Mental Health Exam IV Review IV Overall Review

Which is an effective nursing intervention to assist an angry patient learn to manage anger without violence?

• Use aversive conditioning such as popping a rubber band on the wrist, to help extinguish angry feelings

• Help a patient identify a thought that produces on anger, evaluate the validity of the belief and substitute realist-based thinking.

• Provide negative reinforcement such as restraint or seclusion in response to angry outbursts, whether or not violence or not violence is present

• administer an antipsychotic or antianxiety medication

Which assessment finding presents the greatest risk for violent behavior directed at others?

• Bizarre delusions

• Verbalized hopelessness and powerlessness

• Severe agoraphobia

• History of spousal abuse

A client diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less

intrusive, but the client continues to have apathy, poverty of thought, and social isolation. The nurse would expect a change to

which medication?

• Haloperidol

• Olanzapine

• Chlorpromazine

• Diphenhydramine

Answer explanation

Olanzapine is a second-generation atypical antipsychotic that targets both positive and negative symptoms of schizophrenia.

Haloperidol and chlorpromazine are conventional antipsychotics that target only positive symptoms. Diphenhydramine is an

antihistamine.

The family of a client diagnosed with schizophrenia is unfamiliar with the illness and family’s role in recovery. Which type of

therapy should the nurse recommend?

• Psychoeducational

• Psychoanalytic

• Transactional

• Family

Answer explanation

A psychoeducational group explores the causes of schizophrenia, the role of medication, the importance of medication compliance,

support for the ill member, and hints for living with a person with schizophrenia. Such a group can be of immeasurable practical

assistance to the family. The other types of therapy do not focus on psychoeducation.

A student nurse visiting a senior center says, “It’s depressing to see these old people. They are weak and frail. I doubt any of them

can engage in a discussion.” The student is expressing what bias?

• reality

• ageism

• empathy

• vulnerability

Answer explanation

Ageism is a bias against older people because of their age. None of the other options applies to the ideas expressed by the student.

A nurse plans an educational program for staff of a home health agency specializing in care of the elderly. Which topic is the

highest priority to include?

• Pain assessment techniques for older adults

• Psychosocial stimulation for those who live alone

• Preparation of psychiatric advance directives in the elderly

• Ways to manage disinhibition in elderly persons with dementia

Answer explanation

The topic of greatest immediacy is the assessment of pain in older adults. Unmanaged pain can precipitate other problems, such as

substance abuse and depression. Elderly clients are less likely to be accurately diagnosed and adequately treated for pain. The

distracters are unrelated or of lesser importance.

What is the best comment for a nurse to begin an interview with an elderly client?

• “I am a nurse. Are you familiar with what nurses do?”

• “Hello. I am going to ask you some questions to get to know you better.”

• “You look comfortable and ready to participate in an admission interview. Shall

  we get started?”

• “Hello. My name is _______ and I am a nurse. How you would like to be

  addressed by staff?”

A physically frail elderly client with mild cognitive impairments needs services of a facility that can provide supervision and safety

as well as recreation and social interaction. The family cares for this client during the evening and night. Which type of facility

should the nurse suggest to meet this client’s needs?

• Adult day care program

• Skilled nursing facility

• Partial hospitalization

• Group home

Answer explanation

A day care program provides recreation and social interaction as well as supervision in a safe environment. Nursing, medical, and

rehabilitative care are usually not provided. Skilled nursing facilities go beyond meeting recreational and social needs by providing

medical interventions and nursing and rehabilitation services on a 24-hour basis. Partial hospitalization provides acute psychiatric

hospital programs. A group home is inappropriate and would not meet the client’s needs.

In a sad voice, an elderly client tells the nurse of the recent deaths of a spouse and close friend. The client has no other family and

only a few acquaintances in the community. The nurse’s priority is to determine whether which nursing diagnosis applies to this

client?

• Risk for suicide related to recent deaths of significant others

• Anxiety related to sudden and abrupt lifestyle changes

• Social isolation related to loss of existing family

• Spiritual distress related to anger with God

Answer explanation

The client appears to be experiencing normal grief related to the loss of her family, but because of age and social isolation, the risk

for suicide should be determined and has high priority. No defining characteristics exist for the diagnoses of anxiety or spiritual

distress. The client’s social isolation is important, but the risk for suicide has higher priority.

An 85-year-old has difficulty walking after a knee replacement. The client tells the nurse, “It’s awful to be old. Every day is a

struggle. No one cares about old people.” What is the nurse’s best response?

• “Everyone here cares about old people. That’s why we work here.”

• “It sounds like you’re having a difficult time. Tell me about it.”

• “Let’s not focus on the negative. Tell me something good.”

• “You are still able to get around, and your mind is alert.”

Answer explanation

The nurse uses empathetic understanding to permit the client to express frustration and clarify her “struggle” for the nurse. The

distracters block communication.