Nursing 3381- Psychiatric-Mental Health Nursing of Individuals, Families, and Groups
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Free Nursing 3381- Psychiatric-Mental Health Nursing of Individuals, Families, and Groups Questions
A patient with paranoia states, “The state is monitoring us through the listening devices hidden in this room. Be careful what you say.” Which response by the nurse would be most therapeutic?
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“You have lost touch with reality, which is a symptom of your illness.”
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“It sounds like you’re concerned about your privacy.”
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“The government is prohibited from operating in health care facilities.”
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“Let’s talk about something other than the government.”
Explanation
The Correct Answer is:
B. “It sounds like you’re concerned about your privacy.”
Detailed Explanation:
The most therapeutic response is one that acknowledges the patient’s feelings without validating or confronting the delusion. By saying, “It sounds like you’re concerned about your privacy,” the nurse focuses on the emotion underlying the delusion (fear and mistrust) rather than arguing about the content of the belief. This approach helps build trust and rapport, which are essential when working with a paranoid patient. It also keeps the communication grounded in reality while showing empathy and respect.
Which of the following speech patterns is an example of tangential thinking?
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Involuntary, excessive continuation or repetition of a single response or idea
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Has a lack of a logical relationship between thoughts making the speech vague, diffuse and unfocused
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Overproductive speech which rapidly moves from topic to topic with a tenuous logical link between topics
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Provides a lot of unnecessary detail, never returns to the central point and never answers the question
Explanation
The Correct Answer is:
D. Provides a lot of unnecessary detail, never returns to the central point and never answers the question.
Detailed Explanation:
Tangential thinking is a thought process disturbance often seen in conditions such as schizophrenia or mania. The person gives excessive, irrelevant, or unrelated details in response to a question and fails to return to the main point or answer directly. Although the speech may seem coherent on the surface, it lacks focus and never reaches a logical conclusion.
For example, when asked, “Do you have children?” a tangential response might be: “Well, I used to live near a school, and there were lots of kids there. They played outside every day. The school had a blue fence…”—never actually answering the question.
A patient is undergoing diagnostic tests. The patient says, "Nothing is wrong with me except a stubborn chest cold." The spouse reports that the patient smokes, coughs daily, has recently lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using?
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Projection
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Regression
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Denial
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Displacement
Explanation
The Correct Answer is:
C. Denial.
Detailed Explanation:
Denial is an ego defense mechanism in which an individual refuses to acknowledge painful or threatening realities. In this case, despite clear signs of possible serious illness (chronic cough, weight loss, fatigue), the patient insists that only a “stubborn chest cold” is the problem. Denial serves as a temporary protective response to reduce anxiety and fear associated with potentially bad news, such as a serious lung condition or cancer.
At one point in an assessment interview a nurse asks, “Does your faith help you in stressful situations?” What assessment topic does this question fall under?
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Coping strategies
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Religious affiliation
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Educational background
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Culture
Explanation
The Correct Answer is:
A. Coping strategies.
Detailed Explanation:
The question “Does your faith help you in stressful situations?” explores how the patient uses faith or spirituality as a coping mechanism during difficult times. This falls under the category of coping strategies, which assess the methods a person relies on to manage stress, anxiety, or emotional pain. Understanding how a patient’s faith supports resilience allows the nurse to provide holistic care that respects and incorporates the patient’s strengths and beliefs.
A patient prescribed a muscarinic-receptor blocker will require assessment for what side effect?
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Dry mouth
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Orthostatic hypotension
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Pseudoparkinsonism
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Gynecomastia
Explanation
The Correct Answer is:
A. Dry mouth.
Detailed Explanation:
Muscarinic-receptor blockers (anticholinergic drugs) inhibit the action of acetylcholine on parasympathetic (muscarinic) receptors. This leads to a reduction in parasympathetic activity, producing anticholinergic side effects. The most common of these include dry mouth, blurred vision, constipation, urinary retention, and tachycardia.
Medications with anticholinergic properties—such as certain antipsychotics, tricyclic antidepressants, and antihistamines—require careful monitoring, especially in older adults, because these side effects can contribute to dehydration, confusion, and falls.
A nurse works with a patient to establish goals/outcomes. The nurse believes that one outcome suggested by the patient is not in the patient’s best interest. What is the nurse’s best action?
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Remain silent and add the suggested outcome to the plan.
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Formulate a more appropriate outcome without the patient’s input
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Explore with the patient possible consequences of the outcome
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Educate the patient that the outcome is not realistic
Explanation
The Correct Answer is:
C. Explore with the patient possible consequences of the outcome.
Detailed Explanation:
When a patient proposes an outcome that the nurse feels is not in the patient’s best interest, the nurse should collaborate and engage the patient in critical thinking by exploring the possible consequences of that outcome. This approach respects the patient’s autonomy while promoting therapeutic communication and shared decision-making. Through open discussion, the nurse helps the patient reflect on potential outcomes, risks, and benefits, empowering them to make a more informed and realistic choice.
After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference?
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The nurse develops a trusting relationship with the patient.
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The patient states, “Talking to you feels like talking to my parents.”
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The patient’s reactions toward the nurse seem realistic and appropriate.
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The nurse feels extremely happy when the patient’s mood begins to lift.
Explanation
The Correct Answer is:
D. The nurse feels extremely happy when the patient’s mood begins to lift.
Detailed Explanation:
Countertransference occurs when the nurse unconsciously transfers personal feelings, experiences, or emotional reactions onto the patient, often based on past relationships or unresolved emotions. If the nurse feels an unusually strong emotional response—such as extreme happiness, protectiveness, anger, or frustration—toward a patient, this may indicate countertransference.
In this case, the nurse’s excessive emotional investment in the patient’s progress (feeling “extremely happy” when the patient’s mood lifts) suggests a personal emotional reaction that could cloud professional judgment and objectivity. Recognizing and managing countertransference through supervision or reflection is essential for maintaining therapeutic boundaries and professional effectiveness.
Planning for patients diagnosed with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for a patient presenting with what characteristic?
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Has no reliable support systems in the local community.
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Presents a clear danger to self or others.
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Develops new symptoms during the course of an illness.
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Consistently noncompliant with medications at home.
Explanation
The Correct Answer is:
B. Presents a clear danger to self or others.
Detailed Explanation:
Inpatient psychiatric hospitalization is typically reserved for patients who present an immediate risk of harm to themselves or others, or who are unable to care for their basic needs due to the severity of their illness. The goal of inpatient care is to ensure safety, stabilize acute symptoms, and initiate treatment in a controlled environment. Once stabilized, patients are transitioned to outpatient or community-based settings for ongoing care, in accordance with the least restrictive environment principle.
Which patient would a nurse refer to partial hospitalization?
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One who spent yesterday in the 24-hour supervised crisis care center and continues to be actively suicidal.
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One who is experiencing agoraphobia and panic episodes and who would benefit from psychoeducation for relaxation therapy.
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One who has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up
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One who states, "I'm not sure I can avoid using alcohol when my spouse goes to work every morning."
Explanation
The Correct Answer is:
D. One who states, "I'm not sure I can avoid using alcohol when my spouse goes to work every morning."
Detailed Explanation:
Partial hospitalization programs (PHPs) are structured, daytime treatment programs designed for patients who require intensive therapy and monitoring but do not need 24-hour inpatient care. They are ideal for individuals who are medically stable but still at risk for relapse, such as patients recovering from substance use disorders who need daily support to prevent relapse. PHPs provide therapy, medication management, and coping skills training while allowing the patient to return home in the evenings.
Which of the following side effects is associated with the blockade of attachment of norepinephrine to α₁-receptors?
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Orthostatic hypotension
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Increased psychotic symptoms
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Severe appetite disturbance
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Hypertensive crisis
Explanation
The Correct Answer is:
A. Orthostatic hypotension.
Detailed Explanation:
α₁-adrenergic receptors are located in vascular smooth muscle and are responsible for vasoconstriction when stimulated by norepinephrine. When these receptors are blocked—as can occur with certain antipsychotics (e.g., chlorpromazine) or antidepressants (e.g., tricyclics)—the blood vessels fail to constrict properly upon standing, leading to orthostatic (postural) hypotension.
This results in symptoms such as dizziness, lightheadedness, blurred vision, or fainting when changing positions. The risk is highest during the initiation of therapy or with dose increases.
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