Mental Health Exam With Questions And 100% Correct Answers Already Graded A, Exams of Psychiatry

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Mental Health Exam With Questions And 100% Correct Answers

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 A 30-year-old sales manager tells the nurse, "I am thinking about a job change. I don't feel like I am living up to my potential." Which of Maslow'sdevelopmental stages is the sales manager attempting to achieve? A. Self-Actualization. Correct B. Loving and Belonging. C. Basic Needs. D. Safety and Security. Self-actualization is the highest level of Maslow's development stages, which is an attempt to fulfill one's full potential (C). (B) is identifying support systems. (C) is the first level of Maslow's developmental stages and is the foundation upon which higher needs rest. Individuals who feel safe and secure (D) in their environment perceive themselves as having physical safety and lack fear of harm.  The nurse observes a client who is admitted to the mental health unit and identifies that the client is talking continuously, using words that rhyme but that have no context or relationship with one topic to the next in the conversation. This client's behavior and thought processes are consistent withwhich syndrome? A. Dementia. B. Depression. C. Schizophrenia. Correct D. Chronic brain syndrome. The client is demonstrating symptoms of schizophrenia (C), such as disorganized speech that may include word salad (communication that includes both real and imaginary words in no logical order), incoherent speech, and clanging (rhyming).Dementia (A) is a global impairment of intellectual (cognitive) functions that may be progressive, such as Alzheimer's or organic brain syndrome (D). Depression (C) is typified by psychomotor retardation, and the client appears to be sloweddown in movement, in speech, and would appear listless and disheveled.

 The nurse is assessing a client's intelligence. Which factor should thenurse remember during this part of the mental status exam? A. Acute psychiatric illnesses impair intelligence. B. Intelligence is influenced by social and cultural beliefs. Correct C. Poor concentration skills suggests limited intelligence. D. The inability to think abstractly indicates limited intelligence. Social and cultural beliefs (B) have significant impact on intelligence. Chronic psychiatric illness may impair intelligence (A), especially if it remains untreated.Limited concentration does not suggest limited intelligence (C). Difficulties withabstractions are suggestive of psychotic thinking (D), not limited intelligence.  A young adult male client, diagnosed with paranoid schizophrenia, believesthat world is trying poison him. What intervention should the nurse include in this client's plan of care? A. Remind the client that his suspicions are not true. B. Ask one nurse to spend time with the client daily. Correct C. Encourage the client to participate in group activities. D. Assign the client to a room closest to the activity room. A client with paranoid schizophrenia has difficulty with trust and developing a trusting relationship with one nurse (B) is likely to be therapeutic for this client.

(A) is argumentative. Stress increases anxiety, and anxiety increases paranoid ideation; (C)

would be too stressful and anxiety-promoting for a client who is experiencing pathological suspicions. (D) also might increase anxiety and stress.  The nurse observes a female client with schizophrenia watching the news on TV. She begins to laugh softly and says, "Yes, my love, I'll do it." When thenurse questions the client about her comment she states, "The news

commentator is my lover and he speaks to me each evening. Only I can understand what he says." What is the best response for the nurse to make? A. What do you believe the news commentator said to you? Correct B. Let's watch news on a different television channel. C. Does the news commentator have plans to harm you or others? D. The news commentator is not talking to you. It is imperative that the nurse determine what the client believes she heard (A).The idea of reference may be to hurt herself or someone else, and the main function of a psychiatric nurse is to maintain safety. (B) is acceptable, but it is best to determine the client's beliefs. (C) is validating the idea of reference, while (D) is challenging the client.  A male client with mental illness and substance dependency tells the mentalhealth nurse that he has started using illegal drugs again and wants to seek treatment. Since he has a dual diagnosis, which person is best for the nurse to refer this client to first? A. The emergency room nurse. B. His case manager. Correct C. The clinic healthcare provider. D. His support group sponsor. The case manager (B) is responsible for coordinating community services, and since this client has a dual diagnosis, this is the best person to describe availabletreatment options. (A) is unnecessary, unless the client experiences behaviors that threaten his safety or the safety of others. (C and D) might also be useful, but it is most important at this time that a treatment program be coordinated tomeet this client's needs.  A male client is admitted to the psychiatric unit with a medical diagnosis ofparanoid schizophrenia. During the admission procedure, the client looks up and states, "No, it's not MY fault. You can't blame me. I didn't kill him, you did." What action is best for the nurse to take? A. Reassure the client by telling him that his fear of the admissionprocedure is to be expected.

B. Tell the client that no one is accusing him of murder and remind himthat the hospital is a safe place. C. Assess the content of the hallucinations by asking the client whathe is hearing.Correct D. Ignore the behavior and make no response at all to his delusional statements. Further assessment is indicated (C). The nurse should obtain information about what the client believes the voices are telling him--they may be telling him to killthe nurse! (A) is telling the client how he feels (fearful). The nurse should leave communications open and seek more information. (B) is arguing with the client's delusion, and the nurse should never argue with a client's hallucinations or delusions, also (B) is possibly offering false reassurance. (D) is avoiding the situation and the client's needs.  A child is brought to the emergency room with a broken arm. Because of other injuries, the nurse suspects the child may be a victim of abuse. When the nurse tries to give the child an injection, the child's mother becomes veryloud and shouts, "I won't leave my son! Don't you touch him! You'll hurt my child!" What is the best interpretation of the mother's statements? The mother is A. regressing to an earlier behavior pattern. B. sublimating her anger. C. projecting her feelings onto the nurse. Correct D. suppressing her fear. Projection is attributing one's own thoughts, impulses, or behaviors onto another--it is the mother who is probably harming the child and she is attributingher actions to the nurse (C). The mother may be immature, but (A) is not the best description of her behavior. (B) is substituting a socially acceptable feeling for an unacceptable one. These are not socially acceptable feelings. The mother may besuppressing her fear (D) by displaying anger, but such an interpretation cannot be concluded from the data presented.  A 45-year-old male client tells the nurse that he used to believe that he was Jesus Christ, but now he knows he is not. Which response is best for the nurse to make? A. Did you really believe you were Jesus Christ?

B. I think you're getting well. C. Others have had similar thoughts when under stress. Correct D. Why did you think you were Jesus Christ? (C) offers support by assuring the client that others have suffered as he has (alsothe principle on which Alcoholics Anonymous acts). (A) is belittling. (B) is makingan inappropriate judgment. You may have narrowed your choices to (C and D). However, you should eliminate (D) because it is a "why" question, and the clientdoes not know why!  A client on the psychiatric unit appears to imitate a certain nurse on the unit. The client seeks out this particular nurse and imitates her mannerisms.The nurse knows that the client is using which defense mechanism? A. Sublimation. B. Identification. Correct C. Introjection. D. Repression. Identification (B) is an attempt to be like someone or emulate the personality traits ofanother. (A) is substituting an unacceptable feeling for one that is more socially acceptable. (C) is incorporating the values or qualities of an admired person orgroup into one's own ego structure. (D) is the involuntary exclusion of painfulthoughts or memories from one's awareness.  An anxious client expressing a fear of people and open places is admitted to the psychiatric unit. What is the most effective way for thenurse to assist this client? A. Plan an outing within the first week of admission. B. Distract her whenever she expresses her discomfort about being with others. C. Confront her fears and discuss the possible causes of these fears. D. Accompany her outside for an increasing amount of time each day. Correct The process of gradual desensitization by controlled exposure to the situation which is feared (D), is the treatment of choice in phobic reactions. (A and C) arefar too aggressive for the

initial treatment period and could even be considered hostile. (B) promotes denial of the problem, and gives the client the message that discussion of the phobia is not permitted.  On admission, a highly anxious client is described as delusional. The nurse understands that delusions are most likely to occur with which class of disorder? A. Neurotic. B. Personality. C. Anxiety. D. Psychotic. Correct Delusions are false beliefs associated with psychotic behavior, and psychotic persons are not in touch with reality (D). (A, B, and C) are mental health disorderswhich are not associated with a break in reality, nor with hallucinations (false sensations such as hearing, or seeing) or delusions (false beliefs).  A client who has been admitted to the psychiatric unit tells the nurse, "Myproblems are so bad that no one can help me." Which response is best for thenurse to make? A. How can I help? Correct B. Things probably aren't as bad as they seem right now. C. Let's talk about what is right with your life. D. I hear how miserable you are, but things will get better soon. Offering self shows empathy and caring (A), and is the best of the choices provided. Combining the first part of (D) with (A) would be the best response, butthis is not a fill-in-the- blank or an essay test! Choose the best of those choices provided and move on. (B) dismisses the client, things are bad as far as this clientis concerned. (C) avoids the client's problems and promotes denial. "I hear how miserable you are" is an example of reflective dialogue and would be the best choice if it were not for the rest of the sentence--"but things will get better" which is offering false reassurance.

 The nurse plans to help an 18-year-old female mentally retarded client ambulate the first postoperative day after an appendectomy. When the nurse tells the client it is time to get out of bed, the client becomes angry and tells thenurse, "Get out of here! I'll get up when I'm ready!" Which response is best for the nurse to make? A. Your healthcare provider has prescribed ambulation on the first postoperative day. B. You must ambulate to avoid complications which could cause morediscomfort than ambulating. C. I know how you feel. You're angry about having to ambulate, but this willhelp you get well. D. I'll be back in 30 minutes to help you get out of bed and walkaround the room.Correct (D) provides a "cooling off" period, is firm, direct, non-threatening, and avoids arguing with the client. (A) is avoiding responsibility by referring to the healthcare provider. (B) is trying to reason with a mentally retarded client and isthreatening the client with "complications." (C) is telling the client how she feels(angry), and the nurse does not really "know" how this client feels, unless the nurse is mentally retarded and has just had an appendectomy!  A client who is diagnosed with schizophrenia is admitted to the hospital. The nurse assesses the client's mental status. Which assessment finding is mostcharacteristic of a client with schizophrenia? A. Mood swings. B. Extreme sadness. C. Manipulative behavior. D. Flat affect. Correct Disinterest, and diminished or lack of facial expression is characteristic of schizophrenia and is referred to as a flat affect (D). (A) is associated with bipolardisorder. (B) is associated with depression. (C) is usually associated with personality disorders and is often seen in clients who abuse substances.  A 19-year-old female client with a diagnosis of anorexia nervosa wantsto help serve dinner trays to other clients on a psychiatric unit. What action should the nurse take?

A. Encourage the client's participation in unit activities by asking her to passtrays for the rest of the week. B. Provide an additional challenge by asking the client to also help feed the older clients. C. Suggest another way for this client to participate in unit activities. Correct D. Tell the client that hospital policy does not permit her to pass trays. Anorexics gain pleasure from providing others with food and watching them eat.Such behaviors reinforce their perception of self-control. These clients should notbe allowed to plan or prepare food for unit activities and their desires to do so should be redirected (C). (A and B) are contraindicated for a client with anorexia nervosa. (D) avoids addressing the problem and is manipulative in that the nurseis blaming hospital policy for treatment protocol. 17.A nurse working on a mental health unit receives a community call from aperson who is tearful and states, "I just feel so nervous all of the time. I don'tknow what to do about my problems. I haven't been able to sleep at night and have hardly eaten for the past 3 or 4 days." The nurse should initiate a referral based on which assessment? A. Altered thought processes. B. Moderate levels of anxiety. Correct C. Inadequate social support. D. Altered health maintenance. The nurse should initiate a referral based on anxiety levels (B) and feelings of nervousness that interfere with sleep, appetite, and the inability to solve problems. The client does not report symptoms of (A) or evidence of (C). There isnot enough information to initiate a referral based on (D). 18.When preparing a teaching plan for a client who is to be discharged with a prescription for lithium carbonate (Lithonate), it is most important for the nurse to include which instruction? A. It may take 3 to 4 weeks to achieve therapeutic effects. B. Keep your dietary salt intake consistent. Correct C. Avoid eating aged cheese and chicken liver. D. Eat foods high in fiber such as whole grain breads.

Lithium's effectiveness is influenced by salt intake (B). Too much salt causesmore lithium to be excreted, thereby decreasing the effectiveness of the drug. Too little salt causes less lithium to be excreted, potentially resulting in toxicity. (A, C, and D) are not specific instructions pertinent to teaching about lithium carbonate (Lithonate). 19.A client who is known to abuse drugs is admitted to the psychiatric unit. Which medication should the nurse anticipate administering to aclient who is exhibiting benzodiazepine withdrawal symptoms? A. Perphenazine (Trilafon). B. Diphenhydramine (Benadryl). C. Chlordiazepoxide (Librium). Correct D. Isocarboxazid (Marplan). Librium (C), an antianxiety drug, as well as other benzodiazepines, are used in titrated doses to reduce the severity of abrupt benzodiazepine withdrawal. (A) is an antipsychotic agent. (B) is an antihistamine and antianxiety drug. (D) is anMAO inhibitor.

20. Which diet selection by a client who is depressed and taking the MAO inhibitor tranylcypromine sulfate (Parnate) indicates to the nurse that theclient understands the dietary restrictions imposed by this medication regimen? A. Hamburger, French fries, and chocolate milkshake. B. Liver and onions, broccoli, and decaffeinated coffee. C. Pepperoni and cheese pizza, tossed salad, and a soft drink. D. Roast beef, baked potato with butter, and iced tea. Correct Only (D) contains no tyramine. Tyramine in foods interacts with MAOI in thebody causing a hypertensive crisis which is life-threatening, and Parnate is classified as an MAOI antidepressant. Some items in (A, B, and C) contain tyramine and would not be permitted for a client taking Parnate. 21. On admission to a residential care facility, an elderly female client tells the nurse that she enjoys cooking, quilting, and watching television. Twenty-fours after admission, the

nurse notes that the client is withdrawn and isolated. It is best for the nurse to encourage this client to become involved in which activity? A. Clean the unit kitchen cabinets. B. Participate in a group quilting project. Correct C. Watch television in the activity room. D. Bake a cake for a resident's birthday. Peer interaction in a group activity (B) will help to prevent social isolation and withdrawal. (A, C, and D) are activities that can be accomplished alone, withoutpeer interaction.

22. The charge nurse is collaborating with the nursing staff about the plan of care for a client who is very depressed. What is the most important intervention to implement during the first 48 hours after the client's admissionto the unit? A. Monitor appetite and observe intake at meals. B. Maintain safety in the client's milieu. Correct C. Provide ongoing, supportive contact. D. Encourage participation in activities. The most important reason for closely observing a depressed client immediatelyafter admission is to maintain safety (B), since suicide is a risk with depression. (A, C, and D) are all important interventions, but safety is the priority. 23. The nurse is taking a history for a female client who is requesting a routinefemale exam. Which assessment finding requires follow-up? A. Menstruation onset at age 9. B. Contraceptive method includes condoms only. C. Menstrual cycle occurs every 35 days. D. Black-out after one drink last night on a date. Correct A "black-out" typically occurs after ingestion of alcohol beverages that the clienthas no recall of the experiences or one's behavior and is indicative of high bloodalcohol levels, but the client's experience of a "black-out" after one drink (D) is suspicious of the client receiving a

"date rape" drug (Flunitrazepam) and needs additional follow-up. Although (A and C) occur on the outer ranges of "average," both are within acceptable or "normal" ranges. (B) is an individual preference, but using condoms as the only contraceptive method carries a higher chance of conception.

24. A woman arrives in the Emergency Center and tells the nurse she thinks she has been raped. The client is sobbing and expresses disbelief that a rapecould happen because the man is her best friend. After acknowledging the client's fear and anxiety, how should the nurse respond? A. “I would be very upset and mad if my best friend did that to me.” B. “You must feel betrayed, but maybe you might have led him on?” C. “Rape is not limited to strangers and frequently occurs by someone who is known tothe victim.” Correct D. “This does not sound like rape. Did you change your mind about havingsex after the fact?” A victim of date rape or acquaintance rape is less prone to recognize what is happening because the incident usually involves persons who know each otherand the dynamics are different than rape by a stranger. (C) provides confrontation for the client's denial because the victim frequently knows and trusts the perpetrator. Nurses should not express personal feelings (A) when dealing with victims. Suggesting that the client led on the rapist (B)indicates that the sexual assault was somehow the victim’s fault. (D) is judgmental and does not display compassion or establish trust between thenurse and the client. 25. The nurse is assessing the parents of a nuclear family who are attending a support group for parents of adolescents. According to Erikson, these parentswho are adapting to middle adulthood should exhibit which characteristic? A. Loss of independence. B. Increased self-understanding. Correct C. Isolation from society. D. Development of intimate relationships. Middle adulthood is characterized by self-reflection, understanding, and acceptance (B), and

generativity or guidance of children. (A and C) are maladaptive behaviors in middle adulthood.

Although middle-aged adults maydelay or re-establish intimate relationships, (D) is initially developed during young adulthood.

26. At the first meeting of a group of older adults at a daycare center for the elderly, the nurse asks one of the members what kinds of things she would liketo do with the group. The older woman shrugs her shoulders and says, "You tell me, you're the leader." What is the best response for the nurse to make? A. Yes, I am the leader today. Would you like to be the leader tomorrow? B. Yes, I will be leading this group. What would you like to accomplishduring this time?Correct C. Yes, I have been assigned to be the leader of this group. I will be herefor the next six weeks. D. Yes, I am the leader. You seem angry about not being the leader yourself. Anxiety over participation in a group and testing of the leader characteristically occur in the initial phase of group dynamics. (B) provides information and focusesthe group back to defining its function. (A) is manipulative bargaining. Although

(A) provides information, it does not focus the group on its purpose or task. (D)

isinterpreting the client's feelings and is almost challenging.

27. A male adolescent is admitted with bipolar disorder after being released from jail for assault with a deadly weapon. When the nurse asks the teen to identify his reason for the assault, he replies, "Because he made me mad!" Which goal is best for the nurse to include in the client's plan of care? The clientwill A. outline methods for managing anger. B. control impulsive actions toward self and others. Correct C. verbalize feelings when anger occurs. D. recognize consequences for behaviors exhibited. Those with bipolar disorder often exhibit poor impulse control, and the most important goal for this client at this time is to learn to control impulsive behavior

(B) so that he can avert the social consequences related to such behaviors. (A, C,and D) are

important goals, but they do not address the acute issue of impulse control, which is necessary to reduce the likelihood of harming self or others.

28. The nurse should include which interventions in the plan of care for a severely depressed client with neurovegetative symptoms? (Select all that apply.) A. Permit rest periods as needed.Correct B. Speaking slowly and simply. C. Place the client on suicide precautions. D. Allow the client extra time to complete tasks. Correct E. Observe and encourage food and fluid intake. Correct F. Encourage mild exercise and short walks on the unit Correct (A, B, D, E, and F) should be included in this client's plan of care because these measures promote the client's comfort and well-being. Neurovegetative symptoms accompany the mood disorder of depression and include physiologicaldisruptions, such as anorexia, constipation, sleep disturbance, and psychomotor retardation. Suicidal ideation (C) does not usually accompany the neurovegetative state because the client does not have the energy or high level of anxiety associated with a suicide attempt. 29. An elderly female client with advanced dementia is admitted to the hospital with a fractured hip. The client repeatedly tells the staff, "Takeme home. I want my Mommy." Which response is best for the nurse toprovide? A. Orient the client to the time, place, and person. B. Tell the client that the nurse is there and will help her. Correct C. Remind the client that her mother is no longer living. D. Explain the seriousness of her injury and need for hospitalization.

Those with dementia often refer to home or parents when seeking security andcomfort. The nurse should use the techniques of "offering self" and "talking to the feelings" to provide reassurance (B). Clients with advanced dementia have permanent physiological changes in the brain (plaques and tangles) that prevent them from comprehending and retaining new information, so (A, C, and D) are likely to be oflittle use to this client and do not help the client's emotional needs.

30. The nurse is planning care for a 32-year-old male client diagnosed with HIVinfection who has a history of chronic depression. Recently, the client's viral load has begun to increase rather than decrease despite his adherence to the HIV drug regimen. What should the nurse do first while taking the client's history upon admission to the hospital? A. Determine if the client attends a support group weekly. B. Hold all antidepressant medications until further notice. C. Ask the client if he takes St. John's Wort routinely. Correct D. Have the client describe any recent changes in mood. St. John's Wort, an herbal preparation, is an alternative (nonconventional) therapy for depression, but it may adversely interact with medications used to treat HIV infection (C). The nurse's top priority upon admission is to determine ifthe client has been taking this herb concurrently with HIV antiviral drugs, whichmay explain the rise in the viral load. Asking about (A or D) may be helpful in gathering more data about the client's depressive state, but these issues do nothave the priority of (C). (B) may be harmful to the client. 31. A 22-year-old male client is admitted to the emergency center following asuicide attempt. His records reveal that this is his third suicide attempt in thepast two years. He is conscious, but does not respond to verbal commands for treatment. Which assessment finding should prompt the nurse to preparethe client for gastric lavage?

A. He ingested the drug 3 hours prior to admission to the emergency center. B. The family reports that he took an entire bottle of acetaminophen (Tylenol). C. He is unresponsive to instructions and is unable to cooperate withemetic therapy.Correct D. Those with repeated suicide attempts desire punishment to relieve their guilt. Because the client is unable to follow instructions, emetic therapywould be very difficult to implement and gastric lavage would be necessary (C). (A and B) should be considered in determining the course of treatment, but they are not the basis for determining ifgastric lavage will be implemented. Medical treatments should never be used as "punitive" measures (D).  The nurse is preparing to administer phenelzine sulfate (Nardil) to a client on the psychiatric unit. Which complaint related to administration ofthis drug should the nurse expect this client to make? A. My mouth feels like cotton. Correct B. That stuff gives me indigestion. C. This pill gives me diarrhea. D. My urine looks pink. A dry mouth (A) is an anticholinergic effect that is an expected side effect of MAOinhibitors such as phenelzine sulfate (Nardil). (B, C, and D) are not expected side effects of this medication.  The nurse is planning discharge for a male client with schizophrenia. The client insists that he is returning to his apartment, although the healthcare provider informed him that he will be moving to a boarding home. What is themost important nursing diagnosis for discharge planning? A. Ineffective denial related to situational anxiety. Correct B. Ineffective coping related to inadequate support. C. Social isolation related to difficult

interactions. D. Self-care deficit related to cognitive impairment.

The best nursing diagnosis is (A) because the client is unable to acknowledge the move to a boarding home. (B, C, and D) are potential nursing diagnoses, but denial is most important because it is a defense mechanism that keeps theclient from dealing with his feelings about living arrangements.  The nurse should hold the next scheduled dose of a client's haloperidol(Haldol) based on which assessment finding(s)? A. Dizziness when standing. B. Shuffling gait and hand tremors. C. Urinary retention. D. Fever of 102° F. Correct A fever (D) may indicate neuroleptic malignant syndrome (NMS), a potentially fatal complication of antipsychotics. The healthcare provider should be contactedbefore administering the next dose of Haldol. (A, B, and C) are all adverse effectsof Haldol which can be managed.  Within several days of hospitalization, a client is repeatedly washing thetop of the same table. Which initial intervention is best for the nurse to implement to help the client cope with anxiety related to this behavior? A. Administer a prescribed PRN antianxiety medication. B. Assist the client to identify stimuli that precipitates the ritualistic activity. C. Allow time for the ritualistic behavior, then redirect the client toother activities.Correct D. Teach the client relaxation and thought stopping techniques. Initially, the nurse should allow time for the ritual (C) to prevent anxiety. (A) mayhelp reduce the client's anxiety, but will not prevent ritualistic behavior resultingfrom the client's ineffective coping ability. (B) is a long-term goal of individual therapy, but is not directly related to controlling the behavior at this time. (D) lists techniques that can be used to assist the client in learning new ways of interrupting obsessive thoughts and resulting ritualistic behavior as

treatment progresses.

 A male client with schizophrenia who is taking fluphenazine decanoate (Prolixin decanoate) is being discharged in the morning. A repeat dose of medication is scheduled for 20 days after discharge. The client tells the nursethat he is going on vacation in the Bahamas and will return in 18 days. Whichstatement by the client indicates a need for health teaching? A. When I return from my tropical island vacation, I will go to theclinic to get myProlixin injection. Correct B. While I am on vacation and when I return, I will not eat or drink anythingthat contains alcohol. C. I will notify the healthcare provider if I have a sore throat or flu-like symptoms. D. I will continue to take my benztropine mesylate (Cogentin) every day. Photosensitivity is a side effect of Prolixin and a vacation in the Bahamas (with itstropical island climate) increases the client's chance of experiencing this side effect. He should be instructed to avoid direct sun (A) and wear sunscreen. (B, C,and D) indicate accurate knowledge. Alcohol acts synergistically with Prolixin (B). (C) lists signs of agranulocytosis, which is also a side effect of Prolixin. In order toavoid extrapyramidal symptoms (EPS), and C) would support the delusion.  The nurse is conducting discharge teaching for a client with schizophrenia who plans to live in a group home. Which statement is most indicative of theneed for careful follow-up after discharge? A. Crickets are a good source of protein. B. I have not heard any voices for a week. C. Only my belief in God can help me. Correct D. Sometimes I have a hard time sitting still. The most frequent cause of increased symptoms in psychotic clients is non-compliance with the medication regimen. If clients believe that "God alone" is going to heal them (C), then they may discontinue their medication, so (C) would

pose the greatest threat to this client's prognosis. (A) would require further teaching, but is not as significant a statement as (C). (B)indicates an improvement in the client's condition. (D) may be a sign ofanxiety that could improve with treatment, but does not have the priority of (C).  A 46-year-old female client has been on antipsychotic neuroleptics for the past three days. She has had a decrease in psychotic behavior and appears to be responding well to the medication. On the fourth day, the client's blood pressure increases, she becomes pale and febrile, and demonstrates muscularrigidity. Which action should the nurse initiate? A. Place the client on seizure precautions and monitor carefully. B. Immediately transfer the client to ICU. Correct C. Describe the symptoms to the charge nurse and record on the client's chart. D. No action is required at this time as these are known side effects of such drugs. These symptoms are descriptive of neuroleptic malignant syndrome (NMS) whichis an extremely serious/life threatening reaction to neuroleptic drugs (B). The major symptoms of this syndrome are fever, rigidity, autonomic instability, and encephalopathy. Respiratory failure, cardiovascular collapse, arrhythmias, and/orrenal failure can result in death. This is an EMERGENCY situation, and the client requires immediate critical care. Seizure precautions (A) are not indicated in this situation. (C and D) do not consider the seriousness of the situation.  A woman brings her 48-year-old husband to the outpatient psychiatric unit and describes his behavior to the admitting nurse. She states that he has been sleepwalking, cannot remember who he is, and exhibits multiple personalities. The nurse knows that these behaviors are often associated with A. dissociative disorder. Correct B. obsessive-compulsive disorder C. panic disorder. D. post-traumatic stress syndrome. Sleepwalking, amnesia, and multiple personalities are examples of detaching emotional conflict from one's consciousness, which is the definition of a dissociative disorder (A). (B) is characterized by persistent, recurrent intrusive thoughts or urges (obsessions) that are unwilled and cannot be ignored, and provoke impulsive acts (compulsions) such as handwashing. (C) is an acute attack of anxiety characterized by personality disorganization. (D) is re-experiencing a psychologically terrifying or distressing event that is outside the usual range of

 A client is admitted with a diagnosis of depression. The nurseknows that which characteristic is most indicative of depression? A. Grandiose ideation. B. Self-destructive thoughts. C. Suspiciousness of others. D. A negative view of self and the future. Correct Negative self-image and feelings of hopelessness about the future (D) are specificindicators for depression. (A and/or C) occurs with paranoia or paranoid ideation. (B) may be seen in depressed clients, but are not always present, so (D) is abetter answer than (B).  A client with bipolar disorder on the mental health unit becomes loud, andshouts at one of the nurses, "You fat tub of lard! Get something done around here!" What is the best initial action for the nurse to take? A. Have the orderly escort the client to his room. B. Tell the client his healthcare provider will be notified if he continuesto be verbally abusive. C. Redirect the client's energy by asking him to tidy the recreation room. Correct D. Call the healthcare provider to obtain a prescription for a sedative. Distracting the client, or redirecting his energy (C), prevents further escalation ofthe inappropriate behavior. (A) could result in escalating the abuse and unnecessarily involve another staff member in the abusive situation. (B) is a threat and is using a healthteam member (healthcare provider) as the threat. (D) may be indicated if the behavior escalates, but, at this time, the best initial action is (C).  A client, who is on a 30-day commitment to a drug rehabilitation unit, asks the nurse if he can go for a walk on the grounds of the treatment center. Whenhe is told that his privileges do not include walking on the grounds, the client becomes verbally abusive. Which approach should the nurse use? A. Call a staff member to escort the client to his room. B. Tell the client to talk to his healthcare provider about his privileges. C. Remind the client of the unit rules.

D. Ignore the client's inappropriate behavior. Correct The client is trying to engage the nurse in a dispute. Ignoring the behavior (D) provides no reinforcement for the inappropriate behavior. (A) is not necessaryunless the client becomes a physical threat to the nurse. (B) would be inappropriate, because it is referring the situation to the healthcare provider and is not in keeping with good health team management. Consistent limits must be established and enforced. (C) would subject the nurse to more verbalabuse because the client could use any response as an excuse to attack the nurse once again.  A nurse working in the emergency room of a children's hospital admits achild whose injuries could have resulted from abuse. Which statement most accurately describes the nurse's responsibility in cases of suspected child abuse? A. The nurse should obtain objective data such as x-rays before reportingsuspicions to the authorities. B. The nurse should confirm any suspicions of child abuse with thehealthcare provider before reporting to the authorities. C. The nurse should report any case of suspected child abuse to thenurse in charge.Correct D. The nurse should note in the client's record any suspicions of childabuse so that a history of such suspicions can be tracked. It is the nurse's legal responsibility to report all suspected cases of child abuse.Notifying the charge nurse starts the legal reporting process (C).  A 38-year-old female client is admitted with a diagnosis of paranoid schizophrenia. When her tray is brought to her, she refuses to eat and tells thenurse, "I know you are trying to poison me with that food." Which response is most appropriate for the nurse to make? A. I'll leave your tray here. I am available if you need anything else. Correct B. You're not being poisoned. Why do you think someone is trying to poison

you?

C. No one on this unit has ever died from poisoning. You're safe here. D. I will talk to your healthcare provider about the possibility of changing your diet. A) is the best choice cited. The nurse does not argue with the client nor demand that she eat, but offers support by agreeing to "be there if needed", e.g., to warmthe food. (B and C) are arguing with the client's delusions, and (B) asks "why" which is usually not a good question for a psychotic client. (D) has nothing to do with the actual problem; i.e., the problem is not the diet (she thinks any food given to her is poisoned.)  An adult male client who was admitted to the mental health unit yesterdaytells the nurse that microchips were planted in his head for military surveillance of his every move. Which response is best for the nurse to provide? A. You are in the hospital, and I am the nurse caring for you. B. It must be difficult for you to control your anxious feelings. C. Go to occupational therapy and start a project. Correct D. You are not in a war area now; this is the United States. Delusions often generate fear and isolation, so the nurse should help the clientparticipate in activities that avoid focusing on the false belief and encourage interaction with others (C). Delusions are often well-fixed, and though (A) reinforces reality, it is argumentative and dismisses the client's fears. It is often difficult for the client to recognize the relationship between delusions and anxiety (B), and the nurse should reassure the client that he is in a safe place. Dismissing delusional thinking (D) is unrealistic because neurochemical imbalances that cause positivesymptoms of schizophrenia require antipsychotic drug therapy.  The wife of a male client recently diagnosed with schizophrenia asks thenurse, "What exactly is schizophrenia? Is my husband all right?" Which response is best for the nurse to provide to this family member? A. It sounds like you're worried about your husband. Let's sit down and talk. B. It is a chemical imbalance in the brain that causes disorganized thinking. Correct C. Your husband will be just fine if he takes his medications regularly.