Test Bank Foundations Psychiatric Mental Health Nursing 7th Edition
Chapter 01: Mental Health and Mental Illness
1. A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional intervention?
a. Conduct mental health assessments. c. Establish therapeutic relationships.
b. Prescribe psychotropic medication. d. Individualize nursing care plans.
2. When a nursing student expresses concerns about how mental health nurses “lose all their nursing skills,” the best response by the mental health nurse is:
a. “Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of the patients’ problems.”
b. “Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations.”
c. “That’s a misconception. Psychiatric nurses frequently use high technology monitoring equipment and manage complex intravenous therapies.”
d. “Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That appeals to me.”
3. When a new bill introduced in Congress reduces funding for care of persons with mental illness, a group of nurses writes letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled?
a. Recovery c. Advocacy
b. Attending d. Evidence-based practice
4. Which comment best indicates that a patient perceived the nurse was caring? “My nurse:
a. always asks me which type of juice I want to help me swallow my medication.”
b. explained my treatment plan to me and asked for my ideas about how to make it better.”
c. spends time listening to me talk about my problems. That helps me feel like I am not alone.”
d. told me that if I take all the medicines the doctor prescribes, then I will get discharged sooner.”
5. Which assessment finding most clearly indicates that a patient may be experiencing a mental illness? The patient:
a. reports occasional sleeplessness and anxiety.
b. reports a consistently sad, discouraged, and hopeless mood.
c. is able to describe the difference between “as if” and “for real.”
d. perceives difficulty making a decision about whether to change jobs.
6. Which finding best indicates that the goal “Demonstrate mentally healthy behavior” was achieved? A patient:
a. sees self as capable of achieving ideals and meeting demands.
b. behaves without considering the consequences of personal actions.
c. aggressively meets own needs without considering the rights of others.
d. seeks help from others when assuming responsibility for major areas of own life.
7. A nurse encounters an unfamiliar psychiatric disorder on a new patient’s admission form. Which resource should the nurse consult to determine criteria used to establish this diagnosis?
a. International Statistical Classification of Diseases and Related Health Problems (ICD-10)
b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
c. A behavioral health reference manual
8. A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information?
a. Nursing Outcomes Classification (NOC)
b. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
c. The ANA’s Psychiatric-Mental Health Nursing Scope and Standards of Practice
d. International Statistical Classification of Diseases and Related Health Problems (ICD-10)
9. Which individual is demonstrating the highest level of resilience? One who:
a. is able to repress stressors.
b. becomes depressed after the death of a spouse.
c. lives in a shelter for two years after the home is destroyed by fire.
d. takes a temporary job to maintain financial stability after loss of a permanent job.
10. Complete this analogy. NANDA: clinical judgment: NIC: _________________
a. patient outcomes c. diagnosis
b. nursing actions d. symptoms
Chapter 02: Relevant Theories and Therapies for Nursing Practice
1. A parent says, “My 2-year-old child refuses toilet training and shouts ‘No!’ when given directions. What do you think is wrong?” Select the nurse’s best reply.
a. “Your child needs firmer control. It is important to set limits now.”
b. “This is normal for your child’s age. The child is striving for independence.”
c. “There may be developmental problems. Most children are toilet trained by age 2.”
d. “Some undesirable attitudes are developing. A child psychologist can help you develop a plan.”
2. A 26-month-old displays negative behavior, refuses toilet training, and often says, “No!” Which stage of psychosexual development is evident?
a. Oral c. Phallic
b. Anal d. Genital
3. A 26-month-old displays negative behavior, refuses toilet training, and often says, “No!” Which psychosocial crisis is evident?
a. Trust versus mistrust c. Industry versus inferiority
b. Initiative versus guilt d. Autonomy versus shame and doubt
4. A 4-year-old grabs toys from siblings and says, “I want that now!” The siblings cry, and the child’s parent becomes upset with the behavior. According to Freudian theory, this behavior is a product of impulses originating in which system of the personality?
a. Id c. Superego
b. Ego d. Preconscious
5. The parent of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, and using good manners. The nurse supports this use of praise related to these behaviors. These qualities are likely to be internalized and become part of which system of the personality?
a. Id c. Superego
b. Ego d. Preconscious
6. A nurse supports a parent for praising a child behaving in a helpful way. When this child behaves with politeness and helpfulness in adulthood, which feeling will most likely result?
a. Guilt c. Humility
b. Anxiety d. Self-esteem
7. An adult says, “I never know the answers,” and “My opinion doesn’t count.” Which psychosocial crisis was unsuccessfully resolved for this adult?
a. Initiative versus guilt c. Autonomy versus shame and doubt
b. Trust versus mistrust d. Generativity versus self-absorption
8. Which patient statement would lead the nurse to suspect unsuccessful completion of the developmental task of infancy?
a. “I have very warm and close friendships.”
b. “I’m afraid to allow anyone to really get to know me.”
c. “I’m always absolutely right, so don’t bother saying more.”
d. “I’m ashamed that I didn’t do things correctly in the first place.”
9. A patient is suspicious and frequently manipulates others. To which psychosexual stage do these traits relate?
a. Oral c. Phallic
b. Anal d. Genital
10. A patient expresses a desire to be cared for by others and often behaves in a helpless fashion. Which stage of psychosexual development is most relevant to the patient’s needs?
a. Latency c. Anal
b. Phallic d. Oral
Chapter 03: Biological Basis for Understanding Psychiatric Disorders and Treatments
1. A patient asks, “What are neurotransmitters? The doctor said mine are imbalanced.” Select the nurse’s best response.
a. “How do you feel about having imbalanced neurotransmitters?”
b. “Neurotransmitters protect us from harmful effects of free radicals.”
c. “Neurotransmitters are substances we consume that influence memory and mood.”
d. “Neurotransmitters are natural chemicals that pass messages between brain cells.”
2. The parent of an adolescent diagnosed with schizophrenia asks the nurse, “My child’s doctor ordered a PET. What kind of test is that?” Select the nurse’s best reply.
a. “This test uses a magnetic field and gamma waves to identify problem areas in the brain. Does your teenager have any metal implants?”
b. “PET means positron-emission tomography. It is a special type of scan that shows blood flow and activity in the brain.”
c. “A PET scan passes an electrical current through the brain and shows brain-wave activity. It can help diagnose seizures.”
d. “It’s a special x-ray that shows structures of the brain and whether there has ever been a brain injury.”
3. A patient with a long history of hypertension and diabetes now develops confusion. The health care provider wants to make a differential diagnosis between Alzheimer’s disease and multiple infarcts. Which diagnostic procedure should the nurse expect to prepare the patient for first?
a. Skull x-rays
b. Computed tomography (CT) scan
c. Positron-emission tomography (PET)
d. Single-photon emission computed tomography (SPECT)
4. A patient’s history shows drinking 4 to 6 liters of fluid and eating more than 6,000 calories per day. Which part of the central nervous system is most likely dysfunctional for this patient?
a. Amydala c. Hippocampus
b. Parietal lobe d. Hypothalamus
5. The nurse prepares to assess a patient diagnosed with major depression for disturbances in circadian rhythms. Which question should the nurse ask this patient?
a. “Have you ever seen or heard things that others do not?”
b. “What are your worst and best times of the day?”
c. “How would you describe your thinking?”
d. “Do you think your memory is failing?”
6. The nurse administers a medication that potentiates the action of gamma-aminobutyric acid (GABA). Which effect would be expected?
a. Reduced anxiety c. More organized thinking
b. Improved memory d. Fewer sensory perceptual alterations
7. A nurse would anticipate that treatment for a patient with memory difficulties might include medications designed to:
a. inhibit gamma-aminobutyric acid (GABA).
b. prevent destruction of acetylcholine.
c. reduce serotonin metabolism.
d. increase dopamine activity.
8. A patient has disorganized thinking associated with schizophrenia. Neuroimaging would likely show dysfunction in which part of the brain?
a. Hippocampus c. Cerebellum
b. Frontal lobe d. Brainstem
9. The nurse should assess a patient taking a drug with anticholinergic properties for inhibited function of the:
a. parasympathetic nervous system. c. reticular activating system.
b. sympathetic nervous system. d. medulla oblongata.
10. The therapeutic action of neurotransmitter inhibitors that block reuptake cause:
a. decreased concentration of the blocked neurotransmitter in the central nervous system.
b. increased concentration of the blocked neurotransmitter in the synaptic gap.
c. destruction of receptor sites specific to the blocked neurotransmitter.
d. limbic system stimulation.
Chapter 04: Settings for Psychiatric Care
1. Inpatient hospitalization for persons with mental illness is generally reserved for patients who:
a. present a clear danger to self or others.
b. are noncompliant with medication at home.
c. have limited support systems in the community.
d. develop new symptoms during the course of an illness.
2. A patient was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the case manager learned that the patient received a notice of eviction immediately prior to admission. Select the case manager’s most appropriate action.
a. Postpone the patient’s discharge from the hospital.
b. Contact the landlord who evicted the patient to further discuss the situation.
c. Arrange a temporary place for the patient to stay until new housing can be arranged.
d. Determine whether the adverse medication reaction was genuine because the patient had nowhere to live.
3. Select the example of tertiary prevention.
a. Helping a person diagnosed with a serious mental illness learn to manage money
b. Restraining an agitated patient who has become aggressive and assaultive
c. Teaching school-age children about the dangers of drugs and alcohol
d. Genetic counseling with a young couple expecting their first child
4. A patient diagnosed with schizophrenia had an exacerbation related to medication noncompliance and was hospitalized for 5 days. The patient’s thoughts are now more organized, and discharge is planned. The patient’s family says, “It’s too soon for discharge. We will just go through all this again.” The nurse should:
a. ask the case manager to arrange a transfer to a long-term care facility.
b. notify hospital security to handle the disturbance and escort the family off the unit.
c. explain that the patient will continue to improve if the medication is taken regularly.
d. contact the health care provider to meet with the family and explain the discharge rationale.
5. A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor’s closet is locked. These observations relate to:
a. coordinating care of patients.
b. management of milieu safety.
c. management of the interpersonal climate.
d. use of therapeutic intervention strategies.
6. The patients below were evaluated in the emergency department. The psychiatric unit has one bed available. Which patient should be admitted? The patient:
a. feeling anxiety and a sad mood after separation from a spouse of 10 years.
b. who self-inflicted a superficial cut on the forearm after a family argument.
c. experiencing dry mouth and tremor related to taking haloperidol (Haldol).
d. who is a new parent and hears voices saying, “Smother your baby.”
7. A suspicious, socially isolated patient lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. Select a community psychiatric nurse’s best initial action.
a. Explore ways to help the patient stop smoking.
b. Report the situation to the manager of the shelter.
c. Assess the patient’s weight; determine foods and amounts eaten.
d. Arrange hospitalization for the patient in order to formulate a new treatment plan.
8. A nurse surveys medical records. Which finding signals a violation of patients’ rights?
a. A patient was not allowed to have visitors.
b. A patient’s belongings were searched at admission.
c. A patient with suicidal ideation was placed on continuous observation.
d. Physical restraint was used after a patient was assaultive toward a staff member.
9. Which principle has the highest priority when addressing a behavioral crisis in an inpatient setting?
a. Resolve the crisis with the least restrictive intervention possible.
b. Swift intervention is justified to maintain the integrity of a therapeutic milieu.
c. Rights of an individual patient are superseded by the rights of the majority of patients.
d. Patients should have opportunities to regain control without intervention if the safety of others is not compromised.
10. Clinical pathways are used in managed care settings to:
a. stabilize aggressive patients.
b. identify obstacles to effective care.
c. relieve nurses of planning responsibilities.
d. streamline the care process and reduce costs.
Chapter 05: Cultural Implications for Psychiatric Mental Health Nursing
1. Which Western cultural feature may result in establishing unrealistic outcomes for patients of other cultural groups?
b. Present orientation
c. Flexible perception of time
d. Direct confrontation to solve problems
2. A psychiatric nurse leads a medication education group for Hispanic patients. This nurse holds a Western worldview and uses pamphlets as teaching tools. Groups are short and concise. After the group, the patients are most likely to believe:
a. the nurse was uncaring. c. the teaching was efficient.
b. the session was effective. d. they were treated respectfully.
3. To provide culturally competent care, the nurse should:
a. accurately interpret the thinking of individual patients.
b. predict how a patient may perceive treatment interventions.
c. formulate interventions to reduce the patient’s ethnocentrism.
d. identify strategies that fit within the cultural context of the patient.
4. A black patient, originally from Haiti, has a diagnosis of depression. A colleague tells the nurse, “This patient often looks down and is reluctant to share feelings. However, I’ve observed the patient spontaneously interacting with other black patients.” Select the nurse’s best response.
a. “Black patients depend on the church for support. Have you consulted the patient’s pastor?”
b. “Encourage the patient to talk in a group setting. It will be less intimidating than one-to-one interaction.”
c. “Don’t take it personally. Black patients often have a resentful attitude that takes a long time to overcome.”
d. “The patient may have difficulty communicating in English. Have you considered using a cultural broker?”
5. A Haitian patient diagnosed with depression tells the nurse, “There’s nothing you can do. This is a punishment. The only thing I can do is see a healer.” The culturally aware nurse assesses that the patient:
a. has delusions of persecution.
b. has likely been misdiagnosed with depression.
c. may believe the distress is the result of a curse or spell.
d. feels hopeless and helpless related to an unidentified cause.
6. A group activity on an inpatient psychiatric unit is scheduled to begin at 1000. A patient, who was recently discharged from United States Marine Corps, arrives at 0945. Which analysis best explains this behavior?
a. The patient wants to lead the group and give directions to others.
b. The patient wants to secure a chair that will be close to the group leader.
c. The military culture values timeliness. The patient does not want to be late.
d. The behavior indicates feelings of self-importance that the patient wants others to appreciate.
7. A nurse in the clinic has a full appointment schedule. A Hispanic American patient arrives at 1230 for a 1000 appointment. A Native American patient does not keep an appointment at all. What understanding will improve the nurse’s planning? These patients are:
a. members of cultural groups that have a different view of time.
b. immature and irresponsible in health care matters.
c. acting out feelings of anger toward the system.
d. displaying passive-aggressive tendencies.
8. The sibling of an Asian American patient tells the nurse, “My sister needs help for pain. She cries from the hurt.” Which understanding by the nurse will contribute to culturally competent care for this patient? Persons of an Asian American heritage:
a. often express emotional distress with physical symptoms.
b. will probably respond best to a therapist who is impersonal.
c. will require prolonged treatment to stabilize these symptoms.
d. should be given direct information about the diagnosis and prognosis.
9. Which communication techniques would be most effective for a nurse to use during an assessment interview with an adult Native American patient?
a. Open and friendly; ask direct questions; touch the patient’s arm or hand occasionally for reassurance.
b. Frequent nonverbal behaviors, such as gestures and smiles; make an unemotional face to express negatives.
c. Soft voice; break eye contact occasionally; general leads and reflective techniques.
d. Stern voice; unbroken eye contact; minimal gestures; direct questions.
10. A Native American patient sadly describes a difficult childhood. The patient abused alcohol as a teenager but stopped 10 years ago. The patient now says, “I feel stupid and good for nothing. I don’t help my people.” How should the treatment team focus planning for this patient?
a. Psychopharmacological and somatic therapies should be central techniques.
b. Apply a psychoanalytic approach, focused on childhood trauma.
c. Depression and alcohol abuse should be treated concurrently.
d. Use a holistic approach, including mind, body, and spirit.
Chapter 06: Legal and Ethical Guidelines for Safe Practice
1. A psychiatric nurse best applies the ethical principle of autonomy by:
a. exploring alternative solutions with a patient, who then makes a choice.
b. suggesting that two patients who were fighting be restricted to the unit.
c. intervening when a self-mutilating patient attempts to harm self.
d. staying with a patient demonstrating a high level of anxiety.
2 A nurse finds a psychiatric advance directive in the medical record of a patient experiencing psychosis. The directive was executed during a period when the patient was stable and competent. The nurse should:
a. review the directive with the patient to ensure it is current.
b. ensure that the directive is respected in treatment planning.
c. consider the directive only if there is a cardiac or respiratory arrest.
d. encourage the patient to revise the directive in light of the current health problem.
3. Two hospitalized patients fight whenever they are together. During a team meeting, a nurse asserts that safety is of paramount importance, so treatment plans should call for both patients to be secluded to keep them from injuring each other. This assertion:
a. reinforces the autonomy of the two patients.
b. violates the civil rights of both patients.
c. represents the intentional tort of battery.
d. correctly places emphasis on safety.
4. In a team meeting a nurse says, “I’m concerned about whether we are behaving ethically by using restraint to prevent one patient from self-mutilation, while the care plan for another self-mutilating patient requires one-on-one supervision.” Which ethical principle most clearly applies to this situation?
a. Beneficence c. Fidelity
b. Autonomy d. Justice
5. Select the example of a tort.
a. The plan of care for a patient is not completed within 24 hours of the patient’s admission.
b. A nurse gives a PRN dose of an antipsychotic drug to an agitated patient because the unit is short-staffed.
c. An advanced practice nurse recommends hospitalization for a patient who is dangerous to self and others.
d. A patient’s admission status changed from involuntary to voluntary after the patient’s hallucinations subside.
6. What is the legal significance of a nurse’s action when a patient verbally refuses medication and the nurse gives the medication over the patient’s objection? The nurse:
a. has been negligent. c. fulfilled the standard of care.
b. committed malpractice. d. can be charged with battery.
7. Which nursing intervention demonstrates false imprisonment?
a. A confused and combative patient says, “I’m getting out of here, and no one can stop me.” The nurse restrains this patient without a health care provider’s order and then promptly obtains an order.
b. A patient has been irritating and attention-seeking much of the day. A nurse escorts the patient down the hall saying, “Stay in your room, or you’ll be put in seclusion.”
c. An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. The nurse rushes after the patient and convinces the patient to return to the unit.
d. An involuntarily hospitalized patient with homicidal ideation attempts to leave the facility. A nurse calls the security team and uses established protocols to prevent the patient from leaving.
8. Which patient meets criteria for involuntary hospitalization for psychiatric treatment? The patient who:
a. is noncompliant with the treatment regimen.
b. fraudulently files for bankruptcy.
c. sold and distributed illegal drugs.
d. threatens to harm self and others.
9. A nurse prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot) to an outpatient with schizophrenia. As the nurse swabs the site, the patient shouts, “Stop! I don’t want to take that medicine anymore. I hate the side effects.” Select the nurse’s best action.
a. Assemble other staff for a show of force and proceed with the injection, using restraint if necessary.
b. Stop the medication administration procedure and say to the patient, “Tell me more about the side effects you’ve been having.”
c. Proceed with the injection but explain to the patient that there are medications that will help reduce the unpleasant side effects.
d. Say to the patient, “Since I’ve already drawn the medication in the syringe, I’m required to give it, but let’s talk to the doctor about delaying next month’s dose.”
10. A nurse is concerned that an agency’s policies are inadequate. Which understanding about the relationship between substandard institutional policies and individual nursing practice should guide nursing practice?
a. Agency policies do not exempt an individual nurse of responsibility to practice according to professional standards of nursing care.
b. Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care.
c. Faced with substandard policies, a nurse has a responsibility to inform the supervisor and discontinue patient care immediately.
d. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.
Chapter 07: The Nursing Process and Standards of Care for Psychiatric Mental Health Nursing
1. A new staff nurse completes an orientation to the psychiatric unit. This nurse will expect to ask an advanced practice nurse to perform which action for patients?
a. Perform mental health assessment interviews.
b. Prescribe psychotropic medication.
c. Establish therapeutic relationships.
d. Individualize nursing care plans.
2. A newly admitted patient diagnosed with major depression has gained 20 pounds over a few months and has suicidal ideation. The patient has taken an antidepressant medication for 1 week without remission of symptoms. Select the priority nursing diagnosis.
a. Imbalanced nutrition: more than body requirements
b. Chronic low self-esteem
c. Risk for suicide
3. A patient diagnosed with major depression has lost 20 pounds in one month, has chronic low self-esteem, and a plan for suicide. The patient has taken an antidepressant medication for 1 week. Which nursing intervention has the highest priority?
a. Implement suicide precautions.
b. Offer high-calorie snacks and fluids frequently.
c. Assist the patient to identify three personal strengths.
d. Observe patient for therapeutic effects of antidepressant medication.
4. The desired outcome for a patient experiencing insomnia is, “Patient will sleep for a minimum of 5 hours nightly within 7 days.” At the end of 7 days, review of sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. The nurse will document the outcome as:
a. consistently demonstrated. c. sometimes demonstrated.
b. often demonstrated. d. never demonstrated.
5. The desired outcome for a patient experiencing insomnia is, “Patient will sleep for a minimum of 5 hours nightly within 7 days.” At the end of 7 days, review of sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. What is the nurse’s next action?
a. Continue the current plan without changes.
b. Remove this nursing diagnosis from the plan of care.
c. Write a new nursing diagnosis that better reflects the problem.
d. Examine interventions for possible revision of the target date.
6. A patient begins a new program to assist with building social skills. In which part of the plan of care should a nurse record the item, “Encourage patient to attend one psychoeducational group daily”?
a. Assessment c. Implementation
b. Analysis d. Evaluation
7. Before assessing a new patient, a nurse is told by another health care worker, “I know that patient. No matter how hard we work, there isn’t much improvement by the time of discharge.” The nurse’s responsibility is to:
a. document the other worker’s assessment of the patient.
b. assess the patient based on data collected from all sources.
c. validate the worker’s impression by contacting the patient’s significant other.
d. discuss the worker’s impression with the patient during the assessment interview.
8. 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.
9. A patient states, “I’m not worth anything. I have negative thoughts about myself. I feel anxious and shaky all the time. Sometimes I feel so sad that I want to go to sleep and never wake up.” Which nursing intervention should have the highest priority?
a. Self-esteem–building activities c. Sleep enhancement activities
b. Anxiety self-control measures d. Suicide precautions
10. Select the best outcome for a patient with the nursing diagnosis: Impaired social interaction related to sociocultural dissonance as evidenced by stating, “Although I’d like to, I don’t join in because I don’t speak the language very well.” Patient will:
a. show improved use of language.
b. demonstrate improved social skills.
c. become more independent in decision making.
d. select and participate in one group activity per day.
Chapter 08: Therapeutic Relationships
1. A nurse assesses a confused older adult. The nurse experiences sadness and reflects, “The patient is like one of my grandparents…so helpless.” Which response is the nurse demonstrating?
a. Transference c. Catastrophic reaction
b. Countertransference d. Defensive coping reaction
2. Which statement shows a nurse has empathy for a patient who made a suicide attempt?
a. “You must have been very upset when you tried to hurt yourself.”
b. “It makes me sad to see you going through such a difficult experience.”
c. “If you tell me what is troubling you, I can help you solve your problems.”
d. “Suicide is a drastic solution to a problem that may not be such a serious matter.”
3. After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference?
a. The patient’s reactions toward the nurse seem realistic and appropriate.
b. The patient states, “Talking to you feels like talking to my parents.”
c. The nurse feels unusually happy when the patient’s mood begins to lift.
d. The nurse develops a trusting relationship with the patient.
4. A patient says, “Please don’t share information about me with the other people.” How should the nurse respond?
a. “I will not share information with your family or friends without your permission, but I share information about you with other staff.”
b. “A therapeutic relationship is just between the nurse and the patient. It is up to you to tell others what you want them to know.”
c. “It depends on what you choose to tell me. I will be glad to disclose at the end of each session what I will report to others.”
d. “I cannot tell anyone about you. It will be as though I am talking about my own problems, and we can help each other by keeping it between us.”
5. A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, “I really need to talk to you.” The nurse should:
a. invite the interrupting patient to join in the session with the current patient.
b. say to the interrupting patient, “I am not available to talk with you at the present time.”
c. end the unproductive session with the current patient and spend time with the interrupting patient.
d. tell the interrupting patient, “This session is 5 more minutes; then I will talk with you.”
6. Termination of a therapeutic nurse-patient relationship has been successful when the nurse:
a. avoids upsetting the patient by shifting focus to other patients before the discharge.
b. gives the patient a personal telephone number and permission to call after discharge.
c. discusses with the patient changes that happened during the relationship and evaluates outcomes.
d. offers to meet the patient for coffee and conversation three times a week after discharge.
7. What is the desirable outcome for the orientation stage of a nurse-patient relationship? The patient will demonstrate behaviors that indicate:
a. self-responsibility and autonomy. c. rapport and trust with the nurse.
b. a greater sense of independence. d. resolved transference.
8. During which phase of the nurse-patient relationship can the nurse anticipate that identified patient issues will be explored and resolved?
a. Preorientation c. Working
b. Orientation d. Termination
9. At what point in the nurse-patient relationship should a nurse plan to first address termination?
a. During the orientation phase
b. At the end of the working phase
c. Near the beginning of the termination phase
d. When the patient initially brings up the topic
10. A nurse introduces the matter of a contract during the first session with a new patient because contracts:
a. specify what the nurse will do for the patient.
b. spell out the participation and responsibilities of each party.
c. indicate the feeling tone established between the participants.
d. are binding and prevent either party from prematurely ending the relationship.
Chapter 09: Communication and the Clinical Interview
1. A patient says to the nurse, “I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn’t rested well.” Which response should the nurse use to clarify the patient’s comment?
a. “It sounds as though you were uncomfortable with the content of your dream.”
b. “I understand what you’re saying. Bad dreams leave me feeling tired, too.”
c. “So you feel as though you did not get enough quality sleep last night?”
d. “Can you give me an example of what you mean by ‘stoned’?”
2. A patient diagnosed with schizophrenia tells the nurse, “The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say.” Which response by the nurse would be most therapeutic?
a. “Let’s talk about something other than the CIA.”
b. “It sounds like you’re concerned about your privacy.”
c. “The CIA is prohibited from operating in health care facilities.”
d. “You have lost touch with reality, which is a symptom of your illness.”
3. The patient says, “My marriage is just great. My spouse and I always agree.” The nurse observes the patient’s foot moving continuously as the patient twirls a shirt button. The conclusion the nurse can draw is that the patient’s communication is:
a. clear. c. precise.
b. mixed. d. inadequate.
4. A nurse interacts with a newly hospitalized patient. Select the nurse’s comment that applies the communication technique of “offering self.”
a. “I’ve also had traumatic life experiences. Maybe it would help if I told you about them.”
b. “Why do you think you had so much difficulty adjusting to this change in your life?”
c. “I hope you will feel better after getting accustomed to how this unit operates.”
d. “I’d like to sit with you for a while to help you get comfortable talking to me.”
5. Which technique will best communicate to a patient that the nurse is interested in listening?
a. Restating a feeling or thought the patient has expressed.
b. Asking a direct question, such as “Did you feel angry?”
c. Making a judgment about the patient’s problem.
d. Saying, “I understand what you’re saying.”
6. A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate?
a. “What are the common elements here?”
b. “Tell me again about your experiences.”
c. “Am I correct in understanding that . . .”
d. “Tell me everything from the beginning.”
7. A patient tells the nurse, “I don’t think I’ll ever get out of here.” Select the nurse’s most therapeutic response.
a. “Don’t talk that way. Of course you will leave here!”
b. “Keep up the good work, and you certainly will.”
c. “You don’t think you’re making progress?”
d. “Everyone feels that way sometimes.”
8. Documentation in a patient’s chart shows, “Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, ‘I enjoy spending time with you.’” Which analysis is most accurate?
a. The patient is giving positive feedback about the nurse’s communication techniques.
b. The nurse is viewing the patient’s behavior through a cultural filter.
c. The patient’s verbal and nonverbal messages are incongruent.
d. The patient is demonstrating psychotic behaviors.
9. While talking with a patient diagnosed with major depression, a nurse notices the patient is unable to maintain eye contact. The patient’s chin lowers to the chest, while the patient looks at the floor. Which aspect of communication has the nurse assessed?
a. Nonverbal communication c. A cultural barrier
b. A message filter d. Social skills
10. During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patient’s hand. Select the correct analysis of the nurse’s behavior.
a. It shows empathy and compassion. It will encourage the patient to continue to express feelings.
b. The gesture is premature. The patient’s cultural and individual interpretation of touch is unknown.
c. The patient will perceive the gesture as intrusive and overstepping boundaries.
d. The action is inappropriate. Psychiatric patients should not be touched.
Chapter 10: Understanding and Managing Responses to Stress
1. The adult child of a patient diagnosed with major depression asks, “Do you think depression and physical illness are connected? Since my father’s death, my mother has had shingles and the flu, but she’s usually not one who gets sick.” Which answer by the nurse best reflects current knowledge about psychoneuroimmunology?
a. “It is probably a coincidence. Emotions and physical responses travel on different tracts of the nervous system.”
b. “You may be paying more attention to your mother since your father died and noticing more things such as minor illnesses.”
c. “So far, research on emotions or stress and becoming ill more easily is unclear. We do not know for sure if there is a link.”
d. “Negative emotions and stress may interfere with the body’s ability to protect itself and can increase the likelihood of infection.”
2. A patient diagnosed with emphysema has severe shortness of breath and needs portable oxygen when leaving home. Recently the patient has reduced activity because of fear that breathing difficulty will occur. A nurse suggests using guided imagery. Which image should the patient be encouraged to visualize?
a. Engaging in activity without using any supplemental oxygen
b. Sleeping comfortably and soundly, without respiratory distress
c. Feeling relaxed and taking regular deep breaths when leaving home
d. Having a younger, healthier body that knows no exercise limitations
3. A nurse leads a psychoeducational group for depressed patients. The nurse plans to implement an exercise regime for each patient. The rationale to use when presenting this plan to the treatment team is that exercise:
a. has an antidepressant effect comparable to selective serotonin reuptake inhibitors.
b. prevents damage from overstimulation of the sympathetic nervous system.
c. detoxifies the body by removing metabolic wastes and other toxins.
d. improves mood stability for patients with bipolar disorders.
4. A recent immigrant from Honduras comes to the clinic with a family member who has been a U.S. resident for 10 years. The family member says, “The immigration to America has been very difficult.” Considering cultural background, which expression of stress by this patient would the nurse expect?
a. Motor restlessness c. Memory deficiencies
b. Somatic complaints d. Sensory perceptual alterations
5. A patient nervously says, “Financial problems are stressing my marriage. I’ve heard rumors about cutbacks at work; I am afraid I might get laid off.” The patient’s pulse is 112/minute; respirations are 26/minute; and blood pressure is 166/88. Which nursing intervention will the nurse implement?
a. Advise the patient, “Go to sleep 30 to 60 minutes earlier each night to increase rest.”
b. Direct the patient in slow and deep breathing via use of a positive, repeated word.
c. Suggest the patient consider that a new job might be better than the present one.
d. Tell the patient, “Relax by spending more time playing with your pet.”
6. According to the Recent Life Changes Questionnaire, which situation would most necessitate a complete assessment of a person’s stress status and coping abilities?
a. A person who has been assigned more responsibility at work
b. A parent whose job required relocation to a different city
c. A person returning to college after an employer ceased operations
d. A man who recently separated from his wife because of marital problems
7. A patient newly diagnosed as HIV-positive seeks the nurse’s advice on how to reduce the risk of infections. The patient says, “I used to go to church and I was in my best health then. Maybe I should start going to church again.” Which response will the nurse offer?
a. “Religion does not usually affect health, but you were younger and stronger then.”
b. “Contact with supportive people at church might help, but religion itself is not especially helpful.”
c. “Studies show that spiritual practices can enhance immune system function and coping abilities.”
d. “Going to church would expose you to many potential infections. Let’s think about some other options.”
8. When a nurse asks a newly admitted patient to describe social supports, the patient says, “My parents died last year and I have no family. I am newly divorced, and my former in-laws blame me. I don’t have many friends because most people my age just want to go out drinking.” Which action will the nurse apply?
a. Advise the patient that being so particular about potential friends reduces social contact.
b. Suggest using the Internet as a way to find supportive others with similar values.
c. Encourage the patient to begin dating again, perhaps with members of the church.
d. Discuss how divorce support groups could increase coping and social support.
9. A patient experiencing significant stress associated with a disturbing new medical diagnosis asks the nurse, “Do you think saying a prayer would help?” Select the nurse’s best answer.
a. “It could be that prayer is your only hope.”
b. “You may find prayer gives comfort and lowers your stress.”
c. “I can help you feel calmer by teaching you meditation exercises.”
d. “We do not have evidence that prayer helps, but it wouldn’t hurt.”
10. A patient is brought to the Emergency Department after a motorcycle accident. The patient is alert, responsive, and diagnosed with a broken leg. The patient’s vital signs are pulse (P) 72 and respiration (R) 16. After being informed surgery is required for the broken leg, which vital sign readings would be expected?
a. P 64, R 14 c. P 72, R 16
b. P 68, R 12 d. P 80, R 20
Chapter 11: Childhood and Neurodevelopmental Disorders
1. Which factor presents the highest risk for a child to develop a psychiatric disorder?
a. Having an uncle with schizophrenia c. Living with an alcoholic parent
b. Being the oldest child in a family d. Being an only child
2. Which nursing diagnosis is universally applicable for children diagnosed with autism spectrum disorders?
a. Impaired social interaction related to difficulty relating to others
b. Chronic low self-esteem related to excessive negative feedback
c. Deficient fluid volume related to abnormal eating habits
d. Anxiety related to nightmares and repetitive activities
3. Which behavior indicates that the treatment plan for a child diagnosed with an autism spectrum disorder was effective? The child:
a. plays with one toy for 30 minutes.
b. repeats words spoken by a parent.
c. holds the parent’s hand while walking.
d. spins around and claps hands while walking.
4. A kindergartener is disruptive in class. This child is unable to sit for expected lengths of time, inattentive to the teacher, screams while the teacher is talking, and is aggressive toward other children. The nurse plans interventions designed to:
a. promote integration of self-concept.
b. provide inpatient treatment for the child.
c. reduce loneliness and increase self-esteem.
d. improve language and communication skills.
5. A nurse will prepare teaching materials for the parents of a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which medication will the information focus on?
a. Paroxetine (Paxil) c. Methyphenidate (Ritalin)
b. Imipramine (Tofranil) d. Carbamazepine (Tegretol)
6. What is the nurse’s priority focused assessment for side effects in a child taking methylphenidate (Ritalin) for attention deficit hyperactivity disorder (ADHD)?
a. Dystonia, akinesia, and extrapyramidal symptoms
b. Bradycardia and hypotensive episodes
c. Sleep disturbances and weight loss
d. Neuroleptic malignant syndrome
7. A desired outcome for a 12-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) is to improve relationships with other children. Which treatment modality should the nurse suggest for the plan of care?
a. Reality therapy c. Social skills group
b. Simple restitution d. Insight-oriented group therapy
8. The parent of a 6-year-old says, “My child is in constant motion and talks all the time. My child isn’t interested in toys but is out of bed every morning before me.” The child’s behavior is most consistent with diagnostic criteria for:
a. communication disorder.
b. stereotypic movement disorder.
c. intellectual development disorder.
d. attention deficit hyperactivity disorder.
9. A child diagnosed with attention deficit hyperactivity disorder had this nursing diagnosis: impaired social interaction related to excessive neuronal activity as evidenced by aggression and demanding behavior with others. Which finding indicates the plan of care was effective? The child:
a. has an improved ability to identify anxiety and use self-control strategies.
b. has increased expressiveness in communication with others.
c. shows increased responsiveness to authority figures.
d. engages in cooperative play with other children.
10. When a 5-year-old diagnosed with attention deficit hyperactivity disorder (ADHD) bounces out of a chair and runs over and slaps another child, what is the nurse’s best action?
a. Instruct the parents to take the aggressive child home.
b. Direct the aggressive child to stop immediately.
c. Call for emergency assistance from other staff.
d. Take the aggressive child to another room.
Chapter 12: Schizophrenia and Schizophrenia Spectrum Disorders
1. A person has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today the person shouts, “They’re all plotting to destroy me. Isn’t that true?” Select the nurse’s most therapeutic response.
a. “Everyone here is trying to help you. No one wants to harm you.”
b. “Feeling that people want to destroy you must be very frightening.”
c. “That is not true. People here are trying to help you if you will let them.”
d. “Staff members are health care professionals who are qualified to help you.”
2. A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, “I saw two doctors talking in the hall. They were plotting to kill me.” The nurse may correctly assess this behavior as:
a. echolalia. c. a delusion of infidelity.
b. an idea of reference. d. an auditory hallucination.
3. A patient diagnosed with schizophrenia says, “My co-workers are out to get me. I also saw two doctors plotting to kill me.” How does this patient perceive the environment?
a. Disorganized c. Supportive
b. Dangerous d. Bizarre
4. When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol (Haldol) was prescribed. The patient now says, “I stopped taking those pills. They made me feel like a robot.” What are common side effects the nurse should validate with the patient?
a. Sedation and muscle stiffness
b. Sweating, nausea, and diarrhea
c. Mild fever, sore throat, and skin rash
d. Headache, watery eyes, and runny nose
5. Which hallucination necessitates the nurse to implement safety measures? The patient says,
a. “I hear angels playing harps.”
b. “The voices say everyone is trying to kill me.”
c. “My dead father tells me I am a good person.”
d. “The voices talk only at night when I’m trying to sleep.”
6. A patient’s care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating?
a. Detachment and overconfidence
b. Darting eyes, tilted head, mumbling to self
c. Euphoric mood, hyperactivity, distractibility
d. Foot tapping and repeatedly writing the same phrase
7. A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social function. The patient is also overweight and hypertensive. Which drug should the nurse advocate?
a. Clozapine (Clozaril) c. Olanzapine (Zyprexa)
b. Ziprasidone (Geodon) d. Aripiprazole (Abilify)
8. A patient diagnosed with schizophrenia tells the nurse, “I eat skiller. Tend to end. Easter. It blows away. Get it?” Select the nurse’s best response.
a. “Nothing you are saying is clear.”
b. “Your thoughts are very disconnected.”
c. “Try to organize your thoughts and then tell me again.”
d. “I am having difficulty understanding what you are saying.”
9. A patient diagnosed with schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which patient needs are of priority importance?
a. Self-esteem c. Physiological
b. Psychosocial d. Self-actualization
10. A patient diagnosed with schizophrenia demonstrates little spontaneous movement and has waxy flexibility. The patient’s activities of daily living are severely compromised. An appropriate outcome would be that the patient will:
a. demonstrate increased interest in the environment by the end of week 1.
b. perform self-care activities with coaching by the end of day 3.
c. gradually take the initiative for self-care by the end of week 2.
d. accept tube feeding without objection by day 2.
Chapter 13: Bipolar and Related Disorders
1. A person was online continuously for over 24 hours, posting rhymes on official government websites and inviting politicians to join social networks. The person has not slept or eaten for 3 days. What features of mania are evident?
a. Increased muscle tension and anxiety c. Poor judgment and hyperactivity
b. Vegetative signs and poor grooming d. Cognitive deficits and paranoia
2. A patient diagnosed with bipolar disorder is dressed in a red leotard and bright scarves. The patient twirls and shadow boxes. The patient says gaily, “Do you like my scarves? Here; they are my gift to you.” How should the nurse document the patient’s mood?
a. Euphoric c. Suspicious
b. Irritable d. Confident
3. A person was directing traffic on a busy street, rapidly shouting, “To work, you jerk, for perks” and making obscene gestures at cars. The person has not slept or eaten for 3 days. Which assessment findings will have priority concern for this patient’s plan of care?
a. Insulting, aggressive behavior
b. Pressured speech and grandiosity
c. Hyperactivity; not eating and sleeping
d. Poor concentration and decision making
4. A patient diagnosed with acute mania has distributed pamphlets about a new business venture on a street corner for 2 days. Which nursing diagnosis has priority?
a. Risk for injury
b. Ineffective coping
c. Impaired social interaction
d. Ineffective therapeutic regimen management
5. A patient diagnosed with bipolar disorder becomes hyperactive after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate?
a. “Stop that! No one did anything to provoke an attack by you.”
b. “If you do that one more time, you will be secluded immediately.”
c. “Do not hit anyone. If you are unable to control yourself, we will help you.”
d. “You know we will not let you hit anyone. Why do you continue this behavior?”
6. This nursing diagnosis applies to a patient with acute mania: Imbalanced nutrition: less than body requirements related to insufficient caloric intake and hyperactivity as evidenced by 5-pound weight loss in 4 days. Select an appropriate outcome. The patient will:
a. ask staff for assistance with feeding within 4 days.
b. drink six servings of a high-calorie, high-protein drink each day.
c. consistently sit with others for at least 30 minutes at meal time within 1 week.
d. consistently wear appropriate attire for age and sex within 1 week while on the psychiatric unit.
7. A patient demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine (Zyprexa). What is the rationale for the addition of olanzapine to the medication regimen? It will:
a. minimize the side effects of lithium.
b. bring hyperactivity under rapid control.
c. enhance the antimanic actions of lithium.
d. be used for long-term control of hyperactivity.
8. A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed?
a. phenytoin (Dilantin) c. risperidone (Risperdal)
b. clonidine (Catapres) d. carbamazepine (Tegretol)
9. The exact cause of bipolar disorder has not been determined; however, for most patients:
a. several factors, including genetics, are implicated.
b. brain structures were altered by stress early in life.
c. excess sensitivity in dopamine receptors may trigger episodes.
d. inadequate norepinephrine reuptake disturbs circadian rhythms.
10. The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Which response should the nurse provide?
a. “A high proportion of patients with bipolar disorders are found among creative writers.”
b. “A higher rate of relatives with bipolar disorder is found among patients with bipolar disorder.”
c. “Patients with bipolar disorder have higher rates of relatives who respond in an exaggerated way to daily stress.”
d. “More individuals with bipolar disorder come from high socioeconomic and educational backgrounds.”
Chapter 14: Depressive Disorders
1. A patient became severely depressed when the last of the family’s six children moved out of the home 4 months ago. The patient repeatedly says, “No one cares about me. I’m not worth anything.” Which response by the nurse would be the most helpful?
a. “Things will look brighter soon. Everyone feels down once in a while.”
b. “Our staff members care about you and want to try to help you get better.”
c. “It is difficult for others to care about you when you repeatedly say the same negative things.”
d. “I’ll sit with you for 10 minutes now and 10 minutes after lunch to help you feel that I care about you.”
2. A patient became depressed after the last of the family’s six children moved out of the home 4 months ago. Select the best initial outcome for the nursing diagnosis Situational low self-esteem related to feelings of abandonment. The patient will:
a. verbalize realistic positive characteristics about self by (date).
b. agree to take an antidepressant medication regularly by (date).
c. initiate social interaction with another person daily by (date).
d. identify two personal behaviors that alienate others by (date).
3. A patient diagnosed with major depression says, “No one cares about me anymore. I’m not worth anything.” Today the patient is wearing a new shirt and has neat, clean hair. Which remark by the nurse supports building a positive self-esteem for this patient?
a. “You look nice this morning.” c. “I like the shirt you are wearing.”
b. “You’re wearing a new shirt.” d. “You must be feeling better today.”
4. An adult diagnosed with major depression was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest?
a. Social skills training c. Desensitization techniques
b. Relaxation training classes d. Use of complementary therapy
5. Priority interventions for a patient diagnosed with major depression and feelings of worthlessness should include:
a. distracting the patient from self-absorption.
b. careful unobtrusive observation around the clock.
c. allowing the patient to spend long periods alone in meditation.
d. opportunities to assume a leadership role in the therapeutic milieu.
6. When counseling patients diagnosed with major depression, an advanced practice nurse will address the negative thought patterns by using:
a. psychoanalytic therapy.
b. desensitization therapy.
c. cognitive behavioral therapy.
d. alternative and complementary therapies.
7. A patient says to the nurse, “My life doesn’t have any happiness in it anymore. I once enjoyed holidays, but now they’re just another day.” The nurse documents this report as an example of:
a. dysthymia. c. euphoria.
b. anhedonia. d. anergia.
8. A patient diagnosed with major depression began taking a tricyclic antidepressant 1 week ago. Today the patient says, “I don’t think I can keep taking these pills. They make me so dizzy, especially when I stand up.” The nurse will:
a. limit the patient’s activities to those that can be performed in a sitting position.
b. withhold the drug, force oral fluids, and notify the health care provider.
c. teach the patient strategies to manage postural hypotension.
d. update the patient’s mental status examination.
9. A patient diagnosed with depression is receiving imipramine (Tofranil) 200 mg qhs. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug?
a. Dry mouth c. Nasal congestion
b. Blurred vision d. Urinary retention
10. A patient diagnosed with major depression tells the nurse, “Bad things that happen are always my fault.” Which response by the nurse will best assist the patient to reframe this overgeneralization?
a. “I really doubt that one person can be blamed for all the bad things that happen.”
b. “Let’s look at one bad thing that happened to see if another explanation exists.”
c. “You are being extremely hard on yourself. Try to have a positive focus.”
d. “Are you saying that you don’t have any good things happen?”
Chapter 15: Anxiety and Obsessive-Compulsive Related Disorders
1. A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first?
a. Verify the patient’s learning style.
b. Lower the patient’s current anxiety.
c. Create outcomes and a teaching plan.
d. Assess how the patient uses defense mechanisms.
2. A woman is 5’7”, 160 lbs, and wears a size 8 shoe. She says, “My feet are huge. I’ve asked three orthopedists to surgically reduce my feet.” This person tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely?
a. Social anxiety disorder
b. Body dysmorphic disorder
c. Separation anxiety disorder
d. Obsessive-compulsive disorder due to a medical condition
3. A patient experiencing moderate anxiety says, “I feel undone.” An appropriate response for the nurse would be:
a. “What would you like me to do to help you?”
b. “Why do you suppose you are feeling anxious?”
c. “I’m not sure I understand. Give me an example.”
d. “You must get your feelings under control before we can continue.”
4. A patient fearfully runs from chair to chair crying, “They’re coming! They’re coming!” The patient does not follow the staff’s directions or respond to verbal interventions. The initial nursing intervention of highest priority is to:
a. provide for the patient’s safety.
b. encourage clarification of feelings.
c. respect the patient’s personal space.
d. offer an outlet for the patient’s energy.
5. A patient fearfully runs from chair to chair crying, “They’re coming! They’re coming!” The patient does not follow the staff’s directions or respond to verbal interventions. Which nursing diagnosis has the highest priority?
a. Fear c. Self-care deficit
b. Risk for injury d. Disturbed thought processes
6. A patient checks and rechecks electrical cords related to an obsessive thought that the house may burn down. The nurse and patient explore the likelihood of an actual fire. The patient states this event is not likely. This counseling demonstrates principles of:
a. flooding. c. relaxation technique.
b. desensitization. d. cognitive restructuring.
7. A patient undergoing diagnostic tests says, “Nothing is wrong with me except a stubborn chest cold.” The spouse reports the patient smokes, coughs daily, lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using?
a. Displacement c. Projection
b. Regression d. Denial
8. A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty understanding the nurse’s comments and asks, “What do you mean? What are they going to do?” Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patient’s level of anxiety?
a. Mild c. Severe
b. Moderate d. Panic
9. A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is most appropriate?
a. Reassure the patient that all nurses are skilled in providing postoperative care.
b. Present the information again in a calm manner using simple language.
c. Tell the patient that staff is prepared to promote recovery.
d. Encourage the patient to express feelings to family.
10. A patient is experiencing moderate anxiety. The nurse encourages the patient to talk about feelings and concerns. What is the rationale for this intervention?
a. Offering hope allays and defuses the patient’s anxiety.
b. Concerns stated aloud become less overwhelming and help problem solving begin.
c. Anxiety is reduced by focusing on and validating what is occurring in the environment.
d. Encouraging patients to explore alternatives increases the sense of control and lessens anxiety.
Chapter 16: Trauma, Stressor-Related, and Dissociative Disorders
1. A nurse works with a patient diagnosed with posttraumatic stress disorder who has frequent flashbacks as well as persistent symptoms of arousal. Which intervention should be included in the plan of care?
a. Trigger flashbacks intentionally in order to help the patient learn to cope with them.
b. Explain that the physical symptoms are related to the psychological state.
c. Encourage repression of memories associated with the traumatic event.
d. Support “numbing” as a temporary way to manage intolerable feelings.
2. Four teenagers died in an automobile accident. One week later, which behavior by the parents of these teenagers most clearly demonstrates resilience? The parents who:
a. visit their teenager’s grave daily.
b. return immediately to employment.
c. discuss the accident within the family only.
d. create a scholarship fund at their child’s high school.
3. After the sudden death of his wife, a man says, “I can’t live without her…she was my whole life.” Select the nurse’s most therapeutic reply.
a. “Each day will get a little better.”
b. “Her death is a terrible loss for you.”
c. “It’s important to recognize that she is no longer suffering.”
d. “Your friends will help you cope with this change in your life.”
4. A woman just received notification that her husband died. She approaches the nurse who cared for him during his last hours and says angrily, “If you had given him your undivided attention, he would still be alive.” How should the nurse analyze this behavior?
a. The comment suggests potential allegations of malpractice.
b. In some cultures, grief is expressed solely through anger.
c. Anger is an expected emotion in an adjustment disorder.
d. The patient had ambivalent feelings about her husband.
5. A wife received news that her husband died of heart failure and called her family to come to the hospital. She angrily tells the nurse who cared for him, “He would still be alive if you had given him your undivided attention.” Select the nurse’s best intervention.
a. Say to the wife, “I understand you are feeling upset. I will stay with you until your family comes.”
b. Say to the wife, “Your husband’s heart was so severely damaged that it could no longer pump.”
c. Say to the wife, “I will call the health care provider to discuss this matter with you.”
d. Hold the wife’s hand in silence until the family arrives.
6. A child drowned while swimming in a local lake 2 years ago. Which behavior indicates the child’s parents have adapted to their loss? The parents:
a. visit their child’s grave daily.
b. maintain their child’s room as the child left it 2 years ago.
c. keep a place set for the dead child at the family dinner table.
d. throw flowers on the lake at each anniversary date of the accident.
7. A store clerk was killed during a robbery 2 weeks ago. His widow, who has a long history of schizoaffective disorder, cries spontaneously when talking about his death. Select the nurse’s most therapeutic response.
a. “Are you taking your medications the way they are prescribed?”
b. “This loss is harder to accept because of your mental illness. Do you think you should be hospitalized?”
c. “I’m worried about how much you are crying. Your grief over your husband’s death has gone on too long.”
d. “The unexpected death of your husband is very painful. I’m glad you are able to talk about your feelings.”
8. Which scenario demonstrates a dissociative fugue?
a. After being caught in an extramarital affair, a man disappeared but then reappeared months later with no memory of what occurred while he was missing.
b. A man is extremely anxious about his problems and sometimes experiences dazed periods of several minutes passing without conscious awareness of them.
c. A woman finds unfamiliar clothes in her closet, is recognized when she goes to new restaurants, and complains of “blackouts” despite not drinking.
d. A woman reports that when she feels tired or stressed, it seems like her body is not real and is somehow growing smaller.
9. The nurse who is counseling a patient with dissociative identity disorder should understand that the assessment of highest priority is:
a. risk for self-harm. c. memory impairment.
b. cognitive function. d. condition of self-esteem.
10. A patient states, “I feel detached and weird all the time. It is as though I am looking at life through a cloudy window. Everything seems unreal. It really messes up things at work and school.” This scenario is most suggestive of which health problem?
a. Acute stress disorder
b. Dissociative amnesia
c. Depersonalization disorder
d. Disinhibited social engagement disorder
Chapter 17: Somatic Symptom Disorders
1. Which assessment data would help the health care team distinguish symptoms of conversion (functional neurological) disorder from symptoms of illness anxiety disorder (hypochondriasis)?
a. Voluntary control of symptoms c. Results of diagnostic testing
b. Patient’s style of presentation d. The role of secondary gains
2. Which prescription medication would the nurse expect to be prescribed for a patient diagnosed with a somatic symptom disorder?
a. Narcotic analgesics for use as needed for acute pain
b. Antidepressant medications to treat underlying depression
c. Long-term use of benzodiazepines to support coping with anxiety
d. Conventional antipsychotic medications to correct cognitive distortions
3. A medical-surgical nurse works with a patient diagnosed with a somatic symptom disorder. Care planning is facilitated by understanding that the patient will probably:
a. readily seek psychiatric counseling.
b. be resistant to accepting psychiatric help.
c. attend psychotherapy sessions without encouragement.
d. be eager to discover the true reasons for physical symptoms.
4. A patient has blindness related to conversion (functional neurological) disorder but is unconcerned about this problem. Which understanding should guide the nurse’s planning for this patient?
a. The patient is suppressing accurate feelings regarding the problem.
b. The patient’s anxiety is relieved through the physical symptom.
c. The patient’s optic nerve transmission has been impaired.
d. The patient will not disclose genuine fears.
5. A patient has blindness related to conversion (functional neurological) disorder. To help the patient eat, the nurse should:
a. establish a “buddy” system with other patients who can feed the patient at each meal.
b. expect the patient to feed self after explaining arrangement of the food on the tray.
c. direct the patient to locate items on the tray independently and feed self.
d. address needs of other patients in the dining room, then feed this patient.
6. A patient with blindness related to conversion (functional neurological) disorder says, “All the doctors and nurses in the hospital stop by often to check on me. Too bad people outside the hospital don’t find me as interesting.” Which nursing diagnosis is most relevant?
a. Social isolation c. Interrupted family processes
b. Chronic low self-esteem d. Ineffective health maintenance
7. To assist patients diagnosed with somatic symptom disorders, nursing interventions of high priority:
a. explain the pathophysiology of symptoms.
b. help these patients suppress feelings of anger.
c. shift focus from somatic symptoms to feelings.
d. investigate each physical symptom as it is reported.
8. A patient with fears of serious heart disease was referred to the mental health center by a cardiologist. Extensive diagnostic evaluation showed no physical illness. The patient says, “My chest is tight, and my heart misses beats. I’m often absent from work. I don’t go out much because I need to rest.” Which health problem is most likely?
a. Dysthymic disorder
b. Somatic symptom disorder
c. Antisocial personality disorder
d. Illness anxiety disorder (hypochondriasis)
9. A nurse assessing a patient diagnosed with a somatic symptom disorder is most likely to note that the patient:
a. sees a relationship between symptoms and interpersonal conflicts.
b. has little difficulty communicating emotional needs to others.
c. rarely derives personal benefit from the symptoms.
d. has altered comfort and activity needs.
10. To plan effective care for patients diagnosed with somatic symptom disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms:
a. are generally chronic. c. can be voluntarily controlled.
b. have a physiological basis. d. provide relief from health anxiety.
Chapter 18: Feeding, Eating, and Elimination Disorders
1. Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. This person wears layered loose clothing. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely?
a. Binge eating
b. Bulimia nervosa
c. Anorexia nervosa
d. Eating disorder not otherwise specified
2. Disturbed body image is a nursing diagnosis established for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor?
a. Weight, muscle, and fat congruence with height, frame, age, and sex
b. Calorie intake is within required parameters of treatment plan
c. Weight reaches established normal range for the patient
d. Patient expresses satisfaction with body appearance
3. A patient referred to the eating disorders clinic has lost 35 pounds during the past 3 months. To assess eating patterns, the nurse should ask the patient:
a. “Do you often feel fat?”
b. “Who plans the family meals?”
c. “What do you eat in a typical day?”
d. “What do you think about your present weight?”
4. A patient diagnosed with anorexia nervosa virtually stopped eating 5 months ago and lost 25% of body weight. A nurse asks, “Describe what you think about your present weight and how you look.” Which response by the patient is most consistent with the diagnosis?
a. “I am fat and ugly.”
b. “What I think about myself is my business.”
c. “I’m grossly underweight, but that’s what I want.”
d. “I’m a few pounds overweight, but I can live with it.”
5. A patient was diagnosed with anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is currently 2.7 mg/dL. Which nursing diagnosis applies?
a. Adult failure to thrive related to abuse of laxatives as evidenced by electrolyte imbalances and weight loss
b. Disturbed energy field related to physical exertion in excess of energy produced through caloric intake as evidenced by weight loss and hyperkalemia
c. Ineffective health maintenance related to self-induced vomiting as evidenced by swollen parotid glands and hyperkalemia
d. Imbalanced nutrition: less than body requirements related to reduced oral intake as evidenced by loss of 25% of body weight and hypokalemia
6. Outpatient treatment is planned for a patient diagnosed with anorexia nervosa. Select the most important desired outcome related to the nursing diagnosis Imbalanced nutrition: less than body requirements. Within 1 week, the patient will:
a. weigh self accurately using balanced scales.
b. limit exercise to less than 2 hours daily.
c. select clothing that fits properly.
d. gain 1 to 2 pounds.
7. Which nursing intervention has the highest priority as a patient diagnosed with anorexia nervosa begins to gain weight?
a. Assess for depression and anxiety.
b. Observe for adverse effects of refeeding.
c. Communicate empathy for the patient’s feelings.
d. Help the patient balance energy expenditures with caloric intake.
8. A patient diagnosed with anorexia nervosa is resistant to weight gain. What is the rationale for establishing a contract with the patient to participate in measures designed to produce a specified weekly weight gain?
a. Because severe anxiety concerning eating is expected, objective and subjective data may be unreliable.
b. Patient involvement in decision making increases sense of control and promotes compliance with treatment.
c. Because of increased risk of physical problems with refeeding, the patient’s permission is needed.
d. A team approach to planning the diet ensures that physical and emotional needs will be met.
9. The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention “monitor for complications of refeeding.” Which system should a nurse closely monitor for dysfunction?
a. Renal c. Integumentary
b. Endocrine d. Cardiovascular
10. A psychiatric clinical nurse specialist uses cognitive-behavioral therapy for a patient diagnosed with anorexia nervosa. Which statement by the staff nurse supports this type of therapy?
a. “What are your feelings about not eating foods that you prepare?”
b. “You seem to feel much better about yourself when you eat something.”
c. “It must be difficult to talk about private matters to someone you just met.”
d. “Being thin doesn’t seem to solve your problems. You are thin now but still unhappy.”
Chapter 19: Sleep-Wake Disorders
1. A nurse cares for these four patients. Which patient has the highest risk for problems with sleep physiology?
a. Retiree who volunteers twice a week at Habitat for Humanity
b. Corporate accountant who travels frequently
c. Parent with three teenagers
d. Lawn care worker
2. Which comment is most likely from a patient with chronic sleep deprivation?
a. “I turn on the television every night to get to sleep. I set the timer so it goes off in 30 minutes.”
b. “I have diarrhea frequently and not much energy, so I stay at home most of the time.”
c. “I only sleep about 7 hours a night, but I know I should sleep 8 or 9 hours.”
d. “When my alarm clock goes off every morning, it seems like I am dreaming.”
3. The nurse provides health education for an adult experiencing sleep deprivation. Which instruction has the highest priority?
a. “It’s important to limit your driving to short periods. Sleep deprivation increases your risks for serious accidents.”
b. “Sleep deprivation is usually self-limiting. See your health care provider if it lasts more than a year.”
c. “Turn the radio on with a soft volume as you prepare for bed each evening. It will help you relax.”
d. “Three glasses of wine each evening help many patients who suffer from sleep deprivation.”
4. A nurse provides health education for an adult with sleep deprivation. It is most important for the nurse to encourage caution when the patient engages in:
a. using a vacuum cleaner. c. driving a car.
b. cooking a meal. d. bathing.
5. A patient needs diagnostic evaluation of sleep problems. Which test will evaluate the patient for possible sleep-related problems?
a. Skull x-rays
b. Electroencephalogram (EEG)
c. Positron emission tomography (PET)
d. Single-photon emission computed tomography (SPECT)
6. A patient says, “It takes me about 15 minutes to go to sleep each night.” This comment describes:
a. delta sleep. c. sleep latency.
b. parasomnia. d. rapid eye movement sleep.
7. A person says, “I often feel like I have been dreaming just before I awake in the morning.” Which rationale correctly explains the comment?
a. Sleep architecture changes during the sleep period, resulting in increased slow-wave sleep at the end of the cycle.
b. Cycles of rapid eye movement sleep increase in the second half of sleep and occupy longer periods.
c. Dreams occur more frequently when a person is experiencing unresolved conflicts or depression.
d. Dream content relates directly to developmental tasks. The person is likely feeling autonomous.
8. Which person would be most likely to experience sleep fragmentation?
a. An obese adult
b. A toddler who attends day care
c. A person diagnosed with mild osteoarthritis
d. An adolescent diagnosed with anorexia nervosa
9. A person is prescribed lorazepam (Ativan) 2 mg po bid prn for anxiety. When the person takes this medication, which change in sleep is anticipated? The patient will:
a. have fewer dreams.
b. have less slow-wave sleep.
c. experience extended sleep latency.
d. enter sleep through rapid eye movement (REM) sleep.
10. A person is prescribed sertraline (Zoloft) 100 mg PO daily. Which change in sleep is likely secondary to this medication? The patient will have:
a. more dreams.
b. excessive sleepiness.
c. less slow-wave sleep.
d. less rapid eye movement (REM) sleep.
Chapter 20: Sexual Dysfunctions, Gender Dysphoria, and Paraphilias
1. A new staff nurse tells the clinical nurse specialist, “I am unsure about my role when patients bring up sexual problems.” The clinical nurse specialist should give clarification by saying, “All nurses:
a. qualify as sexual counselors. Nurses have knowledge about the biopsychosocial aspects of sexuality throughout the life cycle.”
b. should be able to screen for sexual dysfunction and give basic information about sexual feelings, behaviors, and myths.”
c. should defer questions about sex to other health care professionals because of their limited knowledge of sexuality.”
d. who are interested in sexual dysfunction can provide sex therapy for individuals and couples.”
2. A nurse is performing an assessment for a 59-year-old man who has hypertension. What is the rationale for including questions about prescribed medications and their effects on sexual function in the assessment?
a. Sexual dysfunction may result from use of prescription medications for management of hypertension.
b. Such questions are an indirect way of learning about the patient’s medication adherence.
c. These questions ease the transition to questions about sexual practices in general.
d. Sexual dysfunction can cause stress and contribute to increased blood pressure.
3. An adult experienced a myocardial infarction six months ago. At a follow-up visit, this adult says, “I haven’t had much interest in sex since my heart attack. I finished my rehabilitation program, but having sex strains my heart. I don’t know if my heart is strong enough.” Which nursing diagnosis applies?
a. Deficient knowledge related to faulty perception of health status
b. Disturbed self-concept related to required lifestyle changes
c. Disturbed body image related to treatment side effects
d. Sexual dysfunction related to self-esteem disturbance
4. Which nursing action should occur first regarding a patient who has a problem of sexual dysfunction or sexual disorder? The nurse should:
a. develop an understanding of human sexual response.
b. assess the patient’s sexual functioning and needs.
c. acquire knowledge of the patient’s sexual roles.
d. clarify own personal values about sexuality.
5. A patient tells the nurse that his sexual functioning is normal when his wife wears short, red camisole-style nightgowns. He states, “Without the red teddies, I am not interested in sex.” The nurse can assess this as consistent with:
a. exhibitionism. c. frotteurism.
b. voyeurism. d. fetishism.
6. While performing an assessment, the nurse says to a patient, “While growing up, most of us heard some half-truths about sexual matters that continue to puzzle us as adults. Do any come to your mind now?” The purpose of this question is to:
a. identify areas of sexual dysfunction for treatment.
b. determine possible homosexual urges.
c. introduce the topic of masturbation.
d. identify sexual misinformation.
7. A woman tells the nurse, “My partner is frustrated with me. I don’t have any natural lubrication when we have sex.” What type of sexual disorder is evident?
a. Genito-Pelvic Pain/Penetration Disorder
b. Female Sexual Interest/Arousal Disorder
c. Hypoactive Sexual Desire Disorder
d. Female Orgasmic Disorder
8. The male manager of a health club placed a hidden video camera in the women’s locker room and recorded several women as they showered and dressed. The disorder most likely represented by this behavior is:
a. homosexuality. c. pedophilia.
b. exhibitionism. d. voyeurism.
9. A woman consults the nurse practitioner because she has not achieved orgasm for 2 years, despite having been sexually active. This is an example of:
a. Paraphilic Disorder.
b. Female Orgasmic Disorder.
c. Genito-Pelvic Pain/Penetration Disorder.
d. Female Sexual Interest/Arousal Disorder.
10. An adult consulted a nurse practitioner because of an inability to achieve orgasm for 2 years, despite having been sexually active. This adult was frustrated and expressed concerns about the relationship with the sexual partner. Which nursing diagnosis is most appropriate for this scenario?
a. Defensive coping c. Ineffective sexuality pattern
b. Sexual dysfunction d. Disturbed sensory perception, tactile
AND MUCH MORE