NUR 222 MENTAL HEALTH/PSYCHIATRY NURSING EXAM Study Guide Organized and arranged to ACES.

1. A nurse in an alcohol treatment facility is caring for a client who states, “My job is so stressful that the only way I can cope is to drink.” The nurse should recognize that the client is displaying which of the following defense mechanisms? A. Introjection (Unconscious adoption of the ideas or attitudes of others) B. Repression C. Rationalization D. Intellectualization Repression ● Unconsciously putting unacceptable ideas, thoughts, and emotions out of awareness ● ADAPTIVE USE: A person preparing to give a speech unconsciously forgets about the time when he was young and kids laughed at him while on stage. ● MALADAPTIVE USE: A person who has a fear of the dentist Rationalization ● Creating reasonable and acceptable explanations for unacceptable behavior ● ADAPTIVE USE: An adolescent boy says, “she must already have a boyfriend” when rejected by a girl ● MALADAPTIVE USE: A young adult explains he had to drive home from a party after drinking alcohol because he had to feed his dog Intellectualization ● Separation of emotions and logical facts when analyzing or coping with a situation or event ● ADAPTIVE USE: A law enforcement officer blocks out the emotional aspect of a crime so he can objectively focus on the investigation. ● MALADAPTIVE USE: A person who learns he has a terminal illness focuses on creating a will and financial matters rather than acknowledging his grief. 2. A nurse is obtaining a medical history from a client who is requesting a prescription for bupropion for smoking cessation. Which of the following assessment findings in the client’s history should the nurse report to the provider? A. Knee arthroplasty 1 month ago B. Hepatitis B infection C. Recent head injury (Avoid administering to clients at risk for seizures, such as a client who has a head injury) D. Hypothyroidism Bupropion = ATYPICAL ANTIDEPRESSANT, inhibits Dopamine uptake ○ Alternative to SSRIs for clients unable to tolerate sexual dysfunction side effects ○ Complications: Headache, dry mouth, GI distress, constipation, increased heart rate, nausea, restlessness, insomnia ■ Suppression of appetite = weight loss, contraindicated for those who have anorexia or bulimia 3. A nurse is assessing a client who has histrionic personality disorder. Which of the following findings should the nurse expect? A. Lack of remorse B. Splitting of staff C. Attention-seeking D. Identity disturbance Histrionic ● “POK POK” - Characterized by emotional attention-seeking behavior, in which the person needs to be the center of attention; often seductive and flirtatious. 4. A nurse is providing teaching to the daughter of an older client who has obsessive-compulsive disorder. Which of the following statements by the daughter indicates an understanding of the teaching? A. “I will provide my mother with detailed instructions about how to perform self-care.” (Give simple directions) B. “I will limit my mother’s clothing choices when she is getting dressed.” (If client is indecisive, limit the client's choices; if client still unable to make a decision, give client one outfit to wear) C. “I will wake my mother up a couple of times in the night to check on her.” D. “I will discourage my mother from talking about her physical complaints.” OCD ● The client attempts to suppress persistent thoughts or urges that cause anxiety through compulsive or obsessive behaviors, such as repetitive hand washing. ● Obsessions or compulsions are time-consuming and result in impaired social and occupational functioning. 6. A nurse is providing crisis intervention for a client who was involved in a violent mass casualty situation in the community. Which of the following actions should the nurse take during the initial session with the client? A. Identify the client’s usual coping style. B. Encourage the client to display anger toward the cause of the crisis. (Reduce stress-related manifestations, such as using techniques to alleviate a panic attack) C. Tell the client that this life will soon return to normal (False assurance) D. Help the client focus on a wide variety of topics regarding the crisis. (Reduce stress) 18. A charge nurse is orienting a newly licensed nurse and observes the newly licensed nurse imitating her behaviors. The nurse should recognize this behavior as which of the following defense mechanisms? A. Suppression (Voluntarily denying unpleasant thoughts and feelings) B. Identification (Conscious or unconscious assumption of the characteristics of another individual or group) C. Compensation (Emphasizing strengths to make up for weaknesses) D. Reaction formation (Overcompensating or demonstrating the opposite behavior of what is felt) 21. A nurse in an inpatient mental health facility is assessing a client who has schizophrenia and is taking haloperidol. Which of the following clinical findings is the nurse’s priority? A. Insomnia (Sedation) B. Urinary frequency (Complication → ANTIcholinergic effects) C. High fever (Complication → agranulocytosis) D. Headache Other complications: Acute dystonia, Pseudoparkinsonism, Akathisia, Tardive dyskinesia, Neuroendocrine effects (Gynecomastia, Weight gain, Menstrual irregularities), NMS, Orthostatic Hypotension, Sedation, Sexual dysfunction, Skin effects, Liver impairment 27. A nurse in a mental health facility is caring for a client. Which of the following actions should the nurse take during the working phase of the nurse-client relationship? A. Summarize goals and objectives. B. Address confidentiality. C. Promote problem-solving skills. D. Establish a participation contract 30. A nurse is providing behavioral therapy for a client who has OCD. The client repeatedly checks that the doors are locked at night. Which of the following instructions should the nurse give the client when using thought stopping technique? A. “Keep a journal of how often you check the locks each night.” B. “Ask a family member to check the locks for you at night.” C. “Focus on abdominal breathing whenever you go to check the locks.” D. “Snap a rubber band on your wrist when you think about checking the locks.” Thought stopping: teach pt to say “stop” when negative thoughts/compulsive behaviors arise & substitute positive thought - goal for pt use command silently over time 33. A nurse is assisting with obtaining informed consent for a client who has been legally incompetent. Which of the following actions should the nurse take? A. Explain implied consent to the client’s family. B. Contact the facility social work to obtain the consent. C. Request that the client’s guardian sign the consent D. Ask the charge nurse to obtain informed consent. Client who has been judged incompetent has a temporary or permanent guardian appointed by the court. The guardian can sign the informed consent for the client. 46. A nurse is reviewing the laboratory report of a client who is taking carbamazepine for bipolar disorder. Which of the following laboratory results should the nurse report to the provider? A. Urine specific gravity 1.029 B. Platelets 90,000/mm C. Urine pH 5.6 D. RBC 4.7/mm Complications: CNS effects, Blood Dyscrasias, Teratogenesis, Hyperosmolality (ANTI-diuretic), Skin Disorders 49. A nurse in a mental health facility is making plans for client’s discharge. Which of the following interdisciplinary team members should the nurse contact to assist the client with housing placement? A. Social worker B. Occupational therapist C. Clinical nurse specialist D. Recreational therapist 50. A nurse is caring for a client who reports that he is angry with his partner because she thinks he is trying to gain attention. When the nurse attempts to talk to the client, he becomes angry and tells her to leave. Which of the following defense mechanisms is the client demonstrating? (ATI p.21) A. Rationalization B. Compensation C. Denial D. Displacement Displacement - shifting feelings r/t to an object, person or situation to another less threatening object, person, or situation 59. A nurse is creating a plan of care for a client who has major depressive disorder. Which of the following interventions should the nurse include in the plan? A. Encourage physical activity for the client during the day. B. Keep a bright light on in the client’s room at night. C. Identify and schedule alternative group activities for the client. D. Discourage the client from expressing feelings of anger. 64. An older adult client is brought to the mental health clinic by her daughter. The daughter reports that her mother is not eating and seems uninterested in routine activities. The daughter states, “I’m so worried that my mother is depressed.” Which of the following responses should the nurse make? A. “Tell me the reasons you think your mother is depressed.” B. “You shouldn't worry about this, because depressive disorder is easily treated.” C. “Everyone gets depressed from time to time.” D. “Older adults are usually diagnosed with depressive disorder as they age.” 70. A nurse in the emergency department is assessing a client who has major depressive disorder. Which of the following actions should the nurse take? something’s missing from this question….. NVM -_- it’s an EXHIBIT question -_-’ A. Administer dantrolene IV bolus to the client - muscle relaxant B. Ask the client if she has eaten foods containing tyramine - yes, they could possibly be on MAOI’s C. Give regular insulin subcutaneously to the client D. Prepare the client for ECT - indicated for depressive d/o’s that are resistant to other forms of tx 2. A nurse is counseling a client following the death of the client’s partner 8 months ago. Which of the following client statements indicates maladaptive grieving? a. “I am so sorry for the times i was angry with my partner” b. “I like looking at his personal items in the closet” c. “I find myself thinking about my partner often” d. “I still don’t feel up to returning to work” Rationale: 8 months too long Maladaptive Grief: . Distorted or exaggerated grief response - unable to perform activities of daily living. 
 RISK FACTORS FOR MALADAPTIVE GRIEVING ●● Being dependent upon the deceased ●● Unexpected death at a young age, through violence, or by a socially unacceptable manner ●● Inadequate coping skills or lack of social support ●● Pre-existing mental health issues, such as depression or substance use disorder 3. A nurse in an inpatient mental health facility is assessing a client who has schizophrenia and is taking haloperidol (anti-psychotic, 1st gen). Which of the following clinical findings is the nurse’s priority? a. Headache b. Insomnia (sedation) c. Urinary hesitancy (anticholinergic effect) d. High Fever (neuroleptic malignant syndrome) Rationale: A.E.: Neuroleptic malignant syndrome Life-threatening medical emergency. Manifestations include sudden high-grade fever, blood pressure fluctuations, dysrhythmias, muscle rigidity, diaphoresis, drooling, and change in level of consciousness developing into coma 4. A nurse is planning care for a client who has obsessive compulsive disorder. Which of the following recommendations should the nurse include in the client’s plan of care? a. Reality orientation therapy (re-orient to reality) b. Operant conditioning (receives positive rewards for positive behavior) c. Thought stopping (say “stop” when compulsive behaviors arise & substitute w/ positive thought) d. Validation therapy (acknowledging pt’s feelings) Rationale: OCD - pt has intrusive thoughts of unrealistic obsessions & tries to control thoughts w/ compulsive behaviors 5. A nurse is caring for a client who is in the manic phase of bipolar disorder. Which of the following actions should the nurse take? a. Provide in depth explanation of nursing expectations (inability to focus - give concise explanations) b. Encourage the client to participate in group activities (decrease stimulation) c. Avoid power struggles by remaining neutral (do not react personally to pt’s comments) d. Allow the client to set limits for his behavior (nurse sets limits) 6. REPEAT 7. A nurse is caring for a client who has a cocaine use disorder. Which of the following manifestations should the nurse expect the client to have during withdrawal? a. Hand tremors - intoxication b. Fatigue c. Seizures - intoxication d. Rapid speech Rationale: Pg: 97 WITHDRAWAL MANIFESTATIONS● Depression, fatigue, craving, excess sleeping or insomnia, dramatic unpleasant dreams, psychomotor retardation, agitation● Not life-threatening, but possible occurrence of suicidal ideation 
 Cocaine = STIMULANT → OPPOSITE of HEROIN ● Withdrawal = opposite effects 10. A nurse is assessing a client who is experiencing acute alcohol withdrawal. Which of the following findings should the nurse expect? a. Diminished reflexes b. Hypotension - increased BP c. Insomnia d. Bradycardia Rationale: Common manifestations include nausea; vomiting; tremors; restlessness and inability to sleep; depressed mood or irritability; increased heart rate, blood pressure, respiratory rate, and temperature; diaphoresis; tonic-clonic seizures; and illusions. 11. A nurse is caring for a client who has schizophrenia and displays severe symptoms of the disorder. Which of the following actions should the nurse take? P . 80 ch 15 a. Use medication to decrease frequency of auditory and visual hallucinations b. Assist the client to identify somatic and thought broadcasting delusions (Identify symptom triggers, such as loud noises (can trigger auditory hallucinations in certain clients) and situations that seem to trigger conversations about the client’s delusions. c. Manage the client’s loud, rambling, and incoherent communication patterns d. Direct the client to perform her own daily hygiene and grooming tasks- promote self care Somatic delusions - believes that his body is changing in an unusual way, such as growing a third arm. Thought broadcasting - believes that her thoughts are heard by others. Schizophrenia: The client has psychotic thinking or behavior present for at least 6 months. Areas of functioning, including school or work, self-care, and interpersonal relationships, are significantly impaired. 12. A nurse is caring for a client who was involuntarily committed and is scheduled to receive electroconvulsive therapy. The client refuses the treatment and will discuss why with the healthcare team. Which of the following actions should the nurse take? Ch 10 p. 51 a. Document the client’s refusal of the treatment in the medical record. b. Tell the client he cannot refuse the treatment because he was involuntarily committed c. Inform the client the ECT does not require client consent d. Ask the client family to encourage the client to receive ECT Clients admitted under involuntary commitment are still considered competent and have the right to refuse TX,. 13. REPEAT 14. A nurse in the emergency department is caring for a client who reports feeling sad, worthless, and hopeless 9 months after the death of her son. Which of the following actions should the nurse take first? P. 179 ch 30 a. Encourage the client to attend a grief support group b. Discuss the client’s coping skills c. Request a mental health consult for the client d. Ask the client if she has thought about harming herself- given - she’s showing signs of depression and no reason to live so we asked if she's going to commit suicide. Feelings of powerlessness and isolation and death of a loved one are risk factors. Eh di wow. hahah 15. A nurse is planning care for an adolescent who has autism spectrum disorder. Which of the following outcomes should the nurse include in the plan of care? P . 171 ch 28 a. Acknowledges that his delusions are not real b. Changes behavior as a result of peer pressure c. Initiate social interactions with caregiver- ppl with autism have a