Tuesday, 5 January 2021

MENTAL HEALTH

On a psychiatric unit, the preferred milieu environment is best described as:

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Providing an environment that is safe for the patient to express feelings

Fostering a sense of well-being and independence in the patient

Providing an environment that will support the patient in his or her therapeutic needs

 

Fostering a therapeutic social, cultural, and physical environment    

 

Correct answer

Fostering a therapeutic social, cultural, and physical environment

 

When caring for clients with psychiatric diagnoses, the nurse recalls that the purpose of psychiatric diagnoses or psychiatric labelling to:

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Identify those individuals in need of more specialized care

Identity those individuals who are at risk for harming others

Define the nursing care for individuals with similar diagnoses

 

Enable the client's treatment team to plan appropriate and comprehensive care

 

Correct answer

Enable the client's treatment team to plan appropriate and comprehensive care

 

A patient with antisocial personality disorder enters the private meeting room of a nursing unit as a nurse is meeting with a different patient. Which of the following statements by the nurse is BEST?

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"Please leave and I will speak with you when I am done"

"I need you to leave us alone"

"You may sit with us as long as you are quiet"

 

"I'm sorry, but HIPPA says that you can't be here Do you mind leaving?"

 

Correct answer

"Please leave and I will speak with you when I am done"

 

Which of the following is a guiding principle for the nurse in distinguishing mental disorders from the expected changes associated with aging?

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A competent clinician can readily distinguish mental disorders from the expected changes associated with aging

 

Older people are believed to be more prone to mental illness than young people

The clinical presentation of mental illness in older adults differs from that in other age groups

When physical deterioration becomes a significant feature of an elder’s life, the risk of comorbid psychiatric illness rises

 

Correct answer

The clinical presentation of mental illness in older adults differs from that in other age groups

 

The Mental Capacity Act 2005 does not explore which of the following concepts?

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Advance treatment decision

 

Act's code of practice

Independent mental capacity advocates

Mental health advocates

 

Correct answer

Mental health advocates

 

Risk for health issues in a person with mental health issues:

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Increased than in normal people

Slightly decreased than in normal people

 

Very low as compared to normal people

Risk is same in people with and without mental illness

 

Correct answer

Increased than in normal people

 

Patient's husband died. The brother of the patient saw that she was upset but mentally and physically unwell. After a few weeks, the patient called her brother and said that her husband died yesterday, she verbalized "I didn't know he was sick". She also told her brother that she has been seeing mice and rats in the house. The patient had difficulty sleeping, had incontinence and pain in urinating. A community nurse visited the patient. She observed that the patient is reclusive, passive but pleasant. What could be the problem?

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Delirium due to UTI

 

Uncoping ability because her husband just died

Onset of Alzheimer's disease from dementia

Delayed bereavement due to dementia

 

What are the principles of communicating with a patient with delirium?

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Use short statements and closed questions in a well lit, quiet, familiar environment

 

Use short statements and open questions in a well lit, quiet, familiar environment

Write down all questions for the patient to refer back to

Communicate only through the family using short statements and closed questions

 

Which of the following would be an appropriate strategy in reorienting a confused patient to where her room is?

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Place picture of her family on the bedside stand

Put her name in a large letters on her forehead

Remind the patient where her room is

Let the other residents know where the patient's room is

 

Correct answer

Remind the patient where her room is

 

You are caring for a patient who is known to have dementia. What particular issues should you consider prior to discharge?

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You involve in his care: Independent Mental Capacity Advocacy Service (Mental Capacity Act 2005)

 

You involve other support services in his discharge: The hospital discharge team, social services, the metal health team

 

 

 

How should be the surrounding area of a patient with dementia?

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Increased stimuli

Creative environment

 

Restrict activities

 

What is the difference between denial and collusion?

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Denial is when a healthcare professional refuses to tell a patient their diagnosis for the protection of the patient whereas collusion is when healthcare professionals and the patient agree on the information to be told to relatives and friends

 

Denial is when a patient refuses treatment and collusion is when a patient agrees to it

 

Denial is a coping mechanism used by an individual with the intention of protecting themselves from painful or distressing information whereas collusion is the withholding of information from the patient with the intention of ‘protecting them’

 

Denial is a normal acceptable response by a patient to a life threatening diagnosis whereas collusion is not

 

Correct answer

Denial is a coping mechanism used by an individual with the intention of protecting themselves from painful or distressing information whereas collusion is the withholding of information from the patient with the intention of ‘protecting them’

 

 

 

 

What is the first stage of the grief process according to Kubler Ross?

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Denial

Anger

 

Bargaining

Depression

 

Correct answer

Denial

 

A newly diagnosed patient with cancer says "I hate cancer, why did God give it to me". Nurse understands which stage patient is in according to Kubbler Ross stages of death?

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Denial

Bargaining

 

Depression

Anger

 

Correct answer

Anger

 

A patient who refuses to believe a terminal diagnosis is exhibiting:

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Regression

 

Mourning

Denial

Rationalization

 

Correct answer

Denial

 

Sue’s husband passed away. Sue handled this death by crying and withdrawing from friend and family. As a nurse you would notice that Sue’s intensified grief is most likely a sign of which type of grief?

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Distorted or exaggerated Grief

Anticipatory Grief

Chronic or Prolonged Grief

 

Delayed or Inhibited Grief

 

Correct answer

Distorted or exaggerated Grief

 

Missy is 23 years old and looking forward to being married the following day. Missy’s mother feels happy that her daughter is starting a new phase in her life but is feeling a little bit sad as well. When talking to Missy’s mother you would explain this feeling to her as a sign of what?

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Anticipated Grief

Lifestyle Loss

Situational Loss

Maturational Loss

 

Self Loss

 

After the suicide of her best friend Marry feels a sense of guilt, shame and anger because she had not answered the phone when her friend called shortly before her death. Which of the following statements is the most accurate when talking about Mary’s feelings?

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Mary’s feelings are normal and are a form of perceived loss

Mary’s feelings are normal and are a form of situational loss

 

Mary’s feelings are not normal and are a form of situational loss

Mary's feelings are not normal and are a form of physical loss

 

Correct answer

Mary’s feelings are not normal and are a form of situational loss

 

A 42 year old female has been widowed for 3 years yet she becomes very anxious, sad, and tearful on a specific day in June. Which of the following is this widow experiencing?

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Preparatory depression

Psychological isolation

Acceptance

 

Anniversary reaction

 

Correct answer

Anniversary reaction

 

The wife of a recently deceased male is contacting individuals to inform them of her husband's death. She decides, however, to drive to her parent's home to tell them in person instead of using the telephone. Of what benefit did this communication approach serve?

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She needed to get out of the house

 

For the family to gain support from each other

No benefit

She was having a pathological grief response

 

Correct answer

For the family to gain support from each other

 

A 52-year-old man is admitted to a hospital after sustaining a severe head injury in an automobile accident. When the patient dies, the nurse observes the patient’s wife comforting other family members. Which of the following interpretations of this behaviour is most justifiable?

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She has already moved through the stages of the grieving process

She is repressing anger related to her husband’s death

She is experiencing shock and disbelief related to her husband’s death

She is demonstrating resolution of her husband’s death

 

Correct answer

She is experiencing shock and disbelief related to her husband’s death

 

If you were explaining anxiety to a patient, what would be the main points to include?

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Signs of anxiety include behaviours such as muscle tension, palpitations, a dry mouth, fast shallow breathing, dizziness and an increased need to urinate or defaecate

 

Anxiety has three aspects: physical - bodily sensations related to flight and fight response, behavioural - such as avoiding the situation, and cognitive (thinking) - such as imagining the worst

 

Anxiety is all in the mind, if they learn to think differently, it will go away

 

Anxiety has three aspects: physical - such as running away, behavioural - such as imagining the worse (catastrophizing), and cognitive (thinking) - such as needing to urinate

 

 

 

Which of the following is not a usual sign and symptom associated with depression?

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Feeling of sadness, hopelessness

Anorexia

Increased energy

 

Reserved and isolated

 

Which of the following cannot be seen in a depressed client?

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Inactivity

Sad facial expression

 

Slow monotonous speech

Increased energy

 

Correct answer

Increased energy

 

You have just finished dressing a leg ulcer. You observe patient is depressed and withdrawn. You ask the patient whether everything is okay. She says yes. What is your next action?

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Say "I observe you don't seem as usual Are you sure you are okay?"

 

Say "Cheer up , Shall I make a cup of tea for you?"

Accept her answer and leave attend to other patients

Inform the doctor about the change of the behaviour

 

An adolescent male being treated for depression arrives with his family at the Adolescent Day Treatment Centre for an initial therapy meeting with the staff. The nurse explains that one of the goals of the family meeting is to encourage the adolescent to:

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Trust the nurse who will solve his problem

Learn to live with anxiety and tension

 

Accept responsibility for his actions and choices

Use the members of the therapeutic milieu to solve his problems

 

Correct answer

Accept responsibility for his actions and choices

 

A 16 -year-old patient had recently undergone an orthopaedic surgery due to an accident. She is stable and can care for herself. Few days after, she started not to feed and wash herself even though she is physically able to. What could be the reason for this behaviour?

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She wants to displace her experience by not taking care of herself

 

She wants to repress her feeling to forget the accident

She is depressed

 

She went to an earlier state which is very dependent She wants the same attention she had before when she was ill

 

Correct answer

She went to an earlier state which is very dependent She wants the same attention she had before when she was ill

 

A 17-year old patient who was involved in an orthopaedic accident is observed not eating the meals that she previously ordered and refuses to take a bath even if she is already in recovery stage. As a nurse what do you think is the best explanation for her reaction to the accident that happened to her?

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Suppression

Undoing

Regression

 

Repression

 

The supervisor reprimands the charge nurse because the nurse has not adhered to the budget. Later the charge nurse accuses the nursing staff of wasting supplies. This is an example of

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Denial

 

Repression

Suppression

Displacement

 

Correct answer

Displacement

 

The nurse cares for a client diagnosed with conversion reaction. The nurse identifies the client is utilizing which of the following defence mechanisms?

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Introjection

Displacement

Identification

Repression

 

 

You are assessing a patient who has a low BMI but complains that she is overweight. To whom shall you refer this patient?

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Psychiatric health professional

Dietitian

Police

 

Social services

 

Correct answer

Psychiatric health professional

 

Patient has low BMI but patient thinks she is fat- to whom should you refer?

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Dietician

Mental health

Professional

GP

 

Correct answer

Mental health

 

On physical examination of a 16 year old female patient, you notice partial erosion of her tooth enamel and callus formation on the posterior aspect of the knuckles of her hand. This is indicative of:

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Self-induced vomiting and she likely has bulimia nervosa

A genetic disorder and her siblings should also be tested

Self-mutilation and correlates with anxiety

 

A connective tissue disorder and she should be referred to dermatology

 

Correct answer

Self-induced vomiting and she likely has bulimia nervosa

 

A suicidal Patient is admitted to psychiatric facility for 3 days when suddenly he is showing signs of cheerfulness and motivation. The nurse should see this as:

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That treatment and medication is working

She has made new friends

 

That she has finalised suicide plan

 

Correct answer

That she has finalised suicide plan

 

What is an indication that a suicidal patient has an impending suicide plan:

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She/he is cheerful and seems to have a happy disposition

Talk or write about death, dying or suicide

Threaten to hurt or kill themselves

 

Actively look for ways to kill themselves, such as stockpiling tablets

 

Correct answer

She/he is cheerful and seems to have a happy disposition

 

Which of the following situations on a psychiatric unit are an example of a trusting patient-nurse relationship?

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The patient tells the nurse that he feels suicidal

The nurse offers to contact the doctor if the patient has a headache

The nurse gives the patient his daily medication right on schedule

The nurse enforce rules strictly on the unit

 

Correct answer

The patient tells the nurse that he feels suicidal

 

After two weeks of receiving lithium therapy, a patient in the psychiatric unit becomes depressed. Which of the following evaluations of the patient’s behavior by the nurse would be most accurate?

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The treatment plan is not effective; the patient requires a larger dose of lithium

 

This is a normal response to lithium therapy; the patient should continue with the current treatment plan

 

This is a normal response to lithium therapy; the patient should be monitored for suicidal behavior

 

The treatment plan is not effective; the patient requires an antidepressant

 

A new mother is admitted to the acute psychiatric unit with severe postpartum depression. She is tearful and states, “I don’t know why this happened to me! I was excited for my baby to come, but now I don’t know!” Which of the following responses by the nurse is most therapeutic?

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Having a new baby is stressful, and the tiredness and different hormones levels don’t help It happens to many new mothers and is very treatable

Maybe you weren’t ready for a child after all

 

What happened once you brought the baby home? Did you feel nervous?

Has your husband been helping you with the housework at all?

 

Correct answer

Having a new baby is stressful, and the tiredness and different hormones levels don’t help It happens to many new mothers and is very treatable

 

The wife of a client with PTSD (post-traumatic stress disorder) communicate to the nurse that she is having trouble dealing with her husband's condition at home. Which of the following suggestions made by the nurse is correct?

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·       “Discourage your husband from exercising, as this will worsen his condition”

·       “Encourage your husband to avoid regular contact with outside family members”

·       “Do not touch or speak to your husband during an active flashback Wait until it is finished to give him support”

·       “Keep your cupboards free of high-sugar and high-fat foods”

 

 

An eight year old girl with learning disabilities is admitted for a minor surgery, she is very restless and agitated and wants her mother to stay with her, what will you do?

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Act according to company policy

Inform the Doctor

Tell her you will take care of the child

 

Advice the mother to stay till she settles

 

Correct answer

Advice the mother to stay till she settles

 

A patient with dementia is moaning and pulling the dress during night what do you understand from this?

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Patient is incontinent

Patient is having pain

Patient has medication toxicity

 

Correct answer

Patient is incontinent

 

A patient with a history of schizophrenia is admitted to the acute psychiatric care unit. He mutters to himself as the nurse attempts to take a history and yells. “I don’t want to answer any more questions! There are too many voices in this room!” Which of the following assessment questions should the nurse as next?

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"Are the voices telling you to do things?"

 

"Do you feel as though you want to harm yourself or anyone else?"

"Who else is talking in this room? It’s just you and me."

"I don’t hear any other voices." 

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