Q&A Hero

Q: Delirium poses a serious threat to a client's:1. Family relationships and roles.2. Lifestyle and habits.3. Dignity and safety.4. Spirituality and religious beliefs.

Q: Which symptom would indicate that a client is delirious?1. Dehydration2. Illusions or hallucinations3. Unsteady gait4. Slurred speech

Q: An 82-year-old man is admitted to a medical-surgical unit for diagnostic confirmation and management of probable delirium. Which of the following statements by the client's daughter best supports the diagnosis?1. "Dad has always been so independent. He's lived alone for years since my mom died."2. "Dad just didn't seem to know what he was doing. He would forget what he had for breakfast."3. "Maybe it's just caused by aging. This usually happens by age 82."4. "The changes in his behavior came on so quickly. I wasn"t sure what was happening."

Q: Creutzfeldt"Jakob disease is thought to be caused by:1. A response to multiple medications.2. A rare genetic disorder.3. An infection caused by a prion.4. Ischemic vascular disease.

Q: Which of the following community support programs should the nurse recommend to family members of a client with severe and persistent mental illness (SPMI) who is living independently in the community?Standard Text: Select all that apply.1. Residential special care units2. Hospices3. Day treatment4. Case management5. Medication management

Q: A client with generalized anxiety disorder frequently skips weekly scheduled appointments with a primary nurse therapist in the managed care organization (MCO), showing up only when the client is feeling severely stressed. Which of the following statements best explains this behavior?1. The client is aware that MCO's frequently "double-book" appointments to balance out the "no-shows."2. The client does not have transportation for scheduled appointments with the therapist.3. MCO consumers do not have to make co-payments for missed appointments.4. MCO consumers find it easier than non-MCO consumers to not keep scheduled appointments, partly because services are prepaid.

Q: Which of the following services are typically performed by psychiatric nurses employed in managed care organizations?Standard Text: Select all that apply.1. Performing mental health assessments2. Scheduling appointments for therapy3. Providing stress management classes4. Contacting medication prescribers to arrange for changes5. Triaging initial requests for services

Q: Which of the following statements regarding the impact of managed health care on the delivery of psychiatric services is true?1. Managed mental health care has resulted in shorter, more intense psychiatric hospital stays to keep costs down.2. Clients are admitted to hospitals in earlier stages of psychiatric illnesses.3. Cost containment has created an entire range of ambulatory care services that are considered ineffective.4. Shorter models for psychiatric services and outpatient treatment do not meet the lifestyle needs of clients and their employers.

Q: Which of the following qualifications best explains why nurses are better suited for the role of case management than social workers?1. Nurses have broader clinical experiences with a variety of clients.2. Nurses have thorough training in psychobiology and pharmacology.3. Nurses have superior therapeutic communication skills.4. Nurses have better therapeutic relationships with their clients.

Q: Which of the following activities is the central element that differentiates case management from other types of care?1. Coordinating one episode of care across multiple treatment settings2. Preventing re-hospitalization3. Focusing treatment goals in the most restrictive setting4. Advocating for clients requiring extensive services

Q: The interdisciplinary treatment team is discussing appropriate strategies for a homebound client who has a history of medication nonadherence. Which of the following rationales should the nurse case manager use when a treatment team member suggests that the nurse case manager make daily home visits to administer medications?1. "My job description does not include medication administration to clients in the home."2. "My role as case manager is to remain objective and look at the whole picture. If I deliver direct care, I may lose this perspective."3. "My time is more importantly spent supervising others to provide this type of direct care."4. "My daily schedule is too full to commit this amount of time to administering medications."

Q: The nurse case manager is participating in a treatment team meeting where members are discussing treatment options for a client with a history of medication and treatment nonadherence. The client's health insurance plan does not cover the cost of expensive atypical antipsychotic depot medications. Which of the following is not an appropriate action by the nurse in this situation?1. Suggesting affordable alternatives for treatment2. Discussing possible treatment options with the client3. Monitoring the client's response to current medication treatment4. Enrolling the client in another health insurance plan

Q: A nurse case manager is assigned to a client with recurring substance abuse issues. Which of the following strategies would be most important in providing care to this client?1. Assessment and problem identification2. Ordering psychological testing3. Arranging for inpatient hospital care4. Administering medications

Q: A psychiatric home health nurse makes home visits in a neighborhood that has a high incidence of reported crimes. What reasonable safety measures should the nurse implement during home visits?Standard Text: Select all that apply.1. Make all visits in the daytime2. Ask for a police escort during visits3. Call the client before arrival at the home4. Carry a cell phone at all times5. Ask to be accompanied on visits by a co-worker

Q: The psychiatric home health nurse has made repeated attempts to make a home visit to a homebound client, only to find that the client is not at home at the scheduled time. What is the best action by the nurse?1. Wait outside in the car until the client returns home.2. Reevaluate the client's homebound status.3. Call the client the day before each scheduled visit as a reminder.4. Call the client's landlord and ask to be let into the client's home.

Q: A psychiatric home care nurse knocks on the client's door for the first time and is told by the client, "Go away and leave me alone. I don"t want to buy any Girl Scout cookies." What should the nurse do in this instance?1. Leave, and try to gain admittance to the client's home tomorrow2. Show the client identification and explain the purpose of the visit3. Offer to give the client money to buy Girl Scout cookies4. Call the home health agency and request a new assignment

Q: A client with chronic paranoid schizophrenia is scheduled to be discharged from the inpatient psychiatric unit in two days. The nurse is working with the client's family to develop a plan for managing psychotic symptoms and emergency behaviors after discharge. Which of the following nursing diagnoses is most appropriate?1. Noncompliance: Medication Regimen related to paranoid ideation2. Self-Care Deficit: Bathing/Hygiene related to irrational thought processes3. Knowledge Deficit: Symptom Management related to inadequate understanding of disease processes4. Risk for Violence Directed Toward Others related to delusional and persecutory thought process

Q: A client and his wife are visiting in the day room of an inpatient psychiatric unit when a client with acute psychosis experiencing auditory hallucinations sits down next to them and begins talking to the "voices." Which of the following nursing actions is most appropriate?1. Take the client with psychosis by the hand and lead the client to another area in the day room.2. Announce over the intercom that visiting hours are over.3. Observe the situation and intervene only if the client with psychosis becomes aggressive.4. Remind the client with psychosis to respect the privacy of the other client and his wife.

Q: A client admitted to the inpatient psychiatric unit after a recent suicide attempt tells the nurse, "Even though suicide is against my religion, I was in so much emotional distress that I didn't think I could keep on living. I"m really struggling with my spiritual conscience and don"t know what I should do." Which of the following nurse responses is most appropriate?1. "It sounds like spirituality plays a significant role in your life. Tell me what beliefs are most important to you."2. "I"m not very comfortable discussing religious matters. This is something you should talk to your priest or pastor about."3. "I think you should pray for forgiveness and turn all your problems over to God."4. "I hear that you are having a real struggle with your spiritual beliefs. Tell me what I can do to help."

Q: A client on the inpatient psychiatric unit asks the nurse, "Why is the daily schedule so full of activities and why do we have so many rules to follow?" Which of the following is the best response by the nurse?1. "A daily routine helps you keep on track and organize your thoughts. The rules help people live together respectfully."2. "Clients with mental illness get too chaotic and unpredictable when they don"t have a structured routine to follow."3. "Idle hands and minds are the devil's playground."4. "The real world is full of rules and activities for everyone to follow."

Q: Which of the following aspects of the structural environment pose the greatest risk to client safety in the hospital setting?1. Plastic clothes hangers in clients' closets2. Program schedules posted on bulletin boards behind glass doors3. Potted plants in plastic containers in the day room4. Breakaway shower rods in the clients' bathrooms

Q: Which of the following client behaviors is the best illustration of a positive response to the therapeutic environment in an inpatient ward?1. Sitting alone in the day room working a jigsaw puzzle2. Watching television during leisure time3. Napping in the dayroom after lunch4. Signing up during the community meeting for ward duties

Q: The nurse has completed a new client's orientation to the inpatient psychiatric unit and asks if the client has any questions. Which of the following questions indicates further teaching is needed regarding the client's rights in a therapeutic environment?1. "Where do I go if I want to smoke?"2. "What time does morning group start?"3. "What time are meals served on the unit?"4. "What happens if I refuse to attend a group activity?"

Q: Which of the following programs are often available to mentally ill clients in community treatment settings?Standard Text: Select all that apply.1. Group homes2. Halfway houses3. Sheltered workshops4. Day treatment centers5. Adult day care centers

Q: Which of the following would be considered a disadvantage of Assertive Community Treatment (ACT) programs?1. They are expensive, sophisticated programs.2. They include small interdisciplinary teams of staff members.3. They control access to resources such as housing and money.4. They reduce stress and burnout of individual case managers.

Q: Which of the following services are not typically offered by community mental health centers?1. Psychoeducation groups2. Medication management clinics3. Vocational rehabilitation4. Legal assistance

Q: Which of the following treatment programs would be most appropriate for homeless clients whose judgment is severely impaired by paranoid delusions and command hallucinations due to medication and treatment nonadherence?1. Inpatient hospital-based care2. Mobile outreach units3. Assertive community treatment4. Partial hospitalization programs

Q: A nurse is learning how to advocate for populations with mental disorders. Which of the following statements by the nurse would reflect that learning has taken place?1. "We cannot provide service if there is no money to pay for treatment."2. "Nursing should monitor treatment planning and delivery of service for the abuse of client rights."3. "All psychiatric clients have delusions."4. "Policy is directed toward staff only."

Q: A nurse is planning a presentation for psychiatric clients and their families on client rights. This would be an example of:1. Maleficence.2. Duty to warn.3. Advocacy.4. Competency.

Q: A client tells the nurse, "My therapist stroked my face and asked me to come to his house for a romantic evening." What action should the nurse take?1. Call the police.2. Immediately report the client's claims to the appropriate authority.3. Discuss the statements with the medical director.4. Do nothing, as psychiatric clients often are unreliable.

Q: A client with a diagnosis of bipolar disorder has had several hospitalizations to treat this mental illness and feels that the care he received was not consistent with his best interests. The client's experience is indicative of which of the following needs?1. Informed consent2. Psychiatric advance directive (PAD)3. Right to treatment4. Competency

Q: The nurse and a client talk about the signs and symptoms of acute mania. The client states, "When I am feeling really good and don"t need to sleep, I am manic, but the last thing I want is treatment." The nurse recognizes that this experience is indicative of the need for:1. Competency.2. Psychiatric advance directive (PAD).3. Right to treatment.4. Informed consent.

Q: A client with schizophrenia has decided to develop a psychiatric advance directive. What would be included in this document?1. Conditions under which life support will be discontinued2. A legal representative for power of attorney3. Do not resuscitate (DNR) requests4. List of persons who can make decisions on the client's behalf

Q: A unit has a protocol for research on medications. The protocol identifies essential items that must be shared with clients to ensure ethical nursing practice. Which of the following factors should be shared with clients?1. Problems that all other clients have had in the study2. Risks that can be encountered3. All aspects of the research study4. Cost of the research

Q: The staff are discussing the competency of a client who was recently involuntary admitted to the unit. Which of the following statements about competency is inaccurate?1. Competency is affected by client compliance with treatment.2. Competency is a medical determination made by the client's physician.3. A guardian is appointed to make decisions on the person's behalf when the client is determined to be incompetent.4. A competent client means the client can make reasonable judgments and decisions.

Q: When a client gives written notice of intention to leave the hospital after a voluntary admission, what determines the number of hours or days between the notice and the discharge?1. Hospital policy2. State law3. Insurer4. Federal law

Q: A client is voluntarily admitted to the mental health unit. The nurse knows that this means:1. The client gave informed consent for hospitalization.2. The client has signed away all civil rights.3. The client will need a court hearing within seven days.4. The client has to remain hospitalized for three days.

Q: The relative of a chronically mentally ill woman requests that the mentally ill woman be committed because of her history of 12 previous hospitalizations and because she sits around the house all day refusing to get dressed. The nurse tells the relative that the woman cannot be committed because:1. It is less than two weeks since her most recent hospital discharge.2. She has used up her hospital coverage.3. She has not voluntarily requested hospitalization.4. There is no evidence that she is a danger to self or others.

Q: A 15-year-old girl is brought by her mother to see a psychiatric nurse practitioner. The client's mother demands that her daughter be admitted for treatment of "behavioral problems." Her mother states that the daughter stays out until 4 a.m. and is hanging out with "bad" kids. The nurse will recommend which of the following?1. Involuntary admission for the daughter2. Therapy for the daughter3. Outpatient therapy for the mother and daughter4. Therapy for the mother

Q: A client who was admitted voluntarily to the unit verbally refuses his medication. The nurse proceeds to give the medication over the client's objections. What is the legal significance of the nurse's actions?1. The nurse could be charged with malpractice.2. The nurse could be charged with negligence.3. The nurse cannot be held liable.4. The nurse could be charged with battery.

Q: The nurse is working with a client who has just stated that she beats her toddler with a wooden paddle. The nurse determines that the client's verbal admission warrants:1. A report to appropriate government authorities.2. A report to the nursing supervisor.3. A report to the physician.4. A report to the chief of staff.

Q: A client becomes upset when touched by a staff member who is attempting to assess the client's blood pressure. The nurse recognizes that there is a problem with:1. Confidentiality.2. Staff control.3. Duty to protect.4. Informed consent.

Q: A psychiatric"mental health nurse is attending a seminar. The speaker discusses how certain psychiatric diagnoses are associated with stereotypes. Which of the following actions ensures that the client's social identity is not discredited?1. Refer to a client as delusional and psychotic.2. Refer to a client as a schizophrenic.3. Refer to a client as a paranoid.4. Refer to a client as X who has a diagnosis of schizophrenia.

Q: The nurse is having lunch with colleagues from a medical-surgical unit. One of the medical-surgical nurses states, "I don"t know how you can work with psych patients! They scare the heck out of me." How should the nurse respond?1. "It's not that bad, and most of the clients are not that scary."2. "The clients I work with have physical disorders just like the clients you work with."3. "I don"t know; sometimes I wonder what I am doing."4. "I must have better nursing skills than you do."

Q: The student nurse is learning how to reduce the stigma associated with mental illness. Which of the following statements by the student nurse reflects that learning has taken place?1. "We"re admitting another schizophrenic who hears God talking."2. "A 19-year-old who reports hearing voices is being admitted with a diagnosis of psychosis not otherwise specified."3. "We"re admitting another crazy client."4. "They"ve added another paranoid to the unit."

Q: The nurse educator is teaching a group of students about the ethical dilemma of involuntary commitment. Which of the following would the educator use as a situation that would support the use of an involuntary commitment?1. The client uses profanity when angry2. The client self-medicates with marijuana3. The client has threatened family members4. The client reports auditory hallucinations

Q: The client is concerned that the information given to the nurse remains confidential. Which is the nurse's best response?1. "If the information is important to your care, I will need to share it with the staff."2. "We can keep the information just between the two of us if you prefer."3. "I will share the information with staff members only with your approval."4. "You can make the decision concerning whether your physician needs this information for your care."

Q: The nurse conducts ongoing evaluation of the crisis situation to ensure the client's right to the least restrictive intervention. This means the assessment factor receiving the highest priority is:1. The client's condition in comparison to the adequacy of the environment designed to prevent injury.2. The client's mental status.3. The client"staff ratio.4. The comfort level of the environment.

Q: The nurse acts on the client's behalf as an advocate for the client's needs and best interests. What principle of bioethics is being demonstrated by the nurse?1. Veracity2. Beneficence3. Fidelity4. Justice

Q: A nurse observes an acutely psychotic client scratching at his arms with his fingernails until his arms bleed. When asked what is happening, the client states he is trying to let the evil spirits out of his body. He is easily redirected by the nurse, but resumes scratching when the nurse leaves his side. The nurse orders 1:1 supervision of the client to keep him from harming himself. Which principle of bioethics was applied in this situation?1. Justice2. Fidelity3. Beneficence4. Veracity

Q: For a nurse studying bioethics, which of the following statements would indicate that learning has occurred regarding autonomy?1. "All clients should be given their due."2. "Part of our profession is doing good things for others."3. "We must always be honest with clients."4. "After I provide information, I will respect my client's right to make a decision."

Q: The psychiatric home health nurse is evaluating whether a client's level of functioning has improved since starting the prescribed psychotropic medication. What evidence does the nurse look for?1. There is no change in the GAF score.2. There is a significant decrease (by 10 or more points) in the client's GAF score.3. The client no longer qualifies for a GAF score.4. There is an increase in the client's GAF score.

Q: Select the priority nursing diagnosis for a client with a Global Assessment of Functioning (GAF) score of 10.1. Risk for Impaired Social Interaction2. Risk for Injury3. Knowledge Deficit4. Risk for Communication Deficit

Q: After interviewing a client for admission, the nurse gives the client a score of 50 on the Global Assessment of Functioning Scale (GAF). The nurse selected this score based on the client's level of functioning:1. Since being given a psychiatric diagnosis.2. Within the past week.3. Since beginning the psychotropic medication.4. Within the past year.

Q: The school nurse, who must be familiar with mental health issues, will find child clinical disorders classified under:1. Axis II.2. Axis I.3. Axis X.4. Axis VII.

Q: A client is admitted with the following diagnosis:Axis I: 300.01 Panic disorder without agoraphobiaAxis II: 301.83 Borderline personality disorderAxis III: No diagnosisAxis IV: UnemploymentWhat conclusions can the nurse make relative to the client's Axis III information?1. This client has problems with environment, but they are not related to mental disorder.2. The client's environment has not been evaluated.3. The client's health status has not been evaluated.4. The client has no diagnosed physiological health problems relevant to mental disorder at the time of admission.

Q: How might the nurse make use of the information contained in a client's multiaxial diagnosis?Standard Text: Select all that apply.1. To address physiological problems2. To plan client-centered interventions3. To communicate client needs4. To assess client strengths5. To identify nursing diagnoses

Q: The nurse on the inpatient unit is reviewing the record of a client admitted the previous day, and notes the client has an Axis I diagnosis. What inferences can the nurse make about the client?1. The client has a clinical psychiatric disorder.2. The client is in need of immediate medical attention.3. The client has a chronic condition.4. The client lacks a support system.

Q: A female client disclosed to the nurse that she is in an abusive situation. This information will be used to contribute to:1. Axis IV.2. Axis III.3. Nothing, since this is confidential information and should not be shared.4. Axis I.

Q: The nurse in the community mental health clinic assesses a client and determines the presence of an Axis II diagnosis. What conclusions can the nurse draw?1. The client is in need of further evaluation.2. The client has a personality disorder.3. The client will need a special diet.4. The client is a candidate for the least restrictive environment.

Q: A depressed client asks why a physical exam is necessary before being admitted for outpatient treatment. The nurse explains to the client that a physical exam will:1. Provide information about medications the client will need.2. Make sure the client gets all necessary treatment.3. Complete the admission process.4. Ensure the client has not ingested any caustic material or inhaled noxious vapors.

Q: A family member reports that his mother has started hiding valuables around the house, then can"t remember where she put them. He asks the nurse to explain what is happening. Which of the following assessment tools might the nurse utilize to screen the mother for signs of cognitive dysfunction?1. Benton Visual Retention Test2. Thematic Apperception Test3. Raven's Progressive Matrices Test4. Sentence Completion Test

Q: An anxious client is to complete the Minnesota Multiphasic Personality Inventory-2 as part of the psychological testing. The client is worried about not having enough time to prepare for the test. To decrease anxiety, the nurse reviews the purpose of the test and explains that the client will:1. Just need to complete a series of sentences.2. Interpret ink blots.3. Only have to copy geometric designs.4. Be answering true or false questions.

Q: During a mental status assessment, the examiner asks the client to repeat these words: motorcar, teacup, and lilies. Five minutes later the client is asked to repeat the words again. The purpose of this exercise is to test the client's:1. Insight.2. Retention and recall.3. Recall of recent past experiences.4. Abstract thinking.

Q: A client makes the following statement during a mental status assessment: "I can"t use the phones; the CIA has bugged all the wires." Which of the following categories will the nurse use to document the client's response?1. Orientation2. Content of thought3. Emotional state4. General behavior

Q: The psychiatric examination includes a psychiatric history and a mental status assessment. When conducting the mental status assessment, the nurse:Standard Text: Select all that apply.1. Includes observations.2. Limits the assessment to verbal responses.3. Provides the client with a form to complete.4. May or may not follow a strict sequence.5. Uses a group format.

Q: The nurse is talking with the family of a mentally ill client who lives with them. The client is being admitted to the inpatient psychiatric unit. What is the priority information to gather from the family?1. Whether the client had a flu shot recently2. The number of medications prescribed for the client3. How the client's symptoms are expressed at home4. The type of soap the client prefers to use

Q: The nurse reviews the data family and friends provided in the comprehensive assessment of a client's situation. The nurse knows to treat the data as:1. Invalid until confirmed with the client.2. Subjective data.3. Primary data.4. Peripheral to the assessment.

Q: As part of the comprehensive admission assessment, the nurse talks with family and friends who may contribute additional data to a client's psychiatric history. When reviewing the data obtained from these sources, the nurse keeps in mind which of the following perspectives of the data? The information provided:1. Will vary according to the source's relationship to the client.2. Comes from each individual's perspective.3. Is considered false.4. Is considered accurate.

Q: A nurse who is admitting a client to the inpatient unit conducts a comprehensive assessment. How does the nurse use the data gathered from the assessment?Standard Text: Select all that apply.1. To support nursing diagnoses2. To determine the length of stay3. To exclude data from secondary sources4. To plan appropriate interventions5. To make sound clinical judgments

Q: A nursing student is working to develop assessment skills. The student knows that nurses utilize principles of assessment:1. Upon admission.2. Throughout hospitalization.3. At the point of entry to care.4. Prior to discharge.

Q: Which of the following best describes the information the nurse will use to construct a nursing care plan?1. A mental status examination2. An intake assessment and reason for admission3. A psychiatric history and mental status examination4. A detailed psychiatric history

Q: The nurse is admitting a client from the emergency room. Which of the following would be used to clarify the nurse's understanding of the client's chief complaint?1. "If you are bleeding, where is the blood?"2. "I feel your pain when I see you hold your side."3. "Are you saying you feel that you are bleeding inside?"4. "Don"t worry; we have the technology to take care of you."

Q: When considering communication skills, the nurse caring for an older client anticipates that the client will:1. Interrupt frequently.2. Take longer to respond.3. Answer questions with one-word responses.4. Remain silent.

Q: The nurse gathering data from a client admitted to labor and delivery is overheard making the comment, "You are lying. You need to tell me the truth so we can do what is best for your baby." The nurse's communication is:1. A perception check.2. Nontherapeutic.3. Necessary.4. Therapeutic.

Q: In the immunization clinic, the nurse notices a client displaying tense body posture. Which of the following is the most therapeutic response for the nurse to make?1. "This won"t hurt a bit."2. "You need to relax."3. "I can tell you"ve had a bad experience before."4. "I notice you are clenching your fists."

Q: Which of the following interventions promotes mindful listening in any health care setting?1. Telling the client to get off the phone2. Encouraging the family to step outside before assessing the client3. Turning off the television before interviewing a client4. Asking clients what they would like to drink when taking medication

Q: A delusional client walks up to the nurse and says, "I am the appointed overseer. Who are you and why are you here?" The most therapeutic response is which of the following?1. "I am your nurse and I will be here to help you until suppertime."2. "You don"t know who I am?"3. "You know who I am."4. "You are not the overseer; you are a client in the hospital."

Q: Which of the following is an example of clarifying a client's verbal response?1. "Are you saying you feel the medicine is helping you?"2. "See, the medicine does work."3. "I knew it would work; it just takes time."4. "Everything seems to work out eventually."

Q: A client states, "I just know my brother will not come back from the war." Which of the following examples would be used to encourage the client to explore this concern?1. "Maybe he will be one of the lucky ones."2. "How do you know this?"3. "Where is your brother going?"4. "What do you feel will happen to him?"