Quiz 1 -- NURS 3370 Mental Health

After discharge teaching regarding the drug Tranylcpromine, which of the following patient statemnets/outcomes indicates a need for further instruction? Select all that apply.

a. "I can have roast beef"
b. "I can have chicken"
c. "I can having beef jerky"
d. "I can have coke"
e. "I can have soy sauce"

c, d, e

Medications used for long term anxiety problems include the following: (Select all that apply.)

a. Chlordiazepoxide HCL
b. Fluxetine HCL
c. Alprazolam
d. Buspirone
e. Paroxetine

b, d, e

An outpatient with a history of major depression states that he is happy and thinks he no longer needs his anti-depressant. What is the best response by the nurse?

a. "Don't stop your anti-depressant. You need it for your depression."
b. "This issue needs to be discussed with your healthcare provider."
c. "Your medicine is working. If you discontinue your anti-depressant, your depression will come back."
d. "If you discontinue your anti-depressant, your must wean off or you will experience undesirable effects."

c. "Your medicine is working. If you discontinue your anti-depressant, your depression will come back."

A patient is being prepped for heart valve replacement surgery. His BP is up to 138/86, HR 98, RR 22, T 97.4*F, and he complains of one episode of a loose stool this morning. What is the best next action by the nurse?

a. Assess the patient's feelings about the upcoming surgery.
b. Obtain a surgical permit.
c. Conduct a thorough GI assessment.
d. Continue prepping the patient for the surgery.

a. Assess the patient's feelings about the upcoming surgery.

The driver of an MVA is admitted unconscious to the ICU. The passenger is able to report that the patient "drinks a lot." Which question should the nurse ask next?

a. "When was your friend's last drink?"
b. "How much did your friend drink today?"
c. "What does your friend like to drink?"
d. "How much have you had to drink?"

a. "When was your friend's last drink?"

Which of the following exemplifies Reaction Formation coping behavior?

a. The new graduate is offered a job in a geriatric unit at graduation. She selects it deciding she can learn many basic skills in this area.
b. A new graduate who hates geriatrics is offered a new position in geriatrics, so she asks her mom who is a seasoned nurse what she would do.
c. The new graduate really dislikes geriatrics and is offered this area of practice at graduation. She decides there is no problem with this area.
d. The new graduate nurse really dislikes geriatrics but decides to work in a geriatric setting to improve her outlook.

d. The new graduate nurse really dislikes geriatrics but decides to work in a geriatric setting to improve her outlook.

A direct admission with no orders enters the psychiatric unit wearing a sheer black negligee, rings that appear to be diamonds on all 10 fingers, and no shoes, and accompanied by 2 hospital security personnel. Which of the following rooms would be most appropriate for this patient?

a. A private room furthest from the nurses' station.
b. Sharing a room with a depressed, suicidal patient close to the nurses' station.
c. Sharing a room with a substance abuse client who overdosed.
d. A private room closest to the nurses' station.

a. A private room furthest from the nurses' station.

The nurse is admitting a new patient to the unit and needs to complete the patient's history. Which of the following communication techniques will be most useful to complete this task?

a. Open-ended communication techniques
b. Closed-ended communication techniques
c. Non-facilitative techniques
d. Reflecting-Restating techniques

b. Closed-ended communication techniques

A young male college student, working as a substitute teacher at a high school, wants to be recognized as a teacher rather than a student, so uses the coping skill identification. Which of the following behaviors exemplifies identification?

a. He notes one of the students is coming onto him, and he asks her out.
b. The student wears adult leather tie up shoes, a button down shirt, and a tie to work.
c. The student attempts to speak business type jargon.
d. The student wears the same type of clothes as the students to relate to them.

b. The student wears adult leather tie up shoes, a button down shirt, and a tie to work.

A patient makes a near lethal suicide attempt on the unit. After addressing the life-threatening injury, what should the nurse delegate the CNA to do after calling a code?

a. Come back to the room and help with the patient who is injured.
b. Immediately conduct a check of all patients on the unit.
c. Move all patients to the day room and stay with them.
d. Meet the individuals arriving for the code at the door and direct them to the patient's room.

c. Move all patients to the day room and stay with them.

A depressed client presents to the nurses' station complaining of extreme fatigue and dry mouth, and asks if he can lay down in his room rather than go to the group session this morning. What is the best response by the nurse?

a. "No! You cannot sleep through group therapy. You must go!"
b. "Depression causes fatigue and so does your medication. Go lie down and get some needed rest."
c. "Your medication is causing your dry mouth and fatigue. Get some water and go to group, which is a part of your contract we covered on admission."
d. "I am so sorry you are tired and know you must want to sleep. I am also sorry that you must go to group, but it is necessary for your recovery."

c. "Your medication is causing your dry mouth and fatigue. Get some water and go to group, which is a part of your contract we covered on admission."

Which of the following are characteristics of a manic state? Select all that apply.

a. Hyperactivity
b. Pressured speech
c. Sexual acting out
d. Delusions
e. Hallucinations

a, b, c, d ?

Which of the following are symptoms of PTSD? Select all that apply.

a. Nightmares
b. Flashbacks of the experience
c. Intrusive thoughts
d. Hallucinations
e. Emotional detachment

a, b, c, e

A patient says, "I'm finished with it all." What is the best response by the nurse?

a. "Don't worry, everything will be better soon."
b. "What do you mean when you say that?"
c. "Lunch is here. We can finish our discussion later."
d. Remain silent so the client may continue.

b. "What do you mean when you say that?"

A bipolar patient in a manic state is not eating the food sent by dietary. What is the best plan by the nurse to address this issue?

a. Order pre-wrapped/sealed finger foods.
b. Obtain a 24-hour dietary recall.
c. Obtain dietary preferences from the family.
d. Ask the patient foods he/she likes and order these foods.

a. Order pre-wrapped/sealed finger foods.

Which of the following behaviors exemplifies passive-aggressive coping skills? Select all that apply.

a. A teenage girls who likes the quarterback tells her friends he's coming onto her.
b. A supervisor states that you are performing well, but makes cutting remarks about you in front of your peers.
c. The mother-in-law arrived uninvited 2 hours early to her daughter-in-law's dinner party to help.
d. A local candidate running for office says that the well-respected governor is offering his support.
e. An employee is informed his tardiness to meetings is problematic. The next meeting the employee is 5 minutes later than usual.

b, c, e

Which of the following discharge teaching points should be included when instructing a patient about Lithium? Select all that apply.

a. Drink plenty of fluids.
b. Contact your provider if you experience nausea, vomiting, and/or diarrhea.
c. Exercise in a climate controlled environment on a steady routine.
d. Come to the clinic for regular blood level checks.
e. Eat a stead diet in green vegetables.

a, b, c, d

A woman who was drinking and driving and seriously injured a young man joins MADD to prevent such incidents. Which coping skill does this represent?

a. Sublimation
b. Reaction Formation
c. Intellectualization
d. Undoing

d. Undoing

Discharge teaching for a patient started on Duloxetine should include which of the following points? Select all that apply.

a. You may experience sexual dysfunction
b. Fluid retention is common
c. Weight gain may occur
d. It will take 2-3 weeks for this drug to reach therapeutic levels
e. Take every day and do not stop abruptly

a, d, e

Which of the following behaviors represents the coping behavior Suppression?

a. A man who hunted wild animals joins a committee to protect animals.
b. A woman diagnosed with Parkinson's disease tells her family that her tests were all clear for Parkinson's.
c. The father of a family of 5 has yet to make out a will. He keeps saying, "I'll do that later."
d. Someone who dislikes animals works at an animal shelter.

c. The father of a family of 5 has yet to make out a will. He keeps saying, "I'll do that later."

A seasoned RN is critiquing the new graduate's ability to admit the psychiatric patient. The new RN notices the patient has a T-shirt from Delta-Nu and says, "I'm a Delta Nu too." Later, the experienced RN says this was inappropriate. What is the new grad's best response?

a. "This is a theory I learned in school that works. You must be an ADN!"
b. "I can see how that might be perceived as sharing too much information. I won't do that again."
c. "The girl is so scared. I was trying to reduce her anxiety."
d. "I was attempting to build trust by pointing out a similarity we have."

d. "I was attempting to build trust by pointing out a similarity we have."

A TTU student nurse is expected not to cheat. The same TTU graduate nurse has the opportunity to hide a medication error. Being a TTU graduate, the nurse reports the error because he/she feels it is expected of him/her. What coping skill is this?

a. Denial
b. Repression
c. Introjection
d. Intellectualization

c. Introjection

An admitted client with COPD has a co-existing diagnosis of panic attacks, especially when exposed to spiders. The patient starts hyperventilating uncontrollably when she sees a spider on television. What action should the nurse take first?

a. Give the patient a Benzodiazapine.
b. Explain that there is nothing to panic about.
c. Use slow, deep breathing exercises to help the patient relax.
d. Place a brown paper bag over the patient's mouth to increase CO2 levels.

d. Place a brown paper bag over the patient's mouth to increase CO2 levels.

A patient in the ER with a fractured femur requests pain medication. His admission assessment reports he takes Phenelzine Sulfate daily. Which order for pain should be questioned first?

a. Ibuprofen 500 mgs PO every 6-8 hours as needed for pain.
b. 1 mg Morphine Sulfate IV per minute up to 8 mgs until pain relieved.
c. Meperdine 10 mgs IM now for pain.
d. Acetaminaphin 500 mgs PO every 6-8 hours as needed for pain.

c. Meperdine 10 mgs IM now for pain.

A child who wants to play football is too small to be successful, but found he has marvelous skills in chorus. Which coping skill does this represent?

a. Projection
b. Rationalization
c. Sublimation
d. Intellectualization

c. Sublimation

The mother of a teen who is seriously injured from an MVA runs into the ER. She is standing in shock and not allowed to see her son yet. What actions by the nurse will best help the mother through this crisis?

a. Give simple, short commands that are not life long decisions -- ex: "Who do you need to call now? Where is your phone?" etc.
b. Help the mother determine if she wants the child to be an organ donor.
c. Contact the mother's PCP to obtain medication for the mother.
d. Contact family members for the mother and explain the situation.

a. Give simple, short commands that are not life long decisions -- ex: "Who do you need to call now? Where is your phone?" etc.

A person gets a speeding ticket and comes home and throws a lamp across the room. What coping skill is this?

a. Reaction Formation
b. Sublimation
c. Projection
d. Displacement

d. Displacement

The new graduate notices the RN admitting an uncooperative, making no eye contact, patient to the psychiatric unit. You notice the RN immediately start the nursing admission assessment and the patient becomes more agitated. You interpret this behavior as?

a. This patient needs to be placed in a private room furthest from the nurses station.
b. This patient needs a 1:1 to protect the client.
c. This patient needs a benzodiazepine before the behavior gets out of control.
d. The RN failed to attempt to establish trust with this patient.

d. The RN failed to attempt to establish trust with this patient.

A patient admitted for depression and suicidal ideation 5 days ago suddenly displays a happier affect this morning. How should the nurse interpret this change in behavior?

a. The patient is feeling more comfortable with peers on the unit.
b. The patient may be suicidal. A suicidal assessment is critical.
c. The group therapy sessions are effective with this client.
d. The antidepressant(s) are starting to work.

b. The patient may be suicidal. A suicidal assessment is critical.

A patient enters the ER drunk. Two of his three children are dead on arrival and the third has a severe head injury. You are assigned to the father. Which coping skill is necessary to give this patient safe, competent care?

a. Denial
b. Isolation
c. Intellectualization
d. Rationalization

b. Isolation

A former patient calls the unit complaining that the antidepressant isn't working. You determine the medication was started 2 weeks ago. What is the best response by the nurse?

a. "You shouldn't being to worry until after 3 weeks."
b. "It takes 2-3 weeks to get to a therapeutic level. Let's give it another week."
c. "Don't worry. It should be ok by the end of next week."
d. "Why don't you wait another week and then let us know what is going on with your medication."

b. "It takes 2-3 weeks to get to a therapeutic level. Let's give it another week."

When is the best time to draw blood for a Lithium level?

a. Immediately before the next dose is given.
b. 30 minutes before the next dose is due.
c. 20 hours after the last dose was given.
d. 30 minutes after the last dose was given.

c. 20 hours after the last dose was given.

A patient with rule out bipolar disorder diagnosis is admitted to the unit. Orders include Lithium, regular diet, CBC, and thyroid function tests. What action should the nurse take to insure accurate patient outcomes?

a. CBC should be drawn before Lithium is started.
b. T3 and T4 should be obtained before Lithium is started.
c. CBC should be obtained while patient is NPO.
d. TSH should be drawn after Lithium is started.

b. T3 and T4 should be obtained before Lithium is started.

Which of the following behaviors best represents Repression?

a. An abused teen who refuses to talk about the abusive events.
b. An abused school-age child who starts bed-wetting.
c. A sexually abused teen who cannot remember the traumatic event(s).
d. A sexually abused child now as an adult work with sexually abused children.

c. A sexually abused teen who cannot remember the traumatic event(s).

A man learns that the company he works for is reducing employees to save money, and he is one of those people. Which of the following behaviors demonstrates Denial?

a. The man starts searching for a future job.
b. The man talks about the situation with other employees.
c. The man fails to file for unemployment.
d. The man talks with his wife about the incident.

c. The man fails to file for unemployment.

Which of the following exemplifies Rationalization? Select all that apply:

a. "I didn't do well on that exam because the teacher didn't cover that material."
b. "I didn't do well on that exam because that wasn't the material I studied."
c. "I didn't do well on that test because I didn't study enough."
d. "I didn't do well on that test because I waited too late to study and stayed up all night."
e. "I didn't do well on that test because the teacher writes bad test questions."

a, b, e

On the third day of admission, a depressed psychiatric patient is noted spending more time with the patients than staff. How does the nurse interpret this behavior?

a. The patient is moving from the staff to the patient population -- a negative move.
b. The patient is moving to a more social relationship and this needs to be stopped and interventions carried out.
c. The patient is moving to a more social relationship.
d. The patient is moving from the staff to the patient population -- a positive move.

d. The patient is moving from the staff to the patient population -- a positive move.

Identify the examples of non-facilitative statements made by the nurse to the patient. Select all that apply:

a. "If it were me, I'd try another more successful coping skill."
b. "Why don't you stop feeling those negative feelings?"
c. "I think you should contact your uncle."
d. "You should know the policies of the unit by now."
e. "Just a minute, I'll be back in just a minute."

a, b, c, d, e

Match the phobia with its appropriate definition.

a. Fear of heights
b. Fear of crowds or open places/spaces
c. Fear of the dark
d. Fear of water
e. Fear of death

1. Acrophobia
2. Agoraphobia
3. Hydrophobia
4. Nyctophobia
5. Thantophobia

a - 1
b - 2
c - 4
d - 3
e - 5

Which of the following patients would be the best room assignment for a new admission depressed, suicidal patient with a history of alcohol abuse?

a. Major Depression patient
b. Schizophrenia of the paranoia type
c. Bipolar disorder-manic phase
d. Substance (alcohol) withdrawal

a. Major Depression patient

A suicidal inpatient refuses to comply with a "no harm to self or others" verbal contract. What is the priority nursing action?

a. Contact the primary care provider.
b. Place the patient on 1:1 observation.
c. Document the patient's response.
d. Administer a PRN medication.

b. Place the patient on 1:1 observation.

On admission, whom should the RN assign the task of searching the patient's belongings for sharps and other harmful paraphernalia?

a. LPN
b. The RN him/herself should do this during the admission assessment period.
c. CNA
d. A separate RN

c. CNA

Which of the following statements made by the nurse to the patient is top priority on admission to a psychiatric unit?

a. What is your plan of action to harm yourself?
b. Do you have current access to a gun?
c. Are you having thoughts of harming yourself or others?
d. Why did you bring a gun to the hospital?

c. Are you having thoughts of harming yourself or others?

Which of the following symptoms your patient is exhibiting supports depression? Select all that apply:

a. Compulsive acts
b. Constipation
c. Sleep pattern changes
d. Changed physical appearance (unkempt, slumped, etc.)
e. Indecisiveness

b, c, d, e

Which of the following medications from the MAR would be most appropriate to administer to a patient displaying physical outbursts that are non-reponsive to de-escalating techniques?

a. Lorazepam
b. Fluvoxamine
c. Buspirone
d. Sertaline

a. Lorazepam -- a Benzodiazepine

Which of the following behaviors of a wife married to an alcoholic exemplifies Intellectualization?

a. The wife acknowledges her husband's disease and does not interfere with his employer.
b. The wife recognizes her husband is an alcoholic but calls his employer and reports him ill when he has a hangover.
c. The wife accepts the implications of her husband's disease.
d. The wife has difficulty accepting the implications of her husband's disease.

b. The wife recognizes her husband is an alcoholic but calls his employer and reports him ill when he has a hangover.

A high school student learns he did not get into the college of his choice. Which of the following behaviors represents the most severe form of Regression?

a. Cries
b. Curls up in bed
c. Throws items
d. Sucks his thumb

b. Curls up in bed (displaying fetal position)

Which of the following responses are the communication techniques Acknowledgement and Clarification?

a. "You have had some bad things happen, but you really shouldn't worry."
b. "After listening to your situation, have you considered other options?"
c. "So am I hearing you say that you believe a woman has a right to make her own choice when it comes to abortion?"
d. "So are you saying you are a vegan?"

c. "So am I hearing you say that you believe a woman has a right to make her own choice when it comes to abortion?"

A new nurse working on a psychiatric unit finds that none of the patients respond positively to her (seek her out to talk about problems, etc.). What is the best way to learn about this issue?

a. Talk to the patients about herself and her needs.
b. Ask her family about her non-verbal signals.
c. Discuss with peers what non-verbal signals she might be sending that is creating this response.
d. Just ignore the issue as it will resolve itself as she gets more experience.

c. Discuss with peers what non-verbal signals she might be sending that is creating this response.

True or False: A patient with an anxiety disorder should be admitted to a room closest to the nurses' station.

False.