Nokea
A patient presents to the emergency department with mixed psychiatric symptoms. The admission nurse suspects the symptoms may be the result of a medical problem. Lab results show elevated BUN (blood urea nitrogen) and creatinine. What is the nurse's next best action?
- A. Report the findings to the health care provider.
- B. Assess the patient for a history of renal problems.
- C. Assess the patient's family history for cardiac problems.
- D. Arrange for the patient's hospitalization on the psychiatric unit.
Correct Answer: B
Rationale: Elevated BUN and creatinine suggest renal problems. Renal dysfunction can often imitate psychiatric disorders. The nurse should further assess the patient's history for renal problems and then share the findings with the health care provider.
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Which of the following drugs is administered to minimize respiratory secretions preoperatively?
- A. Valium (diazepam)
- B. Phenergan (promethazine)
- C. Atropine sulfate
- D. Demerol (Meperidine)
Correct Answer: C
Rationale: Atropine sulfate (Option C), an anticholinergic, dries secretions to prevent aspiration during surgery. Valium (A) is an anxiolytic, Phenergan (B) an antihistamine, and Demerol (D) an opioid—none target secretions.
A young adult says, "I was sexually abused by my older brother. During those assaults, I went somewhere else in my mind. I don't remember the details. Now, I often feel numb or unreal in romantic relationships, so I just avoid them." Which disorders should the nurse suspect based on this history? (Select all that apply.)
- A. Acute stress disorder
- B. Depersonalization disorder
- C. Generalized anxiety disorder
- D. PTSD
Correct Answer: A
Rationale: Acute stress disorder, depersonalization disorder, and PTSD can involve dissociative elements, such as numbing, feeling unreal, and being amnesic for traumatic events. All three disorders are also responses to acute stress or trauma, which has occurred here. The distracters are disorders not evident in this patient's presentation. Generalized anxiety disorder involves extensive worrying that is disproportionate to the stressors or foci of the worrying. Reactive attachment disorder and disinhibited social engagement disorder are problems of childhood.
A patient diagnosed with schizophrenia lives in the community. On a home visit, the community psychiatric nurse case manager learns that the patient: wants to attend an activity group at the mental health outreach center, is worried about being able to pay for the therapy, does not know how to get from home to the outreach center, has an appointment to have blood work at the same time an activity group meets, wants to attend services at a church that is a half-mile from the patients home. Which tasks are part of the role of a community mental health nurse?Select one that does not apply.
- A. Rearranging conflicting care appointments
- B. Negotiating the cost of therapy for the patient
- C. Arranging transportation to the outreach center
- D. Accompanying the patient to church services weekly
Correct Answer: D
Rationale: The correct answers reflect the coordinating role of the community psychiatric nurse case manager. Negotiating the cost of therapy and accompanying the patient to church services are interventions the nurse would not be expected to undertake. The patient can walk to the church services; the nurse can provide encouragement.
A nurse assigned to a mental health hotline receives a call from a nurse who has been working on a Covid-19 unit. The caller states, 'I just don't think I can be a nurse anymore.' Which of the following types of trauma should the nurse recognize this person is experiencing?
- A. Acute trauma
- B. Chronic trauma
- C. Complex trauma
- D. Secondary trauma
Correct Answer: D
Rationale: Secondary trauma occurs when healthcare professionals experience emotional distress as a result of caring for clients who have experienced trauma. The nurse's statement suggests they are experiencing secondary trauma due to their work on the Covid-19 unit.
A client is fearful and reluctant to talk. Which of the following techniques is most effective when trying to engage the client in interaction?
- A. Broad opening
- B. Focusing
- C. Giving information
- D. Silence
Correct Answer: A
Rationale: Broad openings allow the client to choose what to share, easing engagement. Focusing narrows, information provides facts, silence waits passively.