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NURSING 4340
PSYCHIATRIC AND MENTAL
HEALTH NURSING
EXAM
- A nurse is caring for a client who has been diagnosed with major depressive disorder. The client tells the nurse that he feels hopeless and worthless, and that he has no interest in anything. The nurse should recognize that these statements indicate which of the following? a) Anhedonia b) Apathy c) Avolition d) Agoraphobia Answer: a) Anhedonia. Rationale: Anhedonia is the inability to experience pleasure or joy in activities that were previously enjoyable. It is a common symptom of major depressive disorder and can contribute to the client's feelings of hopelessness and worthlessness.
- A nurse is conducting a mental status examination on a client who has schizophrenia. The nurse asks the client to repeat the phrase "no ifs, ands, or buts". The client responds by saying "no ifs, ants, or nuts". The nurse should document this response as an example of which of the following? a) Clang association b) Echolalia c) Neologism
d) Phonemic paraphasia Answer: d) Phonemic paraphasia. Rationale: Phonemic paraphasia is a type of speech disturbance in which the client substitutes or adds sounds to words, resulting in nonsensical or distorted speech. It is often seen in clients who have schizophrenia or other psychotic disorders.
- A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. The nurse should include which of the following interventions in the plan of care? a) Encourage the client to participate in group activities b) Provide the client with frequent snacks and fluids c) Allow the client to have unlimited visitors d) Restrict the client's physical activity Answer: b) Provide the client with frequent snacks and fluids. Rationale: Clients who are experiencing a manic episode may have increased energy, decreased appetite, and impaired judgment. They may neglect their basic needs such as nutrition and hydration, which can lead to physical exhaustion and dehydration. Therefore, the nurse should provide the client with frequent snacks and fluids to maintain their health and well-being.
- A nurse is teaching a client who has obsessive-compulsive disorder (OCD) about exposure and response prevention (ERP) therapy. The nurse should explain that ERP therapy involves which of the following? a) Gradually exposing the client to anxiety-provoking stimuli while preventing them from performing their compulsive behaviors b) Repeatedly exposing the client to anxiety-provoking stimuli until they become desensitized and no longer experience anxiety c) Systematically exposing the client to anxiety-provoking stimuli while teaching them relaxation techniques to cope with their anxiety d) Randomly exposing the client to anxiety-provoking stimuli while distracting them from their compulsive behaviors Answer: a) Gradually exposing the client to anxiety-provoking stimuli while preventing them from performing their compulsive behaviors. Rationale: ERP therapy is a type of cognitive-behavioral therapy that aims to reduce the client's anxiety and compulsions by breaking the cycle of avoidance and reinforcement. The therapist guides the client through a hierarchy of anxiety-provoking stimuli, starting from the least to the most distressing, while preventing them from engaging in their compulsive behaviors. This allows the client to learn that they can tolerate their anxiety without resorting to their compulsions.
A 4. A patient in the emergency department reports, “I hear voices saying someone is stalking me. They want to kill me because I found the cure for cancer. I will stab anyone that threatens me.” Which aspects of mental health have the greatest
immediate concern to a nurse? ( Select all that apply. ) a. (^) Happiness b. (^) Appraisal of reality c. (^) Control over behavior d. (^) Effectiveness in work e. (^) Healthy self-concept
- Which of the following factors distinguishes home health care from other types of Psychiatric Mental Health nursing care? a. The setting b. The focus on recovery c. The focus on rehabilitation d. The client-centered focus
- Which of the following individuals is most likely to benefit from brief cognitive therapy? a. A young male who has a diagnosis of schizophrenia, paranoid type b. A college freshman who is experiencing intense anxiety in the days before his final exam c. A female student who has been diagnosed with anorexia-nervosa d. A woman with major depressive disorder who is scheduled to undergo ECT
- The therapeutic action of monoamine oxidase inhibitors (MAOIs) blocks neurotransmitter reuptake, causing: a. (^) Increased concentration of neurotransmitters in the synaptic gap. b. (^) Decreased concentration of neurotransmitters in serum. c. (^) Destruction of receptor sites. d. (^) Limbic system stimulation.
- A patient has anxiety, increased heart rate, and fear. The nurse would suspect the presence of a high concentration of which neurotransmitter? a. (^) GABA b. (^) Histamine c. (^) Acetylcholine d. (^) Norepinephrine
- Dietary modifications are most likely necessary when a client is treated with which of the following antidepressants? a. Atypical antidepressants b. Tricyclic antidepressants c. MAOI’s d. SSRI’s
- In teaching a patient about the antidepressant, fluoxetine (Prozac), which of the following would the nurse include? Select all that apply:
a. Report confusion, agitation, or restlessness b. Keep taking the medication, it takes a few days to weeks to be effective c. Go to the lab each week and have your blood drawn to see if the level is therapeutic d. Take this drug before bedtime because this drug is extremely sedative e. Report rapid heart rate and high blood pressure
- An individual is experiencing problems associated with memory. Which cerebral structures are most likely to be involved in this deficit? ( Select all that apply. ) a. (^) Prefrontal cortex b. (^) Occipital lobe c. (^) Temporal lobe d. (^) Parietal lobe e. (^) Basal ganglia
- A multidisciplinary health care team meets 12 hours after an adolescent is hospitalized after a suicide attempt. Members of the team report their assessments. What outcome can be expected from this meeting? a. (^) A treatment plan will be formulated. b. (^) The health care provider will order neuroimaging studies. c. (^) The team will request a court-appointed advocate for the patient. d. Assessment of the patient’s need for placement outside the home will be undertaken. The 117. Needs are placed conceptually on a pyramid with the most basic and important needs on the bottom. When lower needs are met, higher level needs are able to emerge. This is based on what theory? a. Maslow’s hierarchy of needs b. Freuds id, ego, and superego c. Beck’s Cognitive Behavioral therapy d. Skinners classical conditioning
- To plan effectively for an individual who is in a crisis, the nurse must have an understanding of: a. Methods of establish a rapport b. Family counseling techniques c. The meaning of the crisis to the individual d. Posttraumatic stress disorder treatment modalities
- A new staff nurse completes orientation to the psychiatric unit. This nurse will expect to ask an advanced practice nurse to perform which action for patients? a. (^) Perform mental health assessment interviews. b. (^) Establish therapeutic relationships. c. (^) Prescribe psychotropic medication. d. (^) Individualize nursing care plans.
- A patient begins a new program to assist with building social skills. In which part of the plan of care should a nurse record the item “Encourage patient to attend one psychoeducational group daily”? a. (^) Assessment b. (^) Analysis c. (^) Planning d. (^) Implementation e. (^) Evaluation
- Select the best outcome for a patient with this nursing diagnosis: impaired social interaction, related to sociocultural dissonance as evidenced by stating, “Although I’d like to, I don’t join in because I don’t speak the language very well.” The patient will:
a. (^) Demonstrate improved social skills. b. (^) Express a desire to interact with others. c. (^) Become more independent in decision making. d. (^) Select and participate in one group activity per day.
- A nurse assesses a patient who reluctantly participates in activities, answers questions with minimal responses, and rarely makes eye contact. What information should be included when documenting the assessment? ( Select all that apply. ) a. (^) Uncooperative patient b. (^) Patient’s subjective responses c. (^) Only data obtained from the patient’s verbal responses d. (^) Description of the patient’s behavior during the interview e. (^) Analysis of why the patient is unresponsive during the interview
- Which technique will best communicate to a patient that the nurse is interested in listening? a. (^) Restate a feeling or thought the patient has expressed. b. (^) Ask a direct question, such as, “Did you feel angry?” c. (^) Make a judgment about the patient’s problem. d. (^) Say, “I understand what you’re saying.”
- During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. The nurse should respond by saying: a. (^) “You’ve turned the tables on me.” b. (^) “Nurses direct the interviews with patients.” c. (^) “Do not ask questions about my personal life.” d. (^) “The time we spend together is to discuss your concerns.”
- A client with Obsessive-Compulsive Disorder (OCD) experiences improvement after beginning treatment with a Selective serotonin inhibitor (SSRI). This phenomena supports the theory that OCD is: a. Norepinephrine deficiency
d. (^) Parasympathetic nervous system
- A veteran of the war in Afghanistan was diagnosed with posttraumatic stress disorder (PTSD). The veteran says, “If there’s a loud noise at night, I get under my bed because I think we’re getting bombed.” What type of experience has the veteran described? a. (^) Illusion b. (^) Flashback c. (^) Nightmare d. (^) Auditory hallucination
- Which experiences are most likely to precipitate posttraumatic stress disorder (PTSD)? ( Select all that apply. ) a. (^) An 8 - year-old child watches an R-rated movie with both parents. b. (^) A young adult jumps from a bridge with a bungee cord with a best friend. c. (^) An adolescent is kidnapped and held for 2 years in the home of a sexual predator. d. (^) A passenger is in a bus that overturns on a sharp curve in the road, tumbling down an embankment. e. (^) An adult is trapped for 3 hours at an angle in an elevator after a portion of the supporting cable breaks.
- A person who is speaking about a contender for a significant other’s affection says in a gushy, syrupy voice, “What a lovely person. That’s someone I simply adore.” The individual is demonstrating: a. (^) reaction formation. b. (^) repression. c. (^) projection. d. (^) denial.
- Which assessment questions are most appropriate to ask a patient with possible obsessive- compulsive disorder? ( Select all that apply. ) a. (^) “Have you been a victim of a crime or seen someone badly injured or killed?” b. (^) “Are there certain social situations that cause you to feel especially uncomfortable?” c. (^) “Do you have to do things in a certain way to feel comfortable?” d. (^) “Is it difficult to keep certain thoughts out of awareness?” e. (^) “Do you do certain things over and over again?”
- A woman says, “I can’t take anymore! Last year my husband had an affair. Three months ago, I found a lump in my breast. Yesterday my daughter said she’s quitting college.” What type of crisis is this person experiencing? a. (^) Maturational b. (^) Adventitious c. (^) Situational d. (^) Recurring
- During the initial interview at the crisis center, a patient says, “I’ve been served with divorce papers. I’m so upset and anxious that I can’t think clearly.” What could the nurse say to assess personal coping skills? a. (^) “What would you like us to do to help you feel more relaxed?” b. (^) “In the past, how did you handle difficult or stressful situations?” c. (^) “Do you think you deserve to have things like this happen to you?” d. (^) “I can see you are upset. You can rely on us to help you feel better.”
- An adult attempts suicide after declaring bankruptcy. The patient is hospitalized and takes an antidepressant medication for five days. The patient is now more talkative and shows increased energy. Select the highest priority nursing intervention. a. (^) Supervise the patient 24 hours a day. b. (^) Begin discharge planning for the patient. c. (^) Refer the patient to art and music therapists. d. (^) Consider the discontinuation of suicide precautions.
43 A client is diagnoses of agoraphobia is preparing to go on a walk around the block as part
. of their treatment regime. The care team has taught the client a number of relaxation techniques that she can use to inhibit her anxiety prior to and during her time in public. This client has received what? a. systematic desensitization b. aversion therapy c. therapeutic lifestyle counseling d. assertiveness training
- A nurse states to a client, “Things will look better tomorrow after a good night’s sleep.” This is an example of which non-therapeutic communication technique? a. Giving advice b. Restating c. Offering self d. Presenting reality
- The nurse would recognize that typical nursing assessment findings in a client experiencing anxiety are: a. Blunted affect, looseness of thought, and rapid speech b. Slurred speech, ataxia, and unsteady gait c. Hallucinations, dilated pupils, and increased pulse d. Palpitations, sweaty palms, shortness of breathe .
- A nurse designs a plan of exercise for a patient experiencing stress. The rationale the nurse should explain when presenting this plan to the treatment team is that exercise: a. (^) Will stimulate endorphins and improve the patient’s feelings of well-being. b. (^) Prevents damage from overstimulation of the sympathetic nervous system. c. (^) Detoxifies the body by removing metabolic wastes and other toxins. d. (^) Will prevent exacerbation of the stress by the limbic system.
- A patient with a mass in the left upper lobe of the lung is scheduled for a biopsy. The patient has difficulty understanding the nurse’s comments and asks, “What are they going to do?” Assessment findings include a tremulous voice, respirations 28 breaths per minute, and pulse rate 110 beats per minute. What is the patient’s level of anxiety? a. (^) Mild b. (^) Moderate c. (^) Severe d. (^) Panic
- A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate? a. “What are the common elements here?” b. (^) “Tell me again about your experiences.” c. (^) “Am I correct in understanding that…?” d. (^) “Tell me everything from the beginning.”
- A patient’s nursing diagnosis is insomnia. The desired outcome is: “Patient will sleep for a minimum of 5 hours nightly by October 31.” On November 1, a review of the sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. Which evaluation should be documented? a. (^) Consistently demonstrated b. (^) Often demonstrated c. (^) Sometimes demonstrated d. (^) Never demonstrated
