Psychiatric Answers II

31. Answer: C

Rationale: A situational crisis arises from external rather than internal sources. External situations that could precipitate crisis include loss of or change of a job, the death of a loved one, abortion, a change in financial status, divorce, the addiction of new family members, pregnancy and sever illness. Options A, B and D identify adventitious crisis. An adventitious crisis is not a part of every day life, is unplanned and accidental. (Saunders, 2nd Edition)

32. Answer: A

Rationale: A nurse's initial task when gathering data from a client in crisis is to assess the individual or family and the problem. The more clearly the problem can be defined, the better the chance a solution can be found. Option A will assist in determining data related to the precipitating event that led to the crisis. Options B and D identify situational supports. Option C identifies personal coping skills. (Saunders, 2nd Edition)

33. Answer: D

Rationale: Although each crisis response can be described in similar terms as far as presenting symptoms are concerned, what constitutes a crisis for one person may not constitute a crisis for another person because each is a unique individual. Being in a crisis state does not mean that the client is suffering from an emotional or mental illness as stated in options B and C. (Saunders, 2nd Edition)

34. Answer: A

Rationale: Going for counseling demonstrates the client's recognition that assistance is needed. In option B, there are no data to support such conclusion. (Mosby, 17th Edition, 2003)

35. Answer: A

Rationale: It is not the events but how the individual perceives them that is most significant in either precipitating or avoiding crisis. In option B, changes in role may occur but again, the individual's perception of these changes is most influential. Option C may be a factor but perception is most important. Option D is not a significant factor; the family may provide support and yet a crisis can still occur. (Mosby, 17th Edition, 2003)

36. Answer: C

Rationale: Clients who are depressed may be at risk for suicide. It is critical for the nurse to assess suicidal ideation and plan. The client should be directly asked if a plan for self-harm exists. Options A, B and D are not therapeutic responses. (Saunders, 2nd Edition)

37. Answer: B

Rationale: the client is experiencing loss and is feeling hopeless. The most therapeutic response by the nurse is the one that attempts to translate words into feelings. In option A, the nurse is voicing doubt, which is often used when a client verbalizes delusional ideas. In option C, the nurse is disagreeing with the client, which implies that the nurse has passed judgment on the client's ideas or opinions. In option D, the nurse uses sarcasm, which gives advice and is nontherapeutic as a nursing response. (Saunders, 2nd Edition)

38. Answer: C

Rationale: Concentration and memory are poor in a client with severe depression. When a client has a diagnosis of severe depression, the nurse needs to provide activities that require little concentration. Activities that have no right or wrong choices or decisions minimize opportunities for the client to put themselves down. (Saunders, 2nd Edition)

39. Answer: D

Rationale: A depressed, suicidal client often “gives” away that which is of value as way of saying “good-bye” and wanting to be remembered. Options A, B and C identify acting-out behaviors. (Saunders, 2nd Edition)

40. Answer: A

Rationale: Hanging is a serious suicide attempt. The plan of care must reflect action that will promote the client's safety. Constant observation status (one-on-one) with a staff member who is never less than an arm's length away is the best intervention. (Saunders, 2nd Edition)

41. Answer: D

Rationale: Because therapeutic and toxic dosage ranges are so close, lithium blood levels must be monitored very closely, more frequently at first and then once every several months (A). The client should be instructed to contact the physician if excessive diarrhea, vomiting or diaphoresis occurs (B). Lithium is irritating to the gastric mucosa; therefore lithium should be taken with meals (C). A normal diet and normal salt and fluid intake (1500 to 3000 ml per day) should be maintained because lithium decreases sodium reabsorption by the renal tubules, which could cause sodium depletion. A low sodium intake causes lithium retention and could lead to toxicity. (Saunders, 2nd Edition)

42. Answer: D

Rationale: The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. Serum lthium levels above the therapeutic level will produce signs of toxicity. (Saunders, 2nd Edition)

43. Answer: C

Rationale: The client who is on lithium carbonate must be off the medication for 1 to 2 days before a scheduled surgical procedure and can resume the medication when full oral intake is ordered after the surgery. Options A, B and D are incorrect. (Saunders, 2nd Edition)

44. Answer: D

Rationale: The therapeutic serum level of lithium is 0.6 to 1.2 mEq/L. A level of 3 mEq/L indicates toxicity. (Saunders, 2nd Edition)

45. Answer: C

Rationale: Lithium is the medication of choice to treat manic-depressive illness. Many over-the-counter (OTC) medications interact with lithium, and the client is instructed to avoid OTC medications while taking lithium. Lithium is not addicting (B) and although serum lithium levels need to be monitored, it is not necessary to check these levels every 2 weeks (D). In option A, a tyramine-free diet is associated with monoamine oxidase inhibitors (MAOIs). (Saunders, 2nd Edition)

46. Answer: D

Rationale: Fluoxetine HCl (Prozac) is administered in the early morning without consideration to meals. Options A, B and C are incorrect. (Saunders, 2nd Edition)

47. Answer: C

Rationale: The therapeutic effects of administration of imipramine HCl (Tofranil) may not occur for 2 to 3 weeks after the antidepressant therapy has been initiated. (Saunders, 2nd Edition)

48. Answer: A

Rationale: Clomipramine (Anafranil) is commonly used in the treatment of obsessive-compulsive disorder. Handwashing is a common obsessive-compulsive behavior. Weight gain is a common side effect of this medication. Tachycardia and sedation are side effects. Insomnia may occur as a seldom side effect. (Saunders, 2nd Edition)

49. Answer: B

Rationale: Bupropion (Wellbutrin) does not cause significant orthostatic blood pressure changes (A). Seizure activity is common in dosages greater than 450 mg a day. Bupropion frequently causes a drop in body weight. Insomnia is side effect (D), but seizure activity causes a greater client risk. (Saunders, 2nd Edition)

50. Answer: D

Rationale: Tranylcypromine sulfate (Parnate) is a monoamine oxidase inhibitor (MAOI) used to treat depression. A tyramine-restricted diet is required while on this medication to avoid hypertensive crisis, a life-threatening side effect of the medication. Foods to be avoided are meats prepared with tenderizer, smoked or picked fish, beef or chicken liver, and dry sausage (salami, pepperoni, bologna). In addition, figs, bananas, aged cheese, yogurt, sour cream, beer, red wine, alcoholic beverages, soy sauce, yeast extract, chocolate, caffeine, and aged, pickled, fermented or smoked foods need to be avoided. Many over-the-counter medications also contain tyramine and must be avoided as well. (Saunders, 2nd Edition)

51. Answer: A

Rationale: In option A, the response invited the client to explore the issue in more depth by focusing on it. (B) Clarifying is a technique used to ask the client to give an example to better understand the nature of the client's statement. (C) Reflecting is a technique used to either reiterate the content or the feeling message; in content reflection, the nurse repeats basically the same statement; in feeling reflection, the nurse verbalizes what seems to be implied about feelings in the comment. (D) This is incorrect; refocusing is to bring the subject back to a previous point; there is no information that this was discussed previously. (Mosby, 17th Edition, 2003)

52. Answer: D

Rationale: Ambivalence about life and death plus the introspection commonly found in clients with emotional problems would lead to increased anxiety and fear in the group members. Option A will probably be a secondary goal of the group leader. Option B is not a primary goal; but this lack of concern should also be explored later on to see what is behind such apparent indifference, which may be a mask to cover feelings. In option C, these feelings must be handled within the support and supervisory systems for the staff; the other group members are the primary concern. (Mosby, 17th Edition, 2003)

53. Answer: C

Rationale: Option C puts the focus on feelings, not on a statement of what did or did not happen. Option A implies that the client may have had some part in causing another person's death. Option B does not give the client an opportunity to explore feelings. Option D closes the door to any further communication of feelings or fears. (Mosby, 17th Edition, 2003)

54. Answer: A

Rationale: This statement recognizes the importance of feelings and provide an opening so that client may talk about them. In the statement on option B, the client is not going to believe this, and it is not helping the client express feelings. Option C is incorrect because the nursing goal is to help people function outside the hospital environment, not be afraid to leave it. In option D, a statement like this avoids the real issue and solves nothing. (Mosby, 17th Edition, 2003)

55. Answer: D

Rationale: Commenting on the silence will encourage exploration of what is happening in the group and the members' thoughts and feelings about it. (A) waiting indefinitely can result in increased anxiety and a power struggle between members and leaders, each determined to outwait the other. In option B, calling on specific members limit growth potential of members. In option C, forcing responses instead of allowing spontaneous responses will decrease thoughtful exploration of what is happening. (Mosby, 17th Edition, 2003)

56. Answer: A

Rationale: It is the most effective method for the child to play out feelings; when the feelings are allowed to surface, the child can then learn to face them by controlling, accepting, or abandoning them; through this process, the child can experience growth. Options B, C and D are not child specific and generally are more suited for adolescents, young adults and adults. (Mosby, 17th Edition, 2003)

57. Answer: D

Rationale: The nurse's response urges the client to reflect on feelings and encourages the communication of feeling tones. Option A is an evasion technique which shift the responsibility from the nurse to the doctor. Option B closes the door to further communication since it is not what the client is asking the nurse. In option C, “Why” asks the client to draw a conclusion, which this client may not be able to do. (Mosby, 17th Edition, 2003)

58. Answer: C

Rationale: Helping an individual to maintain an interest in future is therapeutic. Option A would be appropriate for an older-aged adult. In option B, lectures may or may not include emotional aspects of aging. In option D, listening is therapeutic; however, it does not ensure the client will discuss the emotional aspects of aging. (Mosby, 17th Edition, 2003)

59. Answer: D

Rationale: The first step in a plan of care should be the establishment of a meaningful relationship because it is through this relationship that the client can be helped. In option A. encouraging this behavior would not be therapeutic. Option B would be a long-term goal. In option C, reduction of stimuli may limit the hallucinations, but there is no evidence the client is not eating meals. (Mosby, 17th Edition, 2003)

60. Answer: B

Rationale: This simply states facts without getting involved in role conflict. Being a doctor is a big part of this client's self-esteem, and by the remarks made by the nurse on option A is threatening that self-esteem. Option C is incorrect because firm, consistent limits need to be set and the nurse-client role should be established. Option D is incorrect because threats will only make the situation worse and set the tone for future nurse-client interactions. (Mosby, 17th Edition, 2003)