Essentials Of Psychiatric Mental Health Nursing

36 Questions | Total Attempts: 460

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Essentials Of Psychiatric Mental Health Nursing

The need for psychiatric mental health nursing has its roots near the end of the 19th century when it was believed that patients in mental hospitals should receive nursing care. Psychiatric mental health nursing has since come a long way, with psychiatric-mental health content incorporated into all diploma and baccalaureate nursing programs. As new needs for services developed in the health care arena, the role and function of the psychiatric-mental health nurse expanded, leading to advanced practice registered nurses in psychiatric-mental health nursing (APRN-PMH). Psychiatric-mental health nurses are a rich resource as providers of psychiatric-mental health services and patient care partners for the consumers of those services.


Questions and Answers
  • 1. 
    A paA patient is referred to the mental health center by the family health care provider. Over the past year, the patient has cooked gourmet meals for family members, but eats only tiny portions of the food. The patient wears layers of loose clothing, saying, “It’s just my style.” The patient’s weight has dropped from 130 to 95 pounds. The patient has amenorrhea. The history and symptoms are most consistent with which medical diagnosis?
    • A. 

      Anorexia nervosa

    • B. 

      Bulimia nervosa

    • C. 

      Binge eating

    • D. 

      Eating disorder not otherwise specified

  • 2. 
    DisDisturbed body image is the nursing diagnosis for a patient with an eating disorder. Which outcome indicator is most appropriate to monitor?
    • A. 

      Weight, muscle, and fat congruence with height, frame, age, and sex

    • B. 

      Calorie intake within required parameters of treatment plan

    • C. 

      Weight at established normal range for the patient

    • D. 

      Patient satisfaction with body appearance

  • 3. 
    A patient referred to the eating disorders clinic has lost 35 pounds during one summer. To assess the patient’s eating patterns, the nurse should ask:
    • A. 

      “Do you often feel fat?”

    • B. 

      “Who plans the family meals?”

    • C. 

      “What do you eat in a typical day?”

    • D. 

      “What do you think about your present weight?”

  • 4. 
    A patient is diagnosed with anorexia nervosa. The history reveals the patient virtually stopped eating 5 months ago and lost 25% of body weight. A nurse tells the patient, “Describe what you think about your present weight and how you think you look.” Which response would be most consistent with the diagnosis?  
    • A. 

      “I’m fat and ugly.”

    • B. 

      “What I think about myself is my business.”

    • C. 

      “I’m grossly underweight, but thin is interesting.”

    • D. 

      “I’m a few pounds overweight, but I can live with it.”

  • 5. 
    A psychiatric clinical nurse specialist uses cognitive therapy techniques with a patient with anorexia nervosa. Which statement by the nurse supports this type of therapy?  
    • A. 

      “What are your feelings about not eating the food that you prepare?”

    • B. 

      “You seem to feel much better about yourself when you eat something.”

    • C. 

      “It must be difficult to talk about private matters to someone you just met.”

    • D. 

      “Being thin doesn’t seem to solve your problems. You’re thin now but still unhappy.”

  • 6. 
    A student transferred from a hometown community college to a university 100 miles from home. She was slow to make new friends at the university. The history shows a close relationship with her mother and sister and that she broke up with her boyfriend of 2 years. She began to eat large quantities when she felt sad, and then induce vomiting. These cycles continued until they interfered with her schoolwork. She sought help from the university health clinic. During the initial interview, what other priority issue should a nurse address?
    • A. 

      Sleep patterns

    • B. 

      School activities

    • C. 

      Losses

    • D. 

      Menstrual flow

  • 7. 
    One bed is available on the inpatient eating disorders unit. Which patient should be admitted? The patient whose weight dropped from:
    • A. 

      150 to 100 pounds over a 4-month period. Vital signs: temperature, 35.9° C; pulse, 38 beats/min; blood pressure 60/40 mm Hg

    • B. 

      120 to 90 pounds over a 3-month period. Vital signs: temperature, 36° C; pulse, 50 beats/min; blood pressure 70/50 mm Hg

    • C. 

      110 to 70 pounds over a 4-month period. Vital signs: temperature 36.5° C; pulse, 60 beats/min; blood pressure 80/66 mm Hg

    • D. 

      90 to 78 pounds over a 5-month period. Vital signs: temperature, 36.7° C; pulse, 62 beats/min; blood pressure 74/48 mm Hg

  • 8. 
    A patient with an eating disorder has been under significant stress and works long hours. At home, the patient watches television and eats until going to bed. The patient is too tired to exercise and has gained 25 pounds in 1 month. The patient is 5 feet tall and weighs 175 pounds. A desired outcome for the patient is to recognize the anxiety that precedes binge eating and reduce it with a constructive strategy. Which intervention addresses the outcome?  
    • A. 

      Teach stress reduction techniques such as relaxation and imagery.

    • B. 

      Explore the patient’s need to single-handedly make up for a staff shortage.

    • C. 

      Explore ways in which the patient may feel in control of the environment.

    • D. 

      Encourage the patient to attend a support group such as Overeaters Anonymous.

  • 9. 
    A patient being admitted to the eating disorders unit has a yellow cast to the skin, has hair that is limp and dry, and has fine, downy hair covering the body. The patient weighs 70 pounds; height is 5 feet 4 inches. The patient is quiet and sullen during the physical assessment saying only, “I don’t intend to eat until I lose enough weight to look thin.” What is the best initial nursing diagnosis?  
    • A. 

      Disturbed body image related to weight loss

    • B. 

      Anxiety related to fear of weight gain

    • C. 

      Ineffective coping related to lack of conflict resolution skills

    • D. 

      Imbalanced nutrition: less than body requirements related to self-starvation

  • 10. 
    Nursing physical assessment of a patient with bulimia often reveals:
    • A. 

      Prominent parotid glands.

    • B. 

      Peripheral edema.

    • C. 

      Thin, brittle hair.

    • D. 

      Amenorrhea.

  • 11. 
    When a nurse finds a patient with anorexia nervosa vigorously exercising before gaining the agreed upon weekly weight, the nurse should state:
    • A. 

      “It bothers me to see you exercising. You’ll lose more weight.”

    • B. 

      “You and I will have to sit down and discuss this problem.”

    • C. 

      “According to our agreement, no exercising is permitted until you have gained a specific amount of weight.”

    • D. 

      “Let’s discuss the relationship between exercise and weight loss and how that affects your body.”

  • 12. 
    A patient referred to the eating disorders clinic has lost 35 pounds during the summer and developed amenorrhea. For which physical manifestations of anorexia nervosa should a nurse assess? (More than one answer is correct.)
    • A. 

      Peripheral edema

    • B. 

      Parotid swelling

    • C. 

      Constipation

    • D. 

      Hypotension

    • E. 

      Dental caries

    • F. 

      Lanugo

  • 13. 
    When a patient with anorexia is admitted for treatment, what should the milieu provide? (More than one answer is correct.)
    • A. 

      Flexible mealtimes

    • B. 

      Adherence to a selected menu

    • C. 

      Observation during and after meals

    • D. 

      Unscheduled weight checks

    • E. 

      Monitoring during bathroom trips

    • F. 

      Privileges correlated with affective display

  • 14. 
    An alcohol-dependent patient was hospitalized at 0200 today. When would the nurse expect withdrawal symptoms to peak?  
    • A. 

      Between 0800 and 1000 today (6 to 8 hours after drinking stopped)

    • B. 

      Between 0200 tomorrow and hospital day 2 (24 to 48 hours after drinking stopped)

    • C. 

      About 0200 on hospital day 3 (72 hours after drinking stopped)

    • D. 

      About 0200 on hospital day 4 (96 hours after drinking stopped)

  • 15. 
    A nurse reviews vital signs for a patient admitted last night with an injury sustained while intoxicated. The medical record shows the following blood pressure and pulse readings: Admission, 0200—122/80 mm Hg and 72 beats/min; 0400—126/78 mm Hg and 76 beats/min; 0600—124/80 mm Hg and 72 beats/min; 0800—132/88 mm Hg and 80 beats/min; 1000—148/88 mm Hg and 96 beats/min. What is the nurse’s priority action?
    • A. 

      Encourage the patient to drink plenty of liquids.

    • B. 

      Obtain a clean-catch urine sample.

    • C. 

      Place the patient in a vest-type restraint.

    • D. 

      Consult the health care provider.

  • 16. 
    A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours. The patient is shaky, irritable, anxious, and diaphoretic, and reports nightmares. The pulse rate is 130 beats/min. The patient shouts, “Bugs are crawling on my bed. I’ve got to get out of here,” and begins to thrash about. The most accurate assessment of the situation would be that the patient:  
    • A. 

      Is attempting to obtain attention by manipulating staff.

    • B. 

      May have sustained a head injury before admission.

    • C. 

      Is having a recurrence of an acute psychosis.

    • D. 

      Has symptoms of alcohol withdrawal delirium.

  • 17. 
    A patient admitted yesterday for injuries sustained in a fall while intoxicated believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. Which medication can the nurse anticipate the health care provider will prescribe?
    • A. 

      A benzodiazepine, such as lorazepam (Ativan) or chlordiazepoxide (Librium)

    • B. 

      A phenothiazine, such as chlorpromazine (Thorazine) or thioridazine (Mellaril)

    • C. 

      A monoamine oxidase inhibitor, such as phenelzine (Nardil)

    • D. 

      A narcotic analgesic, such as codeine

  • 18. 
    A hospitalized patient, injured in a fall while intoxicated, believes spiders are spinning entrapping webs in the room. The patient is anxious, agitated, and diaphoretic. Which nursing intervention should be instituted?  
    • A. 

      Check the patient every 15 minutes.

    • B. 

      Provide one-on-one supervision.

    • C. 

      Keep the room dimly lit.

    • D. 

      Rigorously encourage fluid intake.

  • 19. 
    A patient experienced alcohol withdrawal delirium, but now has a clear sensorium. The patient says, “Drinking helps me cope with being a single parent.” Which response by the nurse would help the patient conceptualize the drinking more objectively?
    • A. 

      “Sooner or later, alcohol will kill you. Then what will happen to your children?”

    • B. 

      “I hear a lot of defensiveness in your voice. Do you really believe this?”

    • C. 

      “If you were coping so well, why were you hospitalized again?”

    • D. 

      “Tell me what happened the last time you drank.”

  • 20. 
    During the third week of treatment, the spouse of a patient in an alcoholism rehabilitation program says, “After discharge, I’m sure everything will be just fine.” Which remark by the nurse will be most helpful to the spouse?  
    • A. 

      “It is good that you’re supportive of your spouse’s sobriety and want to help maintain it.”

    • B. 

      “Although sobriety solves some problems, new ones may emerge as one adjusts to living without alcohol.”

    • C. 

      “It will be important for you to structure life to avoid as much stress as possible. You will need to provide social protection.”

    • D. 

      “Remember that alcoholism is a disease of self-destruction. You will need to observe your spouse’s behavior carefully.”

  • 21. 
    In the emergency department, a patient’s vital signs are: BP 66/40 mm Hg; pulse 140 beats/min; respirations 8 breaths/min and shallow. Naloxone (Narcan) is administered. The nursing diagnosis is “ineffective breathing pattern related to depression of respiratory center secondary to narcotic overdose.” Select the desired outcome.
    • A. 

      Within 8 hours, vital signs will stabilize as evidenced by BP greater than 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above12 breaths/min.

    • B. 

      The patient will be able to describe a plan for home care and achieving a drug-free state before release from the emergency department.

    • C. 

      The patient will demonstrate effective coping skills within 1 week of hospitalization.

    • D. 

      The patient will identify two community resources for treatment of substance abuse by discharge.

  • 22. 
    A nurse worked at a community hospital for several months, resigned, then took a position at another hospital. In the new position, the nurse volunteered or switched with others to be the medication nurse. After a year, several serious medication errors occurred in rapid succession. During the investigation, it was learned that the nurse was allowed to resign from the community hospital after diverting patient narcotics for self-use. The nurse manager could retrospectively identify which early indicator of the nurse’s drug use?  
    • A. 

      Accepting responsibility for medication errors.

    • B. 

      High sociability with peers.

    • C. 

      Seeking to be assigned as medication nurse.

    • D. 

      Presenting a neat physical appearance.

  • 23. 
    A nurse with a history of narcotic abuse is found unconscious in the hospital locker room after overdosing. The nurse is transferred from the emergency department to the inpatient psychiatric unit. Which attitudes or behaviors on the part of nursing staff may be enabling behaviors?
    • A. 

      Conveying understanding that pressures experienced in nursing underlie substance use.

    • B. 

      Pointing out that work problems are the result, but not the cause, of substance abuse.

    • C. 

      Empathizing when the nurse discusses fears of disciplinary action by the state board of nursing.

    • D. 

      Providing health teaching about stress management.

  • 24. 
    A nurse manager tells the staff nurse, “We anticipate this patient will have symptoms of withdrawal from sedative-hypnotics, so close observation is needed.” For which symptoms should the staff nurse assess the patient?  
    • A. 

      Dilated pupils, tachycardia, elevated blood pressure, elation

    • B. 

      Mood lability, incoordination, fever, drowsiness

    • C. 

      Nausea, vomiting, diaphoresis, anxiety, tremors

    • D. 

      Excessive eating, constipation, headache

  • 25. 
    A patient has smoked two packs of cigarettes daily for many years. When the patient does not smoke or tries to cut back, anxiety, craving, poor concentration, and headache result. What does this scenario describe?
    • A. 

      Substance abuse

    • B. 

      Substance intoxication

    • C. 

      Substance dependence

    • D. 

      Recreational use of a social drug