Psychiatric and Mental Health Nursing D449
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Free Psychiatric and Mental Health Nursing D449 Questions
The nurse is providing teaching to a client and family about schizophrenia before discharge from an inpatient facility. The nurse should instruct the family to notify the healthcare provider when which behavior is observed?
- Changes in appetite.
- Decreased attention to detail.
- Fear of large dogs.
- Social withdrawal.
Explanation
Explanation
Social withdrawal is an early warning sign of relapse in clients with schizophrenia. It may indicate worsening negative symptoms or the return of psychotic symptoms. Early recognition and reporting allow the healthcare provider to adjust treatment and prevent further deterioration.Correct Answer Is:
D. Social withdrawal.A preschool-aged girl tells the school nurse that her hair hurts. The nurse finds that the child's hair has been arranged to cover several small bald spots. Which finding indicates to the nurse that the hair loss is not disease related?
- Evidence of patches of lost hair.
- Erythema of the localized lesions.
- Ecchymotic blood accumulations.
- Episodic reports of pruritus.
Explanation
Explanation
Ecchymotic blood accumulations (bruising) around areas of hair loss suggest trauma rather than a medical condition affecting hair growth. This finding may indicate that the hair was pulled out or that physical injury occurred, which is not typical of disease-related hair loss. Conditions such as infections or dermatologic disorders more commonly present with redness, itching, or patchy hair loss without bruising.Correct Answer Is:
C. Ecchymotic blood accumulations.A client at the mental health center reports difficulty concentrating at work, feeling very tired during the day, and sleeping 4 to 5 hours at night. To further assess for depression, which question is most important for the nurse to ask?
- “Do you often feel sad?”
- “What foods do you like to eat?”
- “Have you experienced sleep changes?”
- “Have you experienced recent stresses?”
Explanation
Explanation
A persistent depressed or sad mood is a primary symptom of major depressive disorder. Asking directly about feelings of sadness helps determine whether the client is experiencing one of the core indicators of depression. The client has already reported sleep problems and fatigue, so assessing mood is the most important next step.Correct Answer Is:
A. “Do you often feel sad?”During a one-to-one session, the nurse begins to become angry with the client. Which action should the nurse take?
- Terminate the session before the feelings escalate.
- Resolve the feelings with the client after discharge.
- Share similar experiences the nurse has had in the past.
- Identify the client's transference of feelings of annoyance.
Explanation
Explanation
When a nurse begins to experience strong emotions toward a client, this reflects countertransference. The appropriate action is to stop the interaction before the feelings interfere with therapeutic communication. Ending the session allows the nurse to regain emotional control and maintain professional boundaries, preventing harm to the therapeutic relationship.Correct Answer Is:
A. Terminate the session before the feelings escalate.An adolescent client is admitted to the postoperative unit following open reduction of a fractured femur which occurred when the client fell down the stairs at a party. The nurse notices needle marks on the client’s arms. Which assessment findings should the nurse document related to suspected narcotic withdrawal?
- Vomiting, seizures, and loss of consciousness.
- Depression, fatigue, and dizziness.
- Agitation, sweating, and abdominal cramps.
- Hypotension, shallow respirations, and dilated pupils.
Explanation
Explanation
Opioid withdrawal commonly produces symptoms such as agitation, restlessness, sweating, muscle aches, abdominal cramps, nausea, vomiting, and diarrhea. These symptoms occur as the body reacts to the absence of the opioid drug after dependence has developed.Correct Answer Is:
C. Agitation, sweating, and abdominal cramps.The nurse is teaching a client about the initiation of a prescribed abstinence therapy using disulfiram. Which information should the client provide to acknowledge understanding?
- Completely abstain from heroin or cocaine use.
- Admit to others that he is a substance abuser.
- Attend monthly meetings of Alcoholics Anonymous.
- Remain alcohol free for 12 hours prior to the first dose.
Explanation
Explanation
Disulfiram is used to support abstinence in individuals with alcohol use disorder. Alcohol must be avoided before starting the medication because combining disulfiram with alcohol can cause a severe reaction, including flushing, nausea, vomiting, and hypotension. Clients should remain alcohol free for at least 12 hours before the first dose.Correct Answer Is:
D. Remain alcohol free for 12 hours prior to the first dose.Patient Data
History and Physical
The client is a 24-year-old female. She has not had any serious illnesses or surgeries. She has had minor injuries in the past from falling.
The client is married and pregnant with her first child. She is approximately 24 weeks into the pregnancy. She has been working as a veterinary technician for the past few years and plans to continue to work as long as possible.
Her family lives close by, including an older sister and both parents. They are able to help when the baby arrives.
The nurse reads the history and physical and enters the room to perform the intimate partner violence screening.
Which action(s) can the nurse take to increase the likelihood that the client will disclose abuse if it is happening? Select all that apply.
- Probe the client if she does not speak up immediately
- Convince the client that she is a bad mother if she does not tell
- Ask the permission of the husband to perform an exam
- Use an evidence-based screening tool
- Conduct the interview in private
- Start with less personal questions first to build rapport
Explanation
Explanation
Effective screening for intimate partner violence requires a safe and supportive environment. Using an evidence-based screening tool helps guide the nurse in asking appropriate and validated questions. Conducting the interview in private increases safety and allows the client to speak freely without fear of the partner hearing the conversation. Beginning with less personal questions helps build rapport and trust, which can increase the likelihood of disclosure. Pressuring the client, shaming her, or involving the partner can reduce trust and prevent honest disclosure.Correct Answer Is:
D. Use an evidence-based screening toolE. Conduct the interview in private
F. Start with less personal questions first to build rapport
Patient Data
History and Physical
The client is a 24-year-old female. She has not had any serious illnesses or surgeries. She has had minor injuries in the past from falling.
The client is married and pregnant with her first child. She is approximately 24 weeks into the pregnancy. She has been working as a veterinary technician for the past few years and plans to continue to work as long as possible.
Her family lives close by, including an older sister and both parents. They are able to help when the baby arrives.
Nurses' Notes
0900
Using the abuse assessment screen, the client reports that she had been hit two times in the face and pushed to the floor once in the past month. She denies having been forced to have sexual activity. She reports she feels afraid of her husband occasionally.
The client reports that her husband had not hit or pushed her before this past month. The last time that he hit her was 2 weeks ago. Since then, he has apologized several times and brought her flowers every day. She reports that he promised never to hit her again.
The nurse goes on to assess the client’s risk for lethality.
Which 2 factors increase the potential for lethal intimate partner violence?
- Alcohol and drug use
- A gun in the home
- Previous marriage
- A history of infidelity
- Unemployment
- Presence of close family members
Explanation
Explanation
Certain factors significantly increase the risk of lethal intimate partner violence. Alcohol and drug use can increase aggression, impair judgment, and escalate violent behavior. The presence of a gun in the home greatly increases the risk of homicide in abusive relationships because firearms make violent encounters far more deadly. These two factors are strongly associated with increased lethality in cases of intimate partner violence.Correct Answer Is:
A. Alcohol and drug useB. A gun in the home
A client with a major depressive disorder is admitted to the inpatient psychiatric unit. Which intervention should the nurse use to demonstrate support of the client?
- Incorporate animated communication techniques.
- Recommend journaling and time taken in self-reflection.
- Assist the client to identify symptoms of depression.
- Schedule regular periods of time for interaction with client.
Explanation
Explanation
Clients with major depression often feel isolated and may lack motivation to initiate social interaction. Scheduling consistent, brief interactions demonstrates availability, support, and interest from the nurse. Regular contact helps build trust and encourages the client to engage in communication and therapeutic relationships.Correct Answer Is:
D. Schedule regular periods of time for interaction with client.A client with bipolar disorder tells the nurse about the need to make some deals to improve a retirement savings. Based on this information, which client outcome should the nurse include in the care?
- Seek legal counsel when making business decisions.
- Identify the feelings associated with the behavior.
- Delay business decisions until mania subsides.
- Describe feelings of fear about finances.
Explanation
Explanation
Clients experiencing mania often demonstrate poor judgment, impulsive decision-making, and excessive involvement in risky financial activities. Encouraging the client to delay important financial or business decisions until mood stabilization occurs helps prevent harmful consequences and supports safer decision-making.Correct Answer Is:
C. Delay business decisions until mania subsides.How to Order
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