MENTAL HEALTH EAQs ACTUAL EXAM COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS
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Med surg 1
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Med Surg 1
MENTAL HEALTH EAQs ACTUAL EXAM COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS MENTAL HEALTH EAQs ACTUAL EXAM COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS MENTAL HEALTH EAQs ACTUAL EXAM COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS MENTAL HEALTH EAQs ACTUAL EXAM COMPLETE QUESTIONS AND CORRECT ...
MENTAL HEALTH EAQs ACTUAL EXAM
COMPLETE QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED
ANSWERS) ALREADY GRADED A+
1. What is the basic therapeutic tool used by the nurse to foster a client's
psychologic coping?
1. self
2. milieu
3. helping process
4. client's intellect: 1. self
The self is often the most important tool available to the nurse to help a client
cope; to be therapeutic, the nurse must be present, actively listening, and
attentive. The environment is important, but it is not the most basic tool. The
nurse first must use the self before the helping process can begin. The client's
intellect is not generally a therapeutic tool used by the nurse.
2. A client is admitted to the emergency department after ingesting a tricyclic
antidepressant in an amount 30 times the daily recommended dose. What is the
immediate treatment anticipated by the nurse?
1. Administration of physostigmine as soon as possible
2. Closer monitoring to prevent further suicidal attempts
3. Gastric lavage with activated charcoal and support of physiologic function4.
IV administration of an anticholinergic in response to changes in vital signs:
3. Gastric Lavage
Gastric lavage with charcoal may help decrease the level of tricyclic antidepressant
overdose. Supportive measures such as mechanical ventilation may be needed until
,the medical crisis passes. Physostigmine salicylate was used in the past to promote
improvement in consciousness. Now its use is contraindicated because it can cause
bradycardia, asystole, and seizures in clients with tricyclic antidepressant toxicity.
Prevention of suicidal behavior is always advantageous; however, in this case
immediate emergency intervention is necessary. The acetylcholine level is
depressed as a result of the tricyclic antidepressant; anticholinergics are most
effective in managing the side effects of antipsychotic and neuroleptic drugs, not
tricyclic antidepressant drugs.
3. An older depressed person at an independent living facility constantly
complains about her health problems to anyone who will listen. One day the
client says, "I'm not going to any more activities. All these old crabby people do
is talk about their problems." What defense mechanism does the nurse conclude
that the client is using?
The client is assigning to others those feelings and emotions that are unacceptable
to herself. Introjection is treating something outside the self as if it is inside the self.
Somatization is the unconscious transformation of anxiety into a physical symptom
that has no organic cause. Rationalization is the use of a socially acceptable logical
explanation to justify personally unacceptable material.
4. A nurse is assessing a client for the use of defense mechanisms. In the
presence of which defense mechanism does the client express emotional
conflicts through motor, sensory, or somatic disabilities?
The defense mechanism is called conversion because the individual reduces
emotional anxiety to a physical disability. Projection occurs when people assign
,their own unacceptable thoughts and feelings to others. With dissociation there is
separation of certain mental processes from consciousness as though they belonged
to another; a dissociative reaction is expressed as amnesia, fugue, multiple
personality, aimless running, depersonalization, sleepwalking, and other
behaviors. Compensation is a mechanism used to make up for a lack in one area by
emphasizing capabilities in another.
5. A client has been diagnosed with generalized anxiety disorder (GAD). Which
behavior supports this diagnosis?
1. Making huge efforts to avoid "any kind of bug or spider"
2. Experiencing flashbacks to an event that involved a sexual attack
3. Spending hours each day worrying about something "bad happening"4.
Becoming suddenly tachycardic and diaphoretic for no apparent reason: 3.
Spending hours each day worrying about something "bad happening"
Using worrying as a coping mechanism is a behavior characteristic of GAD.
Experiencing an accelerated heart rate and perfuse sweating for no apparent
reason is consistent with a panic attack. Avoiding bugs and spiders would
indicate a phobia.
Flashbacks to traumatic events are characteristic of posttraumatic stress disorder
(PTSD).
6. A mother and her three young children arrive at the mental health clinic. The
woman says that she is seeking help in leaving her husband. She reports that he
has been beating her for years but just started hitting the children. What is the
best initial action by the nurse?
1. Arranging for a staff member to watch the children so the mother and nurse
can talk
2. Calling a facility where the mother and her children will be safe until the
crisis is resolved
3. Determining whether the mother is ambivalent about this decision before
making permanent plans
4. Suggesting that the mother and her husband return for couples counseling
so the marriage can be saved: 1. answer
, This emotionally charged topic should be discussed with the client in a confidential
session; after the nurse has assessed the situation, the woman and the nurse can
plan the family's future. Although a safe facility may be called, a determination of
the client's ambivalence may be made, and couples counseling may be
recommended eventually, all three actions are premature if a thorough assessment
of the situation has not been made.
7. The nurse is scheduled to be the co-leader of a therapy group being formed in
the mental health clinic. When planning for the first meeting, it is of primary
importance that the nurse consider what?
1. Number of clients in the group
2. Needs of the clients being included
3. Diagnoses of the clients being included
4. Socioeconomic status of the clients in the group: 2. answer
When planning a group, the nurse must ensure that clients have similar needs to
promote relationships and interactions; diverse needs do not foster group process.
Although important, the number of clients is not a primary consideration.
Behavior and needs, rather than diagnoses, are of primary importance. The
socioeconomic status of the clients in the group has little effect on group process.
8. A nurse is planning to teach a client about self-care. What level of anxiety will
best enhance the client's learning abilities?
1. Mild
2. Panic
3. Severe
4. Moderate: 1. answer
Mild anxiety motivates one to action, such as learning or making changes. Higher
levels of anxiety tend to blur the individual's perceptions and interfere with
functioning. Attention is severely reduced by panic. The perceptual field is greatly
reduced with severe anxiety and narrowed with moderate anxiety.
9. A client is found to have a borderline personality disorder. What is a realistic
initial intervention for this client?
1. Establishing clear boundaries
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