NR 668 EXAM PREP LATEST: Psychiatric Mental Health Capstone Practicum & Intensive

Which statement made by a patient prescribed bupropion (Wellbutrin) demonstrates that the medication education the patient received was effective? Select all that apply.

Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages?

The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving:

A psychiatric nurse is reviewing prescriptions for a patient with major depression at the county clinic. Since the patient has a mild intellectual disability, the nurse would question which classification of antidepressant drugs:

The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.

Pablo is a homeless adult who has no family connection. Pablo passed out on the street and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select all that apply.

Which statement made by the nurse demonstrates the best understanding of nonverbal communication?

Which nursing statement is an example of reflection?

When should a nurse be most alert to the possibility of communication errors resulting in harm to the patient?

During an admission assessment and interview, which channels of information communication should the nurse be monitoring? Select all that apply.

What principle about nurse-patient communication should guide a nurse’s fear about “saying the wrong thing” to a patient?

You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic?

Which student behavior is consistent with therapeutic communication?

James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, “Last night, demons came to my room and tried to rape me.” Which response would be most therapeutic?

Therapeutic communication is the foundation of a patient-centered interview. Which of the following techniques is not considered therapeutic?

Carolina is surprised when her patient does not show for a regularly scheduled appointment. When contacted, the patient states, “I don’t need to come see you anymore. I have found a therapy app on my phone that I love.” How should Carolina respond to this news?

Which statement demonstrates a well-structured attempt at limit setting?

Which activity is most appropriate for a child with ADHD?

Cognitive-behavioral therapy is going well when a 12-year-old patient in therapy reports to the nurse practitioner:

What assessment question should the nurse ask when attempting to determine a teenager’s mental health resilience? Select all that apply.

Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply.

In pediatric mental health there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: Select all that apply.

Child protective services have removed 10-year-old Christopher from his parents’ home due to neglect. Christopher reveals to the nurse that he considers the woman next door his “nice” mom, that he loves school, and gets above average grades. The strongest explanation of this response is:

April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April’s mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that:

Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to:

Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia?

Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia?

To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition? Select all that apply.

A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?

Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?

Gilbert, age 19, is described by his parents as a “moody child” with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert’s early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:

Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient’s nursing diagnosis is altered thought processes?

When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:

Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply.

Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas’s nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:

Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar and her support system? Select all that apply.

Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply.

The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply.

A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially?

Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply.

Substance abuse is often present in people diagnosed with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that:

Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted’s wife and his blood tests confirm. To reduce Ted’s mania the psychiatric nurse practitioner recommends:

A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, “You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing”:

Tatiana has been hospitalized for an acute manic episode. On admission the nurse suspects lithium toxicity. What assessment findings would indicate the nurse’s suspicion as correct?

Luc’s family comes home one evening to find him extremely agitated and they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting?

Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder?

Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply.

Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population?

Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply.

%1 NR 668 EXAM PREP LATEST: Psychiatric Mental Health Capstone Practicum & Intensive %2%3 Deze oefenvragen zijn ontworpen om studenten te helpen zich voor te bereiden op het NR 668 examen voor Psychiatric Mental Health Capstone Practicum & Intensive. De vragen beslaan een breed scala aan onderwerpen binnen de psychiatrische zorg, inclusief diagnostische methoden, behandelstrategieën en therapeutische communicatie. %4Q1: What are the main components of a psychiatric assessment and what are some tools or methods to conduct each component?A1: A psychiatric assessment consists of four main components: history, mental status examination, physical examination, and diagnostic tests. Some tools or methods to conduct each component are:- History: interviewing the patient and obtaining information from other sources (e.g., family, medical records) about the patients personal, family, medical, psychiatric, social, occupational, and substance use history.- Mental status examination: observing and documenting the patients appearance, behavior, mood, affect, speech, thought process, thought content, perception, cognition, insight, and judgment.- Physical examination: performing a general physical examination and focusing on any signs or symptoms that may indicate a medical condition that could affect the patients mental health or interfere with the treatment.- Diagnostic tests: ordering and interpreting laboratory tests (e.g., blood tests, urine tests), imaging studies (e.g., CT scan, MRI), or other tests (e.g., electroencephalogram, neuropsychological testing) that may help to rule out or confirm a diagnosis or identify any comorbidities.Q2: What are some common psychiatric emergencies and how would you manage them in a clinical setting?A2: Some common psychiatric emergencies are:- Suicidal ideation or behavior: assessing the patients risk level, ensuring their safety, providing support and crisis intervention, initiating or modifying the treatment plan, and arranging for follow-up care or referral.- Aggressive or violent behavior: assessing the patients risk level, ensuring the safety of the patient and others, using de-escalation techniques or physical restraint if necessary, administering medication if indicated, and evaluating the cause and triggers of the behavior.- Psychotic symptoms: assessing the patients level of reality testing, ensuring their safety, providing support and reassurance, administering medication if indicated, and evaluating the cause and severity of the symptoms.- Substance intoxication or withdrawal: assessing the patients level of intoxication or withdrawal, ensuring their safety, providing supportive care and monitoring vital signs, administering medication if indicated, and evaluating the need for detoxification or referral.Q3: What are some evidence-based psychotherapies for major depressive disorder and how do they work?A3: Some evidence-based psychotherapies for major depressive disorder are:- Cognitive-behavioral therapy (CBT): a short-term therapy that aims to identify and modify the patients negative thoughts and behaviors that contribute to their depression. It also teaches the patient coping skills and problem-solving strategies to deal with stressful situations and improve their mood.- Interpersonal therapy (IPT): a short-term therapy that focuses on the patients interpersonal relationships and how they affect their depression. It also helps the patient to improve their communication skills and resolve any conflicts or role transitions that may cause distress.- Behavioral activation (BA): a therapy that involves increasing the patients engagement in rewarding activities that are consistent with their values and goals. It also helps the patient to reduce their avoidance of unpleasant situations and cope with negative emotions.- Mindfulness-based cognitive therapy (MBCT): a therapy that combines CBT with mindfulness techniques such as meditation and awareness exercises. It helps the patient to become more aware of their thoughts and feelings without judging them or reacting to them. It also helps the patient to prevent relapse by recognizing early signs of depression and applying coping skills.Q4: What are some pharmacological treatments for bipolar disorder and what are their indications, contraindications, side effects, and monitoring parameters?A4: Some pharmacological treatments for bipolar disorder are:- Mood stabilizers: medications that help to prevent or reduce the frequency and severity of manic and depressive episodes. Examples are lithium, valproate, carbamazepine, and lamotrigine. Their indications are acute mania, acute depression, or maintenance treatment. Their contraindications are hypersensitivity, severe renal or hepatic impairment, or pregnancy (for some agents). Their side effects include gastrointestinal distress, weight gain, tremor, sedation, cognitive impairment, rash, and blood dyscrasias. Their monitoring parameters include serum levels, renal function, liver function, thyroid function, and blood counts.- Antipsychotics: medications that help to control psychotic symptoms such as delusions, hallucinations, or paranoia that may occur in bipolar disorder. Examples are olanzapine, quetiapine, risperidone, aripiprazole, and ziprasidone. Their indications are acute mania with psychotic features, acute depression with psychotic features.Q5: Besides antianxiety agents, which classification of drugs is also commonly given to treat anxiety and anxiety disorders?A5: Antidepressants.Q6: What assessment question will provide the nurse with information regarding the effects of a woman’s circadian rhythms on her quality of life?A6: “How much sleep do you usually get each night?”Q7: You realize that your patient who is being treated for a major depressive disorder requires more teaching when she makes the following statement:A7: “I am going to ask my nurse practitioner to discontinue my Prozac today and let me start taking a monoamine oxidase inhibitor tomorrow.”Q8: A patient being treated for insomnia is prescribed ramelteon (Rozerem). Which comorbid mental health condition would make this medication the hypnotic of choice for this particular patient?A8: Substance use disorder.Q9: Which statement made by a patient prescribed bupropion (Wellbutrin) demonstrates that the medication education the patient received was effective? Select all that apply.A9: - “I hope Wellbutrin will help my depression and also help me to finally quit smoking.”- “I’m happy to hear that I won’t need to worry too much about weight gain.”- “My partner and I have discussed the possible effects this medication could have on our sex life.”Q10: Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages?A10: Antipsychotics.Q11: The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving:A11: Lithium (Eskalith).Q12: A psychiatric nurse is reviewing prescriptions for a patient with major depression at the county clinic. Since the patient has a mild intellectual disability, the nurse would question which classification of antidepressant drugs:A12: Monoamine oxidase inhibitors.Q13: The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.A13: - “Is the patient expressing suicidal thoughts?”- “Does the patient have intact judgment and insight into his situation?”- “Does the patient require a therapeutic environment to support the management of psychotic symptoms?”- “Does the patient require the regular involvement of their family/significant other in planning and executing the plan of care?”Q14: Pablo is a homeless adult who has no family connection. Pablo passed out on the street and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select all that apply.A14: - He requires stabilization of multiple symptoms.- He has nutritional and self-care needs.- He is in imminent danger of harming himself.Q15: Which statement made by the nurse demonstrates the best understanding of nonverbal communication?A15: “When my patient responds to my question, I check for congruence between verbal and nonverbal communication to help validate the response.”Q16: Which nursing statement is an example of reflection?A16: “So you are saying that life has no meaning.”Q17: When should a nurse be most alert to the possibility of communication errors resulting in harm to the patient?A17: Change of shift report.Q18: During an admission assessment and interview, which channels of information communication should the nurse be monitoring? Select all that apply.A18: - Auditory- Visual- Tactile- OlfactoryQ19: What principle about nurse-patient communication should guide a nurse’s fear about “saying the wrong thing” to a patient?A19: Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.Q20: You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic?A20: “You say you look forward to the meeting, but you appear anxious or unhappy.”Q21: Which student behavior is consistent with therapeutic communication?A21: Summarizing the essence of the patient’s comments in your own words.Q22: James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, “Last night, demons came to my room and tried to rape me.” Which response would be most therapeutic?A22: “You seem very upset. Please tell me more about what you experienced last night.”Q23: Therapeutic communication is the foundation of a patient-centered interview. Which of the following techniques is not considered therapeutic?A23: Asking “why” questions.Q24: Carolina is surprised when her patient does not show for a regularly scheduled appointment. When contacted, the patient states, “I don’t need to come see you anymore. I have found a therapy app on my phone that I love.” How should Carolina respond to this news?A24: “That sounds exciting, would you be willing to visit and show me the app?”Q25: Which statement demonstrates a well-structured attempt at limit setting?A25: “Hitting me when you are angry is unacceptable.”Q26: Which activity is most appropriate for a child with ADHD?A26: Tennis.Q27: Cognitive-behavioral therapy is going well when a 12-year-old patient in therapy reports to the nurse practitioner:A27: “I thought that everyone at school hated me. That’s not true. Most people like me and I have a friend named Todd.”Q28: What assessment question should the nurse ask when attempting to determine a teenager’s mental health resilience? Select all that apply.A28: - “How did you cope when your father deployed with the Army for a year in Iraq?”- “Who did you go to for advice while your father was away for a year in Iraq?”Q29: Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply.A29: - Limited language skills- Level of cognitive development- Level of emotional development- Parental denial that a problem existsQ30: In pediatric mental health there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: Select all that apply.A30: - Children of color and poor economic conditions being underserved- Increased stress in the family unit- Premature termination of servicesQ31: Child protective services have removed 10-year-old Christopher from his parents’ home due to neglect. Christopher reveals to the nurse that he considers the woman next door his “nice” mom, that he loves school, and gets above average grades. The strongest explanation of this response is:A31: Resilience.Q32: April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April’s mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that:A32: Time-out is no longer an effective therapeutic measure.Q33: Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to:A33: Cerebellum maturation.Q34: Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia?A34: Always afraid another student will steal her belongings.Q35: Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia?A35: Screening a group of males between the ages of 15 and 25 for early symptoms.Q36: To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition? Select all that apply.A36: - Alcohol use disorder- Major depressive disorder- Polydipsia- Metabolic syndromeQ37: A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?A37: She should experience a reduction in hallucinations.Q38: Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?A38: Paranoia.Q39: Gilbert, age 19, is described by his parents as a “moody child” with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert’s early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:A39: To have a less positive outcome.Q40: Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient’s nursing diagnosis is altered thought processes?A40: “You say you hear voices, what are they telling you?”Q41: When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:A41: They are not actually ill.Q42: Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply.A42: - Hold his medication and contact his prescriber.- Wipe him with a washcloth wet with cold water or alcohol.Q43: Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas’s nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:A43: Anxiety and depression.Q44: Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar and her support system? Select all that apply.A44: - “Remember that alcohol and caffeine can trigger a relapse of your symptoms.”- “It’s critical to let your healthcare provider know immediately if you aren’t sleeping well.”- “Is your family prepared to be actively involved in helping manage this disorder?”- “The symptoms tend to come and go and so you need to be able to recognize the early signs.”Q45: Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply.A45: - “I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day.”- “I discussed the diuretic my cardiologist prescribed with my psychiatric care provider.”- “I’ve already made arrangements for my monthly lab work.”Q46: The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply.A46: - An upset stomach for no apparent reason- Shaky hands that make holding a cup difficultQ47: A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially?A47: Instruct the patient to hold the next dose of medication and contact the prescriber.Q48: Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply.A48: - Monitor the patient’s vital signs frequently.- Provide the patient with frequent milkshakes and protein drinks.- Reduce the volume on the television and dim bright lights in the environment.- Use a firm but calm voice to give specific concise directions to the patient.Q49: Substance abuse is often present in people diagnosed with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that:A49: Alcohol ingestion is a form of self-medication.Q50: Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted’s wife and his blood tests confirm. To reduce Ted’s mania the psychiatric nurse practitioner recommends:A50: Electroconvulsive therapy (ECT).Q51: A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, “You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing”:A51: A lower dosage.Q52: Tatiana has been hospitalized for an acute manic episode. On admission the nurse suspects lithium toxicity. What assessment findings would indicate the nurse’s suspicion as correct?A52: Ataxia, severe hypotension, large volume of dilute urine.Q53: Luc’s family comes home one evening to find him extremely agitated and they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting?A53: Energy drink containers.Q54: Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder?A54: “I go to sleep around 11 p.m. but I’m always up by 3 a.m. and can’t go back to sleep.”Q55: Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply.A55: - “What do you do to manage anxiety?”- “Do you have a history of disordered eating?”- “Do you think that you drink too much?”Q56: Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population?A56: Conducting routine suicide screenings at a senior center.Q57: Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply.

%1 NR 668 EXAM PREP LATEST: Psychiatric Mental Health Capstone Practicum & Intensive %2%3 Deze oefenvragen zijn ontworpen om studenten te helpen zich voor te bereiden op het NR 668 examen voor Psychiatric Mental Health Capstone Practicum & Intensive. De vragen beslaan een breed scala aan onderwerpen binnen de psychiatrische zorg, inclusief diagnostische methoden, behandelstrategieën en therapeutische communicatie. %4Q1: What are the main components of a psychiatric assessment and what are some tools or methods to conduct each component?A1: A psychiatric assessment consists of four main components: history, mental status examination, physical examination, and diagnostic tests. Some tools or methods to conduct each component are:- History: interviewing the patient and obtaining information from other sources (e.g., family, medical records) about the patients personal, family, medical, psychiatric, social, occupational, and substance use history.- Mental status examination: observing and documenting the patients appearance, behavior, mood, affect, speech, thought process, thought content, perception, cognition, insight, and judgment.- Physical examination: performing a general physical examination and focusing on any signs or symptoms that may indicate a medical condition that could affect the patients mental health or interfere with the treatment.- Diagnostic tests: ordering and interpreting laboratory tests (e.g., blood tests, urine tests), imaging studies (e.g., CT scan, MRI), or other tests (e.g., electroencephalogram, neuropsychological testing) that may help to rule out or confirm a diagnosis or identify any comorbidities.Q2: What are some common psychiatric emergencies and how would you manage them in a clinical setting?A2: Some common psychiatric emergencies are:- Suicidal ideation or behavior: assessing the patients risk level, ensuring their safety, providing support and crisis intervention, initiating or modifying the treatment plan, and arranging for follow-up care or referral.- Aggressive or violent behavior: assessing the patients risk level, ensuring the safety of the patient and others, using de-escalation techniques or physical restraint if necessary, administering medication if indicated, and evaluating the cause and triggers of the behavior.- Psychotic symptoms: assessing the patients level of reality testing, ensuring their safety, providing support and reassurance, administering medication if indicated, and evaluating the cause and severity of the symptoms.- Substance intoxication or withdrawal: assessing the patients level of intoxication or withdrawal, ensuring their safety, providing supportive care and monitoring vital signs, administering medication if indicated, and evaluating the need for detoxification or referral.Q3: What are some evidence-based psychotherapies for major depressive disorder and how do they work?A3: Some evidence-based psychotherapies for major depressive disorder are:- Cognitive-behavioral therapy (CBT): a short-term therapy that aims to identify and modify the patients negative thoughts and behaviors that contribute to their depression. It also teaches the patient coping skills and problem-solving strategies to deal with stressful situations and improve their mood.- Interpersonal therapy (IPT): a short-term therapy that focuses on the patients interpersonal relationships and how they affect their depression. It also helps the patient to improve their communication skills and resolve any conflicts or role transitions that may cause distress.- Behavioral activation (BA): a therapy that involves increasing the patients engagement in rewarding activities that are consistent with their values and goals. It also helps the patient to reduce their avoidance of unpleasant situations and cope with negative emotions.- Mindfulness-based cognitive therapy (MBCT): a therapy that combines CBT with mindfulness techniques such as meditation and awareness exercises. It helps the patient to become more aware of their thoughts and feelings without judging them or reacting to them. It also helps the patient to prevent relapse by recognizing early signs of depression and applying coping skills.Q4: What are some pharmacological treatments for bipolar disorder and what are their indications, contraindications, side effects, and monitoring parameters?A4: Some pharmacological treatments for bipolar disorder are:- Mood stabilizers: medications that help to prevent or reduce the frequency and severity of manic and depressive episodes. Examples are lithium, valproate, carbamazepine, and lamotrigine. Their indications are acute mania, acute depression, or maintenance treatment. Their contraindications are hypersensitivity, severe renal or hepatic impairment, or pregnancy (for some agents). Their side effects include gastrointestinal distress, weight gain, tremor, sedation, cognitive impairment, rash, and blood dyscrasias. Their monitoring parameters include serum levels, renal function, liver function, thyroid function, and blood counts.- Antipsychotics: medications that help to control psychotic symptoms such as delusions, hallucinations, or paranoia that may occur in bipolar disorder. Examples are olanzapine, quetiapine, risperidone, aripiprazole, and ziprasidone. Their indications are acute mania with psychotic features, acute depression with psychotic features.Q5: Besides antianxiety agents, which classification of drugs is also commonly given to treat anxiety and anxiety disorders?A5: Antidepressants.Q6: What assessment question will provide the nurse with information regarding the effects of a woman’s circadian rhythms on her quality of life?A6: “How much sleep do you usually get each night?”Q7: You realize that your patient who is being treated for a major depressive disorder requires more teaching when she makes the following statement:A7: “I am going to ask my nurse practitioner to discontinue my Prozac today and let me start taking a monoamine oxidase inhibitor tomorrow.”Q8: A patient being treated for insomnia is prescribed ramelteon (Rozerem). Which comorbid mental health condition would make this medication the hypnotic of choice for this particular patient?A8: Substance use disorder.Q9: Which statement made by a patient prescribed bupropion (Wellbutrin) demonstrates that the medication education the patient received was effective? Select all that apply.A9: - “I hope Wellbutrin will help my depression and also help me to finally quit smoking.”- “I’m happy to hear that I won’t need to worry too much about weight gain.”- “My partner and I have discussed the possible effects this medication could have on our sex life.”Q10: Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages?A10: Antipsychotics.Q11: The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving:A11: Lithium (Eskalith).Q12: A psychiatric nurse is reviewing prescriptions for a patient with major depression at the county clinic. Since the patient has a mild intellectual disability, the nurse would question which classification of antidepressant drugs:A12: Monoamine oxidase inhibitors.Q13: The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.A13: - “Is the patient expressing suicidal thoughts?”- “Does the patient have intact judgment and insight into his situation?”- “Does the patient require a therapeutic environment to support the management of psychotic symptoms?”- “Does the patient require the regular involvement of their family/significant other in planning and executing the plan of care?”Q14: Pablo is a homeless adult who has no family connection. Pablo passed out on the street and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select all that apply.A14: - He requires stabilization of multiple symptoms.- He has nutritional and self-care needs.- He is in imminent danger of harming himself.Q15: Which statement made by the nurse demonstrates the best understanding of nonverbal communication?A15: “When my patient responds to my question, I check for congruence between verbal and nonverbal communication to help validate the response.”Q16: Which nursing statement is an example of reflection?A16: “So you are saying that life has no meaning.”Q17: When should a nurse be most alert to the possibility of communication errors resulting in harm to the patient?A17: Change of shift report.Q18: During an admission assessment and interview, which channels of information communication should the nurse be monitoring? Select all that apply.A18: - Auditory- Visual- Tactile- OlfactoryQ19: What principle about nurse-patient communication should guide a nurse’s fear about “saying the wrong thing” to a patient?A19: Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.Q20: You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic?A20: “You say you look forward to the meeting, but you appear anxious or unhappy.”Q21: Which student behavior is consistent with therapeutic communication?A21: Summarizing the essence of the patient’s comments in your own words.Q22: James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, “Last night, demons came to my room and tried to rape me.” Which response would be most therapeutic?A22: “You seem very upset. Please tell me more about what you experienced last night.”Q23: Therapeutic communication is the foundation of a patient-centered interview. Which of the following techniques is not considered therapeutic?A23: Asking “why” questions.Q24: Carolina is surprised when her patient does not show for a regularly scheduled appointment. When contacted, the patient states, “I don’t need to come see you anymore. I have found a therapy app on my phone that I love.” How should Carolina respond to this news?A24: “That sounds exciting, would you be willing to visit and show me the app?”Q25: Which statement demonstrates a well-structured attempt at limit setting?A25: “Hitting me when you are angry is unacceptable.”Q26: Which activity is most appropriate for a child with ADHD?A26: Tennis.Q27: Cognitive-behavioral therapy is going well when a 12-year-old patient in therapy reports to the nurse practitioner:A27: “I thought that everyone at school hated me. That’s not true. Most people like me and I have a friend named Todd.”Q28: What assessment question should the nurse ask when attempting to determine a teenager’s mental health resilience? Select all that apply.A28: - “How did you cope when your father deployed with the Army for a year in Iraq?”- “Who did you go to for advice while your father was away for a year in Iraq?”Q29: Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply.A29: - Limited language skills- Level of cognitive development- Level of emotional development- Parental denial that a problem existsQ30: In pediatric mental health there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: Select all that apply.A30: - Children of color and poor economic conditions being underserved- Increased stress in the family unit- Premature termination of servicesQ31: Child protective services have removed 10-year-old Christopher from his parents’ home due to neglect. Christopher reveals to the nurse that he considers the woman next door his “nice” mom, that he loves school, and gets above average grades. The strongest explanation of this response is:A31: Resilience.Q32: April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April’s mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that:A32: Time-out is no longer an effective therapeutic measure.Q33: Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to:A33: Cerebellum maturation.Q34: Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia?A34: Always afraid another student will steal her belongings.Q35: Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia?A35: Screening a group of males between the ages of 15 and 25 for early symptoms.Q36: To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition? Select all that apply.A36: - Alcohol use disorder- Major depressive disorder- Polydipsia- Metabolic syndromeQ37: A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?A37: She should experience a reduction in hallucinations.Q38: Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?A38: Paranoia.Q39: Gilbert, age 19, is described by his parents as a “moody child” with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert’s early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:A39: To have a less positive outcome.Q40: Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient’s nursing diagnosis is altered thought processes?A40: “You say you hear voices, what are they telling you?”Q41: When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:A41: They are not actually ill.Q42: Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply.A42: - Hold his medication and contact his prescriber.- Wipe him with a washcloth wet with cold water or alcohol.Q43: Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas’s nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:A43: Anxiety and depression.Q44: Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar and her support system? Select all that apply.A44: - “Remember that alcohol and caffeine can trigger a relapse of your symptoms.”- “It’s critical to let your healthcare provider know immediately if you aren’t sleeping well.”- “Is your family prepared to be actively involved in helping manage this disorder?”- “The symptoms tend to come and go and so you need to be able to recognize the early signs.”Q45: Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply.A45: - “I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day.”- “I discussed the diuretic my cardiologist prescribed with my psychiatric care provider.”- “I’ve already made arrangements for my monthly lab work.”Q46: The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply.A46: - An upset stomach for no apparent reason- Shaky hands that make holding a cup difficultQ47: A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially?A47: Instruct the patient to hold the next dose of medication and contact the prescriber.Q48: Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply.A48: - Monitor the patient’s vital signs frequently.- Provide the patient with frequent milkshakes and protein drinks.- Reduce the volume on the television and dim bright lights in the environment.- Use a firm but calm voice to give specific concise directions to the patient.Q49: Substance abuse is often present in people diagnosed with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that:A49: Alcohol ingestion is a form of self-medication.Q50: Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted’s wife and his blood tests confirm. To reduce Ted’s mania the psychiatric nurse practitioner recommends:A50: Electroconvulsive therapy (ECT).Q51: A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, “You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing”:A51: A lower dosage.Q52: Tatiana has been hospitalized for an acute manic episode. On admission the nurse suspects lithium toxicity. What assessment findings would indicate the nurse’s suspicion as correct?A52: Ataxia, severe hypotension, large volume of dilute urine.Q53: Luc’s family comes home one evening to find him extremely agitated and they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting?A53: Energy drink containers.Q54: Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder?A54: “I go to sleep around 11 p.m. but I’m always up by 3 a.m. and can’t go back to sleep.”Q55: Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply.A55: - “What do you do to manage anxiety?”- “Do you have a history of disordered eating?”- “Do you think that you drink too much?”Q56: Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population?A56: Conducting routine suicide screenings at a senior center.Q57: Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply.

%1 NR 668 EXAM PREP LATEST: Psychiatric Mental Health Capstone Practicum & Intensive %2%3 Deze oefenvragen zijn ontworpen om studenten te helpen zich voor te bereiden op het NR 668 examen voor Psychiatric Mental Health Capstone Practicum & Intensive. De vragen beslaan een breed scala aan onderwerpen binnen de psychiatrische zorg, inclusief diagnostische methoden, behandelstrategieën en therapeutische communicatie. %4Q1: What are the main components of a psychiatric assessment and what are some tools or methods to conduct each component?A1: A psychiatric assessment consists of four main components: history, mental status examination, physical examination, and diagnostic tests. Some tools or methods to conduct each component are:- History: interviewing the patient and obtaining information from other sources (e.g., family, medical records) about the patients personal, family, medical, psychiatric, social, occupational, and substance use history.- Mental status examination: observing and documenting the patients appearance, behavior, mood, affect, speech, thought process, thought content, perception, cognition, insight, and judgment.- Physical examination: performing a general physical examination and focusing on any signs or symptoms that may indicate a medical condition that could affect the patients mental health or interfere with the treatment.- Diagnostic tests: ordering and interpreting laboratory tests (e.g., blood tests, urine tests), imaging studies (e.g., CT scan, MRI), or other tests (e.g., electroencephalogram, neuropsychological testing) that may help to rule out or confirm a diagnosis or identify any comorbidities.Q2: What are some common psychiatric emergencies and how would you manage them in a clinical setting?A2: Some common psychiatric emergencies are:- Suicidal ideation or behavior: assessing the patients risk level, ensuring their safety, providing support and crisis intervention, initiating or modifying the treatment plan, and arranging for follow-up care or referral.- Aggressive or violent behavior: assessing the patients risk level, ensuring the safety of the patient and others, using de-escalation techniques or physical restraint if necessary, administering medication if indicated, and evaluating the cause and triggers of the behavior.- Psychotic symptoms: assessing the patients level of reality testing, ensuring their safety, providing support and reassurance, administering medication if indicated, and evaluating the cause and severity of the symptoms.- Substance intoxication or withdrawal: assessing the patients level of intoxication or withdrawal, ensuring their safety, providing supportive care and monitoring vital signs, administering medication if indicated, and evaluating the need for detoxification or referral.Q3: What are some evidence-based psychotherapies for major depressive disorder and how do they work?A3: Some evidence-based psychotherapies for major depressive disorder are:- Cognitive-behavioral therapy (CBT): a short-term therapy that aims to identify and modify the patients negative thoughts and behaviors that contribute to their depression. It also teaches the patient coping skills and problem-solving strategies to deal with stressful situations and improve their mood.- Interpersonal therapy (IPT): a short-term therapy that focuses on the patients interpersonal relationships and how they affect their depression. It also helps the patient to improve their communication skills and resolve any conflicts or role transitions that may cause distress.- Behavioral activation (BA): a therapy that involves increasing the patients engagement in rewarding activities that are consistent with their values and goals. It also helps the patient to reduce their avoidance of unpleasant situations and cope with negative emotions.- Mindfulness-based cognitive therapy (MBCT): a therapy that combines CBT with mindfulness techniques such as meditation and awareness exercises. It helps the patient to become more aware of their thoughts and feelings without judging them or reacting to them. It also helps the patient to prevent relapse by recognizing early signs of depression and applying coping skills.Q4: What are some pharmacological treatments for bipolar disorder and what are their indications, contraindications, side effects, and monitoring parameters?A4: Some pharmacological treatments for bipolar disorder are:- Mood stabilizers: medications that help to prevent or reduce the frequency and severity of manic and depressive episodes. Examples are lithium, valproate, carbamazepine, and lamotrigine. Their indications are acute mania, acute depression, or maintenance treatment. Their contraindications are hypersensitivity, severe renal or hepatic impairment, or pregnancy (for some agents). Their side effects include gastrointestinal distress, weight gain, tremor, sedation, cognitive impairment, rash, and blood dyscrasias. Their monitoring parameters include serum levels, renal function, liver function, thyroid function, and blood counts.- Antipsychotics: medications that help to control psychotic symptoms such as delusions, hallucinations, or paranoia that may occur in bipolar disorder. Examples are olanzapine, quetiapine, risperidone, aripiprazole, and ziprasidone. Their indications are acute mania with psychotic features, acute depression with psychotic features.Q5: Besides antianxiety agents, which classification of drugs is also commonly given to treat anxiety and anxiety disorders?A5: Antidepressants.Q6: What assessment question will provide the nurse with information regarding the effects of a woman’s circadian rhythms on her quality of life?A6: “How much sleep do you usually get each night?”Q7: You realize that your patient who is being treated for a major depressive disorder requires more teaching when she makes the following statement:A7: “I am going to ask my nurse practitioner to discontinue my Prozac today and let me start taking a monoamine oxidase inhibitor tomorrow.”Q8: A patient being treated for insomnia is prescribed ramelteon (Rozerem). Which comorbid mental health condition would make this medication the hypnotic of choice for this particular patient?A8: Substance use disorder.Q9: Which statement made by a patient prescribed bupropion (Wellbutrin) demonstrates that the medication education the patient received was effective? Select all that apply.A9: - “I hope Wellbutrin will help my depression and also help me to finally quit smoking.”- “I’m happy to hear that I won’t need to worry too much about weight gain.”- “My partner and I have discussed the possible effects this medication could have on our sex life.”Q10: Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages?A10: Antipsychotics.Q11: The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving:A11: Lithium (Eskalith).Q12: A psychiatric nurse is reviewing prescriptions for a patient with major depression at the county clinic. Since the patient has a mild intellectual disability, the nurse would question which classification of antidepressant drugs:A12: Monoamine oxidase inhibitors.Q13: The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.A13: - “Is the patient expressing suicidal thoughts?”- “Does the patient have intact judgment and insight into his situation?”- “Does the patient require a therapeutic environment to support the management of psychotic symptoms?”- “Does the patient require the regular involvement of their family/significant other in planning and executing the plan of care?”Q14: Pablo is a homeless adult who has no family connection. Pablo passed out on the street and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select all that apply.A14: - He requires stabilization of multiple symptoms.- He has nutritional and self-care needs.- He is in imminent danger of harming himself.Q15: Which statement made by the nurse demonstrates the best understanding of nonverbal communication?A15: “When my patient responds to my question, I check for congruence between verbal and nonverbal communication to help validate the response.”Q16: Which nursing statement is an example of reflection?A16: “So you are saying that life has no meaning.”Q17: When should a nurse be most alert to the possibility of communication errors resulting in harm to the patient?A17: Change of shift report.Q18: During an admission assessment and interview, which channels of information communication should the nurse be monitoring? Select all that apply.A18: - Auditory- Visual- Tactile- OlfactoryQ19: What principle about nurse-patient communication should guide a nurse’s fear about “saying the wrong thing” to a patient?A19: Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.Q20: You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic?A20: “You say you look forward to the meeting, but you appear anxious or unhappy.”Q21: Which student behavior is consistent with therapeutic communication?A21: Summarizing the essence of the patient’s comments in your own words.Q22: James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, “Last night, demons came to my room and tried to rape me.” Which response would be most therapeutic?A22: “You seem very upset. Please tell me more about what you experienced last night.”Q23: Therapeutic communication is the foundation of a patient-centered interview. Which of the following techniques is not considered therapeutic?A23: Asking “why” questions.Q24: Carolina is surprised when her patient does not show for a regularly scheduled appointment. When contacted, the patient states, “I don’t need to come see you anymore. I have found a therapy app on my phone that I love.” How should Carolina respond to this news?A24: “That sounds exciting, would you be willing to visit and show me the app?”Q25: Which statement demonstrates a well-structured attempt at limit setting?A25: “Hitting me when you are angry is unacceptable.”Q26: Which activity is most appropriate for a child with ADHD?A26: Tennis.Q27: Cognitive-behavioral therapy is going well when a 12-year-old patient in therapy reports to the nurse practitioner:A27: “I thought that everyone at school hated me. That’s not true. Most people like me and I have a friend named Todd.”Q28: What assessment question should the nurse ask when attempting to determine a teenager’s mental health resilience? Select all that apply.A28: - “How did you cope when your father deployed with the Army for a year in Iraq?”- “Who did you go to for advice while your father was away for a year in Iraq?”Q29: Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply.A29: - Limited language skills- Level of cognitive development- Level of emotional development- Parental denial that a problem existsQ30: In pediatric mental health there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: Select all that apply.A30: - Children of color and poor economic conditions being underserved- Increased stress in the family unit- Premature termination of servicesQ31: Child protective services have removed 10-year-old Christopher from his parents’ home due to neglect. Christopher reveals to the nurse that he considers the woman next door his “nice” mom, that he loves school, and gets above average grades. The strongest explanation of this response is:A31: Resilience.Q32: April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April’s mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that:A32: Time-out is no longer an effective therapeutic measure.Q33: Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to:A33: Cerebellum maturation.Q34: Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia?A34: Always afraid another student will steal her belongings.Q35: Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia?A35: Screening a group of males between the ages of 15 and 25 for early symptoms.Q36: To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition? Select all that apply.A36: - Alcohol use disorder- Major depressive disorder- Polydipsia- Metabolic syndromeQ37: A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?A37: She should experience a reduction in hallucinations.Q38: Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?A38: Paranoia.Q39: Gilbert, age 19, is described by his parents as a “moody child” with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert’s early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:A39: To have a less positive outcome.Q40: Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient’s nursing diagnosis is altered thought processes?A40: “You say you hear voices, what are they telling you?”Q41: When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:A41: They are not actually ill.Q42: Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply.A42: - Hold his medication and contact his prescriber.- Wipe him with a washcloth wet with cold water or alcohol.Q43: Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas’s nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:A43: Anxiety and depression.Q44: Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar and her support system? Select all that apply.A44: - “Remember that alcohol and caffeine can trigger a relapse of your symptoms.”- “It’s critical to let your healthcare provider know immediately if you aren’t sleeping well.”- “Is your family prepared to be actively involved in helping manage this disorder?”- “The symptoms tend to come and go and so you need to be able to recognize the early signs.”Q45: Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply.A45: - “I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day.”- “I discussed the diuretic my cardiologist prescribed with my psychiatric care provider.”- “I’ve already made arrangements for my monthly lab work.”Q46: The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply.A46: - An upset stomach for no apparent reason- Shaky hands that make holding a cup difficultQ47: A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially?A47: Instruct the patient to hold the next dose of medication and contact the prescriber.Q48: Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply.A48: - Monitor the patient’s vital signs frequently.- Provide the patient with frequent milkshakes and protein drinks.- Reduce the volume on the television and dim bright lights in the environment.- Use a firm but calm voice to give specific concise directions to the patient.Q49: Substance abuse is often present in people diagnosed with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that:A49: Alcohol ingestion is a form of self-medication.Q50: Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted’s wife and his blood tests confirm. To reduce Ted’s mania the psychiatric nurse practitioner recommends:A50: Electroconvulsive therapy (ECT).Q51: A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, “You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing”:A51: A lower dosage.Q52: Tatiana has been hospitalized for an acute manic episode. On admission the nurse suspects lithium toxicity. What assessment findings would indicate the nurse’s suspicion as correct?A52: Ataxia, severe hypotension, large volume of dilute urine.Q53: Luc’s family comes home one evening to find him extremely agitated and they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting?A53: Energy drink containers.Q54: Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder?A54: “I go to sleep around 11 p.m. but I’m always up by 3 a.m. and can’t go back to sleep.”Q55: Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply.A55: - “What do you do to manage anxiety?”- “Do you have a history of disordered eating?”- “Do you think that you drink too much?”Q56: Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population?A56: Conducting routine suicide screenings at a senior center.Q57: Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply.

%1 NR 668 EXAM PREP LATEST: Psychiatric Mental Health Capstone Practicum & Intensive %2%3 Deze oefenvragen zijn ontworpen om studenten te helpen zich voor te bereiden op het NR 668 examen voor Psychiatric Mental Health Capstone Practicum & Intensive. De vragen beslaan een breed scala aan onderwerpen binnen de psychiatrische zorg, inclusief diagnostische methoden, behandelstrategieën en therapeutische communicatie. %4Q1: What are the main components of a psychiatric assessment and what are some tools or methods to conduct each component?A1: A psychiatric assessment consists of four main components: history, mental status examination, physical examination, and diagnostic tests. Some tools or methods to conduct each component are:- History: interviewing the patient and obtaining information from other sources (e.g., family, medical records) about the patients personal, family, medical, psychiatric, social, occupational, and substance use history.- Mental status examination: observing and documenting the patients appearance, behavior, mood, affect, speech, thought process, thought content, perception, cognition, insight, and judgment.- Physical examination: performing a general physical examination and focusing on any signs or symptoms that may indicate a medical condition that could affect the patients mental health or interfere with the treatment.- Diagnostic tests: ordering and interpreting laboratory tests (e.g., blood tests, urine tests), imaging studies (e.g., CT scan, MRI), or other tests (e.g., electroencephalogram, neuropsychological testing) that may help to rule out or confirm a diagnosis or identify any comorbidities.Q2: What are some common psychiatric emergencies and how would you manage them in a clinical setting?A2: Some common psychiatric emergencies are:- Suicidal ideation or behavior: assessing the patients risk level, ensuring their safety, providing support and crisis intervention, initiating or modifying the treatment plan, and arranging for follow-up care or referral.- Aggressive or violent behavior: assessing the patients risk level, ensuring the safety of the patient and others, using de-escalation techniques or physical restraint if necessary, administering medication if indicated, and evaluating the cause and triggers of the behavior.- Psychotic symptoms: assessing the patients level of reality testing, ensuring their safety, providing support and reassurance, administering medication if indicated, and evaluating the cause and severity of the symptoms.- Substance intoxication or withdrawal: assessing the patients level of intoxication or withdrawal, ensuring their safety, providing supportive care and monitoring vital signs, administering medication if indicated, and evaluating the need for detoxification or referral.Q3: What are some evidence-based psychotherapies for major depressive disorder and how do they work?A3: Some evidence-based psychotherapies for major depressive disorder are:- Cognitive-behavioral therapy (CBT): a short-term therapy that aims to identify and modify the patients negative thoughts and behaviors that contribute to their depression. It also teaches the patient coping skills and problem-solving strategies to deal with stressful situations and improve their mood.- Interpersonal therapy (IPT): a short-term therapy that focuses on the patients interpersonal relationships and how they affect their depression. It also helps the patient to improve their communication skills and resolve any conflicts or role transitions that may cause distress.- Behavioral activation (BA): a therapy that involves increasing the patients engagement in rewarding activities that are consistent with their values and goals. It also helps the patient to reduce their avoidance of unpleasant situations and cope with negative emotions.- Mindfulness-based cognitive therapy (MBCT): a therapy that combines CBT with mindfulness techniques such as meditation and awareness exercises. It helps the patient to become more aware of their thoughts and feelings without judging them or reacting to them. It also helps the patient to prevent relapse by recognizing early signs of depression and applying coping skills.Q4: What are some pharmacological treatments for bipolar disorder and what are their indications, contraindications, side effects, and monitoring parameters?A4: Some pharmacological treatments for bipolar disorder are:- Mood stabilizers: medications that help to prevent or reduce the frequency and severity of manic and depressive episodes. Examples are lithium, valproate, carbamazepine, and lamotrigine. Their indications are acute mania, acute depression, or maintenance treatment. Their contraindications are hypersensitivity, severe renal or hepatic impairment, or pregnancy (for some agents). Their side effects include gastrointestinal distress, weight gain, tremor, sedation, cognitive impairment, rash, and blood dyscrasias. Their monitoring parameters include serum levels, renal function, liver function, thyroid function, and blood counts.- Antipsychotics: medications that help to control psychotic symptoms such as delusions, hallucinations, or paranoia that may occur in bipolar disorder. Examples are olanzapine, quetiapine, risperidone, aripiprazole, and ziprasidone. Their indications are acute mania with psychotic features, acute depression with psychotic features.Q5: Besides antianxiety agents, which classification of drugs is also commonly given to treat anxiety and anxiety disorders?A5: Antidepressants.Q6: What assessment question will provide the nurse with information regarding the effects of a woman’s circadian rhythms on her quality of life?A6: “How much sleep do you usually get each night?”Q7: You realize that your patient who is being treated for a major depressive disorder requires more teaching when she makes the following statement:A7: “I am going to ask my nurse practitioner to discontinue my Prozac today and let me start taking a monoamine oxidase inhibitor tomorrow.”Q8: A patient being treated for insomnia is prescribed ramelteon (Rozerem). Which comorbid mental health condition would make this medication the hypnotic of choice for this particular patient?A8: Substance use disorder.Q9: Which statement made by a patient prescribed bupropion (Wellbutrin) demonstrates that the medication education the patient received was effective? Select all that apply.A9: - “I hope Wellbutrin will help my depression and also help me to finally quit smoking.”- “I’m happy to hear that I won’t need to worry too much about weight gain.”- “My partner and I have discussed the possible effects this medication could have on our sex life.”Q10: Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages?A10: Antipsychotics.Q11: The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving:A11: Lithium (Eskalith).Q12: A psychiatric nurse is reviewing prescriptions for a patient with major depression at the county clinic. Since the patient has a mild intellectual disability, the nurse would question which classification of antidepressant drugs:A12: Monoamine oxidase inhibitors.Q13: The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.A13: - “Is the patient expressing suicidal thoughts?”- “Does the patient have intact judgment and insight into his situation?”- “Does the patient require a therapeutic environment to support the management of psychotic symptoms?”- “Does the patient require the regular involvement of their family/significant other in planning and executing the plan of care?”Q14: Pablo is a homeless adult who has no family connection. Pablo passed out on the street and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select all that apply.A14: - He requires stabilization of multiple symptoms.- He has nutritional and self-care needs.- He is in imminent danger of harming himself.Q15: Which statement made by the nurse demonstrates the best understanding of nonverbal communication?A15: “When my patient responds to my question, I check for congruence between verbal and nonverbal communication to help validate the response.”Q16: Which nursing statement is an example of reflection?A16: “So you are saying that life has no meaning.”Q17: When should a nurse be most alert to the possibility of communication errors resulting in harm to the patient?A17: Change of shift report.Q18: During an admission assessment and interview, which channels of information communication should the nurse be monitoring? Select all that apply.A18: - Auditory- Visual- Tactile- OlfactoryQ19: What principle about nurse-patient communication should guide a nurse’s fear about “saying the wrong thing” to a patient?A19: Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.Q20: You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic?A20: “You say you look forward to the meeting, but you appear anxious or unhappy.”Q21: Which student behavior is consistent with therapeutic communication?A21: Summarizing the essence of the patient’s comments in your own words.Q22: James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, “Last night, demons came to my room and tried to rape me.” Which response would be most therapeutic?A22: “You seem very upset. Please tell me more about what you experienced last night.”Q23: Therapeutic communication is the foundation of a patient-centered interview. Which of the following techniques is not considered therapeutic?A23: Asking “why” questions.Q24: Carolina is surprised when her patient does not show for a regularly scheduled appointment. When contacted, the patient states, “I don’t need to come see you anymore. I have found a therapy app on my phone that I love.” How should Carolina respond to this news?A24: “That sounds exciting, would you be willing to visit and show me the app?”Q25: Which statement demonstrates a well-structured attempt at limit setting?A25: “Hitting me when you are angry is unacceptable.”Q26: Which activity is most appropriate for a child with ADHD?A26: Tennis.Q27: Cognitive-behavioral therapy is going well when a 12-year-old patient in therapy reports to the nurse practitioner:A27: “I thought that everyone at school hated me. That’s not true. Most people like me and I have a friend named Todd.”Q28: What assessment question should the nurse ask when attempting to determine a teenager’s mental health resilience? Select all that apply.A28: - “How did you cope when your father deployed with the Army for a year in Iraq?”- “Who did you go to for advice while your father was away for a year in Iraq?”Q29: Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply.A29: - Limited language skills- Level of cognitive development- Level of emotional development- Parental denial that a problem existsQ30: In pediatric mental health there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: Select all that apply.A30: - Children of color and poor economic conditions being underserved- Increased stress in the family unit- Premature termination of servicesQ31: Child protective services have removed 10-year-old Christopher from his parents’ home due to neglect. Christopher reveals to the nurse that he considers the woman next door his “nice” mom, that he loves school, and gets above average grades. The strongest explanation of this response is:A31: Resilience.Q32: April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April’s mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that:A32: Time-out is no longer an effective therapeutic measure.Q33: Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to:A33: Cerebellum maturation.Q34: Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia?A34: Always afraid another student will steal her belongings.Q35: Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia?A35: Screening a group of males between the ages of 15 and 25 for early symptoms.Q36: To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition? Select all that apply.A36: - Alcohol use disorder- Major depressive disorder- Polydipsia- Metabolic syndromeQ37: A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?A37: She should experience a reduction in hallucinations.Q38: Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?A38: Paranoia.Q39: Gilbert, age 19, is described by his parents as a “moody child” with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert’s early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:A39: To have a less positive outcome.Q40: Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient’s nursing diagnosis is altered thought processes?A40: “You say you hear voices, what are they telling you?”Q41: When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:A41: They are not actually ill.Q42: Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply.A42: - Hold his medication and contact his prescriber.- Wipe him with a washcloth wet with cold water or alcohol.Q43: Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas’s nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:A43: Anxiety and depression.Q44: Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar and her support system? Select all that apply.A44: - “Remember that alcohol and caffeine can trigger a relapse of your symptoms.”- “It’s critical to let your healthcare provider know immediately if you aren’t sleeping well.”- “Is your family prepared to be actively involved in helping manage this disorder?”- “The symptoms tend to come and go and so you need to be able to recognize the early signs.”Q45: Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply.A45: - “I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day.”- “I discussed the diuretic my cardiologist prescribed with my psychiatric care provider.”- “I’ve already made arrangements for my monthly lab work.”Q46: The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply.A46: - An upset stomach for no apparent reason- Shaky hands that make holding a cup difficultQ47: A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially?A47: Instruct the patient to hold the next dose of medication and contact the prescriber.Q48: Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply.A48: - Monitor the patient’s vital signs frequently.- Provide the patient with frequent milkshakes and protein drinks.- Reduce the volume on the television and dim bright lights in the environment.- Use a firm but calm voice to give specific concise directions to the patient.Q49: Substance abuse is often present in people diagnosed with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that:A49: Alcohol ingestion is a form of self-medication.Q50: Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted’s wife and his blood tests confirm. To reduce Ted’s mania the psychiatric nurse practitioner recommends:A50: Electroconvulsive therapy (ECT).Q51: A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, “You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing”:A51: A lower dosage.Q52: Tatiana has been hospitalized for an acute manic episode. On admission the nurse suspects lithium toxicity. What assessment findings would indicate the nurse’s suspicion as correct?A52: Ataxia, severe hypotension, large volume of dilute urine.Q53: Luc’s family comes home one evening to find him extremely agitated and they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting?A53: Energy drink containers.Q54: Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder?A54: “I go to sleep around 11 p.m. but I’m always up by 3 a.m. and can’t go back to sleep.”Q55: Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply.A55: - “What do you do to manage anxiety?”- “Do you have a history of disordered eating?”- “Do you think that you drink too much?”Q56: Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population?A56: Conducting routine suicide screenings at a senior center.Q57: Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply.

%1 NR 668 EXAM PREP LATEST: Psychiatric Mental Health Capstone Practicum & Intensive %2%3 Deze oefenvragen zijn ontworpen om studenten te helpen zich voor te bereiden op het NR 668 examen voor Psychiatric Mental Health Capstone Practicum & Intensive. De vragen beslaan een breed scala aan onderwerpen binnen de psychiatrische zorg, inclusief diagnostische methoden, behandelstrategieën en therapeutische communicatie. %4Q1: What are the main components of a psychiatric assessment and what are some tools or methods to conduct each component?A1: A psychiatric assessment consists of four main components: history, mental status examination, physical examination, and diagnostic tests. Some tools or methods to conduct each component are:- History: interviewing the patient and obtaining information from other sources (e.g., family, medical records) about the patients personal, family, medical, psychiatric, social, occupational, and substance use history.- Mental status examination: observing and documenting the patients appearance, behavior, mood, affect, speech, thought process, thought content, perception, cognition, insight, and judgment.- Physical examination: performing a general physical examination and focusing on any signs or symptoms that may indicate a medical condition that could affect the patients mental health or interfere with the treatment.- Diagnostic tests: ordering and interpreting laboratory tests (e.g., blood tests, urine tests), imaging studies (e.g., CT scan, MRI), or other tests (e.g., electroencephalogram, neuropsychological testing) that may help to rule out or confirm a diagnosis or identify any comorbidities.Q2: What are some common psychiatric emergencies and how would you manage them in a clinical setting?A2: Some common psychiatric emergencies are:- Suicidal ideation or behavior: assessing the patients risk level, ensuring their safety, providing support and crisis intervention, initiating or modifying the treatment plan, and arranging for follow-up care or referral.- Aggressive or violent behavior: assessing the patients risk level, ensuring the safety of the patient and others, using de-escalation techniques or physical restraint if necessary, administering medication if indicated, and evaluating the cause and triggers of the behavior.- Psychotic symptoms: assessing the patients level of reality testing, ensuring their safety, providing support and reassurance, administering medication if indicated, and evaluating the cause and severity of the symptoms.- Substance intoxication or withdrawal: assessing the patients level of intoxication or withdrawal, ensuring their safety, providing supportive care and monitoring vital signs, administering medication if indicated, and evaluating the need for detoxification or referral.Q3: What are some evidence-based psychotherapies for major depressive disorder and how do they work?A3: Some evidence-based psychotherapies for major depressive disorder are:- Cognitive-behavioral therapy (CBT): a short-term therapy that aims to identify and modify the patients negative thoughts and behaviors that contribute to their depression. It also teaches the patient coping skills and problem-solving strategies to deal with stressful situations and improve their mood.- Interpersonal therapy (IPT): a short-term therapy that focuses on the patients interpersonal relationships and how they affect their depression. It also helps the patient to improve their communication skills and resolve any conflicts or role transitions that may cause distress.- Behavioral activation (BA): a therapy that involves increasing the patients engagement in rewarding activities that are consistent with their values and goals. It also helps the patient to reduce their avoidance of unpleasant situations and cope with negative emotions.- Mindfulness-based cognitive therapy (MBCT): a therapy that combines CBT with mindfulness techniques such as meditation and awareness exercises. It helps the patient to become more aware of their thoughts and feelings without judging them or reacting to them. It also helps the patient to prevent relapse by recognizing early signs of depression and applying coping skills.Q4: What are some pharmacological treatments for bipolar disorder and what are their indications, contraindications, side effects, and monitoring parameters?A4: Some pharmacological treatments for bipolar disorder are:- Mood stabilizers: medications that help to prevent or reduce the frequency and severity of manic and depressive episodes. Examples are lithium, valproate, carbamazepine, and lamotrigine. Their indications are acute mania, acute depression, or maintenance treatment. Their contraindications are hypersensitivity, severe renal or hepatic impairment, or pregnancy (for some agents). Their side effects include gastrointestinal distress, weight gain, tremor, sedation, cognitive impairment, rash, and blood dyscrasias. Their monitoring parameters include serum levels, renal function, liver function, thyroid function, and blood counts.- Antipsychotics: medications that help to control psychotic symptoms such as delusions, hallucinations, or paranoia that may occur in bipolar disorder. Examples are olanzapine, quetiapine, risperidone, aripiprazole, and ziprasidone. Their indications are acute mania with psychotic features, acute depression with psychotic features.Q5: Besides antianxiety agents, which classification of drugs is also commonly given to treat anxiety and anxiety disorders?A5: Antidepressants.Q6: What assessment question will provide the nurse with information regarding the effects of a woman’s circadian rhythms on her quality of life?A6: “How much sleep do you usually get each night?”Q7: You realize that your patient who is being treated for a major depressive disorder requires more teaching when she makes the following statement:A7: “I am going to ask my nurse practitioner to discontinue my Prozac today and let me start taking a monoamine oxidase inhibitor tomorrow.”Q8: A patient being treated for insomnia is prescribed ramelteon (Rozerem). Which comorbid mental health condition would make this medication the hypnotic of choice for this particular patient?A8: Substance use disorder.Q9: Which statement made by a patient prescribed bupropion (Wellbutrin) demonstrates that the medication education the patient received was effective? Select all that apply.A9: - “I hope Wellbutrin will help my depression and also help me to finally quit smoking.”- “I’m happy to hear that I won’t need to worry too much about weight gain.”- “My partner and I have discussed the possible effects this medication could have on our sex life.”Q10: Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages?A10: Antipsychotics.Q11: The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving:A11: Lithium (Eskalith).Q12: A psychiatric nurse is reviewing prescriptions for a patient with major depression at the county clinic. Since the patient has a mild intellectual disability, the nurse would question which classification of antidepressant drugs:A12: Monoamine oxidase inhibitors.Q13: The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.A13: - “Is the patient expressing suicidal thoughts?”- “Does the patient have intact judgment and insight into his situation?”- “Does the patient require a therapeutic environment to support the management of psychotic symptoms?”- “Does the patient require the regular involvement of their family/significant other in planning and executing the plan of care?”Q14: Pablo is a homeless adult who has no family connection. Pablo passed out on the street and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select all that apply.A14: - He requires stabilization of multiple symptoms.- He has nutritional and self-care needs.- He is in imminent danger of harming himself.Q15: Which statement made by the nurse demonstrates the best understanding of nonverbal communication?A15: “When my patient responds to my question, I check for congruence between verbal and nonverbal communication to help validate the response.”Q16: Which nursing statement is an example of reflection?A16: “So you are saying that life has no meaning.”Q17: When should a nurse be most alert to the possibility of communication errors resulting in harm to the patient?A17: Change of shift report.Q18: During an admission assessment and interview, which channels of information communication should the nurse be monitoring? Select all that apply.A18: - Auditory- Visual- Tactile- OlfactoryQ19: What principle about nurse-patient communication should guide a nurse’s fear about “saying the wrong thing” to a patient?A19: Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.Q20: You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic?A20: “You say you look forward to the meeting, but you appear anxious or unhappy.”Q21: Which student behavior is consistent with therapeutic communication?A21: Summarizing the essence of the patient’s comments in your own words.Q22: James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, “Last night, demons came to my room and tried to rape me.” Which response would be most therapeutic?A22: “You seem very upset. Please tell me more about what you experienced last night.”Q23: Therapeutic communication is the foundation of a patient-centered interview. Which of the following techniques is not considered therapeutic?A23: Asking “why” questions.Q24: Carolina is surprised when her patient does not show for a regularly scheduled appointment. When contacted, the patient states, “I don’t need to come see you anymore. I have found a therapy app on my phone that I love.” How should Carolina respond to this news?A24: “That sounds exciting, would you be willing to visit and show me the app?”Q25: Which statement demonstrates a well-structured attempt at limit setting?A25: “Hitting me when you are angry is unacceptable.”Q26: Which activity is most appropriate for a child with ADHD?A26: Tennis.Q27: Cognitive-behavioral therapy is going well when a 12-year-old patient in therapy reports to the nurse practitioner:A27: “I thought that everyone at school hated me. That’s not true. Most people like me and I have a friend named Todd.”Q28: What assessment question should the nurse ask when attempting to determine a teenager’s mental health resilience? Select all that apply.A28: - “How did you cope when your father deployed with the Army for a year in Iraq?”- “Who did you go to for advice while your father was away for a year in Iraq?”Q29: Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply.A29: - Limited language skills- Level of cognitive development- Level of emotional development- Parental denial that a problem existsQ30: In pediatric mental health there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: Select all that apply.A30: - Children of color and poor economic conditions being underserved- Increased stress in the family unit- Premature termination of servicesQ31: Child protective services have removed 10-year-old Christopher from his parents’ home due to neglect. Christopher reveals to the nurse that he considers the woman next door his “nice” mom, that he loves school, and gets above average grades. The strongest explanation of this response is:A31: Resilience.Q32: April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April’s mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that:A32: Time-out is no longer an effective therapeutic measure.Q33: Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to:A33: Cerebellum maturation.Q34: Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia?A34: Always afraid another student will steal her belongings.Q35: Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia?A35: Screening a group of males between the ages of 15 and 25 for early symptoms.Q36: To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition? Select all that apply.A36: - Alcohol use disorder- Major depressive disorder- Polydipsia- Metabolic syndromeQ37: A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?A37: She should experience a reduction in hallucinations.Q38: Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?A38: Paranoia.Q39: Gilbert, age 19, is described by his parents as a “moody child” with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert’s early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:A39: To have a less positive outcome.Q40: Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient’s nursing diagnosis is altered thought processes?A40: “You say you hear voices, what are they telling you?”Q41: When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:A41: They are not actually ill.Q42: Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply.A42: - Hold his medication and contact his prescriber.- Wipe him with a washcloth wet with cold water or alcohol.Q43: Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas’s nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:A43: Anxiety and depression.Q44: Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar and her support system? Select all that apply.A44: - “Remember that alcohol and caffeine can trigger a relapse of your symptoms.”- “It’s critical to let your healthcare provider know immediately if you aren’t sleeping well.”- “Is your family prepared to be actively involved in helping manage this disorder?”- “The symptoms tend to come and go and so you need to be able to recognize the early signs.”Q45: Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply.A45: - “I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day.”- “I discussed the diuretic my cardiologist prescribed with my psychiatric care provider.”- “I’ve already made arrangements for my monthly lab work.”Q46: The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply.A46: - An upset stomach for no apparent reason- Shaky hands that make holding a cup difficultQ47: A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially?A47: Instruct the patient to hold the next dose of medication and contact the prescriber.Q48: Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply.A48: - Monitor the patient’s vital signs frequently.- Provide the patient with frequent milkshakes and protein drinks.- Reduce the volume on the television and dim bright lights in the environment.- Use a firm but calm voice to give specific concise directions to the patient.Q49: Substance abuse is often present in people diagnosed with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that:A49: Alcohol ingestion is a form of self-medication.Q50: Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted’s wife and his blood tests confirm. To reduce Ted’s mania the psychiatric nurse practitioner recommends:A50: Electroconvulsive therapy (ECT).Q51: A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, “You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing”:A51: A lower dosage.Q52: Tatiana has been hospitalized for an acute manic episode. On admission the nurse suspects lithium toxicity. What assessment findings would indicate the nurse’s suspicion as correct?A52: Ataxia, severe hypotension, large volume of dilute urine.Q53: Luc’s family comes home one evening to find him extremely agitated and they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting?A53: Energy drink containers.Q54: Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder?A54: “I go to sleep around 11 p.m. but I’m always up by 3 a.m. and can’t go back to sleep.”Q55: Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply.A55: - “What do you do to manage anxiety?”- “Do you have a history of disordered eating?”- “Do you think that you drink too much?”Q56: Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population?A56: Conducting routine suicide screenings at a senior center.Q57: Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply.

%1 NR 668 EXAM PREP LATEST: Psychiatric Mental Health Capstone Practicum & Intensive %2%3 Deze oefenvragen zijn ontworpen om studenten te helpen zich voor te bereiden op het NR 668 examen voor Psychiatric Mental Health Capstone Practicum & Intensive. De vragen beslaan een breed scala aan onderwerpen binnen de psychiatrische zorg, inclusief diagnostische methoden, behandelstrategieën en therapeutische communicatie. %4Q1: What are the main components of a psychiatric assessment and what are some tools or methods to conduct each component?A1: A psychiatric assessment consists of four main components: history, mental status examination, physical examination, and diagnostic tests. Some tools or methods to conduct each component are:- History: interviewing the patient and obtaining information from other sources (e.g., family, medical records) about the patients personal, family, medical, psychiatric, social, occupational, and substance use history.- Mental status examination: observing and documenting the patients appearance, behavior, mood, affect, speech, thought process, thought content, perception, cognition, insight, and judgment.- Physical examination: performing a general physical examination and focusing on any signs or symptoms that may indicate a medical condition that could affect the patients mental health or interfere with the treatment.- Diagnostic tests: ordering and interpreting laboratory tests (e.g., blood tests, urine tests), imaging studies (e.g., CT scan, MRI), or other tests (e.g., electroencephalogram, neuropsychological testing) that may help to rule out or confirm a diagnosis or identify any comorbidities.Q2: What are some common psychiatric emergencies and how would you manage them in a clinical setting?A2: Some common psychiatric emergencies are:- Suicidal ideation or behavior: assessing the patients risk level, ensuring their safety, providing support and crisis intervention, initiating or modifying the treatment plan, and arranging for follow-up care or referral.- Aggressive or violent behavior: assessing the patients risk level, ensuring the safety of the patient and others, using de-escalation techniques or physical restraint if necessary, administering medication if indicated, and evaluating the cause and triggers of the behavior.- Psychotic symptoms: assessing the patients level of reality testing, ensuring their safety, providing support and reassurance, administering medication if indicated, and evaluating the cause and severity of the symptoms.- Substance intoxication or withdrawal: assessing the patients level of intoxication or withdrawal, ensuring their safety, providing supportive care and monitoring vital signs, administering medication if indicated, and evaluating the need for detoxification or referral.Q3: What are some evidence-based psychotherapies for major depressive disorder and how do they work?A3: Some evidence-based psychotherapies for major depressive disorder are:- Cognitive-behavioral therapy (CBT): a short-term therapy that aims to identify and modify the patients negative thoughts and behaviors that contribute to their depression. It also teaches the patient coping skills and problem-solving strategies to deal with stressful situations and improve their mood.- Interpersonal therapy (IPT): a short-term therapy that focuses on the patients interpersonal relationships and how they affect their depression. It also helps the patient to improve their communication skills and resolve any conflicts or role transitions that may cause distress.- Behavioral activation (BA): a therapy that involves increasing the patients engagement in rewarding activities that are consistent with their values and goals. It also helps the patient to reduce their avoidance of unpleasant situations and cope with negative emotions.- Mindfulness-based cognitive therapy (MBCT): a therapy that combines CBT with mindfulness techniques such as meditation and awareness exercises. It helps the patient to become more aware of their thoughts and feelings without judging them or reacting to them. It also helps the patient to prevent relapse by recognizing early signs of depression and applying coping skills.Q4: What are some pharmacological treatments for bipolar disorder and what are their indications, contraindications, side effects, and monitoring parameters?A4: Some pharmacological treatments for bipolar disorder are:- Mood stabilizers: medications that help to prevent or reduce the frequency and severity of manic and depressive episodes. Examples are lithium, valproate, carbamazepine, and lamotrigine. Their indications are acute mania, acute depression, or maintenance treatment. Their contraindications are hypersensitivity, severe renal or hepatic impairment, or pregnancy (for some agents). Their side effects include gastrointestinal distress, weight gain, tremor, sedation, cognitive impairment, rash, and blood dyscrasias. Their monitoring parameters include serum levels, renal function, liver function, thyroid function, and blood counts.- Antipsychotics: medications that help to control psychotic symptoms such as delusions, hallucinations, or paranoia that may occur in bipolar disorder. Examples are olanzapine, quetiapine, risperidone, aripiprazole, and ziprasidone. Their indications are acute mania with psychotic features, acute depression with psychotic features.Q5: Besides antianxiety agents, which classification of drugs is also commonly given to treat anxiety and anxiety disorders?A5: Antidepressants.Q6: What assessment question will provide the nurse with information regarding the effects of a woman’s circadian rhythms on her quality of life?A6: “How much sleep do you usually get each night?”Q7: You realize that your patient who is being treated for a major depressive disorder requires more teaching when she makes the following statement:A7: “I am going to ask my nurse practitioner to discontinue my Prozac today and let me start taking a monoamine oxidase inhibitor tomorrow.”Q8: A patient being treated for insomnia is prescribed ramelteon (Rozerem). Which comorbid mental health condition would make this medication the hypnotic of choice for this particular patient?A8: Substance use disorder.Q9: Which statement made by a patient prescribed bupropion (Wellbutrin) demonstrates that the medication education the patient received was effective? Select all that apply.A9: - “I hope Wellbutrin will help my depression and also help me to finally quit smoking.”- “I’m happy to hear that I won’t need to worry too much about weight gain.”- “My partner and I have discussed the possible effects this medication could have on our sex life.”Q10: Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages?A10: Antipsychotics.Q11: The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving:A11: Lithium (Eskalith).Q12: A psychiatric nurse is reviewing prescriptions for a patient with major depression at the county clinic. Since the patient has a mild intellectual disability, the nurse would question which classification of antidepressant drugs:A12: Monoamine oxidase inhibitors.Q13: The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.A13: - “Is the patient expressing suicidal thoughts?”- “Does the patient have intact judgment and insight into his situation?”- “Does the patient require a therapeutic environment to support the management of psychotic symptoms?”- “Does the patient require the regular involvement of their family/significant other in planning and executing the plan of care?”Q14: Pablo is a homeless adult who has no family connection. Pablo passed out on the street and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select all that apply.A14: - He requires stabilization of multiple symptoms.- He has nutritional and self-care needs.- He is in imminent danger of harming himself.Q15: Which statement made by the nurse demonstrates the best understanding of nonverbal communication?A15: “When my patient responds to my question, I check for congruence between verbal and nonverbal communication to help validate the response.”Q16: Which nursing statement is an example of reflection?A16: “So you are saying that life has no meaning.”Q17: When should a nurse be most alert to the possibility of communication errors resulting in harm to the patient?A17: Change of shift report.Q18: During an admission assessment and interview, which channels of information communication should the nurse be monitoring? Select all that apply.A18: - Auditory- Visual- Tactile- OlfactoryQ19: What principle about nurse-patient communication should guide a nurse’s fear about “saying the wrong thing” to a patient?A19: Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.Q20: You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic?A20: “You say you look forward to the meeting, but you appear anxious or unhappy.”Q21: Which student behavior is consistent with therapeutic communication?A21: Summarizing the essence of the patient’s comments in your own words.Q22: James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, “Last night, demons came to my room and tried to rape me.” Which response would be most therapeutic?A22: “You seem very upset. Please tell me more about what you experienced last night.”Q23: Therapeutic communication is the foundation of a patient-centered interview. Which of the following techniques is not considered therapeutic?A23: Asking “why” questions.Q24: Carolina is surprised when her patient does not show for a regularly scheduled appointment. When contacted, the patient states, “I don’t need to come see you anymore. I have found a therapy app on my phone that I love.” How should Carolina respond to this news?A24: “That sounds exciting, would you be willing to visit and show me the app?”Q25: Which statement demonstrates a well-structured attempt at limit setting?A25: “Hitting me when you are angry is unacceptable.”Q26: Which activity is most appropriate for a child with ADHD?A26: Tennis.Q27: Cognitive-behavioral therapy is going well when a 12-year-old patient in therapy reports to the nurse practitioner:A27: “I thought that everyone at school hated me. That’s not true. Most people like me and I have a friend named Todd.”Q28: What assessment question should the nurse ask when attempting to determine a teenager’s mental health resilience? Select all that apply.A28: - “How did you cope when your father deployed with the Army for a year in Iraq?”- “Who did you go to for advice while your father was away for a year in Iraq?”Q29: Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply.A29: - Limited language skills- Level of cognitive development- Level of emotional development- Parental denial that a problem existsQ30: In pediatric mental health there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: Select all that apply.A30: - Children of color and poor economic conditions being underserved- Increased stress in the family unit- Premature termination of servicesQ31: Child protective services have removed 10-year-old Christopher from his parents’ home due to neglect. Christopher reveals to the nurse that he considers the woman next door his “nice” mom, that he loves school, and gets above average grades. The strongest explanation of this response is:A31: Resilience.Q32: April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April’s mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that:A32: Time-out is no longer an effective therapeutic measure.Q33: Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to:A33: Cerebellum maturation.Q34: Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia?A34: Always afraid another student will steal her belongings.Q35: Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia?A35: Screening a group of males between the ages of 15 and 25 for early symptoms.Q36: To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition? Select all that apply.A36: - Alcohol use disorder- Major depressive disorder- Polydipsia- Metabolic syndromeQ37: A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?A37: She should experience a reduction in hallucinations.Q38: Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?A38: Paranoia.Q39: Gilbert, age 19, is described by his parents as a “moody child” with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert’s early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:A39: To have a less positive outcome.Q40: Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient’s nursing diagnosis is altered thought processes?A40: “You say you hear voices, what are they telling you?”Q41: When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:A41: They are not actually ill.Q42: Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply.A42: - Hold his medication and contact his prescriber.- Wipe him with a washcloth wet with cold water or alcohol.Q43: Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas’s nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:A43: Anxiety and depression.Q44: Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar and her support system? Select all that apply.A44: - “Remember that alcohol and caffeine can trigger a relapse of your symptoms.”- “It’s critical to let your healthcare provider know immediately if you aren’t sleeping well.”- “Is your family prepared to be actively involved in helping manage this disorder?”- “The symptoms tend to come and go and so you need to be able to recognize the early signs.”Q45: Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply.A45: - “I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day.”- “I discussed the diuretic my cardiologist prescribed with my psychiatric care provider.”- “I’ve already made arrangements for my monthly lab work.”Q46: The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply.A46: - An upset stomach for no apparent reason- Shaky hands that make holding a cup difficultQ47: A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially?A47: Instruct the patient to hold the next dose of medication and contact the prescriber.Q48: Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply.A48: - Monitor the patient’s vital signs frequently.- Provide the patient with frequent milkshakes and protein drinks.- Reduce the volume on the television and dim bright lights in the environment.- Use a firm but calm voice to give specific concise directions to the patient.Q49: Substance abuse is often present in people diagnosed with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that:A49: Alcohol ingestion is a form of self-medication.Q50: Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted’s wife and his blood tests confirm. To reduce Ted’s mania the psychiatric nurse practitioner recommends:A50: Electroconvulsive therapy (ECT).Q51: A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, “You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing”:A51: A lower dosage.Q52: Tatiana has been hospitalized for an acute manic episode. On admission the nurse suspects lithium toxicity. What assessment findings would indicate the nurse’s suspicion as correct?A52: Ataxia, severe hypotension, large volume of dilute urine.Q53: Luc’s family comes home one evening to find him extremely agitated and they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting?A53: Energy drink containers.Q54: Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder?A54: “I go to sleep around 11 p.m. but I’m always up by 3 a.m. and can’t go back to sleep.”Q55: Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply.A55: - “What do you do to manage anxiety?”- “Do you have a history of disordered eating?”- “Do you think that you drink too much?”Q56: Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population?A56: Conducting routine suicide screenings at a senior center.Q57: Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply.

%1 NR 668 EXAM PREP LATEST: Psychiatric Mental Health Capstone Practicum & Intensive %2%3 Deze oefenvragen zijn ontworpen om studenten te helpen zich voor te bereiden op het NR 668 examen voor Psychiatric Mental Health Capstone Practicum & Intensive. De vragen beslaan een breed scala aan onderwerpen binnen de psychiatrische zorg, inclusief diagnostische methoden, behandelstrategieën en therapeutische communicatie. %4Q1: What are the main components of a psychiatric assessment and what are some tools or methods to conduct each component?A1: A psychiatric assessment consists of four main components: history, mental status examination, physical examination, and diagnostic tests. Some tools or methods to conduct each component are:- History: interviewing the patient and obtaining information from other sources (e.g., family, medical records) about the patients personal, family, medical, psychiatric, social, occupational, and substance use history.- Mental status examination: observing and documenting the patients appearance, behavior, mood, affect, speech, thought process, thought content, perception, cognition, insight, and judgment.- Physical examination: performing a general physical examination and focusing on any signs or symptoms that may indicate a medical condition that could affect the patients mental health or interfere with the treatment.- Diagnostic tests: ordering and interpreting laboratory tests (e.g., blood tests, urine tests), imaging studies (e.g., CT scan, MRI), or other tests (e.g., electroencephalogram, neuropsychological testing) that may help to rule out or confirm a diagnosis or identify any comorbidities.Q2: What are some common psychiatric emergencies and how would you manage them in a clinical setting?A2: Some common psychiatric emergencies are:- Suicidal ideation or behavior: assessing the patients risk level, ensuring their safety, providing support and crisis intervention, initiating or modifying the treatment plan, and arranging for follow-up care or referral.- Aggressive or violent behavior: assessing the patients risk level, ensuring the safety of the patient and others, using de-escalation techniques or physical restraint if necessary, administering medication if indicated, and evaluating the cause and triggers of the behavior.- Psychotic symptoms: assessing the patients level of reality testing, ensuring their safety, providing support and reassurance, administering medication if indicated, and evaluating the cause and severity of the symptoms.- Substance intoxication or withdrawal: assessing the patients level of intoxication or withdrawal, ensuring their safety, providing supportive care and monitoring vital signs, administering medication if indicated, and evaluating the need for detoxification or referral.Q3: What are some evidence-based psychotherapies for major depressive disorder and how do they work?A3: Some evidence-based psychotherapies for major depressive disorder are:- Cognitive-behavioral therapy (CBT): a short-term therapy that aims to identify and modify the patients negative thoughts and behaviors that contribute to their depression. It also teaches the patient coping skills and problem-solving strategies to deal with stressful situations and improve their mood.- Interpersonal therapy (IPT): a short-term therapy that focuses on the patients interpersonal relationships and how they affect their depression. It also helps the patient to improve their communication skills and resolve any conflicts or role transitions that may cause distress.- Behavioral activation (BA): a therapy that involves increasing the patients engagement in rewarding activities that are consistent with their values and goals. It also helps the patient to reduce their avoidance of unpleasant situations and cope with negative emotions.- Mindfulness-based cognitive therapy (MBCT): a therapy that combines CBT with mindfulness techniques such as meditation and awareness exercises. It helps the patient to become more aware of their thoughts and feelings without judging them or reacting to them. It also helps the patient to prevent relapse by recognizing early signs of depression and applying coping skills.Q4: What are some pharmacological treatments for bipolar disorder and what are their indications, contraindications, side effects, and monitoring parameters?A4: Some pharmacological treatments for bipolar disorder are:- Mood stabilizers: medications that help to prevent or reduce the frequency and severity of manic and depressive episodes. Examples are lithium, valproate, carbamazepine, and lamotrigine. Their indications are acute mania, acute depression, or maintenance treatment. Their contraindications are hypersensitivity, severe renal or hepatic impairment, or pregnancy (for some agents). Their side effects include gastrointestinal distress, weight gain, tremor, sedation, cognitive impairment, rash, and blood dyscrasias. Their monitoring parameters include serum levels, renal function, liver function, thyroid function, and blood counts.- Antipsychotics: medications that help to control psychotic symptoms such as delusions, hallucinations, or paranoia that may occur in bipolar disorder. Examples are olanzapine, quetiapine, risperidone, aripiprazole, and ziprasidone. Their indications are acute mania with psychotic features, acute depression with psychotic features.Q5: Besides antianxiety agents, which classification of drugs is also commonly given to treat anxiety and anxiety disorders?A5: Antidepressants.Q6: What assessment question will provide the nurse with information regarding the effects of a woman’s circadian rhythms on her quality of life?A6: “How much sleep do you usually get each night?”Q7: You realize that your patient who is being treated for a major depressive disorder requires more teaching when she makes the following statement:A7: “I am going to ask my nurse practitioner to discontinue my Prozac today and let me start taking a monoamine oxidase inhibitor tomorrow.”Q8: A patient being treated for insomnia is prescribed ramelteon (Rozerem). Which comorbid mental health condition would make this medication the hypnotic of choice for this particular patient?A8: Substance use disorder.Q9: Which statement made by a patient prescribed bupropion (Wellbutrin) demonstrates that the medication education the patient received was effective? Select all that apply.A9: - “I hope Wellbutrin will help my depression and also help me to finally quit smoking.”- “I’m happy to hear that I won’t need to worry too much about weight gain.”- “My partner and I have discussed the possible effects this medication could have on our sex life.”Q10: Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages?A10: Antipsychotics.Q11: The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving:A11: Lithium (Eskalith).Q12: A psychiatric nurse is reviewing prescriptions for a patient with major depression at the county clinic. Since the patient has a mild intellectual disability, the nurse would question which classification of antidepressant drugs:A12: Monoamine oxidase inhibitors.Q13: The mental health team is determining treatment options for a male patient who is experiencing psychotic symptoms. Which question(s) should the team answer to determine whether a community outpatient or inpatient setting is most appropriate? Select all that apply.A13: - “Is the patient expressing suicidal thoughts?”- “Does the patient have intact judgment and insight into his situation?”- “Does the patient require a therapeutic environment to support the management of psychotic symptoms?”- “Does the patient require the regular involvement of their family/significant other in planning and executing the plan of care?”Q14: Pablo is a homeless adult who has no family connection. Pablo passed out on the street and emergency medical services took him to the hospital where he expresses a wish to die. The physician recognizes evidence of substance use problems and mental health issues and recommends inpatient treatment for Pablo. What is the rationale for this treatment choice? Select all that apply.A14: - He requires stabilization of multiple symptoms.- He has nutritional and self-care needs.- He is in imminent danger of harming himself.Q15: Which statement made by the nurse demonstrates the best understanding of nonverbal communication?A15: “When my patient responds to my question, I check for congruence between verbal and nonverbal communication to help validate the response.”Q16: Which nursing statement is an example of reflection?A16: “So you are saying that life has no meaning.”Q17: When should a nurse be most alert to the possibility of communication errors resulting in harm to the patient?A17: Change of shift report.Q18: During an admission assessment and interview, which channels of information communication should the nurse be monitoring? Select all that apply.A18: - Auditory- Visual- Tactile- OlfactoryQ19: What principle about nurse-patient communication should guide a nurse’s fear about “saying the wrong thing” to a patient?A19: Patients tend to appreciate a well-meaning person who conveys genuine acceptance, respect, and concern for their situation.Q20: You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic?A20: “You say you look forward to the meeting, but you appear anxious or unhappy.”Q21: Which student behavior is consistent with therapeutic communication?A21: Summarizing the essence of the patient’s comments in your own words.Q22: James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, “Last night, demons came to my room and tried to rape me.” Which response would be most therapeutic?A22: “You seem very upset. Please tell me more about what you experienced last night.”Q23: Therapeutic communication is the foundation of a patient-centered interview. Which of the following techniques is not considered therapeutic?A23: Asking “why” questions.Q24: Carolina is surprised when her patient does not show for a regularly scheduled appointment. When contacted, the patient states, “I don’t need to come see you anymore. I have found a therapy app on my phone that I love.” How should Carolina respond to this news?A24: “That sounds exciting, would you be willing to visit and show me the app?”Q25: Which statement demonstrates a well-structured attempt at limit setting?A25: “Hitting me when you are angry is unacceptable.”Q26: Which activity is most appropriate for a child with ADHD?A26: Tennis.Q27: Cognitive-behavioral therapy is going well when a 12-year-old patient in therapy reports to the nurse practitioner:A27: “I thought that everyone at school hated me. That’s not true. Most people like me and I have a friend named Todd.”Q28: What assessment question should the nurse ask when attempting to determine a teenager’s mental health resilience? Select all that apply.A28: - “How did you cope when your father deployed with the Army for a year in Iraq?”- “Who did you go to for advice while your father was away for a year in Iraq?”Q29: Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply.A29: - Limited language skills- Level of cognitive development- Level of emotional development- Parental denial that a problem existsQ30: In pediatric mental health there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: Select all that apply.A30: - Children of color and poor economic conditions being underserved- Increased stress in the family unit- Premature termination of servicesQ31: Child protective services have removed 10-year-old Christopher from his parents’ home due to neglect. Christopher reveals to the nurse that he considers the woman next door his “nice” mom, that he loves school, and gets above average grades. The strongest explanation of this response is:A31: Resilience.Q32: April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April’s mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that:A32: Time-out is no longer an effective therapeutic measure.Q33: Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to:A33: Cerebellum maturation.Q34: Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia?A34: Always afraid another student will steal her belongings.Q35: Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia?A35: Screening a group of males between the ages of 15 and 25 for early symptoms.Q36: To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition? Select all that apply.A36: - Alcohol use disorder- Major depressive disorder- Polydipsia- Metabolic syndromeQ37: A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms?A37: She should experience a reduction in hallucinations.Q38: Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia?A38: Paranoia.Q39: Gilbert, age 19, is described by his parents as a “moody child” with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert’s early and slow onset of what is now recognized as schizophrenia, his prognosis is considered:A39: To have a less positive outcome.Q40: Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient’s nursing diagnosis is altered thought processes?A40: “You say you hear voices, what are they telling you?”Q41: When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that:A41: They are not actually ill.Q42: Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply.A42: - Hold his medication and contact his prescriber.- Wipe him with a washcloth wet with cold water or alcohol.Q43: Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas’s nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with:A43: Anxiety and depression.Q44: Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar and her support system? Select all that apply.A44: - “Remember that alcohol and caffeine can trigger a relapse of your symptoms.”- “It’s critical to let your healthcare provider know immediately if you aren’t sleeping well.”- “Is your family prepared to be actively involved in helping manage this disorder?”- “The symptoms tend to come and go and so you need to be able to recognize the early signs.”Q45: Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply.A45: - “I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day.”- “I discussed the diuretic my cardiologist prescribed with my psychiatric care provider.”- “I’ve already made arrangements for my monthly lab work.”Q46: The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply.A46: - An upset stomach for no apparent reason- Shaky hands that make holding a cup difficultQ47: A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially?A47: Instruct the patient to hold the next dose of medication and contact the prescriber.Q48: Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply.A48: - Monitor the patient’s vital signs frequently.- Provide the patient with frequent milkshakes and protein drinks.- Reduce the volume on the television and dim bright lights in the environment.- Use a firm but calm voice to give specific concise directions to the patient.Q49: Substance abuse is often present in people diagnosed with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that:A49: Alcohol ingestion is a form of self-medication.Q50: Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted’s wife and his blood tests confirm. To reduce Ted’s mania the psychiatric nurse practitioner recommends:A50: Electroconvulsive therapy (ECT).Q51: A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, “You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing”:A51: A lower dosage.Q52: Tatiana has been hospitalized for an acute manic episode. On admission the nurse suspects lithium toxicity. What assessment findings would indicate the nurse’s suspicion as correct?A52: Ataxia, severe hypotension, large volume of dilute urine.Q53: Luc’s family comes home one evening to find him extremely agitated and they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting?A53: Energy drink containers.Q54: Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder?A54: “I go to sleep around 11 p.m. but I’m always up by 3 a.m. and can’t go back to sleep.”Q55: Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply.A55: - “What do you do to manage anxiety?”- “Do you have a history of disordered eating?”- “Do you think that you drink too much?”Q56: Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population?A56: Conducting routine suicide screenings at a senior center.Q57: Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply.