Nursing Expert Q&A

The relapse of a patient diagnosed with schizophrenia is related to medication nonadherence. The patient is hospitalized for 5 days, medication is restarted, and the patient's thoughts are now more organized. The patient's family members are upset and say, "It's too soon for discharge. Hospitalization is needed for at least a month." The nurse should:

A) call the psychiatrist to come explain the discharge rationale.
B) explain that health insurance will not pay for a longer stay for the patient.
C) call security to handle the disturbance and escort the family off the unit.
D) explain that the patient will continue to improve if medication is taken regularly.

The spouse of a patient who has delusions asks the nurse, "Are there any circumstances under which the treatment team is justified in violating the patient's right to confidentiality?" The nurse must reply that confidentiality may be breached:

A) under no circumstances.
B) at the discretion of the psychiatrist.
C) when questions are asked by law enforcement.
D) if the patient threatens the life of another person.

To provide comprehensive care to patients, which competency is more important for a nurse who works in a community mental health center than a psychiatric nurse who works in an inpatient unit?

A) Problem-solving skills
B) Calm and caring manner
C) Ability to cross service systems
D) Knowledge of psychopharmacology

A basic level registered nurse works with patients in a community setting. Which groups should this nurse expect to lead? (Select all that apply.)

A) Symptom management
B) Medication education
C) Family therapy
D) Psychotherapy
E) Self-care

Operant conditioning will be used to encourage speech in a child who is nearly mute. Which technique would a nurse include in the treatment plan?

A) Ignore the child for using silence.
B) Have the child observe others talking.
C) Give the child a small treat for speaking.
D) Teach the child relaxation techniques, then coax speech.

A person received an invitation to be in the wedding of a friend who lives across the country. The individual is afraid of flying. What type of therapy should the nurse recommend?

A) Psychoanalysis
B) Milieu therapy
C) Systematic desensitization
D) Short-term dynamic therapy

Select the most appropriate label to complete this nursing diagnosis: ___________, related to feelings of shyness and poorly developed social skills as evidenced by watching television alone at home every evening.

A) Deficient knowledge
B) Ineffective coping
C) Powerlessness
D) Social isolation

The nurse wants to assess for disturbances in circadian rhythms in a patient admitted for major depressive disorder. Which question best implements this assessment?

A) "Do you ever see or hear things that others do not?"
B) "Do you have problems with short-term memory?"
C) "What are your worst and best times of day?"
D) "How would you describe your thinking?"

Cognitive behavioral therapy was provided for a patient who frequently said, "I'm stupid." Which statement by the patient indicates the therapy was effective?

A) "I'm disappointed in my lack of ability."
B) "I always fail when I try new things."
C) "Things always go wrong for me."
D) "Sometimes I do stupid things."

A patient has delusions and hallucinations. Before beginning treatment with a psychotropic medication, the health care provider wants to rule out the presence of a brain tumor. For which test will a nurse need to prepare the patient?

A) Cerebral arteriogram
B) Functional magnetic resonance imaging (fMRI)
C) Computed tomography (CT) scan or magnetic resonance imaging (MRI)
D) Positron emission tomography (PET) or single-photon emission computed tomography (SPECT)

Which research evidence would most influence a group of nurses to change their practice?

A) Expert committee report of recommendations for practice
B) Systematic review of randomized controlled trials
C) Non-experimental descriptive study
D) Critical pathway

Which assessment finding for a patient living in the community requires priority intervention by the nurse? The patient:

A) receives Social Security disability income plus a small check from a trust fund.
B) lives in an apartment with two patients who attend day hospital programs.
C) has a sibling who is interested and active in care planning.
D) purchases and uses marijuana on a frequent basis.

Which belief by a nurse supports the highest degree of patient advocacy during a multidisciplinary patient care planning session?

A) All mental illnesses are culturally determined.
B) Schizophrenia and bipolar disorder are cross-cultural disorders.
C) Symptoms of mental disorders are constant from culture to culture.
D) Some symptoms of mental disorders may reflect a person's cultural patterns.

Which entry in the medical record best meets the requirement for problem-oriented charting?

A) "A: Pacing and muttering to self. P: Sensory perceptual alteration, related to internal auditory stimulation. I: Given fluphenazine (Prolixin) 2.5 mg at 0900, and went to room to lie down. E: Calmer by 0930. Returned to lounge to watch TV."
B) "S: States, 'I feel like I'm ready to blow up.' O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol (Haldol) 2 mg. I: (Haldol) 2 mg at 0900. E: Returned to lounge at 0930 and quietly watched TV."
C) "Agitated behavior. D: Patient muttering to self as though answering an unseen person. A: Given haloperidol (Haldol) 2 mg and went to room to lie down. E: Patient calmer. Returned to lounge to watch TV."
D) "Pacing hall and muttering to self as though answering an unseen person. haloperidol (Haldol) 2 mg administered at 0900 with calming effect in 30 minutes. Stated, 'I'm no longer bothered by the voices.'"

Two hospitalized patients fight when they are in the same room. During a team meeting, a nurse asserts that safety is of paramount importance and therefore the treatment plans should call for both patients to be secluded to prevent them from injuring each other. This assertion:

A) reveals that the nurse values the principle of justice.
B) reinforces the autonomy of the two patients.
C) violates the civil rights of the two patients.
D) represents the intentional tort of battery.

A critical care nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and a nursing diagnosis. Select the psychiatric nurse's best response.

A) "No functional difference exists between the two diagnoses. Both serve to identify a human deviance."
B) "The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis includes cultural variables."
C) "The DSM-5 diagnosis profiles present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems."
D) "The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience."

A nurse uses Peplau's interpersonal therapy while working with an anxious, withdrawn patient. Interventions should focus on:

A) changing the patient's perceptions about self.
B) improving the patient's interactional skills.
C) using medications to relieve anxiety.
D) reinforcing specific behaviors.

A patient diagnosed with major depressive disorder has lost 20 pounds in one month. The patient has chronic low self-esteem and a plan for suicide. The patient has taken an antidepressant medication for 1 week. Which nursing intervention is most directly related to this priority: "Patient will refrain from gestures and attempts to harm self"?

A) Implement suicide precautions.
B) Frequently offer high-calorie snacks and fluids.
C) Assist the patient to identify three personal strengths.
D) Observe patient for therapeutic effects of antidepressant medication.

A patient begins therapy with a first generation antipsychotic medication. What teaching should a nurse provide related to the drug's strong dopaminergic effect?

A) Chew sugarless gum.
B) Increase dietary fiber.
C) Arise slowly from bed.
D) Report muscle stiffness.

Several nurses are concerned that agency policies related to restraint and seclusion are inadequate. Which statement about the relationship of substandard institutional policies and individual nursing practice should guide nursing practice?

A) The policies do not absolve an individual nurse of the responsibility to practice according to the professional standards of nursing care.
B) Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care.
C) In an institution with substandard policies, the nurse has a responsibility to inform the supervisor and leave the premises.
D) Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.