Psychiatric Answers

1. Answer: A

Rationale: Involuntary admission is made without the client's consent. Involuntary admission is necessary when a person is a danger to self or others or is in need of psychiatric treatment or physical care. Options B, C and D describe the process of voluntary admission. (Saunders, 2nd Edition)

2. Answer: B

Rationale: Denial is refusal to admit to a painful reality, which is treated as if it does not exist. (A) In projection, a person unconsciously rejects emotionally unacceptable features and attributes them to other people, objects or situations. (C) In regression, the client returns to an earlier, more comforting, although less mature way of behaving. (D) Rationalization is justifying the unacceptable attributes about oneself. (Saunders, 2nd Edition)

3. Answer: D

Rationale: Option D identifies the therapeutic communication technique of restatement. Although it is a technique that has a prompting component to it, it repeats the client's major theme and provides the perception of the problem from the client's perspective. Option A allows the client to direct the discussion when it needs to be more focused at this point. Option B uses reflection that simply repeats the client's last words to prompt further discussion. Option C focuses on the number of nights rather than the specific problem of sleep. (Saunders, 2nd Edition)

4. Answer: D

Rationale: Option D is the only option that recognizes the client's need. This response helps the client to focus on the emotion underlying the delusion, but does not argue with it. If the nurse attempts to change the client's mind, the delusion may in fact be even more strongly held. (Saunders, 2nd Edition)

5. Answer: C

Rationale: In the termination phase, the relationship comes to a close. Ending treatment may sometimes be traumatic for clients who have come to value the relationship and the help. Because loss is an issue, any unresolved feelings related to loss may resurface during this phase. Options A, B and D are incorrect. (Saunders, 2nd Edition)

6. Answer: C

Rationale: Clients who are involuntarily admitted do not lose their right to informed consent. The informed consent needs to be obtained from the client. Options A, B and D are incorrect. (Saunders, 2nd Edition)

7. Answer: B

Rationale: A client may request to be secluded or restrained. Federal laws require the consent of the client unless an emergency situation exists in which an immediate risk to the client or others can be documented. The use of seclusion and restraint is permitted only on the written order of a physician, which also must specify the type of restraint to be used. (Saunders, 2nd Edition)

8. Answer: C

Rationale: Milieu therapy provides a safe environment that is adapted to the individual client's needs and also provides greater comfort and freedom of expression that has been experienced in the past by the client. All members contribute to the planning and functioning of the setting. (Saunders, 2nd Edition)

9. Answer: D

Rationale: Aversion therapy, also known as aversion conditioning or negative reinforcement, is a technique used to change behavior. In this therapy, a stimulus (alcohol) attractive to the client is paired with an unpleasant event in hopes of instituting the stimulus with negative properties. (A) Desensitization is the reduction of intense reactions to a stimulus by repeated exposure to the stimulus in a weaker and milder form. (B) Self-control therapy combines cognitive and behavioral approaches and is useful to deal with stress. (C) Milieu therapy provides positive environmental manipulation, both physical and social, to effect a positive change in the client. (Saunders, 2nd Edition)

10. Answer: A

Rationale: In the forming or initial stage, the members are identifying tasks and boundaries. (B) Storming involves responding emotionally to tasks. © In the norming stage, members express intimate personal opinions and feelings around personal tasks. (D) In the performing stage, members direct group energy toward the completion of tasks. (Saunders, 2nd Edition)

11. Answer: C

Rationale: responding to the feelings expressed by a client is an effective therapeutic communication technique. The correct option is an example of the use of restating. Options A, C and D block communication because they minimize the client's experience and do not facilitate exploration of the client's expressed feelings. (Saunders, 2nd Edition)

12. Answer: C

Rationale: When reading the question, you do not know whether the client is responding to the nurse's gender or is simply uncomfortable sharing personal information. The most therapeutic response for the male nurse is not to bring what may be his own gender issues into the response at this time. Options A, B and D are nontherapeutic responses. (Saunders, 2nd Edition)

13. Answer: D

Rationale: The most therapeutic response is the one that reflects the client's feelings and offers the client control of care. In option A, the nurse uses avoidance and information giving. Option B is an aggressive and nontherapeutic communication technique. Option C is social and nontherapeutic because it labels the client's behavior and is likely to provoke anger from the client. (Saunders, 2nd Edition)

14. Answer: A

Rationale: Reflection is the therapeutic communication technique that redirects the client's feeling back in order to validate what the client is saying. In option B, the nurse attempts to use focusing, but the attempt to discuss central issues seems premature. In option C, the nurse makes a judgment and is nontherapeutic in the one-on-one relationship. In option D, the nurse is attempting to assess the client's ability to openly discuss feelings with family members. Although this may be appropriate, the timing is somewhat premature and closes off facilitation of the client's feeling. (Saunders, 2nd Edition)

15. Answer: B

Rationale: The nurse should never promise to keep a secret. Secrets are appropriate in a social relationship but not in a therapeutic one. The nurse need to be honest with the client and tell the client that a promise cannot be made to keep the secret. (Saunders, 2nd Edition)

16. Answer: C

Rationale: Mania is a mood characterized by excitement, euphoria, hyperactivity, excessive energy, decreased need for sleep and impaired ability to concentrate or complete a single train of thought. It is a period when the mood is predominantly elevated, expansive or irritable. Option C identifies a physiological need requiring immediate intervention. (Saunders, 2nd Edition)

17. Answer: A

Rationale: A person who is experiencing mania lacks insight and judgment, has poor impulse control and is highly excitable. The nurse must take control without increasing the client's stress or anxiety. A quiet, firm approach while distracting the client (walking her to her room and assisting with dressing) achieves the goal of having her dressed appropriately and preserving psychosocial integrity. In option B, “Insisting” that the client go to her room may meet with a great deal of resistance. In option C, confronting the client and offering the client a consequence of “time-out” may be meaningless. Option D is inappropriate. (Saunders, 2nd Edition)

18. Answer: B

Rationale: A person who is experiencing mania is overactive, full of energy, lacks concentration and has poor impulse control. The client needs an activity that will allow her to use excess energy, yet not endanger others during the process. Option A, C and D are relatively sedate activities that require concentration, a quality that is lacking in the manic state. Such activities may lead to increased frustration and anxiety for the client. Tetherball is an exercise that uses the large muscle groups of the body and is a great way to expend the increased energy this client is experiencing. (Saunders, 2nd Edition)

19. Answer: A

Rationale: The client is at risk for injury to self and others and therefore should be escorted out of the dayroom. Hyperactive and agitated behavior usually responds to haloperidol (Haldol). Option B may increase the agitation that already exist in this client. In option C, orientation will not halt the behavior. In option D, telling the client that the behavior is not appropriate has already been attempted by the psychiatric aide. (Saunders, 2nd Edition)

20. Answer: D

Rationale: Enemas are not a component of the pretreatment care for a client scheduled for ECT. Options A, B and C are a part of the pretreatment plan. Additionally, an informed consent is required and the nurse should teach the client and family what to expect with ECT and allow the client to discuss her feelings regarding the procedure. (Saunders, 2nd Edition)

21. Answer: A

Rationale: Behavior therapy is used to help clients identify and examine dysfunctional thoughts as well as identify and examine values and belief that maintain these thoughts. Options B, C and D are incorrect. (Saunders, 2nd Edition)

22. Answer: C

Rationale: Clients with anorexia nervosa are frequently preoccupied with rigorous exercise and pu7sh themselves beyond normal limits to work off caloric intake. The nurse must provide for appropriate exercise as well as place limits on rigorous activities. Options A, b and D are inappropriate nursing actions. (Saunders, 2nd Edition)

23. Answer: D

Rationale: Clients with anorexia nervosa have the desire to please others. Their need to be correct or perfect interferes with rational decision-making processes. These clients are moralistic. Rules and rituals help these clients manage their anxiety. Options A and B have absolute word “always” and should be eliminated. Option C is not characteristic of the client with anorexia. (Saunders, 2nd Edition)

24. Answer: C

Rationale: Excessive exercise is a characteristic of anorexia nervosa, not a characteristic of clients with bulimia. Frequent vomiting, in addition to laxative and diuretic abuse, may lead to dehydration and electrolyte imbalance. Assessing for dehydration and electrolyte imbalance are important nursing actions. Option C is the only option that is not a characteristic of bulimia. (Saunders, 2nd Edition)

25. Answer: B

Rationale: The client receiving diagnostic tests is an acceptable roommate. The client with anorexia is most likely experiencing hematological complications, such as leukopenia. In option A, having a roommate with pneumonia would place the client with anorexia nervosa at risk for infection. In options C and D, the client with anorexia nervosa should not be put in a situation in which they are able to focus on the nutritional needs of others or being managed by others, because this may contribute to sublimation and suppression of their own hunger. (Saunders, 2nd Edition)

26. Answer: A

Rationale: The symptoms associated with DTs (delirium tremors) typically are anxiety, insomnia, anorexia, hypertension, disorientation, visual or tactile hallucinations, changes in level of consciousness, agitation, fever and delusions. (Saunders, 2nd Edition)

27. Answer: B

Rationale: The most helpful response is the one that encourages the client to problem-solve. In option A, giving advice implies that the nurse knows what is best and can also foster dependency. The nurse is also agreeing with the client, which should be avoided. Option C uses the word “Why,” which should be avoided in communication. Option D should be eliminated because this option places the client's feelings on hold. The nurse should not request the client to provide explanations. (Saunders, 2nd Edition)

28. Answer: A

Rationale: Early signs of alcohol withdrawal develop within a few hours after cessation or reduction of alcohol and peaks after 24 to 48 hours. (Saunders, 2nd Edition)

29. Answer: B

Rationale: Al Anon support groups are a protected, supportive opportunity for spouses and significant others to learn what to expect and to obtain suggestions about successful behavioral changes. Option B is the most healthy response because it exemplifies an understanding that the alcoholic partner is responsible for his behavior and cannot be allowed to blame family members for loss of control. In option A, the nonalcoholic partner indicates responsibility when the spouse loses control. Option C, indicates that the wife remains codependent. Option D indicates that the group is being seen as an escape, not a place to work on issues. (Saunders, 2nd Edition)

30. Answer: B

Rationale: Alcoholic Anonymous is a major self-help organization for the treatment of alcoholism. Option A is a group for families of alcoholics. Option C is a group for the children of alcoholics. Option D is for nicotine addicts. (Saunders, 2nd Edition)