Which of the following is a true statement regarding anger?
C. Humans can choose to slow down their reactions and to think and behave differently in response to various events
According to Johnson's systematic review of the literature about violence on inpatient psychiatric units, which of the following is a predictor of violence?
D. Suspiciousness
Which of the following approaches is important in caring for patients who are aggressive or violent?
D. Knowing where colleagues are and making sure that they know where you are
The nurse who works with potentially aggressive patients should do so with respect and concern. Which of the following are goals of de-escalation? Select all that apply.
a. Empathize with the patient's persepective
b. Approach patients calmly
c. Work with patients to find solutions
d. Sympathize with the patient's perspective
e. Avoid a power struggle
a. Empathize with the patient's persepective
b. Approach patients calmly
c. Work with patients to find solutions
e. Avoid a power struggle
Patients with a history of damage to the cerebral cortex are more likely to exhibit which of the following? Select all that apply.
A. Decresed inhibition
c. Decreased judgement
e. Increased impulsivity
Usually, there are precursors to aggression and violence. Which of the following behaviors indicate an impending aggressive episode? Select all that apply.
a. Tone and volume
b. Staring and eye contact
c. Anxiety
d. Lethargy
e. Pacing
Which of the following is accurate regarding a crisis?
B. Occurs when an individual is at a breaking point
For a person involved in disaster, which of the following are predictive of later developing posttraumatic stress disorder? Select all that apply.
a. Lack of finances
b. Inability to access health care
c. Fear
d. Dissociation
e. Lack of family support
c. Fear
d. Dissociation
Which of the following would be considered a situation crisis?
D. Job promotion
For a patient in crisis, the assessment of the psychological domain focuses on which of the following? Select all that apply.
D. Emotions
e. Coping strengths
Which of the following is an example of a traumatic crisis?
D. Kidnapping
Which of the following therapeutic factors refers to the group members' relationships to the therapist and other group members?
A. Group cohesiveness
According to Yalom (2005), there are 11 primary factors through which therapeutic changes occur in group psychotherapy. Which of the following factors correlates with learning to give to others?
B. Altruism
During which phase of Tuckman's model of group development does the group reach a consensus and develop cooperative relationships?
D. Performing
During a group therapy session, the nurse restates the interaction with the patient to check the patient's meaning. The nurse is using which technique?
C. Clarification
Which type of group is usually associated with patients who have dementia who have difficulty with recent memory?
B. Reminiscence groups
A patient diagnosed with schizophrenia is having hallucinations. Which type of group would be benefical for this patient?
D. Symptom management
Which of the following is an accurate characteristic of small groups?
A. They are usually no more than seven to eight members
During which phase of group development does the group leader develop rapport with the members?
A. Beginning
Which group member attempts to stimulate the group to action or decision?
D. Energizer
During which phase of group development does the group realize its purpose?
C. Working
A group has been given the assignment of planning their weekend trip. This is an example of which type of group?
A. Task
Which of the following maintenance roles is responsible for mediating differences among group members and relieves tension in conflict situations?
C. Harmonizer
The client states, "Who is confused? He said I should go, but I didn't. Is that weird?" Which response by the nurse would be best to clairfy the client's statement?
B. "I dont understand. Can you explain in another way?"
The nurse assesses a client as being on the mental health end of the mental health/mental illness continuum. Which statement by the client best supports this assessment? Select all that apply.
A. "I am satisfied with my life and life choices."
d. "I'm an average person leading a normal average life."
Which comment is an example of directing a conversation to explore a topic in depth?
B. "Let's go back to the situation where you felt uncomfortable in class."
A client has been working on relationship issues with a psychiatric nurse. The client usually changes the subject or reverts to cracking jokes when discussing a sensitive, emotionally charged subject. Today, the client remains focused on the subject. Which therapeutic communication technique would MOST appropriately encourage the client to continue to explore new ideas or issues in more depth?
D. "That sounds really important to you. Tell me more about this."
You are a psychiatric nurse working with a client who feels a strong need to be in control at all times. Which therapeutic communication technique would MOST appropriately encourage this client to consider a new treatment approach?
B. "Would it help you to talk with people who have tried those treatments themselves?"
One of your assigned clients speaks about family members, indicating that the members are highly educated with advanced doctorate and medical degrees. The client states, "I can never measure up to them." The nurse's BEST reply would be:
C. "What would somone have to do to measure up?"
You are working with a client who becomes upset one day and tells you, "I've decided just to give up on finishing the nursing program; it's too much." The BEST response from the nurse would be:
A. "You think it's too much for you?"
Which statement by a client would indicate that the termination phase of the nurse-client relationship is resolved?
D. "I didn't always agree with the nurse, but she gave good nursing care."
A patient has undergone diagnostic testing to determine whether she has breast cancer. She goes shopping at the mall to stop thinking about the possibility of cancer. She is using which of the following defense mechanisms?
A. Suppression
A patient comes to the emergency department with alcohol intoxication. He fell and hit his head at home and has a minor laceration. The nurse asks when his last drink was. The patient states that he didn't have a drink and "never touches the stuff." The patient is exhibiting which of the following defense mechanisms?
B. Denial
Which of the following communication techniques does the nurse use in establishing trust and developing empathy?
A. Acceptance
Which of the following is inconsistent with principles of therapeutic communication?
B. The nurse is the primary focus of the relationship.
During which phase of the nurse-patient relationship does the patient identify and explore specific problems?
C. Working
A teenager is mad at his parents about not being able to drive his father's car. He begins to stay out late with his friends after curfew. What defense mechanism is the teenager using?
B. Acting out
Which of the following would be considered a therapeutic communication technique? Select all that apply.
C. Restatement
d. Confrontation
A patient diagnosed with borderline personality disorder is pitting one nurse against the other, calling one a best friend and declaring that the other is horrible. The patient is using which defense mechanism?
C. Splitting
In a nurse-patient relationship, the patient may exhibit "testing behaviors." During which stage of the relationship does the patient typically use these behaviors?
C. Orientation
A patient diagnosed with a delusional disorder who uses excessive health care resources most likely has which type of delusions?
C. Somatic
Schizoaffective disorder has symptoms typical of both schizophrenia and which of the following type of disorder?
A. Mood disorders
Medications are not often used for a person with delusional disorder, but which of the following medication classifications are helpful during exacerbations? Select all that apply.
a. Benzodiazepines
b. Antipsychotics
c. Antidepressants
d. Nonbenzodiazepines
e. Antianxiety
a. Benzodiazepines
b. Antipsychotics
Which of the follwing statements is accurate regarding a person with delusional disorder?
D. Few, if any, psychological deficits are noted
A patient diagnosed with schizophrenia is telling everyone that he is the president of the United States. This patient is exhibiting which type of delusion?
B. Grandiose
Which type of disorder is frequently found in patients with delusional disorders?
C. Mood
Which of the following is the central focus of persecutory delusions?
A. Injustice that must be remedied by legal action
Encephalipathic syndrome has occurred in a few patients when haloperidol is taken with which of the following medications?
B. Lithium carbonate (Lithium)
Assessment is the deliberate and systematic collection of biopsychosocial information or date to determine current and past health and functional status and to evaluate present and past coping patterns. Which of the following is a component of the social assessment?
C. Quality of life
The nurse is completing an assessment interview. The nurse is attempting to bring the conversation back to the questions at hand when the patient goes off on a tangent. Which assessment interview behavior is the nurse using?
A. Focusing
Which of the following interventions uses the reading of written materials to express feelings or gain insight?
D. Bibliotherapy
According to the World Health Organization, by 2030, which mental illness is projected to be the leading burden of disese worldwide?
A. Depression
According to the DSM-IV-TR, antisocial personality is placed on which of the following axes?
B. II
Which of the following is an accurate statement regarding mental health recovery?
D. It is a growth experience with setbacks
A patient diagnosed with schizophrenia is being assessed using the DSM-IV-TR criteria. It has been determined that the patient has a Global Assessment Functioning (GAF) score of 46. This score is associated with which of the following descriptions?
D. Serious symptoms or serious impairment in social, occupational, or school functioning
A patient diagnosed with an anxiety disorder and diabetes mellitus is being seen in the outpatient mental health clinic. When using the DSM-IV-TR, diabetes would be listed under which Axis?
D. III
Which question would best serve the crisis intervention nurse who wished to assess a client's coping skills?
D. "How do you usually manage problems or unhapiness?"
On the second appointment at the crisis clinic, the client tells the nurse, "I worry hour after hour about my problem. I can't get away from it. I feel as though I'm going crazy." A helpful technique the nurse can recommend to the client to limit worry is to:
A. Reserve an hour a day for worrying and devote the entire time to worry
A client as the crisis clinic who is embarrassed over losing control when the crisis occurred tells the nurse, "I have never wept or withdrawn before in my life." The intervention that will be of greatest help to him in regaining self-esteem is to:
A. Give the client unconditional positive regard during all interactions
An effective way of evaluating learning provided by crisis intervention therapy is to:
C. Ask what the client would do if a similar situation ocurred
A client at the crisis clinic has had four prior admissions for suicidal gestures. This time the client relates having gone into the bathroom and making superficial cuts on her wrists when her boyfriend told her he was going to break off the relationship. She showed the boyfriend her bleeding wrists, and he responded by bringing her to the clinic. To the nurse it is apparent that the client is being rewarded for being in crisis. This situation is called:
C. Secondary gain
Which of the following are negative symptoms associated with schizophrenia? Select all that apply.
a. Ambivalence
b. Avolition
c. Anhedonia
d. Deulsions
e. Hallucinations
a. Ambivalence
b. Avolition
c. Anhedonia
Which of the following are key diagnostic criteria for schizophrenia? Select all that apply.
a. A direct physiologic effect of a substance or medical condition
b. Major depression occuring concurrently with active symptoms
c. One or more major areas of social or occupational functioning markedly below previously achieved levels
d. Delusions present for a significant portion of time during a 1-month period
e. Continuous signs for at least 6 months
c. One or more major areas of social or occupational functioning markedly below previously achieved levels
d. Delusions present for a significant portion of time during a 1-month period
e. Continuous signs for at least 6 months
A patient diagnosed with schizophrenia is in anticholinergic crisis. The nurse would expect which finding to be noted upon assessment?
A. Facial flushing
A patient has been prescribed clozapine (Clozaril) for treatment of schizophrenia. The patient must be taught to monitor which blood levels weekly while taking this drug?
C. WBC
Patients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which of the following may occur as a result of water intoxication?
D. Hyponatremia
A patient diagnosed with schizophrenia is having delusions that he is being plotted against by the government. This would be documented as which of the following types of delusion?
C. Persecutory
Which of the following is an anticholinergic side effect associated with some antipsychotic medications?
B. Photophobia
Positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be caused by hyperactivity of which neurotransmitter?
B. Dopamine
Which of the following extrapyramidal side effects is noted by the patient having bradykinesia (slow movements) and a shuffling gait?
D. Pseudoparkinsonism
The nurse in the emergency department is assessing a client suspected of being suicidal. Number the following assessment questions, beginning with the most critical and ending with the least critical.
"Are you currently thinking about suicide?"
"Do you have a gun in your possession?"
"Do you have a plan to commit suicide?"
"Do you live alone? Do you have local friends or family?"
1. "Are you currently thinking about suicide?"
2. "Do you have a plan to commit suicide?"
3. "Do you have a gun in your possession?"
4. "Do you live alone? Do you have local friends or family?"
A suicidal Jewish-American client is admitted to an in-patient psychiatric unit 2 days after the death of a parent. Which intervention must the nurse include in the care of this patient?
A. Allow the client time to mourn the loss during this time of shiva
Which intervention takes priority when working with newly admitted clients experiencing suicidal ideations?
A. Monitor the client at close, but irregular intervals
A client notifies a staff member of current suicidal ideations. Which intervention by the nurse would take priority?
B. Determine if the client has a specific plan to commit suicide
Theresa, who has been hospitalized following a suicide attempt, is placed on suicide precautions on the psychiatric unit. She admits that she is still feeling suicidal. Which of the following interventions is most appropriate in this instance?
C. Check on Theresa every 15 mins or assign a staff person to stay with her on a one-to-one basis
Which of the following interventions are appropriate for a client on suicide precautions? Select all that apply.
a. Remove all sharp objects, belts, and other potentially dangerous articles from the client's enviornment
b. Accompany the client to off-unit activities
c. Obtain a promise from the client that she will not do anything to harm herself for the next 12 hours
d. Put all of the client's possessions in storage and explain to her that she may have them back when she is off suicide precautions
a. Remove all sharp objects, belts, and other potentially dangerous articles from the client's enviornment
b. Accompany the client to off-unit activities
c. Obtain a promise from the client that she will not do anything to harm herself for the next 12 hours
Which statement describes a major difference between a client diagnosed with major depressive disorder and a client diagnosed with dysthymic disorder?
A. A client diagnosed with dysthymic disorder has symptoms for at lest 2 years
Which charting entry most accurately documents a client's mood?
C. "The client rates mood at a 2 out of 10"
Which client is at highest risk for the diagnosis of major depressive disorder?
D. A 24 year old married woman
A client is admitted to an in-patient psychiatric unit with a diagnosis of major depressive disorder. Which of the following data would the nurse expect to assess? Select all that apply.
a. Loss of interest in almost all activities and anhedonia
b. A change of more than 5% of body weight in 1 month
c. Fluctuation between increased energy and loss of energy
d. Psychomotor retardation or agitation
e. Insomnia or hypersomnia
a. Loss of interest in almost all activities and anhedonia
b. A change of more than 5% of body weight in 1 month
d. Psychomotor retardation or agitation
e. Insomnia or hypersomnia
A client is exhibiting behavioral symptoms of depression. Which charting entry would appropriately document these symptoms?
D. "Became irritable and agitated on waking"
Which symptom is an example of physiological alterations exhibited by clients diagnosed with moderate depression?
D. Decreased libido
Which of the following medications may be administered before ECT? Select all that apply.
a. Glycopyrrolate (Robinul)
b. Thipental sodium (Pentothal)
c. Succinylcholine chloride (Anectine)
d. Lorazepam (Ativan)
e. Divalproex sodium (Depakote)
a. Glycopyrrolate (Robinul)
b. Thipental sodium (Pentothal)
c. Succinylcholine chloride (Anectine)
A client diagnosed with major depressive disorder is presribed phenelzine (Nardil). Which teaching should the nurse prioritize?
D. Instruct the client and family about the many food-drug and drug-drug interactions
A client diagnosed with major depressive disorder is newly prescribed sertraline (Zoloft). Which of the following teaching points would the nurse review with the client? Select all that apply.
a. Monitor the client for suicidal ideations related to depressed mood
b. Discuss the need to take medications, even when symptoms improved
c. Instruct the client about the risks of abruptly stopping the medication
d. Alert the client to the risks of dry mouth, sedation, nausea, and sexual side effects
e. Remind the client that the medications full effect does not occur for 4 to 6 weeks
b. Discuss the need to take medications, even when symptoms improved
c. Instruct the client about the risks of abruptly stopping the medication
d. Alert the client to the risks of dry mouth, sedation, nausea, and sexual side effects
e. Remind the client that the medications full effect does not occur for 4 to 6 weeks
Which symptoms would the nurse expect to assess in a client suspected to have serotonin syndrome?
D. Alterations in mental status, restlessness, tachycardia, labile blood pressure, and diaphoresis
Which medication would be classified as a tricyclic antidepressant?
D. Nortriptyline (Pamelor)
Atropine sulfate is administered to a client receiving ECT for what purpose?
A. To decrease secretions
Succinylcholine is administered to a client receiving ECT for what purpose?
A. To relax muscles
Which symptom is an example of an affective alteration exhibited by clients diagnosed with severe depression?
D. Apathy
Major depressive disorder would be most difficult to detect in which of the following clients?
C. A 13-year old boy
Which nursing diagnosis takes priority for a client immediately after ECT?
B. Risk for injury r/t altered mental status
A clients outcome states, "The client will make a plan to control of one life situation by discharge." Which nursing diagnosis documents the client's problem that this outcome addresses?
D. Powerlessness
A client admitted with major depressive disorder has a nursing diagnosis of ineffective sleep pattern r/t aches and pains. Which is an appropriate short-term outcome for this client?
D. The client will sleep 6 to 8 hours at night by day 5
A client diagnosed with major depressive disorder is being considered for ECT. Which client teaching should the nurse prioritize?
A. Discuss with the client and family expected short-term memory loss
The client presents in the emergency room with constricted pupils, slurred speech, drowsiness, and respirations of 8/min. The person who accompanied the client to the ER reports the client had taken an unknown quanity of meperidine (Demerol) tablets 30 mins earlier. Which medication should the nurse anticipate giving the client?
C. Naloxone (Narcan)
The nurse is completing an admission assessment for a client admitted to the medical unit with a diagnosis of Acute Alcohol Intoxication. When asked to describe his drinking pattern and amount, the client states, "I only drink when I am under a lot of stress." The clients response indicated what defense mechanism?
B. Rationalization
A graduate nurse is assigned to work on a unit with mentally ill chemically abusing (MICA) clients. Which of the following statements by the nurse is reason for concern?
A. "These clients have more excuses for their problems than anyone I know."
The client with paranoid schizophrenia and cocaine abuse is at risk for:
D. increased psychiatric symptoms
A client diagnosed with bipolar I disorder is experiencing auditory hallucinations and flight of ideas. Which medication combination would the nurse expect to be prescribed to treat these symptoms?
A. Risperidone (Risperdal) and Lamotrigine (Lamictal)
A client prescribed lithium carbonate (Eskalith) is experiencing an excessive output of dilute urine, tremors, and muscular irritability. These symptoms would lead the nurse to expect that the clients lithium serum level would be which of the following?
B. 2.6 mEq/L
The physician orders lithium carbonate 600 mg tid for a newly diagnosed client with Bipolar I Disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. Therapeutic range for acute mania is:
A. 1.0 to 1.5 mEq/L
Although historically lithium has been the drug of choice for mania, several other drugs have been used with good results. Which of the following are used in the treatment of bipolar disorder? (Select all that apply)
C. Olanzepine (Zyprexa)
c. Carbamazepine (Tegretol)
d. Gabapentin (Neurontin)
A nurse is educating a client about his lithium therapy. She is explaining signs and symptoms of lithium toxicity. For which of the following would she instruct the client to be on the alert?
B. Tinnitus, severe diarrhea, ataxia
A client diagnosed with bipolar mania enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse?
A. Quietly walk with her back to her room and help her change into something more appropriate
A nurse on an in-patient psychiatric unit receives report at 1500 hours. Which client would need to be assessed first?
B. A client pacing the hall and experiencing irritability and flight of ideas
A nurse is planning to teach about appropriate coping skills. The nurse would expect which client to be at the highest level of readiness to participate in this instruction?
C. A client admitted 6 days ago for suicidal ideations following a depressive episode
Which nursing charting entry is documentation of a behavioral symptom of mania?
C. "Pacing halls throughout the day. Exhibits poor impulse control."
The nurse is reviewing expected outcomes for a client diagnosed with Bipolar I disorder. Number the outcomes presented in order in which the nurse would address them.
__The client exhibits no evidence of physical injury
__The client eats 70% of all finger foods offered
__The client is able to access available out-patient resources
__The client accepts responsibility for own behaviors
1. The client exhibits no evidence of physical injury
2. The client eats 70% of all finger foods offered
3. The client accepts responsibility for own behaviors
4. The client is able to access available out-patient resources
A client diagnosed with bipolar II disorder has nursing diagnosis of impaired social interactions r/t egocentrism. Which short-term outcome is an appropriate expectation for this client problem?
D. The client will have an appropriate one-on-one interaction with a peer by day 4
A client newly admitted to an in-patient psychiatric unit who is experiencing a manic episode. The client's nursing diagnosis is imbalanced nutrition, less than body requirements. Which meal is most appropriate for this client?
A. Chicken fingers and french fries
A provocatively dressed client diagnosed with bipolar I disorder is observed laughing loudly with peers in the milieu. Which nursing action is a priority in this situation?
C. Privately discuss with the client the inappropriateness of provocative dress during hospitalization
A client diagnosed with bipolar I disorder in the manic phase is yelling at another peer in the milieu. Which nursing intervention takes priority?
C. Calmly redirect and remove the client from the milieu
A competent, voluntary client has stated he wants to leave the hospital. The nurse hides his clothes in an effort to keep him from leaving. With which of the following legal actions might the nurse be charged because of this nursing action?
C. False imprisonment
Joe is very restless and is pacing a lot. The nurse says to Joe, "If you dont sit down in the chair and be still, I'm going to put you in restraints!" With which of the following legal actions might the nurse be charged because of this nursing action?
B. Assault
An individual may be considered gravely disabled for which of the following reasons? (Select all that apply)
a. A person, because of mental illness, cannot fufill basic needs
b. A mentally ill person is in danger of physical harm based on inability to care for self
c. A mentally ill person lacks the resourse to provide the necessities of life
d. A mentally ill person is unable to make use of available resources to meet daily living requirements
a. A person, because of mental illness, cannot fufill basic needs
b. A mentally ill person is in danger of physical harm based on inability to care for self
d. A mentally ill person is unable to make use of available resources to meet daily living requirements
Which of the following statements is (are) correct regarding the use of restraints? (Select all that apply)
D. Orders for restraints must be reissued by a physician every 2 hours for children and adolescents
d. An in-person evaluation must be conducted within 1 hour of initiating restraints
Guidelines relating to "duty to warn" state that a therapist should consider taking action to warn a third party when his or her client: (Select all that apply)
a. Threatens violence toward another individual
b. Identifies a specific intended victim
c. Is having command hallucinations
d. Reveals paranoid delusions about another individual
a. Threatens violence toward another individual
b. Identifies a specific intended victim
Attempting to calm an angry client by using "talk therapy" is an example of which of the following clients' rights?
A. The right to the least-restrictive treatment alternative
Which would be a cue to an increased risk of a person becoming violent in the workplace?
D. Poor on the job relationships
The nurse is caring for a woman who states she was beaten and sexually assualted by a male friend. What should the nurse do first?
A. Stay with the client during the physical exam
Which is the best action for the nurse to take when assessing a child who might be abused?
C. Consult with a professional member of the health team and making a report
Which is true about domestic violence between same-sex partners?
C. Rates of violence are about the same as between heterosexual partners
The nurse is designing an in-service for the ED staff as victims of partner abuse. It would be particularly important to include which factor?
B. Leaving an abusive partner is a process over time. Returing to the abuser is typical
A high risk factor for childhood sexual abuse includes:
D. parents who were sexually abused as children
Which type of child abuse can be most difficult to treat effectively?
C. emotional
Women in battering relationships often remain in those relationships as a result of faulty or incorrect beliefs. Which of the following beliefs is valid?
A. If she tried to leave, she would be at increased risk for violence
A client with a long history of alcoholism presents in the ED with a sudden onset of muscle pain, swelling, and weakness, and reddish-tinged urine. What lab value would the nurse evaluate as evidence of this clients disorder?
B. Increase in CPK
A client has been diagnosed with Wernicke-Korsakoff syndrome. Which is an example of this client's use of confabulation?
C. The client clearly discussed a field trip, when in reality no field trip occurred
A client with a long history of alcohol dependence comes to the ED with SOB and an enlarged abdomen. Which complication of alcoholism is this client experiencing, and what is the probable cause?
C. Ascities resulting from cirrhosis of the liver
A client with a long history of alcohol dependence comes to the ED with frank hemopytsis. Which life-threatning complication of alcoholism is this client experiencing, and what is the probably cause?
D. Hemorrhage of esophageal varices resulting from portal HTN
A client with a history of alcoholism is seen in the ED 2 days after a binge of excessive alcohol consumption. The nurse suspects pancreatitis. Which symptoms would support the nurses suspicion?
B. Constant, severe epigastric pain; nausea and vomiting; and abdominal distension
What substance stimulates the CNS?
A. Crack
The nurse is educating a client about how to avoid sources of stimulation. What produces the least signifcant stimulation to the CNS?
