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NUR 2488/ NUR2488: Mental Health Final
Exam Questions
During a psychiatric nursing assessment, Sally reports to the nurse that she was sexually assaulted 6 months ago and since then has had trouble concentrating at work. Her employer tells her he is sensitive to the amount of stress she is under, since she also recently went through a divorce, but that she needs to seek help for her anxiety and depression to avoid further consequences at work. Which of these data support the diagnosis of PTSD according to DSM-5 criteria? Select all that apply.
- She directly experienced a traumatic event.
- She is a single female.
- She has had difficulty concentrating at work.
- Her anxiety and depression are interfering with job functioning.
- Her symptoms have been present for more than 6 months. - ANSWER ~
- She directly experienced a traumatic event.
- She has had difficulty concentrating at work.
- Her anxiety and depression are interfering with job functioning.
- Her symptoms have been present for more than 6 months. Jared returned from active duty in the military and has beendiagnosed with PTSD. Which of the following interventions has been strongly advocated for as an effective strategy in this population?
- Group therapy with patients who have a variety of diagnoses
- Group therapy with patients who have anger management issues
- Group therapy with patients who have experienced similar traumas
- Group therapy with patients who have experienced different types of trauma - ANSWER ~ 3) Group therapy with patients who have experienced similar traumas The family of a patient being treated for PTSD asks the nurse to describe EMDR (eye movement desensitization and reprocessing), since it is being recommended for this patient. Which of the following teaching points are accurate descriptions of this intervention? Select all that apply.
- EMDR has been shown to be effective in the treatment of all mental illnesses, including schizophrenia.
- The process involves rapid eye movement while processing painful memories.
- This process is contraindicated for patients with retinal detachment or glaucoma.
- This process is thought to relieve anxiety so that the trauma can be processed from a more detached perspective.
- The biological mechanism that makes EMDR effective is that it releases opioid- like chemicals in the brain. - ANSWER ~ 2) The process involves rapid eye movement while processing painful memories.
- This process is contraindicated for patients with retinal detachment or glaucoma.
- This process is thought to relieve anxiety so that the trauma can be processed from a more detached perspective. 4.The nurse is conducting an intake assessment for a patient with PTSD. Which of the following pieces of information support this diagnosis? Select all that apply.
- The patient reports having nightmares but can't remember what they are about.
7.Beth is being treated for an adjustment disorder following a job demotion 2 months ago. Since the demotion, she has frequently called in sick, complains of incapacitating migraines, and has been disciplined for yelling at her boss. Her husband asks the nurse why his wife is still having so much trouble functioning, since he knows people who have lost their jobs entirely and have since resolved their concerns. Which of these statements by the nurse accurately reflects understanding of the dynamics of different kinds of stressors in patient recovery?
- Women have more difficulty managing work-related stressors than men.
- Ongoing stressors are associated with more maladaptive behaviors than sudden-shock types of stressors.
- Job demotion is associated with longer-term recovery because it is so uncommon.
- Carol probably had pre-existing difficulties managing stressors as a child. - ANSWER ~ 2) Ongoing stressors are associated with more maladaptive behaviors than sudden-shock types of stressors. 8.An adult male has sought counseling at a community mental health center for PTSD. He reports during assessment that he witnessed the murder of a close friend last year in a random, drive-by shooting in his neighborhood. Since this loss he has had recurrent nightmares, explosive episodes, and frequently incapacitating anxiety. Which of the following nursing diagnoses would be appropriate, based on this assessment data? Select all that apply.
- Post Trauma Syndrome R/T distressing events, as evidenced by recurrent nightmares.
- Complicated grieving R/T loss of a friend in the traumatic event, as evidenced by explosive outbursts and reports of incapacitating anxiety.
- Isolation R/T unresolved anxiety, as evidenced by complaints of incapacitating anxiety.
- Risk for suicide R/T survivor guilt. - ANSWER ~ 1) Post Trauma Syndrome R/T distressing events, as evidenced by recurrent nightmares.
- Complicated grieving R/T loss of a friend in the traumatic event, as evidenced by explosive outbursts and reports of incapacitating anxiety. 9.The nurse is conducting an assessment for a patient diagnosed with PTSD. She recognizes that people with PTSD are at high risk for several comorbid conditions. Which of the following will she need to assess carefully because of the high risk in people with PTSD? Select all that apply.
- Trichotillomania
- Depression and suicide ideation
- Substance abuse
- Verbal or physical aggression
- Narcissistic Personality Disorder - ANSWER ~ 2) Depression and suicide ideation
- Substance abuse
- Verbal or physical aggression 10.The nurse is developing a plan of care for a patient diagnosed with PTSD. Which of the following variables will have an impact on the patient's response to interventions? Select all that apply.
- Patient's self-esteem
- Socioeconomic status
- History of psychopathology
- Amount of control over recurrence
- Temperament
- Immediate crisis debriefing - ANSWER ~ 1) Patient's self-esteem
13.A patient with PTSD who has been having nightmares is prescribed propranolol to treat PTSD symptoms. He asks the nurse why this medication was ordered since he doesn't have high blood pressure. Which of the following is the most appropriate response by the nurse at this point?
- Call the doctor and question this order.
- Discontinue the medication and check the patient's blood pressure.
- Explain that propranolol has been shown to be effective in reducing nightmares associated with PTSD.
- Explain that this medication is used to treat hypertension that often accompanies PTSD. - ANSWER ~ 3) Explain that propranolol has been shown to be effective in reducing nightmares associated with PTSD. 14.A female patient, Sally, was admitted to the psychiatric inpatient unit with PTSD following a rape 6 months ago in which she suffered several physical injuries. This evening she was approached from behind by a male patient who touched her on the shoulder, and Sally began screaming "I'm going to kill you for what you did to me!" Which of these immediate interventions by the nurse demonstrates a safe and effective care environment? Select all that apply.
- Place the patient in seclusion for the safety of others.
- Offer the patient reassurance that she is in a safe environment.
- Tell the patient to share the details that she remembers about the traumatic event.
- Stay with the patient.
- Acknowledge and validate the patient's feelings as they are expressed. - ANSWER ~ 2) Offer the patient reassurance that she is in a safe environment.
- Stay with the patient.
- Acknowledge and validate the patient's feelings as they are expressed
15.Jennifer is working with the nurse on her care plan related to post trauma syndrome. Jennifer repeatedly asks the nurse why she is writing down everything and who will be seeing this information. Which of these interpretations by the nurse reflects an understanding of the post trauma patient?
- Post trauma patients may be suspicious of others in their environment.
- Post trauma patients need a lot of redirection.
- Female post trauma patients are often very confused about details.
- Post trauma patients are always confrontational and challenging with health care professionals. - ANSWER ~ 1) Post trauma patients may be suspicious of others in their environment. 16.A patient who has recently been diagnosed with PTSD asks the nurse what his options are for treatment of this disorder. Which of the following items should the nurse include in teaching the patient about primary treatments for PTSD? Select all that apply.
- Prolonged exposure therapy
- Cognitive therapy
- ECT
- Antipsychotic medication
- EMDR - ANSWER ~ 1) Prolonged exposure therapy
- Cognitive therapy
- EMDR
3.A client diagnosed with autism spectrum disorder was recently admitted to the hospital. This client grabs a toy and hits another child. Which is the most appropriate nursing action?
- Isolate the client for 24 hours.
- Encourage the client to explain the hostile behavior.
- Assume a nonpunitive attitude and remove the client from the conflict.
- Call the parents for input regarding behavioral management. - ANSWER ~
- Assume a nonpunitive attitude and remove the client from the conflict. 4.The disorder that is characterized by the presence of multiple motor tics and one or more vocal tics is called ____________. - ANSWER ~ Tourette's disorder 5.Joey, a 12-year-old boy diagnosed with ADHD, is being assessed to determine appropriateness for behavioral therapy-based group treatment. The nurse should also assess for symptoms of which disorders that commonly co-occur with ADHD? Select all that apply.
- Oppositional defiant disorder (ODD)
- Narcissistic personality disorder
- Schizophrenia
- Conduct disorder
- Substance abuse - ANSWER ~ 1) Oppositional defiant disorder (ODD)
- Conduct disorder
- Substance abuse 6.A client diagnosed with attention-deficit/hyperactivity disorder (ADHD) is prescribed the neurotransmitter-altering drug methylphenidate (Ritalin). Another client, diagnosed with narcolepsy, also receives Ritalin. Why is Ritalin given for these two opposing problems?
- ADHD responds positively to a decreased level of neurotransmitters, whereas narcolepsy responds positively to an increased level of neurotransmitters.
- Narcolepsy responds positively to a decreased level of neurotransmitters, whereas ADHD responds positively to an increased level of neurotransmitters.
- Both ADHD and narcolepsy respond positively to a decreased level of neurotransmitters.
- Both ADHD and narcolepsy respond positively to an increase in levels of neurotransmitters. - ANSWER ~ 4) Both ADHD and narcolepsy respond positively to an increase in levels of neurotransmitters. 7.Conduct disorder is a precursor to the diagnosis of which personality disorder?
- Narcissistic personality disorder
- Antisocial personality disorder
- Histrionic personality disorder
- Obsessive-compulsive disorder - ANSWER ~ 2) Antisocial personality disorder
1.Tori has been talking to the nurse about her husband's behavior. She claims that although her husband is very controlling, he can't be described as manifesting intimate partner violence because he has never struck her. Which of these responses by the nurse is an accurate description of intimate partner violence?
- Intimate partner violence is only physical abuse, but controlling behavior is dysfunctional, too.
- The National Coalition Against Domestic Violence describes battering as different from intimate partner violence.
- The U.S. Department of Justice defines intimate partner violence as any pattern of abusive behavior used to control an intimate partner, which can include physical, psychological, and other threats of intimidation or control.
- Intimate partner violence relates to only acts of fatal violence. - ANSWER ~
- The U.S. Department of Justice defines intimate partner violence as any pattern of abusive behavior used to control an intimate partner, which can include physical, psychological, and other threats of intimidation or control. 2.A frightened young woman calls the ED and tearfully tells the nurse, "I've been raped. Please help me!" Which nursing questions take priority?
- "Are you injured, and are you in a safe place?"
- "Do you know your whereabouts, and do you have transportation?"
- "Have you notified the police and do you know your assailant?"
- "Have you bathed, douched, or changed your clothes?" - ANSWER ~
- "Are you injured, and are you in a safe place?"
3.Veronica presents at the emergency room with multiple bruises, a black eye, and a broken leg, which her husband states were the result of falling on a patch of ice. He requests to stay with her, and the nurse notices that Veronica appears fearful. Which of these is the best approach to conducting assessment?
- Tell the husband how much you appreciate his support and engage him in the assessment process.
- Instruct the husband that hospital policy dictates that certain aspects of physical assessment be done in private, and interview the client alone.
- Ask Veronica if she would like her husband to be present throughout the interview.
- Confront the husband about the suspiciousness of Veronica's injuries. - ANSWER ~ 2) Instruct the husband that hospital policy dictates that certain aspects of physical assessment be done in private, and interview the client alone. 4.Sarah convinces her husband to make an appointment at the health center and tells the intake nurse that her husband has been exhibiting violent behavior for the first time in their 14-year marriage. Which of the following should the nurse explore when assessing the husband for the origins of his behavior? Select all that apply.
- History or evidence of brain diseases such as encephalitis or epilepsy
- Substance use and medication history
- Evidence of PTSD
- History of abuse in his family of origin
- Evidence of codependent personality traits in Sarah - ANSWER ~ 1) History or evidence of brain diseases such as encephalitis or epilepsy
- Substance use and medication history
- Evidence of PTSD
- History of abuse in his family of origin
- Unmet needs for security, resulting in an underdeveloped ego and a weak super ego
- Imitation of individuals who have a predisposition toward aggressive behavior
- Various levels of norepinephrine, dopamine, and serotonin
- The influence of culture and social structure - ANSWER ~ 3) Various levels of norepinephrine, dopamine, and serotonin 9.A 12-year-old female suddenly refuses to change for gym or participate in physical activities, has difficulty walking and sitting, and will not eat her food at lunchtime. What should the school nurse consider when assessing this child's symptoms?
- Sexual abuse
- Emotional neglect
- Physical neglect
- Incest - ANSWER ~ 1) Sexual abuse 10.After an examination and treatment for rape, the nurse prepares to discharge a client from the ED. Which discharge teaching should the nurse provide? (If one part of an ANSWER ~ is incorrect, the entire ANSWER ~ is incorrect.)
- Information on available community resources
- The names and phone numbers of local attorneys who defend rape victims
- When to return to the ED for follow-up care
- The phone number of the battered women's shelter and the crisis intervention center - ANSWER ~ 1) Information on available community resources
11.The nurse is planning care for Carla, who, despite suffering several broken bones as a result of spousal abuse, has decided not to leave her husband. In order to provide patient-centered care, the nurse must understand that which of these factors may contribute to the victim's desire to stay in the relationship? Select all that apply.
- Fear of retaliation
- Grandiose delusions
- Concern for children
- Lack of financial resources
- Large support networks - ANSWER ~ 1) Fear of retaliation
- Concern for children
- Lack of financial resources 12.Dolores is seeing the nurse at the community mental health clinic for depression and reveals that her husband was physically abusive to her but "things are better now because he felt terrible and he has been great to me ever since." Which of the phases in the cycle of battering is Dolores describing?
- The tension-building phase
- The acute battering incident
- The "honeymoon" phase
- The resolution phase - ANSWER ~ 3) The "honeymoon" phase 1.A despondent, recently widowed woman tells the home health nurse, "My husband's lucky! I'm so lonely, there's no one to talk to, and life is not worth living with this arthritis pain." Which nursing diagnosis takes priority?
- Risk for Suicide
- Social Isolation
- Pain
- Complicated Grieving - ANSWER ~ 1) Risk for Suicide
4.In developing a community-based care plan, the community health nurse should address which of the following ongoing problems for homeless individuals? Select all that apply.
- Alcoholism and thermoregulation
- Sexually transmitted diseases
- Conditions related to dietary deficiencies
- Tuberculosis
- The aging process - ANSWER ~ 1) Alcoholism and thermoregulation
- Sexually transmitted diseases
- Conditions related to dietary deficiencies
- Tuberculosis 5.The community mental health nurse is conducting a community assessment to identify the region's priority mental health issues. Which of the following should be included in the assessment because of their correlation to emotional illness? Select all that apply.
- The level of poverty in the region
- Environmental conditions
- Traumas
- The number of residents who rent versus own their home - ANSWER ~
- The level of poverty in the region
- Environmental conditions
- Traumas
6.The nurse is teaching a community education class on drugs of abuse as a primary prevention strategy. One of the participants asks about the negative effects of alcohol on the body. Which of the following would be important to include in responding to this question? Select all that apply.
- Cirrhosis of the liver
- Peripheral nerve damage
- Pulmonary hemorrhage
- Pancreatitis
- Sexual dysfunction - ANSWER ~ 1) Cirrhosis of the liver
- Peripheral nerve damage
- Pancreatitis
- Sexual dysfunction 7.The community health nurse should include which tertiary level of prevention intervention for a homeless, unemployed individual with severe and persistent mental illness?
- Providing education and support to reduce the incidence of mental illness.
- Referring to a homeless shelter
- Teaching daily living skills to encourage independence
- Referring to an inpatient psychiatric hospital - ANSWER ~ 3) Teaching daily living skills to encourage independence 8.Based on the public health model of primary level of prevention, which services would the community nurse provide?
- Teaching recovering clients daily living skills and encouraging independence
- Monitoring effectiveness of aftercare services through home health visits
- Providing ongoing assessment of individuals at high risk for illness exacerbation
