Mental Health Nursing Practice Questions 1 with complete solutions

The nurse is caring for a client with schizophrenia. Which of the following outcomes is the least desirable? A) The client spends more time by himself B) The client doesn't engage in delusional thinking C) The client doesn't harm himself or others D) The client demonstrates ability to meet his own self-care needs - ANSWER A) The client spends more time by himself The client with schizophrenia is commonly socially isolated and withdrawn; therefore, having the client spend more time by himself wouldn't be a desirable outcome. Rather, a desirable outcome would specify that the client spend more time with other clients and staff on the unit. Delusions are false personal beliefs. Reducing or eliminating delusional thinking using talking therapy and antipsychotic medications would be a desirable outcome. Protecting the client and others from harm is a desirable client outcome achieved by close observation, removing any dangerous objects, and administering medications. Because the client with schizophrenia may have difficulty meeting his or her own self-care needs, fostering the ability to perform self-care independently is a desirable client outcome. The nurse formulates a nursing diagnosis of Impaired verbal communication for a client with schizotypal personality disorder. Based on this nursing diagnosis, which nursing intervention is most appropriate? A) Helping the client to participate in social interactions B) Establishing a one-on-one relationship with the client C) Establishing alternative forms of communication D) Allowing the client to decide when he wants to participate in verbal communication with the nurse - ANSWER B) Establishing a one-on-one relationship with the client By establishing a one-on-one relationship, the nurse helps the client learn how to interact with people in new situations. The other options are appropriate but should take place only after the nurse-client relationship is established. Since admission 4 days ago, a client has refused to take a shower, stating, "There are poison crystals hidden in the showerhead. They'll kill me if I take a shower." Which nursing action is most appropriate? A) Dismantling the showerhead and showing the client that there is nothing in it B) Explaining that other clients are complaining about the client's body odor C) Asking a security officer to assist in giving the client a shower D) Accepting these fears and allowing the client to take a sponge bath - ANSWER D) Accepting these fears and allowing the client to take a sponge bath By acknowledging the client's fears, the nurse can arrange to meet the client's hygiene needs in another way. Because these fears are real to the client, providing a demonstration of reality (as in option A) wouldn't be effective at this time. Options B and C would violate the client's rights by shaming or embarrassing the client. Drug therapy with thioridazine (Mellaril) shouldn't exceed a daily dose of 800 mg to prevent which adverse reaction? A) Hypertension B) Respiratory arrest C) Tourette Syndrome D) Retinal pigmentation - ANSWER D) Retinal pigmentation Retinal pigmentation may occur if the thioridazine dosage exceeds 800 mg per day. The other options don't occur as a result of exceeding this dose. A client with paranoid personality disorder is admitted to a psychiatric facility. Which remark by the nurse would best establish rapport and encourage the client to confide in the nurse? A) "I get upset once in a while, too." B) "I know just how you feel. I'd feel the same way in your situation." C) "I worry, too, when I think people are talking about me." D) "At times, it's normal not to trust anyone." - ANSWER A) "I get upset once in a while, too." Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse can't know how the client feels. Telling the client otherwise, as in option B, would justify the suspicions of a paranoid client; furthermore, the client relies on the nurse to interpret reality. Option C is incorrect because it focuses on the nurse's feelings, not the client's. Option D wouldn't help establish rapport or encourage the client to confide in the nurse. How soon after chlorpromazine (Thorazine) administration should the nurse expect to see a client's delusional thoughts and hallucinations eliminated? A) Several minutes B) Several hours C) Several days D) Several weeks - ANSWER D) Several weeks Although most phenothiazines produce some effects within minutes to hours, their antipsychotic effects may take several weeks to appear. A client is about to be discharged with a prescription for the antipsychotic agent haloperidol (Haldol), 10 mg by mouth twice per day. During a discharge teaching session, the nurse should provide which instruction to the client? A) Take the medication 1 hour before a meal. B) Decrease the dosage if signs of illness decrease C)Apply a sunscreen before being exposed to the sun. D) Increase the dosage up to 50 mg twice per day if signs of illness don't decrease. - ANSWER C) Apply a sunscreen before being exposed to the sun. Because haloperidol can cause photosensitivity and precipitate severe sunburn, the nurse should instruct the client to apply a sunscreen before exposure to the sun. The nurse also should teach the client to take haloperidol with meals — not 1 hour before — and should instruct the client not to decrease or increase the dosage unless the physician orders it. A client with paranoid schizophrenia repeatedly uses profanity during an activity therapy session. Which response by the nurse would be most appropriate? A) "Your behavior won't be tolerated. Go to your room immediately." B) "You're just doing this to get back at me for making you come to therapy." C) "Your cursing is interrupting the activity. Take time out in your room for 10 minutes." D) "I'm disappointed in you. You can't control yourself even for a few minutes." - ANSWER A) "Your behavior won't be tolerated. Go to your room immediately." The nurse should set limits on client behavior to ensure a comfortable environment for all clients. The nurse should accept hostile or quarrelsome client outbursts within limits without becoming personally offended, as in option A. Option B is incorrect because it implies that the client's actions reflect feelings toward the staff instead of the client's own misery. Judgmental remarks, such as option D, may decrease the client's self-esteem. Which of the following is one of the advantages of the newer antipsychotic medication risperidone (Risperdal)? A) The absence of anticholinergic effects B) A lower incidence of extrapyramidal effects C) Photosensitivity and sedation D) No incidence of neuroleptic malignant syndrome - ANSWER B) A lower incidence of extrapyramidal effects Risperdal has a lower incidence of extrapyramidal effects than the typical antipsychotics. Risperdal does produce anticholinergic effects and neuroleptic malignant syndrome can occur. Photosensitivity isn't an advantage. The etiology of schizophrenia is best described by: A) genetics due to a faulty dopamine receptor. B) environmental factors and poor parenting. C) structural and neurobiological factors. D) a combination of biological, psychological, and environmental factors. - ANSWER D) a combination of biological, psychological, and environmental factors. A reliable genetic marker hasn't been determined for schizophrenia. However, studies of twins and adopted siblings have strongly implicated a genetic predisposition. Since the mid-19th century, excessive dopamine activity in the brain has also been suggested as a causal factor. Communication and the family system have been studied as contributing factors in the development of schizophrenia. Therefore, a combination of biological, psychological, and environmental factors are thought to cause schizophrenia. A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms? A) benztropine (Cogentin) B) dantrolene (Dantrium) C) clonazepam (Klonopin) D) diazepam (Valium) - ANSWER A) benztropine (Cogentin) Benztropine is an anticholinergic drug administered to reduce extrapyramidal adverse effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Dantrolene, a hydantoin drug that reduces the catabolic processes, is administered to alleviate the symptoms of neuroleptic malignant syndrome, a potentially fatal adverse effect of antipsychotic drugs. Clonazepam, a benzodiazepine drug that depresses the CNS, is administered to control seizure activity. Diazepam, a benzodiazepine drug, is administered to reduce anxiety. A client with a diagnosis of paranoid schizophrenia comments to the nurse, "How do I know what is really in those pills?" Which of the following is the best response? A) Say, "You know it's your medicine." B) Allow him to open the individual wrappers of the medication. C) Say, "Don't worry about what is in the pills. It's what is ordered." D) Ignore the comment because it's probably a joke. - ANSWER B) Allow him to open the individual wrappers of the medication. Option B is correct because allowing a paranoid client to open his medication can help reduce suspiciousness. Option A is incorrect because the client doesn't know that it's his medication and he's obviously suspicious. Telling the client not to worry or ignoring the comment isn't supportive and doesn't offer reassurance. A client tells the nurse that people from Mars are going to invade the earth. Which response by the nurse would be most therapeutic? A) "That must be frightening to you. Can you tell me how you feel about it?" B) "There are no people living on Mars." C) "What do you mean when you say they're going to invade the earth?" D) "I know you believe the earth is going to be invaded, but I don't believe that." - ANSWER A) "That must be frightening to you. Can you tell me how you feel about it?" This response addresses the client's underlying fears without feeding the delusion. Refuting the client's delusion, as in option B, would increase anxiety and reinforce the delusion. Asking the client to elaborate on the delusion, as in option C, would also reinforce it. Voicing disbelief about the delusion, as in option D, wouldn't help the client deal with underlying fears. A client with schizophrenia tells the nurse he hears the voices of his dead parents. To help the client ignore the voices, the nurse should recommend that he: A) sit in a quiet, dark room and concentrate on the voices. B) listen to a personal stereo through headphones and sing along with the music. C) call a friend and discuss the voices and his feelings about them. D) engage in strenuous exercise. - ANSWER B) listen to a personal stereo through headphones and sing along with the music. Increasing the amount of auditory stimulation, such as by listening to music through headphones, may make it easier for the client to focus on external sounds and ignore internal sounds from auditory hallucinations. Option A would make it harder for the client to ignore the hallucinations. Talking about the voices, as in option C, would encourage the client to focus on them. Option D is incorrect because exercise alone wouldn't provide enough auditory stimulation to drown out the voices. A client with schizophrenia is receiving antipsychotic medication. Which nursing diagnosis may be appropriate for this client? A) Ineffective protection related to blood dyscrasias B)Urinary frequency related to adverse effects of antipsychotic medication C) Risk for injury related to a severely decreased level of consciousness D) Risk for injury related to electrolyte disturbances - ANSWER A) Ineffective protection related to blood dyscrasias Antipsychotic medications may cause neutropenia and granulocytopenia, life-threatening blood dyscrasias, that warrant a nursing diagnosis of Ineffective protection related to blood dyscrasias. These medications also have anticholinergic effects, such as urine retention, dry mouth, and constipation. Urinary frequency isn't an approved nursing diagnosis. Although antipsychotic medications may cause sedation, they don't severely decrease the level of consciousness, eliminating option C. These drugs don't cause electrolyte disturbances, eliminating option D. A client with persistent, severe schizophrenia has been treated with phenothiazines for the past 17 years. Now the client's speech is garbled as a result of drug-induced rhythmic tongue protrusion. What is another name for this extrapyramidal symptom? A) Dystonia B) Akathisia C) Pseudoparkinsonism D) Tardive dyskinesia - ANSWER D) Tardive dyskinesia An adverse reaction to phenothiazines, tardive dyskinesia refers to choreiform tongue movements that commonly are irreversible and may interfere with speech. Dystonia refers to involuntary contraction of a muscle group. Akathisia is restlessness or inability to sit still. Pseudoparkinsonism describes a group of symptoms that mimic those of Parkinson's disease. An adverse reaction to phenothiazines, tardive dyskinesia refers to choreiform tongue movements that commonly are irreversible and may interfere with speech. Dystonia refers to involuntary contraction of a muscle group. Akathisia is restlessness or inability to sit still. Pseudoparkinsonism describes a group of symptoms that mimic those of Parkinson's disease. A) Meeting all of the client's physical needs B) Giving the client an opportunity to express concerns C) Administering lithium carbonate (Lithonate) as prescribed D) Providing a quiet environment where the client can be alone - ANSWER A) Meeting all of the client's physical needs Because a client with catatonic schizophrenia can't meet physical needs independently, the nurse must provide for all of these needs, including adequate food and fluid intake, exercise, and elimination. This client is incapable of expressing concerns; however, the nurse should try to verbalize the message conveyed by the client's nonverbal behavior. Lithium is used to treat mania, not catatonic schizophrenia. Despite the client's mute, unresponsive state, the nurse should provide nonthreatening stimulation and should spend time with the client, not leave the client alone all the time. Although aware of the environment, the client doesn't interact with it actively; the nurse's support and presence can be reassuring. A client with a history of medication noncompliance is receiving outpatient treatment for chronic undifferentiated schizophrenia. The physician is most likely to prescribe which medication for this client? A) chlorpromazine (Thorazine) B) imipramine (Tofranil) C) lithium carbonate (Lithane) D) fluphenazine decanoate (Prolixin Decanoate) - ANSWER D) fluphenazine decanoate (Prolixin Decanoate) Fluphenazine decanoate is a long-acting antipsychotic agent given by injection. Because it has a 4-week duration of action, it's commonly prescribed for outpatients with a history of medication noncompliance. Chlorpromazine, also an antipsychotic agent, must be administered daily to maintain adequate plasma levels, which necessitates compliance with the dosage schedule. Imipramine, a tricyclic antidepressant, and lithium carbonate, a mood stabilizer, are rarely used to treat clients with chronic schizophrenia. Propranolol (Inderal) is used in the mental health setting to manage which of the following conditions?