer sensory perceptual alterations.
A nurse would anticipate that treatment for a patient with memory difficulties might include
medications designed to inhibit GABA.
prevent destruction of acetylcholine. reduce serotonin metabolism.
increase dopamine activity.
A patient has disorganized thinking associated with schizophrenia. Neuroimaging would
likely show dysfunction in which part of the brain? Hippocampus
Frontal lobe
Cerebellum
Brainstem.
The nurse should assess a patient taking a drug with anticholinergic properties for inhibited
function of the parasympathetic nervous system.
sympathetic nervous system.
reticular activating system.
medulla oblongata.
The therapeutic action of neurotransmitter inhibitors that block reuptake cause decreased concentration of the blocked neurotransmitter in the central nervous
system. increased concentration of the blocked neurotransmitter in the synaptic gap. destruction of receptor sites specific to the blocked neurotransmitter. limbic system stimulation.
A patient taking medication for mental illness develops restlessness and an uncontrollable
need to be in motion. Which drug action causes these symptoms to develop? Anticholinergic effects
Dopamine-blocking effects Endocrine-stimulating effects
Ability to stimulate spinal nerves.
A fearful patient has an increased heart rate and blood pressure. The nurse suspects
increased activity of which neurotransmitter? GABA
Norepinephrine
Acetylcholine
Histamine.
A patient has acute anxiety related to an automobile accident 2 hours ago. The nurse should
teach the patient about medication from which group? Tricyclic antidepressants
Antipsychotic drugs
Mood stabilizers
Benzodiazepines.
A patient is hospitalized for severe major depressive disorder. Of the medications listed
below, the nurse can expect to provide the patient with teaching about chlordiazepoxide.
b. clozapine.
sertraline.
tacrine.
A patient diagnosed with bipolar disorder displays aggressiveness, agitation, talkativeness,
and irritability. The nurse expects the health care provider to prescribe a medication from
which group? Psychostimulants
Mood stabilizers Anticholinergics
Antidepressants.
A drug causes muscarinic receptor blockade. The nurse will assess the patient for dry mouth.
gynecomastia.
pseudoparkinsonism.
orthostatic hypotension.
A patient begins therapy with a phenothiazine medication. What teaching should the nurse
provide related to the drug’s strong dopaminergic effect? Chew sugarless gum.
Increase dietary fiber.
Arise slowly from bed.
Report changes in muscle movement.
A patient tells the nurse, “My doctor prescribed paroxetine for my depression. I assume I’ll
have side effects like I had when I was taking imipramine.” The nurse’s reply should be
based on the knowledge that paroxetine is a(n) selective norepinephrine reuptake inhibitor.
tricyclic antidepressant.
monoamine oxidase (MAO) inhibitor.
SSRI.
A nurse can anticipate anticholinergic side effects are likely when a patient takes lithium.
buspirone.
imipramine.
risperidone.
Which instruction has priority when teaching a patient about clozapine? Avoid unprotected sex.” “Report sore throat and fever immediately.” “Reduce foods high in polyunsaturated fats.” “Use over-the-counter preparations for rashes.”.
A nurse cares for a group of patients receiving various medications, including haloperidol,
carbamazepine, trazodone, and phenalgine. The nurse will order a special diet for the patient
who takes carbamazepine.
haloperidol.
phenelzine.
trazodone.
A nurse instructs a patient taking a drug that inhibits MAO to avoid certain foods and drugs
because of the risk of cardiac dysrhythmia.
hypotensive shock.
hypertensive crisis.
hypoglycemia.
A nurse caring for a patient taking a SSRI will develop outcome criteria related to coherent thought processes.
improvement in depression.
reduced levels of motor activity.
decreased extrapyramidal symptoms.
By which mechanism do SSRI medications improve depression? Destroying increased amounts of serotonin
Making more serotonin available at the synaptic gap
Increasing production of acetylcholine and dopamine Blocking muscarinic and á1 norepinephrine receptors.
The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell
count of 3000 mm3. Select the nurse’s best action. Report the results to the health care provider immediately.
Administer the next dose as prescribed.
Give aspirin and force fluids.
Repeat the laboratory test.
A drug blocks the attachment of norepinephrine to α1 receptors. The patient may experience hypertensive crisis.
orthostatic hypotension.
severe appetite disturbance.
an increase in psychotic symptoms.
A nurse cares for four patients who are receiving clozapine, lithium, fluoxetine, and
venlafaxine, respectively. With which patient should the nurse be most alert for problems
associated with fluid and electrolyte imbalance? The patient receiving lithium.
clozapine.
fluoxetine.
venlafaxine.
An obese patient has a diagnosis of schizophrenia. Medications that block which receptors
would contribute to further weight gain? H1
5 HT2
Acetylcholine
GABA.
An individual hiking in the forest encounters a large poisonous snake on the path. Which
change in this individual’s vital signs is most likely? Pulse rate changes from 90 to 72. Respiratory rate changes from 22 to 18.
Complaints of intestinal cramping begin.
Blood pressure changes from 114/62 to 136/78.
Consider these medications: carbamazepine, lamotrigine, gabapentin. Which medication
below also belongs to this group? Galantamine
Valproate
Buspirone
Tacrine.
A professional football player is seen in the emergency department after losing
consciousness from an illegal block. Prior to discharge, the nurse assists the patient to
schedule an outpatient computed tomography (CT) scan for the next day. Which strategy
should the nurse use to ensure the patient remembers the appointment? Write the appointment day, time, and location on a piece of paper and give it to the
player. Log the appointment day, time, and location into the player’s cell phone calendar
feature. Ask the health care provider to admit the patient to the hospital overnight.
Verbally inform the patient of the appointment day, time, and location.
A nurse prepares to administer a second-generation antipsychotic medication to a patient
diagnosed with schizophrenia. Additional monitoring for adverse effects will be most
important if the patient has which co-morbid health problems? (Select all that apply.) Parkinson’s disease
Grave’s disease
Hyperlipidemia
Osteoarthritis
Diabetes.
Questions the nurse could ask that would be nonjudgmental when obtaining information
about a patient’s use of complementary and herbal remedies include (Select all that apply) “You don’t regularly take herbal remedies, do you?”
“What herbal medicines have you used to relieve your symptoms?”
“What over-the-counter medicines, vitamins, and nutritional supplements do you
use?” “What differences in your symptoms do you notice when you take herbal
supplements?”
“Have you experienced problems from using herbal and prescription drugs at the
same time?”.
An individual is experiencing problems with memory. Which of these structures are most
likely to be involved in this deficit? (Select all that apply.) Amygdala
Hippocampus
Occipital lobe
Temporal lobe Basal ganglia.
A patient’s sibling says, “My brother has a mental illness, but the doctor ordered a
functional magnetic resonance image (fMRI) test. That test is too expensive and will just
increase the hospital bill.” Select the nurse’s best responses. (Select all that apply.) “Sometimes there are physical causes for psychiatric symptoms. This test will help
us understand whether that is the situation.”
“Some mental illnesses are evident on fMRIs. This test will give information to
help us plan the best care for your brother.” “This test will indicate whether your brother has been taking his psychotropic
medications as prescribed.”
“It sounds like you do not truly believe your brother had a mental illness.” “It would be better for you to discuss your concerns with the health care provider.”.
Inpatient hospitalization for persons with mental illness is generally reserved for patients
who present a clear danger to self or others.
are noncompliant with medication at home. have limited support systems in the community.
develop new symptoms during the course of an illness.
A patient was hospitalized for 24 hours after a reaction to a psychotropic medication. While
planning discharge, the case manager learned that the patient received a notice of eviction
immediately prior to admission. Select the case manager’s most appropriate action. Postpone the patient’s discharge from the hospital. Contact the landlord who evicted the patient to further discuss the situation. Arrange a temporary place for the patient to stay until new housing can be
arranged. Determine whether the adverse medication reaction was genuine because the
patient had nowhere to live.
Select the example of tertiary prevention. Helping a person diagnosed with a serious mental illness learn to manage money Restraining an agitated patient who has become aggressive and assaultive Teaching school-age children about the dangers of drugs and alcohol
Genetic counseling with a young couple expecting their first child.
A patient diagnosed with schizophrenia had an exacerbation related to medication nonadherence
and was hospitalized for 5 days. The patient’s thoughts are now more organized
and discharge is planned. The patient’s family says, “It’s too soon for discharge. We will
just go through all this again.” The nurse should ask the case manager to arrange a transfer to a long-term care facility. notify hospital security to handle the disturbance and escort the family off the unit. explain that the patient will continue to improve if the medication is taken
regularly. contact the health care provider to meet with the family and explain the discharge
rationale.
A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no
one is smoking, and the janitor’s closet is locked. These observations relate to coordinating care of patients. management of milieu safety. management of the interpersonal climate. use of therapeutic intervention strategies.
The patients below were evaluated in the emergency department. The psychiatric unit has
one bed available. Which patient should be admitted? The patient feeling anxiety and a sad mood after separation from a spouse of 10 years. who self-inflicted a superficial cut on the forearm after a family argument. experiencing dry mouth and tremor related to taking antipsychotic medication. who is a new parent and hears voices saying, “Smother your baby.”.
A suspicious, socially isolated patient lives alone, eats one meal a day at a local shelter, and
spends the remaining daily food allowance on cigarettes. Select a community psychiatric
nurse’s best initial action. Explore ways to help the patient stop smoking. Report the situation to the manager of the shelter.
Assess the patient’s weight; determine foods and amounts eaten. Arrange hospitalization for the patient in order to formulate a new treatment plan.
A nurse surveys medical records. Which finding signals a violation of patients’ rights? A patient was not allowed to have visitors. A patient’s belongings were searched at admission. A patient with suicidal ideation was placed on continuous observation. Physical restraint was used after a patient was assaultive toward a staff member.
Which principle has the highest priority when addressing a behavioral crisis in an inpatient
setting? Resolve the crisis with the least restrictive intervention possible.
Swift intervention is justified to maintain the integrity of a therapeutic milieu. Rights of an individual patient are superseded by the rights of the majority of
patients. Patients should have opportunities to regain control without intervention if the
safety of others is not compromised.
Clinical pathways are used in managed care settings to stabilize aggressive patients. identify obstacles to effective care. relieve nurses of planning responsibilities. streamline the care process and reduce costs.
A nurse receives these three phone calls regarding a newly admitted patient.
• The psychiatrist wants to complete an initial assessment.
• An internist wants to perform a physical examination.
• The patient’s attorney wants an appointment with the patient.
The nurse schedules the activities for the patient. Which role has the nurse fulfilled? Advocate Case manager Milieu manager Provider of care.
Which aspect of direct care is an experienced, inpatient psychiatric nurse most likely to
provide for a patient? Hygiene assistance Diversional activities Assistance with job hunting Building assertiveness skills.
Which characteristic would be more applicable to a community mental health nurse than to
a nurse working in an operating room? Kindness Autonomy
Compassion Professionalism.
Which patient would be most appropriate to refer for assertive community treatment (ACT)?
A patient diagnosed with a phobic fear of crowded places. a single episode of major depressive disorder. a catastrophic reaction to a tornado in the community. schizophrenia and four hospitalizations in the past year.
The unit secretary receives a phone call from the health insurer for a hospitalized patient.
The caller seeks information about the patient’s projected length of stay. How should the
nurse instruct the unit secretary to handle the request? Obtain the information from the patient’s medical record and relay it to the caller. Inform the caller that all information about patients is confidential. Refer the request for information to the patient’s case manager. Refer the request to the health care provider.
Select the example of primary prevention. Assisting a person diagnosed with a serious mental illness to fill a pill-minder Helping school-age children identify and describe normal emotions Leading a psychoeducational group in a community care home Medicating an acutely ill patient who assaulted a staff person.
Which level of prevention activities would a nurse in an emergency department employ
most often? Primary
Secondary Tertiary.
The nurse assigned to ACT should explain the program’s treatment goal as assisting patients to maintain abstinence from alcohol and other substances of
abuse.
providing structure and a therapeutic milieu for mentally ill patients whose
symptoms require stabilization. maintaining medications and stable psychiatric status for incarcerated inmates who
have a history of mental illness. providing services for mentally ill individuals who require intensive treatment to
continue to live in the community.
Which scenario best depicts a behavioral crisis? A patient is waving fists, cursing, and shouting threats at a nurse. curled up in a corner of the bathroom, wrapped in a towel. crying hysterically after receiving a phone call from a family member. performing push-ups in the middle of the hall, forcing others to walk around.
The case manager plans to discuss the treatment plan with a patient’s family. Select the case
manager’s first action. Determine an appropriate location for the conference. Support the discussion with examples of the patient’s behavior. Obtain the patient’s permission for the exchange of information. Determine which family members should participate in the conference.
A patient usually watches television all day, seldom going out in the community or
socializing with others. The patient says, “I don’t know what to do with my free time.”
Which member of the treatment team would be most helpful to this patient? Psychologist Social worker Recreational therapist Occupational therapist.
A patient diagnosed with schizophrenia has been stable for 2 months. Today the patient’s
spouse calls the nurse to report the patient has not taken prescribed medication and is having
disorganized thinking. The patient forgot to refill the prescription. The nurse arranges a
refill. Select the best outcome to add to the plan of care. The patient’s spouse will mark dates for prescription refills on the family calendar. The nurse will obtain prescription refills every 90 days and deliver to the patient. The patient will call the nurse weekly to discuss medication-related issues. The patient will report to the clinic for medication follow-up every week.
A community mental health nurse has worked for months to establish a relationship with a
delusional, suspicious patient. The patient recently lost employment and could no longer
afford prescribed medications. The patient says, “Only a traitor would make me go to the
hospital.” Select the nurse’s best initial intervention. With the patient’s consent, contact resources to provide medications without charge temporarily. Arrange a bed in a local homeless shelter with nightly on-site supervision. Hospitalize the patient until the symptoms have stabilized.
Ask the patient, “Do you feel like I am a traitor?”.
Which activity is appropriate for a nurse engaged exclusively in community-based primary
prevention? Medication follow-up Teaching parenting skills Substance abuse counseling
Making a referral for family therapy.
A health care provider prescribed long acting antipsychotic medication injections every 3
weeks at the clinic for a patient with a history of medication nonadherence. For this plan to
be successful, which factor will be of critical importance? The attitude of significant others toward the patient Nutrition services in the patient’s neighborhood The level of trust between the patient and nurse The availability of transportation to the clinic.
Which assessment finding for a patient diagnosed with serious and persistent mental illness
and living in the community merits priority intervention by the psychiatric nurse? The
patient receives social security disability income plus a small check from a trust fund
every month. was absent from two of six planned Alcoholics Anonymous meetings in the past 2
weeks. lives in an apartment with two patients who attend partial hospitalization
programs. has a sibling who was recently diagnosed with a mental illness.
The nurse should refer which of the following patients to a partial hospitalization program?
A patient who has a therapeutic lithium level and reports regularly for blood tests and clinic
follow-up. needs psychoeducation for relaxation therapy related to agoraphobia and panic
episodes. spent yesterday in a supervised crisis care center and continues to have active
suicidal ideation. states, “I’m not sure I can avoid using alcohol when my spouse goes to work every
morning.”.
After a Category 5 tornado hits a community and destroys many homes and businesses, a
community mental health nurse encourages victims to describe their memories and feelings
about the event. This action by the nurse best demonstrates triage. primary prevention. psychosocial rehabilitation. psychiatric case management.
A nurse makes an initial visit to a homebound patient diagnosed with a serious mental
illness. A family member offers the nurse a cup of coffee. Select the nurse’s best response. “Thank you. I would enjoy having a cup of coffee with you.” “Thank you, but I would prefer to proceed with the assessment.” “No, but thank you. I never accept drinks from patients or families.” “Our agency policy prohibits me from eating or drinking in patients’ homes.”.
A nurse performed these actions while caring for patients in an inpatient psychiatric setting.
Which action violated patients’ rights? Prohibited a patient from using the telephone In patient’s presence, opened a package mailed to patient Remained within arm’s length of patient with homicidal ideation Permitted a patient with psychosis to refuse oral psychotropic medication.
A nurse can best address factors of critical importance to successful community treatment
by including making assessments relative to (Select all that apply) housing adequacy. family and support systems. income adequacy and stability. early psychosocial development. substance abuse history and current use.
The health care team at an inpatient psychiatric facility drafts these criteria for admission.
Which criteria should be included in the final version of the admission policy? (Select all
that apply) Clear risk of danger to self or others Adjustment needed for doses of psychotropic medication Detoxification from long-term heavy alcohol consumption needed Respite for caregivers of persons with serious and persistent mental illnes Failure of community-based treatment, demonstrating need for intensive treatment.
|
