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PSYCHIATRIC MENTAL HEALTH NURSING
EXIT EXAM WITH CORRECTLY ANSWERS
QUESTIONS
- Which intervention reflects attention being focused on the patient’s intentions regarding his diagnosis of severe depression? a. Being placed on suicide precautions b. Encouraging visits by his family members c. Receiving a combination of medications to address his emotional needs d. Being asked to decide where he will attend his prescribed therapy sessions
- What is the best explanation to offer when the mother of a chronically ill teenage patient asks, “Under what circumstances would he be considered incompetent?” “When you can provide the court with enough evidence to show that he is not a. able to care for himself safely.” “It is not likely that someone his age would be determined to be incompetent b. regardless of his mental condition.” “He would have to engage in behavior that would result in harm to himself or c. to someone else; like you or his siblings.” d. “If the illness becomes so severe that his judgment is impaired to the point
where the decisions he makes are harmful to himself or to others.”
- Which assessment findings suggest to the nurse that this patient has characteristics seen in an individual who has reached self-actualization? Select all that apply. a. Reports to have, “found peace and security in my religious faith” b. Effectively “changed occupations” when a chronic vision problem worsened c. Has consistently earned a six-figure salary as an architect for the last 10 years Has been in a supportive, loving relationship with the same individual for 15 d. years Provides free literacy tutoring help at the local homeless shelter 3 evenings a e. week ANS: A, B, D, E
- The nurse is attempting to provide a safe environment for a patient at great risk for self-harm. Which intervention shows an understanding of evidence- based practice (EBP)? Using physical restraints only after all other options have been proven a. ineffective Referring to the facility’s policies manual for guidelines for applying physical b. restraints
Collecting data regarding the short-term effects of using physical restraints on c. an aggressive patient Requiring constant monitoring of a patient whose inability to self-regulate d. anger has required the use of physical restraints
- Which statement by the patient reflects patient education that was based on the concept of integrated patient care? a. “I know I’m anxious when I get a tension headache.” b. “My anxiety is a result of stressors I don’t cope well with.” c. “Medication has helped me tremendously with anxiety control.” d. “Anxiety runs in my family; my entire family is trying to deal with it.”
- Which nursing intervention would be appropriately addressed during the orientation phase of the nurse–patient relationship? Self reflection by the nurse regarding personal biases and prejudices regarding a. the patient Patient works at prioritizing personal needs and develops realistic expected b. outcomes Establishing the contract between the nurse and the patient regarding mutual c. needs and expectations
Patient commits to the reinforcement of positive personal characteristics while d. working on problems and concerns
- When preparing to conduct a nursing history and assessment on a patient transferred from the emergency department (ED) whose family believes the patient to be a questionable historian due to cognitive impairment, the nurse initially begins the interview by: a. Reviewing the ED chart b. Contacting the admitting physician c. Directing the questions to the family members d. Establishing a line of communication with the patient
- While discussing assessment of suicidal patients, a novice nurse mentions, “I was taught to always base my care on concrete, evidence-based scientific reasoning and never to rely on intuition.” Which response by the experienced nurse shows understanding of intuitive reasoning? “That’s wise, because intuition went out of favor with the scientific a. revolution.” “Critical thinking and intuition are at opposite poles. Keep relying on your b. expertise.” “It’s possible that intuition about suicidality is generated by transfer of c. feelings from the patient to the nurse.”
“It’s been determined that intuition is nothing more that extrasensory d. perception, so some folks have it, and some don’t.”
- The nurse shows an understanding of the appropriate use of nursing outcomes regarding triggers for a patient diagnosed with chronic alcohol abuse when stating: “Can you work on identifying three situations that cause you to abuse a. alcohol?” ”I’ll help you to identify three triggers for your drinking during today’s b. session.” ”I’m pleased you’ve identified three situations that trigger your abuse of c. alcohol.” “Do you think you will be able to avoid the three triggers that cause you to d. drink?”
- The nurse suspects that the patient’s communication is being negatively influenced by personal attitude when he is heard stating: a. “They think I’m mentally ill but I’m not; I just get a little depressed at times.” “I can’t concentrate on anything besides getting out of here and back to my b. kids.” “Obviously my therapist can’t understand where I’m coming from because c. our lives are so different.”
“There isn’t anyone here in this hospital I can trust enough to talk to about d. why I abuse alcohol and drugs.”
- A patient expresses a sense of genuineness in the nurse providing care when sharing with family members that: a. “I believe the nurse can feel what I’m feeling.” “I always know what the nurse expects of me; the explanations are always b. clear.” “I can tell the nurse is sincere because the face supports what the mouth is c. saying.” “I may not always like what the nurse has to say but I can always depend on d. what I’m told.”
- The nurse has developed a plan in which nursing interventions are used to reinforce the patient’s healthy behaviors. Which statement by the nurse will positively reinforce the patient’s efforts regarding the plan? a. “How can a stress reduction plan help you at home?” b. “It sounds like you have the incentive to make healthy choices.” c. “When you tried to follow the plan, how well did it work for you?” d. “It sounds as though making healthy choices is very important to you.”
- Although stress may result from either a positive or a negative event, the physical effects are similar. Which statement best describes the long term effects of stress? a. Eustress is likely to result in short term stress. b. Chronic distress can take a toll on the individual. c. Stress usually manifests in physical symptoms first. d. Distress generally results in more effective coping skills.
- When explaining the fight-or-flight response to stress, the nurse identifies that the role of the pituitary gland is to: a. Minimize the secretion of cortisol. b. Facilitate the conservation of energy. c. Secrete adrenocorticotropic hormone. d. Encourage fleeing from the stressor.
- A nurse manager is attempting to address issues of work-related stress and dissatisfaction on the unit. Which administrative intervention has been identified through research as providing the most positive impact on staff morale even when job demands are high? a. Scheduling so that all staff gets two weekends off a month
b. Arranging for extra staff when patient activity is above the unit average c. Offering a paid vacation day to anyone who has no absents for six months d. Assuring that no staff will be mandated overtime more than twice monthly
- A patient with depression mentions to the nurse, “My mother says depression is a chemical disorder. What does she mean?” The nurse’s response is based on the theory that depression primarily involves which of the following neurotransmitters? a. Cortisol and GABA b. COMT and glutamate c. Monamine and glycine d. Serotonin and norepinephrine
- A patient has experienced a stroke (cerebral vascular accident) that has resulted in damage to the Broca area. Which evaluation does the nurse conduct to reinforce this diagnosis? a. Observing the patient pick up a spoon b. Asking the patient to recite the alphabet
c. Monitoring the patient’s blood pressure d. Comparing the patient’s grip strength in both hands
- A patient asks the nurse, “My wife has breast cancer. Could it be caused by her chronic depression?” Which response is supported by research data? a. “Too much stress has been proven to cause all kinds of cancer.” b. “There have been no research studies done on stress and disease yet.” c. “Stress does cause the release of factors that suppress the immune system.” “There appears to be little connection between stress and diseases of the d. body”
- An adolescent has been a consistently, poor academic student due to a learning disorder. Which statement overheard by the nurse would support the possibility of a problem with the developmental stage competence versus inferiority? a. “It’s too hard to get good grades.” b. “I’ll never be able to get into a good college.” c. “My parents are disappointed that I do so poorly in school.”
d. “I don’t want people to know I can barely read or write.”
- The parents of an 8-year-old are attempting to help their child comprehend new information. Which intervention suggested by the nurse shows an understanding of the cognitive development theory for this age group? a. The use of drawing and illustrations b. Comparing the child’s experiences to the new material c. Encouraging the child to talk about this new information d. Asking the child to give a reason for how they feel about new information
- Which developmental level would be characterized by a child being able to focus, to coordinate, and to imagine a series of events? a. Preoperational b. Concrete operational c. Formal operational d. Postoperational
- A culturally diverse patient refuses to participate in a group because of the presence of a person who “can put spells on.” The nurse recognizes a priority need to explore this patient’s: a. Economic status b. Home environment c. Health-illness beliefs d. Educational background
- The nurse plans to use pamphlets to teach a newly immigrated Vietnamese patient about diabetes mellitus. Before initiating this education, the priority information for the nurse to obtain is the patient’s: a. Ability to read and understand English b. Readiness and ability to learn this material c. Previous knowledge and interest in the subject d. Willingness to participate and follow instructions
- A patient diagnosed with paranoid schizophrenia is describing religiously- based delusions that other patients find offensive. Which nursing intervention will the nurse implement to provide a therapeutic milieu? a. Engaging the delusional patient in prayer in order to redirect the problematic
behavior Explaining to the delusional patient that such talk is offensive to some of the b. milieu and will not be allowed Asking for the pastoral counselor to visit the unit and talk with both the c. delusional patient as well as the rest of the milieu Removing the delusional patient from the milieu when staff is unable to d. successfully refocus the conversation to a non-religious topic
- The nurse identifies a patient as being in spiritual distress. Which patient statement supports this nursing diagnosis? a. “I’ve never felt so alone before in my entire life.” b. “I don’t know if I could get through this without faith in God.” c. “I’ve always relied on my faith in God but now I feel I’ve been abandoned.” d. “Why do bad things happen to good people? I’ve always been a good person.”
- A patient was placed in restraints for 2 hours in order to help manage impulsive, destructive, unsafe behavior. Which statement made by the charge nurse during a meeting to discuss the incident shows an understanding of the need to use restraints only as a last resort? a. “How did this situation get so out of control?”
b. “You all know that restraints are used only as a last resort.” c. “Can anyone tell me why restraints were used on this patient?” d. “Let’s review what exactly happened that led to the use of restrains.”
- The nurse is explaining the advantage of advanced directives to a patient diagnosed with schizophrenia. Which psychiatric outcome is a result of such preplanning? a. Allows healthcare providers to manage the patient’s mental health care b. Decreases the possibility that the patient will be committed involuntarily Directly impacts the type of care the patient will receive as the disease c. progresses Assures that the patient will retain continued autonomy and independence of d. living
- Electroconvulsive therapy (ECT) has been prescribed for a patient diagnosed with chronic depression. Which statement by the patient helps assure the nurse that the patient’s right to informed consent has been respected? a. “ECT treatment will cure my depression.” b. “ECT is dangerous but I’m almost out of treatments.”
c. “I may not remember things that happened just before the ECT treatment.” d. “I’m likely to permanently lose memory of things like dates and numbers.”
- Discharge preparation for a patient includes the administration of the Hamilton Anxiety Scale (HAS). When asked by the patient to explain the purpose of the assessment the nurse responds: a. “It is an assessment tool used to evaluate the symptoms of anxiety.” b. “The tool is used to help confirm the diagnosis of anxiety disorder.” c. “This tool helps determine if your symptoms have improved with treatment.” d. “It helps identify the presence of any other disorder associated with anxiety.”
- The patient was an awkward child who was ridiculed by his father for his inability to catch a ball. As an adult, the patient developed panic attacks at the time his company established after-work team sporting activities. Which data discussed during the nursing interview provides insight to the possible cause of this anxiety disorder when applying the behavioral model? a. He always avoids sports because “I’m short and not the least bit athletic.” When in fifth grade, the patient caused his team to “lose the big softball b. game.” c. The company he works for places tremendous emphasis of successful team
work. As a child he wore a leg brace that prevented him from participating in school d. sports.
- A college-aged patient complains that, “when I begin to take a test, I freeze up and my mind goes blank.” The nurse will react based on the understanding that this patient’s anxiety level is: a. Mild b. Moderate c. Severe d. Panic
- Which question would the nurse performing an admission interview for a patient with suspected dissociative amnesia disorder identify as a priority? a. “What help would you like us to give you?” b. “Are you experiencing a high level of anxiety?” c. “Do you find rituals make you feel more comfortable?” d. “How would you describe your childhood memories?”
- A diagnosis of dissociative identity disturbance has been identified for a patient who has stated that he is unable to distinguish between himself and his surroundings. What is an appropriate outcome for this patient? a. Refers to himself as “the patient” b. Identifies the onset of increasing anxiety c. Uses manipulative behaviors to meet needs d. Displays ability to suppress feelings of dissatisfaction
- A patient comes to the ED stating that he suddenly became deaf. It is determined that his wife has recently asked for a divorce. What is the basis for the possibility that this patient is experiencing a conversion disorder? a. Inventing the symptom helps in diverting attention from the marital problems. b. Such a traumatic life change is likely to result in some form of mental illness. c. The loss is a protective mechanism to help deal with overwhelming anxiety. Men often exhibit this disorder since it is more accepted than showing d. sadness.
- What is the priority nursing diagnosis for a patient exhibiting signs of acute mania that include exaggerated physical activity, agitation, insomnia, and anorexia?
a. Risk for injury b. Chronic low self-esteem c. Noncompliance d. Insomnia
- An inappropriately dressed patient has not slept for 3 days while making excessive, expensive long-distance phone calls. When the patient can be heard singing loudly in the examining room, the nurse makes initial plans to focus on: a. Assessing needs for food, liquids, and rest b. Setting strict limits on dress and behavior c. Conducting an in-depth suicide assessment d. Obtaining a complete psychosocial assessment
- A patient who has been taking lithium carbonate 300 mg tid comes to the Outpatient Department with a list of medications he is taking. Which of the medications on the list would require re-evaluation of lithium dosage? a. HydroDIURIL daily b. Navane bid
c. Ativan at bedtime d. Cefobid daily
- A newly admitted patient has the diagnosis of catatonic schizophrenia. Which behavior observed in the patient supports that diagnosis? a. Uses a rhyming form of speech b. Refuses to eat any unwrapped foods c. Laughs when watching a sad movie d. Maintains an immobilized state for hours
- What is the priority nursing diagnosis for a catatonic patient? a. Ineffective coping b. Impaired physical mobility c. Impaired social interaction d. Risk for deficient fluid volume
- Which initial short-term outcome would be appropriate for a patient who was admitted expressing delusional thoughts?
a. Accept that delusion is illogical. b. Distinguish external boundaries. c. Explain the basis for the delusions. d. Engage in reality-oriented conversation.
- A 19-year-old patient is admitted for the second time in 9 months and is acutely psychotic with a diagnosis of undifferentiated schizophrenia. The patient sits alone rubbing her arms and smiling. She tells the nurse her thoughts cause earthquakes and that the world is burning. The nurse assesses the primary deficit associated with the patient’s condition as: a. Social isolation b. Disturbed thinking c. Altered mood states d. Poor impulse control
- By discharge, which outcome is appropriate for a patient who hears voices telling him he is evil? a. Respond verbally to the voices. b. Verbalize the reason the voices say he is evil.
c. Identify events that increase anxiety and promote hallucinations. d. Integrate the voices into his personality structure in a positive manner.
- When analyzing the behaviors of a 23-year-old who meets the criteria for antisocial personality disorder, the nurse recognizes that which nursing diagnosis would be pertinent to his care? a. Risk for self-mutilation b. Disturbed personal identity c. Impaired social interaction d. Social isolation
- When planning care for a patient with antisocial personality disorder, which consideration has greatest importance? a. Addressing the demand for constant attention b. Teaching coping skills related to frustration tolerance c. Identifying behaviors related to well-developed superegos
d. Managing the manipulative behaviors resulting from a charming persona
- A 27-year-old woman diagnosed with borderline personality disorder displays a labile affect, impulsivity, frequent angry outbursts, and difficulty tolerating her angry feelings without self-injury. A priority nursing diagnosis for this patient is: a. Anxiety b. Risk for self-mutilation c. Risk for other-directed violence d. Ineffective coping
- Which patient response would support the conclusion that the patient has moved into the ‘dark side’ of a narcotic addition? a. “I’ve been abusing drugs for at least 10 years.” b. “Drugs makes me feel good; that why I use them.” c. “I don’t like the way I feel when I don’t use drugs.” d. “Drugs are something that I can either take or leave”
- If an individual is admitted with a diagnosis of Wernicke- Korsakoff’s syndrome, the nurse would expect to assess:
a. Peptic ulcer b. Vivid illusions c. Cognitive deficits d. Auditory hallucinations
- A patient diagnosed with moderate dementia consistently appears to be distorting the truth resulting in his wife asking, “What should I do when he lies to me about unimportant things?” Upon what rationale should the nurse’s response be based? a. Changing the topic provides diversion. b. Delusions should be confronted to clarify thinking. c. Ignoring memory deficit avoids catastrophic reactions. d. This isn’t lying but rather a way to fill in the memory gaps.
- The nurse is to perform a complete assessment of a patient in her home, using the Mini-Mental State Examination (MMSE) as one component. When the nurse arrives, the patient is seated at the table with her husband, the TV is on, and several grandchildren are visiting. The patient is quiet, but her hands are gripped tightly, and she is staring at the ceiling. The best action for the nurse to take would be which of the following? a. Ask the husband to make an appointment to bring his wife to the clinic for
testing. Explain to the husband that accurate data will be sought, and ask him to stay b. with the grandchildren in another room. Do not perform the test during the assessment (because it will not be valid) c. and rely on observations and reports from the family. Explain the importance of the testing process and make an appointment for d. another day when the environment can be better controlled.
- A patient has been admitted with a diagnosis of hypoactive delirium. Which nursing intervention is supported by this diagnosis? a. Encouraging fluids to minimize constipation b. Frequently assessing both visual and auditory hallucinations c. Scheduling frequent changing of position to prevent skin breakdown d. Dimming the lights to help control eye discomfort resulting from cataracts
- For which medication will the nurse prepare material for the family of a patient diagnosed with mild to moderate Alzheimer’s disease? (Select all that apply.) a. Tacrine (Cognex)
b. Donepezil (Aricept) c. Haloperidol (Haldol) d. Rivastigmine (Exelon) e. Galantamine (Razadyne) ANS: A, B, D, E The only drug that is not generally prescribed for Alzheimer’s disease is Haldol.
- The nurse is assessing a child with autism. Which of the following behaviors would the nurse expect to observe? a. Referring to their imaginary friend, Skipper b. Asking to telephone ‘my friends’ on the weekends c. Repeating, ‘milk, milk, milk, milk’ until given a drink d. Is insistent that a dim light be left on in the bedroom at night
- Which behavior best supports the diagnosis of attention-deficit/hyperactivity disorder in an 8-year-old child? a. Cries when separated from his mother or father
b. Refuses to pick up toys as instructed by his parents c. Is fascinated with spinning and moving toys and objects d. Can concentrate on school work for only very short periods of time
- Which behavior is most characteristic of a conduct disorder? a. Frequently getting up and interrupting while being read to b. Only apologizes for hitting a friend to avoid being punished c. Finds it difficult to spend the night away from family members d. Becomes extremely agitated when the television is turned off
- Which behaviors would support a diagnosis of oppositional-defiant disorder? a. Exhibits involuntary facial twitching and blinking and makes barking sounds Negative, hostile, and spiteful toward parents and blames others for b. misbehavior Displays high anxiety when away from parents, has nightmares, and fears c. being kidnapped