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PSYCHIATRIC MENTAL HEALTH NURSING TEST PART 1
All the questions in the quiz along with their answers are shown below. Your answers are bolded. The correct answers have a green background while the incorrect ones have a red background.
- Your patient is very dependent and submissive. There are times that the patient is very clingy. This behavior reflects what type of personality disorder? ▪ a. Antisocial personality ▪ b. Dependent Personality ▪ c. Manic behavior
▪ D. ANXIETY DISORDER
Dependent personality is characterized by dependence, submission and being clingy. Antisocial personality is impulsive, aggressive and manipulative.
- The appropriate therapeutic distance between you and a psychiatric patient is? ▪ a. 12 inches ▪ b. 35 inches ▪ c. 12 feet
▪ D. 4 FEET
Intimate zone: 0-18 inches. Parents with young children, people who mutually desire personal contact, or people whispering. Personal zone: 18-36 inches. Between family and friends talking. Social zone: 4- 12 feet. Communication in social, work and business settings. Public zone: 12-25 inches. Speaker and an audience. Therapeutic distance: 3-6 feet.
- Nurse Anna is instructing the new nurse to the psychiatric set-up. She also reminded her to use her therapeutic communication skills in dealing with clients. Which of the following techniques enlaces therapeutic communication? ▪ a. What are you thinking about? ▪ b. What made you think that way? ▪ c. Why did you say that?
▪ D. LET’S NOT TALK ABOUT THAT. WHAT DO YOU THINK?
This is using the therapeutic technique BROAD OPENING that allows the client to take the initiative to introduce a topic.
- Mr. Juan is diagnosed with Alzheimer’s disease. The nurse’s intervention should focus on helping the client be oriented with the physical set-up and daily events. Which of the following is the most effective nursing intervention in orienting patients who has Alzheimer’s disease?
▪ a. Encourage the client to talk to family members to reminisce things ▪ b. Provide simple and easily understood directions ▪ c. Perform tasks with a variety of activities each day
▪ D. HAVE THE CLIENT SOCIALIZE WITH OTHER PATIENTS
Providing a daily routine and directions easily understood by the client would help orienting a client with Alzheimer’s disease.
- A therapy that focuses on the remotivation of clients by directing their attention outside themselves to relieve preoccupation with personal thoughts, feelings, and attitudes is known as: ▪ a. Pharmacologic therapy
- When the client told the nurse that he feels good when he mutilates or cuts himself the novice psychiatric nurse answered, “Do you know the risks involved when you cut yourself?” what type of nontherapeutic communication is the nurse using? ▪ a. Defending ▪ b. Testing ▪ c. Making stereotyped comments
▪ D. DISAGREEING
Testing is appraising a client’s degree of insight such as by asking the patient of the risks involved when he cut himself. This forces the client to recognize his problems. Defending is attempting to protect someone from a verbal attack. Stereotyped comments are meaningless clichés such as “it’s for your own good.” 10.A therapy that assists with discharge planning and rehabilitation, focusing on vocational skills and activities of daily living (ADL) to raise self-esteem and promote independence is called: ▪ a. Behavior modification ▪ b. Milieu therapy ▪ c. Recreational therapy
▪ D. OCCUPATIONAL THERAPY
Occupational therapy - Assists with discharge planning and rehabilitation, focusing on vocational skills and activities of daily living (ADL) to raise self-esteem and promote independence 11.Nurse Marie is caring for a patient that underwent alcohol detoxification. Which of the following symptoms would Nurse Marie be most concern? ▪ a. Fever ▪ b. Delusions ▪ c. Excessive sweating
▪ D. INCREASE BP
Once hallucinations and delusions are present; the client’s condition will most likely progress to delirium tremens. 12.The Distance that is observed when family members or friends are talking is under what zone: ▪ a. Intimate ▪ b. Therapeutic ▪ c. Personal
▪ D. SOCIAL
Personal zone: 18-36 inches. Between family and friends talking. Intimate zone: 0-18 inches. Parents with young children, people who mutually desire personal contact, or people whispering. Social zone: 4-12 feet. Communication in social, work and business settings. Therapeutic distance: 3-6 feet. 13.The client is sharing Nurse Marie about his experiences. Suddenly, he paused, looked to the nurse and is hesitant to continue. The nurse responded, “Go on, and tell me about it.” What therapeutic communication technique is the nurse using? ▪ a. Exploring ▪ b. Focusing ▪ c. Encouraging expression
▪ D. GENERAL LEADS
General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. They also encourage the client to continue if he or she is hesitant or uncomfortable of the topic. Examples include, “Go on,” “Tell me about it,” and “And then?”
15.An 18 year old client is brought to the ER due to a suicidal attempt. Her mother told the nurse that she has been drinking alcohol for the last 3 weeks and is depressed. In caring for this patient what is the most important consideration? ▪ a. Administering antidepressant medications ▪ b. Alcohol detoxification ▪ c. Allowing the client to participate in a therapy
▪ D. CLOSE MONITORING
Safety is the most important consideration in client with a suicidal attempt. This is achieved by removing harmful objects around the client and monitoring the client closely. 16.In using a therapeutic communication technique interpreting client cues and signals is very important. Clear statements of intent such as the client saying that he wants to kill himself is a/an: ▪ a. Covert cues ▪ b. Abstract messages ▪ c. Concrete messages
▪ D. OVERT CUES
Overt cues are clear statements of intent such as the client saying, “I want to die.” Covert cues are vague or hidden messages such as if a client verbalizes, “No one can help me.” Abstract messages are unclear patterns of words that often contain figures of speech that are difficult to interpret. Example is when the nurse asked the client, “What are you doing here?” Concrete messages are patterns of words that the nurse uses where words are explicit and does need an explanation. 17.A client was admitted due to self-mutilation. One day during one of the sessions, the client told the nurse that cutting himself feels great. What would be the nurse’s best response? ▪ a. “Do you know the risks involved when you cut yourself?” ▪ b. “I don’t want to hear about that!”
▪ C. “THE BEHAVIOR OF CUTTING IS NOT ACCEPTABLE.”
▪ d. “Tell me more about that.” Presenting reality is the best in this situation as it is obvious that the client is misinterpreting the reality. Asking the client to tell the nurse more about is validating the actions of cutting himself. 18.A behavior that can indicate the speaker’s thoughts, feelings, needs and values that he or she acts out unconsciously is called: ▪ a. Verbal communication ▪ b. Communication
▪ C. NONVERBAL COMMUNICATION
▪ d. Congruent message Nonverbal communication is the behavior that accompanies verbal content such as body language, eye contact, facial expression, tone of voice, speed and hesitations in speech, grunts and groans and
distance from the listeners. This type of communication can indicate the speaker’s thoughts, feelings, needs and values that he or she acts out unconsciously. 19.Restraints are only used for a certain reason. Which of the following is an appropriate reason for placing a client in restraints? ▪ a. Punishment for stealing the other client’s things
▪ B. SELF- HARMING BEHAVIORS
▪ c. Verbal abuse
24.What is the most important criteria that must be accomplished by the nurse before dealing with psychiatric patients? ▪ a. Salary rate
▪ B. SELF-AWARENESS
▪ c. Self-understanding ▪ d. Standard of nursing practice Before a nurse can understand him/herself, being aware of what his/her strengths, weaknesses, limitations, belief and principles is very essential. A nurse who barely knows and understand herself cannot effectively establish a therapeutic communication with psychiatric clients. 25.If a client is a chain smoker, how should his medication dosage be adjusted? ▪ a. Same medication dose
▪ B. INCREASE THE DOSE
▪ c. Decrease the dose ▪ d. Withhold the dose Smoking cigarettes increases the metabolism of some psychiatric medications, thus, medication dose should be increased.
bothersome, or foolish would convey disapproval, impede trust and rapport, promote dysfunctional behavior, and worsen anxiety.
- Nurse Luz is formulating a short-term goal for a client suffering from a severe obsessive- compulsive disorder (OCD). An appropriately stated short-term goal is that after 1 week, the client will: ▪ a. Demonstrate decreased anxiety. ▪ b. Participate in a daily exercise group. ▪ c. Identify the underlying reasons for rituals.
▪ D. STATE THAT THE RITUALS ARE IRRATIONAL.
Participating in a daily exercise group refocuses the client's time toward adaptive activities and may reduce anxiety. Option A isn't stated specifically enough to allow for evaluation; for this goal to be measurable, specific objectives must be stated such as, "The client will verbalize feeling less anxious." Option C is incorrect because identifying the
underlying reasons for rituals takes time and isn't a realistic goal after 1 week. Most clients with OCD are aware that the ritual is irrational but can't stop it, making option D inappropriate as well.
- Because antianxiety agents such as chlordiazepoxide (Librium) can potentiate the effects of other drugs, nurse Raquel should incorporate which of the following instructions in her teaching plan? ▪ a. Avoid mixing antianxiety agents with alcohol or other central nervous system (CNS) depressants ▪ b. Avoid taking antianxiety drugs at bedtime ▪ c. Avoid taking antianxiety drugs on an empty stomach
▪ D. AVOID CONSUMING AGED CHEESE WHEN TAKING ANTIANXIETY
AGENTS
Potentiating effect refers to a drug's ability to increase the potency of another drug if taken together. Therefore, the client should be instructed to avoid alcohol while taking Librium because it potentiates the drug's CNS depressant effect. Taken at bedtime, this drug will induce sleep. Librium comes in capsule form and usually can be taken with water. Aged cheese is restricted with monoamine oxidase inhibitors, not Librium.
- Danilo, arrives on the psychiatric unit exhibiting extreme excitement, disorientation, incoherent speech, agitation, frantic and aimless physical activity, and grandiose delusion. Which nursing diagnosis takes highest priority for the client at this time? ▪ a. Ineffective individual coping ▪ b. Hopelessness ▪ c. Risk for injury
▪ D. DISTURBED IDENTITY
This client is at increased risk for injury because of severe hyperactivity, disorientation, and agitation. Although the other options also are appropriate, the client's safety takes highest priority. The nurse should take immediate action to protect the client from injury.
- Gina, age 18, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the fall semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the psychiatric unit where she is diagnosed with conversion disorder. The client asks nurse Rose, "Why has this happened to me?" What is the nurse's best response? ▪ a. "You've developed this paralysis so you can stay with your parents. You must deal with this conflict if you want to walk again." ▪ b. "It must be awful not to be able to move your legs. You may feel better if you realize the problem is psychological, not physical." ▪ c. "Your problem is real but there is no physical basis for it. We'll work on what is going on in your life to find out why it's happened."
▪ a. "Take this medication. It will reduce your anxiety." ▪ b. "Do you have any concerns about taking the medication?" ▪ c. "Trust us. This medication has helped many people. We wouldn't have you take it if it were dangerous."
▪ D. "HOW CAN WE HELP YOU IF YOU WON'T COOPERATE?"
Providing an opportunity for the client to express concerns about a new medication and to make a choice about taking it can help the client regain a sense of control over his life. The client has the right to refuse the medication. Instead of simply ordering the client to take it, as in option A, the nurse should provide the information the client needs to make an informed decision. Attempting to make the client feel guilty, as in option C, or threatening the client, as in option D, would increase anxiety.
- After seeking help at an outpatient mental health clinic, a client who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, the client returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for this client? ▪ a. Exploring the meaning of the traumatic event with the client ▪ b. Allowing the client time to heal ▪ c. Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle
▪ D. RECOMMENDING A HIGH-PROTEIN, LOW-FAT DIET
The client with PTSD needs encouragement to examine and understand the meaning of the traumatic event and consequent losses. Otherwise, symptoms may worsen and the client may become depressed or engage in self- destructive behavior such as substance abuse. The client must explore the meaning of the event and won't heal without this, no matter how much time passes. Behavioral techniques, such as relaxation therapy, may help decrease the client's anxiety and induce sleep. The physician may prescribe antianxiety agents or antidepressants cautiously to avoid dependence; sleep medication is rarely appropriate. A special diet isn't indicated unless the client also has an eating disorder or a nutritional problem.
- Jane is admitted to an inpatient psychiatric unit for treatment of obsessive-compulsive symptoms. Obsessive- compulsive disorder (OCD) is associated with: ▪ a. Physical signs and symptoms with no physiologic cause ▪ b. Apprehension ▪ c. Inability to concentrate
▪ D. REPETITIVE THOUGHTS AND RECURRING, IRRESISTIBLE IMPULSES
OCD is characterized by repetitive thoughts that the client can't control or exclude from consciousness, along with recurring, irresistible impulses to perform a particular action. Physical signs and symptoms with no physiologic cause typify somatoform disorder. Apprehension and inability to concentrate characterize anxiety disorders.
- A client with obsessive-compulsive disorder and ritualistic behavior must brush the hair back from his forehead 15 times before carrying out any activity. Nurse Leo notices that the client's hair is thinning and the skin on the forehead is irritated — possible effects of this ritual. When planning the client's care, the nurse should assign highest priority to: ▪ a. Helping the client identify how the ritualistic behavior interferes with daily activities
▪ b. Exploring the purpose of the ritualistic behavior ▪ c. Setting consistent limits on the ritualistic behavior if it harms the client or others
▪ D. USING PROBLEM SOLVING TO HELP THE CLIENT MANAGE ANXIETY
MORE EFFECTIVELY
Client safety is the paramount concern and must be maintained. Therefore, setting consistent limits on potentially harmful ritualistic behavior takes highest priority. Although the other options are important, they take lower priority. For instance, helping the client identify how the ritualistic behavior interferes with daily activities increases the client's motivation for using more effective coping behavior. Exploring the purpose of the ritualistic behavior helps the client
This response appropriately focuses on the emotional content of the client's message and helps the client identify feelings. Focusing on the request for extra medication would allow the client to ignore the underlying emotional issues. Clients with borderline personality disorder commonly divide the staff into "good guys" and "bad guys" to meet their needs; staff members must maintain consistency and a united front at all times. The nurse shouldn't take the client's statements personally because this would interfere with the ability to maintain a therapeutic relationship.
- Angel, is admitted to the unit visibly anxious. When assessing her, the nurse would expect to see which of the following cardiovascular effects produced by the sympathetic nervous system? ▪ a. Syncope ▪ b. Decreased blood pressure ▪ c. Increased heart rate
▪ D. DECREASED PULSE RATE
Sympathetic cardiovascular responses to stress include increased heart rate, cardiac contractility, and cardiac output; increased blood pressure; and peripheral vasoconstriction. Syncope is a response to parasympathetic stimulation.
- A male client with Alzheimer's disease has a nursing diagnosis of Risk for injury related to memory loss, wandering, and disorientation. Which nursing intervention should appear in this client's plan of care to prevent injury? ▪ a. Provide the client with detailed instructions ▪ b. Keep the client sedated whenever possible ▪ c. Remove hazards from the environment
▪ D. USE RESTRAINTS AT ALL TIMES
By removing environmental hazards, such as bottles of hydrogen peroxide and benzoin, the nurse can help prevent injury to the client. For a client with Alzheimer's disease, the nurse should provide single, simple instructions, rather than many detailed instructions. The nurse should administer medication as prescribed and as needed — not to keep the client sedated. The nurse should use restraints only when required to prevent self-harm by the client.
- Rudy was found wandering in a local park is unable to state who or where he is or where he lives. He is brought to the emergency department, where his identification is eventually discovered. The client's wife states that he was diagnosed with Alzheimer's disease 3 years ago and has had increasing memory loss. She tells nurseAngelie she is worried about how she'll continue to care for him. Which response by the nurse would be most helpful? ▪ a. "Because of the nature of your husband's disease, you should start looking into nursing homes for him." ▪ b. "What aspect of caring for your husband is causing you the greatest concern?" ▪ c. "You may benefit from a support group called Mates of Alzheimer's Disease Clients."
▪ D. "DO YOU HAVE ANY CHILDREN OR FRIENDS WHO COULD GIVE
YOU A BREAK FROM HIS CARE EVERY NOW AND THEN?"
The nurse should determine the specific concerns of the client's wife. Jumping to conclusions regarding the client's need for a nursing home or other care placement options would be inappropriate. The nurse must tailor care to the client and family, focusing on their needs. Although support groups, children, and friends may prove helpful to the client's wife, the nurse must establish a plan for continued care that addresses her specific concerns.
- Nurse Agnes is aware that nursing action most appropriate when trying to diffuse a male client's impending violent behavior? ▪ a. Helping the client identify and express feelings of anxiety and anger ▪ b. Involving the client in a quiet activity to divert attention ▪ c. Leaving the client alone until he can talk about his feelings
▪ D. PLACING THE CLIENT IN SECLUSION
In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statements as "What happened to get you this angry?" may help
