NUR 326 Psychology/Mental Health Exam 1: Rasmussen

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. A suicidal patient is found by the nurse as he tries to hang himself from the shower in the bathroom. What nursing intervention would address the patient's need for safety while maintaining his self... -esteem? a. Assign a staff member to remain with him at all times. b. Place him in the seclusion room with 15 minute checks c. Request that he remain with the patient group at all times. d. Tell him he may use the bathroom only with staff supervision. 1. The nursing student learned of a high school classmate who recently committed suicide. The classmate's death surprised the student, because the classmate had always seemed very confident and popular. The student knows, however, that suicide is usually: a. An act with a message and purpose b. An impulsive act without meaning c. A random act of selfishness d. A random act without meaning or purpose 1. A voluntary patient mutilates herself whenever she leaves the unit. The nurse suggests use of four-point restraint to prevent the patient from further harming herself. What question should be considered before this measure is undertaken? a. Is this the least restrictive measure possible? b. Can four-point restraint be used for voluntary patients? c. What litigation is likely to follow from this action? d. What documentation will be necessary after restraint application? 1. A patient, who has recently lost a spouse, calls the crisis line stating the occurrence of suicidal ideations that involve jumping off a bridge over the river when no one is around. What level of lethality would a nurse assess for this plan? a. Low b. Moderate c. High d. Lethality cannot be determined from this data 1. Which of the following symptoms indicates Neuroleptic Malignant Syndrome (NMS), a potentially fatal side effect of an antipsychotic medication such as Haldol (haloperidol)? a) Photosensitivity and an itchy rash on face, neck, chest and extremities b) Hyperthermia and muscle rigidity c) Blurred vision, constipation, and urinary retention d) Tongue protrusion, lip smacking, and grimacing 1. The nurse using cognitive behavior techniques when working with patients knows that attributions are meanings the patient gives to events or circumstances that: a. may or may not be objectively accurate b. support a sense of autonomy c. promote rigidity and chaos d. isolate family members from each other 1. A patient was the driver of a car that struck and killed a child. The patient tells a nurse, "I killed a child! I'm haunted by the sight of the body being thrown into the air. If I hadn't been drinking I might have been able to stop. I don't know how I can go on living with myself!" The crisis nurse should give priority to assessing the patient's: a. suicidal risk. b. physical condition. c. recent drug dependency. d. current alcohol consumption. 1. A patient who was savagely attacked by a bear has no memory of the event. Which statement best explains the patients inability to remember the attack? a. The woman lost consciousness and was not cognitively aware of what happened during the attack b. The brain has produced a chemical anemia that will repress the memories of the attack indefinitely. c. The patient is unconsciously using a defense mechanism to protect against the repeated memory of the attack. d. It is a temporary suppression of the attack; her memory will return when she is physically and emotionally ready to handle the memories. Defense mechanisms are used unconsciously to protect us from threats to the physical, mental, and social aspects of ourselves. The memory of the event may or may not come back but this is not generally related to the patients ability to handle the memories. Memory may be lost or impaired as a result of brain trauma but not as likely from a chemical alteration. 2. Which assessment finding exhibited by a patient being assessed for posttraumatic stress disorder (PTSD) would be considered a defining behavior and support such a diagnosis? a. Can describe the attack in great detail b. Experiences dramatic swings in affect c. Describes vivid flashbacks of being attacked d. Is preoccupied with the need to tell someone about the attack One defining behavior that is seen when an individual has PTSD is that the person re-experiences the traumatic event. This takes place by having recurrent and intrusive disturbing recollections of the trauma, including thoughts, images, or perceptions about the incident. The person sometimes experiences recurrent dreams of the incident and acts or feels as though the event was recurring in the present (flashback). Generally the PTSD patient cannot remember all the details of the trauma nor are they particularly interested in re-telling the events of the trauma. The patient generally has a very limited range of affect. 3. What is the basis for assessing a male patient who is agoraphobic for panic attacks? a. Men are more likely to experience panic attacks. b. An overwhelming number of agoraphobic patients also have panic attacks. c. Patients are often unaware that the symptoms they are experiencing are those of panic. d. Panic attacks are generally the cause of a patient developing phobias like agoraphobia. Almost all patients who present with agoraphobia in clinical samples have a current diagnosis or history of panic disorder. Males are not more likely than females to experience panic attacks. Patients are not usually unaware of panic attack symptoms. Panic attacks dont cause, but are often triggered by, phobias. 4. Discharge preparation for a patient includes the administration of the Hamilton Anxiety Scale (HAS). When asked by the patient to explain the purpose of the assessment the nurse responds: a. It is an assessment tool used to evaluate the symptoms of anxiety. b. The tool is used to help confirm the diagnosis of anxiety disorder. c. This tool helps determine if your symptoms have improved with treatment. d. It helps identify the presence of any other disorder associated with anxiety. The HAS is a valid and time-tested tool that gives the most objective measure of the degree to which anxiety has been effectively treated. The HAS does not evaluate for symptoms of anxiety or act as a diagnosis tool for anxiety or another other associated disorder. 5. A patient is admitted for treatment for persistent, severe anxiety. Which nursing diagnosis would help effectively direct patient care? a. Disturbed sensory perception related to narrowed perceptual field b. Risk for injury related to closed perception c. Hopelessness related to total loss of control d. Risk for other-directed violence related to combative behavior A narrowed perceptual field occurs with severe anxiety; therefore this diagnosis should be considered. Data are not present to support the other diagnoses. 8. Which question would assist the nurse in determining whether the patient has been experiencing anxiety? a. Have you had difficulty concentrating lately? b. Have you been feeling sad and especially lonely? c. Do you have a history of failed personal relationships? d. Do you frequently experience difficulty controlling your anger? Concentration difficulties occur when moderate or greater levels of anxiety are present. Loneliness is more related to mood. A failed personal relationship is more related to poor self-esteem. Inability to control anger is related to poor impulse control. 9. The nurse working with patients diagnosed with posttraumatic stress disorder (PTSD) is aware of the need to intervene early in order to de-escalate a patients increasing anxiety level. Which patient behavior is likely an early indication of escalating anxiety? a. Talking rapidly b. Pacing around the unit c. Staring out the window d. Refusing to go to therapy Recognize the patients use of relief behaviors (e.g., pacing, wringing of hands) as indicators of anxiety. Talking rapidly is an indicator of manic behavior. Staring is more likely seen in depression. Refusing to attend therapy is seen in aggressive, defiant patients. 10. The nurse has been working with a patient who experiences anxiety. Which intervention should the nurse implement initially when the patient is observed pacing and wring her hands? a. Asking how she has managed anxiety effectively in the past b. Distracting her by offering to help her make a telephone call c. Asking her what she believes is causing her increased anxiety d. Teaching her to take deep, relaxing breaths to manage the anxiety First help the patient to build on the coping methods that the patient used to manage anxiety in the past. Coping methods that were previously successful will generally be effective in subsequent situations. Distraction is not usually successful initially. Assessing for the cause of the anxiety will not, in this situation, be helpful in managing it; often times patients are not aware of the cause. Teaching will not be effective while the patient is experiencing anxiety but should be done when the patient is relaxed and able to focus. 14. A patient is ordered medication therapy to manage the symptoms of anxiety disorder. Which statement by the patient indicates an understanding of the typical classification of medication prescribed for this disorder? a. Tricyclic antidepressants are particular good for panic attacks. b. I have to give up beer while taking monamine oxidase inhibitors (MAOIs). c. Selective serotonin reuptake inhibitors (SSRIs) help with panic attacks as well. d. Benzodiazepines are usually effective when taken for chronic anxiety like mine. c SSRIs are the most widely prescribed medication to treat panic disorder. They are effective and have a low side-effect profile. Tricyclic antidepressants are not effective for panic attacks and have more side effects than SSRIs. MAOIs are effective but require knowledge of and compliance with a special diet and are not the first choice in this situation. Benzodiazepines are effective but produce alterations in sensorium and other side effects and are not used for long-term management. 16. The head nurse in the ED has received word that a major fire in a high-rise office tower will result in many injured persons being brought to the hospital within the next few minutes. The head nurse tells the staff, You will need to assess for acute stress reactions as well as treating physical problems. Which patient is exhibiting symptoms characteristic of acute stress reaction? a. A male whose moods swing between mania and depression b. A female who reports still hearing her daughters pleas for help c. A male who keeps repeating I dont understand whats going on? d. A female who is rocking her young son and repeating it will be okay. c Acute stress reactions are characterized by indications of dissociation, such as dissociative amnesia. Mood swings are more reflective of a mood disorder. Auditory hallucinations would be consistent with re-living a traumatic event. Comforting and reassuring a child in this manner is not characteristic of an acute stress reaction. 17. A nurse is reprimanded by the nurse manager. Shortly thereafter, a patients family member reports that the nurse curtly told them You cant come in now. You know you need to wait until visiting hours. The incidence should be discussed based on the knowledge that the defense mechanism the nurse used was: a. Displacement b. Projection c. Sublimation d. Suppression a Displacement is transferring a response or feeling toward one person onto another less threatening person. Projection is attributing strong faults to another and is not displayed in this scenario. Sublimation is channeling maladaptive thoughts into socially acceptable behaviors. Suppression is intentionally avoiding thinking about problem areas. 19. A young, married female patient is attracted to a male nurse. When the nurse sets clear boundaries, the patient falsely accuses him of sexual harassment. The nursing supervisor recognizes the defense mechanism of: a. Projection b. Splitting c. Suppression d. Displacement a Projection is attributing strong conflicting feelings to another person. Splitting is seeing others and oneself as all good or all bad. Suppression is incorrect because the person avoids thinking about problem areas. Displacement, or transferring a feeling to a less threatening person, is not being used in this scenario. 20. A college-aged patient complains that, when I begin to take a test, I freeze up and my mind goes blank. The nurse will react based on the understanding that this patients anxiety level is: a. Mild b. Moderate c. Severe d. Panic c In severe anxiety, a person may freeze and problem solving is difficult. A person is relatively relaxed and comfortable in mild anxiety. A person in moderate anxiety may feel energized and focused. A person at panic level has total loss of control. 1. A patient is being evaluated for a possible diagnosis of panic disorder with agoraphobia. Which nursing assessment findings support this diagnosis? Select all that apply. a. Patient states, Ive had these fears for more than 6 years. b. Patient describes having a panic attack several times a month. c. Patient is embarrassed by the limitations the disorder causes. d. Stated, I never even think about going shopping in a crowded mall. e. Condition began after beginning treatment for a chronic intestinal problem. ABCD To meet the first DSM-IV-TR criterion for panic disorder with agoraphobia, the person must experience recurrent, unexpected panic attacks, with at least one attack followed by one of the following for a month: (1) persistent concern about having additional attacks; (2) worry about the implications of the panic attacks; or (3) a significant change in behavior as a result of the attacks. The second criterion is that the individual experiences agoraphobia. Agoraphobic fears typically involve being in a crowd. The third criterion is that the person avoids agoraphobic situations or has anxiety about having a panic attack. This person will not go to an area or event where he or she has experienced an agoraphobic reaction. The fourth criterion states that panic attacks are not caused by the direct effects of a substance, a medication, or a medical condition. 3. Which lifestyle changes should the nurse incorporate in the nursing care plan for a patient with generalized anxiety disorder? Select all that apply. a. Stop smoking. b. Limit caffeine intake. c. Eliminate stress from your life. d. Practice a relaxation technique daily. e. Limit worrying to specific times each day. ABDE CNS stimulants, including caffeine and nicotine, increase anxiety symptoms such as heart rate and muscle tension. Relaxation techniques are invaluable in the management of stress and anxiety. Limiting the time to allow worrying will help control the invasive thoughts. One cannot avoid stressful situations and attempting to do so does not help in managing its affects.` 4. A nursing interview for a patient being admitted for depression reveals that the patient has been taking a benzodiazepine for anxiety for 3 years. Which actions by the nurse reflect an understanding of the effects of this classification of drugs? Select all that apply. a. The nurse asks how much of the drug the patient takes daily. b. The admitting physician is notified of the patients medication history. c. The nurse prepares to discuss the process of detoxification with the patient. d. The nurse suggests to the patient that the dosage is likely to be increased. e. The patient is interviewed regarding how well the anxiety has been controlled. ABC Benzodiazepines are relatively safe and effective for short-term use to control the debilitating symptoms of anxiety. However, longer-term treatment with these drugs raises issues of tolerance, abuse, and dependence. The medication dosage would not be increased. The effectiveness of the medication is irrelevant but rather the length of the therapy is the prime concern. 5. A patient comes to the ED exhibiting severe physical and emotional symptomology. When no physical cause can be found for the symptoms, the patient is diagnosed with severe anxiety with panic attack symptoms. Which assessment data supports this diagnosis? Select all that apply. a. Blood pressure 158/90; 15 minutes later 130/80 b. Claims that she feels like she going to die c. Random but controlled thoughts d. Unable to follow instructions e. Dry, flushed skin ABD Blood pressure will begin to drop in a panic attack as the sympathetic nervous system release occurs; the patient may express an emotional sensation of doom and the patient will not be able to concentrate and so will be unable to follow instructions. Thoughts during a panic attack are uncontrolled and the skin is diaphoretic. The nurse learns at report that a newly admitted manic patient is demonstrating grandiosity. Which statement would be most consistent with this symptom? a. I cant do anything anymore. b. Im the worlds most astute financier. c. I can understand why my wife is upset that I overspend. d. I cant understand where all the money in our family goes. b An individual who is demonstrating grandiosity has an exaggerated view of his abilities. The other options are more moderate statements and lack that element of exaggeration. The nurse will base a discussion of dysthymia on the fact that the condition: a. Typically has an acute onset b. Involves delusional thinking c. Is chronic low-level depression d. Does not include suicidal ideation c Dysthymia is identified as a chronic low-level depression frequently lasting over a period of several years without remitting. Dysthymia has a slow, insidious onset. Delusional thinking is not a common manifestation of dysthymia. Suicidal thoughts are seen among dysthymic patients. 3. What is the priority nursing diagnosis for a patient exhibiting signs of acute mania that include exaggerated physical activity, agitation, insomnia, and anorexia? a. Risk for injury b. Chronic low self-esteem c. Noncompliance d. Insomnia a Risk for injury is the priority diagnosis. Possible injuries include dehydration, which may result from not drinking and trauma, which may result from bumping into objects or from physical altercations. The other options are valid diagnoses, but not of highest priority. . An inappropriately dressed patient has not slept for 3 days while making excessive, expensive long-distance phone calls. When the patient can be heard singing loudly in the examining room, the nurse makes initial plans to focus on: a. Assessing needs for food, liquids, and rest b. Setting strict limits on dress and behavior c. Conducting an in-depth suicide assessment d. Obtaining a complete psychosocial assessment a Patients with mania frequently ignore their basic physiologic needs, as evidenced by not sleeping for 3 days, thus making these assessments the priority. Limits, although appropriate to consider, are not the priority. The manic state precludes a thorough assessment initially. Suicide assessment is not a priority at this time but reckless behavior could result in personal injury. Which statement by the patient would indicate the need for additional education regarding the prescribed lithium treatment regimen? a. I will restrict my daily salt intake. b. I will take my medications with food. c. I will have my blood drawn on schedule. d. I will drink 8 to 12 glasses of liquids daily. [Show More]

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