According to the DSM-5, there is evidence that symptoms & causes of mental illness are influenced by:
cultural & ethnic factors
occupation & status
One characteristic of mental health that allows people to adapt to tragedies, trauma, & loss is:
You are caring for Kiley, a 29-year-old female patient who is being admitted following a suicide attempt. Which of the following illustrates the concept of patient advocacy?
"Dr. Rayed, I notice you ordered Prozac for Kiley. She has stated to me that she does not want to take Prozac because she had adverse effects when it was previously prescribed.
"Dr. Rayed, during her admissions interview Kiley stated that she has had three other suicide attempts in the past."
"Kiley, can you tell me more about your depression & your suicide attempt?"
"Kiley, I will take you on a tour of the unit & orient you to the rules."
You have graduated with your BSN degree & have taken your first job on a psychiatric unit after becoming a licensed Registered Nurse. You are providing teaching to Mason, a newly admitted patient on the psychiatric unit, regarding his daily schedule. Which of the following would not be an appropriate teaching statement?
"You will participate in unit activities & groups daily."
"You will be given a schedule daily of the groups we would like you to attend."
"You will attend a psychotherapy group that I lead."
"You will see your provider daily in a one-to-one session."
A nurse is active in local consumer mental health groups & in local & state mental health associations & who keeps aware of state & national legislation affecting mental illness treatment may positively affect the climate for treatment by:
becoming active in politics leading to a potential political career
reducing the stigma of mental illness & advocating for equality in treatment
encouraging laws that would make the involuntary long-term commitment process easier & faster for caregivers of mentally ill persons
advocating for reduced mental health insurance benefits to discourage abuse of the system by inappropriate psychiatric admissions.
You are caring for Alyssa, a 28-year-old patient with bipolar disorder who was admitted in a manic state. According to Maslow's Hierarchy of Needs theory, which of the following symptoms needs to be the first priority in caring for this patient?
Rapid, pressured speech
Lack of sleep
Lucas states, "I will always be alone because nobody could love me." This is most likely an example of:
You & Jack are two of the nurses working on the psychiatric unit. Jack mentions to you that the biological model for mental illness is the one he embraces, & states, "it's the only one I really believe." Which of the following statements is true regarding believing in only the biological model?
The biological model is the oldest & most reliable model for explaining mental illness
The biological model does not explain every symptom of mental illness
The biological model is the most popular theory among leading psychiatrists & therefore the one that should be fully embraced
In believing only the biological model, other influences on mental health including cultural, environmental, social, & spiritual influences are not taken into account
Sullivan's team security operations & Freud's term of defense mechanism both reflect actions that serve to:
reduce cognitive distortions
You are caring for Vanessa, a 38-year-old patient with major depression. She has just met with her provider. She states to you, "my provider said something about the medicine she is ordering working on my neurotransmitters. What exactly are neurotransmitters?" Your best response is:
"Neurotransmitters are chemical messengers in the brain that help regulate specific functions."
Neurotransmitters are too complicated to explain easily. Just know that the medication will help your mood."
"Neurotransmitters are the reason you are depressed."
"I will ask your provider to give you a more in-depth explanation."
Vanessa's provider writes orders including medication to treat her depression. Based on current understanding of brain physiology, which of the following neurotransmitters would you expect to see targeted with the medication ordered?
The term pharmodynamics refers to the effect of the drug on the body, while pharmokinetics refers to:
the effect of the drug specifically on the brain & movement
the effect of the person on the drug
the effect of the drug on children & adolescents
the effect of the drug on the half-life & ability of the liver to excrete
Which of the following patients would need monitoring for potential development of the side effect of hypothyroidism?
Janelle, who is taking Prozac
Travis, who is taking Depakote
Shelly, who is taking lithium
Anna, who is taking Risperdal
Julie, a 49-year-old patient diagnosed with schizophrenia at 22 years old, is taking resperidone (Risperdal). Which of the following nursing assessments is the priority assessment with Julie?
Monitoring blood levels to avoid toxicity
Monitoring for abnormal involuntary movements
Observing for secondary mania
Observing for memory changes
A peer asks you to help him differentiate between culture & ethnicity for clarification. Which statement by the peer would acknowledge that you had appropriately helped him clarify the difference between the two terms?
"So, ethnicity refers to having the same life goals whereas culture refers to race."
"So, ethnicity refers to norms within a culture, & culture refers to shared likes & dislikes."
"So, ethnicity refers to shared history & heritage, whereas culture refers to sharing the same beliefs & values."
"So, ethnicity refers to race, & culture refers to having the same worldview."
Ms. Wong, aged 52 years, comes to the emergency room with severe anxiety. She was raised in China but immigrated to the United States at age 40 years. She was recently fired from her job because of a major error in the accounting department that she managed. Ms. Wong's aged parents live with her. Ms. Wong states, "I am a failure." Which of the following statements may accurately assess the basis for Ms. Wong's anxiety feelings of failure?
Ms. Wong may feel that she has let herself down since she did not achieve her personal goals in the workplace.
Ms. Wong may feel that she has shamed the family bu being fired & may no longer be able to provide for them.
Ms. Wong may feel personally inadequate since she failed in her quest foe independence and self-reliance.
Ms. Wong may be feeling anxiety because in her family's traditions her failure may result in a changed fate.
Which of the following best explains the concept of cultural competence?
Nurses have enough knowledge about different cultures to be assured they are delivering culturally sensitive care.
Nurses are able to educate their patients from other cultures appropriately about the culture norms of the United States
Nurses adjust their own practices to meet their patients' cultural preferences, beliefs, & practices.
Nurses must take continuing education classes on culture in the process of becoming culturally competent.
Josefina Juarez, aged 36 years, comes to the mental health clinic where you work after being referred by her primary care provider. Josefina came to live in the Unites States from Brazil 5 years ago. She is now a single mother to 6 children, ages 2 to 15, following the death of her husband last year. During the initial intake assessment, Josefina tells you her problem is that she has headaches & backaches "almost every day" & "can't sleep at night." She shakes her head no & looks away when asked about anxiety or depression & states she does not know why she was referred to the mental health clinic. You recognize that Josefina may be exhibiting:
You are working on the psychiatric unit & assisting with the care of Mr. Tran, a refugee from Darfur, who came to the United States 1 year ago. Although Mr. Tran. understand & speaks some very limited English, he is much more comfortable conversing in his native language. Mike, the nurse working directly with Mr. Tran, says to you, "I am so frustrated trying to communicate with Mr. Tran! He insists on speaking his language instead of English. I think if people want to live here, they ought to have to speak our language & act like we do!" Which of the following responses you could make promotes culturally competent care? Select all that apply
"You are right that Mr. Tran needs to speak English, but all patients do have a right to an interpreter, so you need to comply."
" I agree that it is frustrating trying to communicate with Mr. Tran. Maybe we could see if his family members can help convince him to try speaking English."
"Mr. Tran will have to learn to speak English eventually to live & work successfully in this country. Just try to be patient & encourage him to try speaking English."
"What you are saying is actually considered imposition, which is imposing our own culture onto someone from a different culture."
"Mr. Tran's ability to speak & understand English is very limited. He needs to have an interpreter to make sure he can make his needs & feelings known."
You are working on an inpatient psychiatric unit & caring for Elizabeth, who is becoming agitated. You speak with Elizabeth one to one in a private setting, find out the reason for the agitation, & then assist Elizabeth with ways to calm down, possibly including PRN medication to prevent further escalation of Elizabeth's agitation, which could lead to seclusion &/or restraints. You are making care decisions based on:
writ of habeas corpus
least restrictive alternative doctrine
Which of the following patients may be an appropriate candidate for a release from hospitalization known as against medical advice (AMA)?
37-year-old patient hospitalized for 6 days; the provider feels one more day would benefit the patient, but the patient doesn't agree & wishes to be discharged
75-year-old patient with dementia who demands to be allowed to go back to his own home
21-year-old actively suicidal patient on the psychiatric unit who wants to be discharged to home & do outpatient counseling
32-year-old female patient who wishes to stay in the hospital but whose husband demands that she be discharged into his care
Sophie, aged 27 years, has a diagnosis of paranoid schizophrenia. She stopped taking her medications believes that she is to be taken by the aliens to live with them on another planet. She was observed walking through traffic on a busy road, & then was found climbing the railing on a bridge, to "be ready for them to take me in their sip." Sophie is hospitalized. During your shift she begins running up & down the halls, banging her head on the walls, & yelling, " Get them out of my head!" On what basis can Sophie be medicated against her will?
If Sophie has taken the medications in the past & has had no adverse effects
If Sophie may cause imminent harm to herself or others
If Sophie still has the capacity to make an informed decision regarding medication
If Sophie is provided education regarding the medication before administration of the medication
Jonas is a 29-year-old patient with anxiety & a history of alcohol abuse who is an inpatient on the psychiatric unit. He becomes angry & aggressive, strikes another patient, & then attacks a staff member. He is taken to seclusion & medicated with haloperidol & lorazepam. In this case, the haloperidol & lorazepam may be considered:
a medication time-out
Which of the following scenarios describe a HIPAA violation?
Janie, the ED nurse, gives report to Amanda, a nurse on the intensive care unit, regarding Joel, who is being admitted
Mark, a nurse on the medical-surgical floor, calls his patient's primary care provider to obtain a list of current medications
Lyla, a nurse on the cardiac unit, gives report to Chloe, the nurse on the step-down unit, regarding the patient Lyla, who will be transferring, while they are walking in the hospital hallway
Tony, a nurse on the psychiatric unit, gives discharge information to the counseling office where his patient will be going to outpatient treatment after discharge
You are conducting an admission interview with Callie, who was raped 2 weeks ago. When you ask Callie about the rape, she becomes very anxious & upset & begins to sob. Your best course of actions would be to:
push Callie gently for more information about the rape because you need to document this in her chart
acknowledge that the topic of the rape is upsetting to Callie & reassure her that it can be discussed at another time when she feels more comfortable
use silence as a therapeutic tool & wait until Callie is done sobbing to continue discussing the rape
reassure Callie that anything she says to you will remain confidential
You are interviewing Jamie, a 17-year-old female patient. She confides that she has been thinking of ways to kill a female peer who is Jamie's rival for the volleyball team captain position. She asks you if you can keep it a secret. The most appropriate response for you to make is:
"I will keep it a secret, but you & I need to discuss ways to deal with this situation appropriately without committing a crime."
"Yes, I will keep it confidential. We have laws to protect patients confidentiality."
"Jamie, issues of this kind have to be shred with the treatment team & your parents."
"Jamie, I will have to share this with the treatment team, but we will not share it with your parents."
Which response to a patient's question of why you need to conduct an assessment interview best explains the purpose?
"I need to find out more about you & the way you think in order to best help you."
"The assessment interview lets you have an opportunity to express you feelings."
"You are able to tell me in detail about your past so that we can determine why you are experiencing mental health alterations."
"We will be able to form a relationship together where we can discuss the current problems & come up with goals & a plan for treatment."
Joel is a 43-year-old patient being seen in the mental health clinic with depression. Joel states, " I have always been a practicing Jew, but in the past few months I am questioning everything. I just don't know if I believe in it anymore." Which of the following nursing diagnoses best describes Joel's comment?
Risk for self-harm
You are working in the emergency department when a 26-year-old male patient is brought in suffering from psychosis. The patient is unable to give any coherent history. The patient’s best friend is with him and offers to give you information regarding the patient. Which of the following responses is appropriate?
“I’m sorry, but I cannot take any information from you as it would violate confidentiality laws.”
“There is no need for that as I will call his primary care provider to obtain the information we need.”
“Yes, I will be happy to get any information and history that you can provide.”
“Yes, however, we will have to get a release signed from the patient for you to be able to talk with me.”
Bethany, a nurse on the psychiatric unit, has a past history of alcoholism. She has weekly clinical supervision meetings with her mentor, the director of the unit. Which statement by Bethany to her mentor would indicate the presence of countertransference?
“My patient, Miranda, is being discharged tomorrow. I provided discharge teaching and stressed the importance of calling the help line number should she become suicidal again.”
“My patient, Laney, has been abusing alcohol. I told her that the only way to recover was to go ‘cold turkey’ and to get away from her dysfunctional family and to do it now!”
“My patient, Jack, started drinking after 14 years of sobriety. We are focusing on his treatment plan of attending AA meetings five times a week after discharge.”
“My patient, Gayle, is an elderly woman with depression. She calls me by her daughter’s name because she says I remind her of her daughter.”
You are working with Allison on the inpatient psychiatric unit. Which of the following statements reflect an accurate understanding during which phase of the nurse-patient relationship the issue of termination should first be discussed?
“Allison, you are being discharged today, so I’d like to bring up the subject of termination—discussing your time here and summarizing what coping skills you have attained.”
(to fellow nurse): “I haven’t met my new patient Allison yet, but I am working through my feelings of anxiety in dealing with a patient who wanted to kill herself.”
“Allison, now that we are working on your problem-solving skills and behaviors you’d like to change, I’d like to bring up the issue of termination.”
“Allison, now that we’ve discussed your reasons for being here and how often we will meet, I’d like to talk about what we will do at the time of your discharge.”
Your patient, Emma, is crying in your one-to-one session while telling you of her father’s recent death from a car accident. Which of the following responses illustrates empathy?
“Emma, I’m so sorry. My father died two years ago, so I know how you are feeling.”
“Emma, you need to focus on yourself right now. You deserve to take time just for you.”
“Emma, that must have been such a hard situation to deal with.”
“Emma, I know that you will get over this. It just takes time.”
Willis has been admitted to your inpatient psychiatric unit with suicidal ideation. He resides in a halfway house after being released from prison, where he was sent for sexually abusing his teenage stepdaughter. In your one-to-one session he tells you of his terrible guilt over the situation and wanting to die because of it. Which of the following responses you could make reflects a helpful trait in a therapeutic relationship?
“It’s good that you feel guilty. That means you still have a chance of being helped.”
“Of course you feel guilty. You did a horrendous thing. You shouldn’t even be out of prison.”
“The biggest question is, will you do it again? You will end up right back in prison, and have even worse guilt feelings because you hurt someone again.”
“You are suffering with guilt over what you did. Let’s talk about some goals we could work on that may make you want to keep living.”
Which of the following statements are true regarding the differences between a social relationship and a therapeutic relationship? (select all that apply):
In a social relationship, both parties’ needs are met; in a therapeutic relationship only the patient’s needs are to be considered.
A social relationship is instituted for the main purpose of exploring one member’s feelings and issues; a therapeutic relationship is instituted for the purpose of friendship.
Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic.
In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship solutions are discussed but are only implemented by the patient.
In a social relationship, communication is usually deep and evaluated; in a therapeutic relationship communication remains on a more superficial level, allowing patients to feel comfortable.
You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, “I’m fine! Everything’s great.” Which of the following is true regarding verbal and nonverbal communication?
Verbal communication is always more accurate than nonverbal communication.
Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking.
Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message.
Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.
You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, “I’m fine! Everything’s great.” Which of the following responses would be therapeutic?
“Okay, but we are all here to help you, so come get one of the staff if you need to talk.”
“I’m glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going.”
“I don’t believe you. You are not being truthful with me.”
“It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?”
You are caring for William, a 55-year-old patient who recently came to the United States from England on a work visa. He was admitted for severe depression following the death of his wife from cancer 2 weeks ago. While telling you about his wife’s death & how it has affected him, William shows little emotion. Which of the following explanations is most plausible?
William did not love his wife.
William’s response may reflect cultural norms.
William’s response may reflect guilt.
William may have an antisocial personality, which would explain his lack of feeling.
You are admitting 32-year-old Louisa to the psychiatric unit. You pull up your chair and sit close to the patient, with your knees almost touching hers, and lean in close to her to speak. Louisa becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for Louisa’s behavior?
You have violated Louisa’s personal space by physically being too close.
Louisa has issues with sharing personal information.
You have not made the patient feel comfortable by explaining the purpose of the admission interview.
Louisa is responding to the voices in her head telling her to leave.
Which of the following statements indicate a nontherapeutic communication technique? (select all that apply):
“Why didn’t you attend group this morning?”
“From what you have said, you have great difficulty sleeping at night.”
“What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?”
“If I were you, I would quit the stressful job and find something else.”
“I’m really proud of you for the way you stood up to your brother when he visited today.”
“You mentioned that you have never had friends. Tell me more about that.”
“It sounds like you have been having a very hard time at home lately.”
Myla, a 29-year-old patient admitted with anxiety, states, “my counselor keeps talking about my stressors. What exactly are stressors?” Your best response to the patient would be:
“Stressors are events that happen that threaten your current functioning and require you to adapt.”
“Stressors are complicated neuro stimuli that cause mental illness.”
“It’s best if you ask questions like that of your provider for a complete answer.”
“Instead of focusing on what stressors are, let’s explore your coping skills.”
Which of the following examples illustrates eustress?
A college student fails an exam.
A bride is planning for her wedding.
A man is laid off from his job.
An adolescent gets into a fight at school.
Jacob is a college student whose friend recently committed suicide. Jacob rates his stress as low. Melissa was also friends with the person who committed suicide, but she rates her stress as high. The difference in how Jacob and Melissa rate their stress may be explained by:
Melissa, whose friend recently committed suicide, asks you some ways she could cope with her stress regarding the event. Which of the following options would be appropriate to discuss with Melissa?
Isolation for a short time so that the pain isn’t reinforced by explaining her feelings over and over
Antianxiety medication to help her relax
Starting a hobby to keep her mind off the troubling event
Talking with friends and attending a loss support group
Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful?
“I do not have the ability to handle that job.”
“I can be successful if I do all the things required to learn the job.”
“I may be fired from the job but eventually I will find something else to do with my life.”
“I can never learn all there is to know for the job.”
Restraint and seclusion are controversial in children because:
parents may initiate a lawsuit.
nursing staff have conflicted feelings leading to ineffectiveness.
they are psychologically harmful and may be physically harmful.
staff are untrained in use of restraints in children.
A 12-year-old male patient diagnosed with Tourette’s disorder is visiting his provider. The provider tells you to provide education for the patient and his mother because the provider is starting the patient on medication. Based on your knowledge of medications approved to treat this disorder, you will prepare medication teaching on which class of medication?
Sam, a 9-year-old patient, has deficits in social functioning, intellectual functioning, and cannot manage practical aspects of daily life and functioning. You suspect:
intellectual development disorder (IDD).
specific learning disorder.
autism spectrum disorder (ASD).
attention deficit hyperactivity disorder (ADHD).
Taylor is a 3-year-old boy just diagnosed with autism spectrum disorder. Taylor’s mom is tearful and states, “Dr. Coolidge said we need to start therapy right away. I just don’t understand how helpful it will be—he’s only 3 years old!” Your best response, based on knowledge of autism treatment, is:
“You are right, 3 years old is very young to start therapy, but it will make you feel better to be doing something.”
“Starting him on treatment now gives Taylor a much greater chance for a productive life.”
“If Taylor starts therapy now, he will be able to stop therapy sooner.”
“If you have questions, its best to ask Dr. Coolidge.”
Victoria is an 8-year-old patient newly diagnosed with attention deficit hyperactivity disorder (ADHD). Based on your knowledge of the diagnosis of ADHD, you know her symptoms of hyperactivity, inattention, and impulsivity have to be apparent:
in times of severe stress.
in supervised clinical observations.
both at home and at school.
on diagnostic testing tools.
Nico, a 22-year-old patient, is diagnosed with schizophrenia. Which of the following symptoms would alert a provider to a possible diagnosis of schizophrenia?
Excessive sleeping with disturbing dreams
Hearing voices telling him to hurt his roommate
Withdrawal from college because of failing grades
Chaotic and dysfunctional relationships with his family and peers
Tara and Aaron are twins who are both diagnosed with schizophrenia. Aaron was diagnosed at 23 years and Tara at 31 years. Based on your knowledge of early and late onset of schizophrenia, which of the following is true?
Tara and Aaron have the same expectation of a poor long-term prognosis.
Tara will experience more positive signs of schizophrenia such as
Aaron will be more likely to hold a job and live a productive life.
Tara has a better chance for positive outcomes because of later onset
Which of the following is true regarding schizophrenia treatment and outcomes?
If treated quickly following diagnosis, schizophrenia can be cured.
Schizophrenia can be managed by receiving treatment only at the time of acute exacerbations.
Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability.
If patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms.
Declan is a 26-year-old patient with schizophrenia. He states to you, “My, oh my. My mother is brother. Anytime now it can happen to my mother.” Your best response would be:
“You are having problems with your speech. You need to try harder to be clear.”
“You are confused. I will take you to your room to rest a while.”
“I will get you a prn medication for agitation.”
“I’m sorry, I didn’t understand that. Do you want to talk more about your mother as we did yesterday?”
Declan is being discharged from the psychiatric unit on risperidone (Risperdal). You are providing medication teaching to Declan and his mother, who is his primary caregiver. Which of the following statements is the appropriate response to Declan’s mother’s question regarding the risk for extrapyramidal side effects (EPSs) while taking risperidone?
All antipsychotic medications have an equal chance of producing EPSs.
Newer antipsychotic medications have a higher risk for EPSs.
Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics.
Advise Declan’s mother to ask the provider to change the medication to clozapine instead of risperidone.
Which of the following is true of the relationship between bipolar disorder and suicide?
Patients need to be monitored only in the depressed phase because this is when suicides occur.
Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. Correct
Patients with bipolar disorder are not considered high risk for suicide.
As long as patients with bipolar disorder adhere to their medication regimen, there is little risk for suicide.
Tyler is a 31-year-old patient admitted with acute mania. He tells the staff and the other patients that he is on a secret mission given to him by the President of the United States to monitor citizens for terrorist activity. He states, “I am the only one he trusts, because I am the best!” For documentation purposes you know that this behavior is referred to as:
flight of ideas.
Tyler is being discharged home to his family. Which of the following is important teaching to include for the patient and the family to recognize possible signs of impending mania?
Decreased social interaction
Increased attention to bodily functions
Which of the following describe the symptoms of the manic phase of bipolar disorder? (select all that apply):
Fatigue and increased sleep
Withdrawal from environment
1. The major reason for hospitalization for depressed patients is:
inability to go to work.
loss of appetite.
Sasha is a 38-year-old patient admitted with major depression. Which of the following statements Sasha makes alerts you to a common accompaniment to depression?
“I still pray and read my Bible every day.”
“My mother wants to move in with me, but I want to independent.”
“I still feel bad about my sister dying of cancer. I should have done more for her!”
“I’ve heard others say that depression is a sign of weakness.”
Sasha has been having angry outbursts with staff and peers on the unit. You are talking with Sasha on her third day of admission. You ask whether she is having any thoughts of suicide. Sasha becomes angry and defensive, shouting, “I’m sick of you people! Are you ever do is ask me the same question over and over. Get out of here!” Your response is based on the knowledge that:
Sasha is getting better because she is able to be assertive.
Sasha may be at high risk for self-harm.
Sasha is probably experiencing transference.
Sasha may be angry at someone else and projecting that anger to staff.
4. Sasha is started on fluoxetine. Which statement by Sasha indicates that she understands the medication teaching you have provided?
“I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction.”
“I will not take any over-the-counter medication while on the fluoxetine.”
“I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away.”
“I will report increased thirst and urination to my provider.”
Sasha’s roommate Kate was admitted with major depression and suicidal ideation with a plan to overdose. Kate is preparing for discharge and asks you, “Why did Dr. Travis give me a prescription for only 7 days of amitriptyline?” Your response is based on the knowledge that:
amitriptyline (Elavil) is very expensive, so the patient may have to buy fewer at a time.
Dr. Travis is going to see how Kate responds to the first week of medication to evaluate its effectiveness.
Dr. Travis wants to see whether any minor side effects occur within the first week of administration.
amitriptyline (Elavil) is lethal in overdose.
You are providing teaching to Lana, a preoperative patient just before surgery. She is becoming more and more anxious as you talk. She begins to complain of dizziness and heart pounding, and she is trembling. She seems confused. Your best response is to:
reinforce the preoperative teaching by restating it slowly.
have Lana read the teaching materials instead of verbal instruction.
have a family member read the preoperative materials to Lana.
not attempt any teaching at this time.
Lana is out of surgery and on the medical-surgical unit for recovery. You visit her the day after her surgical procedure. While you are in the room, Lana becomes visibly anxious and short of breath, and she states, “I feel so anxious! Something is wrong!” Your best action is to:
reassure Lana that she is experiencing normal anxiety and do deep breathing exercises with her.
use the call light to inquire whether Lana has any prn anxiety medication.
call for help and assess Lana’s vital signs.
tell Lana you will stay with her until the anxiety subsides.
Stella brings her mother, Dorothy, to the mental health outpatient clinic. Dorothy has a history of anxiety. Stella and Dorothy both give information for the assessment interview. Stella states, “My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it’s affecting my ability to go to work.” You suspect:
adult separation anxiety disorder.
social anxiety disorder
Which medication is FDA approved for treatment of anxiety in children?
Fluoxetine (selective serotonin reuptake inhibitor)
Clomipramine (tricyclic antidepressant)
None of the above
Jerry is a 72-year-old patient with Parkinson’s disease and anxiety. He is living by himself and has had several falls lately. His provider orders lorazepam, 1 mg PO bid, for anxiety. You question this order because:
Jerry may become addicted faster than younger patients.
Jerry is at risk for falls.
Jerry has a history of nonadherence with medications.
Jerry should be treated with cognitive therapies rather than medication because of his advanced age.
Hallie, 4 years old, is referred to the outpatient mental health clinic after being in a severe car accident during which her father was driving and her mother died. Her father states she is withdrawn, not sleeping, having nightmares, and acts out the car accident over and over again when playing. Hallie states to you, “It’s my fault because I’m bad.” You suspect:
dissociative identity disorder.
posttraumatic stress disorder (PTSD).
acute stress disorder (ASD).
Which of the following statements about dissociative disorders is true?
Dissociative symptoms are under the person’s conscious control.
Dissociative symptoms are not under the person’s conscious control.
Dissociative symptoms are usually a cry for attention.
Dissociative symptoms are always negative.
Syndromes seen in other cultures but not seen in our own, such as piblokto, Navajo frenzy witchcraft, and amok should be considered:
dissociative disorders such as dissociative identify disorders
physical disorders, not mental disorders.
culture-bound syndromes that are not dissociative disorders.
myths, or rumors, because they have not been sufficiently studied to be classified as real.
Erin has just been diagnosed with dissociative identity disorder. She asks you, “What exactly are ‘alters’? My provider told me I have several of them.” Which statement by Erin illustrates that the education you provided has been effective?
“So, alters are based in mysticism and religiosity, such as demons.”
“So, alters are separate personalities with their own characteristics that take over during stress.”
“So, alters are never aware of each other.”
“So, alters are just like me, but they have no memory of the trauma I went through.”
Hallie’s father, Brent, has now been diagnosed with PTSD as well as Hallie. Which of the following symptoms would lead a provider to suspect PTSD? (select all that apply):
Visiting the scene of the accident over and over
Talking with strangers about the events of the accident
Flashbacks of the accident
In somatization disorders, it is important for the nurse to employ holistic strategies. This can be defined as:
utilizing many different therapeutic strategies or modalities for enhanced coping.
involving every member of the family as well as the patient in treatment.
incorporating spirituality and religion into treatment.
considering all dimensions of the patient, including biological, psychological, and sociocultural.
Emily is a veteran returning from Iraq. Ever since Emily participated in a village raid where explosives were used, she has been unable to walk. All diagnostic testing has been negative for any physical abnormalities, and she was diagnosed with conversion disorder. She asks you what that means. Your best response would be:
"Your legs don’t work because your brain is screwed up.”
"Your emotional distress is being expressed as a physical symptom.”
"You are making up your symptoms as a cry for help.”
"You are overly anxious about having a severe illness.”
What would be an appropriate expected outcome of Emily’s treatment plan?
Emily will walk unassisted within 1 week.
Emily will return to a pre-illness level of functioning within 2 weeks.
Emily will be able to state two new effective coping skills within 2 weeks.
Emily will assume full self-care within 3 weeks.
Emily asks you what kind of therapy will help her. Your best response, based on current knowledge, is:
“A combination of antianxiety and antidepressant therapy is the most effective therapy.”
“Aversion therapy is often used because in effect you are punishing yourself by not being able to walk.”
“Modeling will be used; as you see desired behaviors modeled by the therapist you will be able to also achieve the expected outcome.”
“Cognitive behavioral therapy has been shown to consistently provide the best outcome for these types of disorders.”
Shane, aged 23 years, is admitted to your medical-surgical unit with complaints of abdominal pain, dizziness, and headaches. Results of a physical workup have been negative so far. Today Shane tells you, “Now I am having back pain.” Which of the following in Shane’s medical record may alert you to the possibility of malingering? (select all that apply):
Shane has a court date this week for drunk driving
Shane was adopted at the age of 5 years.
Shane has a history of physical abuse by his stepfather.
Shane has a history of oppositional-defiant disorder.
Shane was raised primarily by his mother.
Which of the following statements is true of bulimia?
Patients with bulimia often appear at a normal weight.
Patients with bulimia binge eat but do not engage in compensatory measures.
Patients with bulimia severely restrict their food intake.
One sign of bulimia is lanugo.
According to current theory, eating disorders:
Are psychotic disorders in which patients experience body dysmorphic disorder.
Are frequently misdiagnosed.
Are possibly influenced by sociocultural factors.
Are rarely comorbid with other mental health disorders.
Your patient, Erin, is a 16-year-old patient newly diagnosed with anorexia. Her provider is starting her on medication to reduce compulsive behaviors regarding food and resistance to weight gain. You prepare teaching on which class of medication that may help these specific symptoms in eating disorders?
When you are educating Erin and her mother about the medication dosage and side effects, Erin becomes upset and tearful, stating, “No! I will not take that medication!” Which of the following is the most likely reason for Erin’s feelings?
Erin feels embarrassed to be taking psychiatric medication.
Erin is upset about the possible side effect of weight gain.
Erin is worried about the common adverse effect of sexual problems.
Erin’s resistance is typical of her characteristics of rigidity and needing
Ali is a 17-year-old patient with bulimia coming to the outpatient mental health clinic for counseling. Which of the following statements by Ali indicates that an appropriate outcome for treatment has been met?
"I purge only once a day now instead of twice.”
"I feel a lot calmer lately, just like when I used to eat four or five cheeseburgers.”
"I am a hard worker and I am very compassionate toward others.”
"I always purge when I’m alone so that I’m not a bad role model for my younger sister.”
Which statement by Kyla, a patient you are educating in the sleep disorders clinic, indicates that she needs further teaching?
“I will be sure to try to get 8 hours of sleep every night, and 9 or 10 hours of sleep if I can.”
“Getting less than 6 hours of sleep at night may increase my risk for medical problems.”
“Getting enough sleep will increase my productivity at work.”
“Since I have to drive for my job, getting enough sleep will help me avoid accidents.”
Kyla asks you to explain what basal sleep requirement is. Your best response is:
“The basal temperature of your body needed to induce the best sleep.”
“The sleep time by your body needed to repair cellular damage.”
“The amount of sleep needed to be fully awake and perform well in the daytime.”
“The amount of sleep needed to transition to REM sleep.”
Ellie, a 38-year-old patient referred for sleep studies, reports frequent daytime lethargy, unintended lapses into sleep, and never feeling rested on awakening in the morning. Ellie’s symptoms describe:
circadian rhythm disorder.
rapid eye movement (REM) sleep behavior disorder.
breathing-related sleep disorder.
Ellie asks what medication may help her condition. Your response is based on the knowledge that:
there is no effective medication treatment for hypersomnolence disorder.
medication therapy with benzodiazepines may be initiated.
Ellie may be prescribed a stimulant.
Ellie will be started on an anticholinesterase inhibitor for increased cognition.
As you are talking with Ellie, she begins to cry and states, “I can’t keep going like this! I work in a bank and if I can’t function correctly I’ll lose my job. I just don’t think I’ll get better.” A therapeutic response would be:
"Don’t worry! I’m sure with treatment everything will get better.”
"You are not alone. Many people who come for sleep studies are going through the same thing.”
“You seem so sad. May I ask if something else is troubling you?”
"There is much hope for improvement through treatment. Let’s talk about some strategies for your problems at work.”
You are interviewing Lance, a 31-year-old patient who has been referred to the sexual disorders clinic by his primary care provider. When describing his problem, Lance states, “I can have an orgasm, no problem. It just happens way too soon.” Lance is describing:
male hypoactive sexual desire disorder.
You find that you feel uncomfortable talking with Lance about his sexual problem. Which of the following actions you could take would be appropriate?
Ask another nurse to take over the interview so you don’t project your feelings onto the patient.
Pause the interview and take time to gather your thoughts and do positive self-talk.
Continue the interview using an appropriate professional tone and matter-of-fact approach.
Ask Lance whether he would feel more comfortable speaking with a physician about his problem.
Lance asks you what medication is usually used for premature ejaculation. You educate him regarding a class of medications that are used for treatment but have to be monitored for the possibility of dosage reduction or change related to the possibility of causing sexual side effects. Which of the following is the class of medications you are educating Lance about?
Which of the following is true of transvestic disorder?
Most people with this disorder are homosexual.
Only men are diagnosed with transvestic disorder.
Sexual orientation has no bearing on transvestic disorder.
Transvestic behavior develops in early to middle adulthood.
Carina, a student nurse on rotation in the emergency department, is assigned to care for Daniel, who was brought in from the local prison with suspected appendicitis. Daniel is in prison for child rape. Carina’s niece was recently sexually abused, and Carina feels this type of crime is reprehensible. She begins feeling very upset and disgusted with Daniel because of his crime and doesn’t know how she can care for him without letting her feelings show. Carina’s best course of action is to:
refuse the assignment because her personal feelings will prevent her from giving good care.
talk with her faculty member or an experienced nurse in the emergency department.
perform the activities of care but not engage in conversation with the patient.
tell Daniel honestly how she feels and let him choose to request a different nurse.
Assessment for oppositional defiant disorder should include:
assessing the history, frequency, and triggers for violent outbursts.
assessing moral development, belief system, and spirituality for the ability to understand the impact of hurtful behavior on others, to empathize with others, and to feel remorse.
assessing issues that result in power struggles and triggers for outbursts.
assessing sibling birth order to understand the dynamics of family interaction.
Nursing interventions for intermittent explosive disorder include:
providing intensive family therapy.
establishing a trusting relationship with the patient.
setting up loose boundaries so the patient will feel relaxed.
limiting decision-making opportunities to avoid frustration.
Which of the following classifications of medication may be prescribed in intermittent explosive disorder?
Antianxiety agents such as benzodiazepines
Eli is a 17-year-old patient admitted to the psychiatric unit with conduct disorder after threatening his mother during an argument. Which of the following would be an appropriate short-term outcome for Eli?
Engages in appropriate coping skills to manage stressors
Maintains self-control during hospitalization
Mother will improve communication skills to interact with Eli
Which of the following statements are true regarding childhood-onset conduct disorder? (select all that apply):
It is more commonly diagnosed in males.
It is characterized by feelings of remorse and regret.
It is usually diagnosed in late teen years.
It is characterized by disregard for the rights of others.
Those with conduct disorder rationalize their aggressive behaviors.
It is usually outgrown by early adulthood.
Erik is a 26-year-old patient who abuses heroin. He states to you, “I’ve been using more heroin lately. I told my provider about it and she said I need more and more heroin to feel the effect I want.” You know this describes:
Which of the following is true regarding substance addiction and medical comorbidity?
Most substance abusers do not have medical comorbidities.
There has been little research done regarding substance addiction disorders and medical comorbidity.
Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities.
Comorbid conditions are thought to positively affect those with substance addiction in that these patients seek help for symptoms earlier.
Cody is a 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months. He is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be an appropriate priority outcome for Cody’s treatment plan while in the hospital?
Cody will return to a predrug level of functioning within 1 week
Cody will be medically stabilized while in the hospital.
Cody will state within 3 days that he will totally abstain from drugs and alcohol.
Cody will take a leave of absence from college to alleviate stress.
The treatment team meets to discuss Cody’s plan of care. Which of the following factors will be priorities when planning interventions?
Readiness to change and support system
Current college performance
Availability of immediate family to come to meetings
Cody is preparing for discharge. He tells you, “Dr. Jacobson is putting me on some medication called naltrexone. How will that help me?” Which response is appropriate teaching regarding naltrexone?
“It helps your mood so that you don’t feel the need to do drugs.”
“It will keep you from experiencing flashbacks.”
“It is a sedative that will help you sleep at night so you are more alert and able to make good decisions.”
“It helps prevent relapse by reducing drug cravings.”
Elaine is a 62-year-old patient who is recovering from a urinary tract infection during which she was hospitalized with delirium. She is following up with her primary care provider 4 weeks after being discharged. Based on research regarding possible postdelirium complications, what are important areas for the provider to assess at this time?
Symptoms of posttraumatic stress
Depression and level of cognition
Trudy is a 72-year-old patient hospitalized with pneumonia and experiencing delirium. She points to her IV pole and screams, “Get him out of here! He’s going to hurt me!” You recognize that what Trudy is experiencing is a(n):
Based on current research, which of the following patients is most likely to develop dementia?
Karen, who works as an office manager in a high-stress environment
Milo, who is a former boxer and is now a trainer
Lilly, who works in a factory where asbestos is found
Justin, who is a bartender in a dark underground club/bar
Rosa, a 78-year-old patient with Alzheimer’s disease, picks up her glasses from the bedside table but does not recognize what they are or their purpose. She is experiencing:
Claire is a student nurse working with Carl, an 82-year-old patient with dementia. She finds herself frustrated at times by not knowing how best to care for or communicate with Carl. Which of the following statements she could make to Carl illustrates best care practice?
Lighthearted banter: “Carl, you look great today in your new sweater, you handsome devil!”
Limit setting: “Carl, you cannot yell out in your room. You are upsetting other patients.”
Firm direction: “You will take a shower this morning; there is no debating about it so don’t try to argue.”
Positive regard: “Carl, I am glad to be here caring for you today. Let’s talk about your plans for the day.”
Mary Alice is a 37-year-old patient referred to the mental health clinic with a suspected personality disorder. She is withdrawn and suspicious and states she has always preferred to be alone. She describes herself as having “special powers” and states that she is thinking of opening a business where she gives “readings” to people about their future. She states, “I believe we can all read each other’s thoughts at times.” Based on this presentation, you suspect:
obsessive-compulsive personality disorder.
narcissistic personality disorder.
avoidant personality disorder.
schizotypal personality disorder (STPD).
Belinda is a 24-year-old patient with borderline personality disorder (BPD). She is admitted to the inpatient psychiatric unit following a suicide attempt. You are caring for Belinda. Which of the following statements by Belinda illustrates a primary coping style of persons with BPD?
"My provider says I might get out of here tomorrow. Do you think I’m ready to go?”
"Last night the nurse let me go outside and smoke. I can’t believe you aren’t letting me. I used to think you were the best nurse here.”
"I will never again speak to any of my messed up family members. I know that this will help me be more functional.”
“I promise I am not feeling suicidal. I won’t hurt myself.”
Which is true of pharmacological therapies for treatment of personality disorders?
Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident.
Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders.
Patients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors.
Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients.
Patients with borderline personality disorder (BPD) exhibit negative effect, which includes emotional lability, described as rapidly moving from one emotional extreme to another.
One of pathological personality traits seen in persons with BPD is negative effect, which is characterized by emotional lability, that is, rapidly shifting emotions from one extreme to another. Patients exhibiting this trait are often documented as being “labile.”
Using the total environment, including the people, setting, and emotional climate, as therapy is called milieu therapy.
Milieu therapy uses the environment, including people, setting, emotional climate, and structure, for healing.
5. Tyler’s nursing care plan has several nursing diagnoses listed. Match the nursing diagnosis to the level of priority (1 to 4):
Risk for injury
Self-care deficit, bathing and hygiene
Levels of Priority Choices
First priority: Risk for Injury
Second priority: Self-care Deficit, bathing and hygiene
Third priority: Knowledge, deficient
Fourth priority: Nonadherence
Which of the following are true of antisocial personality disorder (APD)? (select all that apply):
It is the least studied of the personality disorders.
It is characterized by rigidity and inflexible standards of self and others.
Persons with APD display magical thinking.
Persons with APD are concerned with personal pleasure and power.
It is characterized by deceitfulness, disregard for others, and manipulation.
Persons with APD usually present for treatment because of awareness of how their behavior is affecting others.
Frontal lobe dysfunction is a brain change identified in APD.
Which of the following statements is true regarding culture and protective factors against suicide?
Asian Americans have the highest rates of suicide
Religion and the importance of family are protective factors for Hispanic Americans.
Older women have the highest risk for suicide among African Americans.
American Indians and Pacific Islanders have the lowest rates of suicide.
You are working with Ava, another student nurse on the psychiatric unit. She tells you she doesn’t want to ask her patient about suicidal ideation because “It might put ideas in her head about suicide.” Your best response would be:
"I’m glad you are thinking that way. She may not have thought of suicide before, and we don’t want to introduce that.”
"You are right; however, because of professional liability, we have to ask that question.”
"Actually, it’s a myth that asking about suicide puts ideas into someone’s head.”
"If I were you, I’d ask Dr. Carmichael to talk to the patient about that subject.”
You are talking with Jennifer, a patient admitted with depression. Which statement by the patient indicates the need for further assessment?
"I know a lot of people care about me and want me to get better.”
"I have suicidal thoughts at times, but I don’t have any plan and don’t think I would ever actually hurt myself.”
"I don’t have a good support system, but I am planning on joining a recovery group.”
"I think things will be better soon.”
Jermaine attempted suicide while intoxicated by using a gun, although the bullet missed when he staggered. Jermaine’s method of using a gun to attempt suicide is considered:
high risk, or a hard method.
low risk, or a soft method.
not an actual suicide attempt because he was intoxicated.
a nonlethal means.
Jermaine scores a 7 on the SAD PERSONS scale. What action needs to be taken?
Closely follow up; consider hospitalization.
Hospitalize or commit.
Send home with follow-up.
Strongly consider hospitalization.
Mason and Charlie, both 16 years old, were involved in a bad car accident in which they were both passengers. Mason spoke with a counselor about the incident once and has been able to move forward with little dysfunction. Charlie has been experiencing anxiety and an inability to concentrate in school even after numerous counseling sessions. The difference in the way the accident affected both boys may be explained by:
perception of the event.
Mason’s more laid-back personality.
the possibility that Charlie may have experienced previous trauma from which he did not fully recover.
the possibility that counseling Charlie received may have been inadequate.
Carter, aged 36 years, comes to the crisis clinic for his first visit with complaints of not sleeping, anxiety, and excessive crying. He recently was fired suddenly from his job and 3 days later lost his home to a tornado that devastated the town he lives in. Which of the following statements regarding crisis accurately describes Carter’s situation?
He is experiencing low self-esteem from the job loss, as well as anger because of the loss of his home.
He is experiencing both a situational and an adventitious crisis.
He is experiencing ineffective coping and should be hospitalized for intensive therapy.
He is experiencing a situational crisis with the added stress of financial burden.
Tori is the nurse working with Carter and other members of the community after the tornado. As the weeks go by, she begins to feel anxious and distressed. She speaks to her nurse mentor about her feelings. Which of the following may Tori be experiencing?
Tori knows that Carter needs assistance with many aspects of getting through the crisis. Tori’s highest priority in Carter’s care is:
reduction of Carter’s anxiety.
development of new coping skills.
prevention of boundary blurring.
keeping Carter safe.
Carter experiences each of the following during his crisis. Which of the following describes phase IV of Caplan’s phases of crisis?
Carter experiences increased anxiety and feelings of extreme discomfort the day after the tornado.
Carter comes to the crisis clinic complaining of depression and expresses that he does not want to go on living.
Carter experiences a panic attack at his mother’s home in a nearby town where he is staying after the tornado.
Carter experiences anxiety symptoms the day after he was fired.
Peter, a 21-year-old patient, asks you, “What’s wrong with my brain that I have such a problem with aggression?” Your response is based on the knowledge that:
the prevailing theory is that diminishment of stress hormones causes anger and aggression.
no abnormalities of the brain have been identified that correlate with anger and aggression.
the limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression.
personality type plays a much greater part in anger and aggression than physical factors.
One older concept that is being used currently that may help in violence reduction in patients is:
You are working in the emergency department. You notice Matt, your patient’s husband, pacing in the hallway, muttering to himself, and looking angrily around the emergency department. Which of the following statements to Matt may help prevent escalation and/or violence?
"You need to stay with your wife. She needs you.”
"Hey, what’s up buddy? You look pissed.”
"I am calling security to deal with your behavior.”
"You appear upset. Can I help you with anything?”
You are working on an adolescent psychiatric unit. Katy, aged 16 years, has been angry all day because her boyfriend was not allowed to visit last night. Katy is in the hallway and begins yelling, “It’s not fair! You all hate me! I hate this place!” She begins pounding her fists on the wall. To deal with the situation and prevent further escalation, your best response would be to say:
"Katy, I will help you calm down. Do you want to go to your room and talk or go to the quiet room?”
"Katy, you may yell and bang your fists but you must do it in your own room so you don’t upset the other patients.”
"Katy, stop that right now! You will not be allowed to behave like that!”
"Katy, you will have to go into seclusion and restraints right now.”
When you approach Katy, what considerations should you take?
Stand close to Katy for reassurance and to convey caring.
Have other staff as backup, and stand far enough away to avoid injury.
Take Katy to her room so you can talk to her alone.
Call security and wait until they arrive before approaching Katy.
Which of the following persons has the highest risk factors for physical abuse?
Emma, a 7-month-old baby who has colic and doesn’t sleep through the night
Roland, a 53-year-old man with cardiovascular disease living with his son
Penny, a 28-year-old wife whose husband has a diagnosis of an anxiety disorder
Rose, a 77-year-old woman living with her daughter and son-in-law
Nurses working in emergency departments and walk-in clinics should be aware that some victims of violence may present:
with vague physical complaints such as insomnia or pain.
with extreme anger and unpredictable behavior
with many family members there to support them.
with psychosis and/or mania as a result of long-term abuse.
Lauren brings her 4-year-old daughter, Mikayla, to the emergency department and states that Mikayla has been “acting funny.” Lauren states, “She touches her vagina and rubs herself down there all the time and she never did that before. She drew me a picture showing two people with one on top of the other and said they were ‘doing sex’ and I saw her acting that out with her dolls too. I didn’t know where else to go.” Based on Lauren’s description, you suspect that:
this is normal developmental behavior in a 4-year-old child.
Mikayla has been sexually abused.
Lauren needs education in parenting skills.
Mikayla has been exposed to graphic sexual images on television.
After arranging for a sexual assault nurse examiner (SANE) to see Lauren and Mikayla for further assessment for abuse and proper reporting and follow-up, Lauren tells you she lives with her boyfriend, Darrin, who is not Mikayla’s father. What statement by Lauren would make you suspect she is being emotionally abused?
"Darrin has a good job and keeps control of all the finances but our electricity still got turned off last week.”
"I didn’t tell Darrin I was coming because he is under so much stress at work I didn’t want to add to it.”
"Darrin yells a lot and calls me names, but that’s because I am so stupid and make so many mistakes.”
"Darrin is Latin American and has a fiery temper.”
If it is determined that Mikayla has been sexually abused, what is the priority outcome for Mikayla?
Mikayla’s mother will learn coping techniques to support Mikayla.
Mikayla will be able to verbalize exactly what happened to her.
Mikayla will no longer act out sexually.
The sexual abuse will cease.
Nicole is a 28-year-old married patient who comes to the emergency department after being raped on her way home from work. You have been with her as she cries and talks about what happened. She asks you, “What if I am pregnant?” Your response is guided by the knowledge that:
the risk of pregnancy after rape is high, up to 50%.
about 5% of women who are raped become pregnant as a result.
reproductive functions shut down during a violent attack, and as a result pregnancy does not occur.
Nicole may be worried about how her spouse will accept the baby.
Nicole alternates between sobbing and being quiet and withdrawn. Which of the following illustrates best practice in giving care to a patient who has just been sexually assaulted?
Sympathetic: “I’m so sorry for what you have been through.”
Reassuring: “Don’t worry. It’s hard now, but everything will be alright.”
Supportive: “I am going to stay with you. We can talk as long as you want to.”
Assertive: “Let’s talk about new coping skills you can use.”
It has been 6 months since Nicole was raped, and she has undergone counseling. Which statement by Nicole would indicate that an important outcome has been met?
“I keep having nightmares about the rape and I can’t sleep at night.”
"My husband has been very supportive during this whole thing.”
"I am not going to let that rapist be in control of my life. I know things will keep getting better.”
"I am not pressing charges because I want this whole thing to be over with so I can move on.”
It has now been 1 year since Nicole’s rape. Which of the following statements by Nicole would indicate that she has recovered from the trauma?
"I don’t walk home anymore because I am terrified it may happen again.”
"I am sleeping better but still only get about 5 hours of sleep at night because of bad dreams about the rape.”
"I realize that I was partly to blame for the rape because of walking in an unsafe neighborhood.”
"My husband and I are having sex again and I enjoy it.”
Which of the following are myths surrounding rape? (select all that apply):
Women are usually raped by a stranger.
Women do not “ask” to be raped by their behavior or dress.
Most rapes occur away from home areas such as alleys and behind buildings.
Documented rape cases include women from 8 to 70 years old.
Rape is an expression of aggression and anger.
Rape is usually an impulsive, spur-of-the-moment decision by the rapist.
Unless the assailant is armed, most women should be able to get away and avoid the rape.
Serious mental illness (SMI) affects how many people in the United States?
10% to 15% of the population
30% of the population
1% of the population
5% to 7% of the population
Institutionalization leads to what specific type of behaviors in adults old enough to have been confined to institutions before deinstitutionalization?
Anger and aggression
Passivity and dependence
Assertiveness and candor
Fearfulness and paranoia
Which is true of the relationship between SMI and substance abuse?
Substance abuse rarely occurs within this population.
Substance abuse occurs at approximately the same rate as in the general population.
Of those with SMI, 60% also abuse substances.
Smoking has declined in this population at the same rate as the general public.
Jeremiah is a 20-year-old Amish patient who was diagnosed with paranoid schizophrenia 1 year ago and who lives with his parents. He is admitted to the psychiatric unit with psychosis because of nonadherence to his medication regime. When you are attempting to educate him about his diagnosis and the need for medication, Jeremiah persistently mumbles, “I don’t have mental illness. No, I am not sick.” You recognize that Jeremiah may be exhibiting:
Jeremiah is being discharged from the hospital. Which interventions and/or goals related to planning for discharge would support the recovery model of care?
Jeremiah will attend groups that teach how to cope with his present illness.
Jeremiah’s parents will receive education on how to manage the patient’s deficits.
Interventions will focus on medication adherence
Interventions will focus on Jeremiah’s stated wish for independent living.
Noelle is a patient on the psychiatric unit. She is scheduled to start group therapy today. She asks you, “What does group work mean? My provider said I would be going to group and doing group work.” Your best response is:
"You will attend group therapy and find solutions for each other’s problems.”
"You will give and receive feedback from a group of your peers who may also have similar problems to work through.”
"You will share your issues with the group and then split up to work separately on solutions based on the ideas the other members provide.”
"Group work is the work that you do beforehand so you can present it to the group when you meet.”
Blaine is an advanced practice nurse running a group on the adolescent unit. The patients are talking about their favorite music and artists. Blaine makes no attempt to control the topic or the member’s behavior and makes no comment unless he is asked a direct question. Blaine’s leadership style is:
What is the group leader’s responsibility in the termination phase?
Allowing members to exchange contact information so they may remain as a support for each other
Removing himself or herself from the group so they can function independently
Encouraging group members to reflect on progress made
Encouraging group members to fill out evaluation forms so the group leader can further improve his or her therapeutic technique
Savannah is a patient with borderline personality disorder who is attending a court-ordered therapy group. She projects an angry affect. She doesn’t speak much, but when she does it is usually to make a snide comment about another member of the group or the group’s leader. What is the best way for the leader to handle this?
Respond neutrally to Savannah’s comments, ask for group feedback, and talk to her privately to form a connection.
Spend one entire group session focused on Savannah and try to get her to open up to other members in depth.
Confront Savannah firmly each time she makes a rude comment and let her know she will be taken out of group if she continues.
Advantages of groups include: (select all that apply):
Feedback from peers
Treatment of multiple people at one time
Promotion of independence in problem solving
Provision of an opportunity to practice communication
Promotion of a feeling of belonging
Promotion of confidentiality
The family that consists of a married mother and father and three biological children all living together is referred to as a(n):
Marnie is the nurse working with a family whose boundaries are not clear and whose members are overinvolved with each other. The term that describes this type of family dynamic is:
Grace is the nurse working with the Potter family, which consists of married parents Todd and Rhea, 16-year-old Jasmine, and 19-year-old Jeremy, who has recently been diagnosed with schizophrenia. The rest of the family is bewildered with Jeremy’s symptoms and express that they feel lost in knowing how to deal with things. Which of the following approaches to family therapy would Grace take at this time to provide support and give information to the family that will help them cope with Jeremy’s illness?
Insight-oriented family therapy
Psychoeducational family therapy
Behavioral family therapy
Multigenerational family therapy
As Grace continues to work with the family, Rhea confides that she and her husband Todd have not been getting along well. She states that daughter Jasmine provides much support to her, and that Jasmine “doesn’t really like her dad much anymore and doesn’t talk to him.” Grace suspects:
Grace wants to find out more about the Potter family and tells them she will do a genogram. Rhea asks what a genogram is. The best response would be:
"A genogram will assess risk for mental illness in future generations.”
"A genogram is a tool used for deciding on the best type of therapy for your family.”
"A genogram will help me see your family structure, history, and current functioning.”
"A genogram will help us determine the cause of Jeremy’s schizophrenia.”
Care that places the patient at the center of care, focuses on prevention and wellness, and attends to the patient’s physical, mental, and spiritual needs is referred to as:
Shannon tells you that she is nearing the end of a medication trial where she is taking a pill that may improve her symptoms of gastroesophageal reflux disease. She states, “I found out that I was in the section of the study not actually taking the medicine. I don’t understand that, because all my symptoms improved!” You realize she may be experiencing:
the placebo effect.
an unethical research study.
Elaina, a 53-year-old patient with a pacemaker and history of cerebrovascular accident (stroke) for which she takes Coumadin, comes to see her provider at the office where you work. She tells you she “feels so much better” now that she is taking ginseng to relieve her menopausal symptoms. Your best response is based on the knowledge that:
ginseng is an appropriate herbal supplement for Elaina to use.
ginseng has no effect on menopausal symptoms.
ginseng has anticoagulation effects.
ginseng is implicated in strokes.
Which supplement could be recommended for Elaina’s complaints of hot flashes?
St. John’s Wort
Risks of using complementary and alternative medicine (CAM) therapies include: (select all that apply):
lack of standards or regulations that ensure safety for herbal products.
not informing health care providers of the use of CAM.
interactions between CAM products and prescribed medication.
delayed treatment while experimenting with alternative treatments.
not knowing how much of an ingredient is in supplements because of nonregulation.