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Bundle for Psychiatric Nursing exam 2023
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Psychiatric Nursing Exam #1 questions and answers 2023
The quantitative study of the distribution of mental disorders in human populations is called A).Mortality B). Prevalence C). Epidemiology D). Clinic... [Show More] al epidemiology. C). Epidemiology What phrase best describes the DSM-V? A).Is a multiaxial psychiatric assessment system B). Is a compendium of treatment modalities C). Offers a complete list of nursing diagnoses D). Suggests common interventions for mental disorders A). Is a multiaxial psychiatric assessment system Current information suggests that the most disabling mental disorders are the result of A). biological influcnes B). psychological trauma C). learned behavior D). faulty patterns of early nurturance A). Biological influences A nurse's identification badge includes the wording, 'Psychiatric Mental Health Nurse'. A client with a history of paranoia asks, "What does that title mean?" The nurse responds best when answering: A). "Don't be afraid, it means I'm here to help not hurt you." B). "Psychiatric Mental Health nurses care for people with mental illnesses." C). "We have the specialized skills needed to care for those with mental illnesses." D). "The nurses who work in mental health facilities have that title." C). we have specialized skills needed to care for those with mental illness Regarding individuals with mental disorders, distress refers to a painful symptom, and disability refers to A). the presence of deviant behavior B). impairment in important areas of functioning C). culturally appropriate responses to an event D). a conflict between the individual and society B). impairment in important areas of functioning Which statement best describes the DSM-5? A). It is a medical psychiatric assessment system B). it is a compendium of treatment modaliies C). It offers a complete list of nursing diagnoses D). it suggests common interventions for mental disorders A). it is a medical psychiatric assessment Which statement about diagnosis of a mental disorder is true? A). The symptoms of each disorder are common among all cultures. B).Culture may cause variations in symptoms for each clinical disorder. C). All mental disorders listed in the DSM-5 are seen in all other cultures. D). Psychiatric diagnoses are listed in separately from other physical disorders in a five axes system. B). culture may cause variations in symptoms for each clinical disorder The prevalence rate over a 12-month period for major depressive disorder is A). lower than the prevalence rate for panic disorders B). greater than the prevalence rate for psychotic disorders. C). equal to the prevalence rate for psychotic disorders D). greater than the prevalence rate for generalized anxiety D). greater than the prevalence rate for generalized anxiety These severe mental illnesses are recognized across cultures: A). antisocial and borderline personality disorders. B). schizophrenia and bipolar disorder C). bulimia and anorexia nervosa D). amok and social phobia B). schizophrenia and bipolar disorder An important difference between the developmental theories of Freud and Erikson is A). Freud considers the entire lifespan from birth to old age B). Freud focuses to a greater extent on cognitive development C). Erikson viewed individual growth in terms of social setting D).Eriksin focuses on development of individual moral thinking C). Erikson viewed individual growth in terms of social setting Maslow's theory of Humanistic Psychology has provided nursing with a framework for A). Holistic assessment B). determining moral development C). identifying potential for success in therapy D). conducting nurse-client interpersonal interactions A). holistic assessment The premise underlying behavioral therapy is A). behavior is learned and can be modified B). behavior is a product of unconscious drives C). motives must change before behavior changes D). behavior is determined by cognition. change in cognitions produces behavior A). Behavior is learned and can be modified The nurse planning care for a 14-year-old needs to take into account that the developmental task of adolescence is to A). establish trust B). gain autonomy C). achieve identity D).develop a sense of industry C). achieve indentity Sullivan viewed anxiety as A). emotional experience felt after the age of 5 years B). a sign of guilt in adults C) .any painful feeling or emotion arising from social insecurity D). adults trying to go beyond experiences of guilt and pain C). any painful feeling or emotion arising from social insecurity Which statement best clarifies the difference between the art and the science of nursing? A). The art is the care, compassion, and advocacy component, and the science is the applied knowledge base. B). The art is the way in which knowledge is applied, and the science is the technological aspects of caregiving. C). The art is the applied technology of practice, and the science is the problem-solving and teaching aspects of caregiving. D). The art is the assessing and planning phases of the nursing process, and the science lies in implementing and evaluating. A). the art is the care, compassion, and advocacy component, and the science is the applied knowledge base Which client problem would be most suited to the use of interpersonal therapy? A). Disturbed sensory perception B). impaired social interaction C). medication noncompliance D). dysfunctional grieving D). dysfunctional grieving A cognitive therapist would help a client restructure the thought "I am stupid!" to A). "What I did was stupid" B). "I am not as smart as others" C). "Things usually go wrong for me" D). Things like this should not happen to anyone" A). What I did was stupid The nurse providing anticipatory guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by A). giving the child what he is asking for. B). scolding the child when he displays tantrum behaviors C). spanking the child at the onset of the tantrum behaviors. D). ignoring the tantrum and giving attention when the child acts appropriately D). ignoring the tantrum and giving attention when the child acts appropriately Freud believed that individuals cope with anxiety by using A). the superego B). defense mechanisms C). security operations D). suppression B) defense mechanisms A client receiving a psychotropic drug reports to the nurse that he is drowsy all the time and is having difficulty focusing his attention. The nurse will correctly interpret this symptom as related to the drug's effect on the brain's ability to regulate A). mood B). thought C). memory D). sleep D). Sleep [Show Less]
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Role of the Mental Health Nurse Questions and Answers 2023
The mental health nurse uses which frameworks to maintain patient safety? QSEN QSEN provides current and future nurses with the knowledge, skills, and at... [Show More] titudes to achieve patient safety and quality care. Nursing process The nursing process helps guide professional behaviors and judgments, particularly those that relate to patient safety. Standards of practice Standards of practice help guide nurses in their clinical practice as it relates to maintaining patient safety. The psychiatric nurse uses the HEADSSS tool when assessing which patient population? Adolescent The nurse uses the HEADSSS tool when assessing adolescents to determine safety factors such as drug use, sexuality, suicide risk, and bullying. Match the principle of nursing interventions with its description. Safe: The intervention protects both patient and staff. Appropriate: The intervention aligns with patient's personal goals. Individualized: The intervention is within the patient's capabilities. Evidence-based: The intervention is based on scientific principles. Which is the priority step the mental health nurse would take when documenting a patient's nonadherence? Use neutral language The nurse must use neutral language when documenting a patient's noncompliance to prevent health care staff from blaming or criticizing the noncompliant patient. Match the nurse-patient communication component with its description. Sender: Initiates transmission of information Medium: How the message is sent Receiver: Accepts and interprets message Feedback: Response to the message Which are characteristics of nonverbal communication that the nurse may use when communicating with psychiatric patients? Touch Touch is a form of nonverbal communication since it does not involve the spoken word. Nurses should note that not all patients want to be touched or may misinterpret touch as threatening or sexual in nature. As such, they may respond with aggression or with an inappropriate sexual response. Boundaries need to be clear prior to initiating touch. Cough Cough is an example of paralinguistics, which is any sound that is not a spoken word. Cough is an example of nonverbal communication. It is considered a reflex. Eye movement Eye movement is an example of nonverbal communication since it does not involve the spoken word. Facial expressions Facial expressions are an example of nonverbal communication since they do not involve the spoken word. Which is the most important focus of therapeutic communication? The patient's needs Therapeutic communication focuses on the needs of the patient in an effort to promote stabilization and recovery. Which are expected transformations of the mental health care system that may affect psychiatric nursing under "A Vision for Mental Health Care in America"? Mental health care and information will be accessible via technology. "A Vision for Mental Health Care in America" hopes to make mental health care and information accessible via technology. It is the nurse's role to ensure patients understand they have access to technology and how to use it. Americans will understand the link between mental health and overall health. The initiative hopes to improve American's understanding of the link between mental health and overall health. It is the nurse's role to teach patients the link between mental health and physical health. Common practice will include early mental health screening, assessment, and referral to services. "A Vision for Mental Health Care in America" strives to improve mental health care including mental health screening, assessment, and referral to services. It is the nurse's role to conduct mental health screening, assessment, and referral to services. As defined which component of mental health is a focus of mental health nurses? Considering professional biases and individual differences. The definition of mental health considers the professional biases of mental health workers and the individual differences of mental health patients. The mental health nurse teaches the mental health patient that the health promotion concept of resiliency is most closely related to which mental health process? Adapting Resiliency helps people facing tragedy, loss, trauma, and severe stress, and is most closely related to the process of adapting. The mental health nurse is providing care within the interdisciplinary team. Which describes the mental health nurse's role in assessment of the patient? Perform baseline assessment The role of the mental health nurse in assessment of the patient includes performing a baseline assessment of the patient. Which member of the psychiatric interdisciplinary team leads the planning meetings? Nurse The nurse leads the planning meeting since nurses are present on the unit at all times and contribute valuable patient information, such as continuous assessment finding's, the patient's adjustment to the unit, any health concerns, psycho-educational needs, and patient deficits in self-care. Match the psychiatric emergency care model with the psychiatric nurse's role. Comprehensive Emergency Services Model: Psychiatric nurse works with specialized mental health team. Hospital-Based Consultant Model: Psychiatric nurse serves as part of general ED staff. Mobile Crisis Team Model: Psychiatric nurse stabilizes patients in the field. Match the psychiatrist researcher with his view of spirituality. Xavier: Positive correlation between mental health and spiritual well-being. Frankl: Patients can control perspective of hope. Loder: Adults search spiritually for trust. Which steps should the nurse take when providing spiritual care to psychiatric patients? Take a spiritual history The nurse should take a spiritual history on all patients so that the patient's beliefs can be supported. Support the patient's beliefs The nurse should show respect for the patient's beliefs even if they run contrary to the nurse's. Refer the patient to pastoral care The patient should be referred to pastoral care so that their spiritual needs can be met. Match the culture with its belief about disease. Western: Medical treatment focuses on eliminating disease. Eastern: Disease is caused by imbalance of yin and yang. Indigenous: Disease is due to lack of harmony. In which ways do mental health nurses advocate for mental health patients? Supporting the patient's decisions The mental health nurse advocates for the mental health patient by supporting the patient's decisions. Reporting incidents of neglect or abuse The mental health nurse advocates for the mental health patient by reporting incidents of neglect or abuse that involve the patient. Providing information about the right to refuse treatment The mental health nurse advocates for the mental health patient by providing the patient with information, including information about the right to refuse treatment. Which actions by the mental health nurse demonstrate advocacy for mental health patients? Engaging in public speaking Engaging in public speaking about mental health issues is a way mental health nurses can advocate for mental health patients by brining public awareness to mental health issues. Writing articles for the press Writing articles for the press is a way mental health nurses can advocate for mental health patients by bringing public awareness to mental health issues. Lobbying congressional representatives Lobbying congressional representatives is a way mental health nurses can have a political voice and advocate for change in mental health medicine. Which statement is true regarding the mental health nurse as activist? Can help reverse negative media portrayal of mental illness. The mental health nurse serves as an activist when helping to reverse negative media portrayal of mental illness. Which type of nursing diagnosis is most appropriate to be used in the mental health setting? Risk for self-harm Which is an example of a nursing short-term safety outcome statement for the mental health patient? Patient will state understanding of unit suicide precautions. Which factors should the advanced practice mental health nurse take into consideration when prescribing medication for the psychiatric patient? Age, culture, religious beliefs What is the "message" component of nurse-patient communication? The feeling or idea that is being sent Which statement is true regarding the nurse's use of touch with patients with a mental health disorder? Patients with a mental health disorder may view the nurse's touch as threatening, intimate, or sexual. Patients with a mental health disorder may respond to the nurse's touch with aggression, withdrawal, or an inappropriate sexual overture. Appearance is which form of nurse-patient communication? Nonverbal How can mental health nurses help incorporate the changes proposed in "A Vision for Mental Health Care in America?" Being politically aware. Following the latest research in mental health. Becoming involved in professional nursing associations. How does the nurse explain to the mental health patient the definition of mental health? The ability to realize one's abilities. Which topics are most important for the nurse include when teaching patients who are receiving mental health care? Coping Relaxation prevention Problem-solving skills Which steps should the mental health nurse take in managing the patient's medications? Document patient compliance. Teach about medication side effects. Document patient response to medication. Discuss the expected benefits the patient may receive from the medication. In which ways are clinical pathways helpful to the mental health nurse when providing care? Decreases patient complications. Provides a link between evidence-based information and clinical practice. What is the mental health nurse's primary goal as a member of the Mobile Crisis Team model? Stabilize patients in the field. Which psychiatric nursing cultural competence constructs are found in Campinha-Bacote's Process of Cultural Competence in the Delivery of Health Care Services model? Cultural skill, cultural knowledge, cultural encounters. [Show Less]
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Theories of Psychiatric Nursing Practice questions and answers 2023
Fundamental objectives of the psychiatric mental health nurse The promotion and protection of mental health The prevention of mental disorders The treat... [Show More] ment of mental disorders Recovery and rehabilitation Psychiatric nursing roles Instrumental in providing the structure, framework, and implementation of interventions to reach goals of the milieu model. ex. provide safety for suicidal patients, do crisis intervention strategies, run groups, one to one counseling Therapeutic Relationships Therapeutic relationship is between the nurse and the patient are established to enhance patient growth. -focuses on the patient's issues, problems, challenges, and concerns. -communication techniques are used to identify and explore patient's needs, set goals, assist in development of new coping skills, and encourage behavioral changes. Hildegard Peplau 199-1999 Theory of interpersonal relationships in nursing. Established a systematic theoretical framework for psychiatric nursing. -identified psychiatric nursing as an essential element of general nursing and as a distinct nursing specialty. She was the first to illustrate this. Nurse-patient relationship (as the foundation of nursing practice) Relationship with patient is educative to help the patient/community strive to live more productively. -this relationship is fluid, evolving process that moves through three distinct interlocking and overlapping phases. 1. orientation 2.working 3.termination Factors hampering relationships Lack of nurse availability Lack of contact with nurse Lack of nurse self-awareness Nurse hold negative feelings about the patient, and nonverbal expression is present. Factors beneficial to relationship Being honest and congruent Letting the patient set the pace Listening to the patients concerns Consistant, regular, and private interactions with the patient Positive initial attitudes and preconceptions Promoting patient comfort and balancing control Patient demonstrating trust and actively participating in the relationship Factors enhancing growth in others Genuineness, congruence between verbal content and affect/behaviors Empathy, understanding ideas expressed and feelings present in the other person. Positive regard, implies respect; attitudes and actions (attending, suspending value judgements) Helping clients develop resourses, awareness, encouragement shown toward positive behaviors Positive regard behaviors Mutually establishing times to begin and end and what will happen ie talking, activities, ect. Being on time for all scheduled meetings Actively listening to the patient Neutral comments; nonjudgmental responses Orientation phase Establish boundries of the relationship Role and responsibilities of the nurse and patient are identified Confidentiality is agreed upon Formal and or informal contact is set -the time, place, date and duration of meetings -mutual goals -assessment of care planning -termination terms Working phase Maintain the relationship Gather further data Promote patient problem-solving skills, self-esteem and communication Facilitate behavioral change Overcome resistance behaviors Evaluate problems and goals, redefine prn Practice and express alternative adaptive behaviors (role play and model) Terminations phase When: (any of these) symptoms have improved, patient discharged from facility, goals achieved, impasse in therapy, insurance runs out, change of staff What: deal with intense feelings regarding the experience, summarize goals and objectives achieved, review patient plans for the future and finalize termination. Defense mechanisms and anxiety Anxiety: completely a natural part of living, its a healthy message in many cases. Defense mechanisms: operates at an unconscious level where the ego, in an attempt to ward off intense anxiety or other overwhelming feelings, makes these to prevent the conscious awareness of threatening feelings. Can cause distortions in the individual's preconceptions of reality. What is a defense mechanism? Compensation: counterbalance for deficiencies in one area by excelling in another area. Denial: refusal to perceive or face unpleasant reality as it actually exists. Displacement: the discharge of pent up feelings (usually hostility) unto something or someone else in the environment that is less threatening than the original source of the feelings. ie. you know more than you think, I'm sure. Identification: incorporates the image of an emulated person, then acting, thinking, and feeling like that person. Intellectualiation: the overuse of abstract thinking or generalization to control or minimize painful feelings Minimization: not acknowledging the significance on one's own behavior or feelings. Projection: attributing one's own unacceptable motives or characteristics to another person or group Rationalization: use of contrived socially acceptable and logical explanations to justify unpleasant material and to keep it out of the consciousness. Reaction formations: prevention of awareness or expression of unacceptable desires by adoptionof the opposite behaviors in a n exaggerated way Repression: disturbing thoughts, wishes, or experience are expelled from conscious awareness Regression: returning to an earlier level of adaption Sublimation: modification of an instinctual but socially unacceptable impulse into a constructive acceptable behavior Splitting: Failure to integrate positive and negative aspects of self or others, resulting in polarized images of self and others as "all good" or "all bad" Supression: conscious inhibition of an impulse, idea, or affect. The person is usually fully aware of the behavior. Freud Five psychosexual stages of development from infancy to adulthood. Main focus is on the first five years of life's experiences and development. Freud believed mental illness was a result of early intra-psychic conflict Psychoanalytical therapy: behavior is meaningful, uncover the unconscious impulses and conflicts that influence behavior, increases ego consciousness, dream analysis; free association techniques. Transference The patient's feelings are projected onto the nurse or therapist that were originally held toward significant others in their life. - feelings displaced in transference: desire for affection, desire fro gratification of dependency needs, love, hostility, jealousy, competitiveness. Counter-transference The health care worker's unconscious personal feelings are projected onto the patient. Resistance in therapy In psychoanalysis: process in which the ego opposes the conscious recall of unpleasant experiences. In theory: patient puts road blocks to deal with identified issues. Erik Erickson Used to identify the person's development level for his or her age and qualified goals for each stage. Can be helpful with making care plans to keep the goals realistic Eight stages of development: Infancy- trust vs. mistrust Early childhood- Autonomy vs. shame and doubt Preschool- Initiative vs. guilt School age- industry vs. inferiority Adolescence- identity vs. role confusion Early adulthood- intimacy vs. isolation Middle adulthood-generativity vs. self-absorption Older Adult- integrity vs despair Erikson's Ego theory Describes the eight stages of development from infancy to late adulthood. Stressed development influenced by the mother-child-father triangle (like Freud), but also felt cultural and social influences were very important. Didn't feel the personality was fixed by age five. His model's use in nursing: -used to identify developmental level for age -can help with the development of the care plan, to keep goals realistic Harry Stack Sullivan Interpersonal theory Goal of interpersonal psychotherapy is to reduce or eliminate psychiatric symptoms (particularly depression) by improving interpersonal functioning and satisfaction with social relationships. Four main "problem areas": -grief -role disputes -role transition -interpersonal deficit Sullivan's theory is the foundation for Peplau's nursing theory of interpersonal relationships. Participant observer: the professional helpers cannot be isolated from the therapeutic situation if they are to be effective Psychotherapeutic Environment Group psychotherapy, family therapy, and educational/skills training programs can be incorporated into the patient's treatment. -this is used in residential and day hospital settings today. Behavioral Theories/Therapies Based on the assumption that changes in maladaptive behavior occur without insight into the underlying causes -successful in treatment for phobias, alcoholism, schizophrenia Operant conditioning (skinner) voluntary behaviors learned through consequences Reinforcement (skinner) the behavior responses elicited occur more frequently when reinforced. positive reinforcement (skinner) consequence is a pleasant or pleasurable experience negative reinforcement (skinner) removal of an objectable or aversive stimulus Conditioning Conditioning: pairs behavior with a condition that reinforces or diminishes the behavior's occurance. Ivan Pavlov's classical conditioning theory John B. Watson: behaviorism; personality traits and responses were socially learned through classical conditioning. modeling therapist provides a role model, demonstrates more effective behaviors to help patient cope Cognitive Behavioral therapy Eliciting automatic thoughts testing automatic thoughts identifying maladaptive underlying assumptions testing the validity of the assumptions ... ... Humanistic theories Maslow's Humanistic Theory Hierarchy of needs Emphasis on human potential and the client's strengths as key to success for the nurse-client relationship. Establishes priorities for nursing interventions Other therapies Activity/recreational therapy occupational therapy family therapy group therapy electroconvulsive therapy Primary prevention Teaching stress reduction techniques Offering seminars or classes to populations that are isolated or disenfranchised Offering parenting classes Secondary prevention Early identification of mental illness Early treatment interventions Tertiary prevention Reduce the residual effect of a disorder Promote rehabilitation Evidence based practice Identification and application of empiric research evidence to solve clinical problems. Applying research evidences to clinical situation and problems. Specific interventions are incorporated to reach specific treatment outcomes. Comprehensive care Emphasis on symptom management, restoration, rehabiliation, a return to preillness level of function or better. Goal is to engage again in purposeful activities and meaningful social relationships. In psych, getting them as close to baseline as possible. They may never fully reach baseline. Recovery and rehabilitation model Designed to reintegrate patients into the community and to support them as they more actively participate in their own treatment. Focuses on EBP, provides a set of strategies that enables patients to take responsibility for care and empowers them to learn to identify and define recovery goals. [Show Less]
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Psychiatric Nursing Questions and Answers 2023
Which qualifications are appropriate to the scope of practice of the psychiatric/mental health registered nurse generalist? -The nurse generalist is quali... [Show More] fied to implement crisis intervention. -Part of the professional responsibilities of the psychiatric/mental health registered nurse generalist is crisis intervention. The test taker must be familiar with the scope of practice of various educational levels of the registered nurse and the roles and responsibilities within this scope. Which is the overall, priority goal of in-patient psychiatric treatment? - Stabilization and return to the community. -Stabilization and return to the community is the overall priority goal of in-patient psychiatric treatment. Understanding the current trends in the delivery of mental health care is in the community and in-patient settings assists the test taker in answering this question correctly. Note the keywords, "priority" and "in-patient," which determine the correct answer to this question. When the nurse creates an environment to facilitate healing, the nurse's actions are based on which of the following assumptions? Select all that apply. - A therapeutic relationship can be a healing experience. - Group settings can support ego strengths. - Treatment plans can be formulated by observing social behaviors. - A therapeutic relationship is characterized by rapport, genuineness, and respect and can be a healing experience. - Group processes provide learning experiences and support a client's ego strengths. - During group processes and interactions, staff members can observe social behaviors, and this can determine client needs. Treatment plans can be customized to meet these needs. Reviewing the nurse's actions that assist in creating an environment that facilitates healing assists the test taker in determining the correct answer to this question. Understanding the meaning of counterttansference eliminates option 5. Which of the folloing was the reason for the establishment of large hospitals or asylums that addressed the care of the mentally ill? - Mental illness was perceived as incurable. - Clients with mental illness were perceived as a threat to self and others. - Dorothea Dix saw a need for humane care for the mentally ill. - Because there was no treatment for mental illness before 1840, it was perceived as incurable and there was a need to provide continuous supervision in hospitals or asylums. - Clients with mental illness were thought to be violent toward themselves and others, and a "reasonable" solution to care was to remove them from contract with the general population and observe them continuously in hospitals or asylums. - Dorothea Dix advocated for humane treatment for the mentally ill, and this led to the establishment of many hospitals devoted to their care. Reviewing the history of mental health care assists the test taker in inderstanding how care was delivered in the past. Which of the following are examples of primary prevention in a community mental health setting? Select all that apply - Teaching physical and psychosocial effects of stress to elementary school students. - Teaching a class on child-rearing skills for a group of new parents. - This is an example of primary prevention, which is focused on educational programs to help prevent the incidence of mental illness. - This is an example of primary prevention, which is focused on educational programs to help prevent the incidence of mental illness. Understanding the public health model that describes primary, secondary, and tertiary prevention assist the test taker in answering this question correctly. Which nursing intervention within the community is aimed at reducing the residual defects that are associated with severe or chronic mental illness? - Referring clients for various aftercare services such as day treatment programs. - Tertiary prevention is aimed at reducing the residual defects that are associated with severe or chronic mental illness. Providing aftercare services, such as day treatment programs, is one way to accomplish this. Reviewing the functions of the nurse at all levels of community mental health prevention helps the test taker to distinguish interventions in each prevention category. In the emergency department, the nurse assesses a client who is aggressive and experiencing auditory hallucinations. The client states, "The CIA is plotting to kill me." To which mental health setting would the nurse expect this client to be admitted? - Short-term, in-patient, locked unit. - A short-term, in patient, locked unit would be most appropriate for this client. This setting provides containment and structure for clients who are at risk for harming themselves or others. Understanding the types of care available to mentally ill clients and the types of clients these various settings serve assists the test taker in answering this question. Which action of a mental health nurse case manager reflects the activity of service planning? - Holding a care conference for a client who is having difficulty returning to school. - Holding a care conference for a client who is having difficulty returning to school reflects the activity of service planning. A service care plan is devised with client participation and should include mutually agreed on goals, specific actions directed toward goal achievement, and selection of essential resources and services. Reviewing examples of case management activities, such as identification and outreach, assessment, service planning, linkage with needed services, monitoring service delivery, and advocacy, assists the test taker in recognizing nursing actions that reflect these activities. A client with a long history of alcohol use disorder has been diagnosed with Wernicke-Korakoff syndrome. With which member of the mental health-care team would the nurse collaborate to meet this client's discribed need? - The dietitian to help the client increase consumption of thiamine-rich foods. - The dietitan can help the client to increase the intake of thiamine-rich foods. Thiamine deficiency is the cause of Wernicke-Koraskoff syndrome. The test taker needs to recognize the signs, symptoms, and cause of Wernicke-Korsakoff syndrome. A client on an in-patient psychiatric unit has a nursing diagnosis of nonadherence R/T antipsychotic medications. In which role is the nurse functioning when checking for "cheeking"? "Cheeking" is when the client hides medication between the cheek and gum. Complete inspection of the mouth, with potential use of a tongue blade, is neccessary to discover cheeking. Another way to ensure that the client has swallowed medications is to talk to the client for a few minutes after medication administration. During this time, the medication would begin to dissolve if cheeking has occured. - Medication manager. - In the role of medication manager, the nurse has the resonsibility of ensuring that clients are given the correct medication, in the correct dosage, by the correct route, and at the correct time, and that correct documentation occurs. By checking for "cheeking," the nurse is fulfilling this role. The test taker must look at the nursing action presented in the question. In what role is the nurse functioning when performing this action? On an in-patient psychiatric unit, which of the following actions exemplify the nurse's role of teacher? Select all that apply. - The nurse presents information to help the client and family members to understand the effects of mental illness. - The nurse holds a group to discuss medication side effects. - In the role of teacher, the nurse assists the client and family members in coping with the effects of mental illness. Helping the client to understand his or her illness, its signs and symptoms, the medications and potential side effects, and various coping techniques all are interventions of the nurse functiong in the role of teacher. - In the role of the teacher, the nurse assists the client to understand treatments, including medication actions and their side effects. Holding this teaching group is an intervention that reflects the nurse's role of teacher. To assist the test taker in distinguishing the various roles of the nurse, he or she should consider clinical examples that reflect these roles. Which of the following actions reflect the nurse's role of advocate in an in-patient psychiatric setting? Select all that apply. - The nurse speaks on behalf of a mentally ill client to ensure adequate access to needed mental health services. - The nurse talks with the treatment team to support a shy client's request for less-sedating medications - Advocacy is an essential role of the psychiatric nurse. Often, mentally ill clients cannot identify their personal problems or communicate their needs effectively. A nurse advocate stands alongside clients and empowers them to have a voice when they are weak and vulnerable. - Advocay is an essential role for the psychiatric nurse. A nurse advocate stands alongside of, and empowers, clients to have a voice when they are weak and vulnerable. Understanding the interventions used by the nurse in a psychiatric setting when assuming various roles assists the test taker in categorizing the behaviors presented in the question correctly. A resource person's function is to give specific answers to specific questions, as a counselor's function is to: - Listen as a client reviews feelings related to difficulties experienced in life. - The nurse functioning as a couselor uses interpersonal communication techniques to assist clients in learning to adapt to difficulties or changes in life experiences. These techniques allow the experiences to be integrated with, rather than dissociated from, other experiences in life. An anology is a comparison. Test takers should look at what is being compared and choose an answer that provides information that reflects a similar comparison. On an in-patient psychiatric unit, a client diagnosed with borderline personality disorder is challenging other clients and splitting staff. Which response by the nurse relfects the nurse's role of milieu manager? Ongoing assessment, diagnosis, outcome identification, planning, implementation, and evaluation of the environment are necessary for the successful management of a therapeutic milieu. - Setting strict limits and communicating these limits to all staff members. - By setting strict limits on inappropriate or unacceptable behaviors, the nurse functions in the role of the milieu manager. The safety of the milieu is always the highest priority. The environment of the milieu should be constrcted to provide many opportunities for personal growth and social interaction to build interpersonal skills. To assist in correctly choosing the actions of the nurse that reflect the role of milieu manager, the test taker should review this role and its components. On an in-patient psychiatric unit, a client who is anxious and distressed states. "God has abandoned me." Which nursing action would initiate collaboration with the member of the mental health-care team who can assist this client with this assessed problem? - Consult with the chaplin and describe the client's concerns. - The chaplain provides spiritual counseling. Experiencing anger at God or a higher power can indicate spiritual distress that can be addressed by the chaplain. The test taker should review the roles of the members of the health-care team in a psychiatric setting and how the nurse would collaborate with each team member. A client on an in-patient psychiatric unit exhibits traits of borderline personality disorder. Which action by the nurse would initiate collaboration with the member of the mental health-care team who can best confirm this diagnosis? Personality testing must be done initially to diagnose a client with a personality disorder. This testing is administered by a psychologist. - Colaborate with the clinical psychologist to prepare the client for personality testing. - The clinical psychologist selects, administers, and interprets psychological tests. Clients with personality disorder traits need personality testing such as the Minnesota Multiphasic Personality Inventory (MMPI) to confirm a personality disorder diagnoisis. The test taker must know that the primary function of the psychologist in an in-patient setting is testing. The psychologist performs personality inventiories and IQ testing A client with a long history of alcohol use disorder comes to the out-patient clinic after losing a job and driver's license because of a driving under the influence (DUI) infraction. With which member of the mental health-care team would the nurse collaborate to meet this client's described need? - The occupational therapist for retraining and job placement. - The occupational therapist in a mental health setting focuses on rehabilitation and vocational training to assist clients in becoming productive. The occupational therapist uses manual and creative techniques to elicit desired interpersonal and intrapsychic responses. The occupational therapist helps the client with job training and employment placement, which is the direct problem described in the question. The test taker shoud review the roles of the members of the health-care team in a psychiatric setting and how the nurse would collaborate with each team member. A client states, "My wife is unfaithful. I think I am not worth anything." Which of the following describes this assessment information? Select all that apply. Statements by clients are considered subjective data. - This is subjective information or a "chief complaint." - This information needs objective measurement by a mood rating scale. - Subjective data are reported by the client and significant others in their own words. An example of this is the "chief complaint," which is expressed by the client during the intake interview. - Subjective data are data expressed in the client's own words and can be made objective by the use of a mood scale measurement tool. Mood or anxiety scales objectively measure subjective data. The test taker must understand that subjective data consist of the client's perception of his or her health problems. Objective data are observations or measurements made by the data collector. Which of the following assessment information would be evaluated as objective data? - Clinical Institute Withdrawal Assessement (CIWA) score of 10. - Client's mood rating of 5 on a 10-point scale. - Objective data include scores of rating scales developed to quantify data. A CIWA score rates symptoms of alcohol withdrawal. - Objective data include scores of rating scales developed to quantify data. A mood scale has a client objectively rate his or her mood from 0 to 10 scale. These scales take the subjective data of mood and presents it as objective data. The test taker must understand that the measurement of objective data is based on an accepted standard or scale and may require the use of a measurement tool. The nurse is interviewing a client admitted to an in-patient psychiatric unit with a diagnosis of depressive disorder. Which is the primary goal in the assessment phase of the nursing process for this client? - To collect and organize information. - The primary goal in the assessment phase of the interview is to collect and organize data, which would be used to identify and prioritize the client's problems. The test taker should write the steps of the nursing process next to the goals presented. Which goal reflects the assessment phase? The nurse uses the clock face assessment test to obatain which assessment data? -Early signs of neurocognitive disorder. - The clock face assessmetn is a sensitive way to assess early signs of neurocognitive disorder. The client is asked to place numbers appropriately on a clock face. The test taker should be aware of the purpose of various assessment tools, including the clock face assessment. A welder who recently lost his leg in a work-related accident is being admitted to an in-patient psychiatric unit. The client states, "I'm worried because I can't support my family anymore!" Which nursing diagnosis is most reflective of this client's presenting problem? - Ineffective role performance R/T loss of job. - A defining characteristic of the nursing diagnosis of ineffective role performance is a change in physical capacity to resume a role. The client presented has had a change in body image that affects his ability to perform his role as welder and provider for his family. Test taker must use only the situtaion and client data presented in the question to formulate an appropriate nursing diagnosis and must not read into the question any daya that are not presented. An 85- year-old client has become agitated and physically aggressive after having a stroke with right-sided weakness. The client is started on risperidone (Risperdal) PO 0.5 mg qhs. Which is a priority nursing diagnosis for this client? - Risk for falls R/T right-sided weakness and sedation from risperidon (Risperdal). - Risk for falls R/T right-sided weakness and sedation from risperidone (Risperdal) is the priority diagnosis for this client. A fall would endanger this client, and safety issues always take priority. When evaluating what is being asked for in the question, the test taker should factor in common side effects of medications that the client s receiving. Safety is always prioritized. [Show Less]
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THE PRACTICE OF MENTAL HEALTH/ PSYCHIATRIC NURSING QUESTIONS AND ANSWERS 2023
A nurse working on a unit in a psychiatric hospital is responsible for performing a variety of functions. Which are the ones that a registered nurse is leg... [Show More] ally permitted to perform? Select all that apply. 1. Psychotherapy 2. Health promotion 3. Case management 4. Prescribing medication 5. Treating human responses 2. Health promotion 3. Case management 5. Treating human responses The psychiatrist orders "Restraints PRN" for a client who has a history of violent behavior. Then nurse should: 1. Utilize the restraint order if the client begins to act-out 2. Ask the psychiatrist to clarify the type of restraint order 3. Ensure that the entire staff is aware of the restraint order 4. Recognize that PRN orders for restraints are unacceptable 4. Recognize that PRN orders for restraints are unacceptable New orders must be written each time a client requires restraints. When a client is acting-out, the nurse may use restraints or a seclusion room and then obtain the necessary order. A client on the psychiatric unit asks the nurse about psychiatric advance directives (PAD). The nurse explains that these advanced directives: 1. Make the appointment of a surrogate decision maker unnecessary 2. Permit the client to dictate what treatment will be given during the future hospitalizations 3. Eliminate the need for involuntary admissions when the client is a threat to self or others 4. Allow the client, while having the capacity, to consent or refuse potential psychiatric treatments in the event of a future incapacitating mental health crisis 4. Allow the client, while having the capacity, to consent or refuse potential psychiatric treatments in the event of a future incapacitating mental health crisis The purpose of a PAD is to allow psychiatric clients the opportunity to provide input into future treatment decisions. The statement that best describes the practice of psychiatric nursing is: 1. Helps people with present or potential mental health problems 2. Ensures clients' legal and ethical rights by acting as a client advocate 3. Focuses interpersonal skills on people with physical or emotional problems 4. Acts in a therapeutic way with people who are diagnosed as having a mental disorder 1. Helps people with present or potential mental health problems An important aspect of the role of the psychiatric nurse is primary, secondary, and tertiary interventions to promote emotional equilibrium. A 45-year-old physician is admitted to the psychiatric unit of a community hospital. The client is restless, loud, aggressive, and resistive during the admission procedure and states, "I will take my own blood pressure." What is the most therapeutic response by the nurse? 1. "Right now, doctor, you are just another client." 2. "If you would rather, doctor, I'm sure you will do it OK." 3. "If you do not cooperate, I will get the attendants to hold you down." 4. "I am sorry, but I cannot allow that. I must take your blood pressure." 4. "I am sorry, but I cannot allow that. I must take your blood pressure." This simply states facts without getting involved in role conflict. For most nurses the most difficult part of the nurse-client relationship is: 1. Remaining therapeutic and professional 2. Being able to understand and accept the client's behavior 3. Developing an awareness of self and the professional role in the relationship 4. Accepting responsibility in identifying and evaluating the real needs of the client 3. Developing an awareness of self and the professional role in the relationship The nurse's major tool in psychiatric nursing is the therapeutic use of self. Psychiatric nurses must learn to identify their own feelings and understand who they affect the situation. The father of a 16-year-old boy who has just been diagnosed with Hodgkin's disease tells the nurse he does not want his son to know the diagnosis. What response by the nurse is best in this situation? 1. "It is best is he knows the diagnosis." 2. The cure rate for Hodgkin's disease is high." 3. "Would you like someone with Hodgkin's to talk to you?" 4. "Let's talk about why you don't want him to know." 4. "Let's talk about why you don't want him to know." This statement does not prejudge the father; if encourages communication. A male nurse is caring for a client. The client states, "You know, I've never had a male nurse before." The nurse's best reply should be: 1. "Does it bother you to have a male nurse?" 2. "There aren't many of us; we're a minority." 3. "How do you feel about having a male nurse?" 4. "You sound upset. I will get a female nurse to care for you." 3. "How do you feel about having a male nurse?" This statement encourages the client to express and explore feelings; also, it is open and nonjudgmental. A male nurse reminds a client that it is time for group therapy. The clients responds by yelling at the nurse, "You are always telling me what to do, just like my father." This clients response is an example of: 1. Regression 2. Transference 3. Reaction formation 4. Counter transference 2. Transference With transference a client assigns to someone the feelings and attitudes originally associated with an important significant other. In psychiatric nursing, the most important tool the nurse brings to a helping relationship is: 1. Oneself and a desire to help 2. Knowledge of psychopathology 3. Advanced communication skills 4. Years of experience in psychiatric nursing and milieu management 1. Oneself and a desire to help The nurse brings to a therapeutic relationship the understanding of self and basic principles of therapeutic communication; this is the unique aspect of the helping relationship. A Latino American client with schizophrenia is admitted to an emergency department crisis unit in an aggravated and disheveled state after failing to take prescribed medication for the last 5 days. When developing a plan of care that incorporates the client's cultural background, the nurse gives priority to: 1. Inclusion of the family in the client's plan of care 2. The client's need to control personal and social space 3. The meaning and attention the client places on the future 4. Socioeconomic considerations regarding hospitalization 1. Inclusion of the family in the client's plan of care In the Latino American culture, usually there is a strong family bond, and the support of the family is essential during problematic times. A 30-year-old woman is brought to the local community hospital by a family member because the woman "has been acting strange." When the nurse assess the client, which statements meet involuntary hospitalization criteria? Select all that apply. 1. "I cry all the time I am so depressed." 2. "I would like to end it all with sleeping pills." 3. "The voices say it is okay for me to kill all prostitutes." 4. "My boss is always picking on me and it makes me angry." 2. "I would like to end it all with sleeping pills." This statement indicates a suicide threat; it is a direct expression of intent but without action. 3. "The voices say it is okay for me to kill all prostitutes." The threat to harm others must be heeded; the client must be protected from harming herself as well as harming others The nurse encourages the client to join self-help group after being discharged from a mental health facility. The purpose of having people work in a group is to provide: 1. Support 2. Confrontation 3. Psychotherapy 4. Self-awareness 1. Support Self-help group members share similar experiences and an provide valuable understanding and support to each other. As depression begins to lift, a client is asked to join a small discussion group that meets every evening on the unit. The client is reluctant to join because, "I have nothing to talk about." What is the best response by the nurse? 1. "Maybe tomorrow you will feel more like talking." 2. "Could you start off by talking about your family?" 3. "A person like you has a great deal to offer the group." 4. "You feel you will not be accepted unless you have something to say?" 4. "You feel you will not be accepted unless you have something to say?" This reflective statement allows the client to either validate or correct the nurse. During a group meeting a male client tells everyone of his impending discharge from the hospital. It is most appropriate of the nurse leading the group to respond: 1. "You ought to be happy that you're leaving." 2. "Maybe you're not ready to be discharged yet." 3. "Maybe others in the group have similar feelings that they would share." 4. "How many in the group feel that this member is ready to be discharged?" 3. "Maybe others in the group have similar feelings that they would share." This permits the client to see that personal feelings are not unique but are shared by others. When a psychiatric nurse uses the family systems theory in practice, which statement by the nurse is most typical of this theory? 1. "Describe for me in your own words what caused this situation." 2. "You need to abide by the unit rules and attend the community meetings." 3. "Whenever someone permanently leaves the home, the boundaries are upset." 4. "You're doing better; let's talk to the doctor about lowering your medication dosage 3. "Whenever someone permanently leaves the home, the boundaries are upset." Boundaries relate to family systems theory. A week after the admission of a client with the diagnosis of paranoid schizophrenia, the client stands up in the lounge and throws a chair across the room and starts yelling at the other clients. Several of the other clients have frightened expressions, one starts to cry, and another beings to pace. After removing the agitated client from the room, what should the nurse do next? 1. Refocus the clients' negative comments to more positive ones 2. Arrange a unit meeting to discuss what just happened 3. Continue the unit's activities as if nothing has happened 4. Have a private talk with the clients who cried and started to pace 2. Arrange a unit meeting to discuss what just happened This provides an opportunity for the other clients to voice and share feelings and to identify and separate real from imaginary fears; an open expression of feelings allows the nurse to deal with client's fears and provide reassurance. A female client, whose long-term live-in lover has just terminated their relationship, comes to the emergency service in severe crisis. After being seen by the nurse, the client agrees to call the local mental health clinic for short-term counseling. Which client behavior helps the nurse evaluate whether the nursing intervention was effective? The client: 1. Is seeking out assistance for help with coping 2. Has returned to her pre crisis level of functioning 3. Has learned new methods of coping with her loss 4. Is demonstrating diminished symptoms of anxiety 1. Is seeking out assistance for help with coping Going for counseling demonstrates the client's recognition that assistance is needed. The nurse is aware that a co-worker's mother died 16 months ago. The co-worker cries every time someone mentions the word "mother" or if the mother's name is mentioned. Which should the nurse understand in this situation? 1. Everyone cries when their mother dies 2. This behavior is an expected response 3. This person should seek help with grieving 4. The co-worker was extremely attached to the mother 3. This person should seek help with grieving Crying a release, but the individual should have developed effective coping mechanisms by this time. During a staff development program, the nurse educator emphasizes that nurse caring for middle-aged adults who are experiencing midlife crisis should understand that this crisis is most often a result of the: 1. Many role changes adults experience at this time 2. Individual's perception of his or her life situation 3. Anticipation of negative changes associated with old age 4. Lack of support of family members who are busy with their own lives 2. Individual's perception of his or her life situation Th most significant factor in either precipitation or avoiding crisis is not the events but how the individual perceives them. A 35 year-old is admitted for an amputation of the left leg. Before surgery the nurse observes that the client is diaphoretic, voiding frequently, having difficulty understanding what is being said, and complaining of palpitations. What should the nurse do first after making these assessments? 1. Have a stat ECG done on the client 2. Ask the client to talk about feelings 3. Obtain a urine specimens for culture and sensitivity 4. Ask the physician for a stat order for an IM tranquilizer 2. Ask the client to talk about feelings The symptoms presented are indicative of a severe anxiety reaction related to a crisis; the client has a need to vent feelings. During a staff development program, when discussing the reaction of middle-aged women to their children leaving home, the nurse educator reminds the group that recent studies have demonstrated that today's women most commonly experience a feeling of: 1. Anxiety 2. Depression 3. Satisfaction 4. Hopelessness 3. Satisfaction Studies demonstrate that as more women enter the work force, the experience fewer negative responses to the "empty nest" created by children leaving home. The nurse identifies that the main goal in planning care for a client in crisis is to: 1. Schedule follow-up counseling for the client 2. Restore the client's psychologic equilibrium 3. Have the client gain insight into the problems 4. Refer the client for occupational and physiotherapy 2. Restore the client's psychologic equilibrium Crisis intervention is short-term therapy with the major goal of restoring clients to their pre crisis state. A 30 year old who has been in a gay relationship for the past 3 years comes to the emergency department in a near panic state. He tells the nurse that his lover of many years has just terminated their relationship. What should the nurse do to help the client cope with this loss? 1. Identify his support system 2. Explore his psychotic thoughts 3. Reinforce his current self-image 4. Suggest he explore his sexual orientation 1. Identify his support system A client in crisis needs to rely on available support systems for assistance; therefore it is vital for the nurse to identify the client's support system. Which approach should the nurse use during crisis intervention? 1. Passive and reflective 2. Active and goal-directed 3. Future-oriented and passive 4. Interpretative and analytical 2. Active and goal-directed During crisis intervention the nurse should be goal-directed and active in assessing the current situation and handling the interview with authority. The nurse understands that the outcome that is unrelated to a client in a crisis state is: 1. Decompensating to a lower level of functioning 2. Learning and using more constructive coping skills 3. Adapting and returning to prior level of functioning 4. Continuing a high level of anxiety for more than 3 months 4. Continuing a high level of anxiety for more than 3 months This is not an expected outcome of a crisis because by definition a crisis is resolved in 6 weeks. Which is the most important assessment data for the nurse to gather from the client in crisis? 1. The client's work habits 2. Any significant physical health data 3. A history of any emotional problems in the family 4. The specific circumstances surrounding the client's perceived crisis situation. 4. The specific circumstances surrounding the client's perceived crisis situation This assessment assists the nurse to determine what the situation means to the client An extremely anxious client enters a crisis center and asks for help. Which response by the nurse best reflects the nurse's role in crisis intervention? 1. "Tell me what you have done to help yourself." 2. "Can you tell me about what is bothering you?" 3. "I understand in the past you have had problems." 4. "I will be here for you to help you figure things out." 4. "I will be here for you to help you figure things out." Clients in crisis need assistance with coping; the nurse must be involved with problem solving. When assisting clients to cope with a crisis, the professional care provider should follow the principles of intervention. Place the following interventions in order of priority when caring for a person experiencing a crisis. 1. Stabilize the victim 2. Intervene immediately 3. Encourage self-reliance 4. Utilize available resources 5. Facilitate understanding of the event 2,1,5,4,3 [Show Less]
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Chapter 1: Foundations of psychiatric- mental health nursing Questions and Answers 2023
1. The nurse is assessing the factors contributing to the well-being of a newly admitted client. Which of the following would the nurse identify as having ... [Show More] a positive impact on the individual's mental health? A) Not needing others for companionship B) The ability to effectively manage stress C) A family history of mental illness D) Striving for total self-reliance Ans: B Feedback: Individual factors influencing mental health include biologic makeup, autonomy, independence, self-esteem, capacity for growth, vitality, ability to find meaning in life, emotional resilience or hardiness, sense of belonging, reality orientation, and coping or stress management abilities. Interpersonal factors such as intimacy and a balance of separateness and connectedness are both needed for good mental health, and therefore a healthy person would need others for companionship. A family history of mental illness could relate to the biologic makeup of an individual, which may have a negative impact on an individual's mental health, as well as a negative impact on an individual's interpersonal and social-cultural factors of health. Total self-reliance is not possible, and a positive social/cultural factor is access to adequate resources. 2. Which of the following statements about mental illness are true? Select all that apply. A) Mental illness can cause significant distress, impaired functioning, or both. B) Mental illness is only due to social/cultural factors. C) Social/cultural factors that relate to mental illness include excessive dependency on or withdrawal from relationships. D) Individuals suffering from mental illness are usually able to cope effectively with daily life. E) Individuals suffering from mental illness may experience dissatisfaction with relationships and self. Ans: A, D, E Feedback: Mental illness can cause significant distress, impaired functioning, or both. Mental illness may be related to individual, interpersonal, or social/cultural factors. Excessive dependency on or withdrawal from relationships are interpersonal factors that relate to mental illness. Individuals suffering from mental illness can feel overwhelmed with daily life. Individuals suffering from mental illness may experience dissatisfaction with relationships and self. 3. Which of the following are true regarding mental health and mental illness? A) Behavior that may be viewed as acceptable in one culture is always unacceptable in other cultures. B) It is easy to determine if a person is mentally healthy or mentally ill. C) In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. D) Persons who engage in fantasies are mentally ill. Ans: C Feedback: What one society may view as acceptable and appropriate behavior, another society may see that as maladaptive, and inappropriate. Mental health and mental illness are difficult to define precisely. In most cases, mental health is a state of emotional, psychological, and social wellness evidenced by satisfying interpersonal relationships, effective behavior and coping, positive self-concept, and emotional stability. Persons who engage in fantasies may be mentally healthy, but the inability to distinguish reality from fantasy is an individual factor that may contribute to mental illness. 4. A client grieving the recent loss of her husband asks if she is becoming mentally ill because she is so sad. The nurse's best response would be, A) "You may have a temporary mental illness because you are experiencing so much pain." B) "You are not mentally ill. This is an expected reaction to the loss you have experienced." C) "Were you generally dissatisfied with your relationship before your husband's death?" D) "Try not to worry about that right now. You never know what the future brings." Ans: B Feedback: Mental illness includes general dissatisfaction with self, ineffective relationships, ineffective coping, and lack of personal growth. Additionally the behavior must not be culturally expected. Acute grief reactions are expected and therefore not considered mental illness. False reassurance or overanalysis does not accurately address the client's concerns. 5. The nurse consults the DSM for which of the following purposes? A) To devise a plan of care for a newly admitted client B) To predict the client's prognosis of treatment outcomes C) To document the appropriate diagnostic code in the client's medical record D) To serve as a guide for client assessment Ans: D Feedback: The DSM provides standard nomenclature, presents defining characteristics, and identifies underlying causes of mental disorders. It does not provide care plans or prognostic outcomes of treatment. Diagnosis of mental illness is not within the generalist RN's scope of practice, so documenting the code in the medical record would be inappropriate. 6. Which would be a reason for a student nurse to use the DSM-5? A) Identifying the medical diagnosis B) Treat clients C) Evaluate treatments D) Understand the reason for the admission and the nature of psychiatric illnesses. Ans: D Feedback: Although student nurses do not use the DSM to diagnose clients, they will find it a helpful resource to understand the reason for the admission and to begin building knowledge about the nature of psychiatric illnesses. Identifying the medical diagnosis, treating, and evaluating treatments are not a part of the nursing process. 7. The legislation enacted in 1963 was largely responsible for which of the following shifts in care for the mentally ill? A) The widespread use of community-based services B) The advancement in pharmacotherapies C) Increased access to hospitalization D) Improved rights for clients in long-term institutional care Ans: A Feedback: The Community Mental Health Centers Construction Act of 1963 accomplished the release of individuals from long-term stays in state institutions, the decrease in admissions to hospitals, and the development of community-based services as an alternative to hospital care. 8. Which one of the following is a result of federal legislation? A) Making it easier to commit people for mental health treatment against their will. B) Making it more difficult to commit people for mental health treatment against their will. C) State mental institutions being the primary source of care for mentally ill persons. D) Improved care for mentally ill persons. Ans: B Feedback: Commitment laws changed in the early 1970s, making it more difficult to commit people for mental health treatment against their will. Deinstitutionalization accomplished the release of individuals from long-term stays in state institutions. Deinstitutionalization also had negative effects in that some mentally ill persons are subjected to the revolving door effect, which may limit care for mentally ill persons. 9. The goal of the 1963 Community Mental Health Centers Act was to A) ensure patients' rights for the mentally ill. B) deinstitutionalize state hospitals. C) provide funds to build hospitals with psychiatric units. D) treat people with mental illness in a humane fashion. Ans: B Feedback: The 1963 Community Mental Health Centers Act intimated the movement toward treating those with mental illness in a less restrictive environment. This legislation resulted in the shift of clients with mental illness from large state institutions to care based in the community. Answer choices A, C, and D were not purposes of the 1963 Community Mental Health Centers Act. 10. The creation of asylums during the 1800s was meant to A) improve treatment of mental disorders. B) provide food and shelter for the mentally ill. C) punish people with mental illness who were believed to be possessed. D) remove dangerous people with mental illness from the community. Ans: B Feedback: The asylum was meant to be a safe haven with food, shelter, and humane treatment for the mentally ill. Asylums were not used to improve treatment of mental disorders or to punish mentally ill people who were believed to be possessed. The asylum was not created to remove the dangerously mentally ill from the community. 11. The major problems with large state institutions are: Select all that apply. A) attendants were accused of abusing the residents. B) stigma associated with residence in an insane asylum. C) clients were geographically isolated from family and community. D) increasing financial costs to individual residents. Ans: A, C Feedback: Clients were often far removed from the local community, family, and friends because state institutions were usually in rural or remote settings. Choices B and D were not major problems associated with large state instructions. 12. A significant change in the treatment of people with mental illness occurred in the 1950s when A) community support services were established. B) legislation dramatically changed civil commitment procedures. C) the Patient's Bill of Rights was enacted. D) psychotropic drugs became available for use. Ans: D Feedback: The development of psychotropic drugs, or drugs used to treat mental illness, began in the 1950s. Answer choices A, B, and C did not occur in the 1950s. 13. Before the period of the enlightenment, treatment of the mentally ill included A) creating large institutions to provide custodial care. B) focusing on religious education to improve their souls. C) placing the mentally ill on display for the public's amusement. D) providing a safe refuge or haven offering protection. Ans: C Feedback: In 1775, visitors at St. Mary's of Bethlehem were charged a fee for viewing and ridiculing the mentally ill, who were seen as animals, less than human. Custodial care was not often provided as persons who were considered harmless were allowed to wander in the countryside or live in rural communities, and more dangerous lunatics were imprisoned, chained, and starved. In early Christian times, primitive beliefs and superstitions were strong. The mentally ill were viewed as evil or possessed. Priests performed exorcisms to rid evil spirits, and in the colonies, witch hunts were conducted with offenders burned at the stake. It was not until the period of enlightenment when persons who were mentally ill were offered asylum as a safe refuge or haven offering protection at institutions. 14. The first training of nurses to work with persons with mental illness was in 1882 in which state? A) California B) Illinois C) Massachusetts D) New York Ans: C Feedback: The first training for nurses to work with persons with mental illness was in 1882 at McLean Hospital in Belmont, Massachusetts. 15. What is meant by the term "revolving door effect" in mental health care? A) An overall reduction in incidence of severe mental illness B) Shorter and more frequent hospital stays for persons with severe and persistent mental illness C) Flexible treatment settings for mentally ill D) Most effective and least expensive treatment settings Ans: B Feedback: The revolving door effect refers to shorter, but more frequent, hospital stays. Clients are quickly discharged into the community where services are not adequate; without adequate community services, clients become acutely ill and require rehospitalization. The revolving door effect does not refer to flexible treatment settings for mentally ill. Even though hospitalization is more expensive than outpatient treatment, if utilized appropriately could result in stabilization and less need for emergency department visits and/or rehospitalization. The revolving door effect does not relate to the incidence of severe mental illness. 16. Which of the following statements is true of treatment of people with mental illness in the United States today? A) Substance abuse is effectively treated with brief hospitalization. B) Financial resources are reallocated from state hospitals to community programs and support. C) Only on in four (25%) of people needing mental health services are receiving those services. D) Emergency department visits by persons who are acutely disturbed are declining. Ans: C Feedback: Only one in four (25%) adults needing mental health care receives the needed services. Substance abuse issues cannot be dealt with in the 3 to 5 days typical for admissions in the current managed care environment. Money saved by states when state hospitals were closed has not been transferred to community programs and support. Although people with severe and persistent mental illness have shorter hospital stays, they are admitted to hospitals more frequently. In some cities, emergency department visits for acutely disturbed persons have increased by 400% to 500%. The case manager is providing an educational seminar for the nursing staff, she includes objectives from Healthy People 2020. Which of the following is the priority of the objectives for mental health? D) Treatment of mental illness 17. Which of the following is the priority of the Healthy People 2020 objectives for mental health? A) Improved inpatient care B) Primary prevention of emotional problems C) Stress reduction and management D) Treatment of mental illness Ans: D Feedback: The objectives are to increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives. The objectives also strive to decrease rates of suicide and homelessness, to increase employment among those with serious mental illness, and to provide more services both for juveniles and for adults who are incarcerated and have mental health problems. Answer choices A, B, and C are not priorities of Healthy People 2020. 18. Which is a positive aspect of treating clients with mental illness in a community-based care? A) "You will not be allowed to go out with your friends while in the program." B) "You will have to have supervision when you want to go anywhere else in the community." C) "You will be able to live in your own home while you still see a therapist regularly." D) "You will have someone in your home at all times to ask questions if you have any concerns." Ans: C Feedback: Clients can remain in their communities, maintain contact with family and friends, and enjoy personal freedom that is not possible in an institution. Full-time home care is not included in community-based programs. 19. One of the unforeseen effects of the movement toward community mental health services is A) fewer clients suffering from persistent mental illnesses. B) an increased number of hospital beds available for clients seeking treatment. C) an increased number of admissions to available hospital services. D) Longer hospital stays for people needing mental health services. Ans: C Feedback: Although people with severe and persistent mental illness have shorter hospital stays, they are admitted to hospitals more frequently. Although deinstitutionalization reduced the number of public hospital beds by 80%, the number of admissions to those beds correspondingly increased by 90%. The number of individuals with mental illness did not change. 20. Which is included in Healthy People 2020 objectives? A) To decrease the incidence of mental illness B) To increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives C) To provide mental health services only in the community D) To decrease the numbers of people who are being treated for mental illness Ans: B Feedback: One of the Healthy People 2020 objectives is to increase the number of people who are identified, diagnosed, treated, and helped to live healthier lives. It may not be possible to decrease the incidence of mental illness. At this time, the focus is on ensuring that persons with mental illness are receiving needed treatment. It may not be possible or desirable to provide mental health services only in the community. 21. A client diagnosed with a mild anxiety disorder has been referred to treatment in a community mental health center. Treatment most likely provided at the center includes A) medical management of symptoms. B) daily psychotherapy. C) constant staff supervision. D) psychological stabilization. Ans: A Feedback: Community mental health centers focus on rehabilitation, vocational needs, education, and socialization, as well as on management of symptoms and medication. Daily therapies, constant supervision, and stabilization require a more acute care inpatient setting. There are many areas of practice in psychiatric mental health nursing. One of those is advanced-level practice. Which of the following is considered an advanced-level function? A) Case management B) Counseling C) Evaluation D) Health teaching Ans: C Feedback: Advanced-level functions are psychotherapy, prescriptive authority, consultation and liaison, evaluation, and program development and management. Case management, counseling, and health teaching are basic-level functions in the practice area of psychiatric mental health nursing. Nursing education has become broad in practice settings. The addition of Psychiatric nursing became a requirement in nursing education in 1950 by whom? C) National League of Nursing 23. Psychiatric nursing became a requirement in nursing education in which year? A) 1930 B) 1940 C) 1950 D) 1960 Ans: C Feedback: It was not until 1950 that the National League for Nursing, which accredits nursing programs, required schools to include an experience in psychiatric nursing. 24. A new graduate nurse has accepted a staff position at an inpatient mental health facility. The graduate nurse can expect to be responsible for basic-level functions, including A) providing clinical supervision. B) using effective communication skills. C) adjusting client medications. D) directing program development. Ans: B Feedback: Basic-level functions include counseling, milieu therapy, self-care activities, psychobiologic interventions, health teaching, case management, and health promotion and maintenance. Advanced-level functions include psychotherapy, prescriptive authority for drugs, consultation and liaison, evaluation, program development and management, and clinical supervision. 25. Which one of the following is one of the American Nurses Association standards of practice for psychiatric-mental health nursing? A) Prescriptive authority is granted to psychiatric-mental health registered nurses. B) All aspects of Standard 5: Implementation may be carried out by psychiatric-mental health registered nurses. C) Some aspects of Standard 5: Implementation may only be carried out by psychiatric-mental health advanced practice nurses. D) Psychiatric-mental health advanced practice nurses are the only ones who may provide milieu therapy. Ans: C Feedback: Prescriptive authority is used by psychiatric-mental health advanced practice registered nurses in accordance with state and federal laws and regulations. Standards 5D-G are advanced practice interventions and may be performed only by the psychiatric-mental health advanced practice registered nurse. Psychiatric-mental health registered nurses may provide milieu therapy according to Standard 5C. This is not restricted to psychiatric-mental health advanced practice nurses. The nurse knows that mental health issues are constantly changing. Which of the following is a standard of professional performance to keep in current practice? A) Assessment B) Education C) Planning D) Implementation Ans: B Feedback: Education is a standard of professional performance. Other standards of professional performance include the quality of practice, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership. Assessment, planning, and implementation are components of the nursing process, not standards of professional performance. 27. Which of the following is a standard of practice? A) Quality of care B) Outcome identification C) Collegiality D) Performance appraisal Ans: B Feedback: Standards of practice include assessment, diagnosis, outcomes identification, planning, implementation, coordination of care, health teaching and health promotion, and milieu therapy. The standards of professional performance include quality of practice, education, professional practice evaluation, collegiality, collaboration, ethics, research, resource utilization, and leadership. 28. A student appears very nervous on the first day of clinical in a psychiatric setting. The student reviews the instructor's guidelines and appropriately takes which of the following actions? Select all that apply. A) Tells the client about personal events and interests B) Discusses the anxious feelings with the instructor C) Assumes that the client's unwillingness to talk to a student nurse is a personal insult or failure D) Builds rapport with the patient before asking personal questions E) Consults the instructor if a shocking situation arises F) Gravitates to clients that the student may know personally Ans: B, D, E Feedback: Listening carefully, showing genuine interest, and caring about the client are extremely important rather than speaking about oneself. The student must deal with his or her own anxiety about approaching a stranger to talk about very sensitive and personal issues. Student nurses should not see the client's unwillingness to talk to a student nurse as a personal insult or behavior. Being available and willing to listen are often all it takes to begin a significant interaction with someone. Questions involving personal matters should not be the first thing a student says to the client. These issues usually arise after some trust and rapport have been established. The nursing instructor and staff are always available to assist if the client is shocking or distressing to the student. If the student recognizes someone he or she knows, it is usually best for the student to talk with the client and reassure him or her about confidentiality. The client should be reassured that the student will not read the client's record and will not be assigned to work with the client. 29. The appropriate action for a student nurse who says the wrong thing is to A) pretend that the student nurse did not say it. B) restate it by saying, "That didn't come out right. What I meant was..." C) state that it was a joke. D) ignore the error, since no one is perfect. Ans: B Feedback: No one magic phrase can solve a client's problems; likewise, no single statement can significantly worsen them. Listening carefully, showing genuine interest, and caring about the client are extremely important. A nurse who possesses these elements but says something that sounds out of place can simply restate it by saying, "That didn't come out right. What I meant was..." Pretending that the student nurse did not say it, stating that it was a joke, and ignoring the error are not likely to help the student nurse build and maintain credibility with the client. The newly licensed RN has been hired at the local hospital in the Geri-Psych unit. Today is her first day of orientation to this facility. What would be the nurse's priority action if a client becomes aggressive? B) maintain a safe distance from the client [Show Less]
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Fundamentals of Psychiatric Nursing Questions and Answers 2023
Philippe Pinel Removed chains at Bicetre, France Introduced a more humain psychological approach towards the custody and care of psychiatric patients ... [Show More] Charles K Clark Influenced in bringing about new models of care. Superintendent of Ontario psychiatric hospitals. Made improvements; nurse training in asylum personnel. Established Toronto psychiatric hospital opening in 1925 Clifford Beers Wrote about his abusive experiences in several mental institutions. (A mind that found itself) Founded the national committee for mental hygiene) This committee started the development of child guidance clinics, prison clinics, and industrial mental health approaches. Adolf Meyer Discovered psychiatric pluralism. Integration of human biological functions with environment. Including the surgical treatment for psychosis. Dorothea Dix Responsible for mental Heath Care reform in US, Canada, Britain. Investigated conditions of jail's and plight of mentally ill people. Promoted building mental health hospitals. Advocated for mental institutions in Halifax and St.John. Hildegaurd Pepau Supported a holistic view on patient care. Peplau's work "Interpersonal Relations in Nursing" introduced PHM nursing practice to concepts and importance of a therapeutic relationship. "Mother of psychiatric nursing". Mental institutions early life Custodial (non medical) care and practice management, treatment rarely occurred. Large # of people were forced to to live together. Self contained communities. Psychopharmacology A study of using medications in treating mental disorders. Mental health Integral to general health and can be possessed in the presence of mental illness. How you view or do: Self potential. Cope with life stressors. Able to work productively and contribute to society. Goals of recovery Gaining and retaining hope. Ones abilities and disabilities. Engagement in an active life. Personal autonomy. Social identity. Pros of labelling No more fear of hiding. Less misunderstandings. Receive appropriate treatment. Cons of labelling Stigma's. Discrimination. Prejudice. Hard to get a job. Not able to work for their things. Aboriginal population issues Stereotyping. Prejudice. Colonialism. Assimilation. Displacement. Substitute decision maker An individual whose responsibility to make decisions for one who isn't able to regarding their own health care. communication process Therapeutic communication. Verbal communication. Nonverbal communication. Empathic link. ***** Difference between laws and ethics Ethics: comes from moral values, right/wrong, rules. Laws: punishable, enforced and created by government, use ethics as templates. Mental health commission of Canada Plays catalytic role. Promotes positive change though knowledge exchange. Sponsors major initiatives: opening minds, at home chez ski, psychological health and safety in workplace, mental health first aid. The Canadian federation of mental health nurses Created the first Canadian psychiatric and mental health nursing standards. The international society of psychiatric mental health nurses Work to unite and strengthen the presence and voice of the PHM nurses The college of psychiatric nurses of Manitoba Regulatory body for the psychiatric nursing profession in Manitoba. Carry out activities and govern its members in a manner that serves and protects the public. Provides safe competent care License to practice. Professional practice. Stand by Canadian standards. Effectively manages rapidly changing situations. Ethical Dilemma Threats to dignity. Behaviour control, seclusion, restraint. Psychiatric advance directives. Relational engagement. Confidentiality and privacy. Advance in genetics. Social justice. Research ethics. **** Defence Mechanisms Mechanisms that mediate the clients reaction to emotional conflicts and eternal stressors. Projection. Rationalization. Reaction formula. Repression. Denial. Displacement. Dissociation. Idealization. Undoing. *** Stigma a mark of disgrace associated with a particular circumstance, quality, or person. stigmatization the branding of behavior as highly disgraceful. Unacceptable, devalued, isolated from society. Culture Beliefs, customs, and traditions of a specific group of people. cultural competency The ability to give care and services appropriately to the cultural characteristics of the person, family or community receiving them. Cultural safety Focuses on root causes. Process and outcome whose goal is greater equity. Cultural awareness. Cultural sensitivity. Cultural competence. [Show Less]
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Psychiatric nursing unit 1 Questions and Answers 2023
Which statement about mental illness is true? a. Mental illness is a matter of individual nonconformity with societal norms b. Mental illness is present ... [Show More] when individual irrational and illogical behavior occurs. c. mental illness is defined in relation to the culture, time in history, political system, and group in which it occurs. d. mental illness is evaluated solely by considering individual control over behavior and appraisal of reality. c. mental illness is defined in relation to the culture, time in history, political system, and group in which it occurs. Axis V of the DSM multiaxial system: a. refers to medical illnesses b. reports psychosocial and enviromental problems c. indicates a need for substance abuse treatment d. describes a person's level of functiong d. describes a person's level of functioning Why is it important for a nurse to be aware of the multiple factors that can influence an individual's mental health? a. Rates of illness differ among various groups b. The DSM cannot be used without information on multiple factors. c. The nurse diagnoses and treats human responses, which are influenced by many factors. d. The nurse must contribute these data for epidemiological research. c. The nurse diagnoses and treats human responses, which are influenced by many factors. Factors that affect a person's mental health are: (select all that apply) a. support systems b. developmental events c. socioeconomic status d. cultural beliefs a. support systems b. developmental events d. cultural beliefs Which statement best describes a major difference between a DSM-IV-TR and a nursing diagnosis? a. There is no functional difference between the two. Both serve to identify a human deviance. b. The DSM diagnosis disregards culture, whereas the nursing diagnosis takes culture into account. c. The DSM is associated with present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems. d. The DSM diagnosis distinguishes a person's specific psychiatric disorder, whereas a nursing diagnosis offers a framework for identifying interventions for phenomena a patient is experiencing. d. The DSM diagnosis distinguishes a person's specific psychiatric disorder, whereas a nursing diagnosis offers a framework for identifying interventions for phenomena a patient is experiencing. Which of the following contributions to modern psychiatric nursing practice was made by Freud ? a. The theory of personality structure and levels of awareness b. The concept of a "self actualized personality" c. The thesis that culture and society exert significant influence on personality d. provision of a developmental model that includes the entire life span a. The theory of personality structure and levels of awareness The theory of interpersonal relationships developed by Hildegard Peplau is based on the foundation provided by which of the following early theorists? a. Freud b. Piaget c. Sullivan d. Maslow c. Sullivan According to Maslow's Hierarchy of needs, the most basic needs for psychiatric mental health nursing are: a. Physiological b. safety c. love and belonging d. self-actualization a. Physiological The premise that an individual's behavior and affect are largely determined by the attitudes and assumptions the person has developed about the world underlies: a. modeling b. milieu therapy c. cognitive behavioral therapy d. psychoanalytic psychotherapy a. modeling Providing a safe environment for patients with impaired cognition, referring an abused spouse to a "safe house," and conducting a community meeting are nursing interventions that address aspects of: a. milieu therapy b. cognitive therapy c. behavioral therapy d. interpersonal psychotherapy c. behavioral therapy A 24 year old female is diagnosed with alcohol dependence and requires acute detoxification. The most appropriate setting is: a. partial hospitalization b. residential setting c. rehab unit d. acute inpatient care d. acute inpatient care A significant influence allowing psychiatric treatment to move from the hospital to the community was: a. television b. the development of psychotropic medications c. identification of external causes of mental illness d. the use of a collaborative approach by patients and staff focusing on rehabilitation. b. the development of psychotropic medications Which of the following is a benefit for patients being treated for mental health problems by a primary care physician rather than a psychiatrist? a. A high level of expertise in the diagnosis of psychiatric disorders b. Extended time in the physician's office for a through psychiatric assessment c. Feeling that there is less stigma attached to treatment d. A high level of expertise in the management of psychopharmacological medications for psychiatric illnesses c. Feeling that there is less stigma attached to treatment A 45 year old patient experiencing increased symptoms of anxiety lives in a rural community over 100 miles from the nearest psychiatrist. Other health team members are located closer to his residence. Which of the following health care professionals could provide an initial screening and treatment plan for this patient? ( select all that apply) a. social worker b. psychologist c. primary care provider d. advanced practice psychiatric nurse b. psychologist A community mental health student nurse is asked by her supervisor to develop a stress reduction class for the residents in the surrounding community. The student nurse resists, saying that her responsibilities are to her patient caseload. The supervisor explains to the student why this assignment is appropriate for her role. Which is the most suitable rationale that the supervisor can provide to the student nurse? a. stress reduction is important to patient's mental health. b. funding sources will support the class only if it is developed by a nurse. c. an important concept for community health nursing is to view the entire community as a patient. d. research has demonstrated that stress reduction reduces hypertension in mental health patients. c. an important concept for community health nursing is to view the entire community as a patient. Follow up care after administering blood transfusion inspect IV site and infusion rate + vitals assess changes in VS + chills, dyspnea, flushing, itching, rash assess lab values how long can a bag of blood hang before the risk of bacterial growth occurs 4 hours S/S of an adverse reaction to a blood transfusion Fever with or without chills Tachycardia and/or tachypnea and dyspnea Drop in blood pressure Hives or skin rash, including assessment of the trunk and back Flushing Gastrointestinal symptoms Wheezing, chest pain, and possible cardiac arrest Patient complaints of headache or muscle pain in the presence of fever when is it appropriate to delegate monitoring of a patient who is receiving a blood transfusion? Nurse aide may monitor a patient after the blood transfusion is started and the patient's stability has been confirmed Therapeutic relationship criteria: 7 examples 1. Always goal directed and purposeful 2. Nurse must evaluate own behavior to help patient identify his needs and goals 3. Nurse needs to expect to hear and listen to patient problems 4. Nurse is responsible for staying with patient trough problems that may provoke anxiety. 5. Nurse is responsible for structuring relationship and prepare patient and self for termination 6. Communication is purposeful 7. Nurse has skills that are shared with patient consciously and purposefully Five Elements required to prove negligence 1. Duty 2. Breach of duty 3. Cause in fact 4. Proximate cause 5. Damages Altruism Receiving gratification by meeting others needs Sublimation Unconscious process of substituting socially acceptable activities for strong impulses that are not acceptable. Ex: A hostile man becoming a butcher Humor Dealing with emotional conflicts and stressors by emphasizing the amusement or irony [Show Less]
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Mental Health Exam 2 NCLEX questions and answers 2023
a client with delirium becomes agitated and confused at night. The best initial intervention by the nurse is to: 1.move the client next to the nurse's s... [Show More] tation 2.use a night light and turn off the television 3.keep up the television and a soft light on during the night. 4.play soft music during the night and maintain a well-lit room 2.use a night light and turn off the television a nurse is collecting data on a client who is actively hallucinating. WHich nursing statement would be therapeutic at this time? 1."I know you feel they are out to get you, but its not true" 2."I can hear the voice and she wants you to come to dinner" 3."sometimes people hear things or voices others can't hear" 4."I talked to the voices you're hearing and they won't hurt you now" 3."sometimes people hear things or voices others can't hear" a nurse is caring for a client with a diagnosis of depression. the nurse monitors for signs of constipation and urinary retention, knowing that these problems are likely caused by: 1.poor dietary choices 2.lack of exercise and poor diet 3.inadequate dietary intake and dehydration 4.psychomotor retardation and side effects of medication 4.psychomotor retardation and side effects of medication a client is admitted to the in-patient unit and is being considered for electroconvulsive therapy (ECT). The client appears calm, but the family is hypervigilant and anxious. the client's mother begins to cry and states, "my child's brain will be destroyed. How can the doctor do this?" the nurse makes which therapeutic response? 1."it sounds as though you need to speak to the psychiatrist." 2."perhaps you'd like to see the ECT room and speak to the staff" 3.your child has decided to have this treatment. you should be supportive of the decision" 4.it sounds as though you have some concerns about the ECT procedure. Why don't we sit down together and discuss any concerns you may have?" 4.it sounds as though you have some concerns about the ECT procedure. Why don't we sit down together and discuss any concerns you may have?" a client who is diagnosed with pedophilia and has been recently paroled as a sex offender says "Im in treatment and I have served my time. Now this group has posters of me all over the neighborhood telling about me with my picture on it" which of the following is an appropriate response by the nurse? 1. "when children are hurt as you hurt them, people want you isolated" 2. "you're lucky it doesn't escalate into something pretty scary after your crime" 3."you understand that people fear for their children, but you're feeling unfairly treated?" 4."you seem angry, but you have committed serious crimes against several children, so your neighbors are frightened?" 3."you understand that people fear for their children, but you're feeling unfairly treated?" a nurse is preparing for the hospital discharge of a client with a history of command hallucinations to harm self or others. The nurse instructs the client about about interventions for hallucinations and anxiety and determines that the client understands the interventions when the client states: 1. "my medications won't make me anxious" 2. "i'll go to a support group and talk so that I won't hurt anyone." 3."I won't get anxious or hear things if I get enough sleep and eat well" 4."I can call my therapist when Im hallucinating so that I can talk about my feelings and plans and not hurt anyone" 4."I can call my therapist when Im hallucinating so that I can talk about my feelings and plans and not hurt anyone" a nurse observes that a client is psychotic, pacing, and agitated and is making aggressive gestures. The client's speech pattern is rapid and the client's affect is belligerent. Based on these observations, the nurse's immediate priority of care is to: 1.Provide safety for the client and other clients on the unit 2.Provide the clients on the unit with a sense of comfort and safety 3. Assist the staff in caring for the client in a controlled environment 4.offer the client a less-stimulating area to calm down and gain control 1.Provide safety for the client and other clients on the unit a nurse is caring for a client diagnosed with catatonic stupor. the client is lying on the bed, with the body pulled into a fetal position. the appropriate nursing intervention is which of the following? 1.ask direct questions to encourage talking. 2.leave the client alone and intermittently check on him. 3.sit beside the client in silence and verbalize occasional open-ended questions. 4.take the client into the dayroom with other clients so they can help watch him 3.sit beside the client in silence and verbalize occasional open-ended questions. a mother of a teenage client with an anxiety disorder is concerned about her daughter's progress on discharge. She states that her daughter "stashes food, eats all the wrong things that make her hyperactive" and "hangs out with the wrong crowd". In helping the mother prepare for her daughter's discharge, the nurse suggests that the mother: 1.restrict the daughters socializing time with her friends. 2.restrict the amount of chocolate and caffeine products in the home 3.keep her daughter out of school until she can adjust to the school environment 4.consider taking time from work to help her daughter readjust to the home environment. 2.restrict the amount of chocolate and caffeine products in the home a client is unwilling to go out of the house for fear of "doing something crazy in public". Because of this fear, the client remains homebound except when accompanied outside by the spouse. The nurse determines that the client has: 1.agoraphobia 2.hematophobia 3.claustrophobia 4.hypochondriasis 1.agoraphobia a client has reported that crying spells have been a major problem over the past several weeks, and that the doctor said that depression is probably the reason. The nurse observes that the client is sitting slumped in the chair and the clothes that the client is wearing do not fit well. The nurse interprets that further data collection should focus on: 1.weight loss 2.sleep patterns 3.medication compliance 4.onset of the crying spells 1.weight loss a client was admitted to a medical unit with acute blindness. many tests are performed and there seems to be no organic reason why this client cannot see. the nurse latter learns that the client became blind after witnessing a hit-and-run car crash, in which a family of three was killed. the nurse suspects that the client may be experiencing a: 1.psychosis 2.repression 3.conversion disorder 4.dissociative disorder 3.conversion disorder a manic client announces to everyone in the day room that a stripper is coming to perform that evening. when the psychiatric nurse's aide firmly states that the client's behavior is not appropriate, the manic client becomes verbally abusive and threatens physical violence to the nurse's aide. Based on the analysis of this situation, the nurse determines that the appropriate action would be to: 1.escort the manic client to his or her room 2.orient the client to time, person, and place 3.tell the client that the behavior is not appropriate 4.tell the client that smoking privileges are revoked for 24 hours 1.escort the manic client to his or her room a nurse notes documentation in a client's record that the client is experiencing delusions of persecution. THe nurse understands that these types of delusions are characteristics of which of the following? 1.the false belief that one is a very powerful person. 2.the false belief that one is very important person 3.the false belief that one is being singled out for harm by others 4.the false belief that one's partner is going out with other people 3.the false belief that one is being singled out for harm by others Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? Select all that apply. 1.Communicate expected behaviors to the client 2.ensure that the client knows that he or she is not in charge of the nursing unit 3.assist the client in developing means of setting limits on personal behavior 4.follow through about the consequences of behavior in a nonpunitive manner 5.enforce rules and inform the client that he or she will not be allowed to attend therapy groups. 6.be clear with the client regarding the consequences of exceeding limits set regarding behavior 1.Communicate expected behaviors to the client 3.assist the client in developing means of setting limits on personal behavior 4.follow through about the consequences of behavior in a non-punitive manner 6.be clear with the client regarding the consequences of exceeding limits set regarding behavior a nurse is caring for an older adult client who has recently lost her husband. The client says, "no one cares about me anymore. All the people I loved are dead." Which response by the nurse is therapeutic? 1."right! why not just pack it in?" 2."that seems rather unlikely to me" 3."i don't believe that, and neither do you" 4."you must be feeling all alone at this point" 4."you must be feeling all alone at this point" a nurse is planning care for a client who is being hospitalized because the client has been displaying violent behavior and is at risk for potential harm to others. THe nurse avoids which intervention in the plan of care? 1.facing the client when providing care 2.ensuring that a security officer is within the immediate area 3.keeping the door to the client's room open when with the client 4.assigning the client to a room at the end of the hall to prevent disturbing the other clients. 4.assigning the client to a room at the end of the hall to prevent disturbing the other clients. which behaviors observed by the nurse might lead to the suspicion that a depressed adolescent client could be suicidal? 1.the client gives away a prized CD and a cherished autographed picture of the performer 2.the client runs out of the therapy group swearing at the group leader and then runs to her room 3.the client gets angry with her roommate when the roommate borrows her clothes without asking 4.the client becomes angry while speaking on the telephone and slams the receiver down on the hook. 1.the client gives away a prized CD and a cherished autographed picture of the performer a client is admitted to the psychiatric unit after a serious suicidal attempt by hanging. the nurse's most important aspect of care is to maintain client safety and plans to: 1.request that a peer remain with the client at all times 2.remove the client's clothing and place the client in a hospital gown. 3.assign a staff member to the client who will remain with him or her at all times 4.admit the client to a seclusion room where all potentially dangerous articles are removed will remain with him or her at all times the police arrive at the emergency room with a client who has seriously lacerated both wrists. the initial nursing action is to: 1.administer an anti anxiety agent 2.examine and treat the wound sites 3.secure and record a detailed history 4.encourage and assist the client to vent feelings 2.examine and treat the wound sites [Show Less]
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PSYCH - Exam 1: NCLEX Questions with complete Answers 2023
The nurse is assigned to the care of a patient admitted to the mental health unit. Which behaviors by the nurse reflect the essential principles of therape... [Show More] utic relationship? Select all that apply. a. Empowering the patient to make decisions regarding care b. Looking beyond the illness when interacting with the patient c. Trying to see things from the unique perspective of the patient d. Sharing personal insights that are relevant to the patient's problems e. Ensuring that all physical and emotional needs are met by the nurse A, B, C a. Empowering the patient to make decisions regarding care b. Looking beyond the illness when interacting with the patient c. Trying to see things from the unique perspective of the patient In the context of the therapeutic relationship, nurses strive to empathize with the patient and fully value the perspective of the patient, whether or not it differs from that of the nurse. Nurses also view patients holistically, realizing that they are more than just the sum of the symptoms they present with. Interactions are based on the growth of the patient and interventions should promote as much autonomy and independence as the patient is capable of. Sharing personal interests violates the boundaries of the therapeutic relationship and shifts the focus of the relationship back to the nurse. Acting to meet every patient need is generally inappropriate; nurses should act to promote growth and independence by encouraging patients and families to meet their own needs whenever possible. The nurse is working with a patient who is struggling to over- come a serious mental illness. The patient begins crying after learning that her family will no longer be visiting. Which response by the nurse demonstrates empathy? A. "I am not sure what I would do if I were in your shoes." B. "You must be wondering why they are acting this way." C. "My sense is that this experience has been very painful for you." D. "I understand because I went through something similar one time." C. "My sense is that this experience has been very painful for you." Rationale: The nurse using empathy separates the nurse's own feelings, experiences, and reactions and fully engages with the patient an attempt to get a sense of how the patient is feeling at that moment in time. In this instance, the nurse must be present to what the patient is conveying and act to validate the observation of distress, without conditions or judgment. Options a and d shift focus back to the nurse and fail to recognize the patient's experience as unique. Option b does not validate the patient's verbal or nonverbal messages, but instead makes an assumption that is likely to be based on the own nurse's perspectives. The nurse is acting as a preceptor to a recent nurse graduate who wants to obtain a job on the mental health unit. The new nurse has been struggling to differentiate between social and therapeutic interactions because so many of the patients are around his own age. Which evaluation finding indicates that nurse is acting in accordance with appropriate professional boundaries? Select all that apply. A. The nurse sets limits on inappropriate behaviors. B. The nurse uses colloquial language to foster trust. C. The nurse brings in clothing for a homeless patient. D. The nurse offers a video collection for a group movie night. E. The nurse lets a patient know when their time together will end. A, D, E A. The nurse sets limits on inappropriate behaviors. D. The nurse offers a video collection for a group movie night. E. The nurse lets a patient know when their time together will end. New nurses frequently fall back on relationship skills that have been learned in the context of families and or friendships. When nurses set limits on behaviors they are acting in the role of a counselor, educator and caretaker. Nurses act to meet the needs of all patients, and bringing in movies is an example of sharing a resource that all patients can use. When the nurse maintains the time frames associated with professional and not personal relationships the nurse is upholding boundaries appropriate to nursing role and acting in a manner that is consistent with professional and ethical standards. The use of colloquial language conveys a sense of familiarity that is not consistent with a professional relationship. Bringing in clothing for an individual patient may be construed as "special treatment," and demonstrates an inability to differentiate between professional and personal relationships. The nurse is working with a patient who presents in the outpa- tient setting for the treatment of situational depression. The patient has begun to try out new coping strategies and has taken advantage of a support group the nurse recommended. The nurse recognizes that the patient has entered which phase of therapeutic nurse-patient relationship? A. Orientation B. Working C. Exploitation D. Resolution C. Exploitation During the exploitation phase, the patient begins to make use of the resources and tools that have been offered. The orientation phase consists gaining an understanding of the goals and needs for care. The working phase consists of initial engagement in treatment. The resolution phase consists of reviewing progress and terminating the relationship. The nurse is working with the patient admitted to the mental health unit. The nurse learns that the patient has a history of exposure to trauma that that the nurse can relate to on a per- sonal level. Which rationale best supports nondisclosure on the part of the nurse? A. The patient may use the disclosure against the nurse. B. The nurse may be assuming that the experiences are similar. C. There is a risk of distortion or shifting of caregiver boundaries. D. The patient will not have the same resources to cope as the nurse. C. There is a risk of distortion or shifting of caregiver boundaries. The essential underlying rationale for maintaining professional boundaries is to keep the focus on meeting patient needs. Disclosure may distort this role as the patient may feel compelled to support or care for the nurse or question the nurse's ability to remain focused on the patient's unique needs or experiences. The nurse may have difficulty retaining a focus on the patient's needs while relating aspects of their own experience. In some instances patients may use personal information against the nurse, but the primary reason for non-disclosure relates to the patient's needs, not the nurses. The nurse may be making assumptions about the patient's needs, but this option fails to address the outcome of this assumption or the primary threat to the therapeutic relationship. It may or may not be true that the patient resources differ from that of the nurse; however, this is not as important as the threat to the overall effectiveness of the therapeutic relationship. The nurse is working in an outpatient mental health clinic. The clinic is implementing an initiative to use telecommunication to deliver care to patients living in remote areas. The nurse understands that this change will be most likely to affect which aspects of communication? A. Nonverbal communication only B. Nonverbal and meta-communication C. Verbal and nonverbal communication D. Meta-, nonverbal, and verbal communication B. Nonverbal and meta-communication Verbal communication consists of the words used. Nonverbal communication includes gestures, appearance, tone and volume as well as a variety of other factors. Meta communication refers to those involved in the interaction, how the message is sent, and the context of the message. Telecommunication will impact the ability to convey and receive nonverbal content. Even if visual images are used, the visual field or the quality of the images may be limited, and other sensory information may not be available. Because the context and mode of communication will change with telecommunication, meta-communication will also be impacted. The words or the language used to deliver care will not necessarily be impacted by the use of telecommunication. The nurse is working with a patient in the context of the therapeutic relationship. Which evaluation finding supports the effectiveness of active listening techniques? A. The patient remains focused on the purpose of the interaction. B. The patient takes advantage of opportunities to verbalize concerns. C. The patient affirms the nurse's interpretation of what was communicated. D. The patient provides sufficient information for the nurse to make care decisions. C. The patient affirms the nurse's interpretation of what was communicated. The purpose of active listening is to partner with the patient to determine patient needs. The nurse conveys interest in what the patient is communicating and then actively seeks to interpret and validate interpretations. An essential element is the patient's affirmation of the nurse's interpretation. Patient focus, willingness to take advantage of opportunities to talk, and the amount and quality of the information do not necessarily relate to the effectiveness of the nurses active listening skills. The nurse is caring for a patient who has been in an abusive relationship. The patient relates being concerned that leaving the relationship will result in judgment by family and friends. How should the nurse respond? A. Acknowledge that the decision may not be accepted by others. B. Ask the patient why she cares so much about what others think. C. Remind the patient that everyone has difficult decisions to make. D. Advise the patient to share details of the abuse with family and friends. A. Acknowledge that the decision may not be accepted by others. Acknowledging is a therapeutic response in which the nurse expresses recognition of or validates the existence of the patient's reality. The nurse can then assist the patient to identify strategies that may minimize negative consequences or assist the patient to cope with them. Asking the patient why she cares about what others think direct questioning is a form of challenging that can present a barrier to therapeutic communication. Telling the patient that everyone has difficult decisions to make is a "pat" response that fails to consider the full experience or individuality of the patient. Advice about sharing details of the abuse with family and friends is based on the nurse's opinion and does not necessarily address the patient's concern. The nurse manager is employing tools to assist staff to maintain a sense of objectivity and balance in the context of the therapeutic inpatient psychiatric milieu. Which intervention is most likely to be effective for new nurses? A. Formal education B. Journaling exercises C. Individual supervision D. Peer-led support groups C. Individual supervision Clinical supervision is one of the most important tools for reflective practice in the psychiatric setting. An experienced psychiatric nurse provides valuable insight and feedback in the context of working sessions. Formal education is important, but may not consider the unique experiences and feedback evoked in the context of therapeutic relationships. Journaling may be useful for reflective practice but offers less opportunity for input/feedback from a more experienced clinician. Peer support may provide an emotional outlet, but again lacks the element of guidance from a more experienced nurse. The nurse educator is orienting a group of new nurses to the mental health unit. Which statement by the educator best represents the essential purpose of the nursing process in providing nursing care to patients experiencing mental illness? A. "The nursing process is what differentiates mental health nursing care from that of other professions." B. "The nursing process is a framework for planning and delivering holistic patient- and family-centered care." C. "The nursing process provides a structure for applying knowledge of mental illnesses and their management." D. "The nursing process provides a model for carrying out linear tasks that are intended to lead to a fixed patient outcome." B. "The nursing process is a framework for planning and delivering holistic patient- and family-centered care." The essential purpose of the nursing process is to provide comprehensive nursing care that considers all aspects of the person's life. While the nursing process may distinguish nursing care from that of other professions, its primary purpose is focused on meeting patient and family needs. The focus of the nursing process is not just on the application of knowledge but also on integrating the unique experiences and perspectives of the patient to deliver humanistic, patient-centered care. Although patient outcomes are a component of the nursing process, the model is cyclical and goals and outcomes are constantly reconsidered and redefined. The nurse is carrying out an assessment of a patient presenting with a sudden onset of psychiatric symptoms. Which describes the best approach for the nurse to determine the priority con- cern for the patient? A. The nurse asks the patient directly why he or she is seeking treatment at this time. B. The nurse analyzes the patient's pre-setting background for evidence of a precipitating event. C. The nurse defers to the diagnosis made after all members of the team have interviewed the patient. D. The nurse refers to the primary symptoms identified in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). A. The nurse asks the patient directly why he or she is seeking treatment at this time. The nurse carries out assessment as an independent function and recognizes the patient's statements or communication about why the patient is seeking treatment as most important. The patient's perspective of the situation, not the nurse's, is most essential. The identification of priority nursing problems does not require input from the entire team. The DSM-5 classifies diagnostic information that is specific to particular illnesses. While this tool may be used to inform aspects of nursing care, it is not used to determine the patient's priority concern. The nurse is performing an assessment of a patient being admitted to the inpatient psychiatric unit. Which aspect of the pre-setting background would best assist the nurse to deter- mine the patient's current interest and motivation in treatment? A. The patient's socioeconomic status and living situation B. The patient's and family's understanding of mental illness C. The patient's previous history of treatment for mental illness D. The patient's circumstances that led to the decision to seek treatment D. The patient's circumstances that led to the decision to seek treatment The circumstances or context leading to the decision to seek treatment would be the best indicators of the patient's current interest and motivation in treatment. The nurse would consider whether the patient was brought to the hospital voluntarily and who made the decision to seek help. All of the other factors may contribute to compliance and motivation to seek help, but are less relevant to the patient's current interest in treatment. The nurse is performing a mental status exam. Which technique would be best to determine the patient's affect? A. Having the patient complete a feelings rating scale B. Observing the patient's current behavioral presentation C. Asking the patient to describe his or her current emotional state D. Having the patient respond to a series of cognitive exercises B. Observing the patient's current behavioral presentation Affect is an observed interpretation of a patient's emotional status that takes into account objective factors such as the patient's facial expressions and posture. Options a and c are used to determine the patient mood or subjective interpretation of their own emotional state. Exercises are generally used to determine cognitive function, such as memory, concentration and orientation. The nurse has completed an assessment of a patient present- ing with acute mental health concerns. The nurse concludes that patient has an alteration in mood characterized by mania. Which component of the diagnostic statement will this finding comprise? A. The focal pattern B. The assessment of cause C. The supporting evidence D. The associated symptoms A. The focal pattern The nurse is identifying a problem or focal pattern that based on an assessment of the patient's presentation. The cause has not been identified, such as "related to steroid use," and evidence to support the pattern (e.g. "as evidenced by pressured speech") has not been provided. Associated symptoms such as insomnia have not been identified. The nurse is caring for a patient presenting with symptoms of anxiety that are interfering with the patient's ability to function at work. The patient states that the anxiety began soon after a traumatic event and is severely impacting the patient's functioning. Which issue will be the focal point for making a nursing diagnosis? A. Patient's anxiety due to exposure to a traumatic event B. Patient's difficulty coping C.Patient's inability to function at work due to underlying anxiety and stress D. Making a diagnosis of post-traumatic stress disorder A. Patient's anxiety due to exposure to a traumatic event The nursing problem focuses on the focal pattern of anxiety, which appears to be related to exposure to a traumatic event. A nursing diagnosis of Anxiety due to exposure to a traumatic event would be appropriate. The patient's difficulty coping and functioning at work may be related to either trauma or experience of anxiety, but the patient's anxiety is the focus, as relief of anxiety may improve coping and functioning. Although the patient may require further evaluation for posttraumatic stress disorder, the focus for the nurse at this time is the patient's anxiety level. The nurse is carrying out the components of the planning phase for a patient experiencing a mood disorder. Which step will the nurse take first? A. Determine which problem will be addressed as the priority B. Determine which interventions will support the patient's goals C. Differentiate between collaborative and nursing interventions D. Identify what the nurse wants to achieve as a result of interventions A. Determine which problem will be addressed as the priority Once nursing diagnoses are identified, the nurse identifies problems and their priority in care. The prioritization aids in identifying interventions that will be carried out immediately. The next step would be to determine what the patient, not the nurse, wants to achieve and then selecting appropriate nursing interventions to support that goal. The nurse is evaluating the outcomes of interventions for a patient who is in the recovery phase of depression. Which find- ing best indicates that treatment goals have been met? A. The patient agrees to report suicidal thoughts. B. The patient has resumed occupational functioning. C. The patient manages increased interaction with peers. D. The patient identifies goals to improve further function. B. The patient has resumed occupational functioning. At the stage of recovery, evaluation focuses on progress toward interpersonal, vocational, and spiritual goals. Resumption of occupational function is an evaluation finding appropriate to this phase of illness. The ability to report suicidal thoughts is an evaluation finding that supports the achievement of a short-term goal in the crisis stage of the illness. Management of increased group interactions and the identification of longer-term goals are evaluation findings that are more appropriate in the acute illness phase. The nurse is developing a plan of care for a patient experiencing an acute mental health crisis. Which action would be most likely to be carried out during the intervention phase of the illness? A. Ensuring the safety of the physical environment B. Performing vital signs and a mental status exam C. Determining what factors precipitated the crisis D. Identifying which problem the patient wants to focus on A. Ensuring the safety of the physical environment Ensuring the safety of the physical environment is an action consistent with the intervention phase of the nursing process. Vital signs and mental status exams are assessment activities. Determining which factors precipitated the crisis is an assessment activity. Prioritizing problems is part of the planning phase of the nursing process. The nurse is assessing a patient with an anxiety disorder. Which key finding best supports a neurobiological basis for the illness? A. The patient has a family history of anxiety. B. The patient has a co-morbid medical illness. C. The patient has multiple stressors. D. The patient has had positive responses to anti-anxiety medication. A. The patient has a family history of anxiety. Research on anxiety disorders has demonstrated a strong genetic neurobiological basis for the illness. A family history establishes a genetic predisposition to the illness. Studies have shown that the genetics have a strong influence on the individual's ability to cope environmental and physiological stressors. The presence of a physiological illness does not necessarily support a neurobiological predisposition to anxiety. The ability to cope with stressors is mediated by genetic factors, and the number of stressors does not relate to a neurobiological basis for the illness. Anti-anxiety medications treat the symptoms of the anxiety; they would not support a genetic predisposition to the illness. The nurse is documenting assessment findings for a patient presenting with symptoms of anxiety. Under which category would the nurse include the observation that the patient is constantly scanning the environment to detect threats? A. Spiritual domain B. Cultural domain C. Biological domain D. Psychological domain C. Biological domain The patient who constantly scans the environment for threats is exhibiting hypervigilance, a finding that relates to hyperarousal and biological aspects of illness. The finding would be documented under the category of the biological domain. The nurse is working with a patient who is overcome by feelings of anxiety, each time experiencing thoughts of losing control. The patient states that reorganizing the environment temporarily relieves the anxiety. The nurse correctly interprets this as the use of which defense mechanism? A. Denial B. Undoing C. Projection D. Conversion B. Undoing Undoing is a defense mechanism in which the individual takes action to counteract the unacceptable or threatening thought. In this case, the patient reorders the environment to "undo" the anxiety associated with thoughts of losing control. Denial refers to the refusal to believe or accept the reality of a situation or experience. Projection refers to unconsciously attributing one's thoughts or impulses onto another person. Conversion refers to the transfer of a mental conflict into a physical symptom. The nurse is using Peplau's four levels of anxiety as a model for assessing a patient who has been experiencing panic attacks. At which stage would the nurse anticipate detecting the onset of tachycardia and tachypnea? A. Mild +1 B. Moderate +2 C. Severe +3 D. Panic +4 B. Moderate +2 According to Peplau, stage 2 of anxiety is characterized by the onset of physiological symptoms including increased respirations and heart rate. During stage one the patient experiences psychological changes. Stages 3 and 4 are characterized by progressive and more distressing physiological and psychological symptoms. The nurse is caring for a patient presenting with symptoms of anxiety. The patient states that he has started to avoid any situations that induce panic, such as going to the mall or the theater without a family member. The nurse recognizes that the patient's symptoms are most consistent with which type of anxiety disorder? A. Agoraphobia B. Social anxiety C. Panic disorder D. Separation anxiety A. Agoraphobia Agoraphobia is characterized by a marked fear of situations where escape would be difficult or not immediately accessible. Individuals with this disorder may avoid situations such as going to the mall or theater and or may depend on the assistance of another person to help them manage the situation. Social anxiety is a disorder characterized by fear or anxiety in situations where there is a potential for embarrassment or scrutiny related to interaction or performance, which is not generally associated with these activities. Panic disorder is characterized by recurrent, unpredictable panic attacks. The stimulus generally is not recognized. Separation anxiety is characterized by a developmentally inappropriate fear of separation from or abandonment by other persons. In this case, the client relies on another person to help him manage anxiety related to certain environmental variables, not general fears of separation or abandonment. The nurse is evaluating a patient who has been taking fluvox- amine (Luvox) for the management of obsessive-compulsive disorder (OCD) for 1 week. Which statements by the patient would be cause for concern? Select all that apply. A. "My thoughts and compulsions are still bothersome sometimes." B. "I have needed to drink more because my mouth is frequently dry." C. "I take this medication when I experience the compulsion to clean." D. "My spouse is concerned that I will become addicted to this medication." E. "I have been using Ativan as needed when I have trouble getting to sleep." C, D C. "I take this medication when I experience the compulsion to clean." D. "My spouse is concerned that I will become addicted to this medication." Fluvoxamine is a selective-serotonin inhibiter (SSRI) that is used in the management of select anxiety disorders. Patients need to take the medication every day, generally for several weeks before experiencing the desired effects of the medication. Fluvoxamine does not cause dependency. The nurse would be concerned that the patient is taking the medication only when experiencing symptoms of anxiety. The nurse would correct misinformation suggesting that the patient is at risk for dependence. Benzodiazepines may still be used as prescribed to manage the acute symptoms of anxiety and insomnia, especially in the period before the SRRI becomes effective. Common side effects of SSRIs include dry mouth, which can be alleviated by interventions such as drinking more fluids. The nurse is planning care for a patient experiencing an anxiety disorder. Which variable is essential for the nurse to consider first? A. The research supporting various treatment modalities B. The patient's personal perspective on the anxiety disorder C. The behavioral manifestations related to mental health domains D. The nurse's previous experience with patients with similar disorders B. The patient's personal perspective on the anxiety disorder It is essential that the nurse consider the patient's individual perspective and preferences when formulating a plan of care. All patients have unique experiences and needs, and the goals for treatment should be determined with patient input whenever possible. Further assessment would consider other objective data related to mental health domains. Research and experience can then be used to formulate a care plan that best addresses individual patient needs. [Show Less]
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