NUR 2459 • Mental Health Chapter Review Questions and Complete Solutions Graded AI+

NUR 2459 • Mental Health Chapter Review Questions and Complete Solutions Graded AI+ Recent research on the RAISE approach to the treatment of schizophrenia incorporates which of the following elements as important to improving outcomes? (Select all that apply.) a. Early intervention at the first episode of psychosis b. Support for employment or educational pursuits c. Rapid high-dose loading with antipsychotic medication d. Court-ordered sanctions for treatment e. Recovery-focused psychotherapy - Answer: a. Early intervention at the first episode of psychosis b. Support for employment or educational pursuits e. Recovery-focused psychotherapy Which of the following is the primary goal in working with an actively psychotic, suspicious client? a. Promote interaction with others. b. Decrease his anxiety and increase trust. c. Improve his relationship with his parents. d. Encourage participation in therapy activities. - Answer: b. Decrease his anxiety and increase trust. A client with schizophrenia has physician's orders for haloperidol (Haldol) 5 mg IM STAT and then 3 mg PO tid; 2 mg benztropine PO bid prn. Why is benztropine ordered? a. To treat extrapyramidal symptoms b. To prevent neuroleptic malignant syndrome c. To decrease psychotic symptoms d. To induce sleep - Answer: a. To treat extrapyramidal symptoms A client on the psychiatric unit tells the nurse that the CIA is looking for him and will kill him if they find him. The client's false belief is an example of a: a. Delusion of persecution. b. Delusion of reference. c. Delusion of control or influence. d. Delusion of grandeur. - Answer: a. Delusion of persecution. The primary focus of family therapy for clients with schizophrenia and their families is: a. To discuss problem-solving and adaptive behaviors for coping with stress. b. To introduce the family to others with the same problem. c. To keep the client and family in touch with the health-care system. d. To promote family interaction and increase understanding of the illness. - Answer: d. To promote family interaction and increase understanding of the illness. A client recently admitted to the hospital reports to the nurse, "I don't understand why I was brought here. I was simply hanging out in my apartment and the police said I had to come with them." This is an example of what symptom of schizophrenia? a. Delusions of reference b. Loose association c. Anosognosia d. Auditory hallucinations - Answer: c. Anosognosia Which of the following assessments by the nurse would convey a need for prn benztropine? a. Increased level of agitation b. Complaints of a sore throat c. A yellowish cast to the skin d. Muscle spasms - Answer: d. Muscle spasms A client on the psychiatric unit has been diagnosed with schizophrenia. He tells the nurse that the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is: a. "That's ridiculous. No one is going to hurt you." b. "The CIA isn't interested in people like you." c. "Why do you think the CIA wants to kill you?" d. "I know you believe that, but it's really hard for me to believe." - Answer: d. "I know you believe that, but it's really hard for me to believe." The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. Which of the following is the most appropriate follow-up assessment based on this information? a. Ask the patient if he is experiencing loose associations. b. Ask the patient if he needs more medication. c. Ask the patient if he is hearing something or someone other than the nurse's voice. d. Ask the patient if his neck is stiff. - Answer: c. Ask the patient if he is hearing something or someone other than the nurse's voice. A client reports to the nurse that his foot is on fire and he thinks the demons are trying to burn off his flesh. The priority nursing intervention for this symptom is to: a. Administer prn haloperidol as ordered. b. Evaluate the client's foot to rule out physical causes for his complaint. c. Administer prn benztropine as ordered. d. Ask the client if he would like to speak with a chaplain. - Answer: b. Evaluate the client's foot to rule out physical causes for his complaint. When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first? a. Provide large motor activities to relieve the client's pent-up tension. b. Administer a dose of prn haloperidol to keep the patient calm. c. Call for adequate help to control the situation safely. d. Convey to the client that his behavior is unacceptable and will not be permitted. - Answer: c. Call for adequate help to control the situation safely. A client has been diagnosed with schizophrenia. He has been socially isolated and is hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial nursing intervention for Josh is to: a. Give him an injection of haloperidol. b. Assess his safety toward himself and others. c. Place him in restraints. d. Order him a nutritious diet. - Answer: b. Assess his safety toward himself and others. An example of a treatable (reversible) form of NCD is one that is caused by which of the following? (Select all that apply.) a. Multiple sclerosis b. Huntington's disease c. Electrolyte imbalance d. HIV disease e. Folate deficiency - Answer: c. Electrolyte imbalance e. Folate deficiency A client has been diagnosed with NCD due to Alzheimer's disease. The cause of this disorder is which of the following? a. Multiple small brain infarcts b. Chronic alcohol abuse c. Cerebral abscess d. Unknown - Answer: d. Unknown - Answer: Which of the following medications has been indicated for improvement in cognitive functioning in mild to moderate Alzheimer's disease? (Select all that apply.) a. Donepezil (Aricept) b. Rivastigmine (Exelon) c. Risperidone (Risperdal) d. Sertraline (Zoloft) e. Galantamine (Razadyne) - Answer: a. Donepezil (Aricept) b. Rivastigmine (Exelon) e. Galantamine (Razadyne) Which of the following factors is not associated with an increased incidence of neurocognitive disorder due to Alzheimer's disease? a. Multiple small strokes b. Family history of Alzheimer's disease c. Head trauma d. Advanced age - Answer: a. Multiple small strokes In addition to disturbances in cognition and orientation, individuals with Alzheimer's disease may also show changes in which of the following? (Select all that apply.) a. Personality b. Vision c. Speech d. Hearing e. Mobility - Answer: a. Personality c. Speech e. Mobility A client who has NCD due to Alzheimer's disease has trouble sleeping and wanders around at night. Which of the following nursing actions would be best to promote sleep in this client? a. Ask the doctor to prescribe flurazepam (Dalmane). b. Ensure that the client gets an afternoon nap so she will not be overtired at bedtime. c. Make the client a cup of tea with honey before bedtime. d. Ensure that the client gets regular physical exercise during the day. - Answer: d. Ensure that the client gets regular physical exercise during the day. The night nurse finds a client with Alzheimer's disease wandering the hallway at 4 a.m. and trying to open the door to the side yard. Which of the following is the best initial response by the nurse? a. "That door leads out to the patio. It's nighttime. You don't want to go outside now." b. "You look confused. What is bothering you?" c. "This is the patio door. Are you looking for the bathroom?" d. "Are you lonely? Perhaps you'd like to go back to your room and talk for a w - Answer: c. "This is the patio door. Are you looking for the bathroom?" . A client with neurocognitive disease due to Alzheimer's disease is admitted to the hospital. Which of the following actions by the nurse is a priority? a. Ensuring that she receives food she likes to prevent hunger b. Ensuring that the environment is safe to prevent injury c. Ensuring that she meets the other patients to prevent social isolation d. Ensuring that she takes care of her own ADLs to prevent dependence - Answer: b. Ensuring that the environment is safe to prevent injury Which of the following interventions is most appropriate in helping a client with Alzheimer's disease with ADLs? (Select all that apply.) a. Perform ADLs for her while she is in the hospital. b. Provide her with a written list of activities she is expected to perform. c. Assist her with step-by-step instructions. d. Tell her that if her morning care is not completed by 9 a.m., it will be performed for her by the nurse's aide so that she can attend group therapy. e. Encourage her and give her - Answer: c. Assist her with step-by-step instructions. e. Encourage her and give her plenty of time to perform independently as many of her ADLs as possible A client is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports that he has been a heavy drinker for several years. Laboratory reports reveal he has a blood alcohol level of 250 mg/dL. He is placed on the chemical addiction unit for detoxification. When would the first signs of alcohol withdrawal symptoms be expected to occur? a. Several hours after the last drink b. 2 to 3 days after the last drink c. 4 to 5 days after the last drink d. 6 to 7 days afte - Answer: a. Several hours after the last drink Symptoms of alcohol withdrawal include: a. Euphoria, hyperactivity, and insomnia. b. Depression, suicidal ideation, and hypersomnia. c. Diaphoresis, nausea and vomiting, and tremors. d. Unsteady gait, nystagmus, and profound disorientation. - Answer: .c. Diaphoresis, nausea and vomiting, and tremors. Which of the following medications is the physician most likely to order for a client experiencing alcohol withdrawal syndrome? a. Haloperidol (Haldol) b. Chlordiazepoxide (Librium) c. Methadone (Dolophine) d. Cannabidiol (Epidiolex) - Answer: b. Chlordiazepoxide (Librium) A client who has been admitted to the chemical dependence treatment unit after being discliplined for drinking on the job states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know." Which defense mechanism is the client using? a. Denial b. Projection c. Displacement d. Rationalization - Answer: a. Denial A client who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job states to the nurse, "I don't have a problem with alcohol. My boss is a jerk! I haven't missed any more days than my coworkers." What is the nurse's best response? a. "Maybe your boss is mistaken, Dan." b. "You are here because your drinking was interfering with your work." c. "Get real! You're an alcoholic and you know it!" d. "Why do you think your boss is a jer - Answer: b. "You are here because your drinking was interfering with your work." A client who has been admitted to intensive outpatient treatment for substance use disorder arrives for group therapy and appears groggy with constricted pupils. The client denies using substances. Which of the following would be the best intervention at this time? a. Ask the client to empty his pockets. b. Smell his breath for evidence of alcohol. c. Conduct a drug screen to assess for presence of opioids. d. Discharge the client for failure to comply with treatment expectations. - Answer: c. Conduct a drug screen to assess for presence of opioids. A client admitted to the inpatient detoxification program for alcohol withdrawal approaches the nurse complaining of nausea and feeling shaky. The nurse notices that the client has hand tremors and appears diaphoretic. Which of these nursing interventions is a priority? a. Check the client's temperature. b. Send a urine sample to the laboratory for a random drug screen. c. Ask the client if there is anything that he is particularly stressed about. d. Administer prn benzodiazepine that was orde - Answer: d. Administer prn benzodiazepine that was ordered for management of withdrawal symptoms. A client comes into the emergency department stating that he is "crashing" and feels like he'd "be better off dead." Which of these nursing interventions is a priority? a. Instruct the client not to worry; these are temporary signs of withdrawal and should go away in a few days. b. Request an order for amphetamines to ease the client's withdrawal symptoms. c. Assess the client's risk for suicide. d. Instruct the physician that the client may need naloxone. - Answer: c. Assess the client's risk for suicide. A client is brought to the emergency department unconscious by a friend who says he was injecting heroin. The client is assessed to have a weak pulse. Which of these interventions are priorities? a. Administer naloxone and rescue breathing. b. IV benzodiazepines and continuous monitoring of vital signs. c. Ask the friend how much heroin he took and confirm with a laboratory drug screen. d. Initiate cardiopulmonary resuscitation and prepare to use an external defibrillator. - Answer: a. Administer naloxone and rescue breathing. A client, age 68, is a widow of 6 months. Over the last month she has become socially withdrawn, has lost weight, and told her sister today that she "doesn't have anything more to live for." She has been hospitalized with major depressive disorder. The priority nursing diagnosis for this client would be: a. Imbalanced nutrition: less than body requirements. b. Complicated grieving. c. Risk for suicide. d. Social isolation. - Answer: c. Risk for suicide. The goal of cognitive behavior therapy with depressed clients is to: a. Identify and change dysfunctional patterns of thinking. b. Resolve the symptoms and initiate or restore adaptive family functioning. c. Alter the neurotransmitters that are creating the depressed mood. d. Provide feedback from peers who are having similar experiences. - Answer: a. Identify and change dysfunctional patterns of thinking. A client expresses interest in alternative treatments for depression with seasonal variations and asks the nurse about light therapy. Which of the following are evidence-based teaching points that the nurse may share with the client? (Select all that apply.) a. Light therapy has demonstrated effectiveness that is comparable to antidepressants. b. Light therapy should be used regularly until the season changes. c. Light therapy should be used only when electroconvulsive therapy has proven to be i - Answer: a. Light therapy has demonstrated effectiveness that is comparable to antidepressants. b. Light therapy should be used regularly until the season changes. d. Side effects such as headache, nausea, or agitation, when they occur, are usually mild and transient. A client has just been admitted to the psychiatric unit with a diagnosis of major depressive disorder. Which of the following behavioral manifestations might the nurse expect to assess? (Select all that apply) a. Slumped posture b. Hallucinations c. Feelings of despair d. Appears to have boundless energy e. Anorexia - Answer: a. Slumped posture c. Feelings of despair e. Anorexia A client with depression asks the nurse, "Why would they be checking my thyroid function when I clearly have depression and I'm not overweight?" Which of these is an accurate response? a. An underactive thyroid gland can manifest as depression. b. Depression has been proven to be a hormonal illness. c. Thyroid hormone replacement is a first-line treatment for most clients with depression. d. All of the above. - Answer: a. An underactive thyroid gland can manifest as depression. An acutely depressed client isolates herself in her room and just sits and stares into space. Which of these is the best example of an active communication approach with this client? a. "Do you like exercise?" b. "Come with me. I will go with you to group therapy." c. "Would you like to go to group therapy, stay in bed, or come out to the day lounge for some activities?" d. "Why do you stay in your room all the time?" - Answer: b. "Come with me. I will go with you to group therapy." . A client who has been taking sertraline (Zoloft) 50 mg PO bid for depression tells the nurse, "I've been on this medication for almost a week and I don't feel a bit better." What is the most appropriate response by the nurse? a. "Cheer up. You have so much to be happy about." b. "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms." c. "I'll report that to the physician. Maybe he will order something different." d. "Try not to dwell - Answer: b. "Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms." A client reports to the mental health clinic with complaints of feeling more depressed over the last few weeks. The patient's score on the Hamilton Depression Rating Scale is 40. What is the priority nursing action at this finding? a. Assess the client's history of treatment for depression. b. Encourage the client to keep weekly follow-up appointments at the clinic. c. Educate the client about treatment options for mild, moderate, and severe depression. d. Assess the client's current risk - Answer: d. Assess the client's current risk for suicide. . A client whose husband died 6 months ago is given a diagnosis of major depressive disorder. She says to the nurse, "I start feeling angry that Harold died and left me all alone; he should have stopped smoking years ago! But then I start feeling guilty for feeling that way." What is an appropriate response by the nurse? a. "Yes, he should have stopped smoking. Then he probably wouldn't have gotten lung cancer." b. "I can understand how you must feel." c. "Those feelings are a no - Answer: c. "Those feelings are a normal part of the grief response." A client is admitted to the hospital with major depressive disorder and repeatedly makes negative statements about herself. Which of the following interventions are identified as those that will promote positive self-esteem in the client? (Select all that apply) a. Teach assertive communication skills. b. Make observations to the client when she completes a goal or task. c. Instruct the client that you will not talk with her unless she stops talking negatively about herself. d. Offer to spend ti - Answer: a. Teach assertive communication skills. b. Make observations to the client when she completes a goal or task. d. Offer to spend time with the client using a nonjudgmental, accepting approach. One way to promote adequate nutritional intake for a client in an acute manic episode who is not eating is to: a. Sit with the client during meals to reinforce the importance of eating everything on the tray. b. Have family members bring food from home so the client will have only favorite foods. c. Provide high-calorie, nutritious finger foods and snacks that can be eaten "on the run." d. Restrict the client to their room until they begin to gain weight. - Answer: c. Provide high-calorie, nutritious finger foods and snacks that can be eaten "on the run." The physician orders lithium carbonate 600 mg tid for a newly diagnosed patient with bipolar I disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. The therapeutic range for acute mania is: a. 0.5 to 1.5 mEq/L b. 10 to 15 mEq/L c. 0.5 to 1.0 mEq/L d. 5 to 10 mEq/L - Answer: a. 0.5 to 1.5 mEq/L Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? (Select all that apply.) a. Olanzapine (Zyprexa) b. Oxycodone (OxyContin) c. Carbamazepine (Tegretol) d. Gabapentin (Neurontin) - Answer: a. Olanzapine (Zyprexa) c. Carbamazepine (Tegretol) d. Gabapentin (Neurontin) A client who is experiencing a manic episode is admitted to the psychiatric unit after being brought to the emergency department by a family member. The client yells, "My family is trying to make it look like I'm insane! They just want to take all my money." This behavior is an example of: a. A delusion of grandeur b. A delusion of persecution c. A delusion of reference d. A delusion of control or influence - Answer: b. A delusion of persecution What is the most common comorbid condition in children with bipolar disorder? a. Schizophrenia b. Substance disorders c. Oppositional defiant disorder d. Attention deficit-hyperactivity disorder - Answer: d. Attention deficit-hyperactivity disorder A nurse is educating a patient about his lithium therapy and explaining the signs and symptoms of lithium toxicity. Which of the following would she instruct the patient to be on the alert for? a. Fever, sore throat, malaise b. Tinnitus, severe diarrhea, ataxia c. Occipital headache, palpitations, chest pain d. Skin rash, marked rise in blood pressure, bradycardia - Answer: b. Tinnitus, severe diarrhea, ataxia . A client is brought to the emergency department by a family member who reports that the client stopped taking mood stabilizer medication a few months ago and is now agitated, pacing, demanding, and speaking very loudly. Her family member reports that she eats very little, is losing weight, and almost never sleeps. What is the priority nursing diagnosis? a. Imbalanced nutrition: Less than body requirements related to not eating b. Risk for injury related to hyperactivity c. Disturbed sleep patt - Answer: b. Risk for injury related to hyperactivity A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? a. Tell the client she cannot wear this outfit while she is in the hospital. b. Do nothing, and allow her to learn from the responses of her peers. c. Quietly walk with her back to her room and help her change into something more appropriate. d. Explain to her that if she wears this outfit, she must remain - Answer: c. Quietly walk with her back to her room and help her change into something more appropriate. The nurse is providing medication education to a cliient on lithium. Which of the following are important points to include? (Select all that apply.) a. Significant reductions in sodium intake increase the risk for lithium toxicity. b. Weight loss is a common side effect of lithium. c. Serum lithium levels will need to be checked at regular intervals throughout treatment. d. Lithium therapy should be continued even during periods when the patient feels well. - Answer: a. Significant reductions in sodium intake increase the risk for lithium toxicity. c. Serum lithium levels will need to be checked at regular intervals throughout treatment. d. Lithium therapy should be continued even during periods when the patient feels well. A client admitted to the inpatient psychiatric unit with bipolar disorder tells the nurse, "I need to sit in on change-of-shift report because I have been appointed director of this unit." Which action by the nurse demonstrates the best clinical judgment at this point? a. Invite the client to sit in on the change-of-shift report, but do not share any confidential client information. b. Instruct the client that this is not permitted and redirect the client to other unit activities that are av - Answer: b. Instruct the client that this is not permitted and redirect the client to other unit activities that are available.