Test Bank Essentials Psychiatric Mental Health Nursing 6th Edition, Mary C Townsend
Chapter 1: Mental Health and Mental Illness
1. A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client’s appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client’s behaviors?
1. The client’s behaviors demonstrate mental illness in the form of depression.
2. The client’s behaviors are extensive, which indicates the presence of mental illness.
3. The client’s behaviors are not congruent with cultural norms.
4. The client’s behaviors demonstrate no functional impairment, indicating no mental illness.
2. At what point should the nurse determine that a client is at risk for developing a mental illness?
1. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria.
2. When maladaptive responses to stress are coupled with interference in daily functioning.
3. When a client communicates significant distress.
4. When a client uses defense mechanisms as ego protection.
3. A nurse is assessing a set of 15-year-old identical twins who respond very differently to stress. One twin becomes anxious and irritable, and the other withdraws and cries. How should the nurse explain these different stress responses to the parents?
1. Reactions to stress are relative rather than absolute; individual responses to stress vary.
2. It is abnormal for identical twins to react differently to similar stressors.
3. Identical twins should share the same temperament and respond similarly to stress.
4. Environmental influences to stress weigh more heavily than genetic influences.
4. Which client should the nurse anticipate to be most receptive to psychiatric treatment?
1. A Jewish, female social worker.
2. A Baptist, homeless male.
3. A Catholic, black male.
4. A Protestant, Swedish business executive.
5. A psychiatric nurse intern states, “This client’s use of defense mechanisms should be eliminated.” Which is a correct evaluation of this nurse’s statement?
1. Defense mechanisms can be appropriate responses to stress and need not be eliminated.
2. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated.
3. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not eliminated.
4. Defense mechanisms cause disintegration of the ego and should be fostered and encouraged.
6. During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, “I’m here for my heart, not my head problems.” Which is the nurse’s best response?
1. “It’s just a routine part of our assessment. All clients are asked these same questions.”
2. “Why are you concerned about these types of questions?”
3. “Psychological factors, like excessive stress, have been found to affect medical conditions.”
4. “We can skip these questions, if you like. It isn’t imperative that we complete this section.”
7. An employee uses the defense mechanism of displacement when the boss openly disagrees with suggestions. What behavior would be expected from this employee?
1. The employee assertively confronts the boss.
2. The employee leaves the staff meeting to work out in the gym.
3. The employee criticizes a coworker.
4. The employee takes the boss out to lunch.
8. A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defense mechanism?
3. Reaction formation
9. Which nursing statement about the concept of neurosis is most accurate?
1. An individual experiencing neurosis is unaware that he or she is experiencing distress.
2. An individual experiencing neurosis feels helpless to change his or her situation.
3. An individual experiencing neurosis is aware of psychological causes of his or her behavior.
4. An individual experiencing neurosis has a loss of contact with reality.
10. Which nursing statement regarding the concept of psychosis is most accurate?
1. Individuals experiencing psychoses are aware that their behaviors are maladaptive.
2. Individuals experiencing psychoses experience little distress.
3. Individuals experiencing psychoses are aware of experiencing psychological problems.
4. Individuals experiencing psychoses are based in reality.
Chapter 2: Concepts of Personality Development
1. A jilted college student is admitted to a hospital following a suicide attempt and states, “No one will ever love a loser like me.” According to Erikson’s theory of personality development, a nurse should recognize that this patient has a deficit in which developmental stage?1. Trust versus mistrust2. Initiative versus guilt3. Intimacy versus isolation4. Ego integrity versus despair
2. A nurse observes a 3-year-old client willingly sharing candy with a sibling. According to Peplau, which psychological stage of development should the nurse determine that this child has completed?1. Learning to count on others2. Learning to delay satisfaction3. Identifying oneself4. Developing skills in participation
3. A 9-month-old child screams every time his mother leaves and will not tolerate anyone else changing his diaper. The nurse should determine that, according to Mahler’s developmental theory, this child’s development was arrested at which phase?1. The autistic phase2. The symbiotic phase3. The separation-individuation phase
4. The rapprochement phase
4. According to Peplau, a nurse who provides an abandoned child with parental guidance and praise following small accomplishments is serving which therapeutic role?1. Technical expert2. Resource person3. Surrogate4. Leader
5. When assessing clients, a psychiatric nurse should understand that psychoanalytic theory is based on which underlying concept?
1. A possible genetic basis for the client’s problems2. The structure and dynamics of the personality3. Behavioral responses to stressors4. Maladaptive cognitions
6. Which underlying concept should a nurse associate with interpersonal theory when assessing a client?
1. The effects of social processes on personality development
2. The effects of unconscious processes and personality structures
3. The effects on thoughts and perceptual processes
4. The effects of chemical and genetic influences
7. A physically healthy, 35-year-old, single client lives with parents, who provide total financial support. According to Erikson’s theory, which developmental task should a nurse assist the client to accomplish?1. Establishing the ability to control emotional reactions2. Establishing a strong sense of ethics and character structure3. Establishing and maintaining self-esteem 4. Establishing a career, personal relationships, and societal connections
8. A 1-month-old infant is left alone for extended periods, has little physical stimulation, and is malnourished. Based on this infant’s situation, in which phase of development, according to Mahler’s theory, should a nurse expect to see a potential deficit?1. The symbiotic phase 2. The autistic phase3. The consolidation phase
4. The rapprochement phase
9. A 6-year-old boy uses his father’s flashlight to explore his 3-year-old sister’s genitalia. According to Freud, in which stage of psychosocial development should a nurse identify this behavior as normal?
1. Oral2. Anal3. Phallic4. Latency
10. A married, 26-year-old client works as a schoolteacher. She and her husband have just had their first child. A nurse should recognize that this client is successfully accomplishing which stage of Erikson’s developmental theory?
1. Industry versus inferiority
2. Identity versus role confusion
3. Intimacy versus isolation
4. Generativity versus stagnation
Chapter 3: Biological Implications
1. A depressed client states, “I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again.” Which nursing response is appropriate?
1. “Medications only address biological factors. Environmental and interpersonal factors must also be considered.”
2. “Because biological factors are the sole cause of depression, medications will improve your mood.”
3. “Environmental factors have been shown to exert the most influence in the development of depression.”
4. “Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment).”
2. A client diagnosed with major depressive disorder asks, “What part of my brain controls my emotions?” Which nursing response is appropriate?
1. “The occipital lobe governs perceptions, judging them as positive or negative.”
2. “The parietal lobe has been linked to depression.”
3. “The medulla regulates key biological and psychological activities.”
4. “The limbic system is largely responsible for one’s emotional state.”
3. Which part of the nervous system should a nurse identify as playing a major role during stressful situations?
1. Peripheral nervous system
2. Somatic nervous system
3. Sympathetic nervous system
4. Parasympathetic nervous system
4. Which client statement reflects an understanding of circadian rhythms in psychopathology?
1. “When I dream about my mother’s horrible train accident, I become hysterical.”
2. “I get really irritable during my menstrual cycle.”
3. “I’m a morning person. I get my best work done before noon.”
4. “Every February, I tend to experience periods of sadness.”
5. Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community?
1. Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy.
2. Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill.
3. Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents.
4. Studies in which monozygotic twins were raised together by mentally ill biological parents.
5. All of the above.
6. Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective?
3. Diagnostic technology
7. A withdrawn client, diagnosed with schizophrenia, expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being responsible for this behavior?
1. Dendrites 2. Axons3. Neurotransmitters 4. Synapses
8. An instructor is teaching nursing students about neurotransmitters. Which best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron?
1. Regeneration 2. Reuptake 3. Recycling 4. Retransmission
9. A nurse concludes that a restless, agitated client is manifesting a fight- or-flight response. The nurse should associate this response with which neurotransmitter?
1. Acetylcholine 2. Dopamine 3. Serotonin 4. Norepinephrine
10. A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client’s neurotransmitters should a nurse expect to be elevated?
3. Gamma-aminobutyric acid (GABA)
Chapter 4: Ethical and Legal Issues
1. In response to a student’s question regarding choosing a psychiatric specialty, a charge nurse states, “Mentally ill clients need special care. If I were in that position, I’d want a caring nurse also.” From which ethical framework is the charge nurse operating?
2. Christian ethics
3. Ethical egoism
2. During a hiring interview, which response by a nursing applicant should indicate that the applicant operates from an ethical egoism framework?
1. “I would want to be treated in a caring manner if I were mentally ill.”
2. “This job will pay the bills, and the workload is light enough for me.”
3. “I will be happy caring for the mentally ill. Working in med/surg kills my back.”
4. “It is my duty in life to be a psychiatric nurse. It is the right thing to do.”
3. Without authorization, a nurse administers an extra dose of narcotic tranquilizer to an agitated client. The nurse’s coworker observes this action but does nothing for fear of retaliation. What is the ethical interpretation of the coworker’s lack of involvement?
1. Taking no action is still considered an unethical action by the coworker.
2. Taking no action releases the coworker from ethical responsibility.
3. Taking no action is advised when potential adverse consequences are foreseen.
4. Taking no action is acceptable, because the coworker is only a bystander.
4. Group therapy is strongly encouraged, but not mandatory, in an inpatient psychiatric unit. The unit manager’s policy is that clients can make a choice about whether or not to attend group therapy. Which ethical principle does the unit manager’s policy preserve?
5. Which is an example of an intentional tort?
1. A nurse fails to assess a client’s obvious symptoms of neuroleptic malignant syndrome.
2. A nurse physically places an irritating client in four-point restraints.
3. A nurse makes a medication error and does not report the incident.
4. A nurse gives patient information to an unauthorized person.
6. An involuntarily committed client is verbally abusive to the staff, repeatedly threatening to sue. The client records the full names and phone numbers of the staff. Which nursing action is most appropriate to decrease the possibility of a lawsuit?
1. Verbally redirect the client, and then refuse one-on-one interaction.
2. Involve the hospital’s security division as soon as possible.
3. Notify the client that documenting personal staff information is against hospital policy.
4. Continue professional attempts to establish a positive working relationship with the client.
7. Which statement should a nurse identify as correct regarding a client’s right to refuse treatment?
1. Clients can refuse pharmacological but not psychological treatment.
2. Clients can refuse any treatment at any time.
3. Clients can refuse only electroconvulsive therapy (ECT).
4. Professionals can override treatment refusal by an actively suicidal or homicidal client.
8. Which potential client should a nurse identify as a candidate for involuntarily commitment?
1. The client living under a bridge in a cardboard box
2. The client threatening to commit suicide
3. The client who never bathes and wears a wool hat in the summer
4. The client who eats waste out of a garbage can
9. A client diagnosed with schizophrenia refuses to take medication, citing the right of autonomy. Under which circumstance would a nurse have the right to medicate the client against the client’s wishes?
1. A client makes inappropriate sexual innuendos to a staff member.
2. A client constantly demands attention from the nurse by begging, “Help me get better.”
3. A client physically attacks another client after being confronted in group therapy.
4. A client refuses to bathe or perform hygienic activities.
10. A psychiatric nurse working on an inpatient unit receives a call asking if an individual has been a client in the facility. Which nursing response reflects appropriate legal and ethical obligations?
1. The nurse refuses to give any information to the caller, citing rules of confidentiality.
2. The nurse hangs up on the caller.
3. The nurse confirms that the person has been at the facility but adds no additional information.
4. The nurse suggests that the caller speak to the client’s therapist.
Chapter 5: Cultural and Spiritual Concepts Relevant to Psychiatric/Mental Health Nursing
1. An African American youth, growing up in an impoverished neighborhood, seeks affiliation with a black gang. Soon he is engaging in theft and assault. What cultural consideration should a nurse identify as playing a role in this youth’s choices?
1. Most African American homes are headed by strong, dominant father figures.
2. Most African Americans choose to remain within their own social organization.
3. Most African Americans are uncomfortable expressing emotions and seek out belonging.
4. Most African Americans have few religious beliefs, which contributes to criminal activity.
2. Northern European Americans value punctuality, hard work, and the acquisition of material possessions and status. A nurse should recognize that these values may contribute to which form of psychopathology?
1. Dissociative disorders
2. Alzheimer’s dementia
3. Stress-related disorders
4. Schizophrenia-spectrum disorders
3. A community health nurse is planning a health fair at a local shopping mall. Which middle-class socioeconomic cultural group should the nurse anticipate would most value preventive medicine and primary health care?
1. Northern European Americans
2. Native Americans
3. Latino Americans
4. African Americans
4. Which rationale by a nursing instructor best explains why it is challenging to globally classify the Asian American culture?
1. Extremes of emotional expression prevent accurate assessment of this culture.
2. Suspicion of Western civilization has understandably resulted in minimal participation in cultural research.
3. The small size of this subpopulation makes research virtually impossible.
4. The Asian American culture includes individuals from Japan, China, Vietnam, Korea, and other countries.
5. A Latin American woman refuses to participate in an assertiveness training group. Which cultural belief should a nurse identify as most likely to affect this client’s decision?
1. Future orientation causes the client to devalue assertiveness skills.
2. Decreased emotional expression makes it difficult to be assertive.
3. Assertiveness techniques may not be aligned with the client’s definition of the female role.
4. Religious prohibitions prevent the client’s participation in assertiveness training.
6. A Latin American man refuses to acknowledge responsibility for hitting his wife, stating instead, “It’s the man’s job to keep his wife in line.” Which cultural belief should a nurse associate with this client’s behavior?
1. That families are male–dominated, with clear male-female role distinctions.
2. That religious tenets support the use of violence in a marital context.
3. That the nuclear family is female-dominated and the mother has ultimate authority.
4. That marriage dynamics are controlled by dominant females in the family.
7. When working with clients of a particular culture, which action should a nurse avoid?
1. Making direct eye contact
2. Assuming that all individuals who share a culture or ethnic group are similar
3. Supporting the client in participating in cultural and spiritual rituals
4. Using an interpreter to clarify communication
8. To effectively plan care for Asian American clients, a nurse should be aware of which cultural factor?
1. Obesity and alcoholism are common problems.
2. Older people maintain positions of authority within the culture.
3. “Tai” and “chi” are the fundamental concepts of Asian health practices.
4. Asian Americans are likely to seek psychiatric help.
9. A Native American client is admitted to an emergency department (ED) with an ulcerated toe, secondary to uncontrolled diabetes mellitus. The client refuses to talk to a physician unless a shaman is present. Which nursing intervention is most appropriate?
1. Try to locate a shaman that will agree to come to the ED.
2. Explain to the client that “voodoo” medicine will not heal the ulcerated toe.
3. Ask the client to explain what the shaman can do that the physician cannot.
4. Inform the client that refusing treatment is a client’s right.
10. When planning client care, which folk belief that may affect health-care practices should a nurse identify as characteristic of the Latino American culture?
1. The root doctor is often the first contact made when illness is encountered.
2. The yin and yang practitioner is often the first contact made when illness is encountered.
3. The shaman is often the first contact made when illness is encountered.
4. The curandero is often the first contact made when illness is encountered.
Chapter 6: Relationship Development and Therapeutic Communication
1. What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client?
1. Clarify personal attitudes, values, and beliefs.
2. Obtain thorough assessment data.
3. Determine the client’s length of stay.
4. Establish personal goals for the interaction.
2. If a client demonstrates transference toward a nurse, how should the nurse respond?
1. Promote safety and immediately terminate the relationship with the client.
2. Encourage the client to ignore these thoughts and feelings.
3. Immediately reassign the client to another staff member.
4. Help the client to clarify the meaning of the relationship, based on the present situation.
3. What should be the priority nursing action during the orientation (introductory) phase of the nurse-client relationship?
1. Acknowledge the client’s actions and generate alternative behaviors.
2. Establish rapport and develop treatment goals.
3. Attempt to find alternative placement.
4. Explore how thoughts and feelings about this client may adversely impact nursing care.
4. Which client action should a nurse expect during the working phase of the nurse-client relationship?
1. The client gains insight and incorporates alternative behaviors.
2. The client establishes rapport with the nurse and mutually develops treatment goals.
3. The client explores feelings related to reentering the community.
4. The client explores personal strengths and weaknesses that impact behavioral choices.
5. Which client statement should a nurse identify as a typical response to stress most often experienced in the working phase of the nurse-client relationship?
1. “I can’t bear the thought of leaving here and failing.”
2. “I might have a hard time working with you, because you remind me of my mother.”
3. “I really don’t want to talk any more about my childhood abuse.”
4. “I’m not sure that I can count on you to protect my confidentiality.”
6. A mother who is notified that her child was killed in a tragic car accident states, “I can’t bear to go on with my life.” Which nursing statement conveys empathy?
1. “This situation is very sad, but time is a great healer.”
2. “You are sad, but you must be strong for your other children.”
3. “Once you cry it all out, things will seem so much better.”
4. “It must be horrible to lose a child, and I’ll stay with you until your husband arrives.”
7. When an individual is “two-faced,” which characteristic essential to the development of a therapeutic relationship should a nurse identify as missing?
8. On which task should a nurse place priority during the working phase of relationship development?
1. Establishing a contract for intervention
2. Examining feelings about working with a particular client
3. Establishing a plan for continuing aftercare
4. Promoting the client’s insight and perception of reality
9. Which therapeutic communication technique is being used in the following nurse-client interaction?
Client: “My father spanked me often.”
Nurse: “Your father was a harsh disciplinarian.”
2. Offering general leads
10. Which therapeutic communication technique is being used in the following nurse-client interaction?
Client: “When I am anxious, the only thing that calms me down is alcohol.”
Nurse: “Other than drinking, what alternatives have you explored to decrease anxiety?”
2. Making observations
3. Formulating a plan of action
4. Giving recognition
Chapter 7: The Nursing Process in Psychiatric/Mental Health Nursing
1. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems?
1. Medical history is of little significance and can be eliminated from the nursing assessment.
2. Assessment provides a holistic view of the client, including biopsychosocial aspects.
3. Comprehensive assessments can be performed only by advanced practice nurses.
4. Psychosocial evaluations are gained by subjective reports rather than objective observations.
2. Which statement regarding nursing interventions should a nurse identify as accurate?
1. Nursing interventions are independent from the treatment team’s goals.
2. Nursing interventions are solely directed by written physician orders.
3. Nursing interventions occur independently but in concert with overall treatment team goals.
4. Nursing interventions are standardized by policies and procedures.
3. Within the nurse’s scope of practice, which function is exclusive to the advanced practice psychiatric nurse?
1. Teaching about the side effects of neuroleptic medications
2. Using psychotherapy to improve mental health status
3. Using milieu therapy to structure a therapeutic environment
4. Providing case management to coordinate continuity of health services
4. The nurse should recognize which acronym as representing problem-oriented charting?
5. Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)?
1. CIWA scale
4. CAPS scale
6. What is being assessed when a nurse asks a client to identify name, date, residential address, and situation?
7. What is the purpose of a nurse gathering client information?
1. It enables the nurse to modify behaviors related to personality disorders.
2. It enables the nurse to make sound clinical judgments and plan appropriate care.
3. It enables the nurse to prescribe the appropriate medications.
4. It enables the nurse to assign the appropriate Axis I diagnosis.
8. A nurse on an inpatient psychiatric unit implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. These actions reflect which role of the nurse?
1. Health teacher
2. Case manager
3. Milieu manager
9. The following outcome was developed for a client: “Client will list five personal strengths by the end of day one.” Which correctly written nursing diagnostic statement most likely generated the development of this outcome?
1. Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements
2. Self-care deficit R/T altered thought process
3. Disturbed body image R/T major depressive disorder AEB mood rating of 2/10
4. Risk for disturbed self-concept R/T hopelessness AEB suicide attempt
10. How should a nurse prioritize nursing diagnoses?
1. By the established goal of care
2. By the life-threatening potential
3. By the physician’s priority of care
4. By the client’s preference
Chapter 8: Milieu Therapy—The Therapeutic Community
1. An angry client on an inpatient unit approaches a nurse stating, “Someone took my lunch! People need to respect others, and you need to do something about this now!” The nurse’s response should be guided by which basic assumption of milieu therapy?
1. Conflict should be avoided at all costs on inpatient psychiatric units.
2. Conflict should be resolved by the nursing staff.
3. On inpatient units, every interaction is an opportunity for therapeutic intervention.
4. Conflict resolution should only be addressed during group therapy.
2. A client on an inpatient unit angrily says to a nurse, “Peter is not cleaning up after himself in the community bathroom. You need to address this problem.” Which is the appropriate nursing response?
1. “I’ll talk to Peter and present your concerns.”
2. “Why are you overreacting to this issue?”
3. “You should bring this to the attention of your treatment team.”
4. “I can see that you are angry. Let’s discuss ways to approach Peter with your concerns.”
3. A newly admitted client asks, “Why do we need a unit schedule? I’m not going to these groups. I’m here to get some rest.” Which is the most appropriate nursing response?
1. “The purpose of group therapy is to learn and practice new coping skills.”
2. “Group therapy is mandatory. All clients must attend.”
3. “Group therapy is optional. You can go if you find the topic helpful and interesting.”
4. “Group therapy is an economical way of providing therapy to many clients concurrently.”
4. A client diagnosed with schizophrenia functions well and is bright, spontaneous, and interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment?
1. Peer pressure
2. Structured programming
3. Visitor restrictions
4. Mandated activities
5. To promote self-reliance, how should a psychiatric nurse best conduct medication administration?
1. Encourage clients to request their medications at the appropriate times.
2. Refuse to administer medications unless clients request them at the appropriate times.
3. Allow the clients to determine appropriate medication times.
4. Take medications to the clients’ bedside at the appropriate times.
6. A nurse working on an inpatient psychiatric unit is assigned to conduct a 45-minute education group. What should the nurse identify as an appropriate group topic?
1. Dream analysis
2. Creative cooking
3. Paint by number
4. Stress management
7. What is the best rationale for including family in the client’s therapy within the inpatient milieu?
1. To structure a program of social and work-related activities
2. To facilitate discharge from hospitalization
3. To provide a concrete demonstration of caring
4. To encourage the family to model positive behaviors
8. How does a democratic form of self-government in the milieu contribute to client therapy?
1. By setting punishments for clients who violate the community rules
2. By dealing with inappropriate behaviors as they occur
3. By setting expectations wherein all clients are treated on an equal basis
4. By interacting with professional staff members to learn about therapeutic interventions
9. A client is to undergo psychological testing. Which member of the interdisciplinary team should a nurse consult for this purpose?
1. The psychiatrist
2. The psychiatric social worker
3. The clinical psychologist
4. The clinical nurse specialist
10. In the role of milieu manager, which activity should the nurse prioritize?
1. Setting the schedule for the daily unit activities
2. Evaluating clients for medication effectiveness
3. Conducting therapeutic group sessions
4. Searching newly admitted clients for hazardous objects
Chapter 9: Interventions in Groups
1. During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style?
1. The nurse mandates that all group members reveal an embarrassing personal situation.
2. The nurse asks for a show of hands to determine group topic preference.
3. The nurse sits silently as the group members stray from the assigned topic.
4. The nurse shuffles through papers to determine the facility policy on length of group.
2. During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating?
3. Which situation should a nurse identify as an example of an autocratic leadership style?
1. The president of Sigma Theta Tau assigns members to committees to research problems.
2. Without faculty input, the dean mandates that all course content be delivered via the Internet.
3. During a community meeting, a nurse listens as clients generate solutions.
4. The student nurses’ association advertises for candidates for president.
4. A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yalom’s curative group factors does this illustrate?
1. Imparting of information
2. Instillation of hope
5. A client diagnosed with alcohol use disorder experiences a first relapse. During an AA meeting, another group member states, “I relapsed three times, but now have been sober for 15 years.” Which of Yalom’s curative group factors does this illustrate?
1. Imparting of information
2. Instillation of hope
6. During a group discussion, members freely interact with each other. Which member statement is an example of Yalom’s curative group factor of imparting information?
1. “I found a Web site explaining the different types of brain tumors and their treatment.”
2. “My brother also had a brain tumor and now is completely cured.”
3. “I understand your fear and will be by your side during this time.”
4. “My mother was also diagnosed with cancer of the brain.”
7. Prayer group members at a local Baptist church are meeting with a poor, homeless family whom they are supporting. Which member statement is an example of Yalom’s curative group factor of altruism?
1. “I’ll give you the name of a friend that rents inexpensive rooms.”
2. “The last time we helped a family, they got back on their feet and prospered.”
3. “I can give you all of my baby clothes for your little one.”
4. “I can appreciate your situation. I had to declare bankruptcy last year.”
8. During an inpatient educational group, a client shouts out, “This information is worthless. Nothing you have said can help me.” These statements indicate to a nurse leader that the client is assuming which group role?
1. The group role of aggressor
2. The group role of initiator
3. The group role of gatekeeper
4. The group role of blocker
9. During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development?
1. “It’s hard for me to tell my story when I’m not sure about the reactions of others.”
2. “I think Joe’s Antabuse suggestion is a good one and might work for me.”
3. “My situation is very complex, and I need professional, not peer, advice.”
4. “I am really upset that you expect me to solve my own problems.”
10. Which group leader activity should a nurse identify as being most effective in the final, or termination, phase of group development?
1. The group leader establishes the rules that will govern the group after discharge.
2. The group leader encourages members to rely on each other for problem solving.
3. The group leader presents and discusses the concept of group termination.
4. The group leader helps the members to process feelings of loss.
Chapter 10: Intervening in Crises
1. A new mother is concerned about her ability to perform her parental role. She is quite anxious and ambivalent about leaving the postpartum unit. To offer effective client care, a nurse should be familiar with what information about this type of crisis?
1. This type of crisis is precipitated by unexpected external stressors.
2. This type of crisis is precipitated by preexisting psychopathology.
3. This type of crisis is precipitated by an acute response to an external situational stressor.
4. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.
2. A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, “I can’t function any longer under all this stress.” Which type of crisis is the client experiencing?
1. Maturational/developmental crisis
2. Psychiatric emergency crisis
3. Anticipated life transition crisis
4. Traumatic stress crisis
3. A client comes to a psychiatric clinic experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What long-term outcome is realistic in addressing this client’s crisis?
1. The client will change his type A personality traits to more adaptive ones by one week.
2. The client will list five positive self-attributes.
3. The client will examine how childhood events led to his overachieving orientation.
4. The client will return to previous adaptive levels of functioning by week six.
4. A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the priority nursing diagnosis for this client?
1. Ineffective coping R/T situational crisis AEB powerlessness
2. Anxiety R/T fear of failure
3. Risk for self-directed violence R/T hopelessness
4. Risk for low self-esteem R/T loss events AEB suicidal ideations
5. After threatening to jump off of a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first?
1. “Are you currently thinking about harming yourself?”
2. “Why do you want to harm yourself?”
3. “Have you thought about the consequences of your actions?”
4. “Who is your emergency contact person?”
6. An involuntarily committed client when offered a dinner tray pushes it off the bedside table onto the floor. Which nursing intervention should a nurse implement to address this behavior?
1. Initiate forced medication protocol.
2. Help the client to explore the source of anger.
3. Ignore the act to avoid reinforcing the behavior.
4. With staff support and a show of solidarity, set firm limits on the behavior.
7. A college student who was nearly raped while jogging, completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met?
1. “You’ve really been helpful. Can I count on your for continued support?”
2. “I work out in the college gym rather than jogging outdoors.”
3. “I’m really glad I didn’t go home. It would have been hard to come back.”
4. “I carry mace when I jog. It makes me feel safe and secure.”
8. A despondent client who has recently lost her husband of 30 years tearfully states, “I’ll feel a lot better if I sell my house and move away.” Which nursing response is most appropriate?
1. “I’m confident you know what’s best for you.”
2. “This may not be the best time for you to make such an important decision.”
3. “Your children will be terribly disappointed.”
4. “Tell me why you want to make this change.”
9. An inpatient client with a known history of violence suddenly begins to pace. Which additional client behavior should alert a nurse to escalating anger and aggression?
1. The client requests prn medications.
2. The client has a tense facial expression and body language.
3. The client refuses to eat lunch.
4. The client sits in group with back to peers.
10. What is the best nursing rationale for holding a debriefing session with clients and staff after a take-down intervention has taken place on an inpatient unit?
1. Reinforce unit rules with the client population.
2. Create protocols for the future release of tensions associated with anger.
3. Process client feelings and alleviate fears of undeserved seclusion and restraint.
4. Discuss the situation that led to inappropriate expressions of anger.
Chapter 11: The Recovery Model
1. A nursing instructor is teaching about recovery as it applies to mental illness. Which student statement indicates that further teaching is needed?
1. “The goal of recovery is improved health and wellness.”
2. “The goal of recovery is expedient, comprehensive behavioral change.”
3. “The goal of recovery is the ability to live a self-directed life.”
4. “The goal of recovery is the ability to reach full potential.”
2. Which situation presents an example of the basic concept of a recovery model?
1. The client’s family is encouraged to make decisions in order to facilitate discharge.
2. A social worker, discovering the client’s income, changes the client’s discharge placement.
3. A psychiatrist prescribes an antipsychotic drug based on observed symptoms.
4. A client diagnosed with schizophrenia schedules follow-up appointments and group therapy.
3. A nursing instructor is teaching about the guiding principles of the recovery model, as described by the SAMHSA. Which student statement indicates that further teaching is needed?
1. “Recovery occurs via many pathways.”
2. “Recovery emerges from strong religious affiliations.”
3. “Recovery is supported by peers and allies.”
4. “Recovery is culturally based and influenced.”
4. A client diagnosed with alcohol abuse disorder is referred to a residential care facility after discharge. According to the SAMHSA, which dimension of recovery is supporting this client?
5. A client diagnosed with obsessive-compulsive disorder states, “I really think my future will improve because of my successful treatment choices. I’m going to make my life better.” Which guiding principle of recovery has assisted this client?
1. Recovery emerges from hope.
2. Recovery is person-driven.
3. Recovery occurs via many pathways.
4. Recovery is holistic.
6. A nurse maintains a client’s confidentiality, addressed the client appropriately, and does not discriminate based on gender, age, race, or religion. Which guiding principle of recovery has this nurse employed?
1. Recovery is culturally based and influenced.
2. Recovery is based on respect.
3. Recovery involves individual, family, and community strengths and responsibility.
4. Recovery is person-driven.
7. A nurse on an inpatient unit helps a client understand the significance of treatments, and provides the client with copies of all documents related to the plan of care. This nurse is employing which commitment in the “Tidal Model of Recovery?”
1. Know that Change Is Constant
2. Reveal Personal Wisdom
3. Be Transparent
4. Give the Gift of Time
8. Which is the priority focus of recovery models?
1. Empowerment of the health-care team to bring their expertise to decision-making
2. Empowerment of the client to make decisions related to individual health care
3. Empowerment of the family system to provide supportive care
4. Empowerment of the physician to provide appropriate treatments
9. A client experiences an exacerbation of psychiatric symptoms to the point of threatening self-harm. Which action step of the Wellness Recovery Action Plan (WRAP) model should be employed, and what action reflects this step?
1. Step 3: Triggers that cause distress or discomfort are listed.
2. Step 4: Signs indicating relapse are identified and plans for responding are developed.
3. Step 5: A specific plan to help with symptoms is formulated.
4. Step 6: Following client-designed plan, caregivers now become decision-makers.
10. A nursing instructor is teaching about components present in the recovery process as described by Andresen and associates that led to the development of the Psychological Recovery Model. Which student statement indicates that further teaching is needed?
1. “A client has a better chance of recovery if he or she truly believes that recovery can occur.”
2. “If a client is willing to give the responsibility of treatment to the health-care team, they are likely to recover.”
3. “A client who has a positive sense of self and a positive identity is likely to recover.”
4. “A client has a better chance of recovery if he or she has purpose and meaning in life.”
Chapter 12. Complementary and Psychosocial Therapies
1. A nursing instructor is teaching about complementary therapies. Which student statement indicates that learning has occurred?
1. “Complementary therapies view all humans as being biologically similar.”
2. “Complementary therapies view a person as a combination of multiple, integrated elements.”
3. “Complementary therapies focus on primarily the structure and functions of the body.”
4. “Complementary therapies view disease as a deviation from a normal biological state.”
2. A client reports taking St. John’s wort for major depressive episode. The client states, “I’m taking the recommended dose, but it seems like if two capsules are good, four would be better!” Which is an appropriate nursing response?
1. “Herbal medicines are more likely to cause adverse reactions than prescription medications.”
2. “Increasing the amount of herbal preparations can lead to overdose and toxicity.”
3. “FDA does not regulate herbal remedies, therefore, ingredients are often unknown.”
4. “Certain companies are better than others. Always buy a reputable brand.”
3. A client with chronic lower back pain says, “My nurse practitioner told me that acupuncture may enhance the effect of the medications and physical therapy prescribed.” What type of therapy is the nurse practitioner recommending?
1. Alternative therapy
3. Complementary therapy
4. Biopsychosocial therapy
4. A client diagnosed with chronic migraine headaches is considering acupuncture. The client asks a clinic nurse, “How does this treatment work?” Which is the best response by the nurse?
1. “Western medicine believes that acupuncture stimulates the body’s release of pain-fighting chemicals called endorphins.”
2. “I’m not sure why he suggested acupuncture. There are a lot of risks, including HIV.”
3. “Acupuncture works by encouraging the body to increase its development of serotonin and norepinephrine.”
4. “Your acupuncturist is your best resource for answering your specific questions.”
5. Alternative approaches refer to interventions that are used instead of conventional treatment. A client asks a nurse to explain the difference between alternative and complementary medicine. Which is an appropriate nursing response?
1. “Alternative medicine is a more acceptable practice than complementary medicine.”
2. “Alternative and complementary medicine are terms that essentially mean the same thing.”
3. “Complementary medicine disregards traditional medical approaches.”
4. “Complementary therapies partner alternative approaches with traditional medical practice.”
6. A lethargic client is diagnosed with major depressive disorder. After taking antidepressant therapy for 6 weeks, the client’s symptoms have not resolved. Which nutritional deficiency should a nurse identify as potentially contributing to the client’s symptoms?
1. Vitamin A deficiency
2. Vitamin C deficiency
3. Iron deficiency
4. Folic acid deficiency
7. A client inquires about the practice of therapeutic touch. Which nursing response best explains the goal of this therapy?
1. “The goal is to improve circulation to the body by deep, circular massage.”
2. “The goal is to re-pattern the body’s energy field by the use of rhythmic hand motions.”
3. “The goal is to improve breathing by increasing oxygen to the brain and body tissues.”
4. “The goal is to decrease blood pressure by body toxin release.”
8. A nursing student, having no knowledge of alternative treatments, states, “Aren’t these therapies ‘bogus’ and, like a fad, will eventually fade away?” Which is an accurate nursing response?
1. “Like nursing, complementary therapies take a holistic approach to healing.”
2. “The American Nurses Association is researching the effectiveness of these therapies.”
3. “It is important to remain nonjudgmental about these therapies.”
4. “Alternative therapy concepts are rooted in psychoanalysis.”
9. Herbs and plants can be useful in treating a variety of conditions. Which treatment should a nurse determine is appropriate for a client experiencing frequent migraine headaches?
1. Saint John’s wort combined with an antidepressant
2. Ginger root combined with a beta-blocker
3. Feverfew, used according to directions
4. Kava-kava added to a regular diet
10. A nurse teaches a client about alternative therapies for back pain. When a practitioner corrects subluxation by manipulating the vertebrae of the spinal column, what therapy is the practitioner employing?
1. Allopathic therapy
2. Therapeutic touch therapy
3. Massage therapy
4. Chiropractic therapy
Chapter 13: Neurocognitive Disorders
1. A geriatric nurse is teaching the client’s family about the possible cause of delirium. Which statement by the nurse is most accurate?
1. “Taking multiple medications may lead to adverse interactions or toxicity.”
2. “Age-related cognitive changes may lead to alterations in mental status.”
3. “Lack of rigorous exercise may lead to decreased cerebral blood flow.”
4. “Decreased social interaction may lead to profound isolation and psychosis.”
2. A husband has agreed to admit his spouse, diagnosed with Alzheimer’s disease (AD), to a long-term care facility. He is expressing feelings of guilt and symptoms of depression. Which appropriate nursing diagnosis and subsequent intervention would the nurse document?
1. Dysfunctional grieving; AD support group
2. Altered thought process; AD support group
3. Major depressive episode; psychiatric referral
4. Caregiver role strain; psychiatric referral
3. A client diagnosed with vascular neurocognitive disorder (NCD) is discharged to home under the care of his wife. Which information should cause the nurse to question the client’s safety?
1. His wife works from home in telecommunication.
2. The client has worked the nightshift his entire career.
3. His wife has minimal family support.
4. The client smokes one pack of cigarettes per day.
4. A client diagnosed with AD can no longer ambulate, does not recognize family members, and communicates with agitated behaviors and incoherent verbalizations. The nurse recognizes these symptoms as indicative of which stage of the illness?
1. Stage 4: Mild-to-Moderate Cognitive Decline
2. Stage 5. Moderate Cognitive Decline
3. Stage 6. Moderate-to-Severe Cognitive Decline
4. Stage 7. Severe Cognitive Decline
5. A client is diagnosed in stage seven of AD. To address the client’s symptoms, which nursing intervention should take priority?
1. Improve cognitive status by encouraging involvement in social activities.
2. Decrease social isolation by providing group therapies.
3. Promote dignity by providing comfort, safety, and self-care measures.
4. Facilitate communication by providing assistive devices.
6. Which is the reason for the proliferation of the diagnosis of NCDs?
1. Increased numbers of neurotransmitters has been implicated in the proliferation of NCD.
2. Similar symptoms of NCD and depression lead to misdiagnoses, increasing numbers of NCD.
3. Societal stress contributes to the increase in this diagnosis.
4. More people now survive into the high-risk period for neurocognitive disorders.
7. A client diagnosed recently with AD is prescribed donepezil (Aricept). The client’s spouse inquires, “How does this work? Will this cure him?” Which is the appropriate nursing response?
1. “This medication delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease.”
2. “This medication encourages production of acetylcholine, a chemical in the brain necessary for memory processes. It delays the progression of the disease.”
3. “This medication delays the destruction of dopamine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease.”
4. “This medication encourages production of dopamine, a chemical in the brain necessary for memory processes. It delays the progression of the disease.”
8. Which symptom should a nurse identify that differentiates clients diagnosed with NCDs from clients diagnosed with mood disorders?
1. Altered sleep
2. Altered concentration
3. Impaired memory
4. Impaired psychomotor activity
9. A client diagnosed with AD exhibits progressive memory loss, diminished cognitive functioning, and verbal aggression upon experiencing frustration. Which nursing intervention is most appropriate?
1. Organize a group activity to present reality.
2. Minimize environmental lighting.
3. Schedule structured daily routines.
4. Explain the consequences for aggressive behaviors.
10. After one week of continuous mental confusion, an older African American client is admitted with a preliminary diagnosis of AD. What should cause the nurse to question this diagnosis?
1. AD does not typically occur in African American clients.
2. The symptoms presented are more indicative of Parkinsonism.
3. AD does not develop suddenly.
4. There has been no T3- or T4-level evaluation ordered.
Chapter 14: Substance Use and Addictive Disorders
1. What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal?
1. Risk for injury R/T central nervous system stimulation
2. Disturbed thought processes R/T tactile hallucinations
3. Ineffective coping R/T powerlessness over alcohol use
4. Ineffective denial R/T continued alcohol use despite negative consequences
2. A nurse evaluates a client’s patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance addiction?
1. Narcotic pain medication is contraindicated for all clients with active substance use disorders.
2. Clients who are addicted to alcohol or benzodiazepines may develop cross-tolerance to analgesics and require increased doses to achieve effective pain control.
3. There is no need to assess the client for substance addiction. There is an obvious PCA malfunction, because these clients have a higher pain tolerance.
4. The client is experiencing alcohol withdrawal symptoms and needs accurate assessment.
3. On the first day of a client’s alcohol detoxification, which nursing intervention should take priority?
1. Strongly encourage the client to attend 90 Alcoholics Anonymous (AA) meetings in 90 days.
2. Educate the client about the biopsychosocial consequences of alcohol abuse.
3. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol.
4. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.
4. Which client statement indicates a knowledge deficit related to a substance use disorder?
1. “Although it’s legal, alcohol is one of the most widely abused drugs in our society.”
2. “Tolerance to heroin develops quickly.”
3. “Flashbacks from LSD use may reoccur spontaneously.”
4. “Marijuana is like smoking cigarettes. Everyone does it. It’s essentially harmless.”
5. A lonely, depressed divorcée has been self-medicating with small amounts of cocaine for the past year. Which term should a nurse use to best describe this individual’s situation?
1. Psychological addiction
2. Physical addiction
3. Substance induced disorder
4. Social induced disorder
6. Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during the substance induced disorder of alcohol withdrawal?
1. Antagonist therapy
2. Deterrent therapy
3. Codependency therapy
4. Substitution therapy
7. A client diagnosed with chronic alcohol addiction is being discharged from an inpatient treatment facility after detoxification. Which client outcome, related to AA, would be most appropriate for a nurse to discuss with the client during discharge teaching?
1. After discharge, the client will immediately attend 90 AA meetings in 90 days.
2. After discharge, the client will rely on an AA sponsor to help control alcohol cravings.
3. After discharge, the client will incorporate family in AA attendance.
4. After discharge, the client will seek appropriate deterrent medications through AA.
8. A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 48 hours. When the nurse reports to the ED physician, which client symptom should be the nurse’s first priority?
1. Hearing and visual impairment
2. Blood pressure of 180/100 mm Hg
3. Mood rating of 2/10 on numeric scale
9. Which client statement demonstrates positive progress toward recovery from a substance use disorder?
1. “I have completed detox and therefore am in control of my drug use.”
2. “I will faithfully attend Narcotic Anonymous (NA) when I can’t control my cravings.”
3. “As a church deacon, my focus will now be on spiritual renewal.”
4. “Taking those pills got out of control. It cost me my job, marriage, and children.”
10. A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse’s rationale for this intervention?
1. To assess for emotional strength
2. To assess for Wernicke-Korsakoff syndrome
3. To assess for tachycardia
4. To assess for fine tremors
Chapter 15: Schizophrenia Spectrum and Other Psychotic Disorders
1. A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client’s safety?
1. Assess for medication nonadherance.
2. Note escalating behaviors and intervene immediately.
3. Interpret attempts at communication.
4. Assess triggers for bizarre, inappropriate behaviors.
2. A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be included in the nurse’s teaching?
1. The side effects of medications
2. Deep breathing techniques to decrease stress
3. How to make eye contact when communicating
4. How to be a leader
3. A 16-year-old client diagnosed with schizophrenia spectrum disorder experiences command hallucinations to harm others. The client’s parents ask a nurse, “Where do the voices come from?” Which is the appropriate nursing response?
1. “Your child has a chemical imbalance of the brain, which leads to altered perceptions.”
2. “Your child’s hallucinations are caused by medication interactions.”
3. “Your child has too little serotonin in the brain, causing delusions and hallucinations.”
4. “Your child’s abnormal hormonal changes have precipitated auditory hallucinations.”
4. Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia spectrum disorder, tells them that voices command him to harm others. Which is the appropriate nursing response?
1. “Tell him to stop discussing the voices.”
2. “Ignore what he is saying, while attempting to discover the underlying cause.”
3. “Focus on the feelings generated by the hallucinations and present reality.”
4. “Present objective evidence that the voices are not real.”
5. A nurse is assessing a client diagnosed with schizophrenia spectrum disorder. The nurse asks the client, “Do you receive special messages from certain sources, such as the television or radio?” The nurse is assessing which potential symptom of this disorder?
1. Thought insertion
2. Paranoid delusions
3. Magical thinking
4. Delusions of reference
6. A client diagnosed with schizophrenia spectrum disorder states, “Can’t you hear him? It’s the devil. He’s telling me I’m going to hell.” Which is the most appropriate nursing response?
1. “Did you take your medicine this morning?”
2. “You are not going to hell. You are a good person.”
3. “The voices must sound scary, but the devil is not talking to you. This is part of your illness.”
4. “The devil only talks to people who are receptive to his influence.”
7. A client diagnosed with schizophrenia spectrum disorder tells a nurse about voices commanding him to kill the president. Which is the priority nursing diagnosis for this client?
1. Disturbed sensory perception
2. Altered thought processes
3. Risk for violence: directed toward others
4. Risk for injury
8. Which nursing intervention would be most appropriate when caring for an acutely agitated paranoid client diagnosed with schizophrenia spectrum disorder?
1. Provide neon lights and soft music.
2. Maintain continual eye contact throughout the interview.
3. Use therapeutic touch to increase trust and rapport.
4. Provide personal space to respect the client’s boundaries.
9. Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder?
1. Establishing personal contact with family members
2. Being reliable, honest, and consistent during interactions
3. Sharing limited personal information
4. Sitting close to the client to establish rapport
10. A paranoid client diagnosed with schizophrenia spectrum disorder states, “My psychiatrist is out to get me. I’m sad that the voice is telling me to stop him.” What symptom is the client exhibiting, and what is the nurse’s legal responsibility related to this symptom?
1. Magical thinking; administer an antipsychotic medication.
2. Persecutory delusions; orient the client to reality.
3. Command hallucinations; warn the psychiatrist.
4. Altered thought processes; call an emergency treatment team meeting.
Chapter 16: Depressive Disorders
1. A nurse discovers a client’s suicide note that details the time, place, and means to commit suicide. What should be the priority nursing action, and why?
1. Administer lorazepam (Ativan) prn, because the client is angry about plan exposure.
2. Establish room restrictions, because the client’s threat is an attempt to manipulate the staff.
3. Place client on one-to-one suicide precautions, because specific plans likely lead to attempts.
4. Call an emergency treatment team meeting, because the client’s threat must be addressed.
2. In planning care for a suicidal client, which correctly written outcome should be a nurse’s first priority?
1. The client will not physically harm self.
2. The client will express hope for the future by day three.
3. The client will establish a trusting relationship with the nurse.
4. The client will remain safe during hospital stay.
3. A nurse administers 100% oxygen to a client during and after electroconvulsive therapy treatment (ECT). What is the rationale for this procedure?
1. To prevent increased intracranial pressure resulting from anoxia.
2. To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation.
3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles.
4. To prevent blocked airway, resulting from seizure activity.
4. Immediately after electroconvulsive therapy (ECT), in which position should a nurse place the client?
1. On his or her side, to prevent aspiration
2. In high Fowler’s position, to prevent increased intracranial pressure
3. In Trendelenburg’s position, to promote blood flow to vital organs
4. In prone position, to prevent airway blockage
5. A client is diagnosed with major depressive episode. Which nursing diagnosis should a nurse assign to this client, to address a behavioral symptom of this disorder?
1. Altered communication R/T feelings of worthlessness AEB anhedonia
2. Social isolation R/T poor self-esteem AEB secluding self in room
3. Altered thought processes R/T hopelessness AEB persecutory delusions
4. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia
6. A client diagnosed with major depressive episode hears voices commanding self-harm. Which should be the nurse’s priority intervention at this time?
1. Obtaining an order for locked seclusion until client is no longer suicidal.
2. Conducting 15-minute checks to ensure safety.
3. Placing the client on one-to-one observation while continuing to monitor suicidal ideations.
4. Encouraging client to express feelings related to suicide.
7. A nurse assesses a client suspected of having the diagnosis of major depressive episode. Which client symptom would rule out this diagnosis?
1. The client is disheveled and malodorous.
2. The client refuses to interact with others and isolates self in room.
3. The client is unable to feel any pleasure.
4. The client has maxed-out charge cards and exhibits promiscuous behaviors.
8. A client with a history of suicide attempts has been taking fluoxetine (Prozac) for one month. The client suddenly presents with a bright affect, rates mood at 9 out of 10, and is much more communicative. Which action should be the nurse’s priority at this time?
1. Give the client off-unit privileges as positive reinforcement.
2. Encourage the client to share mood improvement in group.
3. Increase the level of this client’s suicide precautions.
4. Request that the psychiatrist reevaluate the current medication protocol.
9. A nurse reviews the laboratory data of a client suspected of having the diagnosis of major depressive episode. Which lab value would potentially rule out this diagnosis?
1. Thyroid-stimulating hormone (TSH) level of 25 U/mL
2. Potassium (K+) level of 4.2 mEq/L
3. Sodium (Na+) level of 140 mEq/L
4. Calcium (Ca2+) level of 9.5 mg/dL
10. A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. Which theoretical principle best explains the etiology of this client’s depressive symptoms?
1. According to psychoanalytic theory, depression is a result of negative perceptions.
2. According to object-loss theory, depression is a result of overprotection.
3. According to learning theory, depression is a result of repeated failures.
4. According to cognitive theory, depression is a result of anger turned inward.
Chapter 17: Bipolar and Other Related Disorders
1. A highly agitated client paces the unit and states, “I could buy and sell this place.” The client’s mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client’s behavior?
1. “Rates mood 8/10. Exhibiting looseness of association. Euphoric.”
2. “Mood euthymic. Exhibiting magical thinking. Restless.”
3. “Mood labile. Exhibiting delusions of reference. Hyperactive.”
4. “Agitated and pacing. Exhibiting grandiosity. Mood labile.”
2. A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights and a 12-pound weight loss over the past 2 weeks. Which should be this client’s priority nursing diagnosis?
1. Knowledge deficit R/T bipolar disorder AEB concern about symptoms
2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss
3. Risk for suicide R/T powerlessness AEB insomnia and anorexia
4. Altered sleep patterns R/T mania AEB insomnia for the past 3 nights
3. A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the client outcomes in the exhibit?
1. Maintains nutritional status
2. Interacts appropriately with peers
3. Remains free from injury
4. Sleeps 6 to 8 hours a night
1. 2, 1, 3, 4
2. 4, 1, 2, 3
3. 3, 1, 4, 2
4. 1, 4, 2, 3
4. A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family members report that the client has experienced anorexia, insomnia, and recent job loss. Which nursing diagnosis should a nurse prioritize?
1. Risk for suicide R/T hopelessness
2. Anxiety: severe R/T hyperactivity
3. Imbalanced nutrition: less than body requirements R/T refusal to eat
4. Dysfunctional grieving R/T loss of employment
5. A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate (Lithobid) because of excessive weight gain. In order to increase adherence, which medication should a nurse anticipate that a physician may prescribe?
1. Sertraline (Zoloft)
2. Valproic acid (Depakote)
3. Trazodone (Desyrel)
4. Paroxetine (Paxil)
6. A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The client’s spouse questions the Zyprexa order. Which is the appropriate nursing response?
1. “Zyprexa in combination with Eskalith cures manic symptoms.”
2. “Zyprexa prevents extrapyramidal side effects.”
3. “Zyprexa increases the effectiveness of the immune system.”
4. “Zyprexa calms hyperactivity until the Eskalith takes effect.”
7. A client began taking lithium carbonate (Lithobid) for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing response?
1. “That’s strange. Weight loss is the typical pattern.”
2. “What have you been eating? Weight gain is not usually associated with lithium.”
3. “Weight gain is a common, but troubling, side effect.”
4. “Weight gain only occurs during the first month of treatment with this drug.”
8. A client diagnosed with bipolar disorder has been taking lithium carbonate (Lithobid) for one year. The client presents in an emergency department with a temperature of 101°F (38°C), severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms?
1. Symptoms indicate consumption of foods high in tyramine.
2. Symptoms indicate lithium carbonate discontinuation syndrome.
3. Symptoms indicate the development of lithium carbonate tolerance.
4. Symptoms indicate lithium carbonate toxicity.
9. What tool should a nurse use to differentiate occasional spontaneous behaviors of children from behaviors associated with bipolar disorder?
1. “Risky Activity” tool
2. “FIND” tool
3. “Consensus Committee” tool
4. “Monotherapy” tool
10. A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients?
1. “Treatment is compromised when clients can’t sleep.”
2. “Treatment is compromised when irritability interferes with social interactions.”
3. “Treatment is compromised when clients have no insight into their problems.”
4. “Treatment is compromised when clients choose not to take their medications.”
Chapter 18: Anxiety, Obsessive-Compulsive, and Related Disorders
1. A nursing instructor is teaching about specific phobias. Which student statement indicates to the instructor that learning has occurred?
1. “These clients recognize their fear as excessive and frequently seek treatment.”
2. “These clients have a panic level of fear that is overwhelming and unreasonable.”
3. “These clients experience symptoms that mirror a cerebrovascular accident (CVA).”
4. “These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis.”
2. Which nursing statement to a client about social anxiety disorder versus schizoid personality disorder (SPD) is most accurate?
1. “Clients diagnosed with social anxiety disorder can manage anxiety without medications, whereas clients diagnosed with SPD can only manage anxiety with medications.”
2. “Clients diagnosed with SPD are distressed by the symptoms experienced in social settings, whereas clients diagnosed with social anxiety disorder are not.”
3. “Clients diagnosed with social anxiety disorder avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life.”
4. “Clients diagnosed with SPD avoid interactions only in social settings, whereas clients diagnosed with social anxiety disorder tend to avoid interactions in all areas of life.”
3. What symptoms should a nurse recognize that differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)?
1. GAD is acute in nature, and panic disorder is chronic.
2. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders.
3. Hyperventilation is a common symptom in GAD and rare in panic disorder.
4. Depersonalization is commonly seen in panic disorder and absent in GAD.
4. Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (GAD)?
1. Long-term treatment with diazepam (Valium)
2. Acute symptom control with citalopram (Celexa)
3. Long-term treatment with buspirone (BuSpar)
4. Acute symptom control with ziprasidone (Geodon)
5. Which symptoms should a nurse recognize that differentiate a client diagnosed with obsessive-compulsive disorder (OCD) from a client diagnosed with obsessive-compulsive personality disorder?
1. Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not.
2. Clients diagnosed with obsessive-compulsive personality disorder experience both obsessions and compulsions, and clients diagnosed with OCD do not.
3. Clients diagnosed with obsessive-compulsive personality disorder experience only obsessions, and clients diagnosed with OCD experience only compulsions.
4. Clients diagnosed with OCD experience only obsessions, and clients diagnosed with obsessive-compulsive personality disorder experience only compulsions.
6. A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardic and dyspneic. A workup in an emergency department reveals no pathology. Which medical diagnosis should a nurse suspect, and what nursing diagnosis should be the nurse’s first priority?
1. Generalized anxiety disorder and a nursing diagnosis of fear
2. Altered sensory perception and a nursing diagnosis of panic disorder
3. Pain disorder and a nursing diagnosis of altered role performance
4. Panic disorder and a nursing diagnosis of anxiety
7. A client diagnosed with panic disorder states, “When an attack happens, I feel like I am going to die.” Which is the most appropriate nursing response?
1. “I know it’s frightening, but try to remind yourself that this will only last a short time.”
2. “Death from a panic attack happens so infrequently that there is no need to worry.”
3. “Most people who experience panic attacks have feelings of impending doom.”
4. “Tell me why you think you are going to die every time you have a panic attack.”
8. A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred?
1. “Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder.”
2. “Clozapine (Clozaril) is used off-label in long-term treatment of panic disorder.”
3. “Doxepin (Sinequan) can be used in low doses to relieve symptoms of panic attacks.”
4. “Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks.”
9. A family member is seeking advice about an older parent who seems to worry unnecessarily about everything. The family member states, “Should I seek psychiatric help for my mother?” Which is an appropriate nursing response?
1. “My mother also worries unnecessarily. I think it is part of the aging process.”
2. “Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning.”
3. “From what you have told me, you should get her to a psychiatrist as soon as possible.”
4. “Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications.”
10. A client is experiencing a severe panic attack. Which nursing intervention would meet this client’s physiological need?
1. Teach deep breathing relaxation exercises.
2. Place the client in a Trendelenburg position.
3. Have the client breathe into a paper bag.
4. Administer the ordered prn buspirone (BuSpar).
Chapter 19: Trauma and Stressor-Related Disorders
1. A nursing instructor is teaching about trauma and stressor-related disorders. Which student statement indicates that further instruction is needed?
1. “The trauma that women experience is more likely to be sexual assault and child sexual abuse.”
2. “The trauma that men experience is more likely to be accidents, physical assaults, combat, or viewing death or injury.”
3. “After exposure to a traumatic event, only 10 percent of victims develop post-traumatic stress disorder (PTSD).”
4. “Research shows that PTSD is more common in men than in women.”
2. Which factors differentiate the diagnosis of PTSD from the diagnosis of adjustment disorder (AD)?
1. PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to “normal” daily events.
2. AD results from exposure to an extreme traumatic event, whereas PTSD results from exposure to “normal” daily events.
3. Depressive symptoms occur in PTSD and not in AD.
4. Depressive symptoms occur in AD and not in PTSD.
3. Which client would a nurse recognize as being at highest risk for the development of an AD?
1. A young married woman
2. An elderly unmarried man
3. A young unmarried woman
4. A young unmarried man
4. A nursing instructor is explaining the etiology of trauma-related disorders from a learning theory perspective. Which student statement indicates that learning has occurred?
1. “How clients perceive events and view the world affect their response to trauma.”
2. “The psychic numbing in PTSD is a result of negative reinforcement.”
3. “The individual becomes addicted to the trauma owing to an endogenous opioid response.”
4. “Believing that the world is meaningful and controllable can protect an individual from PTSD.”
5. As the sole survivor of a roadside bombing, a veteran is experiencing extreme guilt. Which nursing diagnosis would address this client’s symptom?
2. Altered thought processes
3. Complicated grieving
4. Altered sensory perception
6. A client has been assigned a nursing diagnosis of complicated grieving related to the death of multiple family members in a motor vehicle accident. Which intervention should the nurse initially employ?
1. Encourage the journaling of feelings.
2. Assess for the stage of grief in which the client is fixed.
3. Provide community resources to address the client’s concerns.
4. Encourage attending a grief therapy group.
7. Which clinical presentation is associated with the most commonly diagnosed adjustment disorder (AD)?
1. Anxiety, feelings of hopelessness, and worry
2. Truancy, vandalism, and fighting
3. Nervousness, worry, and jitteriness
4. Depressed mood, tearfulness, and hopelessness
8. Both situational and intrapersonal factors most likely contribute to an individual’s stress response. Which factor would a nurse categorize as intrapersonal?
1. Occupational opportunities
2. Economic conditions
3. Degree of flexibility
4. Availability of social supports
9. A client diagnosed with AD has been assigned the nursing diagnosis of anxiety R/T divorce. Which correctly written outcome addresses this client’s problem?
1. Rates anxiety as 4 out of 10 by discharge.
2. States anxiety level has decreased by day one.
3. Accomplishes activities of daily living independently.
4. Demonstrates ability for adequate social functioning by day three.
10. Eye movement desensitization and reprocessing (EMDR) has been empirically validated for which disorder?
1. Adjustment disorder
2. Generalized anxiety disorder
3. Panic disorder
4. Post-traumatic stress disorder
Chapter 20: Somatic Symptom and Dissociative Disorders
1. A client diagnosed with somatic symptom disorder (SSD) is most likely to exhibit which personality disorder characteristics?
1. Experiences intense and chaotic relationships with fluctuating attitudes toward others.
2. Socially irresponsible, exploitative, guiltless, and disregards rights of others.
3. Self-dramatizing, attention seeking, overly gregarious, and seductive.
4. Uncomfortable in social situations, perceived as timid, withdrawn, cold, and strange.
2. A nurse is working with a client diagnosed with SSD. What criteria would differentiate this diagnosis from illness anxiety disorder (IAD)?
1. The client diagnosed with SSD experiences physical symptoms in various body systems, and the client diagnosed with IAD does not.
2. The client diagnosed with SSD experiences a change in the quality of self-awareness, and the client diagnosed with IAD does not.
3. The client diagnosed with SSD disorder has a perceived disturbance in body image or appearance, and the client diagnosed with IAD does not.
4. The client diagnosed with SSD only experiences anxiety about the possibility of illness, and the client diagnosed with IAD does not.
3. Which would be considered an appropriate outcome when planning care for an inpatient client diagnosed with SSD?
1. The client will admit to fabricating physical symptoms to gain benefits by day three.
2. The client will list three potential adaptive coping strategies to deal with stress by day two.
3. The client will comply with medical treatments for physical symptoms by day three.
4. The client will openly discuss physical symptoms with staff by day four.
4. Which are examples of primary and secondary gains that clients diagnosed with SSD: predominately pain, may experience?
1. Primary: chooses to seek a new doctor; Secondary: euphoric feeling from new medications
2. Primary: euphoric feeling from new medications; Secondary: chooses to seek a new doctor
3. Primary: receives get-well cards; Secondary: pain prevents attending stressful family reunion
4. Primary: pain prevents attending stressful family reunion; Secondary: receives get-well cards
5. A nursing instructor is teaching about the etiology of IAD from a psychoanalytical perspective. What student statement about clients diagnosed with this disorder indicates that learning has occurred?
1. “They tend to have a familial predisposition to this disorder.”
2. “When the sick role relieves them from stressful situations, their physical symptoms are reinforced.”
3. “They misinterpret and cognitively distort their physical symptoms.”
4. “They express personal worthlessness through physical symptoms, because physical problems are more acceptable than psychological problems.”
6. An inpatient client is newly diagnosed with dissociative identity disorder (DID) stemming from severe childhood sexual abuse. Which nursing intervention takes priority?
1. Encourage exploration of sexual abuse.
2. Encourage guided imagery.
3. Establish trust and rapport.
4. Administer antianxiety medications.
7. A client diagnosed with DID switches personalities when confronted with destructive behavior. The nurse recognizes that this dissociation serves which function?
1. It is a means to attain secondary gain.
2. It is a means to explore feelings of excessive and inappropriate guilt.
3. It serves to isolate painful events so that the primary self is protected.
4. It serves to establish personality boundaries and limit inappropriate impulses.
8. A client is diagnosed with DID. What is the primary goal of therapy for this client?
1. To recover memories and improve thinking patterns.
2. To prevent social isolation.
3. To decrease anxiety and need for secondary gain.
4. To collaborate among sub-personalities to improve functioning.
9. According to the DSM-5 diagnostic criteria for dissociative amnesia (DA), what symptom would be essential to meet the criteria for the subcategory of dissociative fugue?
1. An inability to recall important autobiographical information
2. Clinically significant distress in social and occupational functioning
3. Sudden unexpected travel or bewildered wandering
4. “Blackouts” related to alcohol toxicity
10. Which situation is an example of selective amnesia?
1. A client cannot relate any lifetime memories.
2. A client can describe driving to Ohio but cannot remember the car accident that occurred.
3. A client often wanders aimlessly after sunset.
4. A client cannot provide personal demographic information during admission assessment.
AND MUCH MORE