Question 1

A patient with schizophrenia calls the nurse into the room and says,"Help me! The books are on fire!" Which response by the nurse is best?

Accepted Answer

The nurse needs to validate that the patient's comment was heard but then needs to bring the patient back to reality by saying that it is time for a meal.A.Putting water on it is inappropriate-there is no fire.B.Telling a mental health patient he or she is crazy is inappropriate.C.The nurse cannot use logic such as saying that the patient does not have any books.A patient with schizophrenia may be unable to see logic.

Question 2

A patient who is a war veteran states,"It should have been me that died.I'll never forgive myself for leaving my buddy when he needed me." The nurse recognizes this statement is most associated with which diagnosis?

Accepted Answer

A behavior associated with PTSD is survivor guilt,which is the feeling of guilt expressed by those who have survived a tragedy.A survivor of an airline crash may say,"Why me? Why did I make it? I should have died too!" A.B.C.Survival guilt is not associated with bipolar depression,generalized anxiety,or obsessive-compulsive disorder.

Question 3

The nurse notes that another nurse colleague has been acting differently lately.The nurse often has red watery eyes and a runny nose.Today,the nurse was unhappy with the patient assignment and screamed,"Someone is going to pay for this!" What should the nurse who has observed this behavior do?

Accepted Answer

The nurse should document the behavior and inform the supervisor.A.Doing nothing could lead to harm to the nurse's patients.C.Telling the manager that the nurse is using drugs is making an assumption.D.Confronting the nurse is not the role of a coworker.It is the job of the manager to follow up and ensure that the nurse is safe to provide patient care.

Question 4

A patient with schizophrenia has not bathed recently and a family member states that the patient has not been out of the house for 10 days.The patient tells the nurse,"They are trying to hurt me; don't let them hurt me." Which symptom is this patient demonstrating?

Accepted Answer

Patients with paranoid schizophrenia tend to have delusions of persecution or grandeur.Patients experiencing persecutory delusions state that they feel tormented and followed by people.B.In delusions of grandeur,patients may state that they are God or the President of the United States.C.Hallucinations often accompany delusions but are not the same as delusions.The hallucinations can affect any of the five senses but are most commonly auditory followed by visual.A.Patients with paranoid schizophrenia talk about hearing "voices."

Question 5

The spouse of an older male patient is concerned because since retiring the patient sits around the house,avoids eating,naps,and refuses to participate in sporting activities.Which disorder should the nurse recognize as being associated with these manifestations?

Accepted Answer

According to the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V),symptoms of major depression include either a depressed mood or anhedonia which is the loss of pleasure in things that are usually pleasurable along with additional symptoms such as change in appetite and sleep patterns.B.Bipolar disorder is also characterized by periods of mania as well as depression.C.Conversion disorder involves the conversion of a mental health problem into physical symptoms.D.PTSD occurs after a major trauma.

Question 6

A patient who experienced injuries from a motor vehicle crash 6 months ago continues to request prescriptions for an opioid analgesic.When assessing this patient for opioid dependency which finding is the nurse least likely to observe?

Accepted Answer

Being able to work each day is not an observation associated with opioid addiction.A.C.D.The patient with an addiction gives up important social or professional functions to use the substance,has tried at least once to quit but still obsesses about the substance,spends significant time obtaining the substance,and is unable to fulfill major role obligations at work,school,or home.

Question 7

The nurse is providing care for a patient with symptoms of tardive dyskinesia from major tranquilizers.What treatment should the nurse anticipate?

Accepted Answer

Anticholinergic medications such as benztropine (Cogentin)or trihexyphenidyl (Artane)are used to combat the extrapyramidal side effects of the typical antipsychotics by helping return balance between dopamine,acetylcholine,and other neurotransmitters.B.D.Addition of rational emotive therapy or muscle relaxants will not affect the cause of the symptoms.C.Discontinuing the tranquilizers may help but may not be realistic if the patient needs them to control symptoms.

Question 8

The nurse is completing a mental status examination for a newly admitted patient.In which part of the nursing process is the nurse functioning?

Accepted Answer

A mental status examination is part of the assessment phase,though it may be done again during the evaluation phase to determine progress toward goals.B.C.An examination is not completed during the planning or implementation phases of the nursing process.

Question 9

A patient with a mental illness says,"I have to go to the bank.The voices are telling me to go there." Which response by the nurse is best?

Accepted Answer

The nurse needs to validate the patient's concern without exploring and focusing on the delusion.The patient needs to know what is real and what is not.B.Calling a cab and focusing on therapy does not validate the patient's concern.C.Asking the patient about the voices encourages the patient to focus on the delusion.D.Asking about money might be appropriate for an older person with dementia,but a patient with schizophrenia needs to be brought back to reality.

Question 10

A patient who has schizophrenia has a dull facial expression and speaks in a monotone voice,even though a visitor is making an effort to be jovial.What terminology should the nurse use to document this observation?

Accepted Answer

Affect is the outward expression of mood-a patient who speaks in a monotone voice and has a dull expression has a flat affect.B.Depression is a medical diagnosis.A.D.Documenting boredom or ambivalent attitude is subjective and should be verified with additional assessment.

Question 11

A patient who is withdrawing from alcohol is restless and reports seeing snakes on the ceiling.Vital signs are blood pressure 180/100 mm Hg,pulse 92 beats/min,and respirations 22 breaths/min.What should the nurse do first?

Accepted Answer

According to Maslow's hierarchy,physiological symptoms must be attended to first.The patient's blood pressure is at an unsafe level.A.B.Once the patient's blood pressure is under control,then Ativan and relaxation may be helpful.C.Searching the room for alcohol is occasionally necessary,but a patient who has withdrawal symptoms is not likely using alcohol.

Question 12

A patient is newly diagnosed with a trauma related disorder.Which medication should the nurse expect to be prescribed for this patient?

Accepted Answer

Psychopharmacology for trauma related disorders may involve benzodiazepines which are antianxiety medications.Alprazolam (Xanax)is commonly used and is effective in most cases.Benzodiazepines are used for short-term treatment because of the strong potential for chemical dependency.A.B.C.Individuals who need longer term therapy for anxiety or who have chemical dependency tendencies may be treated with buspirone (Buspar),selective serotonin reuptake inhibitors (SSRIs)paroxetine (Paxil)or sertraline (Zoloft).

Question 13

The nurse is cautiously avoiding the temptation to take unused or wasted doses of narcotic medications when providing patient care.What percentages of nurses in the United States are chemically impaired?

Accepted Answer

According to the National Council of State Boards of Nursing,between 6 and 15 percent of nurses in the United States are chemically impaired.A.More than 5% of nurses are chemically impaired.C.D.The percentage of nurses who are chemically impaired is not above 15%.

Question 14

A patient cannot leave home without checking the coffee pot numerous times.This behavior makes the patient late to many functions.Which anxiety disorder should the nurse suspect the patient is experiencing?

Accepted Answer

Repeatedly checking the coffee pot is an example of a compulsion which is a part of obsessive compulsive disorder (OCD).A.B.C.Compulsions are not manifestations associated with GAD,phobias,or PTSD.

Question 15

The nurse is assisting with teaching a patient who has been started on fluphenazine (Prolixin).About which side effect should the nurse focus this teaching?

Accepted Answer

Prolixin can cause photosensitivity,so the patient should be cautioned about sun protection.D.It can cause hypotension,not hypertension.A.B.It is not associated with weight loss or hypoglycemia.

Question 16

The nurse is caring for an older adult patient with a history of depression.Which comment by the patient indicates an immediate need for further assessment?

Accepted Answer

Comments by any older adult referring to hopelessness or desire to die must be explored to assess suicide risk.A.C.These comments may require further assessment however is not as hopeless sounding as the statements about having no reason to be alive.C.Looking forward to seeing a spouse in heaven someday is a positive comment.

Question 17

The nurse is assisting with medication teaching for a patient who is prescribed lithium carbonate (Eskalith)for bipolar disorder.Which instruction by the nurse is most important?

Accepted Answer

Lithium is an antimanic medication with a very narrow therapeutic range so toxic drug levels can easily develop.Lithium levels must be drawn regularly to assess that serum levels are in the therapeutic range.C.Reporting of side effects is important,but nausea and weight gain are not life-threatening.A.The patient should not discontinue other antidepressants unless instructed to do so by the physician.B.Lithium will stabilize mood swings,and it is important to tell the patient this,but not as important as advising the patient to have regular levels checked to avoid toxicity.

Question 18

The nurse assists with admission of a patient to the hospital with pancreatitis and a history of alcohol abuse.Why should the nurse observe the patient for agitation,tremors,and hallucinations?

Accepted Answer

Patients who are actively using drugs or alcohol when admitted to an inpatient setting,or who are cut off from their alcohol abruptly,can experience a condition called delirium tremens (DTs).In DTs,hyper-excitability can cause visual hallucinations,tremors,and possibly tonic-clonic seizures.B.These are not symptoms of cirrhosis.D.Patients with alcohol histories are at risk for cognitive changes,but not necessarily mental illness.C.If the patient were using alcohol in the hospital,he or she would not be experiencing DTs.

Question 19

A patient is diagnosed as having a phobia.Which fear should the nurse expect to observe in this patient?

Accepted Answer

A phobia is an irrational fear of an object or situation-it is not normal to fear leaving the house.A.C.D.The fear of poisonous snakes,failing a test when unprepared,and a child getting hurt when playing in the street are reasonable things to fear.

Question 20

A patient hospitalized for bipolar disorder is sitting in the corner of the room with the lights off,staring into space.Three hours later,the patient is in the same position.What should the nurse say to the patient?

Accepted Answer

Saying "Come with me.I'd like you to join our group for a while," removes the patient from the situation and does not give him or her a choice.A is inappropriate.If the patient could cheer up,he or she would not be in the hospital.D.Asking what is the matter is also inappropriate-the patient does not likely know.C.Telling the patient he or she will not make any progress will cause feelings of guilt,which is not helpful.

Quiz 57: Nursing Care of Patients With Mental Health Disorders