343 - Practice Exam Questions - Depressive disorders, Bipolar disorder, Suicide Prevention, Borderline personality disorder, ATI Mental Health Questions

The client age 68 is a widow of six months over the last month she had become socially withdrawn has lost weight and told her sister today that she doesn't have anything more to live for she has been hospitalized with major depressive disorder the priority nursing diagnosis for this client would be:

A. Imbalance nutrition: less than body requirements
B. Complicated grieving
C. Risk for suicide
D. Social isolation

C. Risk for suicide

The goal of cognitive behavior therapy with depressed clients is to:

A. Identify and change dysfunctional patterns of thinking
B. Resolve the symptoms and initiate and restore adaptive family functioning
C. Alter the neurotransmitters that are creating the depressed mood
D. Provide feedback from peers who are having similar experiences

A. Identify and change dysfunctional patterns of thinking

A nurse expresses interest in alternative treatments for depression with seasonal variations and ask the nurse about light therapy. Which of the following are evidence-based teaching points that the nurse may share with the client? Select all that apply

A. Like therapy has demonstrated effectiveness that is comparable to antidepressant
B. Like therapy should be used regularly until the season changes
C. Like therapy should be used only when electro convulsive therapy has proven to be an effective
D. Side effects such as headache nausea and agitation when they occur are usually mild and transient
E. Like therapy causes sedation so the best time to use it is before bedtime

A. Like therapy has demonstrated effectiveness that is comparable to antidepressant
B. Like therapy should be used regularly until the season changes
D. Side effects such as headache nausea and agitation when they occur are usually mild and transient

A client has just been admitted to the psychiatric unit with a diagnosis of major depressive disorder. Which of the following behavioral manifestations might the nurse expect to assess? Select all that apply

A. Slumped posture
B. Hallucinations
C. Feelings of despair
D. Appears to have boundless energy
E. Anorexia

A. Slumped posture
C. Feelings of despair
E. Anorexia

A client with depression ask the nurse why would they be checking my thyroid function when I clearly have depression and I'm not overweight which of these is an accurate response

A. An under active thyroid gland can manifest as depression
B. Depression has been proven to be a hormonal illness
C. Thyroid hormone replacement is a first line treatment for most clients with depression
D. All of the above

A. And under active thyroid gland can manifest as depression

And acutely depressed client isolates herself in her room and just sits and stares into space. Which of these is the best example of an active communication approach with this client

A. Do you like exercise
B. Come with me I will go with you to group therapy
C. Would you like to go to group therapy stay in bed or come out to the day lounge for some activities
D. Why do you stay in your room all the time

B. Come with me I will go with you to group therapy

A client who has been taking sertraline 50 mg PO be ID for depression tells the nurse I've been on this medication for almost a week and I don't feel a bit better what is the most appropriate response by the nurse

A. Cheer up you have so much to be happy about
B. Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms
C. I'll report it to the physician maybe he will order something different
D. Try not to dwell on your symptoms why don't you join the others down in the dayroom

B. Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms

A client reports to the mental health clinic was complaints of feeling more depressed over the last few weeks. The patient score on the Hamilton depression rating scale is 40 what is the priority nursing action at this finding

A. Assess the clients history of treatment for depression
B. Encourage the client to keep weekly follow up appointment at the clinic
C. Educate the client about treatment options for mild moderate and severe depression
D. Assess the clients current risk for suicide

D. Assess the clients current risk for suicide

A client whose husband died six months ago is given a diagnosis of major depressive disorder she says to the nurse I start feeling angry that Harold died and left me all alone he should have stopped smoking years ago but then I start feeling guilty for feeling that way. What is an appropriate response by the nurse

A. Yes he should've stop smoking then he probably wouldn't have gotten lung cancer
B. I can understand how you must feel
C. Those feelings are a normal part of the grieving process
D. Just think about the good times that you had while he was alive

C. Those feelings are a normal part of the grieving process

A client is admitted to the hospital with major depressive disorder and repeatedly makes negative statements about herself which of the following interventions are identified as those that will promote positive self-esteem in the client? Select all that apply

A. Teach assertive communication skills
B. Make observations to the client when she completes a goal or task
C. Instruct the client that you will not talk with her unless she stops talking negatively about herself
D. Offer to spend time with the client using a non-judge mental accepting approach

A. Teach assertive communication skills
B. Make observations to the client when she completes a goal or task
D. Offer to spend time with the client using a non-judge mental accepting approach

One way to promote adequate nutritional intake for a client and an acute manic episode who is not eating is to:

A. Sit with a client during meals to reinforce the importance of eating everything on the tray
B. Have family members bring food from home so the client will have only favorite food
C. Provide high calorie nutritious finger foods and snacks that can be eaten on the run
D. Restrict the client to their room until they begin to gain weight

C. Provide high calorie nutritious finger foods and snacks that can be eaten on the run

The physician orders lithium carbonate 600 mg TID for a newly diagnosed patient with bipolar one disorder. There is a narrow margin between therapeutic therapeutic and toxic levels of lithium the therapeutic range for acute mania is:

A. 0.5 to 1.5 mEq/L
B. 10 to 15 mEq/L
C. 0.5 to 1.0 mEq/L
D. 5 to 10 mEq/L

A. 0.5 to 1.5 mEq/L

Although historically lithium has been the medication of choice for mania several others have been used with good results which of the following are used in treatment of bipolar disorder? Select all that apply

A. Olanzapine
B. Oxycodone
C. Carbamazepine
D. Gabapentin
E. Tranylcypromine

A. Olanzapine
C. Carbamazepine
D. Gabapentin

A client who is experiencing a manic episode is admitted to the psychiatric unit after being brought to the emergency department by a family member the client yells my family is trying to make it look like I'm insane they just want to take all my money this behavior is an example of

A. A delusion of grandeur
B. A delusion of persecution
C. Are delusion of reference
D. A delusion of control or influence

A. A delusion of persecution

What is the most common comorbid condition in children with bipolar disorder?

A. Schizophrenia
B. Substance abuse
C. Oppositional defiant disorder
D. Attention deficit hyper activity disorder

D. Attention deficit hyper activity disorder

A nurse is educating a patient about his lithium therapy and explaining the signs and symptoms of lithium toxicity which of the following would she instruct the patient to be on the alert for

A. Fever sore throat Malaise
B. Tinnitus, severe diarrhea ataxia
C. Occipital headache palpitations chest pain
D. Skin rash marked raise in blood pressure bradycardia

B. Tinnitus severe diarrhea ataxia

A client is brought to the emergency department by a family member who reports that the client stopped taking mood stabilizer medications a few months ago and is now agitated, pacing, demanding and speaking very loudly her family member reports that she eats very little, is losing weight, and almost never sleeps what is the priority nursing diagnosis

A. Imbalance nutrition: less than body requirements related to not eating
B. Risk for injury related to hyper activity
C. Disturb sleep pattern related to agitation
D. Ineffective coping related to denial of depression

B. Risk for injury related to hyperactivity

A client experiencing a manic episode enters the Milyer area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse

A. Tell the client she cannot wear this outfit while she's in the hospital
B. Do nothing and allow her to learn from the responses of her peers
C. Quietly walk with her back to her room and help her change into something more appropriate
D. Explain to her that if she wears this outfit she must remain in her room

C. Quietly walk with her back to her room and help her change into something more appropriate

The nurse is providing medication education to a client on lithium which of the following are more important points to include? Select all that apply

A. Significant reductions in sodium intake increase the risk of lithium toxicity
B. Weight loss is a common side effect of lithium
C. Serum lithium levels will need to be checked at regular intervals without treatment
D. Lithium therapy should be continued even during periods when the patient feels well

A. Significant reductions in sodium intake increase the risk of lithium toxicity
C. Serum lithium levels will need to be checked at regular intervals without treatment
D. Lithium therapy should be continued even during periods when the patient feels well

A client admitted to the inpatient psychiatric unit with bipolar disorder tells the nurse I need to sit in on change of shift report because I have been appointed director of this unit which action by the nurse demonstrates the best clinical judgment at this point?

A. Invite a client to sit in on the change of shift report but do not share any confidential client information
B. Instruct the client that this is not permitted and redirect the client to other unit activities that are available
C. Tell the client that she is delusional but that these symptoms will go away with medication
D. Place the client in seclusion for protection of self and others

B. Instruct the client that this is not permitted and redirect client to another unit activities that are available

Which of the following individual is at highest risk for a suicide attempt?

A. Client reports he is in deep emotional pain feels hopeless and says no one is there for me
B. A client who has been seeing a doctor for chronic intractable pain and is taking pain medication
C. An American Indian client who just graduated from high school's honors
D. If physician who reports feeling burnt out and is considering retirement

A. A. Client reports he is in deep emotional pain feels hopeless and says no one is there for me

The nurses in the emergency department encounters a client who is expressing suicide ideation the nurse recognizes that which of the following considerations are important to good suicide risk assessment? Select all that apply

A. Collaborating with the patient
B. Asking specific questions about leisure activities
C. Establishing trust and open communication with the patient
D. Asking the patient specific questions about the strength of his intention to die
E. You're gonna find what is the patient has thought about a plan of trying to kill himself

A. Collaborating with the patient
C. Establishing trust and open communication with the patient
D. Asking the patient specific questions about the strength of his intention to die
E. You're gonna find what is the patient has thought about a plan of trying to kill himself

The client is hospitalized and following a suicide attempt after breaking up with her boyfriend. Freudian psychoanalytic theory would explain the client suicide attempt in which of the following ways

A. She feels hopeless about her future without her boyfriend
B. Without her boyfriend she feels like an outsider with her peers
C. She was feeling intense guilt because her boyfriend broke up with her
D. She's angry at her boyfriend for breaking up with her and has turned the anger inward on herself

D. She's angry at her boyfriend for breaking up with her and has turned the anger inward on herself

Through the following interventions are appropriate for a client on suicide precautions? Select all that apply

A. Remove all sharp objects belts and other potentially dangerous articles from the clients environment
B. Accompany the client to a off unit activities
C. Reassess intensity of suicidal thoughts and urges on a regular basis
D. Put all the clients positions in storage and explain to her that she may have them back when she was a suicide cautions

A. Remove all sharp objects belts and other potentially dangerous articles from the clients environment
B. Accompany the client to a off unit activities
C. Reassess intensity of suicidal thoughts and urges on a regular basis

Success of long-term psychotherapy with a client (who attempted suicide following a break up with her boyfriend) could be measured by which of the following behaviors?

A. The client has a new boyfriend
B. The client has an increased sense of self-worth
C. The client does not take antidepressants anymore
D. The client told her old boyfriend how angry she was with him for breaking up with her

B. The client has an increased sense of self-worth

A 27-year-old female client was admitted to the psychiatric unit from the medical intensive care unit where she was treated for taking a deliberate overdose of her antidepressant medication trazodone she says to the nurse my boyfriend broke up with me we have been together for six years I love him so much I know I will never get over him which is the best response by the nurse

A. You'll get over him in time
B. Forget him there are other fish in the sea
C. You must be feeling very sad about your loss
D. Why do you think he broke up with you

C. You must be feeling very sad about your loss

The nurse identifies the primary nursing diagnosis for a client at risk for suicide related to feelings of hopelessness from loss of relationship. Which is the outcome criterion that would be most appropriate for this diagnosis

A. The client has experienced no self harm
B. The clients sets realistic goals
C. The client expressed some optimism and hope for the future
D. The client has reached a stage of acceptance in the loss of the relationship

A. The client has experienced no self harm

A client is hospitalized following a suicide attempt after breaking up with her boyfriend she says to the nurse when I get out of here I'm going to try this again the next time I choose a new film method which is the best response by the nurse

A. You are safe here we will make sure nothing happens to you
B. You're just lucky your roommate came home when she did
C. What exactly do you plan to do
D. I don't understand you have so much to live for

C. What exactly do you plan to do

A client who has been hospitalized following a suicide attempt is placed on suicide precautions on the psychiatric unit she admits that she is still feeling suicidal. Which of the following interventions are most appropriate for this instant? Select all that apply


A. Restrict access to any item that might be harmful by placing the client in a seclusion room
B. Check on the client every 15 minutes at a regular intervals or assign a staff person to stay with her on a one to one basis
C. Obtain an order from the physician to give the client a sedative to calm her and reduce suicide ideas
D. Do not allow the client to participate in any unit activities while she is on suicide precautions
E. Ask the client specific questions about her thoughts plans and intentions related to suicide

B. Check on the client every 15 minutes at a regular intervals or assign a staff person to stay with her on a one to one basis
E. Ask the client specific questions about her thoughts plans and intentions related to suicide

In determining the degree of suicidal risk with a client the nurse assesses the following behavioral manifestations severely depressed withdrawn statements of worthlessness difficulty accomplishing activities of daily living no close support systems. The nurse identifies the client risk for suicide as which of the following?

A. Low risk
B. High risk
C. Imminent risk
D. Unable to determine

B. High risk

1. Kim has a diagnosis of borderline personality disorder. She often exhibits alternating clinging and distancing behaviors. The most appropriate nursing intervention with this type of behavior would be to:
a. Encourage Kim to establish trust in one staff person, with whom all therapeutic interaction should take place.
b. Secure a verbal contract from Kim that she will discontinue these behaviors.
c. Withdraw attention if these behaviors continue.
d. Rotate staff members who work with Kim so that she will learn to relate to more than one person.

d. Rotate staff members who work with Kim so that she will learn to relate to more than one person.

2. Kim, a client diagnosed with borderline personality disorder, manipulates the staff in an effort to fulfill her own desires. All of the following may be examples of manipulative behaviors in the borderline client except:
a. Refusal to stay in room alone, stating, "It's so lonely."
b. Asking Nurse Jones for cigarettes after 30 minutes, knowing the assigned nurse has explained she must wait 1 hour.
c. Stating to Nurse Jones, "I really like having you for my nurse. You're the best one around here."
d. Cutting arms with razor blade after discussing dismissal plans with physician.

a. Refusal to stay in room alone, stating, "It's so lonely."

3. "Splitting" by the client with borderline personality disorder denotes:
a. Evidence of precocious development
b. A primitive defense mechanism in which the client sees objects as all good or all bad
c. A brief psychotic episode in which the client loses contact with reality
d. Two distinct personalities within the borderline client.

b. A primitive defense mechanism in which the client sees objects as all good or all bad

4. According to Margaret Mahler, predisposition to borderline personality disorder occurs when developmental tasks go unfulfilled in which of the following phases?
a. Autistic phase, during which the child's needs for security and comfort go unfulfilled
b. symbiotic phase, during which the child fails to bond with the mother
c. Differentiation phase, during which the child fails to recognize a separateness between self and mother
d. Rapproachement phase, during which the mother withdraws emotional support in response to the child's increasing independence.

d. Rapproachement phase, during which the mother withdraws emotional support in response to the child's increasing independence.

6. Milieu therapy is a good choice for clients with antisocial personality disorder because it:
a. provides a system of punishment and rewards for behavior modification.
b. emulates a social community in which the client may learn to live harmoniously with others
c. provides mostly one-to-one interaction between the client and therapist
d. provides a very structured setting in which the clients have very little input into the planning of their care

b. emulates a social community in which the client may learn to live harmoniously with others

A nurse is caring for a client who has major depressive disorder. Which of the following should the nurse identify as a risk factor for depression? (select all)
A. male sex
B. history of chronic bronchitis
C. recent death in client's family
D. family history of depression
E. personal history of panic disorder

Correct answer:

B. history of chronic bronchitis

C. recent death in client's family

D. family history of depression

E. personal history of panic disorder

Rationales:

A. male sex: Females are twice as likely to experience MDD

B. history of chronic bronchitis: Depressive disorders are more common in a client who has a chronic health issue

A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following actions is the nurse's priority?
A. placing the client on one-to-one observation
B. assisting the client to perform ADLs
C. encouraging the client to participate in counseling
D. teaching the client about medication adverse effects

Correct answer:

A. placing the client on one-to-one observation

Rationale:

All are correct, but the greatest risk for a client who has MDD and anxiety is injury due to self-harm

A charge nurse is discussing the care of a client who has major depressive disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
A. "Care during the continuation phase focuses on treating continued manifestations of MDD"
B. "The treatment of MDD during the maintenance phase lasts for 6-12 weeks."
C. "The client is at greatest risk for suicide during the first weeks of an MDD episode."
D. "Medication and psychotherapy are most effective during the acute phase of MDD."

Correct Answer:

C. "The client is at greatest risk for suicide during the first weeks of an MDD episode."

Rationale:

A. "Care during the continuation phase focuses on treating continued manifestations of MDD"

**Incorrect: the focus of treatment in the continuation phase is relapse prevention. Tx of manifestations is performed in the acute phase of MDD, not continuation.**

B. "The treatment of MDD during the maintenance phase lasts for 6-12 weeks."

**Incorrect: The maintenance phase can last 1 year or more.**

C. "The client is at greatest risk for suicide during the first weeks of an MDD episode."

**Correct: Acute phase increases risk of suicide**

D. "Medication and psychotherapy are most effective during the acute phase of MDD."

**Incorrect: Medications and psychotherapy are most effective during continuation phase to prevent acute/relapse of MDD**

A nurse is interviewing a client who has a new diagnosis of persistent depressive disorder. Which of the following findings should the nurse expect?
A. wide fluctuations in mood
B. report of a minimum of 5 clinical findings of depression
C. presence of manifestations for at least 2 years
D. inflated sense of self-esteem

Correct Answer:

C. presence of manifestations for at least 2 years

Rationale:

A. wide fluctuations in mood

**Incorrect: wide fluctuations of mood are associated with bipolar disorder**

B. report of a minimum of 5 clinical findings of depression Incorrect

C. presence of manifestations for at least 2 years Correct

D. inflated sense of self-esteem

**Incorrect: A decreased, not inflated sense of self esteem is associated with persistent depressive disorder**

A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse include in the plan of care? (select all)
A. Provide flexible client behavior expectations
B. Offer concise explanations
C. Establish consistent limits
D. Disregard client concerns
E. Use a firm approach with communication

Correct Answer:

B. Offer concise explanations

C. Establish consistent limits

E. Use a firm approach with communication

Rationale:

A. Provide flexible client behavior expectations

**Incorrect: establish consistent behavior to prevent manipulation**

B. Offer concise explanations

**Correct: Improves clients ability to focus and comprehend information**

C. Establish consistent limits

**Correct prevents manipulation**

D. Disregard client concerns

**Incorrect: respond to valid concerns to foster a trusting relationship**

E. Use a firm approach with communication

**Correct: promotes structure, minimizes inappropriate behavior**

A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding?
A. "ECT is the recommended initial treatment for bipolar disorder."
B. "ECT is contraindicated for clients who have suicidal ideation."
C. "ECT is effective for clients who are experiencing severe mania."
D. "ECT is prescribed to prevent relapse of bipolar disorder."

Correct Answer:

C. "ECT is effective for clients who are experiencing severe mania."

Rationale:

A. "ECT is the recommended initial treatment for bipolar disorder."

**Incorrect: pharmacological intervention, not ECT is recommended for initial treatment**

B. "ECT is contraindicated for clients who have suicidal ideation."

**Incorrect: Suicidal ideation is an indication, not a contraindication.**

C. "ECT is effective for clients who are experiencing severe mania."

**Correct: this is an indication, along with suicidal ideation**

D. "ECT is prescribed to prevent relapse of bipolar disorder."

**Incorrect: ECT is indicated for an acute episode**

A nurse is caring for a client who has bipolar disorder. Which of the following is the priority nursing action?
A. Set consistent limits for expected client behavior
B. Administer prescribed medications as scheduled
C. Provide the client with step-by-step instructions during hygiene activities
D. Monitor the client for escalating behavior.

Correct Answer:

D. Monitor the client for escalating behavior.

Rationale:

All are correct but safety is priority

A nurse is caring for a client who has bipolar disorder. The client states, 'I am very rich, and I feel I must give my money to you." Which of the following responses should the nurse make?
A. "Why do you think you feel the need to give money away?"
B. "I am here to provide care and cannot accept this from you."
C. "I can request that your case manager discuss appropriate charity options with you."
D. "You should know that giving away your money is inappropriate."

Correct Answer:

B. "I am here to provide care and cannot accept this from you."

Rationale:

A. "Why do you think you feel the need to give money away?"

**Incorrect: asking a "why" question is a nontherapeutic form of communication and can promote a defensive client response**

B. "I am here to provide care and cannot accept this from you."

**Correct: this is a matter-of-fact response and concise**

C. "I can request that your case manager discuss appropriate charity options with you."

**Incorrect: This does not recognize the possibility of poor judgement, which is associated with bipolar disorder**

D. "You should know that giving away your money is inappropriate."

**Incorrect: This response conveys disapproval and can be interpreted as aggressive, prompting a defensive response by the client**

A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in the teaching? (select all)
A. Use caffeine in moderation to prevent relapse.
B. Difficulty sleeping can indicate a relapse.
C. Begin taking your meds as soon as a relapse begins.
D. Participating in psychotherapy can help prevent a relapse.
E. Anhedonia is a clinical manifestation of a depressive relapse.

Correct Answer:

B. Difficulty sleeping can indicate a relapse.

D. Participating in psychotherapy can help prevent a relapse.

E. Anhedonia is a clinical manifestation of a depressive relapse.

Rationale:

A. Use caffeine in moderation to prevent relapse.

**Incorrect: A client with bipolar disorder should caffine altogether because it can cause a relapse**

B. Difficulty sleeping can indicate a relapse.

**Correct: Difficulty sleeping is a sign of a relapse**

C. Begin taking your meds as soon as a relapse begins.

**Incorrect: The client should always take meds, not just during a relapse**

D. Participating in psychotherapy can help prevent a relapse.

**Correct**

E. Anhedonia is a clinical manifestation of a depressive relapse.

**Correct: this is inability to feel pleasure, which is a manifestation of a depressive episode of a relapse**

A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the new nurse indicates an understanding of the teaching?
A. "I can promote my client's sense of control by establishing a schedule."
B. "I should encourage clients who have a schizoid personality disorder to increase socialization."
C. "I should practice limit-setting to help prevent client manipulation."
D. "I should implement assertiveness training with clients who have antisocial personality disorder."

Correct Answer:

C. "I should practice limit-setting to help prevent client manipulation."

Rationale:

A. "I can promote my client's sense of control by establishing a schedule."

**Incorrect: Rather than establishing a schedule, the nurse should work with the client for realistic goals to promote the client's sense of control**

B. "I should encourage clients who have a schizoid personality disorder to increase socialization."

**Incorrect: Avoid over socialization of a client with schizoid personality disorder**

C. "I should practice limit-setting to help prevent client manipulation."

**Correct**

D. "I should implement assertiveness training with clients who have antisocial personality disorder."

**Incorrect: This is only true for dependent or histrionic disorder**

A nurse is caring for a client who has borderline personality disorder. The client says, "The nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the client's statement as an example of which of the following defense mechanisms?
A. Regression
B. Splitting
C. Undoing
D. Identification

Correct Answer:

B. Splitting

Rationale:

A. Regression

**Incorrect: this refers to resorting to earlier coping methods - ex: temper tantrum**

B. Splitting

**Correct**

C. Undoing

**Incorrect: Undoing means to reverse unacceptable acts or thoughts by doing something nice like buying a gift after an affair

D. Identification

**Incorrect: Identification means imitating the behavior of someone admired or feared**

A charge nurse is preparing a staff education session on personality disorders. Which of the following personality characteristics associated with all of the personality disorders should the charge nurse include in the teaching? (select all)
A. Difficulty in getting along with other members of a group
B. Belief in the ability to become invisible during times of stress.
C. Display of defense mechanisms when routines are changed.
D. Claiming to be more important than other persons
E. Difficulty understanding why it is inappropriate to have a personal relationship with staff

Correct Answer:

A. Difficulty in getting along with other members of a group

C. Display of defense mechanisms when routines are changed.

E. Difficulty understanding why it is inappropriate to have a personal relationship with staff

Rationale:

A. Difficulty in getting along with other members of a group

**Correct**

B. Belief in the ability to become invisible during times of stress.

**Incorrect: This is only seen in schizotypical, which believes in magical thinking**

C. Display of defense mechanisms when routines are changed.

**Correct:**

D. Claiming to be more important than other persons

**Incorrect: This is only seen in narcissistic personality disorder**

E. Difficulty understanding why it is inappropriate to have a personal relationship with staff

**Correct:**

A nurse is caring for a client who is prescribed lithium therapy. The client tells of the plan to take ibuprofen for osteoarthitis pain relief. Which of the following statements should the nurse make?
A. "That is a good choice. Ibuprofen does not interact with lithium."
B. "Regular aspirin would be a better choice than ibuprofen."
C. "Lithium decreases the effectiveness of ibuprofen."
D. "The ibuprofen will make your lithium level fall too low."

Correct Answer:

B. "Regular aspirin would be a better choice than ibuprofen."

Aspirin is recommended as a mild analgesic rather than ibuprofen due to the risk for lithium toxicity.

A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the teaching? (select all)
A. Constipation
B. Polyuria
C. Rash
D. Muscle weakness
E. Tinnitus

Correct Answer:

B. Polyuria

D. Muscle weakness

Diarrhea is an early indication of toxicity.

Tinnitus is an indication of severe toxicity

A nurse is discussing routine follow-up needs with a client who has a new prescription for valproate. The nurse should inform the client of the need for routine monitoring of which of the following?
A. AST/ALT and LDH
B. Creatinine and BUN
C. WBC and granulocyte counts
D. Blood sodium and potassium

Correct Answer:

A. AST/ALT and LDH

A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the client's lithium blood level is 1.2 mEq/L. Which of the following actions should the nurse take?
A. Administer the next dose of lithium carbonate as scheduled.
B. Prepare for administration of aminophylline.
C. Notify the provider for a possible increase in the dosage of lithium carbonate.
D. Request a stat repeat of the client's lithium blood level.

Correct Answer:

A. Administer the next dose of lithium carbonate as scheduled.

During a manic episode, the lithium blood level should be 0.8 to 1.4 mEq/L

A nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. When collecting a medical history from the client's caregiver, which of the following statements is the priority to report to the provider?
A. "Current medical conditions include diabetes that is controlled by diet."
B. "Recent medications include a course of prednisone for acute bronchitis."
C. "Current vaccinations include a flu vaccine last month."
D. "Current medications include furosemide for congestive heart failure."

Correct Answer:

D. "Current medications include furosemide for congestive heart failure."

Diuretics are contraindicated for use with lithium due to the risk for toxicity. This is the greatest risk for the client and is therefore the highest priority to report to the provider.

A nurse is reviewing the medical records of multiple clients at a community mental health facility. Which of the following events is an example of client experiencing a maturational crisis?
A. rape
B. marriage
C. severe physical illness
D. job loss

Correct Answer:
B. marriage

A nurse is assessing a client who has major depressive disorder. The nurse should identify which of the following client statements as an overt comment about suicide? (select all)
A. "My family will be better off if I'm dead."
B. "The stress in my life is too much to handle."
C. "I wish my life was over."
D. "I don't feel like I can ever be happy again."
E. "If I kill myself then my problems will go away."

Correct Answer:

A. "My family will be better off if I'm dead."

C. "I wish my life was over."

E. "If I kill myself then my problems will go away."

A nurse is caring for a client who states, "I plan to commit suicide." Which of the following assessments should the nurse identify as the priority?
A. client's educational and economic background
B. lethality of the method and availability of means
C. quality of the client's social support
D. client's insight into the reasons for the decision

Correct Answer:

B. lethality of the method and availability of means

A nurse is assisting with the development of protocols to address the increasing number of suicide attempts in the community. Which of the following interventions should the nurse include as a primary intervention? (select all)
A. Conducting a suicide risk screening on all new clients
B. Creating a support group for family members of clients who completed suicide
C. Educating high school teens about suicide prevention
D. Initiating 1:1 observation for a client who has current suicidal ideation
E. Teaching middle school educators about warning indicators of suicide

Correct Answer:
A. Conducting a suicide risk screening on all new clients C. Educating high school teens about suicide prevention
E. Teaching middle school educators about warning indicators of suicide

A nurse is caring for a client who is on suicide precautions. Which of the following interventions should the nurse include in the plan of care?
A. assign the client to a private room
B. document the client's behavior every hour
C. allow the client to keep perfume in her room
D. ensure that the client swallows medication

Correct Answer:

D. ensure that the client swallows medication

A nurse is conducting a class for a group of newly licensed nurses on caring for clients who are at risk for suicide. Which of the following information should the nurse include in the teaching?
A. a client's verbal threat of suicide is attention-seeking behavior.
B interventions are ineffective for clients who really want to commit suicide.
C. using the term suicide increases the client's risk for a suicide attempt.
D. a no-suicide contract decreases the client's risk for suicide

Correct Answer:

D. a no-suicide contract decreases the client's risk for suicide

A nurse is conducting a group therapy with a group of clients. Which of the following statements made by a client is an example of aggressive communication?
A. "I wish you would not make me angry."
B. "I feel angry when you leave me."
C. "It makes me angry when you interrupt me."
D. "You'd better listen to me."

Correct Answer:

D. "You'd better listen to me."

this statement implies a threat and lack of respect

A nurse is caring for a client who is speaking in a loud voice with clenched fists. Which of the following actions should the nurse take?
A. insist that the client stop yelling
B. request that other staff members remain close by
C. move as close to the client as possible
D. walk away from the client

Correct Answer:
B. request that other staff members remain close by

A nurse is assessing a client in an inpatient mental health unit. Which of the following findings should the nurse expect if the client is in the preassaultive stage of violence? (select all)
A. lethargy
B. defensive responses to questions
C. disorientation
D. facial grimacing
E. agitation

Correct Answer:

B. defensive responses to questions

D. facial grimacing

E. agitation

A nurse is caring for a client in an inpatient mental health facility who gets up from a chair and throws it across the day room. Which of the following is the priority nursing action?
A. encourage the client to express feelings out loud
B. maintain eye contact with the client
C. move the client away from others
D. tell the client that the behavior is not acceptable

Correct Answer:

C. move the client away from others

all are appropriate but safety is the priority

A nurse is caring for a client who is screaming at staff members and other clients. Which of the following is a therapeutic response by the nurse to the client?
A. "stop screaming, and walk with me outside."
B. "why are you so angry and screaming at everyone?"
C. "you will not get your way by screaming."
D. "what was going through your mind when you started screaming?"

Correct Answer:
A. "stop screaming, and walk with me outside."

A charge nurse is leading a peer group discussion about family and community violence. Which of the following statements by a member of the group indicates an understanding of teaching?
A. "children older than 5 are at greater risk for abuse"
B. "substance use disorder does not increase the risk for violence."
C. "entering an intimate relationship increases the risk for violence."
D. "pregnancy increases the risk for violence from a spouse or partner."

Correct Answer:

D. "pregnancy increases the risk for violence from a spouse or partner."

A nurse is preparing a community education seminar about family violence. When discussing types of violence, the nurse should include which of the following?
A. refusing to pay bills for a dependent, even when funds are available, is neglect.
B. intentionally causing someone to fall is an example of physical violence.
C. striking a sexual partner is an example of sexual violence.
D. failure to provide a stimulating environment for normal development is emotional abuse.

Correct Answer:

B. intentionally causing someone to fall is an example of physical violence.

refusing to pay bills is according to ATI "economic abuse" and not neglect

striking a partner is physical violence

failure to provide a stimulating environment for normal development is neglect

A nurse is caring for an adult client who has injuries resulting from spousal violence. The client does not wish to report the violence to law enforcement authorities. Which of the following nursing actions is the highest priority?
A. advise the client about the location of safe houses and shelters
B. encourage the client to participate in a support group for survivors of abuse
C. implement case management to coordinate community and social services
D. educate the client about the use of stress management techniques

Correct Answer:

A. advise the client about the location of safe houses and shelters

the priority action is to assist the client with the development of a safety plan that includes the identification of safe places to live

A nurse is assessing a client who experienced sexual assault. Which of the following findings indicate the client is experiencing an emotional reaction of rape-trauma syndrome? (select all)
A. GU soreness
B. difficulties with low self-esteem
C. sleep disturbances
D. emotional outbursts
E. difficulty making decisions

Correct Answer:

D. emotional outbursts

E. difficulty making decisions

A nurse is discussing the care of a client following a sexual assault with a newly licensed nurse. Which of the following statements by the new nurse indicates an understanding of teaching?
A. "I will administer prophylactic treatment for STIs"
B. "I am not required to obtain informed consent before the SANE collects forensic evidence."
C. "I can expect manifestations of rape-trauma syndrome to be similar to bipolar disorder."
D. "I should use narrative documentation when documenting subjective data."

Correct Answer:

A. "I will administer prophylactic treatment for STIs"

A nurse is caring for a client who was recently sexually assaulted. The client states, "I never should have been out on the street alone at night." Which of the following responses should the nurse make?
A. "your actions had nothing to do with what happened."
B. "you should focus on recovery rather than blaming yourself for what happened."
C. "you believe this wouldn't have happened if you hadn't been out alone?"
D. "why do you feel that you should not have been alone on the street at night?"

Correct Answer:

C. "you believe this wouldn't have happened if you hadn't been out alone?"

A community health nurse is leading a discussion about rape with a neighborhood task force. Which of the following statements by a neighborhood citizen indicates an understanding of the teaching?
A. "rape is a crime of passion."
B. "acquaintance rape often involves alcohol."
C. "young adults are the typical victims of sexual assault."
D. "the majority of rapists are unknown to the victims."

Correct Answer:

B. "acquaintance rape often involves alcohol."

alcohol and drugs are often associated with date/acquaintance rape

A patient with a diagnosis of major depression who attempted suicide says to the nurse, "I should have died! I've always been a failure. Nothing ever goes right for me." Which response 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 this for a while

d. You've been feeling like this for a while

this is the therapeutic technique of restating. This demonstrates that the nurse was listening and allows the nurse to document conversations. The nurse can add, "does that sound correct?" to allow the patient to clarify if needed.

A patient is diagnosed with terminal cancer says to the nurse "I'm going to die, and 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 are probably very depressed, which is understandable with such a diagnosis

c. You're feeling angry that your family continues to hope for you to be cured?

This is the therapeutic technique of restating. Restating is done to clarify the client's message by repeating the same statement back to the client.

When reviewing the admission assessment, the nurse notes that a patient was admitted to the mental health unit involuntarily. Based on this type of admission, the nurse should provide which intervention for this patient:

a. monitor closely for harm to self or others
b. assist in completing an application for admission
c. supply the patient with a written information about their mental illness.
d. provide an opportunity for the family to discuss why they felt the admission was needed

a. monitor closely for harm to self or others

Involuntary admission means that the patient is at risk for harm to self or others based off behavior that happened in the past 30 days. This is phrased as, "clear and present danger to self or others"

When reviewing the admission, a nurse states to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique:

a. The therapeutic technique of "giving advice"
b. the therapeutic technique of "defending"
c. the non-therapeutic technique of "presenting reality"
d. the non- therapeutic technique of "giving false reassurance"

d. the non- therapeutic technique of "giving false reassurance"

Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client's feelings

After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, "I'm so proud of you for being assertive. You are so good!" Which communication technique has the leader employed?

A. The nontherapeutic technique of giving approval
B. The nontherapeutic technique of interpreting
C. The therapeutic technique of presenting reality
D. The therapeutic technique of making observations

A. The nontherapeutic technique of giving approval

Giving approval implies that the nurse has the right to pass judgement on wether the client's ideas or behaviors are "good" or "bad." This creates a conditional acceptance of the client

The nurse calls security and has physical restraints applied when a client who was admitted voluntarily becomes both physically and verbally abusive while demanding to be discharged from the hospital. Which represents the possible legal ramifications for the nurse associated with these interventions? Select all that apply.

A Libel
B Battery
C Assault
D Slander
E False Imprisonment

B Battery
C Assault
E False Imprisonment

Which nursing statement is a good example of the therapeutic communication technique of giving recognition?

a. You did not attend the group today. Can we talk about that?
b. I'll sit with you until it is time for your family session
c. I notice you are wearing a new dress and you have washed your hair
d. I'm happy that you are now taking your medications. They will really help

c. I notice you are wearing a new dress and you have washed your hair

Giving recognition indicates that you are paying attention to the patient and recognize them as an individual. This is more appropriate than complimenting, which reflects judgement of something as "good" or "bad"

A talkative member of a support group for patients diagnosed with bipolar disorder has monopolized the group discussion for 15 min. The nurse leading the group would best intervene by:

a. Maintaining silence. It is important for group members to give feedback to each other
b. Encourage the patient to continue. Patients learn from each other in group settings
c. state " you must allow some of the other members of the group to talk. You cannot monopolize the conversation
d. Address the patient by name and state, "I'm glad you shared your thoughts with us. Let's hear what others think."

d. Address the patient by name and state, "I'm glad you shared your thoughts with us. Let's hear what others think."

As members disperse at the conclusion of a productive group meeting, one member says, "Let's have a big group hug." Select the leader's most appropriate response.

a. "Hugging is not permitted."
b. "I am glad you found the meeting so helpful."
c. "Thanks for that suggestion, but not everyone may be comfortable with hugs."
d. "The group is over now. Members may not have continued contact with each other."

c. "Thanks for that suggestion, but not everyone may be comfortable with hugs."

During a group meeting, one of the patients keep talking and repeatedly answers all the questions and interrupts others. This person is called:

a. uninvolved patient
b. manic
c. dominant patient
d. A jerk

c. dominant patient

Techniques that a group leader uses to conduct group in a therapeutic was (select all that apply):

a. giving information
b. presenting reality
c. making observations
d. giving approval
e. seeking clarification

a. giving information
b. presenting reality
e. seeking clarification

*check this*