NU664C/ NU 664C Midterm Exam (2026/2027 Update) Family Psychiatric Mental Health II | Questions & Answers | Verified Solutions | Regis

…..DLDD NU664C/ NU 664C Midterm Exam (2026/2027 Update) Family Psychiatric Mental Health II | Questions & Answers | Verified Solutions | Regis Q. A nursing instructor is asking students about diseases of adaptation and when they are likely to occur. Which student response indicates that learning has occurred? A. When an individual has limited experience dealing with stress B. When an individual inherits maladaptive genes C. When an individual experiences existing conditions that exacerbate stress D. When an individuals physiological and psychological resources have become depleted Answer D Q. A nurse is interviewing a distressed client, who relates being fired after 15 years of loyal employment. Which of the following questions would best assist the nurse to determine the clients appraisal of the situation? Select all that apply. A. What resources have you used previously in stressful situations? B. Have you ever experienced a similar stressful situation? C. Who do you think is to blame for this situation? D. Why do you think you were fired from your job? E. What skills do you possess that might lead to gainful employment? Answer ABE Q. A patient presents in the Emergency Department immediately following a shooting incident in a school where she has been teaching. There is no evidence of physical injury, but she appears very hyperactive and talkative. Which of these symptoms manifested by the patient are common initial biological responses to stress? Select all that apply. A. Constricted pupils B. Watery eyes C. Unusual food cravings D. Increased heart rate E. Increased respirations Answer BDE Q. Which of the following are identified as psychoneurotic responses to severe anxiety as they appear in the DSM-5? A. Somatic symptom disorders B. Grief responses C. Psychosis D. Bipolar disorder Answer A Q. Which nursing statement about the concept of psychoses is most accurate? A. Individuals experiencing psychoses are aware that their behaviors are maladaptive. B. Individuals experiencing psychoses experience little distress. C. Individuals experiencing psychoses are aware of experiencing psychological problems. D. Individuals experiencing psychoses are based in reality. Answer B Q. Which is the most significant consequence of the excessive use of defense mechanisms? A. The superego will be suppressed. B. Emotions will be experienced intensely. C. Learning and the ability to grow will be enhanced. D. Problem-solving will be limited. Answer D Q. A husband accuses his wife of infidelity. Which situation would indicate to the nurse the husband's use of the ego defense mechanism of projection? A. The husband cries and stamps his feet, demanding that his wife be true to her marriage vows. B. The husband ignores the wife's continued absence from the home. C. The husband has already admitted to having an affair with a coworker. D. The husband takes out his marital frustrations through employee abuse. Answer C Q. Which of the following statements should a nurse recognize as true about defense mechanisms? Select all that apply. A. They are employed when there is a threat to biological or psychological integrity. B. They are controlled by the id and deal with primal urges. C. They are used in an effort to relieve mild to moderate anxiety. D. They are protective devices for the superego. E. They are mechanisms that are characteristically self-deceptive. Answer ACE Q. A nurse is assessing a client who appears to be experiencing moderate anxiety during questioning. Which symptoms might the client demonstrate? Select all that apply. A. Fidgeting B. Laughing inappropriately C. Palpitations D. Nail biting E. Extremely limited attention span Answer ABD Q. Which of the following are cultural aspects of mental illness? Select all that apply. A. Local or cultural norms define pathological behavior. B. The higher the social class the greater the recognition of mental illness behaviors. C. Psychiatrists typically see patients when the family can no longer deny the illness. D. The greater the cultural distance from the mainstream of society, the greater the likelihood that the illness will be treated with sensitivity and compassion. Answer ABC Q. How is the DSM-5 useful in the practice of psychiatric nursing? Select all that apply. A. It informs the nurse of accurate and reliable medical diagnosis. B. It represents progress toward a more holistic view of mindbody. C. It provides a framework for interdisciplinary communication. D. It provides a template for nursing care plans. E. It provides a framework for communication with the client. Answer ABC Q. A nurse should assess a patient taking a drug with anticholinergic properties for inhibited function of the: A. parasympathetic nervous system. B. sympathetic nervous system. C. reticular activating system. D. medulla oblongata. Answer A Q. A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. A nurse can correctly analyze that these symptoms are related to which drug action? A. Dopamine-blocking effects B. Anticholinergic effects C. Endocrine-stimulating effects D. Ability to stimulate spinal nerves Answer A Q. A patient has symptoms of acute anxiety related to the death of a parent in an automobile accident 2 hours ago. The patient will need teaching about a drug from which group? A. Tricyclic antidepressants B. Antimanic drugs C. Benzodiazepines D. Antipsychotic drugs Answer A Q. A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client's neurotransmitters should a nurse expect to be elevated? A. Serotonin B. Dopamine C. Gamma-aminobutyric acid (GABA) D. Histamine Answer B Q. Which mental illness should a nurse identify as being associated with a decrease in prolactin hormone level? A. Major depression B. Schizophrenia C. Anorexia nervosa D. Alzheimer's disease Answer B Q. A nurse understands that the abnormal secretion of growth hormone may play a role in which illness? A. Acute mania B. Schizophrenia C. Anorexia nervosa D. Alzheimer's disease Answer C Q. Which client diagnosis should a nurse associate with a decrease in gamma-aminobutyric acid (GABA)? A. Alzheimer's disease B. Schizophrenia C. Panic disorder D. Depression Answer C Q. A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness? A. Schizophrenia B. Depression C. Body dysmorphic disorder D. Parkinson's disease Answer A Q. Which of the following information should a nurse include when explaining causes of anorexia nervosa to a client? (Select all that apply.) A. There is a possible correlation between abnormal secretion of growth hormone and anorexia nervosa. B. There is a possible correlation between antidiuretic hormone levels and anorexia nervosa. C. There is a possible correlation between low levels of gonadotropin and anorexia nervosa. D. There is a possible correlation between increased levels of prolactin and anorexia nervosa. E. There is a possible correlation between altered levels of oxytocin and anorexia nervosa. Answer AC Q. During a hiring interview, which response by a nursing applicant should indicate that the applicant operates from an ethical egoism framework? A. "I would want to be treated in a caring manner if I were mentally ill." B. "This job will pay the bills, and the workload is light enough for me." C. "I will be happy caring for the mentally ill. Working in Med/Surg kills my back." D. "It is my duty in life to be a psychiatric nurse. It is the right thing to do." Answer B Q. An inpatient psychiatric physician refuses to treat clients without insurance and prematurely discharges those whose insurance benefits have expired. Which violation of an ethical principle should a nurse recognize in this situation? A. Autonomy B. Beneficence C. Nonmaleficence D. Justice Answer D Q. A geriatric client is confused and wandering in and out of every door. Which scenario reflects the least restrictive alternative for this client? A. The client is placed in seclusion. B. The client is placed in a geriatric chair with tray. C. The client is placed in soft Posey restraints. D. The client is monitored by an ankle bracelet. Answer D Q. After disturbing the peace, an aggressive, disoriented, unkempt, homeless individual is escorted to an emergency department by police. The client threatens suicide. Which criteria would enable a physician to consider involuntary commitment? Select all that apply. A. Being dangerous to others B. Being homeless C. Being disruptive to the community D. Being gravely disabled and unable to meet basic needs E. Being suicidal Answer ADE Q. What is the priority nursing action during the orientation (introductory) phase of the nurse-client relationship? A. Acknowledge the client's actions and generate alternative behaviors. B. Establish rapport and develop treatment goals. C. Attempt to find alternative placement. D. Explore how thoughts and feelings about this client may adversely impact care. Answer B Q. Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse-client relationship? A. "I can't bear the thought of leaving here and failing." B. "I might have a hard time working with you. You remind me of my mother." C. "I can't tell my husband how I feel; he wouldn't listen anyway." D. "I'm not sure that I can count on you to protect my confidentiality." Answer C Q. On which task should a nurse place priority during the working phase of relationship development? A. Establishing a contract for intervention B. Examining feelings about working with a particular client C. Establishing a plan for continuing aftercare D. Promoting the client's insight and perception of reality Answer D Q. As the client and nurse move from the orientation stage to the working stage of the therapeutic relationship, which is the nurse's most therapeutic statement? A. "I want to assure you that I will maintain your confidentiality." B. "A long-term goal for someone your age would be to develop better job skills." C. "Which identified problems would you like for us to initially address?" D. "I think first we need to focus on your relationship issues." Answer C Q. What is the main goal of the working phase of the nurse-client therapeutic relationship? A. Role modeling to improve interaction with others B. Resolution of the client's problems C. Using therapeutic communication to clarify perceptions D. Helping the client access outpatient treatment Answer B Q. Which nursing action demonstrates the role of the teacher in a therapeutic milieu? A. The nurse implements a self-affirmation exercise during a one-to-one client interaction. B. The nurse holds a group meeting to present common side effects of psychiatric medications. C. The nurse introduces the concept of fair play while playing cards with a group of clients. D. The nurse models adaptive and effective coping mechanisms with clients on the psychiatric unit. Answer B When is self-disclosure by the nurse appropriate in a therapeutic nurse-client relationship? A. When it is judged that the information may benefit the nurse and client B. When the nurse has a duty to warn C. When the nurse feels emotionally indebted toward the client D. When it is judged that the information may benefit the client D Which therapeutic communication technique is being used in this nurse-client interaction?Client: "When I am anxious, the only thing that calms me down is alcohol."Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" A. Reflecting B. Making observations C. Formulating a plan of action D. Giving recognition C A client's younger daughter is ignoring curfew. The client states, "I'm afraid she will get pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about life?" This is an example of which communication block? A. Requesting an explanation B. Belittling the client C. Making stereotyped comments D. Probing C A student nurse tells the instructor, "I'm concerned that when a client asks me for advice I won't have a good solution." Which should be the nursing instructor's best response? A. "It's scary to feel put on the spot by a client. Nurses don't always have the answer." B. "Remember, clients, not nurses, are responsible for their own choices and decisions." C. "Just keep the client's best interests in mind and do the best that you can." D. "Set a goal to continue to work on this aspect of your practice." B Which nursing statement is a good example of the therapeutic communication technique of focusing? A. "Describe one of the best things that happened to you this week." B. "I'm having a difficult time understanding what you mean." C. "Your counseling session is in 30 minutes. I'll stay with you until then." D. "You mentioned your relationship with your father. Let's discuss that further." D Which of the following individuals are communicating a message? Select all that apply.A. A mother spanking her son for playing with matches B. A teenage boy isolating himself and playing loud music C. A biker sporting an eagle tattoo on his biceps D. A teenage girl writing, "No one understands me" E. A father checking for new e-mail on a regular basis ABCD An adolescent client has problems expressing anger appropriately. Which nursing statement would encourage the client to set realistic goals? A. "What do you think needs to change about how you express anger?" B. "How did you feel after attending the anger management session?" C. "On a scale of 1 to 10, please rate your current level of anger." D. "What bothers you about the actions of others when you get angry?" A After a comprehensive assessment, correctly written nursing diagnoses developed for psychiatric clients may include which of the following components? Select all that apply. A. Medical judgments related to the psychiatric disorder B. Unmet client needs present at the moment C. Supporting data that validate the diagnosis D. Outcomes that will be targets for nursing interventions E. Statements of client problems of a functional nature BCE An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Without further education, which group is this nurse most qualified to lead? A. A psychodrama group B. A psychotherapy group C. A parenting group D. A family therapy group C A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After the client received a college acceptance, the mother repeatedly states, "That's wonderful. I'll be fine all alone." How would the nurse interpret the mother's statements? A. The mother is withholding supportive messages. B. The mother is expressing denigrating remarks. C. The mother is communicating indirectly. D. The mother is using double-bind communication. D To promote self-reliance, how should a psychiatric nurse best conduct medication administration? A. Encourage clients to request their medications at the appropriate times. B. Refuse to administer medications unless clients request them at the appropriate times. C. Allow the clients to determine appropriate medication times. D. Take medications to the clients' bedside at the appropriate times. A What is the best rationale for including the client's family in therapy within the inpatient milieu? A. To structure a program of social and work-related activities B. To facilitate discharge from the hospital C. To provide a concrete demonstration of caring D. To encourage the family to model positive behaviors B A client has undergone psychological testing. With which member of the interdisciplinary team should a nurse collaborate to review these results? A. The psychiatrist B. The psychiatric social worker C. The clinical psychologist D. The clinical nurse specialist C In the role of milieu manager, which activity should the nurse prioritize? A. Setting the schedule for the daily unit activities B. Evaluating clients for medication effectiveness C. Conducting therapeutic group sessions D. Searching newly admitted clients for hazardous objects D A nurse attends an interdisciplinary team meeting on an inpatient unit. Which of the following individuals are typically included as members of the interdisciplinary treatment team in psychiatry? (Select all that apply.) A. Respiratory therapist and psychiatrist B. Occupational therapist and psychologist C. Recreational therapist and art therapist D. Social worker and hospital volunteer E. Mental health technician and chaplain BCE A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, I cant function any longer under all this stress. Which type of crisis is the client experiencing? A. Maturational/developmental crisis B. Psychiatric emergency crisis C. Anticipated life transition crisis D. Traumatic stress crisis B An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which intervention should a nurse prioritize to address this behavior? A. Initiate forced medication protocol. B. Help the client to explore the source of anger. C. Ignore the act to avoid reinforcing the behavior. D. With staff support and a show of solidarity, set firm limits on the behavior. D A despondent client, who has recently lost her husband of 30 years, tearfully states, Ill feel a lot better if I sell my house and move away. Which nursing reply is most appropriate? A. Im confident you know whats best for you. B. This may not be the best time for you to make such an important decision. C. Your children will be terribly disappointed. D. Tell me why you want to make this change. B 9. A nurse should assign which nursing diagnosis to a client needing assistance with assertiveness? A. Disturbed personal identity B. Disturbed thought processes C. Defensive coping D. Impaired verbal communication C One nurse confronts another and says, "You are always so talkative in the meetings. I don't know why you can't stay quiet sometimes." Which reply by the other nurse reflects the technique of "clouding/fogging?" A. "You're right. I do speak up a lot." B. "Sounds to me like you're agitated and we need to talk. What are you truly angry about?" C. "Are you offended that I speak up, or because my thoughts are in opposition to yours?" D. "I have the right to express my opinion." A The dean of nursing criticizes a faculty member about views on academic freedom. The faculty member states, "Are you upset because I believe in academic freedom or because you don't?" The faculty member is using which technique to promote assertive behavior? A. Standing up for one's basic human rights B. Delaying assertively C. Inquiring assertively D. Responding assertively with irony C 7. Which is an appropriate initial nursing intervention for a client with chronic low self-esteem? A. Assessing the content of negative self-talk B. Administering anxiolytic medications C. Using reassurance and physical touch D. Using distraction techniques A A 30-year-old client diagnosed with depression has been exclusively cared for and financially subsidized by his mother since age 17. According to Eriksons theory, the nurse recognizes that the client has been unsuccessful in meeting which developmental task? A. Trust B. Initiative C. Intimacy D. Ego integrity C A nursing instructor is teaching about self-concept. Which student statement indicates a need for further instruction? A. Self-concept is the thinking component of the self. B. Self-concept is a system of learned beliefs about self. C. Self-concept is the degree of regard that individuals have for themselves. D. Self-concept is the attitudes and opinions held true about personal existence. C After less restrictive means have been attempted, an order for client restraints has been obtained for a hostile, aggressive 30- year-old client. If client aggression continues, how long will the nurse expect the client to remain in restraints without a physician order renewal? A. 1 hour B. 2 hours C. 3 hours D. 4 hours D At 3 a.m., when less restrictive methods fail, a physician orders restraints for an angry, aggressive client. To meet Joint Commission standards, at what time and by whom should a nurse expect an in-person client evaluation? A. No later than 8 a.m., by a licensed independent practitioner or a clinical nurse specialist B. No later than 4 a.m., by a physician or a licensed independent practitioner (LIP) C. No later than 3:30 a.m., by a physician or the client's case manager D. No later than 6 a.m., by the psychiatrist or a clinical nurse specialist B On an inpatient psychiatric unit, a restrained 16-year-old client continues to verbally lash out and threatens to abuse staff and kill self when released. To meet Joint Commission standards, at what time should a nurse expect the physician to renew the client's restraint order? A. Within 1 hour of the original restraint order B. Within 2 hours of the original restraint order C. Within 3 hours of the original restraint order D. Within 4 hours of the original restraint order B Which initial nursing approach makes limit-setting better accepted by clients who are aggressively acting out? A. Confronting clients with their needs for secondary gains B. Teaching relaxation techniques C. Reflecting back to the client empathy about the client's distress D. Presenting appropriate values that need to be modified C The treatment team is making a discharge decision regarding a previously suicidal client. Which client assessment information should a nurse recognize as contributing to the teams decision? A. No previous admissions for major depressive disorder B. Vital signs stable; no psychosis noted C. Able to comply with medication regimen; able to problem-solve life issues D. Able to participate in a plan for safety; family agrees to constant observation D A client has been brought to the emergency department for signs and symptoms of Chronic Obstructive Pulmonary Disease (COPD). The client has a history of a suicide attempt 1 year ago. Which nursing intervention would take priority in this situation? A. Assessing the clients pulse oximetry and vital signs B. Developing a plan for safety for the client C. Assessing the client for suicidal ideations D. Establishing a trusting nurseclient relationship A A nursing instructor is teaching about the didactic aspects of cognitive therapy. Which student statement indicates a deficit in meeting the learning objectives of this content? A. "The therapist provides information about the process of cognitive therapy." B. "The therapist uses guided imagery in an effort to elicit automatic thoughts." C. "The therapist provides information about how cognitive therapy works." D. "The therapist uses reading assignments to reinforce learning." B A nursing student states, "The instructor gave me a failing grade on my research paper. I know it's because the instructor doesn't like me." Which cognitive error does a nurse recognize in this student's statement? A. Dichotomous thinking B. Catastrophic thinking C. Magnification D. Overgeneralization C An advanced practice nurse is counseling a client diagnosed with generalized anxiety disorder. The nurse plans to use activity scheduling to address this client's concerns. What is the purpose of this nursing intervention? A. To identify important areas needing concentration during therapy B. To increase self-esteem and decrease feelings of helplessness C. To modify maladaptive behaviors by the use of role-play D. To divert away from intrusive thoughts and depressive ruminations A A labor and delivery nurse listens to a new mother relate thoughts regarding her healthy, 8-pound baby girl. Which statement by the mother indicates to the nurse the use of the cognitive error, selective abstraction? A. "My baby is refusing to nurse, and I know it's because she hates me." B. "My baby needs to be under the 'bilirubin lights,' but I resent her time away from me." C. "My baby is wonderful, but I'm upset and depressed because I wanted twins." D. "My baby has an elevated bilirubin, and I know it will get worse and she will die." C Which client statement would exemplify the cognitive changes that you would expect to see in mild anxiety? A. "Right now I feel as sharp as a tack." B. "I'm having a tough time focusing." C. "Sometimes I feel like I'm having an out-of-body experience." D. "All I seem to focus on is my anger." A A client recovering from alcohol toxicity is using minimization. Which statement reflects this cognitive distortion? A. "I can't give up alcohol right now because I just gave up smoking." B. "I just read that red wine has health benefits." C. "I may have a minor problem, but I can handle it." D. "I don't drink as much as my wife and nobody thinks she has a problem." C A client diagnosed with borderline personality disorder states, "Get out of here. No one cares about me or my situation!" Which nursing reply is an example of a cognitive intervention? A. "You have an anti-anxiety medication ordered. It may make you feel better." B. "It sounds like you are feeling really frustrated." C. "Can you explain further your thinking about your situation?" D. "No one cares about you?" C A nursing instructor is lecturing about cognitive therapy. Which of the following are objectives when implementing this therapy? (Select all that apply.) A. To modify automatic thoughts to promote minimization of negative cognitions B. To apply a variety of methods to create change in an individual's thinking C. To apply cognitive principles in order to change an individual's basic schema D. To modify belief systems in an effort to bring about emotional change E. To modify belief systems in an effort to bring about behavioral change BDE A nurse practitioner uses cognitive therapy with depressed clients. The nurse asks clients to keep a daily record of dysfunctional thoughts. Which of the following are appropriate nursing replies to a client questioning the purpose of this exercise? (Select all that apply.) A. "The purpose of this exercise is to identify automatic thoughts." B. "The purpose of this exercise is to identify rational alternatives." C. "The purpose of this exercise is to modify cognitive errors." D. "The purpose of this exercise is to eliminate irrational beliefs." E. "The purpose of this exercise is to monitor thoughts related to self-esteem." ABC A client is experiencing progressive changes in memory that have interfered with personal, social, and occupational functioning. The client exhibits poor judgment and has a short attention span. A nurse should recognize these as classic signs of which condition? A. Mania B. Delirium C. Neurocognitive disorder D. Parkinsonism C Which symptom should a nurse identify that would differentiate clients diagnosed with neurocognitive disorders from clients with pseudodementia (depression)? A. Altered sleep B. Impaired attention and concentration C. Altered task performance D. Impaired psychomotor activity C After 1 week of continuous mental confusion, an elderly African American client is admitted with a preliminary diagnosis of major neurocognitive disorder due to Alzheimer's disease. What should cause the nurse to question this diagnosis? A. Neurocognitive disorder does not typically occur in African American clients. B. The symptoms presented are more indicative of Parkinsonism. C. Neurocognitive disorder does not develop suddenly. D. There has been no T3 or T4 level evaluation ordered. C An older client has recently moved to a nursing home. The client has trouble concentrating and socially isolates. A physician believes the client would benefit from medication therapy. Which medication should the nurse expect the physician to prescribe? A. Haloperidol (Haldol) B. Donepezil (Aricept) C. Diazepam (Valium) D. Sertraline (Zoloft) D A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? A. Haloperidol (Haldol) to address the negative symptom B. Clonazepam (Klonopin) to address the positive symptom C. Risperidone (Risperdal) to address the positive symptom D. Clozapine (Clozaril) to address the negative symptom C If clozapine (Clozaril) therapy is being considered, the nurse should evaluate which laboratory test to establish a baseline for comparison in order to recognize a potentially life-threatening side effect? A. White blood cell count B. Liver function studies C. Creatinine clearance D. Blood urea nitrogen A During an admission assessment, a nurse notes that a client diagnosed with schizophrenia has allergies to penicillin, prochlorperazine (Compazine), and bee stings. On the basis of this assessment data, which antipsychotic medication would be contraindicated? A. Haloperidol (Haldol), because it is used only in elderly patients B. Clozapine (Clozaril), because of a cross-sensitivity to penicillin C. Risperidone (Risperdal), because it exacerbates symptoms of depression D. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines D A college student has quit attending classes, isolates self because of hearing voices, and yells accusations at fellow students. Based on this information, which nursing diagnosis should the nurse prioritize? A. Altered thought processes R/T hearing voices AEB increased anxiety B. Risk for other-directed violence R/T yelling accusations C. Social isolation R/T paranoia AEB absence from classes D. Risk for self-directed violence R/T depressed mood B A client has been recently admitted to an inpatient psychiatric unit. Which intervention should the nurse plan to use to reduce the client's focus on delusional thinking? A. Present evidence that supports the reality of the situation B. Focus on feelings suggested by the delusion C. Address the delusion with logical explanations D. Explore reasons why the client has the delusion B Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia? Select all that apply. A. Group therapy B. Medication management C. Deterrent therapy D. Supportive family therapy E. Social skills training ABDE The nurse is caring with schizophrenia. Orders from the physician include 100mg chlorpromazine IM STAT and then 50 mg PO bid; 2mg benztropine PO bid prn. Because benztropine was ordered on a prn basis, which of the following assessments by the nurse would convey a need for this medication? a. The client's level of agitation increases b. The clients complains of a sore throat c. The client's skin has a yellowish cast d. The client's developed muscle spasms D Brandon, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is: a. "That ridiculous, Brandon. No one is going to hurt you." b. "The CIA isn't interested in people like you, Brandon." c. 'Why do you think the CIA wants to kill you?" d. "I know you believe that, Brandon, but it's really hard for me to believe." D 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? ions of reference b. loose association c. anosognosia d. auditory hallucinations C A client is diagnosed with major depressive disorder. Which nursing diagnosis should a nurse assign to this client to address a behavioral symptom of this disorder? A. Altered communication R/T feelings of worthlessness AEB anhedonia B. Social isolation R/T poor self-esteem AEB secluding self in room C. Altered thought processes R/T hopelessness AEB persecutory delusions D. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia B What is the priority reason for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive disorder? A. The attention during the assessment is beneficial in decreasing social isolation. B. Depression is a symptom of several medical conditions. C. Physical health complications are likely to arise from antidepressant therapy. D. Depressed clients avoid addressing physical health and ignore medical problems. B What client information does a nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)? A. The client's understanding of the need for regular bloodwork B. The client's mood and affect score, according to the facility's mood scale C. The client's cognitive ability to understand information about the medication D. The client's access to a support network willing to participate in treatment C A client diagnosed with major depressive disorder was raised in a strongly religious family where bad behavior was equated with sins against God. Which nursing intervention would be most appropriate to help the client address spirituality as it relates to his illness? A. Encourage the client to bring into awareness underlying sources of guilt. B. Teach the client that religious beliefs should be put into perspective throughout the life span. C. Confront the client with the irrational nature of the belief system. D. Assist the client to modify his or her belief system in order to improve coping skills A A nurse is caring for four clients taking various medications, including imipramine (Tofranil), doxepine (Sinequan), ziprasidone (Geodon), and tranylcypromine (Parnate). The nurse orders a special diet for the client receiving which medication? A. Tofranil B. Senequan C. Geodon D. Parnate D A 20-year-old female has a diagnosis of premenstrual dysphoric disorder. Which of the following should a nurse identify as consistent with this diagnosis? Select all that apply. A. Symptoms are causing significant interference with work, school, and social relationships. B. Patient-rated mood is 2/10 for the past 6 months C. Mood swings occur the week before onset of menses D. Patient reports subjective difficulty concentrating E. Patient manifests pressured speech when communicating ACD A nursing instructor is teaching about the prevalence of bipolar disorder. Which student statement indicates that learning has occurred? A. "This disorder is more prevalent in the lower socioeconomic groups." B. "This disorder is more prevalent in the higher socioeconomic groups." C. "This disorder is equally prevalent in all socioeconomic groups." D. "This disorder's prevalence cannot be evaluated on the basis of socioeconomic groups." B An adult client diagnosed with bipolar I disorder is prescribed lamotrigine (Lamictal), 400 mg three times a day, for mood stabilization. Which is a true statement about this medication order? A. This dosage is within the recommended dosage range. B. This dosage is lower than the recommended dosage range. C. This dosage is more than twice the recommended dosage range. D. This dosage is four times higher than the recommended dosage range. C Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (GAD)? A. Long-term treatment with diazepam (Valium) B. Acute symptom control with citalopram (Celexa) C. Long-term treatment with buspirone (BuSpar) D. Acute symptom control with ziprasidone (Geodon) C A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred? A. "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder." B. "Clozapine (Clozaril) is used off-label in long-term treatment of panic disorder." C. "Doxepin (Sinequan) can be used in low doses to relieve symptoms of panic attacks." D. "Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks." A A client diagnosed with obsessive-compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization? A. The client will refrain from ritualistic behaviors during daylight hours. B. The client will wake early enough to complete rituals prior to breakfast. C. The client will participate in three unit activities by day 3. D. The client will substitute a productive activity for rituals by day 1. B A nursing student questions an instructor regarding the order for fluvoxamine (Luvox), 300 mg daily, for a client diagnosed with obsessive-compulsive disorder (OCD). Which instructor reply is most accurate? A. "High doses of tricyclic medications will be required for effective treatment of OCD." B. "Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for OCD." C. "The dose of Luvox is low due to the side effect of daytime drowsiness and nighttime insomnia." D. "The dosage of Luvox is outside the therapeutic range and needs to be questioned." B How should a nurse best describe the major maladaptive client response to panic disorder? A. Clients overuse medical care because of physical symptoms. B. Clients use illegal drugs to ease symptoms. C. Clients perceive having no control over life situations. D. Clients develop compulsions to deal with anxiety. C Studies have suggested that re-experiencing a traumatic event can become an addiction of sorts. The evidence suggests that the reason for this is: A. People with PTSD often have addictive personalities. B. Perpetuating the traumatic experience yields secondary gains. C. The re-experiencing of trauma enhances production of endogenous opioid peptides. D. People with PTSD often have concurrent substance abuse issues. C Which of the following characteristics should a nurse identify as "normal" in the development of human sexuality for an 11-year-old child? Select all that apply. A. The child experiments with masturbation. B. The child may experience homosexual play. C. The child shows little interest in the opposite sex. D. The child shows little concern about physical attractiveness. E. The child is unlikely to want to undress in front of others. ABE An adolescent client who was diagnosed with conduct disorder at the age of 8 is sentenced to juvenile detention after bringing a gun to school. How should the nurse apply knowledge of conduct disorder to this client's situation? A. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood. B. Childhood-onset conduct disorder is caused by a difficult temperament, and the child is likely to outgrow these behaviors by adulthood. C. Childhood-onset conduct disorder is diagnosed only when behaviors emerge before the age of 5, and therefore improvement is likely. D. Childhood-onset conduct disorder has no treatment or cure, and children diagnosed with this disorder are likely to develop progressive oppositional defiant disorder. A A nursing instructor is teaching about the typical grieving behaviors of Chinese Americans. Which student statement would indicate that more instruction is needed? A. "In this culture, the color red is associated with death and is considered bad luck." B. "In this culture, there is an innate fear of death." C. "In this culture, emotions are not expressed openly." D. "In this culture, death and bereavement are centered on ancestor worship." A A client with a diagnosis of depression who has attempted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response by the nurse demonstrates therapeutic communication? A. "You have everything to live for" B. "Why do you see yourself as a failure?" C. "Feeling like this is all part of being depressed" D. "You've been feeling like a failure for awhile?" D The nurse visits a client at home. The client states, "I haven't slept at all the last couple of nights." Which response by the nurse demonstrates therapeutic communication? A. "I see" B. Really?" C. You're having difficulty sleeping?" D. Sometimes I have trouble sleeping too" C A client is experiencing disturbed thought process and believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat? A. Using open ended questions and silence B. Sharing personal preference regarding food choices C. Documenting reasons why the client does not want to eat D. Offering opinions about the necessity of adequate nutrition A The nurse should plan which goals of the termination stage of group development? Select all that apply. A. The group evaluates the experience B. The real work of the group is accomplished C. Group interaction involves superficial conversation D. Group members become acquainted with one another E. Some structuring of group norms, roles, and responsibilities takes place F. The group explores members' feelings about the group and impending separation A,F A client diagnosed with terminal cancer says to the nurse, "I'm going to die! I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's dying." Which response by the nurse is therapeutic? A. Have you shared your feelings with your family? B. I think we should talk more about your anger with your family C. You're feeling angry that your family continues to hope for you to be cured? D. You're probably very depressed, which is understandable with such a diagnosis C On review of the client's record, the nurse notes that the admission was voluntary. Based on this information, the nurse plans care anticipating which client behavior? A. Fearfulness regarding treatment measures B. Anger and aggressiveness directed toward others C. An understanding of the pathology and symptoms of the diagnosis D. A willingness to participate in the planning of the care and treatment plan D A client admitted voluntarily for treatment of an anxiety problem demands to be released from the hospital. Which action should the nurse take initially? A. Contact the client's healthcare provider B. Call the client's family to arrange for transportation C. Attempt to persuade the client to stay "for only a few more days" D. Tell the client that leaving would likely result in an involuntary commitment A When reviewing the admission assessment, the nurse notes that the client was admitted to the mental health unit voluntarily. Based on this type of admission, the nurse should provide which intervention for this client? A. Monitor closely for harm to self or others B. Assist in completing an application for admission C. Supply the client with written in information about his or her mental health problem D. Provide an opportunity for the family to discuss why they felt the admission was needed A A client from India states, "My uncle sinned when he slaughtered his cow for profit." Which data should the nurse consider when assessing this client's mental health? A. Delusions are false personal beliefs B. The concepts of mental health and mental illness are defined and influenced by culture and religious beliefs C. Hallucinations are false sensory perceptions not associated with any real external stimuli and may involve the senses D. This client is employing the defense mechanism of projection B Which of the following best exemplifies a client's use of the defense mechanism of displacement. Select all that apply. A. A student fails a dosage calculation test then arbitrarily picks a fight with a roommate. B. An adolescent who feels angry and hostile towards others decides to become a therapist C. A woman is unhappy about being a mother, although others know her as an attentive parent D. A client is drinking 6 to 8 beers a day while still attending AA as a group leading E. After a heated argument with his wife, a husband berates a restaurant waiter for slow service A, E A nursing instructor is teaching about ego defense mechanisms. Which statement indicates a need for further instruction? A. Defense mechanisms are used during periods of increased anxiety and when the strength of the ego is tested B. All individuals who use defense mechanisms to adapt to stress exhibit healthy egos C. At times of mild to moderate anxiety, defense mechanisms can be used adaptively to deal with stress D. Some ego defenses are more adaptive than others but all are used either consciously or unconsciously for ego protection. B Clearly depressed about a transfer to Hawaii because of the High Cost of living, an Air Force Major does research and convinces his family of the great surfing Hawaii offers. A nurse would recognize that the major is using which defense mechanism? A. Intellectualization B. Denial C. Rationalization D. Suppression A Which of the following situations exemplify the use of the ego defense mechanism of compensation? Select all that apply. A. With a flat affect and displaying no emotion, a daughter describes her mother's recent suicide. B. Failing the college entrance examination due to an inability to comprehend math, the student and embarks on a Master Gardener certification C. A woman recently disbarred from the legal profession takes to her bed and finds comfort in sucking her thumb D. A teacher's aide is reprimanded during school then later criticizes the librarian for a lack of reading materials. E. A woman who is unable to Bear children apply as a foster parent through the Department of Social Services B,E Which situation exemplifies the use of the ego defense mechanism of identification? A. A veterinarian who dislikes cats begins with specialty in feline medicine B. A self admitted homosexual tells his parents he has noted homosexual tendencies in his younger brother C. A 10 year old is rescued from a house fire and later in life decides to become a firefighter D. A singer tells her agent that her heavy smoking will not harm her voice C A war veteran describes having his legs blown off during an attack. His affect is flat and he shows no emotion during this disclosure. This veteran is using which defense mechanism? A. Isolation B. Identification C. Introjection D. Displacement A The mother abuses her children and tells the caseworker that it's her husband who abuses the children even though it has been proven that he's a dutiful Father. Which defense mechanism is the mother using? A. Compensation B. Projection C. Displacement D. Denial B A husband yells at his wife because of her self-indulgent extravagances. Later in the day he buys her a $1,000 gift certificate. The husband is using which defense mechanism? A. Denial B. Undoing C. Compensation D. Repression B Which exhibited symptoms would cause a nurse to determine that a client is experiencing a panic level of anxiety? A. The client has difficulty concentrating B. The client, without evidence, is convinced his son is planning his murder C. The client requires assistance in decision making D. The client is restless and complains of muscle tension B What is the rationale for a nurse to perform a psychosocial assessment on a client with a family history of cardiovascular disease? A. Unresolved anxiety can contribute to physiological disorders. B. Cardiovascular disease has been associated with mental illness C. It is important to rule out the diagnosis of personality disorder D. Psychosocial assessment can always predict pathophysiology A A nursing instructor is teaching about the dimensional assessment tools included in Section 3 of the diagnostic and statistical Manual of mental disorders fifth edition. Which student statement indicates a need for further instruction? A. The dimensional assessment tool may be specific to a given disorder B. The dimensional assessment tool can be used initially to establish a baseline C. The dimensional assessment tool provides additional data needed for treatment D. The dimensional assessment tool relies heavily on physician assessment data D A nursing instructor is teaching about the reasons clients are admitted to an inpatient psychiatric unit. Which student statement indicates that more instruction is needed? A. This client should be admitted because he is threatening to kill his mother B. This client should be admitted because he is convinced that all clergy go first to purgatory and then hell C. This client should be admitted because of an attempted jump from a bridge D. The client should be admitted because voices tell him to eliminate all people who look like terrorists B Which is a realistic expectation of clients participating in milieu therapy? A. To control or set limits on threats and aggressive acts B. To learn adaptive coping, interaction, and relationship skills C. That all maladaptive behaviors are eliminated and adaptive behaviors substituted D. That trust and rapport are quickly established in the context of the of the nurse-client relationship B The basic assumptions of a therapeutic community guide a nurse's actions when functioning in the role of milieu manager. Which nursing action is correctly matched with the appropriate assumption? A. The nurse encourages clients to take personal responsibility for personal behaviors (Assumption: peer pressure is a useful and powerful tool) B. The nurse takes immediate action when maladaptive behavior is demonstrated (Assumption: Restrictions and punishments are to be avoided) C. The nurse encourages client participation in environmental decision making. (Assumption: The client owns his or her own environment) D. The nurse uses least restrictive measures to subdue client anger (Assumption: every interaction is an opportunity for therapeutic intervention) C A suicidal client has not been responding to prescribed antianxiety medication. Which of the following should the nurse functioning in the role of medication manager consider when assessing this client? Select all that apply. A. The client may be cheeking the medication B. The client may be trying to accumulate medications for a suicide attempt C. The nurse may need to to check the client's mouth after drug administration D. The nurse may need to advocate for an alternative way to administer the drug E. The client may be allergic to the medication A, B, C, D A nurse believes that the members of a parenting group are in the termination phase of group development. Which group behaviors would support this assumption? A. The group members manage conflict within the group B. The group members use denial as part of a grief response C. The group members compliment the leader and compete for various position roles D. The group members trust one another and the leader B The nurse's ability to have unconditional positive regard for the client and also to maintain a non judgemental attitude is described as which characteristic that enhances the nurse-client relationship? A. Genuineness B. Empathy C. Objectivity D. Respect D When developing a therapeutic relationship with a client, which characteristic is the most essential? A. Catharsis B. Confrontation C. Genuineness D. Giving advice C What should the nurse's primary goal be during the termination phase of the nurse-client relationship? A. To evaluate goal attainment and ensure therapeutic closure B. To establish trust and formulate a contract for intervention C. To explore self perceptions D. To promote client change A A pacing, agitated client diagnosed with bipolar mania is unable to concentrate during an interaction with the nurse. The nurse uses closed-ended questions, offers finger foods, and reassures the client. What is the nurse promoting by these actions? A. Sympathy B. Trust C. Veracity D. Congruency B A client has recently experienced a second trimester miscarriage and is feeling very depressed. Which therapeutic statement by the nurse conveys empathy? A. You are feeling very depressed. I know how you feel. I felt the same way when I lost my first baby B. I can understand you are feeling depressed. It is difficult to lose a baby. I'll sit with you C. You seem depressed. I think it would be helpful if I explained to you the five stages of grief D. I know this is a difficult time for you. Would you like a prn medication to help you feel better? B In which phase of the nurse-client relationship would a nurse role-play with a client to practice appropriate ways to deal with anger? A. Preinteraction B. Orientation C. Working D. Termination C Which situation exemplifies rapport, a condition essential to the development of a therapeutic relationship? A. The nurse communicates regard for the client as a person of worth who is valued and accepted without qualification B. The nurse communicates an understanding of the client's world from the client's internal frame of reference, with sensitivity to the client's feelings C. The nurse communicates openness, self congruency, authenticity, and transparency when dealing with the client D. The nurse communicates acceptance, warmth, friendliness, common interests, a sense of trust, and a non judgemental attitude when dealing with the client D When being confronted for engaging in dysfunctional behavior during group therapy, a client uses the defense mechanism of projection. Which short term outcome is appropriate for this client? A. The client will not injure himself or herself or someone else B. The client will covertly express feelings of anger in group therapy C. The client will take responsibility for the dysfunctional behavior by the end of the shift D. The client will participate in outpatient therapy within 2 weeks of discharge C Which nonverbal behavior should a nurse avoid when gathering assessment data on a newly admitted client? Select all that apply. A. Maintain indirect eye contact with the client B. Provide space by leaning back away from the patient C. Sitting squarely, facing the patient D. Sitting with arms and legs in an open posture E. Standing while the client sits A, B, E A client diagnosed with an anxiety disorder tells the nurse, "I'm not sleeping much. I hurt all over and feel sad and irritable". Which of the following is subjective assessment data? Select all the apply. A. I'm not sleeping much B. My mood is a 4 on that 10 point scale C. I hurt all over D. I'm feeling sad E. I'm feeling irritable A, C, D, E Which data gathering technique can be employed during the evaluation step of the nursing process? Select all that apply. A. Asking the client to rate anxiety after administering an anxiolytic B. Asking the client to verbalize understanding of the explained unit rules C. Asking the client to describe any thoughts of self-harm D. Asking the client if the group on assertiveness skills was helpful E. Asking the client if a prn medication would be helpful A, B, D Which is an example of an open ended question? A. Did you say that your wife has a miscarriage last summer? B. Has your appetite improved since you have been admitted? C. Are you happy about being discharged today? D. How do you feel about your girlfriend's affair? D Which is an example of the therapeutic communication technique of offering a general lead? A: Cl: My wife is threatening to take sole custody of our children/ N: I see B. Cl: I need to talk to you about my divorce/ N: Where would you like to begin? C: Cl: Since the divorce I feel hollow inside/ N: help me understand what you mean by hollow D: Cl: I don't think I will ever be able to marry again/ N: You won't ever be able to marry again? A The client on an inpatient psychiatric unit states, " I don't think I will ever be able to get into a decent relationship". The nurse responds, "You are feeling powerless about establishing relationships?" Which communication technique has the nurse employed? A. Restating B. Focusing C. Reflection D. Exploring C A client states, "My husband says I'm cold but actually I think I am hot." In an attempt to clarify the meaning of the client's statement, which nursing response is the most appropriate? A. In what context are you using the word hot? B. Tell me more about that sensation C. I find that hard to believe D. Are you feeling rejected by your husband? A A client states, "I'm worried about my potential disability." The nurse responds, "You're worried about your disability?" Which communication technique is exemplified by this exchange? A. Broad opening B. Verbalizing the implied C. Restating D. Formulating a plan of action C Which example of a therapeutic communication technique should the nurse use when trying to obtain general information? A. You seem upset. Why do you feel this way? B. Are you feeling okay today? C. Let's talk about your family situation D. I hope that you are packed and ready to leave C Which correct statements related to the following nurse-client communication exchange? Client: "My mother neglected me" Nurse: I see. Go on..." Select all that apply. A. The communication technique is classified as therapeutic B. The communication technique is described as a broad opening C. The communication technique is described as giving recognition D. The communication technique is used to clarify revealed information E. The communication technique is used to communicate that the nurse is listening A,E A nursing instructor is teaching about the use of therapeutic techniques and non-therapeutic blocks to communication. Which student statement indicates that learning has occurred? A. Making an approval statements such as "That was a great decision" is considered non-therapeutic B. The technique of verbalizing the implied is considered non-therapeutic because the nurse is making an assumption C. The technique of suggesting collaboration is non-therapeutic because it implies that there is collusion between the nurse and the client D. Silence is a non therapeutic technique that should be avoided A A mentally ill client has the right to refuse treatment to the extent permitted by the law. It is important for the psychiatric nurse to be aware of this ethical / legal issue. Which situation would the nurse recognize as an example of this client right of refusal? A. The client has expressed a desire to harm a spouse and refuses to take all medications B. A client is benefitting from psychotropic medications but refuses drugs because of command hallucinations C. A client who has been deemed incompetent will not take ordered medications D. A client diagnosed with depression decides to not take his or her antidepressant medication D Which psychiatric therapy, in relationship to the others presented, is considered least restrictive? A. ECT B. Chemical interventions C. Verbal Rehabilitative techniques D. Mechanical restraints C Which action should the clinician take when there is reasonable certainty that a client is going to harm someone? Select all that apply. A. Assess the threat of violence toward another B. Identify the person being threatened C. Notify the identified victim D. Notify only law enforcement authorities to protect confidentiality E. Consider petitioning the court for continued commitment A, B, C, E A nurse is attempting to administer anti-anxiety medication to an involuntarily committed client. The client refuses the medication, curses and states, "I'm going to kill you." Which nursing action is most appropriate at this time? A. The nurse decides to not administer medication B. The nurse initiated the ordered, forced medication protocol C. The nurse initiates legal action to get the client declared competent D. The nurse teaches the client the pros and cons of medication compliance B A client has been deemed a danger to self by an emergency commitment court ruling. Which might the court mandate for this client? A. Voluntary commitment in a locked psychiatric facility B. Involuntary commitment to an outpatient mental health clinic C. Delaration of incompetence with mandatory medication administration D. Declaration of emergency seclusion B A group of inpatient psychiatric clients on a public elevator begin discussing an out-of-control client who is now in seclusion. Which is the appropriate nursing response? A. I know you are upset by the conflict on the unit. I'm glad you can talk about it B. Now you know what happens when you can't control your anger C. It is inappropriate to to discuss another client's situation in public D. Let's just not talk about this now C It has been determined that a newly admitted client is gravely disabled. Which of the following statutes that specifically defined the "gravely disabled" client would have led to the determination? Select all that apply. A. The client who, because of mental illness, cannot fulfill his or her activities of daily living B. The client who, because of mental illness, is unable to provide resources to meet their basic needs C. The client who, because of mental illness, has been deemed a danger to self and/or others D. The client who, because of mental i