Question 1

The client arrives to the ED complaining of severe abdominal pains. The attending health-care provider determines that the client is in labor. Upon further investigation, the nurse discovers that the client uses illegal substances and did not seek prenatal care. Which of the following would best explain this lack of prenatal care?

A) Many states consider substance use during pregnancy as child abuse.
B) The client was never educated about the need for prenatal care.
C) The client had children at home and considered prenatal care unnecessary.
D) The client did not have the financial resources to obtain prenatal care.

Many states consider substance use during pregnancy as child abuse.

Accepted Answer

1.This is correct. Many states consider substance use during pregnancy to be child abuse with legal consequences, and health-care professionals are required to report suspected prenatal drug use.
2.This is incorrect. Despite no education for the need for prenatal care, this is not the best explanation for lack of care.
3.This is incorrect. Each pregnancy is unique, and prenatal care is paramount for the well-being of both mother and infant.
4.This is incorrect. Although prenatal care can be costly, there are resources to help the mother obtain adequate prenatal care.

Question 2

The nurse is providing care for clients in a free community clinic. Which technique should the nurse use to conduct a trauma screening?&#10;A) Perform a general environmental survey.&#10;B) Implement a thorough head-to-toe assessment.&#10;C) Interview in a secluded area.&#10;D) Use empathy with the family members.&#10;

Accepted Answer

1.This is incorrect. Quickly assessing the overall situation is not the technique or purpose of a trauma screening.
2.This is incorrect. Implementing a thorough head-to-toe assessment is not the technique a nurse should use for a trauma screening.
3.This is correct. Interviewing in a secluded area is the technique the nurse should use during a trauma screening. It is critical that nurses conduct trauma screenings in private and communicate with a compassionate, nonjudgmental attitude.
4.This is incorrect. While using empathy is appropriate in a trauma screening, the client is the focus for the empathy. When clients have been abused, experienced violence, or lived through trauma, compassion and sensitivity are needed.

Question 3

The nurse manager has set a new policy on the unit to facilitate effective collaboration and locate referrals for clients who require mental health services. Which of the following is an appropriate resource to locate resources?

A) Online treatment map provided by the Substance Abuse and Mental Health Services Administration
B) Nonsuicidal self-injuring behavioral screening tool
C) Screen for adverse childhood events
D) SBIRT

Online treatment map provided by the Substance Abuse and Mental Health Services Administration

Accepted Answer

1.This is correct. This map provides an online locator to identify mental health and substance abuse treatment services in localities throughout the United States.
2.This is incorrect. This is a screening tool, not a tool for collaboration or referrals.
3. This is incorrect. This is a screening tool regarding the client's background, not a tool for collaboration or referrals.
4.This is incorrect. This is a tool to treat clients with substance abuse disorders.

Question 4

Which student statement indicates that further teaching is needed regarding the recovery process according to Andresen and associates?&#10;A) &#34;A client has a better chance of recovery if he or she truly believes that recovery can occur.&#34;&#10;B) &#34;If a client is willing to give the responsibility of treatment to the health-care team, he or she is likely to recover.&#34;&#10;C) &#34;A client who has a positive sense of self and a positive identity is likely to recover.&#34;&#10;D) &#34;A client has a better chance of recovery if he or she has purpose and meaning in life.&#34;&#10;

Accepted Answer

1.This is incorrect. This statement is accurate; if a client believes recovery can occur, then they are likely to recover. Teaching has been effective.
2.This is correct. In examining a number of studies, Andresen and associates identified four components that were consistently evident in the recovery process. Under responsibility, this model tasks the client, not the health-care team, with taking responsibility for his or her life and well-being. Further teaching is required.
3.This is incorrect. This statement is accurate; A client who has a positive sense of self and a positive identity is likely to recover. No further teaching is required.
4.This is incorrect. If a client feels they have a purpose in life, then they have a better chance of recovery. This statement is accurate, and no further teaching is required.

Question 5

A client tells the nurse they are working on step 3 of the WRAP model and would like some assistance. With which activities would the nurse anticipate assisting the client?&#10;A) Encouraging the client to write a list of strategies to alleviate disturbing symptoms&#10;B) Creating a to-do list and checking off tasks on those lists, such as doing laundry&#10;C) Helping the client list triggers that cause stress or discomfort&#10;D) Encouraging the client to use items from the toolbox when confronted with triggers&#10;E) Identifying warning signs and visiting with a counselor when experiencing warning signs&#10;

Accepted Answer

1.This is incorrect. This describes step 1 (developing a wellness toolbox so the client can use these tools when they are needed later).
2.This is incorrect. This describes step 2 (daily maintenance list).
3.This is correct. Step 3 of the WRAP model involves the client creating a list of triggers that have caused stress or discomfort in the past.
4.This is correct. Step 3 of the WRAP model involves the client creating a list of triggers that have caused stress or discomfort in the past and using items from their toolbox created in step 1 when confronted with those triggers.
5.This is incorrect. This describes step 4 (early warning signs). During this stage, the individual recognizes symptoms are worsening and that the individual should seek help.

Question 6

For which client would the nurse question the use of electroconvulsive therapy (ECT)?&#10;A) A client with schizophrenia and hypertension&#10;B) A client with mania and seasonal allergies&#10;C) A client with obsessive-compulsive disorder (OCD) and a history of cancer&#10;D) A client with major depressive disorder (MDD) who feels sad&#10;

Accepted Answer

1.This is correct. ECT is contraindicated in clients with untreated hypertension or heart disease.
2.This is incorrect. ECT is used for clients with mania; seasonal allergies are not a contraindication.
3.This is incorrect. ECT is not commonly used for OCD but can be useful to treat OCD; it is not contraindicated for clients with a history of cancer.
4.This is incorrect. ECT is used for MDD; sadness is a symptom of MDD.

Question 7

Which statement by the student indicates a need for further teaching regarding client preparation for electroconvulsive therapy (ECT)?&#10;A) &#34;I will ensure my client has voided before the procedure.&#34;&#10;B) &#34;My client's spouse is holding his wedding band while he is having ECT.&#34;&#10;C) &#34;I told my client it is okay for him to wear his contact lenses during the procedure so he does not lose them.&#34;&#10;D) &#34;My client has removed her dentures and placed them in a denture cup with her name on it.&#34;&#10;

Accepted Answer

1.This is incorrect. Teaching has been effective since the student has instructed the client to void.
2.This is incorrect. Teaching has been effective since the client's spouse is holding his jewelry during the procedure.
3.This is correct. Teaching was ineffective because the student told the client they could wear their contact lenses during the procedure. The client must remove eyeglasses and contact lenses for ECT.
4.This is incorrect. Teaching has been effective if the student has instructed the client to remove their dentures for ECT.

Question 8

Which response by the instructor is accurate regarding blood pressure cuff placement on the client's lower leg during an electroconvulsive therapy (ECT) procedure?&#10;A) &#34;The cuff has to be placed on the leg because both arms are used for IV fluids.&#34;&#10;B) &#34;The cuff functions to prevent succinylcholine from reaching the foot.&#34;&#10;C) &#34;The cuff position gives a more-accurate blood pressure reading during the treatment.&#34;&#10;D) &#34;The cuff is placed on the leg so that arms can easily be restrained during seizure.&#34;&#10;

Accepted Answer

1.This is incorrect. Both arms are not used for IV therapy.
2.This is correct. A blood pressure cuff is placed on the lower leg and inflated above systolic pressure before injection of succinylcholine. This is to ensure that seizure activity can be observed and timed in the one limb that is unaffected by the paralytic agent.
3.This is incorrect. The leg does not give a more-accurate blood pressure reading.
4.This is incorrect. A cuff is not placed on the leg in order to restrain the arms.

Question 9

During a course of 12 electroconvulsive therapy (ECT) procedures, an anxious client diagnosed with major depressive disorder (MDD) refuses to bathe or attend group therapy. The client reports some memory problems and says he has trouble figuring out what time of day it is. Which of the following nursing diagnoses should be assigned to this client? Select all that apply.

A) Anxiety R/T post-ECT confusion and memory loss
B) Risk for injury R/T post-ECT confusion and memory loss
C) Risk for activity intolerance R/T post-ECT confusion and memory loss
D) Altered sensory perception R/T post-ECT confusion and memory loss
E) Social isolation R/T post-ECT confusion and memory loss

Accepted Answer

1.This is correct. The most common side effects of ECT leading to client anxiety are temporary memory loss and confusion.
2.This is correct. The client is at risk for injury due to anxiety related to post-ECT side effects of confusion and memory loss.
3.This is correct. The client is at risk for activity intolerance due to post-ECT side effects of confusion and memory loss.
4.This is incorrect. Altered sensory perception is related to psychosis and hallucinations associated with schizophrenia rather than MDD.
5.This is correct. Social isolation characterized by not attending group therapy is related to post-ECT side effects of confusion and memory loss.

Deck 8: The Psychiatric-Mental Health Client in Nonpsychiatric Settings