Psychiatric Nursing: Disorders, Treatments, and Coping Strategies, Exams of Psychiatry

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Psychiatric Mental Health Nursing Module 3 Exam Study

Guide

1.What assessment question is focused on identifying a long-term conse- quence of chronic

stress on physical health?

a. "Do you have any problems with sleeping well?"

b. "How many infections have you experienced in the past 6 months?"

c. "How much moderate exercise do you engage in on a regular basis?"

d. "What management techniques do you regularly use to manage your stress?": b. "How many

infections have you experienced in the past 6 months?"

2.Chapter 27 - Anger, Aggression, and Violence: Review begins “

3.Anger:: An emotional response to frustration of desires, a threat to one's needs (emotional or

physical), or a challenge.

4.Aggression:: An action or behavior that results in a verbal or physical attack.

5.Violence:: Always an objectionable act that involves intentional use of force that results in, or

has the potential to result in, injury to another person

6.Seclusion:: Involuntary confinement of a patient alone in a room, or area from which the

patient is physically prevented from leaving.

7.Restraints:: Any manual method, physical or mechanical device, material, or equipment

that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely.

8.Which patient behavior is a criterion for mechanical restraint?

a. Screaming profanities

b. Assaulting a staff person

c. Refusing a medication dose

d. Throwing a pillow at another patient: b. Assaulting a staff person

9.Which individuals are most at risk for displaying aggressive behavior? Select all that apply.

a. An adolescent embarrassed in front of friends.

b. A young male who feels rejected by the social group.

c. A young adult depressed after the death of a friend.

d. A middle-aged adult who feels that concerns are going unheard.

e. A patient who was discovered telling a lie.: a. An adolescent embarrassed in front of friends.

b. A young male who feels rejected by the social group. d. A middle-aged adult who feels that concerns are going unheard. e. A patient who was discovered telling a lie.

10. A newly admitted male patient has a long history of aggressive behavior toward staff. Which

statement by the nurse demonstrates the need for more information about the use of restraint?

a. "If his behavior warrants restraints, someone will stay with him the entire time he's restrained."

b. "I'll call the primary provider and get an as-needed (prn) seclusion/restraint order."

c. "If he is restrained, be sure he is offered food and fluids regularly."

d. "Remember that physical restraints are our last resort.": b. "I'll call the primary provider and get

an as-needed (prn) seclusion/restraint order."

11.Which intervention(s) should the nurse implement when helping a patient who expresses anger

in an inappropriate manner? Select all that apply.

a. Approach the patient in a calm, reassuring manner.

b. Provide suggestions regarding acceptable ways of communicating anger.

c. Warn the patient that being angry is not a healthy emotional state.

d. Set limits on the angry behavior that will be tolerated.

e. Allow any expression of anger as long as no one is hurt.: a. Approach the patient in a calm,

reassuring manner. b. Provide suggestions regarding acceptable ways of communicating anger. d. Set limits on the angry behavior that will be tolerated.

12.Which guidelines should direct nursing care when deescalating an angry patient? Select all that

apply.

a. Intervene as quickly as possible.

b. Identify the trigger for the anger.

c. Behave calmly and respectfully.

d. Recognize the patient's need for increased personal space.

e. Demands are agreed to as long as they will not result in harm to anyone.: a. Intervene as quickly

as possible.

b.Identify the trigger for the anger.

c. Behave calmly and respectfully.

d. Recognize the patient's need for increased personal space.

13.Which comorbid condition would result in cautious use of an SSRI for a patient with chronic

aggression?

a. Asthma

b. Anxiety disorder

c. Glaucoma

d. Bipolar disorder: d. Bipolar disorder

14.Patrick is a widower with four daughters. He enjoyed a healthy relationship with each of them until

they reached puberty. As the girls began to mature physically, he acted in an aggressive manner, often beating them without provocation. Patrick is most likely acting on:

a. Self-protective measures

b. Stress of raising four daughters

c. Frustration of unhealthy desire

d. Motivating his daughters to be chaste: c. Frustration of unhealthy desire

15.A nurse named Darryl has been hired to work in a psychiatric intensive care unit. He has

undergone training on recognizing escalating anger. Which statement indicates that he understands danger signs in regard to aggres- sion?

a. "I need to be aware of patients who are withdrawn and sitting alone."

b. "An obvious change in behavior is a risk factor for aggression."

c. "Patients who seek constant attention are more likely to be violent."

d. "Patients who talk to themselves are the most dangerous.": b. "An obvious change in behavior

is a risk factor for aggression."

16.An effective method of preventing escalation in an environment with vio- lent offenders is to

develop a level of trust through:

a. A casual authoritative demeanor

b. Keeping patients busy

c. Brief, frequent, nonthreatening encounters

d.Threats of seclusion or punishment: c. Brief, frequent, nonthreatening encoun- ters

17.A 24-hour observation is a good choice for restraint in which of the following patients?

a. An inmate with suicidal ideation on hospice care

b. A sex offender in the psychiatric intensive care unit

c. An aggressive female with antisocial personality disorder

d. An inmate diagnosed with paranoid schizophrenia: a. An inmate with suicidal ideation on

hospice care

18.Post-traumatic stress disorder (PTSD) in adults:: Examples of PTSD-induc- ing events:

• Military combat or hostage situations
• Crime-related events

• Natural disasters
• Human disasters (accidents)

19.Chronic obstructive pulmonary disease, spinal injury, seizure disorder, and pregnancy are

conditions that:

a. Frequently result in out of control behavior.

b. Respond well to therapeutic holding.

c. Necessitate the use of only two-point restraint.

d. Contraindicate restraint and seclusion.: d. Contraindicate restraint and seclu- sion.

20.Chapter 16 - Trauma, Stressor-Related, and Dissociative Disorders: Review begins “

21.Flashbacks:: Re-experiencing the trauma.

22.PTSD in adults:: - Re-experiencing of the trauma

• Avoidance of stimuli associated with trauma
• Persistent symptoms of increased arousal
• Alterations in mood

23.Risk factors for PTSD:: - Genetic: how individuals react to trauma

• Neurobiological: trauma dysregulates neural pathways that integrate emotional regulation and arousal, triggers hypoaroused state leading to dissociation, polyvagal theory
• Environmental factors: children's neuroplasticity (dependence on adults and sys- tems), external factors that support or add stress, resilience

24.Care of individuals with PTSD:: Stage 1: Provide safety and stabilization.

Stage 2: Reduce arousal and regulate emotion through symptom reduction and memory work. Stage 3: Catch up on developmental and social skills; develop a value system.

25.Interventions for children with PTSD:: Use: Use interactive process.

Establish: Establish trust and safety. Use: Use developmentally appropriate language. Teach: Teach relaxation techniques before trauma exploration to restore a sense of control. Use: Use art and play to promote expression of feelings. Involve: Involve caretakers in 1:1s, unless they are the cause of trauma. Educate: Educate child and caretakers about grief process and response to the trauma. Assist: Assist caretakers in resolving their own emotional distress about the trauma. Coordinate: Coordinate with social work for protections.

26.Treatment is effective when:: - Safety is endured

• Anxiety is reduced, and stress handled adaptively
• Emotions and behavior are appropriate for the situation
• Child achieves normal developmental milestones
• Child can seek out adults for nurturance and help when needed

27.Which of the following should be established first in working with an individual with

PTSD?

a. provide safety and stabilization

b. reduce systems

c. develop a value system

d. provide support for catching up on developmental and social skills: a. provide safety and

stabilization

28.Dissociative disorders:: - Dissociative amnesia

• Depersonalization/derealization disorder
• Dissociative identity disorder

29.Dissociative amnesia:: - Inability to recall important personal information

• Often of traumatic or stressful nature
• Dissociative fugue: subtype characterized by sudden, unexpected travel and inabil- ity to recall one's identity/information about the past.

30.Nick, a construction worker, is on duty when a nearly completed wall suddenly falls, crushing a

number of his co-workers. Although badly shaken initially, he seemed to be coping well. About 2 weeks after the tragedy, he begins to experience tremors, nightmares, and periods during which he feels numb or detached from his environment. He finds himself frequently thinking about the tragedy and feeling guilty that he was spared while many others died. Which statement about this situation is most accurate?

a. Nick has acute stress disorder and will benefit from antianxiety medications.

b. Nick is experiencing posttraumatic stress disorder (PTSD) and should be

referred for outpatient treatment.

c. Nick is experiencing anxiety and grief and should be monitored for PTSD symptoms.

d. Nick is experiencing mild anxiety and a normal grief reaction; no interven- tion is needed.: a. Nick

has acute stress disorder and will benefit from antianxiety medications.

31.Depersonalization:: Focus on self: extremely uncomfortable feeling of being an observer of

one's own body or mental processes.

32.Derealization:: Focus on outside world: recurring feeling that one's surround- ings are

unreal or distant. Person feels as if walking around in a fog, bubble, or dream.

33.Psychological therapies for dissociative disorder:: CBT, psychodynamic psychotherapy,

exposure therapy, modified EMDR therapy, hypnotherapy, neuro- feedback, ego state therapies, somatic therapies, medication

34.Depersonalization/derealization disorder:: Persistent or recurrent episodes of:

depersonalization and derealization.

35.Dissociative identity disorder:: - Presence of two or more distinct personality states

• Each alternate personality (alter) has own pattern of: perceiving, relating to, thinking about the self and environment
• Cognitive distortion: an insistence that the "alters" inhabit separate bodies and are unaffected by the actions of one another.

36.You are caring for Susannah, a 29-year-old who has been diagnosed with dissociative identity

disorder. She was recently hospitalized after coming to the emergency department with deep cuts on her arms with no memory of how this occurred. The priority nursing intervention for Susannah is:

a. Assist in recovering memories of abuse.

b. Maintain 1:1 observation.

c. Teach coping skills and stress-management strategies.

d. Refer for integrative therapy.: b. Maintain 1:1 observation.

37.You are caring for Connor, an 8-year-old boy who has been diagnosed with reactive attachment

disorder. Which of the following nursing outcomes would be the most appropriate to achieve?

a. Increases ability to self-control and decreases impulsive behaviors.

b. Avoids situations that trigger conflicts.

c. Expresses complex thoughts.

d. Writes or draws feelings in a journal.: d. Writes or draws feelings in a journal.

38.Ashley is a 21-year-old college student who was sexually assaulted at a party. She was seen

in the local emergency department and referred for counseling after being diagnosed by the provider on call as having acute stress disorder. Which of the following treatment modalities would you expect to see used in therapy with Ashley?

a. Aversion therapy

b. Stress-reduction therapy

c. Cognitive behavioral therapy

d. Short-term classical analysis therapy: c. Cognitive behavioral therapy

39.Jamie, age 24, has been diagnosed with a dissociative disorder following a traumatic event.

Jamie's mother asks you, "Does this mean my daughter is now crazy?" Your best response would be:

a. "People with dissociative disorders are out of touch with reality, so in that way, your daughter is

now mentally ill. Don't worry. Treatment is available."

b. "Jamie will most likely need long-term intensive inpatient treatment to deal with her traumatic

memories as well as to work through her delusions."

c. "Most mental health providers are skeptical about dissociative disorders and aren't sure they

truly exist. Jamie may be making up her symptoms as a cry for help."

d. "Jamie is dealing with the anxiety associated with the trauma by separating herself from it. With

treatment, she can get back to her previous level of functioning.": d. "Jamie is dealing with the anxiety associated with the trauma by separating herself from it. With treatment, she can get back to her previous level of functioning."

40.A young child is found wandering alone at a mall. A male store employee approaches and asks

where her parents are. She responds, "I don't know. Maybe you will take me home with you?" This sort of response in children may be due to: a. A lack of bonding as an infant b. A healthy confidence in the child c. Adequate parental bonding d. Normal parenting: a. A lack of bonding as an infant

41.During a routine health screening, a grieving widow whose husband died 15 months ago reports

emptiness, a loss of self, difficulty thinking of the future, and anger at her dead husband. The nurse suggests bereavement counseling. The widow is most likely suffering from:

a. Major depression

b. Normal grieving

c. Adjustment disorder

d. Posttraumatic stress disorder: c. Adjustment disorder

42.Maggie, a child in protective custody, is found to have an imaginary friend, Holly. The foster

family shares this information with the nurse. The nurse teaches the family members about children who have suffered trauma and knows her teaching was effective when the foster mother states:

a. "I understand that imaginary friends are abnormal."

b. "I understand that imaginary friends are a maladaptive behavior."

c. "I understand that imaginary friends are a coping mechanism."

d. "I understand that we should tell the child that imaginary friends are unacceptable.": c. "I

understand that imaginary friends are a coping mechanism."

43.The school nurse has been alerted to the fact that an 8-year-old boy routinely play acts as a

police officer, "locking up" other children on the playground to the point where the children get scared. The nurse recognizes that this behavior is most likely an indication of:

a. The need to dominate others

b. Inventing traumatic events

c. A need to develop close relationships

d. A potential symptom of traumatization: d. A potential symptom of traumatiza- tion

44.Chapter 22 - Substance-Related and Addictive Disorders: Review begins “

45.Substance use disorder:: - Impaired control

• Social impairment
• Risky use
• Physical effects

46.DMS-5 substance-related and addictive disorders:: - Alcohol

• Caffeine
• Cannabis
• Hallucinogens
• Inhalants
• Opioids
• Sedatives/hypnotics/anxiolytics
• Stimulants
• Tobacco
• Gambling disorder

47.Risk factors for substance use disorders:: - Genetics

• Neurotransmitters: opioid receptors, dopamine, GABA
• Environment
• Social-cultural

48.Caffeine:: - Most widely used psychoactive substance worldwide

• Intoxication: restlessness, nervousness, agitation, flushing diuresis, GI distur- bance, tachycardia, arrhythmia, seizures, death
• Overdose: uncommon but may occur with caffeine supplements (energy drinks)
• Withdrawal: headache, drowsiness, irritability, difficulty concentrating, flu-like symp- toms; 12- 24 hours after last dose, peak in 24-48 hours, resolves in 1 week

49.Alcohol use disorder:: - Affects 5.8% of adults

• Binge drinking- 4 (women) or 5 (men) drinks/2 hours (26.5% of adults)
• Heavy drinking- 8 (women) or 14 (men) drinks/week (6.6% of adults)

50.Intoxication:: - Initially: euphoria, decreased inhibition; impaired judge- ment/concentration,

decreased motor function, slurred speech, vomiting, blackouts, hypothermia, hypotension, bradypnea; 0.0850.10 g/dL- legal intoxication in most states

51.Treatment:: - Librium- mild agitation;

• Valium- seizures/delirium prevention;
• Ativan- acute delirium
• Disulfiram (Antabuse);
• Naltrexone; Acamproste
• Therapy - inpatient/outpatient;
• Withdrawal- inpatient; AA

52.Withdrawal:: - Shakiness/jitters, nausea, vomiting, agitation, insomnia- com- mon with

heavy drinking

• Hallucinations/Impaired perception, seizures, delirium (DTs)- less common, but life threatening

53.Impact of alcohol use disorder:: - Wernicke-Korsakoff's syndrome (thiamine deficiency)

• Blackouts
• Fetal alcohol syndrome
• Neuropathy
• Myopathy/cardiac myopathy
• Gastritis/espophagitis
• Pancreatitis
• Hepatitis/cirrhosis

• Leukopenia/thrombocytopenia
• Cancer

54.Alcohol use disorder assessment:: - AUDIT

• CAGE
• CAGE-AID
• T-ACE
• CIWA
• Family assessment: codependence
• Self-assessment

55.A pregnant woman is in a relationship with a male who routinely abuses her. Her unborn child

may engage in high-risk behavior as a teen as a result of:

a. Maternal stress

b. Parental nurturing

c. Appropriate stress responses in the brain

d. Memories of the abuse: a. Maternal stress

56.Natalya, a patient with a history of alcohol use disorder, has been pre- scribed disulfiram

(Antabuse). Which physical effects support the suspicion that the patient has relapsed? Select all that apply.

a. Intense nausea

b. Diaphoresis

c. Acute paranoia

d. Confusion

e. Dyspnea: a. Intense nausea

b.Diaphoresis

d.Confusion

e. Dyspnea

57.Which assessment data confirm the suspicion that a patient is experienc- ing opioid withdrawal?

Select all that apply.

a. Pupils are dilated

b. Pulse rate is 62 beats/min

c. Slow movements

d. Extreme anxiety

e. Sleepy: a. Pupils are dilated

d. Extreme anxiety

58.The nursing diagnosis denial is especially useful when working with sub- stance use disorders

and gambling. Which statements describe this diagno- sis? Select all that apply.

a. Reports inability to cope

b. Does not perceive the danger of substance use or gambling

c. Minimizes symptoms

d. Refuses healthcare attention

e. Unable to admit the impact of disease on life pattern: b. Does not perceive the danger of

substance use or gambling

c. Minimizes symptoms

d. Refuses healthcare attention

e. Unable to admit the impact of disease on life pattern

59.What action should you take when a female staff member is demonstrating behaviors associated

with a substance use disorder?

a. Accompany the staff member when she is giving patient care.

b. Offer to attend rehabilitation counseling with her.

c. Refer her to a peer assistance program.

d. Confront her about your concerns and/or report your concerns to a supervi- sor immediately.: d.

Confront her about your concerns and/or report your concerns to a supervisor immediately.

60.A patient diagnosed with opioid use disorder has expressed a desire to enter into a rehabilitation

program. What initial nursing intervention during the early days after admission will help ensure the patient's success?

a. Restrict visitors to family members only.

b. Manage the patient's withdrawal symptoms well.

c. Provide the patient a low-stimulus environment.

d. Advocate for at least 3 months of treatment.: b. Manage the patient's withdraw- al symptoms

well.

61.Lester and Alene have always enjoyed gambling. Lately, Alene has discov- ered that their savings

account is down by $50,000. Alene insists that Lester undergo therapy for his gambling behavior. The nurse recognizes that Lester is making progress when he states:

a. "I understand that I am a bad person for depleting our savings."

b. "Gambling activates the reward pathways in my brain."

c. "Gambling is the only thing that makes me feel alive."

d. "We have always enjoyed gaming. I do not know why Alene is so upset.": b. "Gambling activates

the reward pathways in my brain."

62.Opioid use disorder is characterized by:

a. Lack of withdrawal symptoms

b. Intoxication symptoms of pupillary dilation, agitation, and insomnia

c. Tolerance

d. Requiring smaller amounts of the drug to achieve a high over time: c. Tolerance

63.Terry is a young male in a chemical dependency program. Recently, he has become increasingly

distracted and disengaged. The nurse concludes that Terry is:

a. Bored

b. Depressed

c. Bipolar

d. Not ready to change: d. Not ready to change

64.Max is a 30-year-old male who arrives at the emergency department stat- ing, "I feel like I am

having a stroke." During the intake assessment, the nurse discovers that Max has been working for 36 hours straight without eating and has consumed 8 double espresso drinks and 12 caffeinated sodas. The nurse suspects:

a. Fluid overload

b. Dehydration and caffeine overdose

c. Benzodiazepine overdose

d. Sleep deprivation syndrome: b. Dehydration and caffeine overdose

65.Donald, a 49-year-old male, is admitted for inpatient alcohol detoxification. The rationale for

admission into this program is due to:

a. Heavy use of a substance known to cause withdrawal

b. A need for rehabilitation

c. The potential for relapse

d. CNS hypoactivity following cessation of alcohol consumption: a. Heavy use of a substance

known to cause withdrawal

66.Chapter 10 - Stress Response and Stress Management: Review begins “

67.Stress:: - How the brain and body respond to any demand

• Stress is normal and even beneficial
• Long-term or severe stress consequences: mental health disorders, impaired immune function/delayed would healing, cardiovascular disease, GI disturbance/in- sulin resistance, sleep disturbances, reproductive disorders, ACEs

68.Theories of stress response:: - Fight or flight

• General adaptation syndrome: alarm, resistance, exhaustion
• Epinephrine
• Cortisol
• Serotonin

69.Stress mediators:: - Perception of stressor

• Temperament
• Support
• Culture/religion

70.Coping strategies for stress:: - Biofeedback

• Deep breathing
• Guided imagery
• Progressive relaxation
• Mediation/mindfulness
• Exercise
• Cognitive reframing/cognitive behavioral therapy
• Journaling
• Humor/laughter
• Others

71.Which nursing assessments are directed at monitoring a patient's fight-or-flight

response? Select all that apply.

a. Blood pressure

b. Heart rate

c. Respiratory rate

d. Abdominal pain

e. Dilated pupils: a. Blood pressure

b.Heart rate

c. Respiratory rate

e. Dilated pupils

72.The patient you are assigned unexpectedly suffers a cardiac arrest. During this emergency

situation, your body will produce a large amount of:

a. Carbon dioxide

b. Growth hormone

c. Epinephrine

d. Aldosterone: c. Epinephrine

73.Which question is focused on the assessment of an individual's personal ability to manage

stress? Select all that apply.

a. "Have you ever been diagnosed with cancer?"

b. "Do you engage in any hobbies now that you have retired?"

c. "Have you been taking your antihypertensive medication as it is pre- scribed?"

d. "Who can you rely on if you need help after you're discharged from the hospital?"

e. "What do you do to help manage the demands of parenting a 4-year-old and a newborn?": b. "Do

you engage in any hobbies now that you have retired?"

d. "Who can you rely on if you need help after you're discharged from the hospital?"

e. "What do you do to help manage the demands of parenting a 4-year-old and a newborn?"

74.When considering stress, what is the primary goal of making daily entries into a personal

journal?

a. Providing a distraction from the daily stress

b. Expressing emotions to manage stress

c. Identifying stress triggers

d. Focusing on one's stress: c. Identifying stress triggers

75.Jackson has suffered from migraine headaches all of his life. Fatima, his nurse practitioner,

suspects muscle tension as a trigger for his headaches. Fatima teaches him a technique that promotes relaxation by using:

a. Biofeedback

b. Guided imagery

c. Deep breathing

d. Progressive muscle relaxation: d. Progressive muscle relaxation

76.Hugo is 21 and diagnosed with schizophrenia. His history includes signif- icant turmoil as a child

and adolescent. Hugo reports his father was abusive and routinely beat him, all of his siblings, and his mother. Hugo's early expo- sure to stress most likely:

a. Made him resilient to stressful situations

b. Increased his future vulnerability to psychiatric disorders

c. Developed strong survival skills

d. Shaped his nurturing nature: b. Increased his future vulnerability to psychiatric disorders

77.Hugo has a fraternal twin named Franco who is unaffected by mental illness, even though they

were raised in the same dysfunctional household. Franco asks the nurse, "Why Hugo and not me?" The nurse replies:

a. "Your father was probably less abusive to you."

b. "Hugo likely has a genetic vulnerability."

c. "You probably ignored the situation."

d. "Hugo responded to perceived threats by focusing on an internal world.": b. "Hugo likely has a

genetic vulnerability."

78.First responders and emergency department healthcare providers often use dark humor in an

effort to:

a. Reduce stress and anxiety

b. Relive the experience

c. Rectify moral distress

d. Alert others to the stress: a. Reduce stress and anxiety

79.Your 39-year-old patient Samantha, who was admitted with anxiety, asks you what the stress-

relieving technique of mindfulness is. The best response is: