Psychiatric and Mental Health Nursing D449
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Free Psychiatric and Mental Health Nursing D449 Questions
The nurse plans to use role playing as a therapeutic measure. Which individual is most likely to benefit from this type of therapeutic intervention?
- A. An adolescent who is depressed over not being accepted by peers.
- B. A hyperactive 4-year-old who has recently been tested for autism.
- C. An adult with schizophrenia who often refuses to take prescribed antipsychotic medications.
- D. An older adult resident of a long-term care facility who sometimes takes other residents' belongings.
Explanation
Explanation
Role playing is a therapeutic communication technique commonly used to help clients practice social interactions, improve communication skills, and develop confidence in challenging situations. Adolescents experiencing peer rejection may benefit from practicing social scenarios in a safe environment, allowing them to explore appropriate responses and build coping strategies. This intervention helps strengthen interpersonal skills and self-esteem, making it particularly effective for adolescents struggling with peer relationships and social acceptance.Correct Answer Is:
A. An adolescent who is depressed over not being accepted by peers.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.
- A. Probe the client if she does not speak up immediately
- B. Convince the client that she is a bad mother if she does not tell
- C. Ask the permission of the husband to perform an exam
- D. Use an evidence-based screening tool
- E. Conduct the interview in private
- F. 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
Following involvement in a motor vehicle collision, a middle-aged adult client is admitted to the hospital with multiple facial fractures. The client's blood alcohol level is high on admission. Which PRN prescription should be administered if the client begins to exhibit signs and symptoms of delirium tremens (DTs)?
- A. Chlorpromazine 50 mg IM.
- B. Lorazepam 2 mg IM.
- C. Hydromorphone 2 mg IM.
- D. Prochlorperazine 5 mg IM.
Explanation
Explanation
Delirium tremens is a severe form of alcohol withdrawal characterized by agitation, confusion, tremors, and autonomic instability. Benzodiazepines such as lorazepam are the first-line treatment because they reduce central nervous system hyperactivity, control agitation, and help prevent seizures associated with alcohol withdrawal.Correct Answer Is:
B. Lorazepam 2 mg IM.A client who has agoraphobia (a fear of crowds) is beginning desensitization with the therapist, and the nurse is reinforcing the process. Which intervention has the highest priority for this client's plan of care?
- A. Encourage deep breathing when anxiety escalates in a crowd.
- B. Establish trust by providing a calm, safe environment.
- C. Encourage substitution of positive thoughts for negative ones.
- D. Progressively expose the client to larger crowds.
Explanation
Explanation
Establishing a calm and safe environment is the priority because clients with severe anxiety or phobias need to feel secure before engaging in therapeutic interventions. Building trust helps reduce anxiety and increases the client's willingness to participate in treatments such as desensitization and gradual exposure.Correct Answer Is:
B. Establish trust by providing a calm, safe environment.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?
- A. Mental status examination.
- B. Motivation for treatment.
- C. Medication compliance.
- D. 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 male client arrives at the mental health clinic and asks the nurse for more lithium and the antidepressant amitriptyline that he uses to help him sleep. After reviewing the assessment findings with the healthcare provider, a serum creatinine is obtained. Which information supports the reason for this laboratory test?
- A. The effects of amitriptyline can promote and potentiate the risk of lithium toxicity.
- B. Lithium is excreted by the kidneys and creatinine is related to kidney functioning.
- C. The combination of lithium and amitriptyline may need to be changed if creatinine is high.
- D. Creatinine can measure how the body is metabolizing the lithium in the liver.
Explanation
Explanation
Lithium is primarily excreted through the kidneys. Measuring serum creatinine helps evaluate kidney function, which is important because impaired renal function can lead to lithium accumulation and toxicity. Monitoring kidney function is therefore essential for clients receiving lithium therapy.Correct Answer Is:
B. Lithium is excreted by the kidneys and creatinine is related to kidney functioning.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.
1100
Noted that the client is using fantasy, isolation, and suppression as defense mechanisms. Notified the client's healthcare provider (HCP) about the client's issues and concerns.
1200
Provided the client with education about acute stress disorder.
Orders
1115
Start clonazepam 0.25 mg PO every 12 hours.
Which client statement(s) require(s) follow-up teaching by the nurse? Select all that apply.
- A. “This diagnosis means that I am crazy.”
- B. “I am at high risk for post traumatic stress disorder because I have acute stress disorder.”
- C. “Many people have the same response to a stressful situation as I am having right now.”
- D. “I can learn to manage my thoughts better through therapy.”
- E. “I can use holistic approaches like meditation to help my symptoms.”
- F. “I will probably need to be on medication for the rest of my life.”
Explanation
Explanation
Acute stress disorder is a temporary reaction to trauma and does not mean a person is “crazy,” so statement A shows misunderstanding. Statement F is also incorrect because medications like clonazepam are usually used short term to manage symptoms. Many clients improve with therapy and coping strategies rather than lifelong medication.Correct Answer Is:
A. “This diagnosis means that I am crazy.”F. “I will probably need to be on medication for the rest of my life.”
A client is receiving benztropine mesylate for drug-induced extrapyramidal syndrome (EPS). Which finding indicates that the nurse should further evaluate the client?
- A. Presence of a dry mouth.
- B. Decreasing hand tremors.
- C. Increased mouth movements.
- D. Decreased bowel movements.
Explanation
Explanation
Increased mouth movements may indicate tardive dyskinesia, a serious and potentially irreversible side effect associated with antipsychotic medications. This condition is characterized by involuntary movements of the mouth, tongue, or face and requires prompt evaluation. Dry mouth and decreased bowel movements are common anticholinergic effects of benztropine, and decreasing tremors indicates improvement in EPS symptoms.Correct Answer Is:
C. Increased mouth movements.The charge nurse of the psychiatric unit observes clients in the day area. Which client is exhibiting symptoms of a conversion disorder?
- A. An adolescent who becomes extremely anxious about going outside.
- B. A middle-aged man who is troubled with shortness of breath and is diaphoretic.
- C. An older adult who is continuously troubled by a headache and back pain.
- D. A young woman who suddenly goes blind with no indication of organic pathology.
Explanation
Explanation
Conversion disorder involves neurological symptoms that cannot be explained by a medical condition. These symptoms may include blindness, paralysis, or loss of sensation without an identifiable physical cause. Sudden blindness without organic pathology is a classic example of conversion disorder, where psychological stress manifests as physical symptoms.Correct Answer Is:
D. A young woman who suddenly goes blind with no indication of organic pathology.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?
- A. Vomiting, seizures, and loss of consciousness.
- B. Depression, fatigue, and dizziness.
- C. Agitation, sweating, and abdominal cramps.
- D. 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.How to Order
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