Psychiatric and Mental Health Nursing D449
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Free Psychiatric and Mental Health Nursing D449 Questions
Patient Data
History and Physical
The client is in the hospital after her house collapsed during a hurricane. She has been in the intensive care unit for 2 weeks and moved today to the surgical floor to continue monitoring her respiratory function and to complete IV antibiotic administration.
Nurses' Notes
0900
Pain assessment completed. The client's pain is 2 on a 0 to 10 pain scale. The client requests sleeping medication for the night.
She explains that she keeps having horrible thoughts and memories about the house collapsing and that it is keeping her from falling asleep. She states, “I used to be so happy before all of this happened. Now I can't seem to get out of this funk I am in.”
The client would also prefer to be in a quieter area of the unit as she is currently by the nurses' station and hears talking and alarms constantly.
Which other treatment(s) might be helpful for this client? Select all that apply.
- Cognitive behavioral therapy
- Consciousness raising
- Phototherapy
- Electroconvulsive therapy
- Administration of lithium
- Animal therapy
Explanation
Explanation
The client is experiencing symptoms consistent with acute stress reaction or trauma-related anxiety following the traumatic event of her home collapsing. Cognitive behavioral therapy (CBT) is an evidence-based psychological treatment that helps individuals process traumatic experiences, identify negative thought patterns, and develop coping strategies to manage anxiety, intrusive memories, and sleep disturbances. CBT is commonly used in treating trauma-related stress and early symptoms of post-traumatic stress disorder. Animal therapy can also be beneficial because interaction with therapy animals has been shown to reduce stress, anxiety, and emotional distress in hospitalized patients. It can promote relaxation, improve mood, and provide emotional comfort during recovery from traumatic events. The other options are not appropriate in this context: consciousness raising is a concept used in behavior change models rather than clinical trauma treatment, phototherapy is used for conditions such as seasonal affective disorder or neonatal jaundice, electroconvulsive therapy is reserved for severe depression or refractory psychiatric conditions, and lithium is primarily used for bipolar disorder rather than trauma-related anxiety.Correct Answer Is:
A. Cognitive behavioral therapyF. Animal therapy
A client who is admitted with a closed head injury after a fall has a blood alcohol level (BAL) of 280 mg/dL (60.8 mmol/L) and is difficult to arouse. Which intervention during the first 6 hours following admission should the nurse identify as the priority?
Reference Range:
Blood alcohol level (BAL) 0 to 50 mg/dL (0 to 10.9 mmol/L)
- Provide thiamine and folate supplements as prescribed.
- Give lorazepam PRN for signs of withdrawal.
- Place in a side-lying position with head of bed elevated.
- Administer disulfiram immediately.
Explanation
Explanation
The client is difficult to arouse and has a very high blood alcohol level, which increases the risk of vomiting and aspiration. Maintaining airway protection is the priority. Placing the client in a side-lying position with the head of the bed elevated helps keep the airway clear and reduces the risk of aspiration while the client is sedated or minimally responsive.Correct Answer Is:
C. Place in a side-lying position with head of bed elevated.An adult female client with bipolar disorder is seen in the outpatient psychiatric clinic and tells the nurse that she is thinking of harming her sister. Which action is most important for the nurse to take?
- Notify the healthcare provider of the threat.
- Inform the sister of the client’s threat.
- Report the threat to the healthcare team.
- Document the threat in the medical record.
Explanation
Explanation
When a client expresses a threat of harm toward another person, the nurse has a duty to protect potential victims and ensure immediate intervention. The priority action is to notify the healthcare provider so that appropriate safety measures and further evaluation can occur. Documentation and team communication are important but notifying the provider is the most urgent step.Correct Answer Is:
A. Notify the healthcare provider of the threat.The nurse is assessing a client who reports using cocaine several times in the past week. Which observations should the nurse expect on assessment?
- Hallucinations and delusions.
- Lethargy and depression.
- Bradycardia and bradypnea.
- Stimulation and dilated pupils.
Explanation
Explanation
Cocaine is a powerful central nervous system stimulant that increases the activity of neurotransmitters such as dopamine and norepinephrine. This stimulation produces effects such as increased energy, alertness, agitation, elevated heart rate, hypertension, and dilated pupils (mydriasis). Clients using cocaine often appear restless, hyperactive, and highly stimulated. Dilated pupils and increased stimulation are classic physical findings associated with recent cocaine use.Correct Answer Is:
D. Stimulation and dilated pupils.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.The mother of an infant with profound mental and physical disabilities tells the nurse how depressed she is because she realizes that her child will never achieve normal growth and development milestones. How should the nurse respond to this mother?
- Encourage the mother to write thoughts and feelings in a journal.
- Reassure the mother that her child will achieve some growth and development milestones.
- Ask the mother if she has ever thought about harming herself or her child.
- Determine if the mother has other children who do not have developmental disabilities.
Explanation
Explanation
When a client expresses severe depression or distress, the priority is to assess for risk of harm to self or others. Directly asking about thoughts of harming herself or her child helps determine safety risks and allows the nurse to intervene promptly if needed.Correct Answer Is:
C. Ask the mother if she has ever thought about harming herself or her child.The nurse accepts a client who is being transferred to the mental health unit and understands that the client is distractible and is exhibiting a decreased ability to concentrate. The nurse has only 15 minutes to talk with the client. To develop a treatment plan for this client, which assessment is most important for the nurse to obtain?
- Mental status examination.
- Motivation for treatment.
- Medication compliance.
- History of substance use.
Explanation
Explanation
A mental status examination provides a structured assessment of the client’s current cognitive, emotional, and behavioral functioning. It evaluates orientation, mood, thought processes, perception, and concentration. This information is essential for understanding the client’s current condition and forming an appropriate treatment plan, especially when time is limited.Correct Answer Is:
A. Mental status examination.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.The mental health unit nurse completes the admission assessment for a depressed adolescent client with suicidal ideation. The client reports becoming angry with a sibling, so the client took a handful of pills. Which goal is most important for the nurse to establish with this client?
- Identify three effective ways to cope with feelings.
- Attend at least 2 group sessions daily on the unit.
- Verbally express anger towards family.
- Interact positively with the staff on the unit.
Explanation
Explanation
The client attempted self-harm after becoming angry, indicating difficulty managing emotions. The priority goal is to help the client develop healthy coping strategies for dealing with intense feelings. Learning effective coping methods can reduce impulsive behaviors and decrease the risk of future self-harm.Correct Answer Is:
A. Identify three effective ways to cope with feelings.A nurse who is co-leading group therapy recognizes that a client is beginning to experience severe levels of anxiety. Which intervention is best for the nurse to implement?
- Assist the client with relaxation techniques in the group.
- Escort the client from the group to reduce stimuli.
- Provide education about ways to cope with anxiety.
- Ask the client to describe and identify the source of the feelings.
Explanation
Explanation
When a client reaches severe anxiety levels, the ability to concentrate and process information decreases significantly. Reducing environmental stimuli helps lower anxiety and regain emotional control. Escorting the client to a quieter area allows the nurse to provide support while minimizing overstimulation from the group setting.Correct Answer Is:
B. Escort the client from the group to reduce stimuli.How to Order
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