1) A patient with schizophrenia begins to talks about “volmers” hiding in the warehouse at work. The term “volmers” should be documented as:
a. neologism
b. concrete thinking
c. thought insertion
d. idea of reference
ANS: A
- A neologism is a newly coined word having special meaning to the patient. “Volmer” is not a known common noun.
- Concrete thinking refers to the inability to think abstractly.
- Thought insertion refers to thoughts of others that are implanted in one’s mind.
- An idea of reference is a type of delusion in which trivial events are given personal significance.
2) A patient with suicidal impulses is placed on the highest level of suicide precautions. Which measures should be incorporated into the plan of care by the nurse caring for the patient? (More than one answer is correct.)
a. Maintain arm’s-length, one-on-one nursing observation around the clock.
b. Allow no glass or metal on meal trays.
c. Keep patient within visual range while awake. Check every 15 to 30 minutes while the patient is sleeping.
d. Check the patient’s whereabouts every 15 minutes and make frequent verbal contacts.
e. Check whereabouts every hour. Make verbal contact at least three times each shift.
f. Remove all potentially harmful objects from the patient’s possession.
ANS: A, B, F
One-on-one observation is necessary for anyone who has limited control over suicidal impulses.
- Plastic dishes on trays and the removal of potentially harmful objects from the patient’s possession are measures included in any-level suicide precautions.
The remaining options are used in less stringent levels of suicide precautions.
3) A patient diagnosed with schizophrenia anxiously says, “I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror.” While listening, the nurse should:
a. sit close to the patient.
b. place an arm protectively around the patient’s shoulders.
c. place a hand on the patient’s arm and exert light pressure.
d. maintain a normal social interaction distance from the patient.
ANS: D
The patient is describing phenomena that indicate personal boundary difficulties. The nurse should maintain an appropriate social distance and not touch the patient, because the patient is anxious about the inability to maintain ego boundaries and merging with or being swallowed by the environment. Physical closeness or touch could precipitate panic.
4) Which statement indicates a patient with major depression is most likely outlook on life during the acute phase of the illness?
During an acute phase of major depression, the client may feel worthless and deserve bad things to happen personally.
5) A patient diagnosed with bipolar disorder is in the maintenance phase of treatment. The patient asks, “Do I have to keep taking this lithium even though my mood is stable now?” Select the nurse’s appropriate response.
a. “You will be able to stop the medication in about 1 month.”
b. “Taking the medication every day helps reduce the risk of a relapse.”
c. “Usually patients take medication for approximately 6 months after discharge.”
d. “It’s unusual that the health care provider hasn’t already stopped your medication.”
ANS: B
Patients diagnosed with bipolar disorder may be maintained on lithium indefinitely to prevent recurrences. Helping the patient understand this need will promote medication compliance.
6) A person has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today the person shouts, “They’re all plotting to destroy me. Isn’t that true?” Select the nurse’s most therapeutic response.
a.”Everyone here is trying to help you. No one wants to harm you.”
b. “Feeling that people want to destroy you must be very frightening.”
c. “That is not true. People here are trying to help you if you will let them.”
d. “Staff members are health care professionals who are qualified to help you.”
ANS: B
Resist focusing on content; instead, focus on the feelings the patient is expressing. This strategy prevents arguing about the reality of delusional beliefs. Such arguments increase patient anxiety and the tenacity with which the patient holds to the delusion. The other options focus on content and provide opportunity for argument.
7) A patient is undergoing a series of diagnostic tests. The patient says, “Nothing is wrong with me except a stubborn chest cold.” The spouse reports the patient smokes and coughs a lot, has lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using?
a. Regression
b. Displacement
c. Denial
d. Projection
ANS: C
Denial is an unconscious blocking of threatening or painful information or feelings. Regression involves using behaviors appropriate at an earlier stage of psychosexual development. Displacement shifts feelings to a more neutral person or object. Projection attributes one’s own unacceptable thoughts or feelings to another
8) A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardia and dyspneic. A workup in an emergency department reveals no pathology. Which medical diagnosis should a nurse suspect, and what nursing diagnosis should be the nurse’s first priority?
- Generalized anxiety disorder and a nursing diagnosis of fear
- Altered sensory perception and a nursing diagnosis of panic disorder
- Pain disorder and a nursing diagnosis of altered role performance
- Panic disorder and a nursing diagnosis of anxiety
ANS: D
The nurse should suspect that the client has exhibited signs/symptoms of a panic disorder. The priority nursing diagnosis should be anxiety. Panic disorder is characterized by recurrent, sudden onset panic attacks in which the person feels intense fear, apprehension, or terror.
9) The nurse is providing health teaching for a patient who has been prescribed Phenelzine (Nardil) for depression and provides a written list of foods that should not be eaten while taking this medication. What is the potential problem if the patient is not compliant with these dietary restrictions?
hypertensive crisis
foods with tyramine in it
Aged meats or aged cheeses, protein extracts, sour cream, alcohol, anchovies, liver, sausages, overripe figs, bananas, avocados, chocolate, soy sauce, bean curd, natural yogurt, fava beans—tyramine-containing foods—may precipitate hypertensive crisis. Avoid chocolate or caffeine.
Herbal: Ginseng, ephedra, ma huang, St. John’s wort may cause hypertensive crisis.
For depression that is refractory to TCAs. Avoid certain foods such as
cheese, sour cream, wine, beer, figs, anchovies, shrimp, bananas, and chocolate, and avoid drugs (e.g., TCAs).
Risk for hypertensive crisis:
Avoid self-medication. WHY?
OTC preparations containing dextromethorphan, sympathomimetic agents, or antihistamines (e.g., cough, cold, and hay fever remedies, appetite suppressants) can precipitate severe hypertensive reactions if taken during therapy or within 2-3 wk after discontinuation of an MAO inhibitor.
10) Which piece of subjective data obtained during the nurse’s psychosocial assessment of a client experiencing severe anxiety would indicate the possibility of obsessive-compulsive disorder?
a. “I have to keep checking to see where my car keys are.”
b. “My legs feel weak most of the time.”
c. “I’m afraid to go out in public.”
d. “I keep reliving the rape.”
ANS: A
Recurring doubt (obsessive thinking) and the need to check (compulsive behavior) suggest obsessive-compulsive disorder. The repetitive behavior is designed to decrease anxiety but fails and must be repeated. Option B is more in keeping with a somatoform disorder. Option C is associated with agoraphobia and option D with posttraumatic stress disorder.
11) The nurse is evaluating the effectiveness of psychotropic medication on negative symptoms of psychosis. The nurse looks for a decrease in which of the following?
A: Affective flattening.
B: Bizarre behavior.
C: Illogicality.
D: Somatic delusions.
A: Affective flattening.
Reason:
Negative symptoms of psychosis involve a diminution or loss of normal functioning. They include affective flattening, alogia (restricted thought and speech), avolution/apathy (lack of behavior initiation), and anhedonia/asociality (inability to experience pleasure or maintain social contacts). Positive symptoms of psychosis involve an excess or distortion of normal functioning. These include psychotic disorders of thinking (delusions) and disorganization of speech (illogicality) and behavior.
11) The nurse is evaluating the effectiveness of an antipsychotic on negative symptoms of psychosis. Which of the following symptoms would be classified as negative symptoms of psychosis?
Blunted affect
Poverty of thought
Loss of motivation
Inability to experience pleasure or joy
12) A 39-year-old woman is recently divorced and is learning to cope with additional stressors. Which of the following best demonstrate(s) that she is utilizing positive coping strategies to manage her stress? (Select all that apply).
- alter her general lifestyle by moving to another area.
- arrange to increase her job hours, to avoid home life.
- control stress by increased physical activity.
- change her reactions to stress with cognitive behavioral
therapy.
ANS: 3, 4 - control stress by increased physical activity.
- change her reactions to stress with cognitive behavioral
therapy.
13) Which nursing diagnosis is likely to apply to an individual with severe and persistent mental illness who is homeless?
a. Insomnia
b. Substance abuse
c. Chronic low self-esteem
d. Impaired environmental interpretation syndrome
ANS: C
Many individuals with severe mental illness do not live with their families and are homeless. Life on the street or in a shelter has a negative influence on the individual’s self-esteem, making this nursing diagnosis one that should be considered. Insomnia may be noted in some patients but is not a universal problem. Substance abuse is not an approved North American Nursing Diagnosis Association (NANDA) International diagnosis. Impaired environmental interpretation syndrome refers to persistent disorientation, which is not observed in a majority of the homeless.
14) A patient with depression is receiving imipramine (Tofranil) 200 mg every night at bedtime. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug?
a. Dry mouth
c. Nasal congestion
b. Blurred vision
d. Urinary retention
ANS: D. Urinary retention
All the side effects mentioned are the result of the anticholinergic effects of the drug. Only urinary retention and severe constipation warrant immediate medical attention. Dry mouth, blurred vision, and nasal congestion may be less troublesome as therapy continues.
15) Which individual in the emergency department should be considered at the highest risk for completing suicide?
a. An adolescent Asian-American girl with superior athletic and academic skills who has asthma
b. A 38-year-old single African-American female church member with fibrocystic breast disease
c. A 60-year-old married Hispanic man with 12 grandchildren who has type 2 diabetes
d. A 79-year-old single white man with cancer of the prostate gland
ANS: D
High-risk factors include being an older adult, single, and male and having a co-occurring medical illness. Cancer is one of the somatic conditions associated with increased suicide risk. Protective factors for African-American women and Hispanic individuals include strong religious and family ties. Asian Americans have a suicide rate that increases with age.
16) The nurse is caring for a patient who takes antipsychotic medications and has developed muscle rigidity, hyperpyrexia, diaphoresis, and drooling. Which of the following adverse effects of antipsychotic educations is most likely causing these symptoms?
Neuroleptic malignant syndrome
17) A patient with catatonic schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which patient needs are of priority importance?
a. Self-esteem.
c. Physiological
b. Psychosocial.
d. Self-actualization
ANS: C. Physiologic
Physiological needs must be met to preserve life. A patient with waxy flexibility must be fed by hand or tube, toileted, given range-of-motion exercises, and so forth to preserve physiological integrity. Higher level needs are of lesser concern.
18) A nurse works with a patient with paranoid schizophrenia regarding the importance of medication management. The patient repeatedly says, “I don’t like taking pills.” Family members say they feel helpless to foster compliance. Which treatment strategy should the nurse discuss with the health care provider?
a. Use of a long-acting antipsychotic preparation
b. Addition of a benzodiazepine, such as lorazepam (Ativan)
c. Adjunctive use of an antidepressant, such as amitriptyline (Elavil)
d. Prolonged hospitalization; this patient is not ready for discharge
ANS: A.
Use of a long-acting antipsychotic preparation
Medications such as fluphenazine decanoate and haloperidol decanoate are long-acting forms of antipsychotic medications. They are administered by depot injection every 2 to 4 weeks, thus reducing daily opportunities for noncompliance. The other options do not address the patient’s dislike of taking pills.
19) Which documentation indicates that the treatment plan for a patient diagnosed with acute mania has been effective?
a. “Converses with few interruptions; clothing matches; participates in activities.”
b. “Irritable, suggestible, distractible; napped for 10 minutes in afternoon.”
c. “Attention span short; writing copious notes; intrudes in conversations.”
d. “Heavy makeup; seductive toward staff; pressured speech.”
ANS: A
The descriptors given indicate the patient is functioning at an optimal level, using appropriate behavior, and thinking without becoming overstimulated by unit activities. The incorrect options reflect manic behavior.
20) A priority nursing intervention for a patient diagnosed with major depressive disorder is:
a. distracting the patient from self-absorption.
b. carefully and inconspicuously observing the patient around the clock.
c. allowing the patient to spend long periods alone in self-reflection.
d. offering opportunities for the patient to assume a leadership role in the therapeutic milieu.
ANS: B
Approximately two thirds of people with depression contemplate suicide. Patients with depression who exhibit feelings of worthlessness are at higher risk. Regularly planned observations of the patient with depression may prevent a suicide attempt on the unit.
21) A nurse plans health teaching for a patient with generalized anxiety disorder who begins a new prescription for lorazepam (Ativan). What information should be included? (Select all that apply).
a. Caution in use of machinery
b. Foods allowed on a tyramine-free diet
c. The importance of caffeine restriction
d. Avoidance of alcohol and other sedatives
e. Take the medication on an empty stomach
ANS: A, C, D
a. Caution in use of machinery
c. The importance of caffeine restriction
d. Avoidance of alcohol and other sedatives
22) A patient is experiencing moderate anxiety. The nurse encourages the patient to talk about feelings and concerns. What is the rationale for this intervention?
a. Offering hope allays and defuses the patient’s anxiety.
b. Concerns stated aloud become less overwhelming and help problem solving begin.
c. Anxiety is reduced by focusing on and validating what is occurring in the environment.
d. Encouraging patients to explore alternatives increases the sense of control and lessens anxiety.
ANS: b. Concerns stated aloud become less overwhelming and help problem solving begin.
23) A patient diagnosed with major depressive disorder begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. Priority information given to the patient and family should include a directive to:
a. avoid exposure to bright sunlight.
b. report increased suicidal thoughts.
c. restrict sodium intake to 1 g daily.
d. maintain a tyramine-free diet.
ANS: B
Some evidence indicates that suicidal ideation may worsen at the beginning of antidepressant therapy; thus close monitoring is necessary. Avoiding exposure to bright sunlight and restricting sodium intake are unnecessary. Tyramine restriction is associated with monoamine oxidase inhibitor (MAOI) therapy.
24) A veteran of the lraq War describes that he is having intrusive thoughts of missiles, screaming, explosions, and the same feelings of terror first experienced in combat. Which of the following clinical disorders would this patient most likely be describing symptoms of?
ANS: Post-traumatic stress disorder (PTSD)
25) A patient with acute mania approaches the nurse, waves a newspaper, and says, “I want the phone right now. I need to call this store while their sale is going on. I need ten dresses and four pairs of shoes.” Select the nurse’s best intervention.
a. Suggest the patient ask a friend do the shopping and bring purchases to the unit.
b. Invite the patient to sit with the nurse and look at new fashion magazines.
c. Tell the patient phone use is not allowed until self-control is improved.
d. Ask whether the patient has enough money to pay for the purchases.
ANS: B
Situations such as this offer an opportunity to use the patient’s distractibility to staff’s advantage. Patients become frustrated when staff denies requests the patient sees as entirely reasonable. Distracting the patient can avoid power struggles. It is important to satisfy the patient’s need for immediacy but avoid an extravagant expenditure. Provoking the patient would likely precipitate an angry response.
26) A patient tells the nurse, “I wanted my health care provider to prescribe diazepam (Valium) for my anxiety disorder, but buspirone (BuSpar) was prescribed instead. Why?” The nurse’s reply should be based on the knowledge that buspirone:
a. does not produce blood dyscrasias.
b. does not cause dependence.
c. can be administered as needed.
d. is faster acting than diazepam.
ANS: B
Buspirone is considered effective in the long-term management of anxiety because it is not habituating. Because it is long acting, buspirone is not valuable as an as-needed or as a fast- acting medication. The fact that buspirone does not produce blood dyscrasias is less relevant in the decision to prescribe buspirone
27) A client with generalized anxiety disorder and depression comes to the anxiety disorders clinic displaying severe anxiety. Of the medications listed in the client’s medical record, which one, with an appropriate order, can be given as a prn anxiolytic?
a. Buspirone (BuSpar)
b. Lorazepam (Ativan)
c. Phenytoin (Dilantin)
d. Fluoxetine (Paxil)
ANS: B
Lorazepam is a benzodiazepine used to treat anxiety. It may be given as a prn medication. Option A: Buspirone has a long action and is not useful as a prn drug. Option C: Phenytoin is an anticonvulsant. Option D: Fluoxetine is a selective serotonin reuptake inhibitor used to treat the client’s depression.
28) The nurse is caring for a female patient diagnosed with schizophrenia who believes that her thoughts are broadcast from her head. The nurse identifies which of the following as the most appropriate nursing diagnosis for this patient?
A) Risk self-directive violence
B) Disturbed sensory perception
C) Impaired verbal communication
D) Disturbed thought processes
ANS: D
Thought broadcasting and thought withdrawal are disturbed thought processes.
29) What is the best intervention when a pt is responding to an auditory hallucination?
ANS: “Can you tell me what you are hearing?”
Knowing what the patient is hearing is important. A command hallucination could result in injury to self or others. For example: the voice could be telling the pt to self mutilate
30) A patient with depression is evaluated at the clinic and started on citalopram. The patient tells the nurse, “l have some pills I previously took for depression. They’re called MAOIs. I think I should take them along with this new medication.” What information is essential for the nurse to communicate regarding her statements?
Make sure to educate your patients about the expected side effects of MAOI inhibitors, which are:
- Dizziness
- Weakness/fainting resulting from an abrupt positional change
- Drowsiness
- Blurred vision (reversible)
- Nausea and vomiting
- Loss of appetite
- Emotional or mental changes
- Irritability/ nervousness
Patients should be informed about the warning signs that warrant immediate physician/nurse attention as well. They include:
- A headache
- Rashes
- Darkened urine
- Pale stools
- Eye/skin yellowing
- Chills and fever
- A sore throat
31) The nurse is caring for a patient who experiences orthostatic hypotension related to taking chlorpromazine (Thorazine). The nurse should suggest which of the following interventions for managing this side effect?
A. Stay in bed for an hour after taking the medication.
B. Stand quickly, then wait a moment before walking.
C. Rise slowly when getting out of bed.
D. Rise from your left side when getting out of bed.
ANS: C
Sudden position changes lead to dizziness associated with postural hypotension.
32) An adult says, “When I was a child, I took medication because I couldn’t follow my teachers’ directions. I stopped taking it when I was about 13. I still have trouble getting organized, which causes difficulty doing my job.” Which clinical disorder does this scenario suggest?
a. Stress intolerance disorder
b. Generalized anxiety disorder
c. Borderline personality disorder
d. Adult attention deficit hyperactivity disorder (AADHD)
ANS: d.
Adult attention deficit hyperactivity disorder (AADHD)
33) lf a cruel and abusive person rationalizes the behavior, which comment would be most characteristic of rationalization as a defense mechanism?
33) If a cruel and abusive person rationalizes the behavior, which comment would be most characteristic?
a. “I don’t know why it happens.”
b. “That person shouldn’t have provoked me.”
c. “I’m really a coward who is afraid of being hurt.”
d. “I have poor impulse control.”
ANS: B
Rationalization consists of justifying one’s unacceptable behavior by developing explanations that satisfy the teller and attempt to satisfy the listener. The abuser is suggesting that the abuse is not his or her fault and would not have occurred except for the provocation by the other person.
34) At a unit meeting, staff discusses decor for a special bedroom for manic patients- Which is the best suggestion related to caring for an acutely manic patient?
a. An extra-large window with a view of the street
b. Neutral walls with pale, simple accessories
c. Brightly colored walls and print drapes
d. Deep colors for walls and upholstery
ANS: B
The environment for a manic patient should be as simple and non-stimulating as possible. Manic patients are highly sensitive to environmental distractions and stimulation.
35) Two days ago, a client was admitted to the inpatient psychiatric unit with a diagnosis of PTSD and a history of violence. Currently, he continues to have sleep problems, trouble with concentration, and has been feeling increased anger toward another patient who reminds him of a former colleague. The priority nursing diagnosis would be:
a. Risk for violence
b. Ineffective individual coping
c. Sleep deprivation
d. Decisional conflict
ANS: a. Risk for violence
36) A nurse is providing teaching for a client who has a new prescription for clozapine (Clozaril). Which of the following client statements indicates a need for further teaching?
ANS: “This medication will help prevent seizures.”
37) You are the nurse responsible for assessing for extrapyramidal side effects in a patient who has been taking chlorpromazine. Which of the following may be side effects for this medication? (Select all that apply.)
A. acute dystonia
B. akathisia
C. amenorrhea
D. breast secretion
E. dyskinesia
F. Parkinsonism
G. Sexual dysfunction
ANS: A,B,E,F
Extrapyramidal side effects of the central nervous system are involved in the production and control of involuntary and gross motor movements producing acute dystonia, akathisia, dyskinesia and Parkinsonism. Amenorrhea, breast secretion, and sexual dysfunction are endocrine-related side effects of the drug.
38) A nurse answers a suicide crisis line. A caller says, “I live alone in a home several miles from my nearest neighbors. I have been considering suicide for 2 months. I have had several drinks and now my gun is loaded. I’m going to shoot myself in the heart.” How would the nurse assess the lethality of this plan?
a. No risk
b. Low level
c. Moderate level
d. High level
ANS: D
The patient has a highly detailed plan, a highly lethal method, the means to carry it out, lowered impulse control because of alcohol ingestion, and a low potential for rescue.
39) A nurse provided medication education for a patient who takes phenelzine (Nardil) for depression. Which behavior indicates effective learning? The patient:
a. monitors sodium intake and weight daily.
b. wears support stockings and elevates the legs when sitting.
c. consults the pharmacist when selecting over-the-counter medications.
d. can identify foods with high selenium content, which should be avoided.
ANS: C
Over-the-counter medicines may contain vasopressor agents or tyramine, a substance that must be avoided when the patient takes MAOI antidepressants. Medications for colds, allergies, or congestion or any preparation that contains ephedrine or phenylpropanolamine may precipitate a hypertensive crisis.
MAOI antidepressant therapy is unrelated to the need for sodium limitation, support stockings, or leg elevation. MAOIs interact with tyramine-containing foods, not selenium, to produce dangerously high blood pressure.
40) Which statement by a patient in the continuation phase of treatment for bipolar disorder indicates that a referral may still be needed?
41) Your patient is very stressed about work, and has started taking yoga classes. Which comment would indicate that this physical activity has been successful?
42) When assessing a patient’s plan for suicide, what aspect has priority?
a. Patient’s financial and educational status
b. Patient’s insight into suicidal motivation
c. Availability of means and lethality of method
d. Quality and availability of patient’s social support
ANS: C
c. Availability of means and lethality of method
If a person has plans that include choosing a method of suicide readily available and if the method is one that is lethal (i.e., will cause the person to die with little probability for intervention), the suicide risk is high.
43) A nurse receives this laboratory result: lithium level 1.7 mEq/L. How should the nurse interpret this lab value?
43) A nurse receives this laboratory result for a patient diagnosed with bipolar disorder: lithium level 1 mEq/L. This result is:
a. within therapeutic limits
b. below therapeutic limits
c. above therapeutic limits
d. incorrect because of inaccurate testing
ANS:A
The normal range for a blood sample taken 8 to 12 hours after the last dose of lithium is 0.4 to 1 mEq/L.
44) A patient diagnosed with major depression refuses solid foods. In order to meet nutritional needs, which beverage will the nurse offer to this patient?
a. Tomato juice
c. Hot tea
b. Orange juice
d. Milk
ANS: D
Milk is the only beverage listed that provides protein, fat, and carbohydrates. In addition, milk is fortified with vitamins.
45) A patient says to the nurse, “My life doesn’t have any happiness in it anymore. I once enjoyed going out with friends, but now I don’t care if they even invite me.” Which term best describes this patient’s feelings?
45) A patient says to the nurse, “My life doesn’t have any happiness in it anymore. I once enjoyed holidays, but now they’re just another day.” The nurse documents this report as an example of:
a. dysthymia.
c. euphoria.
b. anhedonia.
d. anergia.
ANS:B
Anhedonia is a common finding in many types of depression. It refers to feelings of a loss of pleasure in formerly pleasurable activities. Dysthymia is a diagnosis. Euphoria refers to an elated mood. Anergia means “without energy.”
46) Which of the following are potential complications that the patient receiving Iithium should be assessed for?
46) A patient receiving lithium should be assessed for which evidence of complications?
a. Pharyngitis, mydriasis, and dystonia
b. Alopecia, purpura, and drowsiness
c. Diaphoresis, weakness, and nausea
d. Ascites, dyspnea, and edema
ANS: c. Diaphoresis, weakness, and nausea
47) The nurse knows that sedation is a side effect of many antipsychotics. Which of the following medications should the nurse question if ordered for a patient taking antipsychotics?
A. Diphenoxylate hydrochloride (lomotil)
B. Acetaminophen (Tylenol)
C. Verapamil (Calan)
D. Diphenhydramine (Benadryl)
ANS: D.
Diphenhydramine (Benadryl) is an antihistamine that is likely to enhance the sedative effects of antipsychotic medications. Alcohol and other sleeping aids should also be avoided by the patient taking antipsychotic medications.
48) A patient diagnosed with bipolar disorder commands other patients, “Get me a book. Take this stuff out of here,” and other similar demands. The nurse wants to interrupt this behavior without entering into a power struggle. Select the best initial approach by the nurse.
a. Distraction: “Let’s go to the dining room for a snack.”
b. Humor: “How much are you paying servants these days?”
c. Limit setting: “You must stop ordering other patients around.”
d. Honest feedback: “Your controlling behavior is annoying others.”
ANS: A
The distractibility characteristic of manic episodes can assist the nurse to direct the patient toward more appropriate, constructive activities without entering into a power struggle. Humor usually backfires by either encouraging the patient or inciting anger. Limit setting and honest feedback may seem heavy-handed to a labile patient and may incite anger.
49) Which statement made by a client who has agoraphobia and does not leave her home identifies the thinking typical of a client with this disorder?
a. “I know I’ll get over not wanting to leave home soon; it just takes time.”
b. “When I have a good incentive to go out, I’ll be able to do it.”
c. “My husband and kids tell me they like it now that I stay home.”
d. “Being afraid to go out seems ridiculous, but I can’t go out the door.”
ANS: D
The individual who is agoraphobic generally acknowledges that the behavior is not constructive and that he or she does not really like it. The symptom is ego dystonic. However, the client will state he or she is unable to change the behavior. Options A and B: Agoraphobics are not optimistic about change. Option C: Most families are dissatisfied with the behavior.
50) An adult with depression has been treated with medication and cognitive behavioral therapy. The patient now verbalizes that being passive and letting others make decisions for her contributed to the depression. What referrals could the nurse make to help this patient prevent recurrence of depression?
50) An adult diagnosed with major depressive disorder was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest?
a. Social skills training
b. Relaxation training classes
c. Use of complementary therapy
d. Learning desensitization techniques
ANS: A
Social skills training is helpful in treating and preventing the recurrence of depression. Training focuses on assertiveness and coping skills that lead to positive reinforcement from others and the development of a patient’s support system. The use of complementary therapy refers to adjunctive therapies such as herbals. Assertiveness would be of greater value than relaxation training because passivity is a concern. Desensitization is used in the treatment of phobias.