Major Concepts
An individual with a serious mental illness is more likely to be unhoused if they:
a. Were diagnosed later in life
b. Have an alcohol or drug abuse disorder
c. Receive inpatient psychiatric care
d. Have no history of aggression or violence
What is B. Have an alcohol or drug abuse disorder.
The co-occurring disorder presence in this scenario is the factor that can most influence outcome.
Attempts are made to interact with the client's family and support systems to:
A. Assess their ability to pay for services
B. Determine their problems and needs
C. Measure their role in the client's problem
D. Provide for continuity of the client's care
What is D? Providing for continuity of care after discharge is an important role of the client's support person or system.
A client has been diagnosed with borderline personality disorder. This disorder fits under:
A. Cluster A
B. Cluster B
C. Cluster C
D. Cluster D
What is B? Cluster B personality disorders include borderline, antisocial, narcissistic, and histrionic.
A nurse uses a token economy principle by:
A. Denying free time if patients will work in the soup kitchen.
B. Denying dessert to patients who slept late.
C. Giving chips that patients who perform scheduled tasks can exchange in the unit store.
D. Punishing outbursts with seclusion.
What is C? A token economy involves exchange of items for others.
A patient learns that they are HIV positive. Which reaction would be of greatest concern to the nurse?
A. Tearful, sad, feels guilty about their lifestyle and asks to see a priest.
B. Angry, hostile, and alienated from family and friends.
C. Obsessed with cleanliness and showers several times daily.
D. Cannot make decisions, is helpless, and says they "have a solution for all this mess."
What is D? The client in D has made a covert suicidal threat.
An advanced practice nurse provides psychotherapy to outpatients. Which category best represents her expected patients:
A. Couples with relationship issues
B. Women with stressors
C. Patients requiring stabilization
D. Stable patients with chronic mental illness
What is D? Stable patients are the appropriate patients for outpatient treatment
In milieu management, nurses:
A. Supervise rather than give care directly
B. Modify care based on client resources
C. Control the care environment to promote recovery
D. Decrease restrictions on client movement
A dramatic individual who works in a health clinic called an ambulance after getting a papercut. She is angry that her worker's compensation claim was denied. This personality exemplifies:
What is histrionic personality disorder?
Review these disorders
A patient scheduled for ECT worries and cannot sleep at 2AM on the morning before the procedure. Which action by the nurse is appropriate?
A. Offer a PRN sleep aid.
B. Give warm milk to the client.
C. Sit with the client and offer to talk.
D. Tell the client not to worry.
What is C? Sitting with the client and offering to talk about concerns is appropriate.
The client should be NPO for the ECT and it would not be correct to give warm milk. It is too late for a sleep aid, and telling the client not to worry offers false reassurance.
Which tool can be most helpful to the nurse when communicating with an older adult client?
A. Persistence
B. Determination
C. Reminiscence
D. Offering self
What is C? Reminiscence and reflection are good strategies to promote ego integrity in older adults.
A nurse works with a patient to discuss feelings, stressors, and review coping strategies. The nurse is using:
A. Psychoanalysis
B. Somatic therapy
C. Therapeutic communication
D. Psychopharmacology
What is C? Therapeutic communication involves open ended discussion of client-centered topics, exploration of feelings, stressors, and coping.
When monitoring nonverbal communication, nurses should teach clients:
A. This is a naturally occurring skill
B. Verbal responses are more important than nonverbal cues
C. Nonverbal cues have little meaning
D. Nonverbal cues provide significant information and should be explored
What is D? Nonverbal cues contain a great deal of meaning and should be validated and explored in therapeutic communication. The skill in this area is developed over time, it is not innate.
Be sure to review therapeutic vs. nontherapeutic communication techniques!
What behavior should the nurse least likely expect in a client with avoidant personality disorder?
A. Inhibition, feeling inadequate
B. Lack of involvement with others
C. Promiscuity, impulsiveness
D. Socially awkward, limited risk taking
What is C? Avoidant clients lack involvement with others and feel insecure.
A client has low self-esteem and feelings of failure. Which activity would be most appropriate for the nurse to include on the client's treatment plan?
A. Group sports activity
B. Leading choir in morning devotion
C. Attending Saturday evening dance
D. Making party favors for the children's ward party
What is D? Choosing a low stakes activity that the client can complete with support and guidance will promote success and altruism, or doing good for others has a positive impact on self-esteem.
When working with an abuse victim who has experienced intimate partner violence, which nursing statement is most appropriate?
A. "You feel violated because you felt you could trust your spouse?"
B. "I want you to know I'm here for you, even if you are responsible for your choices."
C. "I have been worried ever since you married them."
D. "You should take an assertiveness class."
What is A? This uses exploring, clarification, and is appropriately open ended.
What is the primary purpose of ego defense mechanisms?
A. Keep id impulses from gaining control
B. Protect the individual's ego
C. Access unconscious feelings and memories
D. Prevent conflict among the id, ego, and superego
What is B? The use of ego defense mechanisms is a protective behavior. It can be adaptive or maladaptive depending on the ego defense mechanism chosen. Review these!
A nurse made an insensitive remark to a client. How should the nurse respond?
A. "That was insensitive. I'm sorry if it hurt you."
B. "See, even I say silly things sometimes."
C. "Sorry about that. Can we go on with the assessment?"
D. "How did you feel about what I said?"
What is A. Acknowledge the insensitivity of the remark and apologize empathetically.
What traits are consistent with obsessive compulsive personality disorder? Select all that apply.
A. Generosity
B. Preoccupation with details
C. Organized
D. Task-driven
E. Rigid, over-conscientious
What is B, C, D, & E?
A patient has been admitted to the inpatient unit for severe depression. What is the most important nursing priority to promote recovery?
A. Focus on managing the milieu and pharmacological interventions.
B. Delve into serious underlying risk factors and client history.
C. Maintain a goal-directed relationship and establish long-term contact with the client.
D. Choose a theoretical model on which to base treatment.
What is A? Milieu therapy for safety and positive interactions and medication management play important roles in establishing and maintaining client recovery. Review principles of safety and treatment/ medication adherence.
An 8 year old is argumentative, defiant, and increasingly hostile toward their step-father. This is causing problems at home and at school. What childhood behavioral disorder should the nurse suspect?
A. Autism
B. Conduct disorder
C. Oppositional defiant disorder
D. Attention-deficit hyperactivity disorder
What is C? Oppositional defiance involves constant challenges to authority figures.
Be sure to review the developmental disorders of childhood and adolescence.
A. Maintain the client's confidentiality
B. Encourage the client to talk to the provider
C. Inform the health care provider
D. Reach out to the client after discharge to check in
What is C? The nurse must act to protect the client. Review client safety priorities & Tarasoff & Duty to Warn if threats are made to others.
It can be helpful to practice when learning new behaviors. Nurses can use the therapeutic communication technique of:
A. Rehearsal
B. Role play
C. Giving feedback
D. Encouraging evaluation
What is B? Role play allows a client opportunity to practice responses in a variety of behaviors. This technique can be helpful with clients who have dependent personalities, among other personality disorders.
A patient with antisocial personality disorder has been pushing the rules and insists he should be allowed to watch a late night comedy hour. What is the nurse's best response?
A. "I won't let you manipulate me."
B. "If you ask again, you will have to go to bed earlier tomorrow."
C. "I will allow it, just once."
D. "Bedtime is 10 PM for everyone on the unit."
What is D? Limit setting and following rules helps with milieu management.
A client with paranoid schizophrenia repeatedly calls the city hall with agitated demands to speak to the mayor during the unit social hour when phone use is permitted. What is the correct nursing action in response to this behavior?
A. Allow the client to continue using the phone as the client has the right to communicate.
B. Request the physician come in now and write an order prohibiting phone use by this client.
C. Suspend the client's phone privileges temporarily and document the reason.
D. Call the mayor at city hall and explain that the patient has a mental health diagnosis.
What is C? The nurse has the authority to manage the unit and can appropriately suspend phone privileges. This is a matter of protecting the client who is responding to his paranoia as a result of the mental illness schizophrenia. The nurse cannot call the mayor due to privacy rules. Requesting the physician come in during off hours is not an appropriate response, nor is it appropriate to allow the client to continue using the phone in a manner that is harassing in nature.
A spouse of a client with dementia does not want to see their loved one getting worse. They constantly test the client with trivia. The nurse evaluates that this could affect the client by:
A. Increasing cognitive functioning.
B. Leading to frustration.
C. Sharpen perceptions.
D. Improve the client's knowledge and memory.
What is B? It can be frustrating to challenge a client's memory when they suffer from dementia.