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Which of the following would be the least useful strategy for an American nurse as he or she enters into a cross-cultural encounter with a female client from Japan?
1. Anticipate diversity.
2. Promote a feeling of acceptance.
3. Learn what it means to be the client by assessing health beliefs.
4. Facilitate communication by using direct eye contact and a handshake.
A mental health nurse with 3 years inpatient experience has been assigned to work in a medication follow-up clinic beginning Monday. The clinic sees culturally diverse clients. To prepare for work in the clinic it would be advisable for the nurse to
1. review the literature on cultural differences in client responses to psychotropic medications
2. read a handbook on the various health beliefs of members of diverse cultures
3. contact the clinical nurse specialist for guidelines for cultural competence
4. take a course in psychotropic pharmacology
A mental health nurse with 3 years inpatient experience is about to begin work in a medication follow-up clinic that serves a culturally diverse client population. Which way of sitting during an interview is most neutral and acceptable to people of most cultures?
1. sitting with legs crossed, leaning slightly backward in chair with one arm extended on the desk
2. sitting with feet on the floor and upper body leaning slightly forward toward client
3. sitting with one leg crossed and the upper body turned slightly away from client
4. sitting straight in chair with feet on the floor and arms crossed over chest
Which question would help the nurse assess power and control issues governing the availability of healing options for a woman of a culture with an interdependent worldview?
1. “What does someone of your culture call this illness?”
2. “How does someone with this illness usually behave?”
3. “How does being a woman affect someone with this illness?”
4. “How do people of your culture express dislike or displeasure?”
During the assessment interview the nurse has ascertained that the client follows cultural tradition and uses spiritual healing. Which question would help the nurse understand healing options available as part of this health system?
1. “What do people believe cause this illness?”
2. “Do people shun or avoid someone who has this illness?”
3. “Are there any ceremonies or prayers used to treat this illness?”
4. “What language do your people generally use when speaking among yourselves?”
1. A new nurse tells his mentor, “I want to convey to my clients that I am interested in them and that I want to listen to what they have to say.” Supervision reveals that the nurse does each of the following things. Which behavior is least helpful in meeting his goal?
1. He introduces himself to the client and identifies his staff role.
2. He sits with his body and head parallel to the client’s.
3. He uses facial expressions that convey interest and encouragement.
4. He assumes an open body posture and sometimes uses mirror imaging.
The nurse is talking with a young male client and has 5 minutes to go in the session with him. He has been silent and sullen most of the session, and has been staring at the floor for the last 10 minutes. A troubled young woman comes to the door of the room and says to the nurse, “I really need to talk to you.” The nurse should
1. end the session and spend time with the young woman
2. tell the woman she is busy at the present time
3. invite the woman to sit down and join in the session with her client
4. tell the woman that the session with this client will take 5 more minutes, after which she can have time to talk
Documentation in a client’s chart includes the following information: “Throughout a 5-minute interaction the client fidgeted and tapped his left foot, periodically covered his face with his hands, looked under his chair, while stating he was enjoying spending time with this nurse.” Of the following assessments, which is most accurate?
1. The client is giving positive feedback about the nurse’s communication techniques.
2. The nurse is viewing the client’s behavior through a cultural filter.
3. The client’s verbal and nonverbal messages are incongruent.
4. The client is demonstrating psychotic behaviors.
The nurse finds himself feeling angry with a client. The nurse should
1. tell the nurse manager to assign the client to another nurse
2. suppress the angry feelings
3. express the anger openly
4. discuss the anger with a clinician during a supervision session
During a nurse-client interview the client attempts to shift the session focus from himself to the nurse by asking personal questions. The nurse should respond by saying
1. “You have no right to ask questions about my personal life.”
2. “Nurses prefer to direct the interview.”
3. “You’ve turned the tables on me.”
4. “This time we spend together is for you to discuss your concerns.”
The nurse is working with a client who is having difficulty in staying focused. Which communication will help the client stay focused?
1. “Go on.”
2. “What would you like to discuss?”
3. “Are you hearing voices?”
4. “It seems as though you have having trouble staying focused.”
After several days of therapeutic encounters with P, a client who recently attempted suicide, what behavior would cause Nurse G to consider the possibility of countertransference?
1. P’s reactions toward him seem realistic and appropriate.
2. P states he is concerned about her, just like her father.
3. He feels exceptionally happy when P’s mood begins to lift.
4. He develops a trusting relationship with P.
As Nurse V considers her relationship with K, a client, at what point in the nurse-client relationship should she plan to first address the issue of termination?
1. in the working phase
2. in the termination phase
3. in the orientation phase
4. when the client initially brings up the topic
The nurse caring for a withdrawn suspicious client finds himself feeling angry with the client. The nurse should
1. suppress the angry feelings
2. express the anger openly
3. tell the nurse manager to assign the client to another nurse
4. discuss the anger with a clinician during a supervisory session
A client states, “I think people should be allowed to commit suicide with no one interfering.” A nurse replies, “You’re wrong! Nothing is ever so bad that dying is justified.” What assessment about this interchange is accurate?
1. The client is correct in his thinking.
2. The nurse is correct.
3. Neither person is totally correct.
4 .Differing values are reflected in the two statements
A nurse remarks to a peer, “All the literature tells nurses that relationships are facilitated by consistency. I wish someone would give me some concrete examples.” The least helpful response would be
1. “Have the same nurse care for a client on a daily basis.”
2. “Provide a schedule of client activities daily.”
3. “ Set a time for regular sessions with the client.”
4. “ Encourage the client to share initial impressions of staff.”
A client asks the nurse, “What are neurotransmitters? My doctor says they’re at the root of my problem.” The best reply would be
1. “You must feel relieved to know that your problem has a physical basis.”
2. “It’s a pretty high-level concept to explain. Perhaps you should ask the doctor to tell you more.”
3. “Neurotransmitters are substances we eat daily that influence the brain functions of memory and mood.”
4. “Neurotransmitters are chemicals manufactured in the brain that are responsible for passing messages between brain cells.”
The mother of an adolescent client with OCD tells the nurse, “My daughter’s doctor wants her to be in a research study and to have a PET scan. I don’t want her to have to go through any tests that are painful. What should I do?” The best reply for the nurse would be
1. “The doctor has made the diagnosis, but having a PET scan would confirm it.”
2. “You might want to ask who will pay for the PET scan, as they’re very expensive.”
3. “PET scans involve an injection and lying still while a machine visualizes brain activity.”
4. “PET scans involve passing an electrical current through the brain and can be uncomfortable.”
A client taking medication for his mental illness develops a profound sense of restlessness and an uncontrollable need to be in motion. The nurse can correctly hypothesize that these symptoms are related to the drugs
1. dopamine blocking effects
2. anticholinergic effects
3. endocrine stimulating effects
4. ability to stimulate spinal nerves
A nurse makes the assessment that the client demonstrates anxiety and a number of responses consistent with sympathetic nervous system stimulation. The nurse would expect the presence of a high concentration of
A client’s laboratory reports show marked deficiencies of both serum sodium and potassium. Based on this finding the nurse should assess the client for symptoms of electrical conduction problems
1. throughout the body
2. in skeletal muscle function only
3. in the central nervous system only
4. in the cardiac conduction system only
The teaching plan for a client taking clozapine should include the following instruction:
1. Report sore throat and fever immediately.
2. Avoid foods high in polyunsaturated fats.
3. Practice unprotected sex.
4. Use over-the-counter preparations for rashes.
The nurse is caring for clients taking various medications, including buspirone, Desyrel, Haldol, Tegretol, Nardil, and Risperdal. The nurse must check to ensure that a special diet has been ordered for each client receiving
1. buspirone and haloperidol
2. trazodone and carbamazepine
Clients taking phenelzine, an MAOI, must be on a tyramine-free diet to prevent hypertensive crisis.
The nurse must tell a client taking a drug that acts by inhibiting monoamine oxidase to avoid certain foods and drugs or risk
1. hypotensive shock
2. hypertensive crisis
3. cardiac dysrhythmia
4. cardiogenic shock
Two psychotic clients on the inpatient unit fight whenever they are together in the same room. During a team meeting, one nurse suggests the safety of the two clients is of paramount importance and that their treatment plans should call for both to be placed in seclusion to keep them from injuring each other. What is the significance of this suggestion?
1. It violates the civil rights of the two clients.
2. It reinforces the autonomy of the two clients.
3. It reveals that the nurse values the principle of justice.
4. It represents the intentional tort of battery.
In a treatment team planning meeting a nurse states her concern about whether the staff is behaving ethically in using restraint to prevent one client from engaging in self-mutilative behavior when the care plan for another self-mutilating client calls for one-on-one supervision. The ethical principle that should govern the situation is
A client tells the nurse, “When I saw my therapist yesterday, he made sexual advances. He stroked my breast and suggested that he will give me a pass to leave the hospital if I will meet him at his apartment.” What action should the nurse take?
1. None. Psychiatric clients are not reliable.
2. Report the client’s statements to the unit nurse manager.
3. Discuss the statements with the medical director.
4. Call the state medical board.
Which nursing intervention could be considered to violate the rights of the psychiatric client?
1. The nurse imposes suicide precautions before the client has been interviewed by the physician.
2. The nurse opens and reads mail the client has left at the nurse’s station to be mailed.
3. The nurse places the client’s expensive watch in the hospital safe.
4. The nurse reports overhearing the client tell a friend that he will spit out his oral medication.
M, age 26 months, is very negativistic. He refuses to have anything to do with toilet training and shouts “No!” all the time. Using Freud’s stages of psychosexual development, the nurse would assess M as being in the stage of development termed
M, age 26 months, is very negativistic. He refuses to have anything to do with toilet training and shouts “No!” all the time. His mother asks what might be the matter with M. The nurse can assess M as dealing with the psychosocial crisis of
1. autonomy versus shame and doubt
2. initiative versus guilt
3. industry versus inferiority
4. trust versus mistrust
M, age 26 months, is very negativistic. He refuses to have anything to do with toilet training and shouts “No!” all the time. His mother asks what might be the matter with M. According to Piaget’s stages of cognitive development, M would be in the period called
3. concrete operational
4. formal operational
Steve is M’s 4-year-old brother. He sometimes grabs toys away from M, saying “I want that!” Using Freudian theory the nurse can interpret this behavior as a product of impulses originating in the
A client mentions, “I’m going to be engaging in cognitive therapy. What can I expect from the sessions?” Which remark would the nurse, framing a reply, find inappropriate to include?
1. “The therapist will be active and questioning.”
2. “You may be given homework assignments.”
3. “The therapist will help you look at ideas and beliefs you have about yourself.”
4. “The goal is to increase your subjectivity about the thoughts that govern your behavior.”
A young male client in a therapy group relates to the therapist as one might to a parent. The client asks permission to attend activities, to socialize with others, etc. This phenomenon is known as
In which stage of a group’s development would the following interaction most likely occur? Leader: “Shall we begin?” Client 1: “Why do you ask us if we want to begin?” Client 2: “You ought to just tell us what you want us to do.” Leader: “You seem irritated.” Client 3: “We thought someone in this group would give us help with our problems, but you don’t give us any answers.”
During group therapy, T states, “When I first started in this group, B wasn’t able to make a decision. Now she can. She’s made a lot of progress. I’m beginning to think that maybe I can conquer my fears, too.” According to Yalom, this statement reflects
N has talked constantly throughout the group therapy session. She has repeated the same material several times. Other members were initially attentive, and then became bored and inattentive. Which intervention would be least effective for the nurse psychotherapist to take?
1.asking the group why they have permitted N to take up their time with her repetitions
2.asking the group members how they have felt when N repeated herself throughout the session
3.mentioning that the group seems withdrawn and uninterested
4.telling N she must allow others to have an opportunity to speak
The most effective actions the nurse psychotherapist can take will be those that encourage the group to solve its own problems.
A client with a dual diagnosis of bipolar disorder and alcoholism is referred to Alcoholics Anonymous. He asks what good meeting with a bunch of ex-drunks is going to do him. The answer that will give the client relevant information about AA is
1.“The group will work to help you create new defenses.”
2.“People with a common problem provide mutual support.”
3.“The group leader sets tasks for members to promote behavioral change.”
4.“You’ll have a sponsor who will watch you to prevent a return to drinking.”
Bowen’s approach to family therapy focuses on differentiation of members. A therapist using this approach would negotiate with the family to arrive at the outcome criteria. The family will
1.restructure dysfunctional triangles
2.use straight messages without manipulation
3.achieve greater individuation of members
4.assess itself in terms of life cycle stage and multicultural issues
D remarks to the nurse, “The family therapist mentioned that our family is enmeshed. Can you tell me what that means?” The best reply from the nurse would be
1.“It means that your family members don’t have a strong sense of their own individual selves.”
2.“It means that your communication patterns often give double messages. Your body language doesn’t match the meaning of what you say.”
3.“Enmeshment refers to the tendency of your family to try to maintain balance. When the balance tips, you take measures to restore the balance.”
4.“Enmeshment refers to blaming the weakest family member for all the troubles of the family.
Enmeshed families have unclear distinctions among family members
The J family has revealed that Mr. J has begun to be verbally abusive to his wife and physically abusive to his oldest son since he lost his job 3 months ago. The son is threatening to run away and the wife/mother has developed increased anxiety. An appropriate nursing diagnosis for the family would be
1.Ineffective coping related to job loss
2.Impaired parenting related to father beating son
3.Caregiver role strain related to increased tension between parents
4.Disabling family coping related to use of verbal and physical abuse
A woman tells the BSN-prepared community health nurse that she and her son, B, fight all the time since B started using drugs. B tells his mother when she counsels against drug use that his drug use is none of her business. The most effective nursing intervention would be to
1.arrange drug detox and rehabilitation for B
2.provide family therapy for both B and his mother
3.turn B in to the police
4.arrange a referral to a family counselor
The advanced practice nurse is assigned to be M’s case manager. Discharge planning includes return to independent living in the community, attendance at a day hospital program, and a maintenance medication program. The activity that the case manager would be least likely to assume would be
1.providing individual counseling
2.serving as M’s advocate with the landlord
3.coordinating services M will receive
4.transporting M within the community
Case management roles include counselor, advocate, teacher, community organizer, and coordinator of services.
While working with K to establish goals for treatment, the nurse believes that one particular client goal is not in the client’s best interest. The best action for the nurse would be to
1. remain silent
2. tell the client that the goal isn’t realistic
3. formulate a different, appropriate goal for the client
4. explore the negative consequences that might occur if the goal is achieved
Which of the following is a correctly written goal?
1. R will find positive outlets for his dependency needs by the end of his hospitalization.
2. By 4 pm A will state her anxiety level has lowered from severe to moderate.
3. B will decide on her future career plans by the end of the week.4. By May 15, S will communicate effectively with the nursing staff and other clients
Which statement made by D during the initial assessment interview can be identified as his chief complaint?
1. “I can always trust my wife.”
2. “You never know who will turn against you.”
3. “I’ve been hearing the voices of my dead parents.”
4. “I wish I knew what I’ve done to deserve so much persecution.”
When the nurse begins the assessment interview with B, age 72, she notes that the client gives answers to questions that seem somewhat vague or slightly unrelated to the question. The client also leans forward and frowns as she listens intently to the nurse. An appropriate question for the nurse to ask would be
1. “I notice you frowning. Are you feeling annoyed with me?”
2. “Are you able to hear clearly when I speak in this tone of voice?”
3. “You seem to be having some trouble focusing on what I’m saying. Is something distracting you?”
4. “How can I make this interview easier for you?”
A nurse is reluctant to ask questions related to spiritual matters when she interviews clients. At what point in the interview could the nurse logically ask the question, “Does your faith help you in stressful situations?”
1. during assessment of substance use and abuse
2. during assessment of client’s childhood
3. during assessment of client coping strategies
4. during client assessment of own symptoms
§ )” I want you to tell the person who did this what you just told me.”
§ b) “How do you know that this person has discussed group business with others.?”
§ c) “I would also be hesitant about sharing anything else in the group”d) “How do you feel about what that person did?
§ a) “What will you do if you get anxious again?”
§ b) “Have you spoken to your physician about changing your medication.”
§ c) “ Are you feeling anxious right now?”
§ d) “I think your anxiety is caused from too much medication.”
best response to give
§ There are no other voices in this room.”
§ b) “What are the voices telling you?”
§ c) “You are frightened?”
§ d) “What can you do to stop hearing voices?”
§ Living with someone who has an addiction must be painful.”
§ b) “How much does your husband drink?”
§ c) “How do your children feel about your husband’s drinking?”
§ d) “I think you should go to Al-Anon.”
o Filling in missing memory with information the believed to be factual (very common in alzheimeirs pts)
o Civil service
o Driver’s license
o Purchases and contracts
o Press charges
o Humane care
o Religious freedom
o Social interaction
o Exercise and recreation
o When duty to warn and protect are mandated-Tarasoff
o When nurse is a mandated child abuse reporter
o When nurse is a mandated elder abuse reporter
o State laws requiring reporting of certain communicable diseases
o State laws requiring reporting of gunshot wounds
o State laws that do not give nurses “privilege” re: disclosures made within the context of the nurse-client relationship
someone who is suffering from hallucinations delusions or cannot put thoughts together.
THEY CANT TEST REALITY.
The exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness. Example: Chris was the only witness to a terrible fire in which several people were seriously injured. Several days later, however, Chris is unable to remember much when questioned by a reporter.
o Transforming anxiety on the unconscious level to a physical symptom that has no organic cause. (kids at camp having stomach ache when scared to sail)
o : An individual deals with emotional conflicts or stressors by actions rather than reflections or feelings. (more educated, more should be able to articulate and not hit)
· Cortical atrophy
· Ventricular enlargement
· Enlarged ventricles
Injected radioactive tracer travels to brain, concentrates in areas of high activity
Scanned images are relayed to a computer for 3D images
§ Technique similar to PET but uses radio nuclides emitting gamma radiation
§ Detects oxygen utilization, glucose metabolism, blood flow, neurotransmitter-receptor interaction
§ Oral- 0-1
§ Anal- 1-3
§ Phallic- girls like dads not moms vice versa . Illness always develops here for freud. Unresolved occurs here- 3-6
§ Latency- 6-12Genital- 12 and up
o Trust v. mistrust 0-1 half
o Autonomy v. shame and doubt- 1half -3
o Initiative v. guilt3-6
o Industry v. inferiority6-12
o Identity v. role confusion12-20
o Intimacy v. isolation20-35
o Generativity v. stagnation35-65
o Wisdom v. despair65 up
§ Sensorimotor- birth-2
§ Preoperational- 2-7
§ Concrete operations- 7-11
§ Formal operations- 11 and up
§ Physiological needs
§ Psychological needsMeta-needs
when a person gets what he precieves as a reward it will reinforce the behavior.
1. The most important question to ask a suicidal patient is:
a) Have you ever attempted suicide?
b) Are you religious?
c) Has any other member of your family attempted or commited suicide?
d) Do you have a plan?
Maximum suicide precautions in the hospital setting are:
a) Keep patient in a double room with another patient.
b) 1-1 monitoring while patient is in room or dayroom.
c) Patient is unable to leave the unit for any reasons, even diagnostic tests or treatmentd) 1-1 monitoring of patient at all times.
The following statement is true of suicide
a) Wrist cutting is a cry for help not a suicide attempt
b) Women commit suicide more often than do men.
c) Every suicide attempt must be taken seriously
d) Older adolescents are at less risk of suicide than younger adolescents.
Suicide as a “never event”
a) is a reasonable goal
b) is an impossible goal
c) is not a consideration
d) is unknown
Most healthcare workers do not assess for suicide because
a) the rates are low outside of the psychiatric hospitals
b) they are uncomfortable with the subject
c) it is not part of the general assessment of a patient
d) asking the question might trigger a suicide action
1. A client is noted to have a high level of non–goal-directed motor activity, running from chair to chair in the solarium. He is wide-eyed and seems terror-stricken. He cries, “They’re coming! They’re coming!” He neither follows staff direction nor responds to verbal efforts to calm him. The initial nursing intervention of highest priority is to
1. provide for client safety
2. increase environmental stimuli
3. respect client’s personal space
4. encourage clarification of feelings
2. Two staff nurses were considered for promotion. The promotion was announced via a memo on the unit bulletin board. The nurse who was not promoted went to the utility room and slammed several cupboard doors. An aide came into the utility room and remarked, “You seem pretty angry.” The nurse replied that she is not the least bit angry. In this instance the nurse is probably utilizing
1. reaction formation
3. Two staff nurses were considered for promotion. The promotion was announced via a memo on the unit bulletin board. The nurse who was not promoted told a friend, “Oh, well, I really didn’t want the job anyway.” This is an example of
5. Two staff nurses were considered for promotion. The promotion was announced via a memo on the unit bulletin board. If, when the nurse who was not promoted met the newly promoted nurse in the hall, she suddenly found she had lost her voice and was unable to offer her congratulations, she would probably be demonstrating
4. Two staff nurses were considered for promotion. The promotion was announced via a memo on the unit bulletin board. The nurse who was not promoted told another friend, “I knew I’d never get the job. The hospital administrator hates me.” If she actually believes this of the administrator, who, in reality, knows little of her, she is demonstrating
2. reaction formation
6. R, an anxious client who receives q4h prn anxiolytic medication, is in the corridor pacing. He grabs the arms of anyone who comes along and asks, “When can I have medication?” His voice is high-pitched and shaky. His respiratory rate is rapid. His assigned nurse should intervene by
1. ascertaining when the client’s medication is due and informing him.
2. sending him to his room to lie down for half an hour.
3. joking with him to reduce tension.
4. suggesting that he watch television.
B, a salesman, has had difficulty holding a job because he accuses co-workers of conspiring to take his sales. Today, he argued with several office mates and threatened to kill one of them. The police were called and he was brought to the mental health center for evaluation. B has had previous admissions to the unit for stabilization of symptoms of paranoid schizophrenia. When the nurse meets him, he points at staff in the nursing station and states loudly, “They’re all plotting to destroy me. Isn’t that true?” An appropriate response for the nurse would be
1.“No, that’s not true. People here are trying to help you, if you’ll let them.”
2.“Everyone is trying to help you. No one wants to harm you.”
3.“Thinking that people want to destroy you must be very frightening.”
4.“That’s absurd, B. The staff are health care workers, not members of the mob.”
B, a newly admitted client with paranoid schizophrenia, is hypervigilant and constantly scans the environment. He states that he saw two doctors talking in the hall and knows they were plotting a way to kill him. The nurse may correctly assess this behavior as
1.an idea of reference
2.a delusion of infidelity
3.an auditory hallucination
B, a newly admitted client with paranoid schizophrenia, believes co-workers plot against him and stated he thinks two doctors on the unit are plotting to kill him. What assessment can be made about the way in which B perceives his environment?
B is a newly admitted client who has paranoid schizophrenia. B’s family mention that they really don’t understand what caused B’s illness. The nurse should answer in terms of the
3.family theory model
B is a client with paranoid schizophrenia who was admitted to the mental health unit after arguing with co-workers and threatening to kill them. On the unit he is aloof and suspicious. He mentioned that two physicians he saw talking are plotting to kill him. Based on data gathered at this point, what two nursing diagnoses should the nurse consider?
1.Disturbed thought processes and Risk for other-directed violence
2.Spiritual distress and Social isolation
3.Risk for loneliness and Deficient knowledge
4.Disturbed personal identity and Noncompliance
When B, a client diagnosed with paranoid schizophrenia, was discharged from the unit 6 months ago, the plan was for him to take chlorpromazine (Thorazine) 100 mg orally four times daily. He tells the nurse he stopped taking his pills after a couple of months because they made him feel like a “zombie.” To what common side effects is B most likely referring?
1.sweating, nausea, diarrhea
2.sedation, dry mouth, stiffness
3.headache, watery eyes, runny nose
4.mild fever, sore throat, skin rash
When B, a client with paranoid schizophrenia, suffers a recurrence of symptoms after deciding to stop taking his chlorpromazine, he is readmitted to the mental health unit. The physician orders the resumption of B’s neuroleptic medication. The nurse adds the nursing diagnosis Noncompliance with neuroleptic medication regimen related to side effects of medication to the client’s care plan. What nursing intervention would be inappropriate for B’s treatment plan?
1.Confer with physician about prescribing an anticholinergic drug.
2.Advise client to chew sugarless gum or use sugarless hard candy.
3.Suggest that client reduce dosage by 5 mg daily if side effects recur.
4.Teach use of caution when operating mechanical devices.
The nurse works with B, a client with paranoid schizophrenia, and his family to help them understand the importance of the client taking medication regularly. B continues to say he does not like taking pills, and his family say they feel helpless to foster his compliance. What treatment strategy should the nurse discuss with the physician?
1.use of an antipsychotic decanoate preparation
2.adjunctive use of amitriptyline (Elavil)
3.use of benzodiazepines such as diazepam (Valium)
4.use of chlordiazepoxide (Librium)
T’s nursing care plan includes the nursing order, assess for auditory hallucinations. What behaviors suggest the client may be hallucinating?
1.aloofness, haughtiness, suspicion
2.elevated mood, hyperactivity, distractibility
3.performing rituals, avoiding open places
4.darting eyes, tilted head, mumbling to self
K is newly diagnosed with paranoid schizophrenia. He is withdrawn, suspicious, and aloof. One of his nursing diagnoses is Deficient diversional activity. What activity would be appropriate to plan for him?
1.a basketball game
4.euchre (card game)
D, age 56, became severely depressed when the last of her six children moved out of the home 4 months ago. Since then she has neglected to care for herself, slept poorly, lost weight, and repeatedly states, “No one cares about me anymore. I’m not worth anything.” Which intervention would be least useful to include in D’s nursing care plan?
1.Observe and record sleep pattern nightly.
2.Weigh weekly and observe eating patterns.
3.Monitor bowel movements daily and evaluate need for laxatives.
4.Provide activities that involve concentration and fine motor skills.
Considering the negative pattern of thinking demonstrated by D, a severely depressed client, the advanced practice nurse believes D can be helped by
3.cognitive behavior therapy
4.alternative and complementary therapies
What can a nurse do to avoid feelings of frustration when establishing a relationship and working with a severely depressed client? Expect the client to
1.be receptive to the plans for nursing care
2.be withdrawn and disinterested in a relationship
3.show signs of improvement after several scheduled sessions
4.show gratitude for attention
When the spouse of a client diagnosed with dysthymia asks what the major difference is between dysthymia and major depressive disorder, the nurse can point out that in major depressive disorder
1.the symptoms persist for 2 or more years
2.there is evidence of an earlier hypomanic episode
3.there is always evidence of suicidal ideation
4.the client does not give a history of feeling depressed for years
A depressed client is to have his initial ECT tomorrow morning. Select the action that would NOT routinely be included in preparing the client for treatment.
1.Withhold food and fluids for a minimum of 6 hours before treatment.
2.Remove dentures, glasses, contact lenses, etc.
3.Administer pretreatment medication as ordered 30 to 45 minutes prior to scheduled treatment.
4.Restrain client in bed using padded wrist and ankle restraints.
Three policemen brought E to the mental health unit for admission. She had been directing traffic on a busy city street. She shouted rhymes like, “to work, you jerk, for perks,” and made obscene gestures at cars that came too close to her. When her husband was contacted at work, he reported that E had stopped taking her lithium 3 weeks ago and had not slept or eaten for 3 days, telling her husband she was “too busy.” During assessment, which two features characteristic of the disorder can be identified?
1.increased muscle tension and anxiety
2.social impairment and elevated mood
3.poor judgment and hyperactivity
4.vegetative signs and poor grooming
E is a manic client who became hyperactive after discontinuing her lithium. At the time of admission the physician ordered q.i.d. doses of chlorpromazine (Thorazine) and twice daily lithium for E. The nurse’s planning will be aided if he or she understands that use of the phenothiazine will
1.bring E’s hyperactivity rapid control under
2.enhance the antimanic action of lithium
3.minimize the side effects of lithium
4.produce long-term control of hyperactivity
E is a manic client who became hyperactive after discontinuing her lithium. E’s husband asks what evidence supports the possibility of genetic transmission of bipolar disorders. Which reply is factual?
1.“A higher proportion of clients with bipolar disorders are found among creative writers.”
2.“A higher rate of relatives with bipolar disorder is found among clients with bipolar disorder.”
3.“A higher rate of relatives of clients with bipolar disorder respond in an exaggerated way to daily stress.”
4.“More individuals with bipolar disorder come from higher socioeconomic and educational backgrounds.”
What characteristic usually manifested by an individual during a manic episode can be used positively as a part of nursing intervention?
3.flight of ideas
At a unit meeting, staff are discussing the decor for a special bedroom for a manic client. The best suggestion from among those listed below would be
1.an extralarge window with a view of the street
2.brightly colored walls and print drapes
3.deep colors for walls and furniture upholstery
4.neutral walls with pale, coordinated accessories
The nurse must develop a health teaching plan for a client receiving lithium. The plan should include instructions to
1.drink twice the usual daily amount of fluid
2.maintain adequate salt in the diet
3.double the usual dose if diarrhea or vomiting occurs
4.avoid aged cheese, processed meats, and red wine
Which of the following best reflects the
evidence on giving multiple sessions of a family
intervention in the treatment of schizophrenia?
_ Multiple sessions are no better than a single session at
reducing the relapse rate at 12 months
_ Multiple sessions of a family intervention are no better
than standard psychiatric care at reducing the relapse rate
at 12 months
_ Multiple sessions of a family intervention reduce relapse
rates at 12 months compared with usual care, single-session
family interventions, or psychoeducational interventions
Multiple sessions of a family intervention reduce relapse
rates at 12 months compared with usual care, single-session
family interventions, or psychoeducational interventions
Which of the following best reflects
the evidence on the value of cognitive behavioral
therapy (CBT) and behavioral therapy in treating
_ There is no evidence that behavioral therapy can help to
improve rates of adherence to antipsychotic medication
_ The best available evidence suggests that CBT is no better
than standard care at reducing relapse rates
_ There is very good evidence that CBT is better than
standard care at reducing relapse rates
The best available evidence suggests that CBT is no better
than standard care at reducing relapse rates
Which of the following best reflects
the evidence on drug therapy for people with
schizophrenia who are resistant to standard
_ There is good evidence that clozapine is better than
standard drugs at improving symptoms
_ There is good evidence that clozapine is better than
other newer “atypical” antipsychotic drugs at improving
_ There is good evidence that olanzapine is better thanstandard drugs at improving symptoms
There is good evidence that clozapine is better than
standard drugs at improving symptoms
o Keeping unacceptable feelings or behaviors are out of awareness by developing the opposite behavior or emotion.
Example: Jim is attracted to other men, but tells himself that he hates all homosexuals.
person who hate animals works for the animal society
Chester sometimes sits for hours in extremely rigid positions. At other times he displayed frenzied motor activity.
- has to do with movement
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