Mental Health Webinar

Justine Buick, MSN, RN

Fundamentals

1. The nurse is establishing a therapeutic nurse-client relationship. In what order will the nurse progress through initiating and ending the therapeutic relationship?

1. Termination phase2. Working phase3. Preinteraction phase4. Conclusion of relationship5. Orientation phase

2. The 94-year-old client, who has been on chronic hemodialysis for 8 years, states to the dialysis nurse upon arrival, “I no longer want to continue dialysis. I have had a good life, and now I am ready to let go.” Which intervention by the nurse is best?

1. Dialysis should be started as scheduled; address the concern later2. Obtain a psychiatric consult regarding suicidal ideations.3. Restate to the client, “You no longer want to continue dialysis?”4. Ask the client, “Why do you want to stop dialysis?”

3. The nurse is completing the final visit with the client being discharged from home-care services. Each time that the nurse attempts to leave, the client offers a new subject and attempts to delay the nurse's departure. What is the best action by the nurse?

1. Abruptly tell the client that the session has ended and that the nurse must leave.2. Set up another appointment for an additional home-care visit.3. Plan to meet the client for a coffee at a time that the client would like.4. Be firm and clear about the relationship terminating and seek feedback from the client.

4. The nurse is caring for the client with Alzheimer's disease who is yelling obscenities at the staff. The client's spouse tearfully states to the nurse, “Never would you have heard those things before the Alzheimer's. I wish that you would have known my spouse before the sickness.” Which is the best response by the nurse?

1. “Why do you think that your spouse is acting like this?”2. “How long has your spouse had Alzheimer's disease?”3. “I can see that it is difficult for you to see your spouse like this.”4. “Tell me about the things your spouse did before the Alzheimer's was diagnosed.”

5. After falling at home, the 84-year-old client is brought to the ED by the client's adult child. Upon assessing the client, the nurse discovers that the client is aphasic and unable to answer any of the nurse's questions. Which interventions should be taken by the nurse initially?

1. Ask the client to nod his or her head “yes” or “no” to questions2. Consult a speech therapist3. Give the client a writing board4. Direct questions to the client's adult child

Disorders

6. The client with major depressive disorder reports disturbed sleep patterns to the nurse. When the nurse is developing the client's plan of care, which nursing actions are most appropriate? Select all that apply.

1. Reinforce reality thinking2. Record and limit caffeinated drinks3. Discourage sleeping during the day4. Encourage measures that aid in relaxation5. Identify sleep patterns prior to hospitalization

7. The nurse is planning care for the client diagnosed withacute mania. What situation must occur prior to initiatingtreatment with lithium carbonate?

1. The client must have been fasting for the past 12 hours.2. The client's kidney function should be within normalparameters.3. The client's behavior has not been controlled with roomseclusion.4. Benzodiazepine use has been discontinued in theclient's treatment plan.

8. The nurse is educating the client about prescriptionantidepressant medications and the appropriateexpectations when taking these medications. Whichstatement by the nurse is accurate?

1. “It is important to continue taking antidepressantmedication even after you feel better.”2. “Your symptoms will subside about 72 hours afterstarting the antidepressant medication.”3. “You will be taking flouxetine, which is the most potentSSRI antidepressant medication.”4. “Some common side effects of SSRIs are dry mouth,blurry vision, and urinary retention.”

9. The client with BPD is prescribe phenelzine fordecreasing impulsitivity and self-destructive acts. Thenurse teaches the client to avoid foods high in tyraminewhen taking phenelzine to prevent which affect?

1. A hypotensive crisis2. A hypertensive crisis3. Poor absorption of tyramine4. Cardiac rhythm abnormalities

10. The nurse is teaching the client diagnosed with dissociative identify disorder (DID). Which actions should the nurse take when working with the client? Select all that apply.

1. Focus on long term goals only.2. Actively listen to each identify state.3. Maintain a calm, reassuring environment.4. Document changes in the client's behavior5. Observe for signs of suicidal thoughts or behaviors.

Addictions/Substance abuse

11. The nurse is teaching new graduates about monitoring for alcohol abuse in older adults. Which response by the new graduate indicates a need for further teaching?

1. “Alcohol abuse is the largest subcategory abuse problems in older adults.”2. “I should monitor more closely for alcohol abuse in single male clients who smoke.”3. “Retirement and freedom from work and family pressures tend to decrease alcohol use.”4. “Confusion, malnutrition, and self-neglect may be signs of alcohol abuse in the elderly.”

12. The nurse is preparing to administer thiamine (vitamin B1) to the client receiving treatment for alcohol dependence. Which statement best describes the rationale for the use of thiamine?

1. Thiamine improves the absorption of other essential vitamins and folic acid.2. Thiamine helps to reverse the malnutrition often associated with alcohol abuse.3. Thiamine reduces the risk of seizures occurring during withdrawal from alcohol.4. Thiamine prevents neuropathy and confusion associated with chronic alcohol use.

13. The hospitalized client has a history of weekly moderate alcohol use. Which symptoms assessed by the nurse indicate that the client may be experiencing alcohol withdrawal? Select all that apply.

1. agitation2. hypotension3. tachycardia4. hallucinations5. tongue tremor

14. The 19-year-old is given a court order to enter treatment for cocaine abuse. The client threatens to leave the treatment facility AMA. Which statement by the nurse demonstrates an accurate understanding of the client's options?

1. “The client is of legal age and can leave on his own will; we can't stop him from leaving.”2. “Due to the court order, the client is not allowed to leave and will be placed in seclusion.”3. “The client is allowed to leave as long as the court is informed; I'll prepare the documents.”4. “The client cannot leave and will be returned to treatment, or another option, by court order.”

Crisis & Abuse

15. The nurse is discharging the client who washospitalized on the mental health unit for suicidal ideation.The nurse should advise the client to seek help bycontacting a mental health professional or the nationalsuicide prevention hotline if experiencing which warningsigns for suicide? Select all that apply.

1. Moderate anxiety2. Hopelessness3. Feelings of being trapped4. Severe anxiety and agitation5. Increasing alcohol and drug use

16. The nurse is caring for an unresponsive toddler in a PICU. The child's parent was arrested for alleged child abuse but released on bail. The parent is pounding at the door, demanding to visit the child. Which is the most appropriate nursing plan of action.

1. Allow the parent to enter the room.2. Tell the parent that the HCP wants to speak with the parent first.3. Contact child protective services to report abuse.4. Initiate the emergency response system for behavioral situations.

17. The client is admitted to an ED with facial bruises, a broken arm, and rib fractures. The client states, “I fell down the stairs.” During the assessment, the nurse notes bruises and lacerations in various stages of healing. Which nursing questions are appropriate? Select all that apply.

1. “Has anyone hurt you?”2. “Are you afraid of anyone at home?”3. “Have you been falling down a lot lately?”4. “Have you had any fainting spells or times that you have been weak?”5. “I noticed you have more bruises. Can you tell me how they happened?”6. “You look abused. Why haven't you reported that you have been abused?”

18. The client has been violent toward other clients on a mental health unit, and interventions have failed. During the application of restraints, which action by the team leader will gain the greatest cooperation from the client?

1. Showing sympathy by apologizing for the need to restrain the client.2. Dispassionately explaining why and how the restraints will be applied.3. Affording the client one last opportunity to avoid restraints by “behaving”.4. Offering to remove the restraints as soon as the client can “control anger”.

19. The client on the medical nursing unit is acutely agitated, getting out of bed unassisted despite having a high risk of falling, and is now hitting and biting staff. Which medication prescribed prn should the nurse administer to help calm the client?

1. olanzapine2. bupropion3. zolpidem4. ondansetron

20. When developing appropriate assignments for the staff, which client should the nurse manager evaluate as being the highest risk of suicide completion?

1. an 85-year-old Caucasian man who lives alone after his wife's death.2. a 34-year-old single Latino woman who has recently been diagnosed with cancer.3. a 15-year-old girl of African descent whose boyfriend broke up with her.4. a 52-year-old Asian man who was terminated from his job because of downsizing.

Questions?

Next time: Meds