MENTAL HEALTH FINAL EXAM 2023 -2024 ACTUAL EXAM TEST BANK 300 QUESTIONS AND CORRECT DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |AGRADE A nurse is assigned to work with a client with borderline personality disorder. The nurse will need to consi der strategies for dealing with the client's A. mood shifts, impulsivity, and splitting . B. grief, anger, and social isolation. C. altered sensory perceptions and suspicion. D. perfectionism and preoccupation with detail. - ....ANSWER...A. mood shifts, impulsivity, and splitting. RATIONALE: Borderline personality disorder has the central characteristic of instability in affect, identity, and relationships. Borderline individuals desperately seek relationships to avoid feeling abandoned. But they often dri ve others away with excessive demands, impulsive behavior, or uncontrolled anger. Their frequent use of the defense of splitting strains personal relationships and creates turmoil in health care settings . A client with histrionic personality disorder wink s at an attractive nurse and states, "You and I should be able to turn those resident physicians into jelly if you'd wear your skirts about two inches shorter." The nurse's reply should be based on the understanding that the client's use of seductive behav ior is A. a response to stress . B. based on a need to dominate. C. seated in primitive rage. D. callous disregard for others. - ....ANSWER...A. a response to stress. RATIONALE: The histrionic person is impulsive and melodramatic and may act flirtatious o r provocative to get the spotlight in an attempt to reduce stress When administering a mental status examination to a patient with delirium, the nurse should a. wait until the patient is well -rested. b. administer an anxiolytic medication. c. choose a pla ce without distracting stimuli . d. reorient the patient during the examination. - ....ANSWER...ANS: C -choose a place without distracting stimuli. RATIONALE: Because overstimulation by environmental factors can distract the patient from the task of answeri ng the nurse's questions, these stimuli should be avoided. The nurse will not wait to give the examination because action to correct the delirium should occur as soon as possible. Reorienting the patient is not appropriate during the examination. Antianxie ty medications may increase the patient's delirium. The nurse is administering a mental status examination to a 48 -year-old patient who has hypertension. The nurse suspects depression when the patient responds to the nurse's questions with a. "Is that rig ht?" b. "I don't know." c. "Wait, let me think about that." d. "Who are those people over there?" - ....ANSWER...ANS: B -"I don't know." RATIONALE: Answers such as "I don't know" are more typical of depression than dementia. The response "Who are those peo ple over there?" is more typical of the distraction seen in a patient with delirium. The remaining two answers are more typical of a patient with mild to moderate dementia. Which action will help the nurse determine whether a new patient's confusion is ca used by dementia or delirium? a. Administer the Mini -Mental Status Exam. b. Use the Confusion Assessment Method tool. c. Determine whether there is a family history of dementia. d. Obtain a list of the medications that the patient usually takes. - .... ANSWER...ANS: B RATIONALE: The Confusion Assessment Method tool has been extensively tested in assessing delirium. Education for the client who is taking MAOI's should include which of the following? A. Fluid and sodium replacement when appropriate, frequen t drug blood levels, signs and symptoms of toxicity. B. Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks. C. Short -term use, possible tolerance to beneficial effects, careful tapering of the drug at the end of treatment. D. Tyramine -restricted diet, prohibitive concurrent use of over -the-counter medications without physician notification. - ....ANSWER...D Rationale Tyramine can cause episodes of hypertensive crisis. Foods that contain tyramine include :aged cheeses, raisins, fava beans, red wines, smoked and processed meats, chicken of beef liver, soy sauce, meat tenderizer, chocolate. There is a lot of medication interactions that occur with MAOI's so it is important to consult your physician before t aking any OTC meds. In teaching a client about his antidepressant medication, fluoxetine, which of the following would the nurse include? (Select ALL that apply) A. Don't eat chocolate while taking this medication. B. Keep taking this medication, even if you don't feel it is helping. It sometimes take a while to take effect. C. Don't take this medication with the migraine drugs "triptans". D. Go to the lab each week to have your blood drawn for therapeutic levels of this drug. E. This drug causes a high degree of sedation, so take it just before bedtime. - ....ANSWER...B, C Rationale A - chocolate is not something you would want your client to eat while taking an MAOI B - Antidepressants can take a few weeks before affects are felt. C - serotonin syndro me may occur with concomitant use of SSRI fluoxetine and "triptans" D - E - SSRI's can cause insomnia so it is important to take the dose early in the day. A client with depression has just been prescribed the antidepressant phenelizine (Nardil). She say s to the nurse, " The doctor says I will need to watch my diet while I'm on this medication. What foods should I avoid?" Which of the following is the correct response by the nurse? A. blue cheese, red wine, raisins B. black beans, garlic, pears C. pork, shellfish, egg yolks D mild, peanuts, tomatoes - ....ANSWER...A Rationale phenelizine is an MAOI. MAOI is known to have serious adverse effects with the possibility of developing hypertensive crisis with the consumption of foods that contain tyramine. T yramine is found in blue cheese, red wine, and raisins. A client whose husband died 6 months ago is diagnosed with major depressive disorder. She says to the nurse, "I start feeling angry that Harold died and left me all alone; he should have stopped smok ing years ago! But then I start feeling guilty for feeling that way. " What is an appropriate response by the nurse? A. Yes, he should have stopped smoking. Then he probably wouldn't have gotten lung cancer. " B. I can understand how you must feel. C. Those feelings are a normal part of the grief response . D. Just think bout the good times that you had while he was alive. - ....ANSWER...C Rationale Teaching the normal states of grief and behaviors associated with each stage should be implemented as a n ursing intervention for someone undergoing complicated grieving . Helping the client understand that feelings such as guilt and anger toward the lost concept are appropriate and acceptable during the grief process and should be expressed rather than held i nside. A newly admitted depressed client isolates herself in her room and just sits and stares into space. How best might the nurse begin an initial therapeutic relationship with this client? A. Say, "Come with me. I will go with you to group therapy. B. Make frequent short visits to her room and sit with her. C. Offer to introduce her to the other clients. D. help her to identify stressors in her life that precipitate crises. - ....ANSWER...B Rationale It is important to begin establishing a trustin g relationship with the client so just taking the time to sit quietly with the client will show them that you care and have an interest in their wellbeing. John is a client at the mental health clinic. He is depressed, has been expressing suicidal ideatio ns, and has been seeing the psychiatric nurse every 3 days. He has been taking 100 mg of sertraline daily for about a month, receiving small amounts of the medication from his nurse at each visit. Today he comes to the clinic in a cheerful mood, much diffe rent than he seemed just 3 days ago. How might the nurse assess this behavioral change? A. The sertraline is finally taking effect. B. He is no longer in need of antidepressant medications. C. He has completed the grief response over loss of his wife. D. He may have decided to carry out his suicide plan . - ....ANSWER...D. Rationale Some clients after beginning antidepressants finally have enough energy to follow through with their suicidal thoughts/plans. It is important to monitor for mood changes
