NURS 413: Nursing Management of Maladaptive Behavior

When providing respectful, appropriate nursing care, how should the nurse identify the patient and his or her observable characteristics?

a.  The manic patient in room 234

b.  The patient in room 234 is a manic

c.  The patient in room 234 is possibly a manic

d.  The patient in room 234 is displaying manic behavior

D

Recognizing the frequency of depression among the American population, the nurse should advocate for which mental health promotion intervention?

a.  Including discussions on depression as part of school health classes

b.  Providing regular depression screening for adolescent and teenage students

c.  Increasing the number of community-­ based depression hotlines available to the public

d.  Encouraging senior centers to provide information on accessing community depression resources

B

Which statement made by a patient demonstrates a healthy degree of resilience? Select all that apply.

a.  “I try to remember not to take other people’s bad moods personally.”

b.  “I know that if I get really mad, I’ll end up being depressed.”

c.  “I really feel that sometimes bad things are meant to happen.”

d.  “I’ve learned to calm down before trying to defend my opinions.”

e.  “I know that discussing issues with my boss would help me get my point across.”

A D E

Which statement demonstrates the nurse’s understanding of the effect of environmental factors on a patient’s mental health?

a. “I’ll need to assess how the patient’s family views mental illness.”

b.  “There is a history of depression in the patient’s extended family.”

c.  “I’m not familiar with the patient’s cultural view on suicide.”

d.  “The patient’s ability to pay for mental health services needs to be assessed.”

C

When considering stigmatization, which statement made by the nurse demonstrates a need for immediate intervention by the nurse manager?

a. “Depression seems to be a real problem among the teenage population.”

b.  “My experience has been that the Irish have a problem with alcohol use.”

c.  “Women are at greater risk for developing suicidal thoughts than acting on them.”

d.  “We’ve admitted several military veterans with posttraumatic stress disorder this month.”

B

A nursing student new to psychiatric-­mental health nursing asks a peer what resources he can use to figure out which symptoms are present in a specific psychiatric disorder. The best answer would be:

a. National Institute of Mental Illness

b. National Alliance on Mental Illness

c. International Classification for Nursing Practice

d. DSM

D

Epidemiological studies contribute to improvements in care for individuals with mental disorders by:

a.  Providing information about effective nursing techniques.

b.  Identifying risk factors that contribute to the development of a disorder.

c.  Identifying individuals in the general population who will develop a specific disorder.

d.  Identifying which individuals will respond favorably to a specific treatment.

B D

Which of the following activities would be considered nursing care and appropriate to be performed by a basic level nurse for a patient suffering from mental illness?

a. Treating major depressive disorder

b. Teaching coping skills for a specific family dynamic

c. Conducting psychotherapy

d. Prescribing antidepressant medication

B

Which statement about mental illness is true?

a. Mental illness is a matter of individual nonconformity with societal norms.

b. Mental illness is present when irrational and illogical behavior occurs.

c. Mental illness changes with culture, time in history, political systems, and the groups defining it.

d. Mental illness is evaluated solely by considering individual control over behavior and appraisal of reality.

C

The World Health Organization describes health as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Which statement is true in regard to overall health? Select all that apply.

a. There is no relationship between physical and mental health.

b. Poor physical health can lead to mental distress and disorders.

c. Poor mental health does not lead to physical illness.

d. There is a strong relationship between physical health and mental health.

e. Mental health needs take precedence over physical health needs.

B D

A male patient reports to the nurse, “I’m told I have memories of childhood abuse stored in my unconscious mind. I want to work on this.” Based on this statement, what information should the nurse provide the patient?

a. To seek the help of a trained therapist to help uncover and deal with the trauma associated with those memories.

b. How to use a defense mechanism such as suppression so that the memories will be less threatening.

c. Psychodynamic therapy will allow the surfacing of those unconscious memories to occur in just a few ­ sessions.

d. Group sessions are valuable to identify underlying themes of the memories being suppressed.

A

Which question should the nurse ask when assessing for what Sullivan’s Interpersonal Theory identifies as the most painful human condition?

a.  “Is self-­ esteem important to you?”

b.  “Do you think of yourself as being lonely?”

c.  “What do you do to manage your anxiety?”

d.  “Have you ever been diagnosed with depression?”

B

When discussing therapy options, the nurse should provide information about interpersonal therapy to which patient? Select all that apply.

a. The teenager who is the focus of bullying at school

b. The older woman who has just lost her life partner to cancer

c. The young adult who has begun demonstrating hoarding tendencies

d. The adolescent demonstrating aggressive verbal and physical tendencies

e. The middle-­aged adult who recently discovered her partner has been unfaithful

A B E

When considering the suggestions of Hildegard Peplau, which activity should the nurse regularly engage in to ensure that the patient stays the focus of all therapeutic conversations?

a. Assessing the patient for unexpressed concerns and fears

b. Evaluating the possible need for additional training and education

c. Reflecting on personal behaviors and personal needs

d. Avoiding power struggles with the manipulative patient

C

Which action reflects therapeutic practices associated with operant conditioning?

a. Encouraging a parent to read to their children to foster a love for learning

b. Encouraging a patient to make daily journal entries describing their feelings

c. Suggesting to a new mother that she spend time cuddling her newborn often during the day

d. Acknowledging a patient who is often verbally aggressive for complimenting a picture another patient drew

D

A nurse is assessing a patient who graduated at the top of his class but now obsesses about being incompetent in his new job. The nurse recognizes that this patient may benefit from the following type of psychotherapy:

a. Interpersonal

b. Operant conditioning

c. Behavioral

d. Cognitive behavioral

D

According to Maslow’s hierarchy of needs, the most basic needs category for nurses to address is:

a. Physiological

b.Safety

c. Love and belonging

d. Self-­ actualization

A

In an outpatient psychiatric clinic, a nurse notices that a newly admitted young male patient smiles when he sees her. One day the young man tells the nurse, “You are pretty like my mother.” The nurse recognizes that the male is exhibiting:

a. Transference

b. Id expression

c. Countertransference

d. A cognitive distortion

A

Linda is terrified of spiders and cannot explain why. Because she lives in a wooded area, she would like to overcome this overwhelming fear. Her nurse practitioner suggests which therapy?

a. Behavioral

b. Biofeedback

c. Aversion

d. Exposure and response prevention therapy

D

A patient is telling a tearful story. The nurse listens empathically and responds therapeutically with:

a. “The next time you find yourself in a similar situation, please call me.”

b. “I am sorry this situation made you feel so badly. Would you like some tea?”

c. “Let’s devise a plan on how you will react next time in a similar situation.”

d. “I am sorry that your friend was so thoughtless. You should be treated better.”

C

Which neurotransmitter is potentiated by benzodiazepines?

a.  Acetylcholine

b.  Dopamine

c.  γ-­ aminobutyric acid

d.  Serotonin

C

Which antidepressant is contraindicated in a patient diagnosed with a seizure disorder?

a.  Bupropion

b.  Mirtazapine

c.  Paroxetine

d.  Venlafaxine

A

Antagonism of which receptor contributes to orthostatic hypotension observed with trazodone therapy?

a. Alpha-­ 1

b. Dopamine-­ 2

c. Histamine-­ 1

d. Muscarinic-­ 1

A

Which antidepressant requires special dietary restrictions to prevent the possible development of hypertensive crisis?

a.  Amitriptyline

b.  Duloxetine

c.  Escitalopram

d.  Phenelzine

D

Which part of the brain regulates voluntary motor movements?

a.  Brainstem

b.  Cerebellum

c.  Cerebrum

d.  Hypothalamus

B

Which antidepressant is FDA approved for the treatment of postpartum depression?

A. Brexanolone

B. Esketamine

c.  Fluoxetine

d.  Levomilnacipran

A

Which mood stabilizer most commonly causes hypothyroidism with long-­ term use?

a.  Carbamazepine

b.  Lamotrigine

c.  Lithium

d.  Valproate

C

Which medication increases blood levels of lamotrigine, increasing Stevens-­ Johnson syndrome risk?

a.  Carbamazepine

b.  Lithium

c.  Quetiapine

d.  Valproate

D

Which pathway is involved in the development of extra-pyramidal symptoms secondary to antipsychotic-­ induced dopamine receptor blockade?

a.  Mesocortical

b.  Mesolimbic

c.  Nigrostriatal

d.  Tuberoinfundibular

C

Which second-­ generation antipsychotic requires routine absolute neutrophil count monitoring?

a. Brexpiprazole

b. Clozapine

c. Risperidone

d. Ziprasidone

B

A patient needs supportive care for the maintenance treatment of bipolar disorder. The new nurse demonstrates an understanding of the services provided by the various members of the patient’s mental healthcare team when he makes which statement:

a. “Your social worker will help you learn to budget your money effectively.”

b. “Your counselor asked me to remind you of the group. session on critical thinking at 2:00 today.”

c. “The mental health technician on staff today will administer the medication that you require.”

d. “Remember to ask the occupational therapist about sources of financial help that you are qualified for.”

B

A patient has been voluntarily admitted to a mental health facility after an unsuccessful attempt to harm himself. Which statement demonstrates a need to better educate the patient on his patient’s rights?

a. “I understand why I was restrained when I was out of control.”

b. “You can’t tell my boss about the suicide attempt without my permission.”

c. “I have a right to know what all of you are planning to do to me.”

d. “I can hurt myself if I want to. It’s none of your business.”

D

Which intervention demonstrates an attempt by nursing staff to meet the goals identified by The Joint Commission as National Patient Safety Goals? Select all that apply.

a. Identifying patients using both name and date of birth before drawing blood.

b. Sitting with the patient diagnosed with an eating disorder during meals.

c. Administering the Beck Scale on each patient at the time of admission.

d. Performing a medication history assessment on each new patient.

e.  Using appropriate hand washing technique at all times.

A C D E

The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.

a. “Is the patient expressing suicidal thoughts?”

b. “Does the patient have intact judgment and insight into his situation?”

c. “Does the patient have experiences with either community or inpatient mental healthcare facilities?”

d. “Does the patient require a therapeutic environment to support the management of psychotic symptoms?”

e. “Does the patient require the regular involvement of their family/significant other in planning and executing the plan of care?”

A B D E

The nurse frequently includes daily sessions involving relaxation techniques. Which assessment data would most indicate a need for this intervention to be included in the initial plan of care for a patient?

a. Family history of anxiety and symptoms of anxiety

b. Significant other has a chronic health issue

c. Hopes to retire in 6 months

d. Recently adopted infant twins

A

A newly divorced 36-­ year-­ old mother of three has difficulty sleeping. When she shares this information to her gynecologist, she suggests which of the following services as appropriate for her patient’s needs?

a. Assertive community treatment

b. Patient-­ centered medical home

c. Psychiatric home care

d. Primary care provider

D

An Afghanistan Conflict veteran has been homeless since being discharged from military service. He is now diagnosed with schizophrenia. The nurse practitioner recognizes that assertive community treatment (ACT) is a good option for this patient since ACT provides:

a. Psychiatric home care

b. Care for hard-­ to-­ engage, seriously ill patients

c. Outpatient community mental health center care

d. A comprehensive emergency service model

B

An adolescent female is readmitted for inpatient care after suicide attempt. What is the most important nursing intervention to accomplish upon admission?

a. Allowing the patient to return to her previous room so that she will feel safe

b. Orienting the patient to the unit and introducing her to patients and staff

c. Building trust through therapeutic communication

d. Checking the patient’s belongings for dangerous items

D

Emma is a 40-­ year-­ old married female who has found it increasingly difficult to leave her home due to agoraphobia. Emma’s family is appropriately concerned and suggests that she seek psychiatric care. After investigating her options, Emma decides to try:

a. Telepsychiatry

b. Assertive community treatment

c. Psychiatric home care

d. Outpatient psychiatric care

A

Pablo is a homeless adult who has no family connection. Pablo passed out on the street and emergency medical services took him to the hospital, where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select all that apply.

a. Intermittent supervision is available in inpatient ­ settings.

b. He requires stabilization of multiple symptoms.

c. He has nutritional and self-­ care needs.

d. Medication adherence will be mandated.

e. He is in imminent danger of harming himself.

B C E

Which intervention demonstrates the nurse’s understanding of what guides effective nursing care with a diverse patient population?

a. Treating all patients the same to avoid prejudicial actions.

b. Identifying the cultural norms of the population being served.

c. Recognizing that race and ethnicity result in specific illness management views.

d. Addressing the physical and emotional needs that originate from genetic factors.

B

Which statement indicates the beliefs and values that tend to be representative of a member of an Indigenous culture? Select all that apply.

a. “I’ve reinforced the importance of taking medications at the time they are prescribed.”

b. “The patient believes that illness is a result of being out of harmony with nature.”

c. “Spending money on medicine for his diabetes is not a comfortable concept for my patient.”

d. “The patient refuses treatment.”

e. “We discussed the patient’s needs regarding warding off evil spirits before her surgery.”

A B C E

Which assessment questions will support effective communication with a patient who recently emigrated from an Asian country? Select all that apply.

a. “What do you call this kind of pain?”

b. “What do you think is causing your pain?”

c. “How do you think your pain should be treated?”

d. “Do you consider this kind of pain a serious problem?”

e. “Do you think American medicine will help your pain?”

A B C D

When one is considering culturally competent care for a Muslim patient diagnosed with cardiac problems, which intervention is particularly important initially when a ow-­ fat diet is prescribed?

a.  Requesting a dietary consult

b.  Identifying dietary considerations

c.  Explaining the importance of a low-­ fat diet

d.  Including the family in conversation about food preparation

B

Which statement by the nurse demonstrates ethnocentrism toward the Latinx patient?

a. “What do you want us to do to help your symptoms?”

b. “Tell me more about what you think is causing these symptoms.”

c. “I’m sure we can do something to make your symptoms more manageable.”

d. “How much have these symptoms made it more difficult for you to go to work?”

C

Ling has a nursing diagnosis of risk for violence. Ling’s Eastern culture family is having difficulty coping with the illness because of their beliefs. A favorable therapeutic modality for this patient might include

a. outpatient therapy.

b. family therapy.

c. long-­ term inpatient care.

d. assimilation therapy.

B

A nurse practitioner is interviewing a female patient from Southeast Asia. She complains of stomach pain and chest discomfort. Knowing that the patient’s adult son died in a car accident a month earlier, the nurse suspects

a. vulnerability.

b. acid reflux.

c. somatization.

d. transference.

C

Which nursing intervention can help a Hindu patient to maintain his religious practice?

a. Helping the patient to choose his own food from the menu

b. Contacting the hospital pastor for a visit

c. Showing him which side of the room faces east

d. Offering him a Torah

A

Intergenerational conflict may arise in immigrant families because the process of acculturation may be

a. ignored due to cultural beliefs.

b. filled with traumatic experiences.

c. easier for children.

d. a function of assimilation.

C

Which nursing actions demonstrate cultural competence? Select all that apply.

a. Planning mealtime around the patient’s prayer schedule

b. Helping a patient to visit with the hospital chaplain

c. Researching foods that a lacto-­ ovo-­ vegetarian patient will eat

d. Providing time for a patient’s spiritual healer to visit

e. Ordering standard meal trays to be delivered three times daily

A B C D

Which statement made by the nurse concerning ethics demonstrates the best understanding of the concept?

a. “It isn’t right to deny someone healthcare because they can’t pay for it.”

b. “I never discuss my patient’s refusal of treatment.”

c. “The hospital needs to buy more respirators so we always have one available.”

d. “Not all ICU patients have the right to unbiased attention from the staff.”

A

Which nursing intervention demonstrates the ethical principle of beneficence?

a. Refusing to administer a placebo to a patient.

b. Attending an in-­service on the operation of the new IV infusion pumps

c. Providing frequent updates to the family of a patient currently in surgery

d. Respecting the right of the patient to make decisions about whether or not to have electroconvulsive therapy

C

How can a newly hired nurse best attain information concerning the state’s mental health laws and statutes?

a. Discuss the issue with the facility’s compliance officer

b. Conduct an internet search using the keywords “mental+ health + statutes + (your state)”

c. Consult the ANA’s Code of Ethics for Nurses

d. Review the facility’s latest edition of the policies manual

B

When considering facility admissions for mental healthcare, what characteristic is unique to a voluntary admission?

a. The patient poses no substantial threat to themselves or to others

b. The patient has the right to seek legal counsel

c. A request in writing is required before admission

d. A mental illness has been previously diagnosed

C

Which situations demonstrate liable behavior on the part of the staff? Select all that apply.

a. Forgetting to obtain consent for electroconvulsive therapy for a cognitively impaired patient

b. Leaving a patient with suicidal thoughts alone in the bathroom to shower

c. Promising to restrain a patient who stole from another patient on the unit

d. Reassuring a patient with paranoia that his antipsychotic medication was not tampered with

e. Placing a patient who has repeatedly threatened to assault staff in seclusion

A B C

A nurse makes a post on a social media page about his peer taking care of a patient with a crime-­ related gunshot wound in the emergency department. He does not use the name of the patient. The nurse:

a. Has not violated confidentiality laws because he did not use the patient’s name.

b. Cannot be held liable for violating confidentiality laws because he was not the primary nurse for the patient.

c. Has violated confidentiality laws and can be held liable.

d. Cannot be held liable because postings on a social media site are excluded from confidentiality laws

C

In providing care for patients of a mental health unit, Li recognizes the importance of standards of care. When Li notices that some policies fall short of the state licensing laws, which of the following statements represents the most appropriate standard of care pathway?

a. Professional association, customary care, facility policy

b. State board of nursing, facility policy, customary care

c. Facility policy, professional associations, state board of nursing

d. State board of nursing, professional association, facility policy

D

Lucas has completed his inpatient psychiatric treatment, which was ordered by the court system. Which statement reveals that Lucas does not understand the concept of conditional release?

a. “I will continue treatment in an outpatient treatment center.”

b. “My nurse practitioner has recommended group therapy.”

c. “I am finally free, no more therapy.”

d. “Attending therapy and taking my meds are a part of this conditional release.”

C

Implied consent occurs when no verbal or written agreement takes place prior to a caregiver delivering treatment. Which of the following examples represents implied consent?

a. The mother of an unconscious patient saying okay to surgery

b. Care given to a heroin overdose victim

c. Immobilizing a patient who has refused to take medication

d. Signing general intake paperwork with specific parameters

B

Based on Maslow’s hierarchy of needs, physiological needs for a restrained patient include: Select all that apply.

a. Private toileting, oral hydration

b. Checking the tightness of the restraints

c. Therapeutic communication

d. Maintaining a patent airway

A B D

 What is the purpose of the Health Insurance Portability and Accountability Act (HIPAA)? Select all that apply.

a. Ensuring that an individual’s health information is protected

b. Providing third-­ party players with access to patient’s medical records

c. Facilitating the movement of a patient’s medical information to the interested parties

d. Guaranteeing that all those in need of healthcare coverage have options to obtain it

e. Allowing healthcare providers to obtain health information to provide high-­ quality healthcare.

A E

Which intervention demonstrates a nurse’s understanding of the initial action associated with the assessment of a patient’s spiritual beliefs?

a. Offering to pray with the patient

b. Providing a consult with the facility’s chaplain

c. Asking the patient what role spirituality plays in his daily life

d. Arranging for care to be provided with respect to religious practices

C

Which nursing interventions best demonstrate an understanding of the Quality and Safety Education in Nursing (QSEN) competences? Select all that apply.

a. Asking the patient what she expects from the treatment she is receiving

b. Seeking recertification for cardiopulmonary resuscitation (CPR)

c. Accessing the internet to monitor social media related to opinions on healthcare

d. Consulting with a dietitian to discuss a patient’s cultural food preferences and restrictions

e. Reviewing the literature regarding the best way to monitor the patient for a fluid imbalance

A B D E

Which disadvantage is inherent to the problem-­ oriented charting system (SOAPIE)?

a. Does not support a universal organizational system

b. Commonly allows for the inclusion of subjective information

c. Documentation is not listed in chronological order

d. Does not support the nursing process as a format

C

Which standardized rating scale will the nurse specifically include in the assessment of a newly admitted patient diagnosed with major depressive disorder?

a. Mini-­ Mental State Examination (MMSE)

b. Body Attitude Test

c. Global Assessment of Functioning Scale (GAF)

d. Beck Inventory

D

A 13-­ year-­ old boy is undergoing a mental health assessment. The nurse practitioner assures him that his medical records are protected and private. The nurse recognizes that this promise cannot be kept when the youth divulges:

a. “I lost my virginity last year.”

b. “I am angry with my parents most of the time.”

c. “I have thoughts of being in love with boys.”

d. “My parents do not know that I hit my grandpa.”

D

During an interview with a non–English-­ speaking middle-aged woman recently diagnosed with major depressive disorder, the patient’s husband states, “She is happy now and doing very well.” The patient, however, sits motionless, looking at the floor, and wringing her hands. A professional interpreter would provide better information due to the fact that a family member in the interpreter role may Select all that apply.

a. Be too close to accurately capture the meaning of the patient’s mood

b. Censor the patient’s thoughts or words

c. Avoid interpretation

d. Leave out unsavory details

B C D

A nurse identified a nursing diagnosis of self-­mutilation for a female diagnosed with borderline personality disorder. The patient has multiple self-­ inflicted cuts on her forearms and inner thighs. What is the most important patient outcome for this nursing diagnosis? Patient will…

a. Identify triggers to self-­ mutilation

b. Refrain from self-­ harm

c. Describe strategies to increase socialization on the unit

d. Describe two strategies to increase self-care

A

Medical records are considered legal documents. Proper documentation needs to reflect patient condition along with changes. It should also be based on professional standards designated by the state board of nursing, regulatory agencies, and reimbursement requirements. Proper documentation can be enhanced by:

a. Only using objective data

b. Using the nursing process as a guide

c. Using language the specific patient can understand

d. Avoiding legal jargon

B

Amadi is a 40-­ year-­ old African national being treated in a psychiatric outpatient setting due to a court order. Amadi’s medical record is limited in scope, so where can Renata, his registered nurse, obtain more data on Amadi’s condition within legal parameters? Select all that apply.

a. Emergency department records

b. Police records related to the offense resulting in the court order for treatment

c. Calling his family in Africa for details about Amadi’s mental health

d. Past medical records in the current facility

A B D

Which characteristics suggest a man is experiencing the prodromal phase of schizophrenia? Select all that apply.

a. Always afraid that others will steal his belongings.

b. Displays unusual interest in numbers and specific topics.

c. Has increasingly unusual thoughts and uses words oddly.

d. Demonstrates increasing difficulty with concentration.

A B C D

Which nursing interventions are particularly well chosen for addressing a population at high risk for developing schizophrenia? Select all that apply.

a. Screening 15-­ to 25-­ year-­ olds for early symptoms.

b. Forming a support group for females aged 25 to 35 who are diagnosed with substance use disorders.

c. Teaching ways to cope and build resiliency.

d. Educating about the risk of psychosis with marijuana use

A C D

To provide effective care for the patient who is taking a second-­ generation antipsychotic, the nurse should frequently assess for

a. Alcohol use disorder

b. Major depressive disorder

c. Stomach cancer

d. Polydipsia

e. Metabolic syndrome

E

A female patient diagnosed with schizophrenia has been prescribed a first-­ generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?

a. Her memory problems will likely decrease.

b. Depressive episodes should be less severe.

c. She will probably enjoy social interactions more.

d. She should experience a reduction in hallucinations.

D

Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?

a. Depersonalization

b. Pressured speech

c. Negative symptoms

d. Paranoia

D

Which therapeutic communication statement might a psychiatric–mental health registered nurse use when a patient’s nursing diagnosis is hallucinations? Select all that apply.

a. “I know you say you hear voices, but I cannot hear them.”

b. “Stop listening to the voices, they are NOT real.”

c. “Tell me more about what you hear.”

d. “Please tell the voices to leave you alone for now.”

A C

When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that

a. The medications provided are ineffective.

b. Nurses are trying to control their minds.

c. The medications will make them sick.

d. They are not actually ill.

D

Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) a week ago. You find him sitting stiffly and not moving. He is diaphoretic, and when you ask if he is okay, he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply.

a. Hold his medication and contact his prescriber stat.

b. Wipe him with a washcloth that has been wetted with cold water or alcohol.

c. Administer an “as needed” medication such as benztropine intramuscularly to correct his dystonic reaction.

d. Reassure him that no treatment is needed and that this reaction will pass.

e. Hold his medication for now and consult his prescriber when he comes to the unit later today

A B

Tomas is a 21-­ year-­ old male with a recent diagnosis of schizophrenia. Tomas’s nurse recognizes that self-medicating with excessive alcohol is common in this disorder and can be an effort to: Select all that apply.

a. Self-­ medicate for social discomfort.

b. Cope with anxiety.

c. Enhance mood.

d. Enable Tomas to better express himself.

A B C

A patient reports that “the voices are really bad today.” Helpful nursing responses would include

a. Giving an additional “as needed” dosage of his antipsychotic medication.

b. Telling him that the voices are not real and that he should ignore them.

c. Directing him to return to his room and try not to think about the voices.

d. Encouraging the patient to use competing auditory stimuli, such as humming or listening to music.

D

What assessment question is focused on identifying a long-­ term consequence of chronic stress on physical health?

a. “Do you have any problems with sleeping well?”

b. “How many infections have you experienced in the past 6 months?”

c. “How much moderate exercise do you engage in on a regular basis?”

d. “What management techniques do you regularly use to manage your stress?”

B

Which nursing assessments are directed at monitoring a patient’s fight-­ or-­ flight response? Select all that apply.

a. Blood pressure

b. Heart rate

c. Respiratory rate

d. Abdominal pain

e. Dilated pupils

A B C E

The patient you are assigned unexpectedly suffers a cardiac arrest. During this emergency situation, your body will produce a large amount of:

a.  Carbon dioxide

b.  Growth hormone

c.  Epinephrine

d.  Aldosterone

C

Which question is focused on the assessment of an individual’s personal ability to manage stress? Select all that apply.

a. “Have you ever been diagnosed with cancer?”

b. “Do you engage in any hobbies now that you have retired?”

c. “Have you been taking your antihypertensive medication as it is prescribed?”

d. “Who can you rely on if you need help after you’re discharged from the hospital?”

e. “What do you do to help manage the demands of parenting a 4-­ year-­ old and a newborn?”

B D E

When considering stress, what is the primary goal of making daily entries into a personal journal?

a. Providing a distraction from the daily stress

b. Expressing emotions to manage stress

c. Identifying stress triggers

d. Focusing on one’s stress

C

Jackson has suffered from migraine headaches all of his life. Fatima, his nurse practitioner, suspects muscle tension as a trigger for his headaches. Fatima teaches him a technique that promotes relaxation by using:

a.  Biofeedback

b.  Guided imagery

c.  Deep breathing

d.  Progressive muscle relaxation

D

Hugo is 21 and diagnosed with schizophrenia. His history includes significant turmoil as a child and adolescent. Hugo reports his father was abusive and routinely beat him, all of his siblings, and his mother. Hugo’s early exposure to stress most likely:

a. Made him resilient to stressful situations

b. Increased his future vulnerability to psychiatric disorders

c. Developed strong survival skills

d. Shaped his nurturing nature

B

Hugo has a fraternal twin named Franco who is unaffected by mental illness, even though they were raised in the same dysfunctional household. Franco asks the nurse, “Why Hugo and not me?” The nurse replies:

a. “Your father was probably less abusive to you.”

b. “Hugo likely has a genetic vulnerability.”

c. “You probably ignored the situation.”

d. “Hugo responded to perceived threats by focusing on an internal world.”

B

First responders and emergency department healthcare providers often use dark humor in an effort to:

a. Reduce stress and anxiety

b. Relive the experience

c. Rectify moral distress

d. Alert others to the stress

A

Your 39-­ year-­ old patient Samantha, who was admitted with anxiety, asks you what the stress-­ relieving technique of mindfulness is. The best response is:

a. Mindfulness is focusing on an object and repeating a word or phrase while deep breathing.

b. Mindfulness is progressively tensing, then relaxing, body muscles.

c. Mindfulness is focusing on the here and now, not the past or future, and paying attention to what is going on around you.

d. Mindfulness is a memory system to assist you in short-term memory recall.

C

Which response by a 15-­ year-­ old demonstrates a common symptom observed in patients diagnosed with major depressive disorder?

a. “I’m so restless. I can’t seem to sit still.”

b. “I spend most of my time studying. I have to get into a good college.”

c. “I’m obsessed with counting telephone poles as I drive by them.”

d. “I go to sleep around 11 p.m. but I’m always up by 3 a.m. and can’t go back to sleep.”

D

Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply.

a. “Do rules apply to you?”

b. “What do you do to manage anxiety?”

c. “Do you have a history of disordered eating?”

d. “Do you think that you drink too much?”

e. “Have you ever been arrested for committing a crime?”

B C D

Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population?

a. Conducting routine suicide screenings at a senior center.

b. Identifying depression as a natural, but treatable result of aging.

c. Identifying males as being at a greater risk for developing depression.

d. Stressing that most individuals experience just a single episode of major depressive disorder in a lifetime.

A

Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply.

a. Female

b. 7 years old

c. Comorbid autism diagnosis

d. Outbursts occur at least once a week

e. Temper tantrums occur at home and in school

B C E

Which chronic medical condition is a common trigger for major depressive disorder?

a. Pain

b. Hypertension

c. Hypothyroidism

d. Crohn disease

A

Tammy, a 28-­ year-­ old with major depressive disorder and bulimia nervosa, is ready for discharge from the county hospital after 2 weeks of inpatient therapy. Tammy is taking citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervosa, what is an alternative antidepressant to consider?

a.  Fluoxetine (Prozac)

b.  Isocarboxazid (Marplan)

c.  Amitriptyline

d.  Duloxetine (Cymbalta)

A

Cabot has multiple symptoms of depression, including mood reactivity, social phobia, anxiety, and overeating. With a history of mild hypertension, which classification of antidepressants dispensed as a transdermal patch would be a safe medication?

a.  Tricyclic antidepressants

b.  Selective serotonin reuptake inhibitors

c.  Serotonin and norepinephrine reuptake inhibitors

d.  Monoamine oxidase inhibitor

D

When a nurse uses therapeutic communication with a withdrawn patient who has major depressive disorder, an effective method of managing the silence is to:

a. Meditate in the quiet environment

b. Ask simple questions even if the patient will not answer

c. Use the technique of making observations

d. Simply sit quietly and leave when the patient falls asleep

C

The biological approach to treating depression with electrodes surgically implanted into specific areas of the brain to stimulate the regions identified to be underactive in depression is:

a. Transcranial magnetic stimulation

b. Deep brain stimulation

c. Vagus nerve stimulation

d. Electroconvulsive therapy

B

Two months ago, Natasha’s husband died suddenly and she has been overwhelmed with grief. When Natasha is subsequently diagnosed with major depressive disorder, her daughter, Nadia, makes which true statement?

a. “Depression often begins after a major loss. Losing dad was a major loss.”

b. “Bereavement and depression are the same problem.”

c. “Mourning is pathological and not normal behavior.”

d. “Antidepressant medications will not help this type of depression.”

A