Title: Exam 1
Course: NUR 1521C Psychiatric/Mental Health Nursing > Section: Module 3

Q: A patient with schizophrenia tells the nurse "I don't know, it's just all the same. You never know. It comes, it goes, it blows away. Get it?" Which of the following is the best response for the nurse to make?
- "Nothing you are saying is clear; you are not making sense."
- "Yes, life can be like that sometimes, very confusing."
- "Try to organize your thoughts and then tell me again."
- "I am having difficulty understanding what you are saying."
A: "I am having difficulty understanding what you are saying."

Q: A patient with catatonic schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which nursing intervention should receive the highest priority?
- Conducting passive range-of-motion exercises
- Exposing the patient to auditory and visual stimuli
- Interacting with the patient as if he is responding
- Including the patient in a variety of milieu activities
A: Conducting passive range-of-motion exercises

Q: A man with schizophrenia living in a slum area is punched, pushed to the ground, and robbed of $7 in broad daylight on a public street. Which statements about violence and serious mental illness in general are accurate? Select all that apply. SMI = Serious Mental Illness
- Lower incomes force SMI persons to live in high-crime areas, increasing risk.
- Persons with SMI are more likely to be violent, endangering their SMI peers.
- Impaired judgment and social skills can provoke hostile or assaultive behavior.
- Criminals may believe SMI persons are less likely to resist or testify against them.
A: Lower incomes force SMI persons to live in high-crime areas, increasing risk.; Impaired judgment and social skills can provoke hostile or assaultive behavior.; Criminals may believe SMI persons are less likely to resist or testify against them.

Q: A patient's nursing care plan includes assessment for auditory hallucinations. Indicators that suggest the patient may be hallucinating include which of the following?
- aloofness, increased distractibility, and suspicion.
- elevated mood, excessive talking, and distractibility.
- performing rituals and avoiding open places.
- darting eyes, distracted, and mumbling to self.
A: darting eyes, distracted, and mumbling to self.

Q: A patient with paranoid schizophrenia tells the nurse, "The FBI is listening through fluorescent lights in this room. Be careful what you say." Which response by the nurse would be most therapeutic?
- "Let's talk about something other than the FBI."
- "It sounds like you're concerned about your privacy."
- "The FBI is prohibited from operating in health care facilities."
- "You have lost touch with reality, which is a symptom of your illness."
A: "It sounds like you're concerned about your privacy."

Q: A newly admitted patient diagnosed with paranoid schizophrenia states that he saw two doctors talking in the hall and knows they were plotting to kill him. When charting, how should the nurse identify this behavior?
- Idea of reference
- Delusion of infidelity
- Auditory hallucination
- Echolalia
A: Idea of reference

Q: A patient with schizophrenia refuses to take his medication because he believes he is not ill. What phenomenon most likely underlies this presentation?
- The patient is unable to face having an illness and is in denial.
- Stigma causes the patient to refuse to admit his mental illness.
- The illness itself is preventing the patient from realizing he is ill.
- Command hallucinations are instructing him to deny the illness.
A: The illness itself is preventing the patient from realizing he is ill.

Q: When a patient with paranoid schizophrenia has a recurrence of positive symptoms after stopping his antipsychotic medication because of its postural hypotension (orthostasis) side effect, he is readmitted to the mental health unit. What measure should the nurse suggest to help the patient address this side effect?
- Ask the doctor to prescribe an anticholinergic drug like trihexyphenidyl (Artane).
- Chew sugarless gum or use sugarless hard candy to moisten your mouth.
- Increase the amount of sleep you get, and try to take frequent rest breaks.
- Wear elastic support hose, drink adequate fluids, and change position slowly.
A: Wear elastic support hose, drink adequate fluids, and change position slowly.

Q: The therapeutic action of neurotransmitter inhibitors that block reuptake cause which of the following?
- decreased concentration of the neurotransmitter in the central nervous system.
- increased concentration of neurotransmitter in the synaptic gap.
- destruction of receptor sites.
- limbic system stimulation.
A: increased concentration of neurotransmitter in the synaptic gap.

Q: A patient tells the nurse, "My doctor prescribed Paxil (paroxetine) for my depression. I assume I'll have side effects like I had when I was taking Tofranil (imipramine)." The nurse's reply should be based on the knowledge that paroxetine is which of the following?
- selective norepinephrine reuptake inhibitor.
- tricyclic antidepressant.
- MAO inhibitor.
- SSRI.
A: SSRI.

Q: SSRIs improve depression by which action? SSRIs:
- destroy increased amounts of serotonin.
- block muscarinic and a_1 norepinephrine receptors.
- make more serotonin available at the synaptic gap.
- increase production of acetylcholine and dopamine.
A: make more serotonin available at the synaptic gap.

Q: Which intervention by a psychiatric nurse best applies the ethical principle of autonomy? The nurse:
- explores alternative solutions with a patient, who then makes a choice.
- suggests that two patients who were fighting be restricted to the unit.
- intervenes when a self-mutilating patient attempts to harm self.
- stays with a patient demonstrating a high level of anxiety.
A: explores alternative solutions with a patient, who then makes a choice.

Q: An informal group of patients discusses their perceptions of nursing care. Which comment best indicates a patient perceived the nurse was caring? "My nurse:
- always asks me which type of juice I want to help me swallow my medication."
- explained my treatment plan to me and asked for my ideas about how to make it better."
- told me that if I take all the medicines the doctor prescribes, then I will get discharged soon."
- spends time listening to me talk about my problems. That helps me feel like I'm not alone."
A: spends time listening to me talk about my problems. That helps me feel like I'm not alone."

Q: A patient asks, "What are neurotransmitters? The doctor said mine are imbalanced." Select the nurse's best response.
- "How do you feel about having imbalanced neurotransmitters?"
- "You must feel relieved to know that your problem has a physical basis."
- "Neurotransmitters are substances we eat daily that influence memory and mood."
- "Neurotransmitters are natural chemicals that pass messages between brain cells."
A: "Neurotransmitters are natural chemicals that pass messages between brain cells."

Q: The nurse wants to assess a patient with major depression for disturbances in circadian rhythms. Which question is best for this aspect of the assessment?
- "Have you ever seen or heard things that others do not?"
- "What are your worst and best times of day?"
- "How would you describe your thinking?"
- "Do you think your memory is failing?"
A: "What are your worst and best times of day?"

Q: A nurse could anticipate that treatment for a patient with memory difficulties might include medications designed to do which of the following?
- inhibit GABA.
- increase dopamine activity.
- reduce neurotensin metabolism.
- prevent destruction of acetylcholine.
A: prevent destruction of acetylcholine.

Q: Which documentation of a patient's behavior best demonstrates a nurse's observations?
- Isolates self from others. Frequently fell asleep during group. Vital signs stable.
- Calmer; more cooperative. Participated actively in group. No evidence of psychotic thinking.
- Appeared to hallucinate. Frequently increased volume on television, causing conflict with others.
- Wore four layers of clothing. States, "I need protection from evil bacteria trying to pierce my skin."
A: Wore four layers of clothing. States, "I need protection from evil bacteria trying to pierce my skin."

Q: A newly admitted acutely psychotic patient is a private patient of the chief of staff and a private-pay patient. To whom does the psychiatric nurse assigned to the patient owe the duty of care?
- Health care provider
- Hospital
- Profession
- Patient
A: Patient

Q: A newly admitted patient with schizophrenia approaches the unit nurse and says, "The voices are bothering me. They are yelling and telling me stuff. They are really bad." Which response by the nurse would be most appropriate?
- "Do you hear these voices very often?"
- "Do you have a plan for getting away from the voices?"
- "I'll stay with you. Tell me what you are hearing."
- "Try to ignore them and play cards with the others."
A: "I'll stay with you. Tell me what you are hearing."

Q: Which finding best indicates that the goal "Demonstrate mentally healthy behavior" was achieved? A patient:
- sees self as approaching ideals and capable of meeting demands.
- seeks others to assume responsibility for major areas of own life.
- behaves without considering the consequences of personal actions.
- aggressively meets own needs without considering the rights of others.
A: sees self as approaching ideals and capable of meeting demands.

Q: A nurse explains the multiaxial DSM-IV-TR to a psychiatric technician. Which of the following conveys the correct information?
- focuses on plans for treatment.
- includes nursing and medical diagnoses.
- classifies problems in multiple areas of functioning.
- uses the framework of a specific biopsychosocial theory.
A: classifies problems in multiple areas of functioning.

Q: Two nursing students discuss their career plans after graduation. One student wants to enter psychiatric nursing. The other asks, "Why would you want to be a psychiatric nurse? The only thing they do is talk. You'll lose all your skills." Select the best response.
- "Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of the patients' problems."
- "Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations."
- "I think I will be good in the mental health field. I did not like clinical rotations in school, so I do not want to continue them after I graduate."
- "Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That appeals to me."
A: "Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations."

Q: A patient in the emergency department says, "The voices say someone is stalking me. They want to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a threat." Which aspect(s) of mental health should be of greatest immediate concern to the nurse? Select all that apply.
- Happiness
- Appraisal of reality
- Control over behavior
- Effectiveness in work
A: Appraisal of reality; Control over behavior

Q: A nurse is planning care for a patient with mental illness. Which problem will receive priority? The patient:
- refuses to eat or bathe.
- reports feelings of alienation from family.
- is reluctant to participate in unit social activities.
- is unaware of medication action and side effects.
A: refuses to eat or bathe.

Q: Which comment most clearly shows a speaker views mental illness with stigma?
- "Some mental illnesses are inherited."
- "Most people with mental illness are unmotivated."
- "Severe environmental stress sometimes causes mental illness."
- "Some mental illnesses are due to neurotransmitter dysregulation."
A: "Most people with mental illness are unmotivated."

Q: In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill? One who:
- describes hearing God's voice speaking.
- is usually pessimistic but strives to meet personal goals.
- is wealthy and gives away $20 bills to needy individuals.
- always has an optimistic viewpoint about life and having own needs met.
A: describes hearing God's voice speaking.

Q: A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. The nurse analyzes that these symptoms relate to which drug action?
- Anticholinergic effects
- Dopamine-blocking effects
- Endocrine-stimulating effects
- Ability to stimulate spinal nerves
A: Dopamine-blocking effects

Q: A patient has acute anxiety related to an automobile accident 2 hours ago. The patient needs teaching about drugs from which group?
- Tricyclic antidepressants
- Antipsychotic drugs
- Antimanic drugs
- Benzodiazepines
A: Benzodiazepines

Q: A college student received an invitation to attend the wedding of a close friend who lives across the country. The student is afraid of flying. What type of therapy would the nurse suggest?
- Psychoanalysis
- Milieu therapy
- Systematic desensitization
- Short-term dynamic therapy
A: Systematic desensitization

Q: A patient has disorganized thinking associated with schizophrenia. Neuroimaging would most likely show dysfunction in which part of the brain?
- Hippocampus
- Frontal lobe
- Cerebellum
- Brainstem
A: Frontal lobe

Q: A nurse can anticipate anticholinergic side effects are likely when a patient takes which of the following medications?
- lithium (Lithobid).
- buspirone (BuSpar).
- sertraline (Zoloft)
- fluphenazine (Prolixin).
A: fluphenazine (Prolixin).

Q: Which instruction has priority when teaching a patient taking clozapine (Clozaril)?
- "Avoid unprotected sex."
- "Report sore throat and fever immediately."
- "Reduce foods high in polyunsaturated fats."
- "Use over-the-counter preparations for rashes."
A: "Report sore throat and fever immediately."

Q: A patient is hospitalized for severe depression. Of the medications listed below, the nurse can expect to provide the patient with teaching about which of the following?
- chlordiazepoxide (Librium).
- clozapine (Clozaril).
- sertraline (Zoloft).
- tacrine (Cognex).
A: sertraline (Zoloft).

Q: A patient begins therapy with a first generation antipsychotic medication. What teaching should the nurse provide related to the drug's strong dopaminergic effect?
- Chew sugarless gum
- Increase dietary fiber
- Arise slowly from bed
- Report muscle stiffness
A: Report muscle stiffness

Q: An interdisciplinary health care team met 12 hours after an adolescent was hospitalized following a suicide attempt. What result can be expected from this meeting?
- A treatment plan will be determined.
- The nurse will assume the surrogate parent role.
- The need for placement outside the home will be assessed.
- The team will request a court-appointed advocate for the patient.
A: A treatment plan will be determined.

Q: Questions that would be nonjudgmental when obtaining information about patient use of herbal remedies include which of the following? Select all that apply.
- "You don't regularly take herbal remedies, do you?"
- "What herbal medicines have you used to relieve your symptoms?"
- "What over-the-counter medicines and nutritional supplements do you use?"
- "Have you experienced toxic effects from mixing herbals and prescription drugs?"
A: "What herbal medicines have you used to relieve your symptoms?"; "What over-the-counter medicines and nutritional supplements do you use?"; "Have you experienced toxic effects from mixing herbals and prescription drugs?"

Q: Consider these medications: carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin). Which medication below also belongs with this group?
- Galantamine (Reminyl)
- Valproate (Depakote)
- Buspirone (BuSpar)
- Tacrine (Cognex)
A: Valproate (Depakote)

Q: A nurse instructs a patient taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of which of the following?
- cardiac dysrhythmia.
- hypotensive shock.
- hypertensive crisis.
- cardiogenic shock.
A: hypertensive crisis.

Q: When a patient diagnosed with paranoid schizophrenia was discharged from the unit 6 months ago, the plan was for him to take chlorpromazine (Thorazine), a conventional (first generation) antipsychotic medication, 300 mg po daily. He tells the nurse he stopped taking his pills after a few months because they made him feel like a "zombie." What other common side effects should the nurse assess?
- Sweating, nausea, and weight gain
- Sedation, tremor, and muscle stiffness
- Headache, watery eyes, and runny nose
- Mild fever, sore throat, and skin rash
A: Sedation, tremor, and muscle stiffness

Q: I have thoroughly read the course description, requirements, assignments/due dates, and calendar information on this site. Further, I have reviewed the procedures for using the discussion, assignments dropbox, and e-mail features of the site. I understand what is required to complete this course successfully and how to use the online tools to do so.
- Yes, I do
- No, I don't
A: Yes, I do
If right: Great, then begin work on Module 1.
If wrong: Uh oh! Then go back and re-read the syllabus materials completely. If you still cannot answer, Yes, I do, contact the instructor immediately.

Q: Which nursing intervention demonstrates false imprisonment?
- A confused and combative patient says, "I'm getting out of here and no one can stop me." The nurse restrains this patient without a health care provider's order and then promptly obtains an order.
- A patient has been irritating and attention seeking much of the day. Now a nurse escorts the patient down the hall saying, "Stay in your room or you'll be put in seclusion."
- An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. The nurse rushes after the patient and convinces the patient to return to the unit.
- An involuntarily hospitalized patient with homicidal ideation attempts to leave the facility. A nurse calls the security team and uses established protocols to prevent the patient from leaving.
A: A patient has been irritating and attention seeking much of the day. Now a nurse escorts the patient down the hall saying, "Stay in your room or you'll be put in seclusion."

Q: Which patient meets criteria for involuntary commitment for psychiatric treatment? The patient who:
- is noncompliant with the treatment regimen.
- fraudulently files for bankruptcy.
- sold and distributed illegal drugs.
- threatens to harm self and others.
A: threatens to harm self and others.

Q: The nurse would refer which patient to a partial hospitalization program? A patient who:
- spent yesterday in a supervised crisis care center and continues to be actively suicidal.
- needs psychoeducation for relaxation therapy related to agoraphobia and panic episodes.
- has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up.
- states, "I'm not sure I can avoid using alcohol when my spouse goes to work every morning."
A: states, "I'm not sure I can avoid using alcohol when my spouse goes to work every morning."

Q: A patient with psychosis asks a psychiatric technician, "What's the matter with me?" The technician replies, "Your wing nuts need tightening." The nurse who overheard the exchange. The nurse will need to take action based on which of the following?
- violation of the patient's right to be treated with dignity and respect.
- the nurse's obligation to report caregiver negligence.
- preventing defamation of the patient's character.
- supervisory liability.
A: violation of the patient's right to be treated with dignity and respect.

Q: A patient with schizophrenia believes a local minister stirred evil spirits and threatens to bomb a local church. The psychiatrist notifies the minister. Which of the following demonstrates the appropriate action? The psychiatrist:
- released information without proper authorization.
- demonstrated the duty to warn and protect.
- violated the patient's confidentiality.
- avoided charges of malpractice.
A: demonstrated the duty to warn and protect.

Q: Which action by a nurse shows a breach of a patient's right to privacy?
- Documents the patient's daily behaviors during hospitalization
- Releases information to the patient's employer without consent
- Discusses the patient's history with other staff during care planning
- Asks family to share information about a patient's prehospitalization behavior
A: Releases information to the patient's employer without consent

Q: Which individual with mental illness may need emergency or involuntary hospitalization for mental illness? The individual who:
- resumes using heroin while still taking naltrexone (ReVia).
- reports hearing angels playing harps during thunderstorms.
- does not keep an outpatient appointment with the mental health nurse.
- throws a heavy plate at a waiter at the direction of command hallucinations.
A: throws a heavy plate at a waiter at the direction of command hallucinations.

Q: A nurse asks a patient, "If you had fever and vomiting for 3 days, what would you do?" Which aspect of the mental status examination is the nurse assessing?
- Behavior
- Cognition
- Affect and mood
- Perceptual disturbances
A: Cognition

Q: Which statement made by a patient should serve as the priority focus for the plan of care?
- "I can always trust my family."
- "It seems like I always have bad luck."
- "You never know who will turn against you."
- "I've been hearing the voices of my dead parents."
A: "I've been hearing the voices of my dead parents."

Q: A newly admitted patient is severely depressed, lost 20 pounds over the past month, and expresses hopelessness for the future. Which of the following is the best nursing diagnosis?
- Imbalanced nutrition: less than body requirements
- Chronic low self-esteem
- Risk for suicide
- Powerlessness
A: Risk for suicide