Mental Health

A nurse is caring for a client with a phobia who is to be treated with systematic desensitization. The nurse, explaining this form of behavior modification to the client, and tells the client that the therapy:

• Involves the use of medication

• Encourages self-control in the client

• Involves the use of a positive stimulus to avoid the negative stimulus

• Involves exposing the client for short periods to the phobic object while the client is in a relaxed state

A home care nurse visits a depressed older adult client in whom type 2 diabetes mellitus was recently diagnosed. As the nurse teaches him about insulin injections, the client says, “I don’t think I’ll ever learn to stick this needle in myself.” Which response by the nurse is therapeutic?

• “With proper diet and exercise, you may be able to stop taking insulin.”

• “Perhaps you could start by telling me what troubles you most about injecting yourself.”

• “Injecting yourself with insulin seems odd at first. Let me show you how to assemble your insulin pen.”

• “All of my clients tell me that when they first start to self-administer insulin, but they learn. You will, too.”

A client with paranoid schizophrenia has been agitated, threatening and shouting at others, and refusing to participate in therapy. Projection and denial are evident in these behaviors. The appropriate nursing action is to:

• Accept the behavior without comment

• Explore past experiences of acting out with the client

• Collect information from the client to develop a database

• Acknowledge the client’s anxiety and then set limits on the behavior

A client compulsively makes and remakes the bed numerous times and often misses breakfast and some morning activities because of this ritual. Which nursing action is appropriate?

• Expressing tactful, mild disapproval of the behavior

• Helping the client make the bed so that the task is finished sooner

• Teaching the client about the neurotransmitters involved in compulsive behavior

• Offering reflective feedback such as “I see you made your bed several times. That takes a lot of energy.”

A client who recently witnessed a murder says, “I feel like I’m losing my mind. I keep hearing the gunshots and seeing the victim lying on the ground.” In light of the client’s statement, the nurse should:

• Teach the client relaxation techniques

• Encourage the client to think about happy events

• Support the client in talking about the event and related feelings

• Ask the healthcare provider to prescribe an antianxiety medication

A client with obsessive-compulsive disorder is hospitalized because his ritualistic behaviors have become so time-consuming that the client is unable to maintain employment. The initial priority nursing intervention is to:

• Provide the client with the unit rules

• Assist the client in carrying out the rituals

• Allow the client time to perform the rituals

• Confront the client about his poor use of time

A depressed client tells the nurse, “I’m powerless, and I’m not worthy of having friends. Sometimes I take too many pills.” The nurse’s priority in planning care for this client is:

• Continual assessments for suicidal ideation

• Providing structured activities with other clients

• Acknowledging the client’s accomplishments to build self-esteem

• Monitoring the effects of the prescribed antidepressant medication

A client admitted to the mental health unit with depression is unclean, has body odor, and is inappropriately dressed. An accompanying family member is embarrassed about the client’s appearance. When planning care, it is most important for the client and family member to understand that:

• Client self-esteem needs take priority over appearance

• Hygiene is not important to those who socially isolate themselves

• The nurse will help the client meet hygiene needs until the client is able to do so

• Group peer pressure on the unit will soon have the client attending to hygiene needs

A nurse works during the evening shift. Which actions should be performed for a client who will undergo electroconvulsive therapy (ECT) on the next day? Select all that apply.

• Helping the client reduce anxiety about the procedure

• Restricting visitors and limiting participation in unit activities

• Discussing the risks and benefits of and alternatives to ECT with the client

• Having the client shampoo and dries her hair, cleaning it of all hairspray and creams

• Implementing nothing-by-mouth (NPO) status for 12 to 16 hours before the procedure

A client says to the nurse, "I’m divorced and my children live in other parts of the country. They never visit or phone me. I feel so lonely. No one would notice if I were gone." The nurse should make which response to the client?

• "You should find new interests."

• "Have you considered an online dating service?"

• "Try to take a more cheerful outlook. Behind every cloud is a silver lining."

• "Things seem very bleak to you right now. Are you thinking of harming yourself?"