Psychiatric Nursing Practice Test 6 (Exam Mode)

The nurse has a responsibility to observe continuously the acutely suicidal client & not provide privacy. The nurse should watch for clues, such as communicating suicidal thoughts, threats, and messages; hoarding medications; and talking about death. By accompanying the client to the bathroom, the nurse will naturally prevent hanging or other injury. The nurse will check the client's area and fix dangerous conditions, such as exposed pipes and windows without safety glass. The nurse will also remove potentially dangerous objects, such as belts, razors, suspenders, glass, and knives.

The nurse helps the client explore his feelings by expressing interest in knowing more about his problem in order to make an accurate assessment. Cliches minimize the client's feelings and block expression. Statements that make unwarranted judgments about the client block communication and may suggest that he should feel guilty for his feelings. The nurse has not explored the client's feelings or made any assessment. Asking the doctor for sleeping pills reflects poor judgment based on insufficient assessment data. Sleeping pills may be inappropriate and not therapeutic for this client.

A delusion of grandeur is a false belief that one is highly important or famous. A delusion of persecution is a false belief that one is being persecuted. A delusion of reference is a false belief that one is connected to events unrelated to oneself or a belief that one is responsible for the evil in the world.

Appropriate nursing interventions for an anxiety attack include using short sentences, staying with the client, decreasing stimuli, remaining calm, and medicating as needed. Leaving the client alone, turning on a stereo or lights, and opening windows may increase the client's anxiety.

Establishing a consistent eating plan and monitoring the client's weight are important for this disorder. The family should be included in the client's care. The client should be monitored during meals & not given privacy. Exercise must be limited and supervised.

Individuals with dependent personality disorder typically show indecisiveness, submissiveness, and clinging behaviors so that others will make decisions for them. These clients feel helpless and uncomfortable when alone and don't show interest in solitary activities. They also pursue relationships in order to have someone to take care of them. Although clients with dependent personality disorder may become depressed and suicidal if their needs aren't met, this isn't a typical response.

Antianxiety drugs provide symptomatic relief. Barbiturates and amphetamines can precipitate panic attacks. Depressants aren't appropriate for treating panic attacks.

The nurse should remain with the client until the attack subsides. If the client is left alone, he may become more anxious. Giving false reassurance is inappropriate in this situation. The client should be allowed to move around and pace to help expend energy. The client may be so overwhelmed that he can't follow lengthy explanations or instructions, so the nurse should use short phrases and slowly give one direction at a time.

Hallucinations are visual, auditory, gustatory, tactile, or olfactory perceptions that have no basis in reality. Delusions are false beliefs, rather than perceptions, that the client accepts as real. Loose associations are rapid shifts among unrelated ideas. Neologisms are bizarre words that have meaning only to the client.

Lithium is chemically similar to sodium. When sodium levels are reduced, such as from sweating or diuresis, lithium is reabsorbed by the kidneys, increasing the risk of toxicity. Clients taking lithium shouldn't restrict their intake of sodium and should drink adequate amounts of fluid each day. The other electrolytes are important for normal body functions, but sodium is most important to the absorption of lithium.

Bulimic behavior is generally a maladaptive coping response to stress and underlying issues. The client must identify anxiety-causing situations that stimulate the bulimic behavior and then learn new ways of coping with the anxiety. Controlling shopping for large amounts of food isn't a goal early in treatment. Managing eating impulses and replacing them with adaptive coping mechanisms can be integrated into the care plan after initially addressing stress and underlying issues. Eating three meals per day isn't a realistic goal early in treatment.

The foundation of any treatment for alcoholism is abstinence. Attendance at AA is helpful to some individuals to maintain strict abstinence. Participation in treatment by the family is beneficial to both the client and the family but isn't essential. Abstinence requires refraining from social drinking.

Denial is an unconscious defense mechanism in which emotional conflict and anxiety is avoided by refusing to acknowledge feelings, desires, impulses, or external facts that are consciously intolerable. Withdrawal is a common response to stress, characterized by apathy. Logical thinking is the ability to think rationally and make responsible decisions, which would lead the client to admitting the problem and seeking help. Repression is suppressing past events from the consciousness because of guilty association.

If the client has a plan, she may be closer to carrying out the act. Option that states "Are you sure you want to kill yourself?" , requires a yes-or-no response and is self-limiting. In Option that states "I know if my husband left me, I'd want to kill myself. Is that what you think?" , the nurse is telling the client what to think and feel. Option that states "Why don't you just look at the positives in your life?" , dismisses the client's feelings.

Setting limits for unacceptable behavior is most important in a manic client. Typically, depressed, anxious, or suicidal clients don't physically or mentally test the limits of the caregiver.

Clients with schizotypal personality disorder experience excessive social anxiety that can lead to paranoid thoughts. Aggressive behavior is uncommon, although these clients may experience agitation with anxiety. Their behavior is emotionally cold with a flattened affect, regardless of the situation. These clients demonstrate a reduced capacity for close or dependent relationships.

A client with an eating disorder will normally exercise to excess in an effort to burn as many calories as possible. The client will usually wear loose-fitting clothing to hide what she considers to be a fat body. Skin and nails become dry and brittle, and blood pressure and body temperature drop from excessive weight loss.

The nurse questions the physician about the order because the client who has been taking an MAOI such as phenelzine must wait 14 days after stopping the MAOI before starting an SSRI such as paroxetine. Serotonin syndrome, a potentially lethal consequence, can occur when combining an MAOI and an SSRI. Serotonin syndrome is characterized by hyperreflexia, hyperthermia, myoclonus, and other symptoms similar to neuroleptic malignant syndrome. Giving the medication as ordered can result in serious
adverse consequences, as described above. The dosage is accurate. Benztropine is not given with an SSRI; it is an antiparkinsonian agent usually ordered for the side effects of antipsychotic medication.

As antidepressants begin to take effect and the client feels better, she may have the energy to initiate and complete another suicide attempt. As the client's energy level increases, the nurse must continue to be vigilant to the risk of suicide. Extrapyramidal symptoms may occur with antipsychotics and aren't adverse effects of antidepressants. A therapeutic relationship should be initiated upon admission to the psychiatric unit, after suicide precautions have been instituted. It's through this relationship that the client develops feelings of self-worth and trust and problem-solving takes place. In a no-suicide contract, the client states verbally or in writing that she won't attempt suicide and will seek out staff if she has suicidal thoughts. When the time period for a contract has expired, a new contract should be obtained from the client.

Acute withdrawal symptoms from alcohol may begin 6 hours after the client has stopped drinking and peak 1 to 2 days later. Delirium tremens may occur 2 to 4 days & even up to 7 days & after the last drink.

The nurse's first responsibility is to protect the client from injuring himself. Listening and being nonjudgmental are important elements of the nurse's communication with the client. After the client's safety has been established, he would benefit from a referral to a mental health professional.

Children may not have the verbal and cognitive skills to express what they feel and may benefit from alternative modes of expression. It's important for the child to find a way to express internalized feelings. The child must also know that he isn't to blame for this situation. In the process of doing play therapy, the child can also have fun, but that isn't the main goal of therapy.

Rotating staff members who work with a client with a borderline personality disorder keeps the client from becoming dependent on any one nurse and reduces the use of splitting behaviors and her fear of abandonment. Firm rules and consistency among staff members will help control the client's behavior. Ignoring splitting behaviors can cause the client to increase the behavior by trying to get a response from the staff. Unit rules must be consistently enforced and followed by each nurse to help the client control behavior.

Signs and symptoms of posttraumatic stress disorder include hyperalertness, sleep disturbances, exaggerated startle, survival guilt, and memory impairment. Also, the client relives the traumatic event through dreams and recollections. Hostility, violent behavior, and anorexia aren't usual signs or symptoms of posttraumatic stress disorder.

Reducing stimuli helps to reduce hyperactivity during a manic state. Group activities would provide too much stimulation. Trying to assist the client with self-care could cause increased agitation. When in a manic state, these clients aren't able to express their inner feelings in a productive, introspective manner. The focus of treatment for a client in the manic state is behavior control.

An amphetamine is a nervous system stimulant that's subject to abuse because of its ability to produce wakefulness and euphoria. An overdose increases tension and irritability. Slow pulse. and hypotension are incorrect because amphetamines stimulate norepinephrine, which increases the heart rate and blood flow. Diarrhea is a common adverse effect, so constipation is incorrect.

Benztropine, trihexyphenidyl, or amantadine is prescribed for a client with Parkinson-type symptoms. Diphenhydramine provides rapid relief for dystonia. Propranolol relieves akathisia. Haloperidol can cause Parkinson-type symptoms.

A sore throat and fever are indications of an infection caused by agranulocytosis, a potentially life-threatening complication of clozapine. Because of the risk of agranulocytosis, white blood cell (WBC) counts are necessary weekly, not monthly. If the WBC count drops below 3,000/ml, the medication must be stopped. Hypotension may occur in clients taking this medication. Warn the client to stand up slowly to avoid dizziness from orthostatic hypotension. The medication should be continued, even when symptoms have been controlled. If the medication must be stopped, it should be slowly tapered over 1 to 2 weeks and only under the supervision of a physician.

Fluoxetine should be taken as early in the day as possible so as not to interfere with nighttime sleep; it may cause nervousness in some clients. The dose is therapeutic and not too high. There is no evidence in this situation to justify the conclusion that the client's depression is worsening. There is no evidence in this situation to justify the conclusion that the client is on the wrong medication.

Perceptual disorders, especially frightening visual hallucinations, are very common with alcohol withdrawal. Coma isn't an immediate consequence. Manipulative behaviors are part of the alcoholic client's personality but not a sign of alcohol withdrawal. Suppression is a conscious effort to conceal unacceptable thoughts, feelings, impulses, or acts and serves as a coping mechanism for most alcoholics.

These symptoms describe dystonia, which commonly occurs after a few days of treatment with haloperidol. The symptoms may be confused with psychotic symptoms and misdiagnosed. Parkinsonism results in muscle rigidity, shuffling gait, stooped posture, flat-faced affect, tremors, and drooling. Signs and symptoms of akathisia are restlessness, pacing, and inability to sit still.

Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit. Sexual dysfunction isn't a common adverse effect of lithium; it's more common with sedatives and tricyclic antidepressants. Diarrhea, not constipation, occurs with lithium. Constipation can occur with other psychiatric drugs, such as antipsychotic drugs. Seizures may be a later sign of lithium toxicity.

If the client tells the nurse to leave, the nurse should leave but let the client know that she'll return so that he doesn't feel abandoned. Not heeding the client's request can agitate him further. Also, challenging the client isn't therapeutic and may increase his anger. False reassurance isn't warranted in this situation.

All of the outcomes stated are desirable; however, the best outcome is that the student would agree to seek the assistance of a professional substance abuse counselor.

Adults between ages 31 and 45 generate new levels of awareness. Having perceptions based on reality and assuming responsibility for actions indicate socialization development & not cognitive development. Demonstrating maximum ability to solve problems and learning new skills occur in young adults between ages 20 and 30.

The client has a legal right to refuse treatment. When a client refuses medication, the nurse must explore the reason for the refusal. The desire to avoid unwanted side effects is a common reason. Legally a client cannot be forcibly medicated unless she is a danger to herself or others or there is a court order to treat. Legally a client cannot be forcibly medicated unless she is a danger to herself or others or there is a court order to treat. Lying to a client about a medication is neither appropriate nor ethical.

Although it's difficult, clients with posttraumatic stress disorder can obtain the most lasting relief if they verbalize memories of the trauma to a sympathetic listener. Family members are commonly frightened by the information and can't be consistently supportive. Antidepressants may help but these drugs can mask feelings and can't provide lasting relief. Treatment for alcohol abuse, including AA meetings, must be considered when planning care but alone doesn't provide lasting relief.

Responses should focus on reality while acknowledging the client's feelings. Arguing with the client or denying his belief isn't therapeutic. Arguing can also inhibit development of a trusting relationship. Continuing to talk about delusions may aggravate the psychosis. Asking the client if a foreign government is trying to kill him may increase his anxiety level and can reinforce his delusions.

The nurse should listen to the client's requests, express willingness to seriously consider the requests, and respond later. The nurse should encourage the client to take short daytime naps because he expends so much energy. The nurse shouldn't try to restrain the client when he feels the need to move around as long as his activity isn't harmful. High-calorie finger foods should be offered to supplement the client's diet, if he can't remain seated long enough to eat a complete meal. The client shouldn't be forced to stay seated at the table to finish a meal. The nurse should set limits in a calm, clear, and self-confident tone of voice.

Exploring the content of the hallucinations will help the nurse understand the client's perspective on the situation. The client shouldn't be touched, such as in taking vital signs, without telling him exactly what's going to happen. Debating with the client about his emotions isn't therapeutic. When the client is calm, engage him in reality-based activities.

Assessment findings in a client abusing opiates include agitation, slurred speech, euphoria, and constricted pupils.

Pseudoparkinsonism may appear 1 to 5 days after starting an antipsychotic and may also include drooling, rigidity, and pill rolling. Akathisia may occur several weeks after starting antipsychotic therapy and consists of restlessness, difficulty sitting still, and fidgeting. An oculogyric crisis is recognized by uncontrollable rolling back of the eyes and, along with dystonia, should be considered an emergency. Dystonia may occur minutes to hours after receiving an antipsychotic and may include extremity and neck spasms, jerky muscle movements, and facial grimacing.

The nurse would call for a multidisciplinary staff meeting because there is a need for staff members to share their feelings of anger, frustration, and grief. Because nurses focus on saving human lives, any feelings of hopelessness regarding a dying client can interfere with the client's care and management. Assigning the staff member to other clients ignores the staff's need to work through feelings. Calling the clinical nurse specialist to deal with the staff member does nothing to help the immediate situation. The
psychiatric clinical nurse specialist would be included in the staff meeting to help the entire staff deal with their feelings. Agreeing with the staff member and discontinuing suicide precautions is highly inappropriate.

Coping is a process by which a person deals with problems using cognitive and noncognitive components. Cognitive responses come from learned skills; noncognitive responses are automatic, focusing on relieving the discomfort. Age could have either a positive or negative effect during crisis, depending on previous experiences. Previous coping skills are cognitive and include the thought and learning necessary to identify the source of stress in a crisis situation. Therefore, previous coping skills is the best answer. Although sometimes useful, noncognitive measures, such as self-esteem, may prevent the person from learning more about the crisis as well as a better solution to the problem. The person involved could have correct or incorrect perception of the problem that could have either a positive or negative outcome.

Focusing on the client's blindness can positively reinforce the blindness and further promote the use of maladaptive behaviors to obtain secondary gains. The client should be encouraged to participate in his own self-care as much as possible to avoid fostering dependency. To promote self-esteem, give positive reinforcement for what the client can do. Blindness and other physical symptoms in a conversion disorder aren't under the client's control and are real to him. Eye exercises won't resolve the client's blindness because no organic pathology is causing the symptoms.

Membership in Alcoholics Anonymous is voluntary. Its rehabilitated members are available to support alcoholics, and the understanding and influence of these rehabilitated members often helps alcoholics change their behavior. The role of rehabilitated members does not include sympathizing with others abusing alcohol. The role of rehabilitated members does not include helping others abusing alcohol to identify personal problems. The role of rehabilitated members does not include helping others abusing alcohol to develop defense mechanisms to cope with alcoholism.

For the client who is noncompliant with oral medication, depot medication is advantageous because the client will only need to keep one appointment every 2 to 4 weeks instead of taking medication daily. Education may or may not affect the client's compliance with medication. Long-term commitment is unnecessary at this time. Participation in a partial hospitalization program may be a desirable referral but would only indirectly affect the client's compliance with medication.

Verbalizing the desire to stop drinking alcohol is an initial outcome that acknowledges alcohol consumption as a problem behavior and leads to further participation in treatment. Describing adaptive methods to use instead of drinking alcohol to induce sleep is an outcome to be reached later in the client's course of treatment. Verbalizing the negative effects of alcohol on the body is a therapeutic behavior but is not specific to helping the client sleep. Describing the dangerous effects of using alcohol with antidepressant medication is a therapeutic behavior but is not specific to helping the client sleep.

Violence is never acceptable to a victim; this myth condones the use of violence. Often, an episode of battering is followed by a period of pleasant relations between the partners, during which the victim may hope that the violence will never happen again. The victim may stay in the relationship for that reason.Women are conditioned to be responsible for the family's well-being. This is often a motivation for a battered woman to stay in an abusive relationship. The victim believes that she can save the relationship
and that her partner will change. Feelings of guilt surrounding issues such as these often influence an abused woman's decisions about staying with her partner. A woman's lack of job skills and financial resources may cause her to stay. Many women are injured or killed when they try to leave in a violent relationship.

Focusing on antidepressant medications would be helpful, but the topic of drug classifications is too general. A topic such as managing the depressed client at home will help family members learn positive techniques for managing day-to-day problems and will promote family cohesiveness. A topic such as receiving support from self-help groups is helpful to family members to reduce feelings of isolation and powerlessness. Educating the family about the illness dispels myths, enlists family cooperation, and promotes adaptive coping skills.