Therapeutic Communication & Defense Mechanisms
I'm testing this, but here is the OG question and answer!
A 6-year-old girl has a crush on a boy in her class. When she's around her classmates, she teases him unrelentingly. Which defense mechanism is she exhibiting?
A. Rationalization
B. Regression
C. Intellectualization
D. Reaction Formation
D. Reaction Formation
Rationale:
Rationalization is making excuses for your behavior. Regression is taking a step backward in terms of developmental progress when dealing with a stressful situation. Intellectualization is using logic to avoid expressing emotions.
You receive a call asking about a client on the mental health unit. What should you do?
A. Answer the caller's questions
B. Give a brief update on the patient only
C. Recommend they call the psychiatrist directly
D. Avoid giving any information over the phone, citing HIPAA
D. Avoid giving any information over the phone, citing HIPAA
True or False: Vomiting and diarrhea are early signs of lithium toxicity, while seizures and coma are late signs of lithium toxicity.
True
Rationale: Nausea, vomiting, and diarrhea are side effects that become prominent when lithium levels rise, even if they are not experienced routinely. As lithium levels rise higher and higher, an individual may experience tremor, blurry vision, altered mental status, and eventually develop seizures, coma, and death due to cardiovascular collapse.
Which of the following phases includes the first interview the nurse has with the client?
A. Working phase
B. Orientation/introductory phase
C. Termination phase
D. Pre-interaction phase
B. Orientation/introductory phase
A. Socioeconomic factors
B. Social determinants of health
C. Coping mechanisms
D. Support systems
B. Social determinants of health
The client tells the nurse, "I just can't seem to get anything done lately because my head is somewhere else." Which of the following responses demonstrates the technique of restating?
A. "Tell me more about your head being somewhere else"
B. "You've been having trouble concentrating"
C. "Go on..."
D. "You've been losing weight, not sleeping well, and struggling at work and school since your break-up"
B. "You've been having trouble concentrating"
Rationale: The nurse is restating what the client is conveying - that she is having difficulty concentrating (this may be a question or statement).
"Tell me more about..." is exploring. "Go on" or "I see" is a general lead. "You've been losing weight, not sleeping well, and struggling at work and school since your break-up" is summarizing (which is similar to restating but includes more information).
Which of the following is an appropriate indication for a client to be involuntarily committed?
A. A client who has schizophrenia
B. A client who is homeless
C. A client who has intent to commit suicide
D. A client who bathes once per week
C. A client who has intent to commit suicide
Alzheimer's disease is most closely associated with low levels of which neurotransmitter?
A. Norepinephrine
B. GABA
C. Acetylcholine
D. Serotonin
C. Acetylcholine
Rationale: Acetylcholine is the cholinergic neurotransmitter. Low levels are associated with Alzheimer's and Parkinson's. Norepinephrine, released by the sympathetic nervous system, is responsible for "fight-or-flight", so high levels are associated with stress and anxiety disorders. Low levels of GABA are associated with anxiety disorders and seizures. Serotonin is linked to many mental illnesses, but low levels are commonly linked to depression and anxiety.
The nurse is caring for a client who is refusing to take his medication. Which of the following should the nurse do first?
A. Notify the healthcare provider
B. Reinforce the contract and treatment plan
C. Tell the client that he won't be discharged tomorrow if he refuses to take his medication
D. Address the reasons or factors contributing to non-compliance
D. Address the reasons or factors contributing to non-compliance
Rationale: The first step in the nursing process is assessment. The nurse should first try to assess the situation to figure out why the client is non-compliant with the regimen and address those reasons. Telling the client that he won't be discharged tomorrow if he refuses his medication is non-therapeutic.
Which of the following is NOT one of Kubler-Ross's stages of grief?
A. Depression
B. Anxiety
C. Denial
D. Bargaining
E. Anger
B. Anxiety
Rationale: The 5 stages are denial, anger, bargaining, depression, and acceptance
A 20-year-old female was recently a victim of sexual assault. When asked about the incident, she cannot seem to remember anything about it despite her best efforts. Which defense mechanism is she demonstrating?
A. Suppression
B. Undoing
C. Denial
D. Repression
D. Repression
Rationale: Suppression is voluntary blocking of thoughts and memories. Undoing is attempting to reverse negative feelings through actions. Denial is refusing to acknowledge something.
Which of the following defines appropriate expectations of the nurse to guide nursing practice?
A. ANA Code of Ethics
B. Michigan Board of Nursing
C. Michigan Mental Health Code
D. Unit policies
A. ANA Code of Ethics
Rationale: The board of nursing, unit policies, & Michigan Mental Health Code outline enforceable rules, which are more than just expectations to guide practice.
Your client was just started on bupropion. Which of the following teaching should you include?
A. Monitor for extrapyramidal side effects, such as facial rigidity, which may indicate acute dystonia.
B. This drug should take about 5-7 days to reach peak effectiveness.
C. This drug can be taken with alcohol, nicotine, and MAOIs.
D. There is an increased risk of bleeding if taken with warfarin.
D. There is an increased risk of bleeding if taken with warfarin.
Rationale:
Extrapyramidal side effects, such as acute dystonia (facial rigidity/"lock jaw") may occur from antipsychotics, not antidepressants. Antidepressants take at least a few weeks to work, so peak effectiveness is generally not seen for about 4-6 weeks. Antidepressants (and most drugs in general) cannot be taken with MAOIs. Alcohol and nicotine also interact with many psychiatric medications, including bupropion.
Which of the following indicates a goal of the termination phase?
A. The client is unable to verbalize strategies to calm his anxiety.
B. The client states he will go to the bar if he is having a stressful day.
C. The client states that he will meditate or take a bath after having a panic attack.
D. The client states that he has a follow-up plan for therapy once he is discharged.
D. The client states that he has a follow-up plan for therapy once he is discharged.
Rationale: A client having a follow-up and contingency plan in place indicates he is ready for discharge. This is a goal for the termination phase. The other answers do not indicate that the client has developed successful coping strategies to manage his emotions properly.
You are taking care of a client who presents to the ER for an acute panic attack. Which of the following interventions should be prioritized?
A. Teach the client about breathing exercises
B. Apply restraints
C. Ask the tech to stay with the client
D. Administer Lorazepam IM
C. Ask the tech to stay with the client
Rationale: The priority here is safety. Never leave a client alone who is experiencing a panic attack. If a patient is experiencing an acute panic attack, teaching will not be effective at this time. Teaching should focus on prevention of panic attacks and long-term management of anxiety, including sleep hygiene (e.g., maintaining consistent sleep schedules). Although lorazepam is an anxiolytic, there is no indication that lorazepam IM or restraints are necessary at this time.
The nurse manager just implemented a new rule that a nurse does not agree with. Which of the following actions made by the nurse demonstrates the defense mechanism of displacement?
A. The nurse calmly verbalizes her objection.
B. The nurse angrily argues that her co-worker has been late 3 times this month without repercussion.
C. The nurse goes to grad school and eventually lands a nurse manager position.
D. The nurse throws his report sheets up and stomps out of the unit huddle.
B. The nurse angrily argues that her co-worker has been late 3 times this month without repercussion.
Rationale: Displacement involves taking out your feelings onto someone else, usually a less threatening target. Calmly verbalizing an objection is appropriate. Going to grad school and eventually landing a nurse manager position is an adaptive defense mechanism (sublimation). Stomping out of the unit huddle may be suppression.
Which of the following is NOT a setting in which psychiatric nurses may practice?
A. Inpatient mental health units
B. Faith-based settings
C. Correctional facilities
D. Outpatient mental health clinics
B. Faith-based settings
Which of the following is true regarding sedative hypnotics?
A. Sleepwalking is an expected side effect
B. Contraindications include liver impairment, hypoxia, and cardiac insufficiency
C. They decrease the amount of GABA in the brain
D. A client sleeping 5-6 hours a night after taking them demonstrates effectiveness of the medication
B. Contraindications include liver impairment, hypoxia, and cardiac insufficiency
Rationale: Sedative hypnotics (e.g., benzodiazepines) are PRN anxiolytics with a strong CNS depressant effect. This increases the risk for sedation; sleep-walking would be an adverse effect to monitor for. These drugs can also cause liver impairment. Anxiolytics increase the amount of GABA (inhibitory neurotransmitter) in the brain. If a client is only sleeping 5-6 hours per night, the anxiolytic was not very effective. Clients should be calmer, have less restlessness, and sleep well after starting an anxiolytic, as these are the desired outcomes.
Which of the following should be done during the first interaction with the client?
A. Look up information about the client
B. Evaluate progress toward the goals
C. Convey warmth and trust through interaction
D. Discuss the need for therapy upon discharge
C. Convey warmth and trust through interaction
Rationale:
Conveying warmth and trust helps build rapport, which is a goal for the orientation/introductory phase (first interaction with the client).
The nurse should look up information about the client during the pre-interaction phase (before meeting the client). Evaluating progress occurs during the working phase. Discussing the need for therapy upon discharge should occur during the termination phase.
Which of the following is NOT one of the components of speech that should be assessed during a mental status exam?
A. Vocabulary
B. Quality
C. Accent
D. Quantity
C. Accent
Rationale: The quality, quantity, tone, volume, and vocabulary should be assessed. Accent is not associated with mental health issues and is not therefore, not pertinent.
Which of the following should be used to convey active listening? Select all that apply.
A. Maintain eye contact with the client
B. Cross your legs
C. Squarely face the client
D. Ensure a relaxed, comfortable environment
E. Lean slightly forward
A. Maintain eye contact with the client
C. Squarely face the client
D. Ensure a relaxed, comfortable environment
E. Lean slightly forward
All of the above except crossing your legs will help promote active listening. You should maintain an open posture without crossing your arms or legs.
Which of the following is true regarding restraints and seclusion? Select all that apply.
A. Restraints & seclusion should be discontinued after 15 minutes
B. Restraints & seclusion may only be used if a client poses an immediate safety risk to self/others
C. You should wait until the order expires to discontinue restraints/seclusion
D. It's appropriate to use seclusion for a client who is rude and demanding
E. A chemical restraint can only be used if a client is physically violent
B. Restraints & seclusion should only be used if a client poses an immediate safety risk to self/others
E. A chemical restraint can only be used if a client is physically violent
Rationale: Restraints & seclusion should only be used if a client is violent or poses an immediate safety risk to self or others. Alternative measures and de-escalation techniques must be attempted first. Restraints & seclusion should be discontinued ASAP - do not wait keep them on for a specific amount of time or until the order expires.
Which of the following may be symptoms of serotonin syndrome and/or neuroleptic malignant syndrome? Select all that apply.
A. Tachycardia
B. Hypothermia
C. Muscle rigidity
D. Seizures
E. High Blood Pressure
A. Tachycardia
C. Muscle rigidity
D. Seizures
E. High Blood Pressure
All of the above symptoms except hypothermia may be seen with serotonin syndrome and/or neuroleptic malignant syndrome. Hyperthermia and diaphoresis would be seen instead. Serotonin syndrome is caused by concurrent use of two or more antidepressants and/or St. John's Wort. Neuroleptic malignant syndrome is an adverse effect of antipsychotics. Both may be fatal.
Which of the following interventions or goals should the nurse focus on during the orientation/introductory phase? Select all that apply.
A. Identify the client's strengths and weaknesses
B. Outline expectations, contract, and relationship parameters
C. Encourage the client to discuss painful topics
D. Develop a plan of care
E. Reassure the client that everything is confidential
A. Identify the client's strengths and weaknesses
B. Outline expectations, contract, and relationship parameters
D. Develop a plan of care
E. Reassure the client that everything is confidential
Rationale: All of the above except encouraging the client to discuss painful topics are appropriate during the introductory/orientation phase. This is when the nurse does the majority of the assessment and planning, though interventions do not occur until the working phase. In addition to this, the nurse should try to build trust and rapport.
Which of the following is true regarding Maslow's Hierarchy of Needs? Select all that apply.
A. Self-actualization is the bottom of the pyramid.
B. An individual who has reached the top of the pyramid has an appropriate perception of reality.
C. An individual who has reached the top of the pyramid has all of their other needs met.
D. If someone has reached self-actualization, they are working toward achieving love and belonging.
E. Physiological needs include shelter, air, food, water, and sleep.
B. An individual who has reached the top of the pyramid has an appropriate perception of reality.
C. An individual who has reached the top of the pyramid has all of their other needs met.
E. Physiological needs include shelter, air, food, water, and sleep.
Rationale: Self-actualization is the top of the pyramid. D. If someone has reached self-actualization, they are no longer "working toward" or "expressing a need for" anything.