Mental Health Final (Other 33%)
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- 1.
2. Two nursing students discuss their career plans after graduation. One student wants to enter psychiatric nursing. The other asks, “Why would you want to be a psychiatric nurse? The only thing they do is talk. You’ll lose all your skills.” Select the best response.
- A.
“Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of the patients’ problems.”
- B.
“Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations.”
- C.
“I think I will be good in the mental health field. I did not like clinical rotations in school, so I do not want to continue them after I graduate.”
- D.
“Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That appeals to me.”
Correct Answer
B. “Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations.”Explanation
The correct answer emphasizes the importance of complex communication skills and critical thinking in psychiatric nursing. It highlights that psychiatric nurses are faced with multidimensional problems that require these skills to solve. This response demonstrates an understanding of the unique challenges and opportunities in the field of psychiatric nursing, showing a genuine interest and motivation to pursue this career path.Rate this question:
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- 2.
3. A new bill introduced in Congress would reduce funding for care of persons with mental illness. Groups of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled?
- A.
Advocacy
- B.
Attending
- C.
Recovery
- D.
Evidence-based practice
Correct Answer
A. AdvocacyExplanation
The nurses have fulfilled the role of advocacy by writing letters to their elected representatives in opposition to the legislation. Advocacy involves speaking up and taking action on behalf of others to promote their rights, needs, and interests. In this case, the nurses are advocating for the care of persons with mental illness by opposing the bill that would reduce funding for their care.Rate this question:
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- 3.
4. An informal group of patients discusses their perceptions of nursing care. Which comment best indicates a patient perceived the nurse was caring? “My nurse:
- A.
Always asks me which type of juice I want to help me swallow my medication.”
- B.
Explained my treatment plan to me and asked for my ideas about how to make it better.”
- C.
Told me that if I take all the medicines the doctor prescribes, then I will get discharged soon.”
- D.
Spends time listening to me talk about my problems. That helps me feel like I’m not alone.”
Correct Answer
D. Spends time listening to me talk about my problems. That helps me feel like I’m not alone.”Explanation
The comment "spends time listening to me talk about my problems. That helps me feel like I’m not alone" indicates that the patient perceived the nurse as caring because the nurse is actively listening and providing emotional support. This shows that the nurse is attentive, empathetic, and willing to spend time with the patient, which can help create a sense of trust and comfort. This kind of interaction fosters a therapeutic relationship and demonstrates a caring attitude from the nurse towards the patient.Rate this question:
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- 4.
5. Which finding best indicates that a patient has a mental illness? The patient:
- A.
Responds to rules, routines, and customs of a group.
- B.
Reports mood is consistently sad, discouraged, and hopeless.
- C.
Performs tasks attempted within the limits set by own abilities.
- D.
Answer option 4
Correct Answer
A. Responds to rules, routines, and customs of a group.Explanation
This answer indicates that the patient has a mental illness because it suggests that the patient is conforming to societal norms and expectations without questioning or challenging them. This behavior can be indicative of a lack of independent thinking or impaired judgment, which are common symptoms of mental illness.Rate this question:
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- 5.
6. Which finding best indicates that the goal “Demonstrate mentally healthy behavior” was achieved? A patient:
- A.
Sees self as approaching ideals and capable of meeting demands.
- B.
Seeks others to assume responsibility for major areas of own life. seeks others to assume responsibility for major areas of own life.
- C.
Behaves without considering the consequences of personal actions.
- D.
Aggressively meets own needs without considering the rights of others.
Correct Answer
A. Sees self as approaching ideals and capable of meeting demands.Explanation
The finding that best indicates that the goal "Demonstrate mentally healthy behavior" was achieved is when the patient sees themselves as approaching ideals and capable of meeting demands. This suggests that the patient has a positive self-perception and believes in their own abilities to handle challenges and responsibilities. It indicates a sense of self-confidence and a healthy mindset.Rate this question:
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- 6.
5. Which finding best indicates that a patient has a mental illness? The patient:
- A.
Responds to rules, routines, and customs of a group.
- B.
Reports mood is consistently sad, discouraged, and hopeless.
- C.
Performs tasks attempted within the limits set by own abilities.
- D.
Is able to see the difference between the “as if” and the “for real.”
Correct Answer
B. Reports mood is consistently sad, discouraged, and hopeless.Explanation
The finding that a patient consistently reports a sad, discouraged, and hopeless mood is indicative of a mental illness. This is because persistent negative emotions can be a symptom of conditions such as depression or anxiety. The other options do not directly indicate a mental illness. Responding to rules, routines, and customs of a group is a normal social behavior. Performing tasks within one's abilities and being able to differentiate between the "as if" and the "for real" are indicators of cognitive functioning.Rate this question:
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7. A nurse encounters an unfamiliar psychiatric disorder on a new patient’s admission form. To determine criteria used to establish this diagnosis, the nurse should consult which resource?
- A.
Diagnostic and Statistical Manual of Mental Disorders
- B.
A nursing diagnosis handbook
- C.
A psychiatric nursing textbook
- D.
A behavioral health reference manual
Correct Answer
A. Diagnostic and Statistical Manual of Mental DisordersExplanation
The correct answer is the Diagnostic and Statistical Manual of Mental Disorders. This manual is widely recognized as the standard reference for diagnosing psychiatric disorders. It provides criteria and guidelines for diagnosing various mental health conditions and is used by healthcare professionals, including nurses, to establish a diagnosis. A nursing diagnosis handbook may provide information on nursing interventions and care plans, but it does not provide the criteria for diagnosing psychiatric disorders. A psychiatric nursing textbook may provide general information on psychiatric disorders, but it may not have the specific criteria needed for diagnosis. A behavioral health reference manual may provide information on behavioral health conditions, but it may not have the comprehensive criteria needed for diagnosis.Rate this question:
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- 8.
8. Which documentation of diagnosis would a nurse expect in a psychiatric treatment setting?
- A.
I Acute renal failure II 75 III Bipolar disorder I, mixed IV Loss of disability benefits 2 months ago V None
- B.
I Schizophrenia, paranoid type II Death of spouse last year III 60 IV None V Diabetes, type 2
- C.
I Polysubstance dependence II Narcissistic Personality Disorder III 90 IV Hyperlipidemia V Charges pending for assault
- D.
I Major Depression II Avoidant Personality Disorder III Hypertension IV Home destroyed by hurricane last year V 80
Correct Answer
D. I Major Depression II Avoidant Personality Disorder III Hypertension IV Home destroyed by hurricane last year V 80 -
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9. A nurse explains the multiaxial DSM-IV-TR to a psychiatric technician and includes information that it:
- A.
Focuses on plans for treatment.
- B.
Includes nursing and medical diagnoses.
- C.
Classifies problems in multiple areas of functioning.
- D.
Uses the framework of a specific biopsychosocial theory.
Correct Answer
C. Classifies problems in multiple areas of functioning.Explanation
The correct answer is "classifies problems in multiple areas of functioning." The multiaxial DSM-IV-TR is a diagnostic tool used in psychiatry to assess and classify mental disorders. It includes five axes, with the fifth axis specifically focusing on problems in multiple areas of functioning such as occupational, social, and psychological functioning. This allows for a comprehensive understanding of the individual's mental health and helps in developing appropriate treatment plans. The other options mentioned, such as focusing on plans for treatment, including nursing and medical diagnoses, and using a specific biopsychosocial theory, are not specific to the multiaxial DSM-IV-TR.Rate this question:
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- 10.
10. A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information?
- A.
The ICD-10
- B.
Nursing Outcomes Classification
- C.
Diagnostic and Statistical Manual of Mental Disorders
- D.
The ANA Psychiatric-Mental Health Nursing Scope and Standards of Practice
Correct Answer
C. Diagnostic and Statistical Manual of Mental DisordersExplanation
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a widely recognized and comprehensive resource for diagnosing mental disorders, including anxiety disorders. It provides detailed descriptions of diagnostic criteria, as well as information on prevalence, risk factors, and treatment options. The ICD-10 also includes diagnostic criteria for mental disorders, but it is more focused on medical coding and classification. Nursing Outcomes Classification and the ANA Psychiatric-Mental Health Nursing Scope and Standards of Practice may provide some information on anxiety disorders, but they are not as comprehensive as the DSM.Rate this question:
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15. The Diagnostic and Statistical Manual of Mental Disorders classifies:
- A.
Deviant behaviors.
- B.
People with mental disorders.
- C.
Present disability or distress.
- D.
Mental disorders people have.
Correct Answer
D. Mental disorders people have.Explanation
The correct answer is "mental disorders people have." The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a widely used classification system for mental disorders. It categorizes and defines various mental disorders based on their symptoms, behaviors, and other diagnostic criteria. Therefore, the DSM classifies the mental disorders that people have, rather than deviant behaviors, people with mental disorders, or present disability or distress.Rate this question:
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- 12.
20. Which belief will best support a nurse’s efforts to provide patient advocacy during a multidisciplinary patient care planning session?
- A.
All mental illnesses are culturally determined.
- B.
Schizophrenia and bipolar disorder are cross-cultural disorders.
- C.
Symptoms of mental disorders are unchanged from culture to culture.
- D.
Assessment findings in mental disorders reflect a person’s cultural patterns.
Correct Answer
D. Assessment findings in mental disorders reflect a person’s cultural patterns.Explanation
The belief that assessment findings in mental disorders reflect a person's cultural patterns will best support a nurse's efforts to provide patient advocacy during a multidisciplinary patient care planning session. This belief recognizes the importance of considering cultural factors when assessing and planning care for individuals with mental disorders. It acknowledges that symptoms and behaviors may be influenced by cultural norms, values, and beliefs, and emphasizes the need for culturally sensitive and appropriate care.Rate this question:
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21. A nurse is part of a multidisciplinary team working with groups of depressed patients. Half the patients receive supportive interventions and antidepressant medication. The other half receives only medication. The team measures outcomes for each group. Which type of study is evident?
- A.
Prevalence
- B.
Clinical epidemiology
- C.
Descriptive epidemiology
- D.
Experimental epidemiology
Correct Answer
B. Clinical epidemiologyExplanation
The given scenario describes a study where a nurse is working with a multidisciplinary team to measure outcomes for groups of depressed patients. The study involves comparing two groups of patients, one receiving supportive interventions and antidepressant medication, and the other receiving only medication. This type of study, which involves measuring outcomes and comparing different interventions, is known as clinical epidemiology.Rate this question:
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- 14.
23. A 40-year-old who lives with parents and works at an unchallenging job says, “I’m as happy as anyone else, even though I don’t socialize much outside of work. My work is routine, but when new things come up, my boss explains things a few times to make sure I catch on. At home, my parents make decisions for me, and I go along with their ideas.” The nurse should identify interventions to improve this patient’s:
- A.
Self-concept.
- B.
Overall happiness.
- C.
Appraisal of reality.
- D.
Control over behavior.
Correct Answer
A. Self-concept.Explanation
The patient's statement suggests that they have a low sense of self-concept. They rely on their parents to make decisions for them and do not socialize much outside of work. This indicates a lack of independence and self-confidence. Improving the patient's self-concept would involve helping them develop a stronger sense of self, assertiveness, and autonomy.Rate this question:
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- 15.
24. The psychiatric nurse addresses axis I of the DSM as the focus of treatment but must also consider physical health problems that may affect treatment. Which axis contains the desired information?
- A.
II
- B.
III
- C.
IV
- D.
V
Correct Answer
B. IIIExplanation
Axis III of the DSM contains information about any physical health problems that may affect treatment. This axis is important for the psychiatric nurse to consider because physical health issues can have a significant impact on the effectiveness of treatment for mental health conditions. By addressing both the psychiatric condition on axis I and any physical health problems on axis III, the nurse can provide comprehensive and holistic care to the patient.Rate this question:
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- 16.
1. A patient asks, “What are neurotransmitters? The doctor said mine are imbalanced.” Select the nurse’s best response.
- A.
“How do you feel about having imbalanced neurotransmitters?”
- B.
“You must feel relieved to know that your problem has a physical basis.”
- C.
“Neurotransmitters are substances we eat daily that influence memory and mood.”
- D.
“Neurotransmitters are natural chemicals that pass messages between brain cells.”
Correct Answer
D. “Neurotransmitters are natural chemicals that pass messages between brain cells.”Explanation
Neurotransmitters are natural chemicals that pass messages between brain cells. This response provides a clear and concise explanation of what neurotransmitters are and their function in the body. It directly addresses the patient's question and provides them with the information they need to understand the concept of imbalanced neurotransmitters.Rate this question:
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- 17.
2. The parent of an adolescent with schizophrenia asks the nurse, “My child’s doctor ordered a PET. What kind of test is that?” Select the nurse’s best reply.
- A.
“This test uses a magnetic field and gamma waves to identify problem areas in the brain. Does your teenager have any metal implants?”
- B.
“PET means positron-emission tomography. An injection is given and images are taken. It shows blood flow and activity in the brain.”
- C.
“A PET scan passes an electrical current through the brain and shows brain-wave activity. It can help diagnose seizures.”
- D.
“It’s a special type of x-ray that shows structures of the brain and whether there has ever been a brain injury.”
Correct Answer
B. “PET means positron-emission tomograpHy. An injection is given and images are taken. It shows blood flow and activity in the brain.”Explanation
The nurse's best reply is "PET means positron-emission tomography. An injection is given and images are taken. It shows blood flow and activity in the brain." This answer accurately describes what a PET scan is and how it is performed. It explains that a radioactive tracer is injected into the patient's bloodstream, which allows the scanner to detect areas of high metabolic activity in the brain. This information is important for the parent to understand the purpose and process of the test.Rate this question:
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- 18.
3. A patient with a long history of hypertension and diabetes now develops confusion. The health care provider wants to make a differential diagnosis between Alzheimer’s disease or multiple infarcts. Which diagnostic procedure should the nurse expect to prepare the patient for first?
- A.
PET
- B.
Skull X-ray
- C.
CT
- D.
SPECT
Correct Answer
C. CTExplanation
The nurse should expect to prepare the patient for a CT scan as the first diagnostic procedure. A CT scan, or computed tomography, uses X-rays and computer technology to create detailed cross-sectional images of the body. It can help identify structural abnormalities in the brain, such as infarcts or areas of decreased blood flow, which can help differentiate between Alzheimer's disease and multiple infarcts. PET, SPECT, and skull X-ray may also be used in the diagnostic process, but CT is typically the initial imaging test performed.Rate this question:
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- 19.
6. The nurse administers a medication that potentiates the action of GABA. Which effect would be expected?
- A.
Reduced anxiety
- B.
Improved memory
- C.
More organized thinking
- D.
Fewer sensory perceptual alterations
Correct Answer
A. Reduced anxietyExplanation
The nurse administers a medication that potentiates the action of GABA. GABA is an inhibitory neurotransmitter in the brain that helps reduce neural activity and promote relaxation. By potentiating the action of GABA, the medication would enhance its calming effects, leading to a reduction in anxiety. Therefore, the expected effect of the medication would be reduced anxiety.Rate this question:
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- 20.
8. A patient has disorganized thinking associated with schizophrenia. Neuroimaging would most likely show dysfunction in which part of the brain?
- A.
Hippocampus
- B.
Frontal lobe
- C.
Cerebellum
- D.
Brainstem
Correct Answer
B. Frontal lobeExplanation
Disorganized thinking is a symptom commonly associated with schizophrenia. The frontal lobe of the brain is responsible for executive functions such as planning, decision-making, and problem-solving. Dysfunction in the frontal lobe can lead to disorganized thinking and difficulty in organizing thoughts and actions. Neuroimaging would most likely show dysfunction in the frontal lobe of the brain in a patient with disorganized thinking associated with schizophrenia.Rate this question:
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- 21.
10. The therapeutic action of neurotransmitter inhibitors that block reuptake cause:
- A.
Decreased concentration of the neurotransmitter in the central nervous system.
- B.
Increased concentration of neurotransmitter in the synaptic gap.
- C.
Destruction of receptor sites.
- D.
Limbic system stimulation.
Correct Answer
B. Increased concentration of neurotransmitter in the synaptic gap.Explanation
When neurotransmitter inhibitors block reuptake, they prevent the reabsorption of neurotransmitters by the presynaptic neuron. This leads to an accumulation of neurotransmitters in the synaptic gap, increasing their concentration. As a result, there is a greater availability of neurotransmitters to bind to receptor sites on the postsynaptic neuron, enhancing the transmission of signals between neurons.Rate this question:
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- 22.
11. A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. The nurse analyzes that these symptoms relate to which drug action?
- A.
Anticholinergic effects
- B.
Dopamine-blocking effects
- C.
Endocrine-stimulating effects
- D.
Ability to stimulate spinal nerves
Correct Answer
B. Dopamine-blocking effectsExplanation
The symptoms described, restlessness and an uncontrollable need to be in motion, are consistent with the side effects of dopamine-blocking medications. Dopamine-blocking medications can lead to a condition called akathisia, which is characterized by restlessness and an inability to sit still. This is a known side effect of antipsychotic medications, which work by blocking dopamine receptors in the brain. Therefore, the correct answer is dopamine-blocking effects.Rate this question:
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- 23.
12. A nurse assesses that a patient has fear as well as increased heart rate and blood pressure. The nurse suspects increased activity of which neurotransmitter?
- A.
GABA
- B.
Histamine
- C.
Acetylcholine
- D.
Norepinephrine
Correct Answer
D. NorepinepHrineExplanation
The nurse suspects increased activity of norepinephrine because fear and increased heart rate and blood pressure are commonly associated with the release of norepinephrine in the body. Norepinephrine is a neurotransmitter that is involved in the body's "fight or flight" response, which is activated during times of stress or fear. It increases heart rate and blood pressure to prepare the body for action.Rate this question:
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- 24.
13. A patient has acute anxiety related to an automobile accident 2 hours ago. The patient needs teaching about drugs from which group?
- A.
Tricyclic antidepressants
- B.
Antipsychotic drugs
- C.
Antimanic drugs
- D.
Benzodiazepines
Correct Answer
D. BenzodiazepinesExplanation
A patient who has acute anxiety related to an automobile accident would benefit from drugs from the benzodiazepine group. Benzodiazepines are commonly used to treat anxiety disorders as they work by enhancing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA) in the brain, which helps to calm down excessive activity and reduce anxiety. Tricyclic antidepressants, antipsychotic drugs, and antimanic drugs are not typically used to treat acute anxiety and may not provide the immediate relief needed in this situation.Rate this question:
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- 25.
14. A patient is hospitalized for severe depression. Of the medications listed below, the nurse can expect to provide the patient with teaching about:
- A.
Chlordiazepoxide (Librium).
- B.
Clozapine (Clozaril).
- C.
Sertraline (Zoloft).
- D.
Tacrine (Cognex).
Correct Answer
C. Sertraline (Zoloft).Explanation
The nurse can expect to provide teaching about sertraline (Zoloft) because it is commonly used to treat depression. Chlordiazepoxide (Librium) is a benzodiazepine used to treat anxiety and alcohol withdrawal symptoms. Clozapine (Clozaril) is an antipsychotic medication used to treat schizophrenia. Tacrine (Cognex) is a medication used to treat symptoms of Alzheimer's disease. Therefore, sertraline (Zoloft) is the most appropriate medication to provide teaching about in the context of severe depression.Rate this question:
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- 26.
16. A drug causes muscarinic receptor blockade. The nurse will assess the patient for
- A.
Dry mouth.
- B.
Gynecomastia.
- C.
Pseudoparkinsonism.
- D.
Orthostatic hypotension.
Correct Answer
A. Dry mouth.Explanation
A drug that causes muscarinic receptor blockade would inhibit the action of acetylcholine on these receptors. Muscarinic receptors are found in various organs including salivary glands, so their blockade would result in decreased saliva production and subsequently dry mouth. Therefore, the nurse should assess the patient for this side effect. Gynecomastia refers to the development of breast tissue in males and is not related to muscarinic receptor blockade. Pseudoparkinsonism refers to symptoms resembling Parkinson's disease, such as tremors and bradykinesia, and is not directly related to muscarinic receptor blockade. Orthostatic hypotension refers to a drop in blood pressure upon standing and is also not specifically associated with muscarinic receptor blockade.Rate this question:
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- 27.
18. A patient tells the nurse, “My doctor prescribed Paxil (paroxetine) for my depression. I assume I’ll have side effects like I had when I was taking Tofranil (imipramine).” The nurse’s reply should be based on the knowledge that paroxetine is a:
- A.
Selective norepinephrine reuptake inhibitor.
- B.
Tricyclic antidepressant.
- C.
MAO inhibitor.
- D.
SSRI
Correct Answer
A. Selective norepinepHrine reuptake inhibitor.Explanation
The nurse should reply that paroxetine is a selective norepinephrine reuptake inhibitor. This means that it works by increasing the levels of norepinephrine in the brain, which can help improve mood and relieve symptoms of depression. It is different from Tofranil (imipramine), which is a tricyclic antidepressant. Therefore, the patient should not assume that they will have the same side effects with paroxetine as they did with Tofranil.Rate this question:
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- 28.
19. A nurse can anticipate anticholinergic side effects are likely when a patient takes:
- A.
Lithium (Lithobid).
- B.
Buspirone (BuSpar).
- C.
Risperidone (Risperdal).
- D.
Fluphenazine (Prolixin).
Correct Answer
D. FlupHenazine (Prolixin).Explanation
Fluphenazine is a typical antipsychotic medication that has strong anticholinergic properties. Anticholinergic side effects include dry mouth, blurred vision, constipation, urinary retention, and confusion. Lithium, buspirone, and risperidone do not typically have anticholinergic side effects.Rate this question:
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- 29.
20. Which instruction has priority when teaching a patient taking clozapine (Clozaril)?
- A.
“Avoid unprotected sex.”
- B.
“Report sore throat and fever immediately.”
- C.
“Reduce foods high in polyunsaturated fats.”
- D.
“Use over-the-counter preparations for rashes.”
Correct Answer
B. “Report sore throat and fever immediately.”Explanation
The instruction to "Report sore throat and fever immediately" has priority when teaching a patient taking clozapine (Clozaril) because these symptoms could indicate a serious condition called agranulocytosis, which is a potentially life-threatening side effect of clozapine. Agranulocytosis is characterized by a severe decrease in white blood cells, which can lead to an increased risk of infection. Therefore, it is crucial for patients taking clozapine to report any signs of infection, such as a sore throat and fever, to their healthcare provider immediately for further evaluation and management.Rate this question:
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- 30.
21. A nurse cares for patients taking various medications, including buspirone (BuSpar), haloperidol (Haldol), carbamazepine (Tegretol), trazodone (Desyrel), and phenelzine (Nardil). The nurse will order a special diet for the patient who takes:
- A.
Buspirone.
- B.
Haloperidol.
- C.
Carbamazepine.
- D.
Phenelzine.
Correct Answer
D. pHenelzine.Explanation
Phenelzine is a monoamine oxidase inhibitor (MAOI) used to treat depression. MAOIs require dietary restrictions due to potential interactions with certain foods and beverages. Foods high in tyramine, such as aged cheeses, cured meats, and fermented foods, can cause a hypertensive crisis when combined with MAOIs. Therefore, a special diet is necessary for patients taking phenelzine to avoid these foods and prevent complications. Buspirone, haloperidol, and carbamazepine do not have specific dietary restrictions associated with their use.Rate this question:
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- 31.
22. A nurse instructs a patient taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of:
- A.
Cardiac dysrhythmia.
- B.
Hypotensive shock.
- C.
Hypertensive crisis.
- D.
Cardiogenic shock.
Correct Answer
C. Hypertensive crisis.Explanation
When a patient takes a drug that inhibits monoamine oxidase (MAO), certain foods and drugs can cause a hypertensive crisis. This is because MAO is responsible for breaking down certain substances in the body, including tyramine, which is found in certain foods and drugs. When MAO is inhibited, tyramine can accumulate and cause a sudden increase in blood pressure, leading to a hypertensive crisis. Therefore, it is important for the patient to avoid these foods and drugs to prevent this potentially dangerous situation.Rate this question:
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- 32.
25. The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3. Select the nurse’s best action.
- A.
Report these results to the health care provider immediately.
- B.
Give the next dose as prescribed.
- C.
Give aspirin and force fluids.
- D.
Repeat the laboratory test.
Correct Answer
A. Report these results to the health care provider immediately.Explanation
The nurse's best action in this situation is to report the white blood cell count of 3000 mm3 to the health care provider immediately. This is because clozapine (Clozaril) is known to cause agranulocytosis, a potentially life-threatening condition characterized by a low white blood cell count. The health care provider needs to be informed promptly so that appropriate interventions can be taken to ensure the patient's safety. Giving the next dose as prescribed, giving aspirin and force fluids, or repeating the laboratory test would not address the urgency of the situation.Rate this question:
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- 33.
30. Consider these medications: carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin). Which medication below also belongs with this group?
- A.
Galantamine (Reminyl)
- B.
Valproate (Depakote)
- C.
Buspirone (BuSpar)
- D.
Tacrine (Cognex)
Correct Answer
B. Valproate (Depakote)Explanation
Valproate (Depakote) belongs with the group of medications carbamazepine (Tegretol), lamotrigine (Lamictal), and gabapentin (Neurontin) because it is also used to treat seizures and certain types of epilepsy.Rate this question:
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- 34.
2. A Hispanic woman comes to the mental health center at the urging of her adult children. The patient has lost 5 pounds since her husband’s death 6 months ago and says, “My husband comes to visit me in the night but I cannot understand what he says.” How should the nurse analyze this situation? The patient is:
- A.
Experiencing auditory and visual hallucinations.
- B.
At high risk for imbalanced nutrition.
- C.
Grieving the husband’s death.
- D.
Denying the husband’s death.
Correct Answer
C. Grieving the husband’s death.Explanation
The patient's statement about her husband visiting her in the night and not being able to understand him suggests that she is experiencing grief and possibly longing for her husband. This is a common reaction to the loss of a loved one and is consistent with the symptoms of grief. The fact that she has lost weight since her husband's death further supports the idea that she is grieving. There is no mention of auditory and visual hallucinations, imbalanced nutrition, or denial of the husband's death, so these options can be ruled out.Rate this question:
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- 35.
6. An African American patient is suspicious, has angry outbursts, and accuses staff of discriminating when they remove possibly harmful objects. Which factor best demonstrates cultural awareness regard this patient’s behavior?
- A.
The patient may have feelings of powerlessness.
- B.
Family solidarity is this patient’s priority need.
- C.
Institutional policies promote discrimination.
- D.
The patient fears abandonment.
Correct Answer
A. The patient may have feelings of powerlessness.Explanation
The patient's suspicious behavior, angry outbursts, and accusations of discrimination suggest that they may feel powerless in their interactions with the staff. This behavior could be a result of past experiences of discrimination or a lack of trust in the healthcare system. Understanding the patient's feelings of powerlessness can help healthcare providers approach the situation with empathy and cultural sensitivity.Rate this question:
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- 36.
17. A Chinese American patient diagnosed with an anxiety disorder says, “My problems began when my energy became imbalanced.” When the nurse asks for the patient’s ideas about how to treat the imbalance, the patient may request:
- A.
Eating special foods.
- B.
Taking antianxiety medication.
- C.
Undergoing cognitive behavior therapy.
- D.
Having a native healer perform a ritual.
Correct Answer
A. Eating special foods.Explanation
The patient's statement about their energy becoming imbalanced suggests that they may have a belief in traditional Chinese medicine or other alternative healing practices. In these practices, imbalances in energy are often believed to be the cause of illness or disorder. Therefore, the patient may request eating special foods as a way to rebalance their energy and treat their anxiety disorder.Rate this question:
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- 37.
22. A hospice nurse plans care for four culturally diverse patients, each of whom has advanced cancer. Which patient will most likely wish to engage actively in end-of-life planning?
- A.
Native American; worked as a forest ranger
- B.
Female immigrant from China; acupuncturist
- C.
Refugee laborer from war-torn African country
- D.
Fourth-generation New England native; accountant
Correct Answer
D. Fourth-generation New England native; accountantExplanation
The fourth-generation New England native who is an accountant is the most likely to wish to engage actively in end-of-life planning because individuals in this profession often value organization and planning. Additionally, being a native of the area may indicate a strong sense of community and family ties, which can contribute to a desire to plan for end-of-life care.Rate this question:
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- 38.
2. Which action by a psychiatric nurse best supports the right of patients to be treated with dignity and respect?
- A.
Consistently addresses patients by title and surname
- B.
Strongly encourages a patient to participate in the unit milieu
- C.
Discusses a patient’s condition with the health care provider in the elevator
- D.
Informs a treatment team that a patient is too drowsy to participate in care planning
Correct Answer
A. Consistently addresses patients by title and surnameExplanation
Consistently addressing patients by title and surname is the best action by a psychiatric nurse to support the right of patients to be treated with dignity and respect. This shows that the nurse recognizes and acknowledges the individuality and importance of each patient, promoting a sense of dignity and respect in the therapeutic relationship. It also demonstrates professionalism and creates a more equal and respectful environment between the nurse and the patient.Rate this question:
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- 39.
6. What is the legal significance of a nurse’s action when a patient verbally refuses medication and the nurse gives the medication over the patient’s objection? The nurse:
- A.
Has been negligent.
- B.
Committed malpractice.
- C.
Fulfilled the standard of care.
- D.
Can be charged with battery.
Correct Answer
D. Can be charged with battery.Explanation
When a patient verbally refuses medication and the nurse gives the medication over the patient's objection, the nurse can be charged with battery. Battery refers to the intentional and unauthorized physical contact with another person, which includes administering medication without the patient's consent. In this scenario, the nurse's action of giving the medication against the patient's objection can be seen as a violation of the patient's bodily autonomy and can be legally considered as battery.Rate this question:
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- 40.
7. Which nursing intervention demonstrates false imprisonment?
- A.
A confused and combative patient says, “I’m getting out of here and no one can stop me.” The nurse restrains this patient without a health care provider’s order and then promptly obtains an order.
- B.
A patient has been irritating and attention seeking much of the day. Now a nurse escorts the patient down the hall saying, “Stay in your room or you’ll be put in seclusion.”
- C.
An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. The nurse rushes after the patient and convinces the patient to return to the unit.
- D.
An involuntarily hospitalized patient with homicidal ideation attempts to leave the facility. A nurse calls the security team and uses established protocols to prevent the patient from leaving.
Correct Answer
B. A patient has been irritating and attention seeking much of the day. Now a nurse escorts the patient down the hall saying, “Stay in your room or you’ll be put in seclusion.”Explanation
The nursing intervention that demonstrates false imprisonment is when the nurse escorts the irritating and attention-seeking patient down the hall and threatens them with seclusion if they don't stay in their room. False imprisonment refers to the intentional confinement or restraint of a person without proper legal authority. In this situation, the nurse is using the threat of seclusion to restrict the patient's movement, which is a form of false imprisonment.Rate this question:
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- 41.
19. A new antidepressant is prescribed for an elderly patient with major depression, but the dose is more than the usual geriatric dose. The nurse should:
- A.
Consult a drug reference.
- B.
Teach the patient about possible side effects and adverse effects.
- C.
Withhold the medication and confer with the health care provider.
- D.
Encourage the patient to increase oral fluids to reduce drug concentration.
Correct Answer
C. Withhold the medication and confer with the health care provider.Explanation
The correct answer is to withhold the medication and confer with the healthcare provider. This is because the dose of the antidepressant is more than the usual geriatric dose, which could potentially lead to adverse effects or side effects in the elderly patient. It is important for the nurse to consult with the healthcare provider before administering the medication to ensure the safety and well-being of the patient.Rate this question:
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- 42.
21. A patient with psychosis became aggressive, struck another patient, and required seclusion. Select the best documentation.
- A.
Patient struck another patient who attempted to leave day room to go to bathroom. Seclusion necessary at 1415. Plan: Maintain seclusion for 8 hours and keep these two patients away from each other for 24 hours.
- B.
Seclusion ordered by physician at 1415 after command hallucinations told the patient to hit another patient. Careful monitoring of patient maintained during period of seclusion.
- C.
Seclusion ordered by MD for aggressive behavior. Begun at 1415. Maintained for 2 hours without incident. Outcome: Patient calmer and apologized for outburst.
- D.
Patient pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At 1415 patient yelled, “I’ll punch anyone who gets near me,” and struck another patient with fist. Physically placed in seclusion at 1420. Seclusion order obtained from MD at 1430.
Correct Answer
D. Patient pacing, shouting. Haloperidol 5 mg given PO at 1300. No effect by 1315. At 1415 patient yelled, “I’ll punch anyone who gets near me,” and struck another patient with fist. pHysically placed in seclusion at 1420. Seclusion order obtained from MD at 1430.Explanation
The answer provides a detailed account of the patient's behavior leading up to the incident, including the administration of medication and the lack of effect. It also describes the patient's aggressive behavior and the action taken to physically place them in seclusion. Additionally, it mentions that a seclusion order was obtained from a physician after the incident. This documentation accurately captures the sequence of events and the necessary interventions taken, providing a comprehensive record of the situation.Rate this question:
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- 43.
5. An adult patient recently diagnosed with cancer states, “I’ve lived my life according to the Bible. I don’t understand why God has forsaken me.” Which nursing diagnosis applies?
- A.
Hopelessness
- B.
Spiritual distress
- C.
Spiritual dysfunction
- D.
Disturbed thought processes
Correct Answer
D. Disturbed thought processesExplanation
The patient's statement suggests a disturbance in their thought processes, as they are expressing confusion and questioning their beliefs in the face of their recent cancer diagnosis. This diagnosis is focused on the patient's cognitive processes and how they are processing and making sense of their situation, rather than directly addressing their feelings of hopelessness or spiritual distress.Rate this question:
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- 44.
13. Which nursing documentation best meets the requirement for problem-oriented charting?
- A.
“Pacing and muttering to self. Sensory perceptual alteration related to internal auditory stimulation. Given fluphenazine 2.5 mg PO at 0900 and went to room to lie down. Calmer by 0930. Returned to lounge to watch TV.”
- B.
“Agitated behavior. Patient muttering to self as though answering an unseen person. Given haloperidol 2 mg PO and went to room to lie down. Patient calmer within 30 minutes. Returned to lounge to watch TV.”
- C.
“S: States ‘I feel like I’m ready to blow up.’ O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol 2 mg PO. I: Haloperidol 2 mg PO given at 0900. E: Returned to lounge at 0930 and quietly watched TV.”
- D.
“Pacing hall and muttering to self as though answering an unseen person. Haloperidol 2 mg PO administered at 0900, with calming effect in 30 minutes. Stated ‘I’m no longer bothered by the voices.’”
Correct Answer
C. “S: States ‘I feel like I’m ready to blow up.’ O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol 2 mg PO. I: Haloperidol 2 mg PO given at 0900. E: Returned to lounge at 0930 and quietly watched TV.”Explanation
This nursing documentation best meets the requirement for problem-oriented charting because it follows the SOAP (Subjective, Objective, Assessment, Plan) format. The documentation includes the patient's subjective statement ("S: States 'I feel like I'm ready to blow up.'"), objective observations ("O: Pacing hall, mumbling to self"), assessment of the problem ("A: Auditory hallucinations"), plan of action ("P: Offer haloperidol 2 mg PO"), intervention performed ("I: Haloperidol 2 mg PO given at 0900"), and evaluation of the intervention ("E: Returned to lounge at 0930 and quietly watched TV"). This format provides a clear and organized structure for documenting the patient's problem and the nursing actions taken.Rate this question:
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- 45.
14. A nurse assesses an elderly patient brought to the emergency department by a grandchild who found the patient wandering in the front yard saying, “I can’t find my way home.” The patient is confused and unable to answer questions. Select the nurse’s next action.
- A.
Document the confusion. Obtain other assessment data from the grandchild.
- B.
Record the patient’s answers to questions on the hospital assessment form.
- C.
Ask a more experienced nurse to perform the assessment interview.
- D.
Call for a mental health advocate to support the patient’s rights.
Correct Answer
A. Document the confusion. Obtain other assessment data from the grandchild.Explanation
The nurse should document the confusion and obtain other assessment data from the grandchild. This is the appropriate next action because the patient is confused and unable to answer questions, indicating a cognitive impairment. By documenting the confusion, the nurse can provide an accurate record of the patient's condition. Obtaining other assessment data from the grandchild can help provide additional information about the patient's medical history, recent events, and potential causes of the confusion. This information will assist the healthcare team in determining the appropriate course of action for the patient's care.Rate this question:
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- 46.
17. An adolescent asks the nurse, “Why should I tell you anything? You’ll just tell my parents whatever you find out.” Select the nurse’s best reply.
- A.
“That isn’t true. What you tell us is private and held in strictest confidence. Your parents have no right to know.”
- B.
“Anything you say about feelings is private, but some things like suicidal thinking must be reported to the treatment team.”
- C.
“Yes, your parents may find out what you say, but it is important that they know about your problems.”
- D.
“It sounds as though you are not really ready to work on your problems and make changes.”
Correct Answer
B. “Anything you say about feelings is private, but some things like suicidal thinking must be reported to the treatment team.”Explanation
The nurse's best reply is "Anything you say about feelings is private, but some things like suicidal thinking must be reported to the treatment team." This response acknowledges the adolescent's concern about confidentiality while also explaining the limitations to confidentiality when it comes to safety concerns such as suicidal thoughts. It shows that the nurse respects the adolescent's privacy but also prioritizes their well-being and safety.Rate this question:
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- 47.
18. A nurse assessing a new patient asks, “What is meant by the old saying, ‘You can’t judge a book by looking at the cover’?” Which aspect of cognition is the nurse assessing?
- A.
Memory
- B.
Orientation
- C.
Attention
- D.
Abstraction
Correct Answer
D. AbstractionExplanation
The nurse is assessing the patient's understanding of the concept of abstraction. The saying "You can't judge a book by looking at the cover" implies that one cannot make accurate judgments about something or someone based solely on their outward appearance. This requires the ability to think abstractly and understand that there may be more to a person or situation than what is immediately apparent.Rate this question:
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- 48.
19. As a nurse assesses an elderly patient, answers seem vague or unrelated to the questions. The patient also leans forward and frowns, listening intently to the nurse. An appropriate question for the nurse to ask would be:
- A.
“Are you having difficulty hearing when I speak?”
- B.
“I notice you frowning. Are you feeling annoyed with me?”
- C.
“How can I make this assessment interview easier for you?”
- D.
“You’re having trouble focusing on what I’m saying. What is distracting you?”
Correct Answer
A. “Are you having difficulty hearing when I speak?”Explanation
The nurse should ask the question "Are you having difficulty hearing when I speak?" because the patient's vague or unrelated answers, leaning forward, and frowning indicate potential hearing difficulties. By asking this question, the nurse can gather more information about the patient's hearing abilities and adjust their communication approach accordingly.Rate this question:
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- 49.
21. When a new patient is hospitalized, a nurse takes the patient on a tour, explains rules of the unit, and explains the daily schedule. The nurse has fulfilled which aspect of care coordination?
- A.
Counseling
- B.
Health teaching
- C.
Milieu management
- D.
Integrative therapy
Correct Answer
C. Milieu managementExplanation
The nurse has fulfilled the aspect of care coordination known as milieu management. Milieu management refers to creating and maintaining a therapeutic environment for patients. In this scenario, the nurse is taking the patient on a tour, explaining the rules of the unit, and explaining the daily schedule, all of which contribute to creating a structured and supportive environment for the patient's care.Rate this question:
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- 50.
4. How should the nurse respond if a patient says, “Please don’t share information about me with the other people”?
- A.
“I cannot tell anyone about you. We can help each other by keeping it between us.”
- B.
“I won’t share information with your family or friends without your permission, but I will share information with other staff.”
- C.
“It depends on what you choose to tell me. I will be glad to disclose at the end of each session what I will report to other staff.”
- D.
“Therapeutic relationships are between the nurse and the patient. It’s up to you to tell others what you want them to know.”
Correct Answer
B. “I won’t share information with your family or friends without your permission, but I will share information with other staff.”Explanation
The nurse should respond by assuring the patient that their information will not be shared with their family or friends without their permission, but it will be shared with other staff members. This response respects the patient's privacy while also acknowledging the need for collaboration and communication among the healthcare team. It maintains confidentiality within the boundaries of the therapeutic relationship.Rate this question:
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Current Version
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Nov 10, 2023Quiz Edited by
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Jan 23, 2015Quiz Created by
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