Comprehensive Mental Health and Psychiatric Nursing NCLEX Practice Quiz #2: 75 Questions

Comprehensive Mental Health and Psychiatric Nursing NCLEX Practice Quiz #2: 75 Questions 1. 1. Question Which nursing intervention is best for facilitating communication with a psychiatric client who speaks a foreign language? o A. Rely on nonverbal communication o B. Select symbolic pictures as aids o C. Speak in universal phrases o D. Use the services of an interpreter Incorrect Correct Answer: D. Use the services of an interpreter An interpreter will enable the nurse to better assess the client’s problems and concerns. Language barriers pose challenges in terms of achieving high levels of satisfaction among medical professionals and patients, providing high- quality healthcare and maintaining patient safety. To address these challenges, many larger healthcare institutions offer interpreter services to improve healthcare access, patient satisfaction, and communication. • Option A: Nonverbal communication is important; however for the nurse to fully determine the client’s problems and concerns, the assistance of an interpreter is essential. Language barriers have negative implications for the delivery of healthcare and patient satisfaction. One study showed that among patients who received treatment from nurses who did not speak the local language, 30% had difficulty understanding medical instructions, 30% had a problem with the reliability of information, and 50% believed that the language barrier contributed to errors. • Option B: Online translation tools such as Google Translate and MediBabble present possible solutions for overcoming these challenges. Further studies on the implications of language barriers and the effectiveness of online translation tools are recommended. Furthermore, new updates with more medical phrases for Google Translate and with more languages included for MediBabble application are recommended. • Option C: The use of universal phrases may assist the nurse in understanding the basic needs of the client; however these are insufficient to assess the client with a psychiatric problem. Some healthcare organizations use online translation tools such as Google Translate and MediBabble to address the challenges of language barriers. These tools are free and easy to access, and they contribute to improving healthcare delivery, patient safety, and increase (up to 92%) the satisfaction of both medical professionals and patients. 2. 2. Question The nurse explains to a mental health care technician that a client’s obsessive-compulsive behaviors are related to an unconscious conflict between id impulses and the superego (or conscience). On which of the following theories does the nurse base this statement? • A. Behavioral theory • B. Cognitive theory • C. Interpersonal theory • D. Psychoanalytic theory Incorrect Correct Answer: D. Psychoanalytic theory Psychoanalytic is based on Freud’s beliefs regarding the importance of unconscious motivation for behavior and the role of the id and superego in opposition to each other. Psychoanalysis is defined as a set of psychological theories and therapeutic methods which have their origin in the work and theories of Sigmund Freud . The primary assumption of psychoanalysis is the belief that all people possess unconscious thoughts, feelings, desires, and memories. The aim of psychoanalysis therapy is to release repressed emotions and experiences, i.e., make the unconscious conscious. It is only having a cathartic (i.e., healing) experience can the person be helped and “cured.” • Option A: Behaviorism, also known as behavioral psychology, is a theory of learning based on the idea that all behaviors are acquired through conditioning. Conditioning occurs through interaction with the environment. Behaviorists believe that our responses to environmental stimuli shape our actions. According to this school of thought, behavior can be studied in a systematic and observable manner regardless of internal mental states. According to this perspective, only observable behavior should be considered—cognitions, emotions, and moods are far too subjective. • Option B: Cognitive theory is an approach to psychology that attempts to explain human behavior by understanding your thought processes. For example, a therapist is using principles of cognitive theory when they teach you how to identify maladaptive thought patterns and transform them into constructive ones. The assumption of cognitive theory is that thoughts are the primary determinants of emotions and behavior. Information processing is a common description of this mental process. Theorists compare the way the human mind functions to a computer. • Option C: Interpersonal theory emphasizes the importance of various developmental stages—infancy, childhood, the juvenile era, preadolescence, early adolescence, late adolescence, and adulthood. Like Freud and Jung, Sullivan (1953b) saw personality as an energy system. Energy can exist either as tension (potentiality for action) or as actions themselves (energy transformations). Energy transformations transform tensions into either covert or overt behaviors and are aimed at satisfying needs and reducing anxiety. 3. 3. Question The nurse observes a client pacing in the hall. Which statement by the nurse may help the client recognize his anxiety? • A. “I guess you’re worried about something, aren’t you? • B. “Can I get you some medication to help calm you?” • C. “Have you been pacing for a long time?” • D. “I notice that you’re pacing. How are you feeling?” Incorrect Correct Answer: D. “I notice that you’re pacing. How are you feeling?” By acknowledging the observed behavior and asking the client to express his feelings the nurse can best assist the client to become aware of his anxiety. Recognition acknowledges a patient’s behavior and highlights it without giving an overt compliment. A compliment can sometimes be taken as condescending, especially when it concerns a routine task like making the bed. However, saying something like “I noticed you took all of your medications” draws attention to the action and encourages it without requiring a compliment. • Option A: The nurse is offering an interpretation that may or may not be accurate; the nurse is also asking a question that may be answered by a “yes” or “no” response, which is not therapeutic. Therapeutic communication is often most effective when patients direct the flow of conversation and decide what to talk about. To that end, giving patients a broad opening such as “What’s on your mind today?” or “What would you like to talk about?” can be a good way to allow patients an opportunity to discuss what’s on their mind. • Option B: The nurse is intervening before accurately assessing the problem. By using nonverbal and verbal cues such as nodding and saying “I see,” nurses can encourage patients to continue talking. Active listening involves showing interest in what patients have to say, acknowledging that you’re listening and understanding, and engaging with them throughout the conversation. Nurses can offer general leads such as “What happened next?” to guide the conversation or propel it forward. • Option C: This statement encourages a “yes” or “no” response, avoids focusing on the client’s anxiety, which is the reason for his pacing. Observations about the appearance, demeanor, or behavior of patients can help draw attention to areas that might pose a problem for them. Observing that they look tired may prompt patients to explain why they haven’t been getting much sleep lately; making an observation that they haven’t been eating much may lead to the discovery of a new symptom. 4. 4. Question A client with obsessive-compulsive disorder is hospitalized in an inpatient unit. Which nursing response is most therapeutic? • A. Accepting the client’s obsessive-compulsive behaviors. • B. Challenging the client’s obsessive-compulsive behaviors. • C. Preventing the client’s obsessive-compulsive behaviors. • D. Rejecting the client’s obsessive-compulsive behaviors. Incorrect Correct Answer: A. Accepting the client’s obsessive-compulsive behaviors A client with obsessive-compulsive behavior uses this behavior to decrease anxiety. Accepting this behavior as the client’s attempt to feel secure is therapeutic. When a specific treatment plan is developed, other nursing responses may also be acceptable. Obsessive-compulsive disorder (OCD) is often a disabling condition consisting of bothersome intrusive thoughts that elicit a feeling of discomfort. To reduce the anxiety and distress associated with these thoughts, the patient may employ compulsions or rituals. These rituals may be personal and private, or they may involve others to participate; the rituals are to compensate for the ego-dystonic feelings of the obsessional thoughts and can cause a significant decline in function. • Option B: In The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5, which was published by the American Psychiatric Association (APA) in 2013, Obsessive-Compulsive Disorder sits under its own category of Obsessive-Compulsive and Related Disorders. Obsessions are defined as intrusive thoughts or urges that cause significant distress; the patient attempts to neutralize this distress by diverting thoughts or performing rituals. Compulsions are actions the patient feels pressured to do in response to the anxiety/distress producing obsessions or to prevent an uncomfortable situation from occurring. These compulsions may be illogical or excessive. • Option C: The most common obsessions include fears of contamination, fears of aggression/harm, sexual fears, religious fears, and need to make things “just right.” The compensatory compulsions for these obsessions include washing and cleaning, checking, reassurance-seeking, repeating, and ordering, and arranging. As OCD has the possibility of hindering one’s social growth and development, the WHO lists OCD as one of the ten most disabling conditions by financial loss and a decrease in quality of life. • Option D: Those who have OCD have a 7% risk of Tourette syndrome and a 20% chance of developing tics. As the treatment for OCD involves selective serotonin reuptake inhibitors (SSRIs) and possible antipsychotics, adverse effects of these medications including but not limited to weight gain, tardive dyskinesia, and dystonia, must also be monitored. 5. 5. Question A 45-year-old woman with a history of depression tells a nurse in her doctor’s office that she has difficulty with sexual arousal and is fearful that her husband will have an affair. Which of the following factors would the nurse identify as least significant in contributing to the client’s sexual difficulty? • A. Education and work history • B. Medication used • C. Physical health status • D. Quality of spousal relationship Incorrect Correct Answer: A. Education and work history Education and work history would have the least significance in relation to the client’s sexual problem. Depression, performance anxiety, and other sexual disorders can be strong contributing factors even when organic causes also exist. While having a sexual dysfunction can feel isolating, it’s actually fairly common. About 40 percent of women experience some type of sexual dysfunction, such as FSIAD, in their life. • Option B: Selective serotonin reuptake inhibitors (SSRIs), a type of antidepressant, may cause FSIAD. Female sexual arousal disorder occurs when the body doesn’t respond to sexual stimulation. If you’re undergoing chemotherapy or radiation, you may experience FSIAD. Likewise, a recent surgery may interfere with arousal and sexual stimulation. • Option C: While FSIAD can affect any woman, older women seem to experience it more. Because FSIAD is a newly defined term according to the DSM-5, studies on its actual occurrence haven’t yet been published. A 2009 study found that 3.3 percent of participants between the ages of 18 and 44 had female sexual arousal disorder, while 7.5 percent of participants between the ages of 45 and 64 experienced it. • Option D: You might have trouble getting aroused if the stimulation you receive from yourself or your partner isn’t sufficient. Arousal sets off a series of events in the body: Blood flow to the tissues around the vaginal opening and clitoris increases, causing swelling. The vagina produces natural lubricant. Studies on female sexual arousal disorder show that low sexual desire and problems with sexual arousal vary widely by age, cultural setting, duration of symptoms, and presence of distress. 6. 6. Question Which nursing intervention is most appropriate for a client with anorexia nervosa during initial hospitalization on a behavioral therapy unit? • A. Emphasize the importance of good nutrition to establish normal weight. • B. Ignore the client’s mealtime behavior and focus instead on issues of dependence and independence. • C. Help establish a plan using privileges and restrictions based on compliance with refeeding. • D. Teach the client information about the long-term physical consequence of anorexia. Incorrect Correct Answer: C. Help establish a plan using privileges and restrictions based on compliance with refeeding. Inpatient treatment of a client with anorexia usually focuses initially on establishing a plan for refeeding to combat the effects of self-induced starvation. Refeeding is accomplished through behavioral therapy, which uses a system of rewards and reinforcements to assist in establishing weight restoration. Treatment for anorexia nervosa is centered on nutrition rehabilitation and psychotherapy. Refeeding, nutritional plans, and weight restoration are crucial parts of the medical stabilization process which is necessary in order to proceed with treatment and eventually achieve recovery. There are many serious and deadly complications that arise during the refeeding process which is why medical supervision is of the utmost importance. • Option A: Anorexia nervosa is a serious eating disorder which has a very high morbidity. The disorder is usually managed with an interprofessional team that consists of a psychiatrist, dietitian, social worker, internist, endocrinologist, gastroenterologist, and nurses. The disorder cannot be prevented and there is no cure. Hence patient and family education is key to preventing the high morbidity. The dietitian should educate the family on the importance of nutrition and limiting exercise. • Option B: The nurse needs to assess the client’s mealtime behavior continually to evaluate treatment effectiveness. Remission in AN varies. Three-fourths of patients treated in out-patient settings remit within 5 years and the same percentage experience intermediate-good outcomes (including weight gain). Relapse is more common in patients who are older with a longer duration of disease or lower body fat/weight at the end of treatment, have comorbid psychiatric disorders, or receive therapy outside of a specialized clinic. Patients who achieve partial remission often develop another form of the eating disorder (ex. bulimia nervosa or unspecified eating disorder). • Option D: Emphasizing nutrition and teaching the client about the long-term physical consequences of anorexia may be appropriate at a later time in the treatment program. For adults, cognitive behavioral therapy — specifically enhanced cognitive behavioral therapy — has been shown to help. The main goal is to normalize eating patterns and behaviors to support weight gain. The second goal is to help change distorted beliefs and thoughts that maintain restrictive eating. 7. 7. Question A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would indicate that the therapy was successful? • A. The parents reinforce increased decision making by the client. • B. The parents clearly verbalize their expectations for the client. • C. The client verbalizes that family meals are now enjoyable. • D. The client tells her parents about feelings of low self-esteem. Incorrect Correct Answer: A. The parents reinforce increased decision making by the client. One of the core issues concerning the family of a client with anorexia is control. The family’s acceptance of the client’s ability to make independent decisions is key to successful family intervention. Reinforce the importance of parents as a couple who have rights of their own. The focus on the child with anorexia is very intense and often is the only area around which the couple interacts. The couple needs to explore their own relationship and restore the balance within it to prevent its disintegration. • Option B: Identify patterns of interaction. Encourage each family member to speak for self. Do not allow two members to discuss a third without that member’s participation. Helpful information for planning interventions. The enmeshed, over-involved family members often speak for each other and need to learn to be responsible for their own words and actions. • Option C: Make a selective menu available, and allow the patient to control choices as much as possible. Patient who gains confidence in herself and feels in control of the environment is more likely to eat preferred foods. Involve patients in setting up or carrying out a program of behavior modification. Provide a reward for weight gain as individually determined; ignore the loss. Provides structured eating situations while allowing the patient some control in choices. Behavior modification may be effective in mild cases or for short-term weight gain. • Option D: Encourage the patient to express anger and acknowledge when it is verbalized. Important to know that anger is part of self and as such is acceptable. Expressing anger may need to be taught to the patient because anger is generally considered unacceptable in the family, and therefore the patient does not express it. Although the remaining options may occur during the process of therapy they would not necessarily indicate a successful outcome; the central family issues of dependence and independence are not addressed in these responses. 8. 8. Question The nurse is working with a client with a somatoform disorder. Which client outcome goal would the nurse most likely establish in this situation? • A. The client will recognize signs and symptoms of physical illness. • B. The client will cope with physical illness. • C. The client will take prescribed medications. • D. The client will express anxiety verbally rather than through physical symptoms. Incorrect Correct Answer: D. The client will express anxiety verbally rather than through physical symptoms. The client with a somatoform disorder displaces anxiety into physical symptoms. The ability to express anxiety verbally indicates a positive change toward improved health. These disorders should be considered early in the evaluation of patients with unexplained symptoms to prevent unnecessary interventions and testing. Up to 50 percent of primary care patients present with physical symptoms that cannot be explained by a general medical condition. Some of these patients meet criteria for somatoform disorders. • Option A: The unexplained symptoms of somatoform disorders often lead to general health anxiety; frequent or recurrent and excessive preoccupation with unexplained physical symptoms; inaccurate or exaggerated beliefs about somatic symptoms; difficult encounters with the health care system; disproportionate disability; displays of strong, often negative emotions toward the physician or office staff; unrealistic expectations; and, occasionally, resistance to or noncompliance with diagnostic or treatment efforts. These behaviors may result in more frequent office visits, unnecessary laboratory or imaging tests, or costly and potentially dangerous invasive procedures. • Option B: The challenge in working with somatoform disorders in the primary care setting is to simultaneously exclude medical causes for physical symptoms while considering a mental health diagnosis. The diagnosis of a somatoform disorder should be considered early in the process of evaluating a patient with unexplained physical symptoms. Appropriate nonpsychiatric medical conditions should be considered, but over-evaluation and unnecessary testing should be avoided. • Option C: Studies supporting the effectiveness of pharmacologic interventions targeting specific somatoform disorders are limited. Antidepressants are commonly used to treat depressive or anxiety disorders and may be part of the approach to treating the comorbidities of somatoform disorders. Antidepressants such as fluvoxamine (Luvox, brand not available) for treating body dysmorphic disorder, and St. John’s wort for treating somatization and undifferentiated somatoform disorders have been proposed. 9. 9. Question Which method would a nurse use to determine a client’s potential risk for suicide? • A. Wait for the client to bring up the subject of suicide. • B. Observe the client’s behavior for cues of suicide ideation. • C. Question the client directly about suicidal thoughts. • D. Question the client about future plans. Incorrect Correct Answer: C. Question the client directly about suicidal thoughts. Directly questioning a client about suicide is important to determine suicide risk. A host of thoughts and behaviors are associated with self-destructive acts. Although many assume that people who talk about suicide will not follow through with it, the opposite is true; a threat of suicide can lead to the completed act, and suicidal ideation is highly correlated with suicidal behaviors. A clear and complete evaluation and clinical interview provide the information upon which to base a suicide intervention. Although risk factors offer major indications of the suicide danger, nothing can substitute for a focused patient inquiry. However, although all the answers a patient gives may be inclusive, a therapist often develops a visceral sense that his or her patient is going to commit suicide. The clinician’s reaction counts and should be considered in the intervention. • Option A: The client may not bring up this subject for several reasons, including guilt regarding suicide, wishing not to be discovered, and his lack of trust in staff. Determine whether the person has any thoughts of hurting him or herself. Suicidal ideation is highly linked to completed suicide. Some inexperienced clinicians have difficulty asking this question. They fear the inquiry may be too intrusive or that they may provide the person with an idea of suicide. In reality, patients appreciate the question as evidence of the clinician’s concern. A positive response requires further inquiry. • Option B: Behavioral cues are important, but direct questioning is essential to determine suicide risk. If suicidal ideation is present, the next question must be about any plans for suicidal acts. The general formula is that more specific plans indicate greater danger. Although vague threats, such as a threat to commit suicide sometime in the future, are the reason for concern, responses indicating that the person has purchased a gun, has ammunition, has made out a will, and plans to use the gun are more dangerous. The plan demands further questions. If the person envisions a gun-related death, determine whether he or she has the weapon or access to it. • Option D: Indirect questions convey to the client that the nurse is not comfortable with the subject of suicide and, therefore, the client may be reluctant to discuss the topic. Determine what the patient believes his or her suicide would achieve. This suggests how seriously the person has been considering suicide and the reason for death. For example, some believe that their suicide would provide a way for family or friends to realize their emotional distress. Others see their death as a relief from their own psychic pain. Still others believe that their death would provide a heavenly reunion with a departed loved one. In any scenario, the clinician has another gauge of the seriousness of the planning. 10. 10. Question A client with a bipolar disorder exhibits manic behavior. The nursing diagnosis is Disturbed thought processes related to difficulty concentrating, secondary to flight of ideas. Which of the following outcome criteria would indicate improvement in the client? • A. The client verbalizes feelings directly during treatment. • B. The client verbalizes a positive “self” statement. • C. The client speaks in coherent sentences. • D. The client reports feelings calmer. Incorrect Correct Answer: C. The client speaks in coherent sentences A client exhibiting flight of ideas typically has a continuous speech flow and jumps from one topic to another. Speaking in coherent sentences is an indicator that the client’s concentration has improved and his thoughts are no longer racing. The defining characteristics of mania are increased talkativeness, rapid speech, decreased the need for sleep (unlike depression or anxiety in which the need for sleep exists, but there is an inability to sleep), racing thoughts, distractibility, increase in goal-directed activity, and psychomotor agitation. • Option A: Some other hallmarks of mania are an elevated or expansive mood, mood lability, impulsivity, irritability, and grandiosity. If the individual experiencing these symptoms requires hospitalization, then this period automatically qualifies as true mania and not hypomania, even if the symptoms are present for less than one week. • Option B: Mania must be distinguished from heightened energy and altered functioning that arises from substance use, medical conditions or other causes. Mania is a “natural” state which is the characteristic of bipolar I disorder. A single manic phase is sufficient to make the diagnosis of bipolar I disorder, although most cases of bipolar I also involve hypomanic and depressed episodes. • Option D: Many families bring their loved ones to the emergency room due to the excessive behavioral changes they have noticed over a brief period. Patients amid a manic phase commonly engage in goal-directed activities that may result in harmful consequences, such as spending excessive money, starting businesses unprepared, traveling, or promiscuity. 11. 11. Question A client tells a nurse. “Everyone would be better off if I wasn’t alive.” Which nursing diagnosis would be made based on this statement? • A. Disturbed thought processes • B. Ineffective coping • C. Risk for self-directed violence • D. Impaired social interaction Incorrect Correct Answer: C. Risk for self-directed violence The nurse should take any nurse statements indicating suicidal thoughts seriously and further assess for other risk factors. The early identification and appropriate treatment of mental disorders is an important prevention strategy – especially given the relevant contribution of depression and other psychiatric problems to suicidal behavior. Equally important is early identification and treatment for people with alcohol and substance abuse problems. • Option A: A variety of stressful events or circumstances can put people at increased risk of harming themselves including the loss of loved ones, interpersonal conflicts with family or friends, and legal or work-related problems. To act as precipitating factors for suicide, though, they must happen to someone who is predisposed or otherwise especially vulnerable to self-harm. The early identification and appropriate treatment of mental disorders is an important prevention strategy – especially given the relevant contribution of depression and other psychiatric problems to suicidal behavior. Equally important is early identification and treatment for people with alcohol and substance abuse problems. • Option B: People who are suicidal generally express difficulty in solving problems. Behavioral therapy approaches are designed to probe underlying factors and to help patients develop problem-solving skills. While conclusive answers are not yet known, there is some evidence to suggest that behavioral therapy approaches are effective in reducing suicidal thoughts and behavior. • Option D: Certain social and environmental factors also increase the likelihood of suicide. Rates of suicide, for instance, are higher during economic recessions and periods of high unemployment. They are also higher during periods of social disintegration, political instability, and social collapse. 12. 12. Question Which information is the most essential in the initial teaching session for the family of a young adult recently diagnosed with schizophrenia? • A. Symptoms of this disease imbalance in the brain. • B. Genetic history is an important factor related to the development of schizophrenia. • C. Schizophrenia is a serious disease affecting every aspect of a person’s functioning. • D. The distressing symptoms of this disorder can respond to treatment with medications. Incorrect Correct Answer: D. The distressing symptoms of this disorder can respond to treatment with medications. This statement provides accurate information and an element of hope for the family of a schizophrenic client. For the initial treatment of acute psychosis, it is recommended to commence an oral second-generation antipsychotic (SGA) such as aripiprazole, olanzapine, risperidone, quetiapine, asenapine, lurasidone, sertindole, ziprasidone, brexpiprazole, molindone, iloperidone, etc. Sometimes, if clinically needed, alongside a benzodiazepine such as diazepam, clonazepam, or lorazepam to control behavioral disturbances and non-acute anxiety. First-generation antipsychotics (FGA) like trifluoperazine, Fluphenazine, haloperidol, pimozide, sulpiride, flupentixol, chlorpromazine, etc. are not commonly used as the first line but can be used. • Option A: There are also arguments that schizophrenia is a neurodevelopmental disorder based on abnormalities present in the cerebral structure, an absence of gliosis suggesting in utero changes, and the observation that motor and cognitive impairments in patients precede the illness onset. • Option B: Several studies postulate that the development of schizophrenia results from abnormalities in multiple neurotransmitters, such as dopaminergic, serotonergic, and alpha-adrenergic hyperactivity or glutaminergic and GABA hypoactivity. Genetics also play a fundamental role – there is a 46% concordance rate in monozygotic twins and a 40% risk of developing schizophrenia if both parents are affected. The gene neuregulin (NGR1) which is involved in glutamate signaling and brain development has been implicated, alongside dysbindin (DTNBP1) which helps glutamate release, and catecholamine O-methyltransferase (COMT) polymorphism, which regulates dopamine function. • Option C: Although the remaining statements are true, they do not provide the empathic response the family needs after just learning about the diagnosis. These facts can become part of the ongoing teaching. The first schizophrenic episode usually occurs during early adulthood or late adolescence. Individuals often lack insight at this stage; therefore few will present directly to seek help for their psychotic symptoms. Common presentations include a relative noticing social withdrawal, personality changes, or uncharacteristic behavior; deliberate self-harm or suicide attempts; calling the police to report their delusional symptoms, or referral via the criminal justice system. 13. 13. Question A nurse is working with a client who has schizophrenia, paranoid type. Which of the following outcomes related to the client’s delusional perceptions would the nurse establish? • A. The client will demonstrate realistic interpretation of daily events in the unit. • B. The client will perform daily hygiene and grooming without assistance. • C. The client will take prescribed medications without difficulty. • D. The client will participate in unit activities. Incorrect Correct Answer: A. The client will demonstrate realistic interpretation of daily events in the unit. A client with schizophrenia, paranoid type, has distorted perceptions and views people, institutions, and aspects of the environment as plotting against him. The desired outcome for someone with delusional perceptions would be to have a realistic interpretation of daily events. Unlike DSM-5, ICD-10 further subcategories schizophrenia based on the key presenting symptoms as either paranoid schizophrenia, hebephrenic schizophrenia, catatonic schizophrenia, undifferentiated schizophrenia, post-schizophrenic depression, residual schizophrenia, and simple schizophrenia. • Option B: The client with a distorted perception of the environment would not necessarily have impairments affecting hygiene and grooming skills. A thorough risk assessment must also be undertaken to determine the risk of harm to self and others. The first schizophrenic episode usually occurs during early adulthood or late adolescence. Individuals often lack insight at this stage; therefore few will present directly to seek help for their psychotic symptoms. • Option C: For the initial treatment of acute psychosis, it is recommended to commence an oral second-generation antipsychotic (SGA) such as aripiprazole, olanzapine, risperidone, quetiapine, asenapine, lurasidone, sertindole, ziprasidone, brexpiprazole, molindone, iloperidone, etc. Sometimes, if clinically needed, alongside a benzodiazepine such as diazepam, clonazepam or lorazepam to control behavioral disturbances and non-acute anxiety. First generation antipsychotic (FGA) like trifluoperazine, Fluphenazine, haloperidol, pimozide, sulpiride, flupentixol, chlorpromazine, etc. are not commonly used as the first line but can be used. • Option D: Although taking medications and participating in unit activities may be appropriate outcomes for nursing intervention; these responses are not related to client perceptions. Cognitive-behavioral therapy (CBT) and the use of art and drama therapies help counteract the negative symptoms of the disease, improve insight, and assist relapse prevention. 14. 14. Question A client with bipolar disorder, manic type, exhibits extreme excitement, delusional thinking, and command hallucinations. Which of the following is the priority nursing diagnosis? • A. Anxiety • B. Impaired social interaction • C. Disturbed sensory-perceptual alteration (auditory) • D. Risk for other-directed violence Incorrect Correct Answer: D. Risk for other-directed violence A client with these symptoms would have poor impulse control and would therefore be prone to acting-out behavior that may be harmful to either himself or others. All of the remaining nursing diagnoses may apply to the client with mania; however, the priority diagnosis would be risk for violence. Mania, or a manic phase, is a period of 1 week or more in which a person experiences a change in normal behavior that drastically affects their functioning. • Option A: The defining characteristics of mania are increased talkativeness, rapid speech, decreased the need for sleep (unlike depression or anxiety in which the need for sleep exists, but there is an inability to sleep), racing thoughts, distractibility, increase in goal-directed activity, and psychomotor agitation. Some other hallmarks of mania are an elevated or expansive mood, mood lability, impulsivity, irritability, and grandiosity. If the individual experiencing these symptoms requires hospitalization, then this period automatically qualifies as true mania and not hypomania, even if the symptoms are present for less than one week. • Option B: Many families bring their loved ones to the emergency room due to the excessive behavioral changes they have noticed over a brief period. Patients amid a manic phase commonly engage in goal-directed activities that may result in harmful consequences, such as spending excessive money, starting businesses unprepared, traveling, or promiscuity. Many patients engage in property damage or even harm themselves or others through verbal or physical assaults. They may also become highly aggressive, agitated, or irritable. • Option C: Mania also commonly presents with psychotic features, which include delusions or hallucinations. Many patients endorse grandiose delusions, believing they are high-level operatives such as spies, government officials, members of secret agencies, or that they are knowledgeable professionals (even when they have no such background). These individuals may also experience auditory or visual hallucinations, which only present when they are in the manic phases. 15. 15. Question A client who abuses alcohol and cocaine tells a nurse that he only uses substances because of his stressful marriage and difficult job. Which defense mechanisms is this client using? • A. Displacement • B. Projection • C. Rationalization • D. Sublimation Incorrect Correct Answer: C. Rationalization Rationalization is the defense mechanism that involves offering excuses for maladaptive behavior. The client is defending his substance abuse by providing reasons related to life stressors. This is a common defense mechanism used by clients with substance abuse problems. • Option A: Displacement is transferring one’s emotional burden or emotional reaction from one entity to another. This defense mechanism may be present in someone who has a stressful day at work and then lashes out against their family at home. • Option B: Projection is attributing one’s own maladaptive inner impulses to someone else. For example, someone who commits an episode of infidelity in their marriage may then accuse their partner of infidelity or may become more suspicious of their partner. • Option D: Sublimation is transforming one’s anxiety or emotions into pursuits that are considered by societal or cultural norms to be more useful. This defense mechanism may be present in someone who channels their aggression and energy into playing sports. 16. 16. Question An 11-year-old child diagnosed with conduct disorder is admitted to the psychiatric unit for treatment. Which of the following behaviors would the nurse assess? • A. Restlessness, short attention span, hyperactivity. • B. Physical aggressiveness, low-stress tolerance, disregard for the rights of others. • C. Deterioration in social functioning, excessive anxiety, and worry, bizarre behavior. • D. Sadness, poor appetite and sleeplessness, loss of interest in activities. Incorrect Correct Answer: B. Physical aggressiveness, low-stress tolerance disregard for the rights of others Physical aggressiveness, low-stress tolerance, and a disregard for the rights of others are common behaviors in clients with conduct disorders. Conduct disorder (CD) is classified in the spectrum of disruptive behavior disorders which also includes the diagnosis of oppositional defiant disorder (ODD). Exhibits a pattern of behavior that violates the rights of others and disregards social norms. • Option A: Restlessness, short attention span, and hyperactivity are typical behaviors in a client with attention deficit hyperactivity disorder. Attention Deficit-Hyperactivity Disorder (ADHD) is a psychiatric condition that has long been recognized as affecting children’s ability to function. Individuals suffering from this disorder show patterns of developmentally inappropriate levels of inattentiveness, hyperactivity, or impulsivity. • Option C: Deterioration in social functioning, excessive anxiety and worry and bizarre behaviors are typical in schizophrenic disorders. Derived from the Greek ‘schizo’ (splitting) and ‘phren’ (mind) with the term first coined by Eugen Bleuler in 1908, schizophrenia is a functional psychotic disorder characterized by the presence of delusional beliefs, hallucinations, and disturbances in thought, perception, and behavior. • Option D: Sadness, poor appetite, sleeplessness, and loss of interest in activities are behaviors commonly seen in depressive disorders. Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. The common features of all depressive disorders are sadness, emptiness, or irritable mood, accompanied by somatic and cognitive changes that significantly affect the individual’s capacity to function. 17. 17. Question The nurse understands that if a client continues to be dependent on heroin throughout her pregnancy, her baby will be at high risk for:A. Mental retardation • A. Mental retardation • B. Heroin dependence • C. Addiction in adulthood • D. Psychological disturbances Incorrect Correct Answer: B. Heroin dependence Babies born to heroin-dependent women are also heroin-dependent and need to go through withdrawal. Heroin use during pregnancy can result in neonatal abstinence syndrome (NAS). NAS occurs when heroin passes through the placenta to the fetus during pregnancy, causing the baby to become dependent, along with the mother. Symptoms include excessive crying, fever, irritability, seizures, slow weight gain, tremors, diarrhea, vomiting, and possibly death. There is no evidence to support any of the remaining answer choices. • Option A: NAS requires hospitalization and treatment with medication (often morphine) to relieve symptoms; the medication is gradually tapered off until the baby adjusts to being opioid-free. Methadone maintenance combined with prenatal care and a comprehensive drug treatment program can improve many of the outcomes associated with untreated heroin use for both the infant and mother, although infants exposed to methadone during pregnancy typically require treatment for NAS as well. • Option C: A NIDA-supported clinical trial demonstrated that buprenorphine treatment of opioid-dependent mothers is safe for both the unborn child and the mother. Once born, these infants require less morphine and shorter hospital stays compared to infants born of mothers on methadone maintenance treatment.23 Research also indicates that buprenorphine combined with naloxone (compared to a morphine taper) is equally safe for treating babies born with NAS, further reducing side effects experienced by infants born to opioid-dependent mothers. • Option D: Depending on the drug the baby is withdrawing from, common signs are: excessive crying, tremors, and jitteriness; poor feeding, vomiting, and swallowing; inability to settle and sleep; or trouble with breathing. If you are treated with methadone or buprenorphine during pregnancy, your 18. 18. Question The emergency department nurse is assigned to provide care for a victim of a sexual assault. When following legal and agency guidelines, which intervention is most important? • A. Determine the assailant’s identity • B. Preserve the client’s privacy • C. Identify the extent of an injury • D. Ensure an unbroken chain of evidence Incorrect Correct Answer: D. Ensure an unbroken chain of evidence Establishing an unbroken chain of evidence is essential in order to ensure that the prosecution of the perpetrator can occur. Explain the forensic specimens you plan to collect; inform the client that they can be used for identification and prosecution of the rapist, for example blood, combing pubic hairs, semen samples, skin from underneath nails. • Option A: Arrange for support follow-up: crisis counseling, group therapy, individual therapy, rape counselor, or a support group. Many individuals carry with them constant emotional distress and trauma. Depression and suicidal ideation are frequent sequelae of rape. As soon as the intervention is carried out, the less complicated the recovery may be. • Option B: The nurse will also need to preserve the client’s privacy and identify the extent of an injury. However, it is essential that the nurse follows legal and agency guidelines for preserving evidence. Provide strict confidentiality. The client’s situation is not to be talked over with anyone other than the medical staff involved unless the client gives consent to it. • Option C: Identifying the assailant is the job of law enforcement, not the nurse. Approach the client in a nonjudgmental manner. Nurses’ attitudes can have an important therapeutic impact. Displays of shock, horror, disgust, or disbelief are not appropriate. Never use judgmental language. 19. 19. Question Which factor is least important in the decision regarding whether a victim of family violence can safely remain in the home? • A. The availability of appropriate community shelters. • B. The non-abusing caretaker’s ability to intervene on the client’s behalf. • C. The client’s possible response to relocation. • D. The family’s socioeconomic status. Incorrect Correct Answer: D. The family’s socioeconomic status Socioeconomic status is not a reliable predictor of abuse in the home so that it would be the least important consideration in deciding issues of safety for the victim of family violence. Family and domestic violence (including child abuse, intimate partner abuse, and elder abuse) is a common problem in the United States. Family and domestic health violence are estimated to affect 10 million people in the United States every year. It is a national public health problem, and virtually all healthcare professionals will at some point evaluate or treat a patient who is a victim of some form of domestic or family violence. • Option A: Unfortunately, each form of family violence begets interrelated forms of violence, and the “cycle of abuse” is often continued from exposed children into their adult relationships, and finally to the care of the elderly. Domestic and family violence includes a range of abuse including economic, physical, sexual, emotional, and psychological toward children, adults, and elders. If the patient elects to leave their current situation, information for referral to a local domestic violence shelter to assist the victim should be given. • Option B: The ability of the non-abusing caretaker to intervene on the client’s behalf are important factor when making safety decisions. Patients that have suffered domestic violence may or may not want a referral. Many are fearful of their lives and financial well-being and hence may be weighing the tradeoff in leaving the abuser leading to loss of support and perhaps the responsibility of caring for children alone. The healthcare provider needs to assure the patient that the decision is voluntary and that the provider will help regardless of the decision. The goal is to make resources accessible, safe, and to enhance support. • Option C: The client’s response to possible relocation (if the client is a competent adult) would be the most important factor to consider; feelings of empowerment and being treated as a competent person can help a client feel less like a victim. If the patient does not want to go to a shelter, provide telephone numbers for domestic violence or crisis hotlines and support services for potential later use. Provide the patient with instructions but be mindful that written materials may pose a danger once the patient returns home. 20. 20. Question The nurse would expect a client with early Alzheimer’s disease to have problems with: • A. Balancing a checkbook • B. Self-care measures • C. Relating to family members • D. Remembering his own name Incorrect Correct Answer: A. Balancing a checkbook In the early stage of Alzheimer’s disease, complex tasks (such as balancing a checkbook) would be the first cognitive deficit to occur. Alzheimer’s disease (AD) is the most common type of dementia, accounting for at least two-thirds of cases of dementia in people age 65 and older. Alzheimer’s disease is a neurodegenerative disease with insidious onset and progressive impairment of behavioral and cognitive functions including memory, comprehension, language, attention, reasoning, and judgment. • Option B: Difficulty performing learned motor tasks (dyspraxia), olfactory dysfunction, sleep disturbances, extrapyramidal motor signs like dystonia, akathisia, and parkinsonian symptoms occur late in the disease. This is followed by primitive reflexes, incontinence, and total dependence on caregivers. • Option C: In the early stages, impairment in executive functioning ranges from subtle to significant. This is followed by language disorder and impairment of visuospatial skills. Neuropsychiatric symptoms like apathy, social withdrawal, disinhibition, agitation, psychosis, and wandering are also common in the mid to late stages. • Option D: Symptoms of Alzheimer’s disease depend on the stage of the disease. Alzheimer’s disease is classified into preclinical or presymptomatic, mild, and dementia-stage depending on the degree of cognitive impairment. These stages are different from the DSM-5 classification of Alzheimer’s disease. The initial and most common presenting symptom is episodic short-term memory loss with relative sparing of long-term memory and can be elicited in most patients even when not the presenting symptom. 21. 21. Question Which nursing intervention is most appropriate for a client with Alzheimer’s disease who has frequent episodes of emotional lability? • A. Attempt humor to alter the client's mood. • B. Explore reasons for the client’s altered mood. • C. Reduce environmental stimuli to redirect the client’s attention. • D. Use logic to point out reality aspects. Incorrect Correct Answer: C. Reduce environmental stimuli to redirect the client’s attention. The client with Alzheimer’s disease can have frequent episodes of labile mood, which can best be handled by decreasing a stimulating environment and redirecting the client’s attention. Maintain a nice quiet neighborhood. Noise, crowds, the crowds are usually the excessive sensory neurons and can increase interference. • Option A: The client with Alzheimer’s disease loses the cognitive ability to respond to either humor or logic. Assess the level of cognitive disorders such as a change to orientation to people, places and times, range, attention, thinking skills. It provides the basis for the evaluation or comparison that will come and influencing the choice of intervention. • Option B: An over-stimulating environment may cause a labile mood, which will be difficult for the client to understand. Maintain consistent scheduling with allowances for patient’s specific needs, and avoid frustrating situations and overstimulation. It prevents patient agitation, erratic behaviors, and combative reactions. Scheduling may need revision to show respect for the patient’s sense of worth and to facilitate the completion of tasks. • Option D: The client lacks any insight into his or her own behavior and therefore will be unaware of any causative factors. Assist with establishing cues and reminders for patient’s assistance. Assists patients with early AD to remember the location of articles and facilitates some orientation. 22. 22. Question Which neurotransmitter has been implicated in the development of Alzheimer’s disease? • A. Acetylcholine • B. Dopamine • C. Epinephrine • D. Serotonin Incorrect Correct Answer: A. Acetylcholine A relative deficiency of acetylcholine is associated with this disorder. The drugs used in the early stages of Alzheimer’s disease will act to increase available acetylcholine in the brain. The remaining neurotransmitters have not been implicated in Alzheimer’s disease. Cholinergic neurons located in the basal forebrain, including the neurons that form the nucleus basalis of Meynert, are severely lost in Alzheimer’s disease (AD). AD is the most ordinary cause of dementia affecting 25 million people worldwide. The hallmarks of the disease are the accumulation of neurofibrillary tangles and amyloid plaques. • Option B: Acetylcholine (ACh) was the first neurotransmitter to be identified. ACh is the neurotransmitter used by all cholinergic neurons, which has a very important role in the peripheral and central nervous systems. All pre- and postganglionic parasympathetic neurons and all preganglionic sympathetic neurons use ACh as a neurotransmitter. In addition, part of the postganglionic sympathetic neurons also uses ACh as a neurotransmitter. • Option C: Given its widespread distribution in the brain, it is not surprising that cholinergic neurotransmission is responsible for modulating important neural functions. The cholinergic system is involved in critical physiological processes, such as attention, learning, memory, stress response, wakefulness and sleep, and sensory information. • Option D: It has been demonstrated that the cholinergic system plays a role in the learning process. Moreover, published data indicate that ACh is involved in memory. Further studies have demonstrated that endogenous acetylcholine is important for modulation of acquisition, encoding, consolidation, reconsolidation, extinction, and retrieval of memory. 23. 23. Question Which factors are the most essential for the nurse to assess when providing crisis intervention for a client? • A. The client’s communication and coping skills. • B. The client’s anxiety level and ability to express feelings. • C. The client’s perception of the triggering event and availability of situational supports. • D. The client’s use of reality testing and level of depression. Incorrect Correct Answer: C. The client’s perception of the triggering event and availability of situational supports The most important factors to determine in these situations are the client’s perception of the crisis event and the availability of support (including family and friends) to provide basic needs. Crisis intervention is a short-term management technique designed to reduce potential permanent damage to an individual affected by a crisis. A crisis is defined as an overwhelming event, which can include divorce, violence, the passing of a loved one, or the discovery of a serious illness. • Option A: A successful intervention involves obtaining background information on the patient, establishing a positive relationship, discussing the events, and providing emotional support. SAFER-R is a common intervention model used, which consists of stabilization, acknowledgment, facilitate understanding, encouragement, recovery, and referral. SAFER-R helps patients return to their mental baseline following a crisis. • Option B: In these cases, psychological crisis intervention is necessary to prevent traumatized victims from developing illnesses. It also alleviates stress upon healthcare workers so that they can continue helping others. Another major concern is what coping strategies are most effective. Social support and problem-solving planning are effective coping mechanisms that are frequently used by school staff following a crisis. • Option D: Although the nurse should assess the other factors, they are not as essential as determining why the client considers this a crisis and whether he can meet his present needs. The use of humor, emotional support, planning, and acceptance also correlate with superior mental health outcomes compared to substance abuse and denial. Positive coping mechanisms, such as the ones listed above, are reported to be effective in crisis management, and with crisis intervention services in place, people will be better equipped to handle unexpected events. 24. 24. Question The nurse considers a client’s response to crisis intervention successful if the client: • A. Changes coping skills and behavioral patterns. • B. Develops insight into reasons why the crisis occurred. • C. Learns to relate better to others. • D. Returns to his previous level of functioning. Incorrect Correct Answer: D. Returns to his previous level of functioning. Crisis intervention is based on the idea that a crisis is a disturbance in homeostasis (steady state). The goal is to help the client return to a previous level of equilibrium in functioning. Based on prior studies, it is evident that crisis intervention plays a significant role in enhancing outcomes in psychiatric cases. Community Mental Health Centers and local government agencies often have crisis intervention teams that provide support to the local community at times of mental health crisis. These teams can also be helpful at times of natural or man-made emergencies. • Option A: Another major concern is what coping strategies are most effective. Social support and problem-solving planning are effective coping mechanisms that are frequently used by school staff following a crisis. The use of humor, emotional support, planning, and acceptance also correlate with superior mental health outcomes compared to substance abuse and denial. Positive coping mechanisms, such as the ones listed above, are reported to be effective in crisis management, and with crisis intervention services in place, people will be better equipped to handle unexpected events. • Option B: Based on prior studies, it is evident that crisis intervention plays a significant role in enhancing outcomes in psychiatric cases. Community Mental Health Centers and local government agencies often have crisis intervention teams that provide support to the local community at times of mental health crisis. These teams can also be helpful at times of natural or man-made emergencies. Crisis intervention teams often assess and triage the situation and can diffuse the situation and triage for urgent attention of medical or mental health personnel in emergency or community care settings. They can call upon local police and other community resources for additional support. • Option C: There are many approaches to integrating crisis intervention, and a member of the healthcare team can complete each step. First responders can triage and assess the situation and administer psychological first aid as needed to victims of a traumatic event to prevent any long-term mental health problems. This approach allows immediate access to crisis intervention, which will facilitate care and lead to improved outcomes. In a hospital setting, the needs of a patient in crisis should be well communicated throughout the management team. 25. 25. Question Two nurses are co-leading group therapy for seven clients in the psychiatric unit. The leaders observe that the group members are anxious and look to the leaders for answers. Which phase of development is this group in? • A. Conflict resolution phase • B. Initiation phase • C. Working phase • D. Termination phase Incorrect Correct Answer: B. Initiation phase Increased anxiety and uncertainty characterize the initiation phase in group therapy. Group members are more self-reliant during the working and termination phases. During the beginning phase of group therapy, issues arise around topics such as orientation, beginners’ anxiety, and the role of the leader. The purpose of the group is articulated, working conditions of the group are established, members are introduced, a positive tone is set for the group, and group work begins. This phase may last from 10 minutes to a number of months. In a revolving group, this orientation will happen each time a new member joins the group. • Option A: The group is a forum where clients interact with others. In this give and take of therapy, clients receive feedback that helps them rethink their behaviors and move toward productive changes. The leader helps group members by allocating time to address the issues that arise, by paying attention to relations among group members, and by modeling a healthy interactional style that combines honesty with compassion. • Option C: The group in its middle phase encounters and accomplishes most of the actual work of therapy. During this phase, the leader balances content, which is the information and feelings overtly expressed in the group, and process, which is how members interact in the group. The therapy is in both the content and process. Both contribute to the connections between and among group members, and it is those connections that are therapeutic. • Option D: Termination is a particularly important opportunity for members to honor the work they have done, to grieve the loss of associations and friendships, and to look forward to a positive future. Group members should learn and practice saying “good?bye,” understanding that it is necessary to make room in their lives for the next “hello.” 26. 26. Question Group members have worked very hard, and the nurse reminds them that termination is approaching. Termination is considered successful if group members: • A. Decide to continue • B. Elevate group progress • C. Focus on positive experience • D. Stop attending prior to termination Incorrect Correct Answer: A. Decide to continue As the group progresses into the working phase, group members assume more responsibility for the group. The leader becomes more of a facilitator. Comments about behavior in a group are indicators that the group is active and involved. In this phase, the LPN and client evaluate the client’s response to treatment and explore the meaning of the relationship and what goals have been achieved. Discussing the achievements, how the client and LPN feel about concluding the relationship, and plans for the future are an important part of the termination phase. • Option B: Termination of a meaningful nurse-client relationship should be final in any setting. To provide the client with even a hint that the relationship will continue is inappropriate, unprofessional, and unethical; for example, the LPN informs the client that he/she may contact the client on social media to check on their condition after discharge. • Option C: Corresponding to the implementation phase of the nursing process, the working phase focuses on self-direction and self-management to whatever extent possible in promoting the client’s health and wellbeing; for example, the LPN provides information and teaching to a client with diabetes about both the importance of proper nutrition and how eating healthy will benefit the client long term with regards to blood glucose levels. Because of teaching, the client decides not to eat the chocolate bar and chooses to eat the apple instead. • Option D: When the client stops attending the group, termination is considered unsuccessful. Every nurse-client relationship, regardless of circumstance, is based on trust, respect, and professional integrity. It requires the appropriate use of authority or power. The LPN must work with the client toward achieving the client’s goals and ensure that the client receives safe competent care. The LPN utilizes a caring attitude and behaviors to meet the needs of the client. 27. 27. Question The nurse is teaching a group of clients about the mood-stabilizing medications lithium carbonate. Which medications should she instruct the clients to avoid because of the increased risk of lithium toxicity? • A. Antacids • B. Antibiotics • C. Diuretics • D. Hypoglycemic agents Incorrect Correct Answer: C. Diuretics The use of diuretics would cause sodium and water excretion, which would increase the risk of lithium toxicity. Clients taking lithium carbonate should be taught to increase their fluid intake and to maintain normal intake of sodium. Treatment for lithium toxicity is primarily hydration and to stop the drug. Give hydration with normal saline, which will also enhance lithium excretion. Avoid all diuretics. If the patient has severe renal dysfunction or failure, or severely altered mental status, then start with hemodialysis. 20 to 30 mg of propranolol given 2 to 3 times per day may help reduce tremors. • Option A: Antacids are a combination of various compounds with various salts of calcium, magnesium, and aluminum as the active ingredients. The antacids act by neutralizing the acid in the stomach and by inhibiting pepsin, which is a proteolytic enzyme. Each of these cationic salts has a characteristic pharmacological property that determines its clinical use. • Option B: The pharmacology behind antibiotics includes destroying the bacterial cell by either preventing cell reproduction or changing a necessary cellular function or process within the cell. Antimicrobial agents are classically grouped into 2 main categories based on their in vitro effect on bacteria: bactericidal and bacteriostatic. • Option D: FDA approved indications for the use of oral hypoglycemic drugs include type 2 diabetes mellitus. Non-FDA approved indications of oral hypoglycemic drugs, such as metformin, are for the preven