Final Exam - Psychiatric Mental Health PDF

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Questions and answers to review for psychiatric hesi as well psychiatric final for this class. Questions from hesi books and powerpoints....

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1 Chapter 14 Questions (8 Questions) 1. Which of the following is least likely to contribute to building an effective therapeutic alliance between the nurse and a patient with anorexia? a. Establishing disciplined eating through the nurse’s authoritarian approach with the patient b. Avoiding the stance of a parental role to foster a sense of empowerment c. Offering a highly structured approach in treating patients who are severely underweight d. Contracting with the outpatient person about treatment terms 2. Which of the following is an example of all or nothing thinking, which is a frequent cognitive distortion of patients with an ED? a. “If i allow myself to gain weight, ill be huge.” b. “I’m unpopular because I am fat” c. When I’m thin, I’m powerful.” d. “When people say I look better, they’re really thinking I look fat.” 3. A patient with bulimia nervosa has become dehydrated from self-induced vomiting. This is most likely to result in: a. Hyperchloremia b. Hypokalemia c. Tachycardia d. Parotid gland atrophy 4. The school nurse assesses 4 adolescents who appear to have a healthy weight. Which comment would lead the nurse to explore further for an eating disorder? a. “I usually try to exercise 30 minutes a day.” b. “I know everything in my life will be better once I lose 15 more pounds.” c. “I forgot my lunch today, so I will only be eating an apple.” d. “I know I shouldn’t eat potato chips, but I just love them.” 5. A nurse assesses 4 adolescents diagnosed with various eating disorders;. Which of the comments would the nurse expect from the adolescent diagnosed with anorexia nervosa? a. “I look good b/c whenever I eat, I purge myself.” b. “I love sweets. I make myself throw up so I can eat more.” c. “I’ve lost 60 lbs, but I am still a size 2. I want to be a size 0.” d. “I’ve hidden my eating disorder from everyone, even my parents.” 6. While patients on an eating disorder unit, the nurse overhears a psychiatric technician say, “I wish I had an eating disorder; maybe I’d lose a little weight.” What is the nurses best action: a. Report the clinical observation to the nursing supervisor b. Ask the psychiatric technician, “What did you mean by that comment?” c. Privately discuss the importance of sensitivity with the psychiatric technician.

2 d. Immediately interrupt the interaction between the patient and psychiatric technician. 7. Shortly after hospitalization, an adolescent diagnosed with anorexia nervosa says to the nurse, “Being fat is the worst thing in the world. I hope it never happens to me.” Which response by the nurse is appropriate? a. “You need to gain weight to become healthier.” b. “Your world would not change if you gained a few lbs.” c. “Tell me how your world would be different if you were fat.” d. “Your attractiveness is not defined by a number on a scale.” 8. A patient is hospitalized with a diagnosis of anorexia nervosa. The nurse reviews the patient’s laboratory results, as follows: i. Sodium 143 mEq/L ii. Potassium 3,1 mEq/L iii. Chloride 102 mEq/L iv. Magnesium 2.2 mEq/L v. Calcium 8.4 mg/dL vi. Phosphate 3.0 mg/dL b. The nurse should take with action first? i. Measure the patients body temperature ii. Inspect the patients skin and sclera for jaundice iii. Assess the patients mucous membranes for erosion iv. Auscultate the patients heart rate, rhythm, and sounds.

Chapter 18 (8 Questions) 1. A nurse assessing a patient with suspected delirium will expect to find that the patients symptoms developed: a. Over a period of hours to days b. Over a period of weeks to months c. With no relationship to another condition d. During middle age 2. Of the following outcomes, which one if the most appropriate for a patient with cognitive impairment related to delirium? a. Participate fully in self-care from admission on. b. Have stable vital signs 6 hours after admission c. Participate in simple activities that bring enjoyment. d. Return to the premorbid level of functioning. 3. In caring for a patient with Late AD, which nursing diagnosis demands the nurse’s highest priority? a. Risk for injury

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b. Self-care deficit c. Chronic low self esteem d. Impaired verbal communication Psychobiological agents showing promise for the treatment of cognitive impairment associated with AD include a. Cholinesterase inhibitors b. Herbals, including ginkgo biloba c. SSRI’s and trazodone d. Benzodiazepines and buspirone Nursing staff that care for patients who are cognitively imparied can develop burnout. Strategies to avoid the development of a burnout include: a. Setting realistic patient goals b. Insulating self from emotional involvement with patients c. Sedating patients to promote rest and minimize catastrophic episodes d. Encouraging the family to permit the use of restraints to promote patient safety. While interacting with a 62-year old adult diagnosed with a progressive neurocognitive disorder, the nurse observes that the adult has slow responses and difficulty finding the right words. What is the nurse’s best initial action? a. Suggest words that the adult may be trying to remember b. Ask th c. e adult, “are you having problems saying what you mean?” d. Use silence to allow the adult an opportunity to compose responses e. Discontinue the interaction to prevent further frustration for the adult. An adult diagnosed with stage 2 Alzheimer’s disease begins a new prescription for rivastigmine (Exelon). Which nursing diagnosis has the highest priority to add to the plan of care? a. Risk for constipation b. Impaired perception c. Impaired oral mucous membrane d. Risk for impaired nutritional status Which newly hospitalized patient should the nurse monitor closely for the development of delirium? a. A 48-year old who usually drinks a six-pack of beer daily b. A 68 year old who takes aspirin 650 mg twice daily for arthritis pain c. A 72 year old who says, “I have a glass of wine every evening to stimulate my appetite.” d. A 78 year old diabetic whos blood glucose levels are consistently greater than 250 mg/dL

4 9. A 84 year old tells the nurse, “I do four or five number puzzles every day to keep my brain healthy and sharp.:” When considering a holistic approach to maintaining mental health, the nurse should respond: a. “It is more important for you to have physical activity every day.” b. “Let’s think of some other activities we can add to your daily routine.” c. “Repetition of the same activity is not helpful for keeping your brain healthy.” d. “There are some herbal preparations that will also help keep your brain sharp.” 10. A family member asks the nurse, “I know uncle’s Alzheimer’s disease has progressed, but is there any medication that can help him now?” Which response by the nurse is correct? a. “I’m sorry but there are no medications that help with severe Alzheimer’s disease.” b. “Alzheimer’s disease sometimes stabilizes. Let’s hope that happens in this situation.” c. “There are few medications that may help. Let’s discuss it with the health care provider.” d. “It sounds like you’re having difficulty accepting your uncle’s disease is irreversible. Would you like to talk about those feelings?” Chapter 19 (13 Questions) 1. Your patient asks, “Will antabuse really help me with my drinking problem?” What is your most appropriate response? a. “Yes, if you are motivated.” b. “Yes, if you use it correctly.” c. “That is totally up to you.” d. “Antabuse works well for some.” 2. Jessie had a blood alcohol level of 0.11% upon arrival at the emergency department. She is now your patient in the hospital psychiatric unit, day 4. She tells you, “I wasn’t drunk. I just had a few beers.: What is an appropriate response? a. “Jessie, of course you were drunk. You always are.” b. “Jessie, you BAL was 0.11%. That clearly indicates that you had alcohol intoxication.” c. “You are in denial, and that will impede your recovery from alcoholism.” d. “Until you recognize your problem, you will never win over this addiction.” 3. Jessie is now attending AA meetings three times a week for the past 6 weeks. She has been sober during this time and visits bi-weekly the community mental health outpatient clinic. Jessie’s nurse counselor wants to talk with her about AA meetings. Which initial question or statement is most appropriate? a. “I am so excited that you are attending the AA sessions!” b. “Do you enjoy attending the AA meetings?” c. “Are the members of the group friendly and accepting?”

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d. “Tell me about the last AA meeting you attended.” Jessie has missed three sessions at the mental health center and sporadically attends AA meeting. SHe is drinking heavily this weekend and has sustained a 2-inch gash in her forehead after serving off the road into a shallow ditch. SHe is taken by rescue to the ED. You are her nurse. She tells you, “I hope I just go to sleep and never wake up.” WHhat is your best intervention? a. Tell Jessie, “You are just tired and have had too much alcohol in your system.” b. Clear the area of any items that Jessie may use to inflect self harm c. Immediately activate the mental health protocol to have Jessie admitted to psychiatric unit. d. Stay with Jessie, call the supervisor, and arrange for continuous monitoring. A young adult has reported heavy use of alcohol and prescription drugs since mid-adolescence. This individual now has a ataxic (unsteady) gait and uses a cane. Which comment by the nurse presents reality while demonstrating compassion? a. “I know you must feel self-conscious about using a cane at your age, but it will help prevent falls.” b. “Addiction is a fatal disease. IF you continue to drink like you have done in the past, you will not live another 10 years.” c. “It’s time to face your addiction. You are disappointing your family and must stop drinking for the sake of the people who love you.” d. “Addiction is powerful. You are young yet cannot walk without a cane. You health has been significantly affected by your long-term use of drugs and alcohol. The nurse at a local clinic reviews phone-in-requests from patients for prescription refills. As the nurse confers with the health care provider about which prescription refill requests should be authorized, which refill request should be considered first? a. Codeine 10 mg PO q4 PRN for an adult with a persistent cough b. Hydroxyzine (Vistaril) 25 mg PO TID PRN for an adult who experiences uncomfortable muscle spasm c. Lorazepam (Ativan) 1mg PO for an adult who has taken it daily for three years for episodes of anxiety. d. Lomotil 2mg PO q6h PRN for an adult experiencing severe diarrhea. A patient tells the nurse, “After many years, I finally quit smoking. Now I use e-cigarettes only.” Which is an appropriate response? a. “Using e-cigarettes is now more socially acceptable than using traditional cigarettes.” b. “Congratulations on quitting, but e-cigarettes contain nicotine and other hazardous chemicals. c. “Nicotine is a power addiction. Quitting smoking is a big step toward adopting a healthier lifestyle.”

6 d. “I am glad you have quit smoking. Your loved ones will no longer be exposed to the hazards of secondhand smoke.” 8. A young adult tells the nurse, “I have a prescription for medical marijuana. I use it several times a day for my frequent muscle spasms.” What information should the nurse provide first to this patient? a. Guidance that the prescription should not be shared with peers. b. Directions to weigh self once a week and maintain a log of the results c. Instructions about safety issues associated with driving or operating machinery d. Information about the potential for amotivational syndrome and memory problems. 9. A nurse teaches a patient with alcohol use disorder about new prescription for naltrexone (reia, vivitrol). Which comment by the patient indicates the teaching was effective? a. “This medicine will stop my craving for alcohol.” b. “I should take this medication only when I feel cravings to drink alcohol.” c. “This medicine is one part of a bigger treatment plan to help me stay sober.” d. “I should not use any products that contain alcohol such as cough medicine and aftershave lotion.”

Chapter 20 (6 Questions Each) 1. Which statement about crisis theory provides a basis for nursing interventions? a. A crisis is an acute, time-limited phenomenon experienced as an overwhelming emotional reaction to a problem perceived as unsolvable. b. A person in criss usually has had adjustment problems and has inadequately coped in his or her usual life situations. c. Crisis is precipitated by an event that enhances the person’s self-concept and self-esteem. d. Nursing intervention in crisis situations rarely has the effect of ameliorating the crisis. 2. Ms. T., a single mother of four, comes to the crisis center 24 hours after an apartment fire in which all the family’s household goods and clothing were lost. Ms. T has no family in the area. Her efforts to mobilize assistance have been disorganized, and she is still without shelter. She is distraught and confused. The nurse assesses the situations which of the following types of crisis? a. Maturational crisis b. Situational crisis c. Adventitious crisis d. Evidence of inadequate Personality 3. For a nurse working in crisis intervention, which belief would be least helpful? a. A person in crisis is incapable of making his or her own decisions.

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b. The crisis counseling relationship is one between partners. c. Crisis counseling helps the patient refocus to gain new perspectives on the situation. d. Anxiety reduction techniques are used to enable the patient’s inner resources to be accessed. When entering the building, an elementary school nurse observes a person in the distance emerging from a forest and approaching the school. The person is dressed in black from head to toe; wearing a backpack; and carrying a long, narrow object. Which action should the nurse take first? a. Move to a secure location b. Observe the intruder’s features c. Take note of the intruder’s location d. Activate the school code for an intruder An adult has had long-term serious medical problems and has just started a new RX resulting in decreased libido and sexual performance. The adult’s spouse privately says to the nurse, “I don’t feel loved anymore. I feel sexual urges, but my partner is not interested.” Select the nurse’s therapeutic response. a. “Tell me about how your partner shows love for you.” b. You’re describing a scenario that many couple face.” c. “Let’s consider some other ways to satisfy your needs.” d. “I’m glad you are able to talk about and accept your situation.” The nurse in a high school meets with a groups of students the day after a school bus accident resulted in the death of five students. Which comment should the nurse use to begin the session? a. “Sometimes life is not fair. Yesterday’s tragedy is an example of just how unfair it can be.” b. “We’re grateful that you are safe. Our discussion is to talk about feelings associated with yesterday’s tragedy.” c. “We’ve had a terrible loss. I also feel your pain. You need to talk about your feelings associated with the event.” d. “Thank you for coming today.” As school leaders, we know it is very important to respond to yesterday’s tragedy.” A patient on an acute psychiatric unit removed the cap from the ceiling sprinkler, resulting in a rapid flooding of the unit. After moving patients to a safe area, which action should the nurse take next? a. Conduct individual sessions with patients regarding the experience. b. Increase the volume of overhead music to distract patients from the event. c. Implement a psychomotor activity to reduce anxiety associated with the event. d. Lead a group session with patients to discuss feelings associated with the event.

8 8. Three weeks after being assaulted by a patient, a nurse develops headache, insomnia, and GI problems. The nurse has had 4 absences from work over a 2 week period. Which action should the nurse supervisor employ? a. Refer the nurse for counseling and support. b. Ask the nurse about current personal problems c. Direct the nurse to take paid vacation for the following week. d. Schedule the nurse for administrative tasks rather than patient care. Chapter 21 (6 Questions) 1. Chloe is now being seen by the ED physician. Her husband, Chad, is quietly demanding to see his wife. As the triage nurse, what are your best actions? Select all that apply. a. Have a staff member regularly touch base with Chad in the waiting room to reassure him that Chloe is fine but no room for visitors is provided b. Immediately call hospital security c. Move chloe to secluded area in the ED so that you can interview her in private and advise her of safe shelters and offer brochures. d. Insist that Chloe admit she is being abused by Chad and immediately report the abuse to the police department. 2. Which is true about elder abuse? a. Abusive caretakers are mentally ill. b. Most abused older adults were abused themselves as parents. c. Often an abusive caretaker is financially dependent on the older adult in their care. d. It is against the law for a caretaker to have any access to an older adult’s bank account. 3. An ED nurse assesses a woman suspected of being abused by an intimate partner. Which assessment finding most clearly confirms the suspicion? a. Leathery facial tone b. Injuries in a bikini pattern c. Reluctance to be examined d. Lack of eye contact with the nurse 4. An ED nurse assesses a child with a fractured ulna. The nurse also observes yellow and purple bruises across the child’s back and shoulders. Which comment by the parents should prompt the nurse to consider making a report to Child Protective Services? a. “We do not believe in immunization of our children.” b. “This child is always creating problems for the family.” c. “Our child would rather play alone than with other children.” d. “We homeschool our children in order to include religious education.” 5. A woman in a relationship characterized by a long history of battering and abuse tells the nurse, “We’ve had a rough time lately. I admit it: He beat me last night but then he was sorry.” Which event would the nurse expect to occur next in this relationship?

9 a. Another beating by the abusive partner. b. Love, gifts, and praise from the abusive partner. c. A brief period during which the partner ignore each other. d. The abusive partner leaving the relationship for a short time. 6. The nurse assessed an elderly person who was abused by the caregiver. Afterward, which internal dialogue should prompt the nurse to seek guidance? a. “Sometimes I get so discouraged and frustrated with my job.” b. “It’s incredible that anyone could hurt a child or elderly person.” c. “The abuser was probably a victim of abuse at some point in life.” d. “I hope the abuser gets victimized so they know what it feels life.” 7. A university football coach invites the campus nurse to talk to the team about healthy relationships in the community. Which topic has priority for the nurse to include? a. Appropriate behavior with intimate partners. b. University resources for counseling and support. c. The importance of role modeling for children and teens. d. Public recognition of children with life threatening illnesses. Chapter 27 (week 14) - (4 Questions)...