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NURSING 1950 Mental Health Module 2 Questions and Answers Solution
A patient asks, "What are neurotransmitters? My doctor said mine are imbalanced." Select the nurse's best response. "Neurotransmitters are natural chemicals that pass messages between brain cells." The patient asked for information, and the correct response is most accurate. Neurotransmitters are chemical substances that function as messengers in the central nervous system. They are released from the axon terminal, diffuse across the synapse, and attach to specialized receptors on the postsynaptic neuron.
1. The parent of an adolescent diagnosed with schizophrenia asks the nurse, "My child's doctor ordered
a PET. What kind of test is that?" Select the nurse's best reply. "PET means positron-emission tomography. It is a special type of scan that shows blood flow and activity in the brain." The parent is seeking information about PET scans. It is important to use terms the parent can understand, so the nurse should identify what the initials mean.
2. A patient with a long history of hypertension and diabetes now develops confusion. The health care
provider wants to make a differential diagnosis between Alzheimer's disease and multiple infarcts. Which diagnostic procedure should the nurse expect to prepare the patient for first? CT scan A CT scan shows the presence or absence of structural changes, including cortical atrophy, ventricular enlargement, and areas of infarct, information that would be helpful to the health care provider.
3. A patient's history shows drinking 4 to 6 L of fluid and eating more than 6,000 calories per day. Which
part of the central nervous system is most likely dysfunctional for this patient? Hypothalamus The hypothalamus, a small area in the ventral superior portion of the brainstem, plays a vital role in such basic drives as hunger, thirst, and sex.
4. The nurse prepares to assess a patient diagnosed with major depressive disorder for disturbances in
circadian rhythms. Which question should the nurse ask this patient? "What are your worst and best times of the day?" Mood changes throughout the day may be related to circadian rhythm disturbances. Questions about sleep pattern are also relevant to circadian rhythms.
5. The nurse administers a medication that potentiates the action of ã-aminobutyric acid (GABA). Which
effect would be expected? Reduced anxiety Increased levels of GABA reduce anxiety. Acetylcholine and substance P are associated with memory enhancement. Thought disorganization is associated with dopamine. GABA is not associated with sensory perceptual alterations.
6. A nurse would anticipate that treatment for a patient with memory difficulties might include
medications designed to prevent destruction of acetylcholine Increased acetylcholine plays a role in learning and memory. Preventing destruction of acetylcholine by acetylcholinesterase would result in higher levels of acetylcholine, with the potential for improved memory.
7. A patient has disorganized thinking associated with schizophrenia. Neuroimaging would likely show
dysfunction in which part of the brain? Frontal lobe The frontal lobe is responsible for intellectual functioning.
8. The nurse should assess a patient taking a drug with anticholinergic properties for inhibited function
of the parasympathetic nervous system Acetylcholine is the neurotransmitter found in high concentration in the parasympathetic nervous system. When anticholinergic drugs inhibit acetylcholine action, blurred vision, dry mouth, constipation, and urinary retention commonly occur.
9. The therapeutic action of neurotransmitter inhibitors that block reuptake cause
increased concentration of the blocked neurotransmitter in the synaptic gap If the reuptake of a substance is inhibited, it accumulates in the synaptic gap, and its concentration increases, permitting ease of transmission of impulses across the synaptic gap. Normal transmission of impulses across synaptic gaps is consistent with normal rather than depressed mood.
10. A patient taking medication for mental illness develops restlessness and an uncontrollable need to
be in motion. Which drug action causes these symptoms to develop?
16. A patient begins therapy with a phenothiazine medication. What teaching should the nurse provide
related to the drug's strong dopaminergic effect? Report changes in muscle movement Phenothiazines block dopamine receptors in both the limbic system and basal ganglia. Movement disorders and motor abnormalities (extrapyramidal side effects), such as parkinsonism, akinesia, akathisia, dyskinesia, and tardive dyskinesia, are likely to occur early in the course of treatment. They are often heralded by sensations of muscle stiffness. Early intervention with antiparkinsonian medication can increase the patient's comfort and prevent dystonic reactions.
17. A patient tells the nurse, "My doctor prescribed paroxetine for my depression. I assume I'll have side
effects like I had when I was taking imipramine." The nurse's reply should be based on the knowledge that paroxetine is a(n) SSRI Paroxetine is an SSRI and will not produce the same side effects as imipramine, a tricyclic antidepressant.
18. A nurse can anticipate anticholinergic side effects are likely when a patient takes
imipramine Imipramine (Tofranil) is a tricyclic antidepressant with strong anticholinergic properties, resulting in dry mouth, blurred vision, constipation, and urinary retention.
19. Which instruction has priority when teaching a patient about clozapine?
"Report sore throat and fever immediately." Clozapine therapy may produce agranulocytosis; therefore, signs of infection should be immediately reported to the health care provider. In addition, the patient should have white blood cell levels measured weekly.
20. A nurse cares for a group of patients receiving various medications, including haloperidol,
carbamazepine, trazodone, and phenalgine. The nurse will order a special diet for the patient who takes phenelzine Patients taking phenelzine, a MAO inhibitor, must be on a low tyramine diet to prevent hypertensive crisis.
21. A nurse instructs a patient taking a drug that inhibits MAO to avoid certain foods and drugs because
of the risk of hypertensive crisis
Patients taking MAO-inhibiting drugs must be on a low tyramine diet to prevent hypertensive crisis. In the presence of MAO inhibitors, tyramine is not destroyed by the liver and in high levels produces intense vasoconstriction, resulting in elevated blood pressure.
22. A nurse caring for a patient taking a SSRI will develop outcome criteria related to
improvement in depression SSRIs affect mood, relieving depression in many cases. SSRIs do not act to reduce thought disorders. SSRIs reduce depression but have little effect on motor hyperactivity. SSRIs do not produce extrapyramidal symptoms.
23. By which mechanism do SSRI medications improve depression?
Making more serotonin available at the synaptic gap Depression is thought to be related to lowered availability of the neurotransmitter serotonin. SSRIs act by blocking reuptake of serotonin, leaving a higher concentration available at the synaptic cleft. SSRIs prevent destruction of serotonin.
24. The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000
mm3. Select the nurse's best action. Report the results to the health care provider immediately These laboratory values indicate the possibility of agranulocytosis, a serious side effect of clozapine therapy. These results must be immediately reported to the health care provider, and the drug should be withheld. The health care provider may repeat the test, but in the meantime, the drug should be withheld.
25. A drug blocks the attachment of norepinephrine to α1 receptors. The patient may experience
orthostatic hypotension Sympathetic-mediated vasoconstriction is essential for maintaining normal blood pressure in the upright position. Blockage of α1 receptors leads to vasodilation and orthostatic hypotension. Orthostatic hypotension may cause fainting and falls. Teach patients ways of minimizing this phenomenon.
26. A nurse cares for four patients who are receiving clozapine, lithium, fluoxetine, and venlafaxine,
respectively. With which patient should the nurse be most alert for problems associated with fluid and electrolyte imbalance? The patient receiving lithium Lithium is a salt and known to alter fluid and electrolyte balance, producing polyuria, edema, and other symptoms of imbalance.
Antipsychotic medications may produce weight gain, which would complicate care of a patient with diabetes, and increase serum triglycerides, which would complicate care of a patient with hyperlipidemia. Parkinson's disease involves changes in transmission of dopamine and acetylcholine, so these drugs would also complicate care of this patient.
32. Questions the nurse could ask that would be nonjudgmental when obtaining information about a
patient's use of complementary and herbal remedies include (Select all that apply) "What herbal medicines have you used to relieve your symptoms?" "What over-the-counter medicines, vitamins, and nutritional supplements do you use?" "What differences in your symptoms do you notice when you take herbal supplements?" "Have you experienced problems from using herbal and prescription drugs at the same time?" The correct responses are neutral in tone and do not express bias for or against the use of complementary or herbal medicines.
33. An individual is experiencing problems with memory. Which of these structures are most likely to be
involved in this deficit? (Select all that apply.) Amygdala Hippocampus Temporal lobe The frontal and temporal lobes of the cerebrum play a key role in the storage and processing of memories. The amygdala and hippocampus also play roles in memory. The occipital lobe is predominantly involved with vision. The basal ganglia influence integration of physical movement, as well as some thoughts and emotions.
34. A patient's sibling says, "My brother has a mental illness, but the doctor ordered a functional
magnetic resonance image (fMRI) test. That test is too expensive and will just increase the hospital bill." Select the nurse's best responses. (Select all that apply.) "Sometimes there are physical causes for psychiatric symptoms. This test will help us understand whether that is the situation." "Some mental illnesses are evident on fMRIs. This test will give information to help us plan the best care for your brother." The correct responses provide information to the sibling. Modern imaging techniques are important tools in assessing molecular changes in mental disease and marking the receptor sites of drug action, which can help in treatment planning. Psychiatric symptoms can be caused by anatomical or physiologic abnormalities.
35. A nurse assesses a confused older adult. The nurse experiences sadness and reflects, "The patient is
like one of my grandparents...so helpless." Which response is the nurse demonstrating? Countertransference
Countertransference is the nurse's transference or response to a patient that is based on the nurse's unconscious needs, conflicts, problems, or view of the world. See relationship to audience response question.
36. Which statement shows a nurse has empathy for a patient who made a suicide attempt?
"You must have been very upset when you tried to hurt yourself." Empathy permits the nurse to see an event from the patient's perspective, understand the patient's feelings, and communicate this to the patient.
37. After several therapeutic encounters with a patient who recently attempted suicide, which
occurrence should cause the nurse to consider the possibility of countertransference? The nurse feels unusually happy when the patient's mood begins to lift. Strong positive or negative reactions toward a patient or over-identification with the patient indicate possible countertransference. Nurses must carefully monitor their own feelings and reactions to detect countertransference and then seek supervision. Realistic and appropriate reactions from a patient toward a nurse are desirable.
38. A patient says, "Please don't share information about me with the other people." How should the
nurse respond? "I will not share information with your family or friends without your permission, but I share information about you with other staff." A patient has the right to know with whom the nurse will share information and that confidentiality will be protected. Although the relationship is primarily between the nurse and patient, other staff needs to know pertinent data.
39. A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent
most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, "I really need to talk to you." The nurse should: Tell the interrupting patient, "This session is 5 more minutes; then I will talk with you." When a specific duration for sessions has been set, the nurse must adhere to the schedule. Leaving the first patient would be equivalent to abandonment and would destroy any trust the patient had in the nurse. Adhering to the contract demonstrates that the nurse can be trusted and that the patient and the sessions are important.
40. Termination of a therapeutic nurse-patient relationship has been successful when the nurse:
Discusses with the patient changes that happened during the relationship and evaluates outcomes.
hope." Accepting a gift creates a social rather than therapeutic relationship with the patient and blurs the boundaries of the relationship. A caring nurse will acknowledge the patient's gesture of appreciation, but the gift should not be accepted.
46. Which remark by a patient indicates passage from orientation to the working phase of a nurse-
patient relationship? "I want to find a way to deal with my anger without becoming violent." Thinking about a more constructive approach to dealing with anger indicates a readiness to make a behavioral change. Behavioral change is associated with the working phase of the relationship.
47. A nurse explains to the family of a mentally ill patient how a nurse-patient relationship differs from
social relationships. Which is the best explanation? "The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient." This response describes elements of a therapeutic relationship.
48. A nurse wants to demonstrate genuineness with a patient diagnosed with schizophrenia. The nurse
should: use congruent communication strategies. Genuineness is a desirable characteristic involving awareness of one's own feelings as they arise and the ability to communicate them when appropriate.
49. A nurse caring for a withdrawn, suspicious patient recognizes development of feelings of anger
toward the patient. The nurse should: discuss the anger with a clinician during a supervisory session The nurse is accountable for the relationship. Objectivity is threatened by strong positive or negative feelings toward a patient. Supervision is necessary to work through countertransference feelings.
50. A nurse wants to enhance growth of a patient by showing positive regard. The nurse's action most
likely to achieve this goal is: staying with a tearful patient Staying with a crying patient offers support and shows positive regard
51. A patient says, "I've done a lot of cheating and manipulating in my relationships." Select a
nonjudgmental response by the nurse. "How do you feel about that?" Asking a patient to reflect on feelings about his or her actions does not imply any judgment about those actions, and it encourages the patient to explore feelings and values.
52. A patient says, "People should be allowed to commit suicide without interference from others." A
nurse replies, "You're wrong. Nothing is bad enough to justify death." What is the best analysis of this interchange? Differing values are reflected in the two statements Values guide beliefs and actions. The individuals stating their positions place different values on life and autonomy. Nurses must be aware of their own values and be sensitive to the values of others.
53. Which issues should a nurse address during the first interview with a patient with a psychiatric
disorder? Relationship parameters, the contract, confidentiality, and termination Relationship parameters, the contract, confidentiality, and termination are issues that should be considered during the orientation phase of the relationship. The remaining options are issues that are dealt with later.
54. An advanced practice nurse observes a novice nurse expressing irritability regarding a patient with a
long history of alcoholism and suspects the new nurse is experiencing countertransference. Which comment by the new nurse confirms this suspicion? "My parents were alcoholics and often neglected our family." Countertransference occurs when the nurse unconsciously and inappropriately displaces onto the patient feelings and behaviors related to significant figures in the nurse's past. In this instance, the new nurse's irritability stems from relationships with parents.
55. Which behavior shows that a nurse values autonomy? The nurse:
discusses options and helps the patient weigh the consequences A high level of valuing is acting on one's belief. Autonomy is supported when the nurse helps a patient weigh alternatives and their consequences before the patient makes a decision. Autonomy or self- determination is not the issue in any of the other behaviors.
56. As a nurse discharges a patient, the patient gives the nurse a card of appreciation made in an arts
and crafts group. What is the nurse's best action?
Consistency implies predictability. Having the same nurse see the patient daily and provide a daily schedule of patient activities and a set time for regular sessions will help a patient predict what will happen during each day and develop a greater degree of security and comfort.
62. A nurse ends a relationship with a patient. Which actions by the nurse should be included in the
termination phase? Select all that apply.
**- Focus dialogues with the patient on problems that may occur in the future.
- Help the patient express feelings about the relationship with the nurse.**
63. A novice psychiatric nurse has a parent with bipolar disorder. This nurse angrily recalls feelings of
embarrassment about the parent's behavior in the community. Select the best ways for this nurse to cope with these feelings. Select all that apply.
**- Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses.
- Recognize that the feelings may add sensitivity to the nurse's practice, but supervision is important.** The nurse needs support to explore these feelings. An experienced psychiatric nurse is a resource that may be helpful. The knowledge and experience gained from the nurse's relationship with a mentally ill parent may contribute sensitivity to compassionate practice.
64. A novice nurse tells a mentor, "I want to convey to my patients that I am interested in them and that
I want to listen to what they have to say." Which behaviors will be helpful in meeting the nurse's goal? Select all that apply.
**- Introducing self to a patient and identifying own role
- Using facial expressions to convey interest and encouragement
- Assuming an open body posture and sometimes mirror imaging** Trust is fostered when the nurse gives an introduction and identifies his or her role. Facial expressions that convey interest and encouragement support the nurse's verbal statements to that effect and strengthen the message. An open body posture conveys openness to listening to what the patient has to say. Mirror imaging enhances patient comfort.
65. A patient says to the nurse, "I dreamed I was stoned. When I woke up, I felt emotionally drained, as
though I hadn't rested well." Which response should the nurse use to clarify the patient's comment? "Can you give me an example of what you mean by 'stoned'?" The technique of clarification is therapeutic and helps the nurse examine the meaning of the patient's statement. Asking for a definition of "stoned" directly asks for clarification.
66. A patient diagnosed with schizophrenia tells the nurse, "The CIA is monitoring us through the
fluorescent lights in this room. Be careful what you say." Which response by the nurse would be most therapeutic?
"It sounds like you're concerned about your privacy." It is important not to challenge the patient's beliefs, even if they are unrealistic. Challenging undermines the patient's trust in the nurse. The nurse should try to understand the underlying feelings or thoughts the patient's message conveys. The correct response uses the therapeutic technique of reflection.
67. The patient says, "My marriage is just great. My spouse and I always agree." The nurse observes the
patient's foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patient's communication is: mixed Mixed messages involve the transmission of conflicting or incongruent messages by the speaker. The patient's verbal message that all was well in the relationship was modified by the nonverbal behaviors denoting anxiety.
68. A nurse interacts with a newly hospitalized patient. Select the nurse's comment that applies the
communication technique of "offering self." "I'd like to sit with you for a while to help you get comfortable talking to me." "Offering self" is a technique that should be used in the orientation phase of the nurse-patient relationship. Sitting with the patient, an example of "offering self," helps to build trust and convey that the nurse cares about the patient.
69. Which technique will best communicate to a patient that the nurse is interested in listening?
Restating a feeling or thought the patient has expressed Restating allows the patient to validate the nurse's understanding of what has been communicated. Restating is an active listening technique.
70. A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification,
which comment would be appropriate? "Am I correct in understanding that.. ." Asking, "Am I correct in understanding that..." permits clarification to ensure that both the nurse and patient share mutual understanding of the communication.
71. A patient tells the nurse, "I don't think I'll ever get out of here." Select the nurse's most therapeutic
response. "You don't think you're making progress?"
77. A Filipino American patient had a nursing diagnosis of situational low self-esteem related to poor
social skills as evidenced by lack of eye contact. Interventions were used to raise the patient's self- esteem, but after 3 weeks, the patient's eye contact did not improve. What is the most accurate analysis of this scenario? The nurse should have assessed the patient's culture before making this diagnosis and plan. The amount of eye contact a person engages in is often culturally determined. In some cultures, eye contact is considered insolent, whereas in others eye contact is expected. Asian Americans, including persons from the Philippines, often prefer not to engage in direct eye contact.
78. When a female Mexican American patient and a female nurse sit together, the patient often holds
the nurse's hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behavior. Which analysis is most accurate? The patient is accustomed to touch during conversation, as are members of many Hispanic subcultures. The most likely answer is that the patient's behavior is culturally influenced. Hispanic women frequently touch women they consider to be their friends.
79. A Puerto Rican American patient uses dramatic body language when describing emotional
discomfort. Which analysis most likely explains the patient's behavior? The patient: belongs to a culture in which dramatic body language is the norm Members of Hispanic American subcultures tend to use high affect and dramatic body language as they communicate.
80. During an interview, a patient attempts to shift the focus from self to the nurse by asking personal
questions. The nurse should respond by saying: "The time we spend together is to discuss your concerns." When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto the patient. Telling the patient that interview time should be used to discuss patient concerns refocuses discussion in a neutral way.
81. Which principle should guide the nurse in determining the extent of silence to use during patient
interview sessions? Silence can provide meaningful moments for reflection. Silence can be helpful to both participants by giving each an opportunity to contemplate what has transpired, weigh alternatives, and formulate ideas.
82. A patient is having difficulty making a decision. The nurse has mixed feelings about whether to
provide advice. Which principle usually applies? Giving advice: is rarely helpful Giving advice fosters dependence on the nurse and interferes with the patient's right to make personal decisions. It robs patients of the opportunity to weigh alternatives and develop problem-solving skills. Furthermore, it contributes to patient feelings of personal inadequacy. It also keeps the nurse in control and feeling powerful.
83. A school age child tells the school nurse, "Other kids call me mean names and will not sit with me at
lunch. Nobody likes me." Select the nurse's most therapeutic response. "Tell me more about how you feel." The correct response uses exploring, a therapeutic technique.
84. A patient with acute depression states, "God is punishing me for my past sins." What is the nurse's
most therapeutic response? "You sound very upset about this." The nurse reflects the patient's comment, a therapeutic technique to encourage sharing for perceptions and feelings.
85. A patient cries as the nurse explores the patient's feelings about the death of a close friend. The
patient sobs, "I shouldn't be crying like this. It happened a long time ago." Which responses by the nurse facilitate communication? Select all that apply.
**- "I can see that you feel sad about this situation."
- "The loss of a close friend is very painful for you."
- "Crying is a way of expressing the hurt you are experiencing."** Reflecting ("I can see that you feel sad," "This is very painful for you") and giving information ("Crying is a way of expressing hurt") are therapeutic techniques.
86. Which benefits are most associated with use of telehealth technologies? Select all that apply.
**- Cost savings for patients
- Maximize care management
- Access to services for patients in rural areas** Telehealth has shown it can maximize health and improve disease management skills and confidence with the disease process. Many rural parents have felt disconnected from services; telehealth technologies can solve those problems.
Insulin resistance and obesity are considered long-term sequelae of the high blood glucose levels incurred when the body responds to stress.
93. A patient is extremely depressed after ending a relationship with a partner. The nurse is teaching
cognitive reframing techniques to this patient as a means to counteract depression. Which response given by the patient indicates effective teaching by the nurse? "I have many friends who love and care for me." The nurse should teach cognitive reframing to patients who are depressed and suffer from self-blame. It helps the patients develop positive insight towards life and real-life situations. In this regard, the patient's response, "I have many friends who love and care for me," is appropriate because it is a positive statement.
94. A Hispanic woman has been in an abusive relationship for 3 years. Which comment by this patient is
most likely? "I have very bad headaches that make it hard for me to care for my children." The patient is experiencing severe stress but expressing it somatically. The overwhelming majority of Asians, Africans, and Central Americans tend to express distress in somatic terms and actually experience it physically. In the correct answer, the patient has expressed her distress about the abuse with complaints of headaches.
95. A nurse teaches a patient a technique for examining negative thoughts and restating them in
positive ways. This technique is called Cognitive reframing Cognitive reframing calls for changing the viewpoint of a situation and replacing it with another viewpoint that fits the facts but is less negative
96. Which interventions will the nurse include in the plan of care of a patient diagnosed with
generalized anxiety syndrome (GAS) resulting from stress? Select all that apply.
**- Going to sleep 30 minutes earlier than usual.
- Listening to soothing music to increase relaxation.
- Including 30 minutes of exercise into your daily routine three days a week.**
97. What should the nurse do for a patient who is experiencing the alarm stage of stress?
Assess for a dry mouth
98. An effective stress-reduction technique a nurse might teach an individual with performance anxiety
is Deep breathing
99. The nurse teaches a patient with anxiety about stress and triggers. Which statement made by the
patient indicates the teaching was effective? "People can have good and bad stress."
100. Which assessment question focuses on determining the resilience of a preteen child? Select all
that apply.
**- "How do you and your friends have fun?"
- "How are you adjusting to your new school?"
- "What would you do if you forgot your homework?"
- "What job would you like when you grow up?"**
101. A patient diagnosed with hypertension uses an automatic cycling blood pressure cuff with audible
changing tones. The patient uses relaxation techniques to lower blood pressure and is informed of ongoing success by the tone. This process describes Biofeedback
102. The nurse is conducting group therapy for geriatric patients. The nurse gives instructions to the
patients, "Close your eyes and imagine a peaceful scene, you are very comfortable, nothing is there to disturb you." What feedback given by the patients after the therapy indicates effective therapy? The patients Report relief from pain
103. Which physiologic responses are associated with severe long-term stress? Select all that apply.
**- Obesity
- Atherosclerosis
- Protein breakdown**
104. What is the psychological state that results in anxiety, depression, confusion, helplessness,
hopelessness, and fatigue? Distress Distress is the result of a negative perception toward a stressor such as a death in the family, financial overload, and school or work demands.
