D. "Let's set some guidelines and goals for your visit here."



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Most adults with severe mental illness have economic pressures and many become homeless. The nurse needs to understand that this is due to their:
a.) lack of overall responsibility
b.) difficulty obtaining employment
c.) neediness and often aggressive behaviors
d.) delusions and hallucinations that interfere with functioning

b.) difficulty obtaining employment


d.) delusions and hallucinations that interfere with functioning

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Which of the following nursing interventions would not be considered essential when working with an adult with ADHD?
a.) Establishing a regular exercise regimen to provide physical release and daily structure
b.) Guiding the patient to identify and use enhanced organizational skills
c.) Educating the patient's significant other about causes, treatments, and ways to cope with its symptoms
d.) Guiding the patient in understanding and practicing stimulation reduction strategies

a.) Establishing a regular exercise regimen to provide physical release and daily structure

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Which statement from a depressed patient might precede a suicide attempt?


A.) I want to be the best I can be.
B.) I have decided to solve all my problems.
C.) I have the most horrendous family.
D.) I will try and work with staff.

B.) I have decided to solve all my problems.

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Which response to a patient experiencing depression would be helpful from the nurse?


A.) Don't worry, we all get down once in a while.
B.) Don't consider suicide. It's an unacceptable option.
C.) Try to cheer up. Things always look darkest before the dawn.
D.) I can see you're feeling down. I'll sit here with you for a while.

D.) I can see you're feeling down. I'll sit here with you for a while.

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A patient diagnosed with major depression appears tired and lethargic, but states he will try a group activity. What nursing intervention best assists this patient to integrate into the milieu?


A.) Have the patient sit outside of groups until he is ready to fully participate.
B.) Encourage the patient to choose which of the several groups he might like to attend.
C.) Arrange for the patient to participate in a structured group activity.
D.) Do nothing and allow the patient to take the initiative in joining group.

B.) Encourage the patient to choose which of the several groups he might like to attend.



Electroconvulsive therapy (ECT): (select all that apply)


A.) is useful in treatment of patients with depressive disorders
B.) can cause memory deficits
C.) has a usual course of therapy that includes 2-3 treatments
D.) can achieve 90% remission rate in 1-2 months

A.) is useful in treatment of patients with depressive disorders


B.) can cause memory deficits




When the nurse is caring for a depressed patient, the problem that should receive the highest nursing priority is:
A.) powerlessness
B.) suicidal ideation
C.) inability to cope effectively
D.) anorexia and weight loss

B.) suicidal ideation

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In communicating with a patient who is experiencing an elated mood, which of the following interventions by the nurse is appropriate?


A.) Use a calm, firm approach.
B.) Give expanded explanations.
C.) Make use of abstract concepts.
D.) Encourage lighthearted optimism.

A.) Use a calm, firm approach.

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Which food selection best meets the needs of the manic patient?


A.) Pineapple, bananas, popcorn
B.) Chicken and mashed potatoes
C.) Corn chowder and spinach
D.) Peanut butter sandwich and carrots

D.) Peanut butter sandwich and carrots



A positive characteristic that assists the nurse in the care of the manic patient is:


A.) flight of ideas
B.) racing thoughts
C.) taunting behavior
D.) distractibility

D.) distractibility



Which activity has a calming effect on the manic patient?


A.) Writing on a notepad
B.) Reading a book
C.) Discussion of current events
D.) Watching a movie

A.) Writing on a notepad

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A patient has a lithium level of 1.1 mEq/L. This level is:


A.) below the therapeutic level.
B.) above the therapeutic level.
C.) within the therapeutic range.
D.) not needed as lithium does not require blood levels.

C.) within the therapeutic range.

which statement about crisis theory provides a basis for nursing intervention

a. a crisis is an acute time limited phenomenon experienced as an overwhelming emotional reaction to a problem perceived as unsolvable


b. a person in crisis usually has had adjustment problems and had coped inadequately in his or her life situations
c. crisis is precipitated by an event that enhances the persons self concept and self esteem
d. nursing intervention in crisis situations rarely has the effect of ameliorating the crisis

a

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the main goal of the initial nursing assessment with a client in crisis is to 

a. obtain a thorough medical hx


b. arrange for a family meeting asap
c. determine the precise level of functioning
d. encourage the pt to return to normal activities

c

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in planning care for a person experiencing a crisis it is important for the nurse to first

a. ensure that the discharge plan includes a medication appointment


b. encourage the pt to discuss past coping strategies
c. refer the pt to an outpatient therapist within his/her provider network
d. collaborate with the health team to determine the anticipated discharge date

b

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for a nurse working in a crisis intervention which belief would be least helpful

a. a person in crisis incapable of making decisions


b. the crisis counseling relationship is one between partners
c. crisis counseling helps the patient refocus to gain new perspectives on the situation
d. anxiety reduction techniques are used so the pts inner resources can be accessed

a

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which of the following is not a function of critical incident stress debriefing (CISD)? to debrief:

a. staff after incidents of pt violence


b. a hotline volunteer after a pts suicide
c. a pt after transplant surgery
d. search and rescue workers after a natural disater

c

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an elderly man accompanied by his son with whom he lives arrives in the ed with many bruises and states he has difficulty moving his left shoulder. the priority nursing action is to

a. discuss the injuries with the pt without his son present


b. call the police and report possible abuse
c. arrange for a social work consultation
d. have the pt call in another family member as a witness

a

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when treating a woman who has been trapped in an abusive marriage for many years which statement would a nurse expect to hear

a. if im patient hell change


b. i deserve to be beaten'
c. ill stay for the sake of the children
d. no adult has the right to control or harm another

d

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when making assessments the nurse should bear in mind that a common characteristic of an abusing parent is

a. being female


b. having poor coping skills
c. having realistic expectations of child behavior
d. abstaining from use of chemical substances of abuse

b

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during a nursing assessment which of the following is a red flag for suspecting that a pt has been a victim of physical violence

a. pt explanation does not match the injury


b. pt has no hx of stress related physical problems
c. pt mentioned having concerned supportive spouse
d. pt is anxious but open and direct in explaining the complaint or injury

a

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an elderly woman has been emotionally and financially abused by her family for years. the nurse has difficulty understanding why she allows the abuse to recur. the best approach is to

a. encourage the pt to break ties with her family


b. avoid talking about the concept of abuse
c. understand that the pt may feel helpless to make a change
d. believe that the pt is not concerned about the abuse

c

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a 19 yo college student jan is taken to the ed by her friend. her friend states that she was sexually assaulted at a frat party. jan has given permission for a forensic exam (photos and specimens). choose the nursing action you would take when working with a victim of sexual assault

a. suggest she should clean up before the vaginal exam in order to fell less violated


b. explain that everything will be ok and that it takes a month or two to get over in order to calm her down
c. try to get her to tell you as much about the assault that can remember so you can put the info in your report to the police
d. explain all the procedures before doing them

d





in the medical record of a victim of rape which of the following types of data are inappropriate to document

a. observations of the pts physical trauma using a body map


b. assessment of signs and symptoms of emotional trauma
c. verbatim statements made by the pt
d. details of the pts sexual hx

d

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when an ed nurse is providing care to a rape victim which two of the following are important elements of care

a. providing non judgmental care


b. conveying disgust that this would happen
c. aligning with her sense of blaming herself
d. discussing confidentiality

a,d




which of the following observations if found in the medical record of a sexual assault survivor would indicate that reorganization after a rape crisis was not yet complete. the patient is

a. free from somatic reactions
b. generally positive about self
c. calm and relaxed during interactions
d. experiencing frequent nightmares

d

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a patient asks the nurse if she should leave her husband who has been sexually violent to her. the best response by the nurse would be

a. it will be safer for you to divorce your husband


b. often women are in more danger during the separation period
c. he will appreciate you ore after you leave him
d. i cannot professionally respond to your question

d





charles brown lost his wife in an automobile accident months ago. since then he has been severely depressed withdrawn from contacts with family and friends and taken to drinking to the numb the pain. on the sad persons assessment scale how many points does mr. brown have
a. 3
b.4
c.5
d.6

d

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what is the most accurate rationale when planning care for suicidal pts in an inpatient setting

a. suicidal attempts are not likely to occur if there is a consistent team approach


b. aggressive behaviors on the unit indicate a need for staff education
c. a completely safe milieu eliminates the chance of suicidal behavior
d. there are safety risks in any plan of care that promotes responsibility and growth

d

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which patient statement indicates that a patient may be a safety risk to self or others

a. i really hate being here


b. when do staff check patient rooms
c. all the rules here are ridiculous
d. which staff are scheduled for tomorrow

b





in assessing an er pt who reports taking an overdose of aspirin (ASA) what is the best answer for the nurse to request in assessing the pt

a. how long have you been depressed


b. describe your support system
c. when did you take the pills and how many
d. are you willing to be hospitialized

c

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which statement is correct regarding care of the suicidal patient

a. the more specific the plan the more likely the patient will attempt suicide


b. teens and elderly persons rarely have suicidal ideation
c. patients who survive suicide attempts rarely try again
d. discussion of suicidal thoughts enhances aggressive behavior

a

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due to a pts angry outburst the nurse makes the determination that the pt may soon become physically violent. select the priority nursing action

a. take the client aside and speak in soft tones


b. call for assistance
c. tell the client to return to his room
d. encourage other pts to help calm down the pt

b

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after a few days on an inpatient unit a pt with a hx pf explosive outbursts states to the nurse i am really feeling angry now. the nurse determines that this represents

a. a clear threat


b. anti social behavior
c. positive behavioral change
d. continued negativity

c

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to help prevent displays of anger and aggression the nurse must understand that anger and aggression are preceded by feelings of

a. vulnerability


b. depression
c. elation
d. isolation

a

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which of the following is most useful to the nurse planning intervention for an angry pt

a. creative individualized approaches to the pts behavior by staff members


b. the availability of group therapy sessions focused on cathartic expression of emotion
c. an understanding of the pts medical dx
d. consistency of approach to the pt by staff memebers

d

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after a client was sent to a quite room following aggressive comments to several pts the nurse explains the purpose of this intervention to the pt

a. this provides a means to ensure safety for you and other pts 


b. this is what happens to all pts who become to aggressive
c. this keeps you away from the other pts
d. this is part of your treatment plan

a

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which of the following medications might be prescribed for a client experiencing a crisis (select all)

a. lithium carbonate


b. paroxetine (paxil)
c. risperidone (risperdal)
d. haloperidol (haldol)
e. lorazepam (ativan)

b,e




a nurse assesses a client at a community mental health facility using the sad persons tool. the nurse knows that that this tool provides which of the following data related to a client?

a. client ?
b. current anxiety level
c. suicide potential
d. mood disturbance

c

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a client says i plan to commit suicide. which of the following should be the nurses priority assessment

a. clients educational and economical background


b. lethality of method and availability of means
c. quality of the clients social support
d. clients insight into the reasons for the decision

b

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which of the following statements made by a client is an example of aggressive communication

a. i wish you would not make me angry


b. i feel angry when you leave me
c. it makes me angry when you interrupt me
d. youd better listen to me

d

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when approaching a client who is speaking in a loud voice with clenched fists a nurse should

a. insist that the client stop yelling


b. request other staff members to remain close by
c. move as close to the client as possible
d. walk away from the client

b

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a nurse is assessing a client in an inpatient mental health unit. which of the following findings should the nurse expect if the client is in the preassaultive stage of violence? select all

a. lethargy


b. defensive responses to questions
c. disorientation
d. rapid breathing
e. facial grimacing
f. agitation

b,d,f




a client in the day room of an inpatient mental health setting gets up from a chair and throws it across the room. which of the following is the priority nursing action?

a. encourage the client to express her feelings
b. maintain eye contact with the clients
c. move the client away from others
d. tell the client that the behavior is not acceptable

c





a nurse is assessing a preschool child in the ed. which of the following findings should cause the nurse to suspect child abuse (select all)?

a. scabs on knees


b. pinpoint burn marks on forearm
c. mismatched clothing
d. broken right arm
e. bruises on torso

b,e




a rape victim states i never should have been on the street alone at night. which of the following is a therapeutic response by the nurse

a. you actions had nothing to do with what happened
b. blaming yourself only increases your anxiety and discomfort
c. you believe this wouldn't have happened if you hadn't been out alone
d. your right, you should not have been alone on the street at night

c





a rape victim reports to the nurse that his family is not very supportive. which of the following is a myth or belief about rape that might contribute to the family's response to the client

a. rape is an act of aggression


b. no one asks to be raped
c. men do not get raped
d. the majority of rapists are known to the victims

c





the rape victim tells the ed nurse i feel so dirty. please let me take a shower before anyone examines me i just cant stand being so filthy. how should the nurse respond

a. arrange for the client to shower


b. give the pt a basin of hot water and towels
c. explain that washing would destroy evidence
d. ask the provider if the client can shower

c





rape trauma syndrome is comparable to which of the following

a. panic attack


b. disorganized schizophrenia
c. ptsd
d. bipolar disorder

c

Stages of Grief



Denial
Anger
Bargaining
Depression
Acceptance




Grieving process depends on __________

The person



Acute phase of grieving process



6-8 weeks




How long before full acceptance in grieving process?

1-2 years



What is a sign the person has moved on from the grieving process?



Remember the good and bad




Anticipatory grieving

Grieving process before death actually happens



Maladaptive grief



Delayed or inhibited
Prolonged
Exaggerated




The difference between normal and maladaptive grief

loss of self esteem



Reaction to an effect that occurs in our life



Stress




Urge to compete

Type A




Easily angered, irritated, impatient

Type A




Aggressive

Type A




Cannot bear delays

Type A




Speak in a loud voice

Type A




Interrupt others

Type A




Finish other people's sentences

Type A




Increased risk of CAD

Type A




Do not feel the urge to compete

Type B




Relaxed


Type B




Not easily provoked

Type B




Tolerant towards others

Type B




Able to wait patiently

Type B




Speak calmly and slowly

Type B




Good listeners

Type B




Half the risk of heart disease

Type B




Concepts of stress

As biological adaptation


As Environmental event
As a transactions b/t the individual and the environment




Stress as a biological response

General adaptation syndrome


(Fight or flight) SNS




Diseases of adaptation

HA, insomnia, CAD, ulcers, colitis, muscle ache, HTN, rashes, IBS, RA, SLE



Stress triggers our response



Stress as an environmental event




Stress causes us to change

Stress as an environmental event



Stress emphasis is on change from the existing state



Stress as an environmental event




Stress, includes Holmes and Rahe Social Readjustment scale

Stress as an environmental event



Holmes and Rahe Social Readjustment Scale issues



Perception
Everyone has different coping levels




Stress, focuses on the relationship between the two

Stress as a transaction b/t the individual and the environment



Stress, whether or not illness occurs depends on the susceptibility of the person



Stress as a transaction b/t the individual and the environment




Elements of stress

-Precipitating event


-Individual perception of event
-Predisposing factors (existing conditions)




Adaptive coping strategies

Awareness


Relaxation
Prayer/meditation
Communication
Problem solving
Pets
Music
Shopping




The individual is exposed to a precipitating event

Phase 1 of crisis development



When previous problem solving techniques do not relieve the stressor, anxiety increases further



Phase 2 of crisis development




All possible resources are called upon to resolve the problem and relieve discomfort

Phase 3 of crisis development



Tension mounts and increases to the breaking point and the individual experiences disorganization



Phase 4 of crisis development




Types of crises

Maturational 


Situational 
Social




Maturational crisis

Predictable life changes that occur



Situational crisis



Unanticipated events threaten a person's biological, social, or psychological integrity




Social crisis

Uncommon, unanticipated events that involve multiples loses or extensive environmental changes



Goal of crisis intervention



Get them back to pre-crisis level of funcitonality




Phases of crisis intervention

Assessment


Planning
Intervention
Evaluation & Anticipatory planning




Crisis intervention: Assessment

(gathering data)


-precipitating event 
-strength and coping skills 
-situational supports




How to assess precipitating event

10-14 days prior


Make sure pt perceives realistically




Crisis intervention: Planning

Develop care map



Crisis intervention: Intervention



(Focus on problem at hand)
-implement the plan
-6-8 interviews




Patients in crisis have a hard time understanding what?

Complicated things



Are drugs typically used for crisis intervention?



No

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Domestic Violence

-Systematic pattern of actual or threatened physical, sexual and/or psychological violence as a process of control over another person




Domestic Violence

-ASD: Autism Spectrum Disorders

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