Test Bank Principles Practice Psychiatric Nursing 10th Edition, Gail
Chapter 1: Roles and Functions of Psychiatric-Mental Health Nurses: Competent Caring
1. In 1952, Hildegard Peplau defined the psychiatric nurse’s role as a:
a. professional who helps patients with attitude adjustment.
b. nurse who is extensively trained to care for psychiatric patients.
c. resource person, a teacher, a leader, and a counselor to patients.
d. professional who is certified to conduct psychosocial therapy sessions.
2. The contribution of Linda Richards that remains a part of contemporary psychiatric nursing practice is the idea that:
a. psychiatric nurses should have advanced preparation.
b. nurses should assess both the physical and the emotional needs of patients.
c. psychotic behavior must be controlled before serious psychotherapy begins.
d. basic physical needs must always be met before emotional needs are addressed.
3. A nurse states, “I plan ways for patients assigned to me to participate in their own care and to be actively involved in all of the activities on the unit.” This approach demonstrates the concept of:
a. social accountability.
b. therapeutic community.
c. nurse-patient relationship.
d. multidisciplinary mental health team.
4. Hildegard Peplau’s classic article “Interpersonal Techniques: The Crux of Psychiatric Nursing” directed psychiatric nursing’s future growth by stating that the primary role of the psychiatric nurse was that of:
d. surrogate parent.
5. When teaching the orientation portion of a psychiatric nursing course, which statement would the instructor be most likely to make to the students?
a. “There is one approved theoretical framework for psychiatric nursing practice.”
b. “Psychiatric nursing has yet to be recognized as a core mental health discipline.”
c. “Contemporary practice of psychiatric nursing is primarily focused on inpatient care.”
d. “The psychiatric nursing patient may be an individual, a family, a group, or even a community.”
6. For psychiatric nurses in the 1980s and 1990s, the scope of practice began to change to include:
a. psychiatric care and medical care given by the home care nurse.
b. new advances in the fields of psychobiology and technology.
c. psychoanalytical therapy provided by the psychiatric nurse in the outpatient setting.
d. new advances in the psychodynamic model of therapy made by the psychiatric nurse in the inpatient setting.
7. During orientation to the inpatient psychiatric unit, new staff members are told, “Address all patients by their title and surname unless you are directed by the patient to do otherwise.” The belief that underlies this directive is that:
a. every person is worthy of respect.
b. every individual has the potential to change.
c. the goals of the individual are growth, health, autonomy, and self-actualization.
d. the person functions as a holistic being who reacts to the environment as a whole person.
8. A psychiatric aide says, “I don’t know why that patient does all that silly giggling and posturing. It’s senseless!” The best reply to this comment would address the psychiatric nursing principle that states:
a. every individual has the potential to change.
b. illness can be a growth-producing experience for the individual.
c. all behavior is meaningful, arising from personal needs and goals.
d. everyone has the right to self-determination that includes the pursuit of health.
9. The role of the psychiatric nurse in today’s contemporary practice settings is:
a. centered on the nurse-patient partnership.
b. concentrated on psychosomatic therapies.
c. centered on management of the patient’s daily needs.
d. caring for chronically ill psychiatric patients in acute-care settings.
10. The primary opportunity provided by psychiatric clinical rotations for nursing students is an opportunity to:
a. become familiar with patients who have chronic psychiatric mental health issues.
b. work with patients who have psychiatric as well as physical health issues.
c. learn to work with patients with various psychiatric mental health issues.
d. learn to care for patients who have emotional disorders.
Chapter 2: Therapeutic Nurse-Patient Relationship
1. A novice nurse states, “Psychiatric nursing can’t be very difficult. After all, I believe in showing care and in mutual exchange with my friends.” The experienced nurse’s understanding of the difference between a social and a therapeutic relationship is primarily based on the:
a. kind of information given.
b. amount of emotion invested.
c. degree of satisfaction obtained.
d. type of responsibility involved.
2. The diagram above is a Johari window that a nurse thinks is accurately self-representative. If the nurse wishes to be more successful in psychiatric nursing, the nurse should make an initial goal to increase the size of quadrant:
3. Which strategy can the nursing student use to foster authenticity in therapeutic relationships with patients?
a. Reading and discussing textbook assignments with a study group
b. Modeling behaviors with patients on the behaviors of a clinically competent staff nurse
c. Attending patient-centered clinical conferences on the assigned psychiatric inpatient unit
d. Analyzing feelings associated with psychiatric clinical experience with the help of instructors and peers
4. A person who has always wished to care for “special children” adopts a biracial child and another child who has spina bifida. What is the highest step of the value clarification process that this person has achieved?
a. Doing something with the choice in a pattern of life
b. Choosing freely from alternatives
c. Being happy with the choice
d. Affirming the choice publicly
5. A nurse makes observations that a depressed patient is more energetic and is smiling much more. Still, the nurse shares with the unit manager that when thinking about the patient a sense of hopelessness surfaces. The nurse manager replies:
a. “Sometimes it’s best to disregard subjective perceptions like that and focus on the objective signs.”
b. “Pay attention to your feelings. They can provide valuable clues about the patient’s feelings.”
c. “You should share your perceptions with the patient and seek an explanation.”
d. “Confrontation can be a useful tool in situations like this.”
6. A new nurse has the following thoughts: “How will I handle things if my patient walks away from me? How will I react if the patient is sexually provocative? How will I cope with a patient who cries?” These thoughts indicate that the nurse is engaged in:
a. role modeling.
c. altruistic thinking.
d. value clarification.
7. A nurse’s most appropriate initial action during the preinteraction phase of a relationship with a homosexual patient should be to:
a. examine personal feelings about homosexuality.
b. review the literature that pertains to the human sexual response.
c. attempt to identify the underlying reasons for the patient’s values.
d. focus on a method to assist the patient with changing personal sexual values.
8. A nurse engaged in the preinteraction phase of the nurse-patient relationship will:
a. consider what he or she has to offer the patient.
b. form a workable but detailed contract.
c. review the general goals of a therapeutic relationship.
d. plan for the first interaction with the patient.
e. identify existing stressors affecting the relationship.
9. When asked to contrast social superficiality with therapeutic intimacy, an experienced nurse mentor explains to a new nurse that the termination component in therapeutic intimacy is:
c. specified and agreed to.
d. closed to negotiation or agreement.
10. Which task would be most appropriate to focus on during the introductory phase of work with a teenage patient with low self-esteem?
a. Mutual formulation of a contract
b. Nurse’s self-analysis of strengths
c. Promotion of patient use of constructive coping mechanisms
d. Review of progress of therapy and goal attainment with patient
Chapter 3: The Stuart Stress Adaptation Model of Psychiatric Nursing Care
1. Which statement can a nurse use to best describe the Stuart Stress Adaptation Model to someone who is unfamiliar with it?
a. “The model recognizes the limitations of the nursing process and organizes treatment along critical pathways.”
b. “The model bases psychiatric nursing practice on principles derived from nursing science and establishes generic goals for each discrete stage of psychiatric treatment.”
c. “The model integrates biopsychosociocultural, environmental, and legal-ethical aspects of psychiatric nursing care into a unified framework for practice throughout the care continuum.”
d. “The model is based primarily on the medical model and organizes psychiatric nursing practice according to discrete treatment stages, selected treatment settings, and legal mandates.”
2. A nurse states, “I don’t understand why the Stuart Stress Adaptation Model uses both the health/illness and adaptation/maladaptation continua.” The best reply is:
a. “The more information that’s contained within the model, the more realistically it represents life.”
b. “The model recognizes that nature is ordered as a social hierarchy from simple to complex. The health/illness continuum is a simple concept; the adaptation/maladaptation continuum is more complex.”
c. “To integrate the theory of four stages of psychiatric treatment, Stuart had to have a health/illness frame of reference. The adaptation/maladaptation continuum was necessary to complement the holistic framework.”
d. “The health/illness continuum reflects a medical world view, whereas the adaptation/maladaptation continuum is derived from nursing’s world view. The two reflect the complementary nature of the nursing and medical models of practice.”
3. A patient in the emergency room of a local community hospital is crying uncontrollably and repeating over and over, “He will hurt me if I don’t get away from him. You have to help me, please.” Which of the following interventions reflects attention to care in the manner advocated by the assumptions stated in the Stuart Stress Adaptation Model?
a. Getting a health care provider to prescribe a sedative for the patient
b. Asking the patient to provide more details about “what he will do”
c. Beginning the nursing process by conducting a nursing assessment
d. Putting the patient in a quiet room to minimize environmental stimuli
4. An adolescent who belongs to a neighborhood gang has been caught both lying and stealing by a parent. After psychiatric testing determines that the adolescent is able to adequately test reality and has no symptoms of a major psychiatric disorder, the most likely finding will be that the child’s behavior demonstrates:
a. healthy deviant.
b. healthy conformist.
c. unhealthy deviant.
d. unhealthy conformist.
5. Which criterion of mental health is a nurse assessing when exploring a patient’s sense of self-determination, balance between dependence and independence, and acceptance of the consequences of behavior?
c. Reality perception
d. Environmental mastery
6. A patient states, “Sometimes I hear voices when no one else is in the room telling me that people are plotting to hurt me.” This patient is experiencing impairment of which criterion of mental health?
c. Reality perception
d. Environmental mastery
7. A nurse documents that a patient is appropriately emotionally responsive, in control, and expresses a unified philosophy of life. This implies that the patient has met the mental health criterion of:
c. reality perception.
d. environmental mastery.
8. A patient mentions, “No one else I know is mentally ill.” What reply would help the patient understand the extent of mental illness?
a. “You are not unique; many people experience mental illness.”
b. “Let’s concern ourselves with you and getting you well again.”
c. “Being among people who understand your problem and want to help is what is important.”
d. “You are truly not alone; almost 50% of adults experience some kind of mental illness.
9. On the basis of predictions from the Global Burden of Disease Study, mental health professionals should be most concerned with increasing primary prevention efforts for:
a. alcohol abuse.
c. bipolar disorder.
d. major depressive disorder.
10. The spouse of a patient with major depressive disorder tells a nurse, “I feel hopeless about my spouse’s condition. It’s not like a physical illness that he can recover from.” Which response will best reassure the spouse?
a. “That’s not true. People with mental illness get well more than 90% of the time.”
b. “While your concerns about your spouse’s recovery are understandable, great strides have been made with the use of new antidepressants.”
c. “It’s not right to try to make comparisons between the effectiveness of treatment of mental and physical illnesses. It’s like comparing apples and oranges.”
d. “New studies show that treatment of depression is effective 65% to 80% of the time, whereas treatments for heart disease and cancer are often only 40% effective.”
Chapter 4: Evidence-Based Psychiatric Nursing Practice
1. Which statement could a nurse use in an argument to support evidence-based psychiatric nursing practice?
a. “Licensing helps ensure effective clinicians.”
b. “Clinical supervision results in more effective clinicians.”
c. “It is unreliable to make generalized assumptions of patients based on only a small sample.”
d. “Information gathered by clinical means tends to be in the form of systematic observations.”
2. Which nursing activities are necessary to provide evidence-based psychiatric nursing care?
a. Obtaining advanced degrees and providing clinical supervision for peers
b. Seeking sound opinion-based processes and maintaining self-directed practice
c. Attending educational programs and supporting the advanced practice licensure
d. Critically synthesizing research findings and applying relevant evidence to practice
3. To substantiate clinical practice the psychiatric nurse should place the greatest reliance on the _____ basis.
4. Which activity will be most useful to a nurse wishing to provide evidence-based psychiatric nursing care?
a. Relying on findings of one properly designed, randomized, controlled trial
b. Using a protocol from several well-designed, cohort, quasiexperimental studies
c. Seeking sound, opinion-based processes and maintaining self-directed practice
d. Applying findings from a meta-analysis of relevant randomized, controlled trials
5. A nurse is developing a set of practice guidelines for a clinical unit and is conducting a literature review to search for examples of criteria that will be relevant to achieving patient-care goals. The search criteria that will be most relevant are those that:
a. explain their complexity in detail.
b. include reduced costs as a major criterion for use.
c. document preferred practices among other mental health professionals.
d. provide methods and procedures that ensure safe and effective treatment.
6. A nurse working at a facility that has just introduced the use of clinical pathways must understand that clinical pathways:
a. do not require quality monitoring.
b. are more specific than clinical algorithms.
c. do not depend on an interdisciplinary approach.
d. are maps with timetables for patient care delivery.
7. Nurses are easily oriented to the use of algorithms because they are familiar with the format of:
b. free text.
c. flow charts.
d. nursing notes.
8. To what extent is outcome measurement important to the delivery of psychiatric nursing care?
a. It is more “nice” than it is necessary.
b. It will support the legitimacy of psychiatric nursing.
c. It will promote descriptive and correlational nursing research.
d. It gives information about the appropriate settings for treatment.
9. For psychiatric nurses, an essential part of outcome measurement is the:
a. development of practice guidelines.
b. systematic review of research literature.
c. systematic use of reliable patient-rating scales.
d. identification of the core knowledge and skills of psychiatric nurses.
10. The psychiatric nurse uses evidence-based practice as a means to better meet patients’ needs. The most current source of nursing research is:
b. journal articles.
c. the DSM-IV-TR.
d. databases of systematic reviews.
Chapter 5: Biological Context of Psychiatric Nursing Care
1. When a patient asks the nurse, “What are neurotransmitters?” The nurse replies that neurotransmitters are:
a. “the chemical messengers that cause brain cells to turn on or off.”
b. “small clumps of cells that alert the other brain cells to receive messages.”
c. “tiny areas of the brain that are responsible for controlling our emotions.”
d. “weblike structures that provide connections among various parts of the brain.”
2. A patient tells a nurse, “My doctor says my problem may be with the neurotransmitters in my brain but I don’t understand what that means.” The nurse responds:
a. “Let’s begin with exploring what your doctor has told you about your problem.”
b. “We should start with a discussion about any concerns you have about having a neurotransmitter disorder.”
c. “First let me say that neurotransmitter problems can usually be treated or cured with medication therapy.”
d. “What you need to understand is that neurotransmitters are chemical messengers in the brain responsible for brain communication.”
3. Which part of the brain is responsible for fine motor coordination?
d. Temporal lobe
4. Which neurotransmitter is located only in the brain, particularly in the raphe nuclei of the brainstem, and is implicated in depression?
5. What part of the brain is responsible for regulating pituitary hormones and is known to regulate the body’s temperature?
c. Limbic system
6. Which neurotransmitter is involved in the movement disorders seen in Parkinson disease and in the deficits seen in schizophrenia and other psychoses?
7. A nurse explains to a patient undergoing diagnostic testing which brain imaging technique measures brain structure?
a. Computed tomography (CT)
b. Positron emission tomography (PET)
c. Brain electrical activity mapping (BEAM)
d. Single-photon emission computed tomography (SPECT)
8. The objective information that has helped mental health professionals understand that schizophrenia has a biological component has been obtained primarily from which of the following?
a. Genetic studies
b. Patient histories
c. Comparisons of blood chemistries
d. Magnetic resonance imaging (MRI) studies
9. A genetic counselor is called to see patients with genetic questions or concerns. With which patient would it be most appropriate for the counselor to speak?
a. A pregnant patient with sickle cell anemia
b. A patient who has made a recent suicide attempt
c. A patient prescribed the most drugs for the treatment of chronic disorders
d. A patient with schizophrenia who had multiple hospital admissions in the last year
10. A patient tells a nurse, “My daughter is pregnant with our first grandchild and my son-in-law has a sibling with cystic fibrosis. Is there a chance the baby might have this disease?” Which response is best?
a. “This is not an inherited disorder.”
b. “You should speak to a genetic counselor.”
c. “Science has not yet developed gene testing for this disease.”
d. “There are new treatments for this illness that are readily available.”
Chapter 6: Psychological Context of Psychiatric Nursing Care
1. A patient admitted for treatment of uncontrolled diabetes mellitus is withdrawn and tearful. The patient says, “I just want to be normal again.” The nurse determines there is a need for a psychiatric evaluation primarily to assist:
a. the patient in verbalizing distress about the disease.
b. in assessing the emotional factors affecting the patient’s present condition.
c. in assessing priorities to be set for the patient’s overall nursing plan of care.
d. the patient in emotionally accepting the chronic nature of the disease.
2. Success in obtaining sufficient data in the initial psychiatric interview depends largely on the:
a. patient’s ability to communicate effectively.
b. interviewer’s ability to establish good rapport.
c. number of psychiatric interviews the nurse has performed.
d. interviewer’s ability to organize and systematically record data.
3. A nurse plans to engage in participant observation while conducting a mental status examination. This will require the nurse to:
a. increase verbalization with the patient.
b. listen attentively to the patient’s response.
c. engage in communication and observation simultaneously.
d. advise the patient on what to do about data obtained during the interview.
4. A nurse conducting a mental status examination should plan to:
a. compare results with at least one other nurse.
b. perform the examination without the patient knowing.
c. integrate the examination into the nursing assessment.
d. perform the examination as the first communication with the patient.
5. A patient visiting from Puerto Rico has become psychotic while staying with family here in the United States. When conducting the mental status examination, the nurse remembers that:
a. sociocultural factors may greatly affect the examination.
b. liking the patient as a person is important to the outcome.
c. an interpreter may help facilitate the verbal portion of the examination.
d. biological expressions of psychiatric illness are not relevant to someone from another culture.
6. A cognitively impaired patient reports to the nurse that, “I had the best time. My husband took me out to dinner and then to a concert. The music was wonderful.” Knowing that the patient is a widow, the nurse determines her remarks are an example of:
a. tangential thinking.
7. A patient diagnosed with depression tells a nurse, “If I hadn’t been admitted, I would have carried out my plan and everyone would have been better off without me.” The nurse responds:
a. “It’s frustrating when plans are interrupted.”
b. “Things can still turn out all right for you while you’re here.”
c. “What specifically did you plan to do before you were admitted?”
d. “I know you’re feeling bad now but if you talk, things will be better.”
8. When asked what a mental status examination is intended to reveal about the patient, the nurse answers:
a. “It gives us a more complete family history.”
b. “It reflects the patient’s current state of function.”
c. “It reveals a lot about the patient’s past experiences.”
d. “It helps us determine the patient’s future prognosis.”
9. A nurse will perform a mental status examination. The data most pertinent for determining the patient’s affective response will be the patient’s:
a. judgment and insight.
b. sensorium and memory.
c. appearance and thought content.
d. statements of mood and affect.
10. Which clinical skills used to conduct a mental status examination are most relevant to establishing rapport?
a. Clarification and restatement
b. Information giving and feedback
c. Systematic inquiry and organization of data
d. Attentive listening, observation, and focused questions
Chapter 7: Social, Cultural, and Spiritual Context of Psychiatric Nursing Care
1. Sociocultural risk factors are identified by assessing which patient characteristic?
a. Belief system
b. Daily health habits
c. Stress management habits
d. Restfulness of the home environment
2. Which of these statements by a nurse suggests that the nurse will display cultural sensitivity when interviewing a patient from a different culture?
a. “The patient’s cultural background is very different from my own.”
b. “I think introducing ethnic humor is an effective way of establishing rapport.”
c. “I have to remember to document the patient’s ethnic origin and religion in the record.”
d. “Before the interview I will take a few minutes to review actions that might offend a patient of this culture.”
3. Which statement will be most important for planning future community mental health services?
a. The population over age 65 years will continue to increase.
b. Many more people will move out of rural and into urban areas.
c. The U.S. population will increase drastically by the year 2050.
d. The U.S. population will become more diverse with regard to race and ethnicity.
4. A nurse working with individuals from ethnic minority groups recognizes which as a factor that affects mental health care?
a. They often delay seeking help until problems become intense or chronic.
b. They characteristically do not engage in early termination from care.
c. They tend to dislike using community support systems.
d. They tend to avoid using family support systems.
5. When conducting an admission interview, a mental health nurse asks a patient a series of questions related to personal beliefs. When the patient asks why these questions are being asked, how should the nurse respond?
a. “These questions are routine and are a mandatory part of the admission process.”
b. “The prime reason is that these questions help the staff to identify any specific health care practices that would conflict with your religious beliefs.”
c. “Mental health can be affected by personal belief systems, so it is important that your treatment plan be developed to be compatible with your beliefs.”
d. “These questions are asked of every patient and are confidential, but if you are not comfortable answering them I will simply note that in your chart.”
6. A nurse working in a mental health center would determine which patient to be the best candidate for a spirituality-based 12-step intervention program?
a. A patient who has generalized anxiety disorder
b. A patient who has an addiction to alcohol
c. A patient with a personality disorder
d. A patient who has agoraphobia
7. A student nurse asks an instructor, “Since most of the patients on the unit are female, does that mean that women experience more mental illness than men?” The instructor replies:
a. “That’s a very astute observation. You’re right.”
b. “The prevalence is relatively the same for men and women.”
c. “As a matter of fact, mental illness is more prevalent among men.”
d. “I’m sure that you will be able to find that information in your textbook.”
8. During a team conference about a patient, the patient’s spouse states, “My spouse is Irish, so I should have expected a drinking problem.” This statement is an example of:
9. One task of an administrator of a culturally sensitive mental health system would be to:
a. eliminate all staff bias related to cultural diversity.
b. hire significant numbers of minority health care providers.
c. incorporate the values of culture competency into all levels of care.
d. keep access to care open for the dominant ethnic, social, and religious groups.
10. Asian patients prescribed psychiatric medications:
a. exhibit better response to antidepressants and phenothiazine than do African-American patients.
b. have less tendency to abuse alcohol with their medications than do white patients.
c. have extrapyramidal side effects at lower dosage levels than do other ethnic groups.
d. experience fewer side effects when taking anticholinergic medications than do white patients taking the same dosage.
Chapter 8: Legal and Ethical Context of Psychiatric Nursing Care
1. A patient with severe depression signed permission for electroconvulsive therapy (ECT). Later, the patient tells the nurse, “I signed permission for treatment after my spouse told me I could be deported if my depression can’t be cured.” The nurse assesses that:
a. the patient’s consent may have been coerced.
b. all the elements of informed consent were met.
c. the patient may not fully understand the risks and benefits.
d. the patient is not competent to sign permission for treatment.
2. When a patient who immigrated to the United States tells a nurse that consent to electroconvulsive therapy (ECT) was only given because the patient’s spouse said, “They will deport you if you didn’t do what they said to do,” the nurse should initially:
a. reassure the patient that the decision is sound.
b. discuss the reasons the spouse believed they must consent.
c. explain that consenting to treatment will not stop deportation.
d. document the comment and notify the health care provider immediately.
3. A patient with a history of assaulting several family members is voluntarily admitted for alcohol detoxification. A nurse suggests use of physical restraints to minimize the risk to the milieu and to manage the patient’s anticipated aggressive behavior. The primary principle guiding the manager’s response is:
a. the right to the least restrictive measure of restriction possible.
b. that legal considerations exist when physical restraints are used.
c. the limitations for the use of physical restraints on voluntarily admitted patients.
d. that thorough documentation is needed whenever physical restraints are applied.
4. A patient was admitted involuntarily. What assumption can the nurse make about the patient?
a. The patient may leave the unit whenever he or she chooses to do so.
b. For the first 48 hours, the patient may be compelled to take prescribed medication.
c. The patient has, through informed consent, agreed to accept treatment and participate fully in care planning.
d. When admitted, the patient was an imminent danger to self or others or was deemed unable to provide for his or her own basic needs.
5. What is the new staff nurse’s immediate duty when a patient discloses a plan to kill a family member upon release from the hospital?
a. Discuss the statement with the patient’s mental health team but otherwise keep the information confidential.
b. Immediately contact the family member and provide a verbal warning concerning his or her physical safety.
c. Inform the patient that the local police department will be called and that oral and written reports will be filed.
d. Document the information in the patient’s medical record, and notify the nursing supervisor of the statement.
6. A patient was admitted voluntarily to the psychiatric unit. A nurse must understand that voluntary status confers the right of the patient to:
a. have visitors at any desired time.
b. come and go from the unit at will.
c. choose the nursing staff assigned to the patient’s care.
d. accept or refuse any recommended treatment modalities.
7. An individual is advised to seek psychiatric hospitalization and agrees to receive treatment and abide by hospital rules. What type of admission is this?
8. Regardless of the type of commitment, which right is guaranteed to a hospitalized psychiatric patient?
a. The right to consult a lawyer
b. The right to release after 72 hours
c. The right to choose agency caregivers
d. The right to keep all personal effects
9. The staff members notify the police that a court-committed patient has eloped. What is the initial action for the staff to take when the patient is returned to the hospital?
a. Discuss with the patient the reason for the elopement.
b. Ask the patient to sign an “against medical advice” release.
c. Request that the patient give written notice of intent to leave.
d. Readmit the patient under the original court-ordered commitment.
10. Two nurses are discussing the rights of hospitalized psychiatric patients. Which of their beliefs requires follow-up by the nurse manager?
a. The hospital is responsible for the patient’s safety.
b. If a committed patient is judged to be incompetent, he or she retains the right of habeas corpus.
c. Privileged communication does not apply to hospital charts, so they can be used in court.
d. Disclosure of patient information to law enforcement agencies is permitted without patient consent.
Chapter 9: Policy and Advocacy in Mental Health Care
1. Health professionals planning treatment initiatives should be most concerned with the burden of disease created by:
a. violence and injury.
b. environmental quality.
c. behavioral health problems.
d. irresponsible sexual behavior.
2. Which disorder is the leading psychiatric cause of disability in the world?
c. Bipolar disorder
d. Obsessive-compulsive disorder
3. To work effectively within the health care system, a nurse must understand the current interface between mental health care and the environment. Which statement accurately reflects this interface?
a. The once simple system has grown from two to six parts, which has significantly complicated the interface.
b. Biases on the part of providers have largely been abolished, greatly improving the effectiveness of the interface.
c. Reimbursers and insurers are primarily concerned with protecting the patient’s constitutional rights regarding access to care and treatment received.
d. In general, families are becoming less concerned with education and empowerment for family members who are patients.
4. Managed behavioral health care settings are involved in:
a. health care reform.
b. universal health care.
c. health care for the underserved.
d. treating mental and substance abuse disorders.
5. A committee is formed to increase the public’s understanding that mental health is essential to overall health. A nurse would expect that the focus of this group’s work would be:
a. improving access to quality care that is culturally competent.
b. protecting and enhancing the rights of people with mental illness.
c. developing and implementing integrated electronic health record and personal health information systems.
d. collaborating with the emergency department to treat mental health problems with the same urgency as physical health problems.
6. A patient receiving mental health services complains about having to get a referral from a primary care physician in order to obtain mental health services. The nurse should explain to the patient that this is a cost control practice used in managed care that is described as:
b. utilization review.
c. case management.
d. preadmission certification.
7. A patient tells a nurse, “I belong to a health maintenance organization (HMO) that advertises being a capitated system. What does that mean?” The nurse replies:
a. “It’s complicated but if you like I’ll have the payments office discuss it with you.”
b. “You pay a sliding fee for each illness based on your monthly take-home income.”
c. “You pay a fixed fee per month while the HMO provides all medically necessary care.”
d. “The HMO pays your physician a flat fee for a particular episode of illness regardless of the number of office visits you make.”
8. Access to care refers to the:
a. availability of health care.
b. degree to which services are comprehensive.
c. overall use of mental health services in a community.
d. convenience and ease of obtaining service and information.
9. In many rural communities the ratio of consumers to doctors is higher than it is in cities. This is an example of:
a. a health access problem in rural areas.
b. a lack of compassion among physicians.
c. reimbursement barriers in rural states.
d. appropriate distribution of health care providers.
10. A psychiatric nurse advocating for behavioral health system change would focus on which topic?
a. Abolishing the health maintenance organization (HMO) system
b. Strengthening current utilization review guidelines
c. Limiting consumer empowerment initiative options
d. Increasing resources for chronic care mental health services
Chapter 10: Families as Resources, Caregivers, and Collaborators
1. During a mental health assessment, a patient reports living with two children from a previous relationship, a sibling, and a sibling’s three children. To use the most precise documentation, the nurse documents that the patient is part of a(n):
b. nuclear family.
c. extended family.
d. traditional family.
2. Which finding is a positive indicator of family functioning?
a. A patient’s child occasionally has an asthma attack when the patient and the patient’s spouse argue.
b. A patient’s spouse leaves for a few days and gambles after a serious fight with the patient.
c. A patient’s 12-year-old child has one daily and one weekly household chore to complete.
d. A patient calls a parent daily concerning decisions such as what to prepare for dinner.
3. Which interview information could indicate the need for further assessment of a potential problem with a patient’s family functioning?
a. The patient spends time away from the family, taking both a weekly art and dance class.
b. Every other week, the patient visits aging parents who live 1 hour away.
c. The patient and spouse resolve problems on their own, although it often takes several hours.
d. The patient often grounds the children for misbehavior in an attempt to raise them “the right way.”
4. A psychiatric nurse working within a competence paradigm would emphasize which of the following when working with a patient with an anxiety disorder?
a. Use of natural family support networks
b. Prevention of negative patient outcomes
c. The view of anxiety disorder as a disease
d. Treatment of dysfunctional characteristics
5. Which statement confirms that a nurse approaches working with mentally ill patients from a pathology paradigm?
a. “The patient made some important gains during the group session today. The patient was able to identify two strategies for coping with stressors to use after discharge.”
b. “It’s understandable that the patient keeps getting readmitted. The family dysfunction that the patient has to cope with must be such a burden after each discharge.”
c. “During our session today, I hope to be able to get the patient to share more about the family’s cultural background.”
d. “The patient has not yet fully grasped the concept of being a full partner in the process of care and in setting goals for functioning after discharge.”
6. A psychiatric nurse is sharing information with a patient and family about psychoeducational programs offered by the National Alliance on Mental Illness (NAMI). The nurse explains that which objective is the primary purpose of such programs?
a. Enhancing compliance with medication therapy
b. Reducing hospital readmission rates
c. Evaluating effectiveness of therapy
d. Providing education and support
7. A psychiatric nurse is helping to plan an educational program for families of mentally ill patients. The title of the program is Enhancing Personal and Family Effectiveness. Which topic should the nurse include in developing this program?
a. Legal issues
b. Conflict resolution
c. Hygiene and appearance
d. Prescribed medications
8. A nurse is educating a patient’s family about becoming involved in the patient’s treatment plan. Which belief held by the nurse would be a barrier to such education?
a. The family system perpetuates the patient’s illness.
b. Alliance with the family will not interfere with patient confidentiality.
c. Services provided to families are as important as those provided to patients.
d. An alliance with the family supports the nurse’s relationship with the patient.
9. The symbolic interactionism theoretical model helps explain the:
a. hypotheses explaining why patients with schizophrenia hear voices.
b. basis for social difficulties experienced by patients with bipolar disorder.
c. impact that living with a mentally ill person has on their family structure.
d. relative lack of support for mentally ill patients of certain U.S. subcultures.
10. When providing education for families of mentally ill patients, the nurse realizes that which of the following organizations places the most importance on this intervention?
a. The Managed Care Association
b. National Alliance on Mental Illness
c. American Psychiatric Nurses Association
d. New Freedom Commission on Mental Health
Chapter 11: Implementing the Nursing Process: Standards of Practice and Professional Performance
1. A nurse teaching a patient about the effects and side effects of the prescribed medication bases the plan on the knowledge that learning is more effective when:
a. patients are actively included in the process.
b. topics are introduced only when the patient expresses an interest.
c. nurses establish realistic goals for learning on behalf of the patient.
d. patients have responsibility for directing the teaching-learning process.
2. A nurse interviewed a reluctant patient who answered questions with minimal responses and rarely made eye contact. When documenting baseline data collected in the interview, the nurse should include:
a. interview content only.
b. a description of the process of the interview.
c. both the content and the process of the interview.
d. both factual data about the patient and the nurse’s emotional reaction.
3. While gathering a baseline history about a patient, a nurse is told by a team social worker that the patient “acts weird and has bad hygiene.” The nurse’s responsibility is to:
a. accept the data without question.
b. form impressions based on data personally gathered.
c. document the impression of the team social worker.
d. discuss the social worker’s impression with the patient.
4. To obtain the clearest clinical information about a patient, a nurse who used several secondary sources, including the patient’s spouse and the report of the admitting psychiatrist, will seek validation from:
a. the patient.
b. psychiatric nursing textbooks.
c. the patient’s extended family.
d. the use of psychiatric behavioral rating scales.
5. If physicians wish to understand the nursing equivalent of the medical DSM-IV-TR, they should seek an understanding of the:
a. nursing diagnoses.
b. nursing process.
c. behavioral rating scales.
d. computerized medical records.
6. Which goal should be given the highest priority?
a. Reduction of anxiety
b. Alleviation of depression
c. Enhancement of self-esteem
d. Protection from self-destructive impulses
7. A nurse who is new to the mental health setting is having difficulty writing meaningful outcome criteria. The nurse’s mentor should suggest which source to best assist the nurse?
a. Nursing Outcomes Classification (NOC)
b. Nursing Interventions Classification (NIC)
c. North American Nursing Diagnosis Association International (NANDA-I)
d. Diagnostic and Statistical Manual of Mental Disorders, ed 4, text revision (DSM-IV-TR)
8. Which is a well-written short-term goal for a socially withdrawn patient who tells a nurse of a wish to reduce social isolation? By day 2, the patient will:
a. express desire to go shopping.
b. participate in one unit activity.
c. become more independent.
d. be more outgoing.
9. A patient is admitted with a diagnosis of bipolar disorder, manic phase, and displays extreme hyperactivity, agitation, talkativeness, and emotional lability. Which is the highest priority nursing diagnosis?
a. Risk for injury related to extreme hyperactivity
b. Disturbed thought processes related to manic state
c. Impaired social interaction related to excessive verbalization
d. Impaired sensory perception related to biochemical alterations
10. A nurse is working with a patient with depression. To best help the patient translate insight into action, a major nursing challenge will be to:
a. promote self-care activities.
b. consult appropriate resources.
c. build adequate incentives to change.
d. identify ineffective behavior patterns.
Chapter 12: Prevention and Mental Health Promotion
1. The nurse explains that the main goal of primary prevention is the reduction of the _____ of mental disorders.
2. A psychiatric nurse is assessing the need for mental health services at the clinic. When estimating the number of patients with bipolar disorder in the community, the nurse places highest priority on which data-gathering technique?
a. Community forums that solicit data shared by patients and families
b. Epidemiological studies that indicate incidence and prevalence of disease
c. Use of key informants, such as local social service personnel, nurses, and physicians
d. Statistics from local public reports about race, marital status, population density, and substance abuse
3. What is the essential difference between the nursing prevention model and the medical prevention model?
a. The medical model targets universal populations; the nursing model targets a selective population.
b. The medical model assumes that all people are at equal risk; the nursing model attempts to identify those who are more vulnerable.
c. The medical model attempts to identify the most likely cause of the disease; the nursing model stresses that mental disorders are multicausal.
d. The medical model offers a continuum of nonspecific preventive measures; the nursing model offers one specific, tested, preventive measure.
4. A psychiatric nurse is responsible for providing patient-focused health education. In order to promote primary prevention of mental health problems, the nurse stresses:
5. A nurse whose primary focus is tertiary prevention of mental disorders would focus on:
a. providing prompt treatment of an individual’s mental disorder.
b. identifying social supports to prevent the need for hospitalization.
c. funding rehabilitative activities to reduce the disability associated with mental disorders.
d. forming a preretirement counseling program staffed by professional mental health nurses.
6. A nurse who works in community mental health identifies a minority neighborhood group as having low self-efficacy and being particularly susceptible to a number of stressors. In which phase of the nursing process did this activity take place?
7. People with low self-efficacy:
a. are often found to engage in antisocial and/or criminal behavior.
b. usually require an inordinately large percentage of the available community health resources.
c. are usually well motivated and handle stress well and typically have low vulnerability to depression.
d. give up in the face of difficulty, recover slowly from setbacks, and easily fall victim to depression.
8. When a community mental health nurse focuses on intervention strategies designed to increase self-efficacy among members of a minority neighborhood group, a realistic primary prevention goal would be:
a. elimination of mental illness in the community.
b. resolving social problems within the community.
c. reducing both stressors and suffering in the group.
d. reducing the incidence of depression in the group.
9. The identification of intervention strategies designed to increase self-efficacy among members of a minority neighborhood group would occur in which phase of the nursing process?
10. A nurse assessing a person who is deemed to be at high risk for mental disorders will find that, as suggested by the nursing primary prevention model, the person has:
a. fewer stressors.
b. more protective factors.
c. unusual developmental tasks.
d. inadequate coping mechanisms.
Chapter 13: Crisis Intervention
1. A patient comes to the mental health clinic with insomnia, irritability, increased tension, and headaches. The symptoms began 1 week ago after the patient was laid off from work. The patient expresses concern that this will result in a relocation that will be hard on the entire family. The patient is most likely experiencing:
a. an anxiety reaction.
b. a situational crisis.
c. a maturational crisis.
d. an adjustment disorder.
2. A jet plane carrying 140 passengers crashes in a nearby community. One can reliably predict that the survivors, families, and community will initially experience:
a. a situational crisis.
b. problem resolution.
c. adjustment disorders.
d. psychological equilibrium.
3. A patient comes to the mental health center and relates feeling very anxious since graduating from high school 1 week ago. The patient is having difficulty concentrating and feels shaky. This typifies:
a. a situational crisis.
b. a maturational crisis.
c. psychological equilibrium.
d. a pseudopsychological crisis.
4. A patient comes to the mental health center after being held hostage during a bank robbery 2 days ago. The patient relates a number of symptoms, including intrusive thoughts, nightmares, and feelings of helplessness. The nurse should consider the possibility that the patient is experiencing a _____ crisis.
5. A patient who undergoes a hostage experience begins crisis intervention therapy. The patient asks, “How long before I will feel like myself again?” The reply that shows the best understanding of the parameters of crisis intervention therapy would be:
a. “No one can really say.”
b. “It usually takes about 6 weeks.”
c. “My best guess would be 6 months.”
d. “The experience usually results in permanent changes.”
6. A teenaged new mother reports she has felt apathetic, fatigued, and helpless since giving birth. She states, “I don’t know what’s expected of me.” The nurse believes the patient will benefit from:
a. crisis intervention.
b. short hospitalization.
c. neuroleptic medication.
d. antidepressant medication.
7. The outcome of crisis intervention therapy that should be identified for a patient who has been apathetic, fatigued, and feeling helpless since the recent birth of her baby is that she will:
a. experience reduced anxiety.
b. undergo personality change.
c. identify the need for a support system.
d. return to the precrisis level of functioning.
8. A patient is being seen for crisis intervention as a result of receiving a poor job evaluation. The self-esteem need that nursing assessment will most likely reveal a problem with:
b. role mastery.
c. biological functioning.
d. unmet financial responsibility.
9. When a crisis clinic nurse asks a patient, “Who takes care of you when you are sick?” the nurse is exploring the balancing factors of:
a. situational support.
b. problem resolution.
c. coping mechanisms.
d. perception of the event.
10. To understand the effects of a precipitating event such as the loss of one’s job, a nurse must assess the:
a. patient’s appraisal of the event.
b. perception of the support group.
c. patient’s awareness or lack of awareness of options.
d. patient’s own feelings about his or her response to the situation.
Chapter 14: Recovery and Psychiatric Rehabilitation
1. A psychiatric nurse whose area of practice is tertiary prevention of mental illness is asked to describe the focus of this type of practice. The nurse can best describe it as:
a. enriching the understanding of mental illness.
b. preventing mental illness from occurring initially.
c. limiting disability related to an episode of mental illness.
d. increasing community awareness of the symptoms of mental illness.
2. When asked to explain how psychiatric rehabilitation under the tertiary prevention model differs from the traditional medical model, the nurse’s response should stress that the focus of tertiary prevention is on:
a. disease as opposed to the coping continuum.
b. learning to receive treatment in institutional settings.
c. health and wellness and not just symptoms of disease.
d. proper diagnosis and appropriate medications to treat disorders.
3. Under the recovery model, a nurse is more likely to work with a patient with a psychiatric disorder:
a. in a decision-making partnership.
b. by prescribing appropriate treatment.
c. with the assumption the patient is curable.
d. from the position of expecting compliance.
4. A patient has been treated for a mental disorder on an outpatient basis. Function has deteriorated and the patient is hospitalized in an inpatient unit; a nurse will now implement the recovery model by:
a. comparing patient deficits to original baseline.
b. identifying and reinforcing patient strengths.
c. reviewing the patient’s former treatment plan for updates.
d. reconsidering expectations when the patient is discharged.
5. A nurse notes that a patient voices shame and socially isolates. The nurse will most likely interpret this behavior as:
a. unrelated to serious mental illness.
b. likely representing learned behaviors.
c. associated with secondary symptoms of serious mental illness.
d. a coincidental response that has little relationship to the illness.
6. Which statement regarding the self-perception of the mentally ill regarding community acceptance is supported by research?
a. “Many feel stigmatized and alienated.”
b. “Most feel well accepted and supported.”
c. “The majority are intensely angry and hostile.”
d. “Most are more concerned with their primary symptoms.”
7. At a community meeting, a homeowner states, “I don’t want mentally ill people in the neighborhood. They’re dangerous!” The community mental health nurse should respond:
a. “Former patients need care and concern, not stigmatization.”
b. “I sincerely believe your fears and concerns are really unfounded.”
c. “The way you act toward former patients will determine how they act toward you.”
d. “Our residents are more apt to be withdrawn and timid than aggressive or violent.”
8. A psychiatric nurse is assessing the family and home of a patient who is being discharged within the next few days from an inpatient unit. The assessment component with the highest priority is:
a. how the family members will make changes to meet the needs of the patient.
b. the attitudes and feelings of family members toward the mentally ill member.
c. how family members will cope with the responsibility of caring for the patient.
d. who will be responsible for helping the client with his or her activities of daily living (ADLs).
9. Which daily stressors would an unemployed 24-year-old diagnosed with chronic depression who lives on a family farm most likely experience?
a. Housing, school, and work problems
b. Money problems, loneliness, and boredom
c. Florid symptoms, odd dress, and bizarre behavior
d. Sexual, anger management, and medication problems
10. A nurse is assessing the community living skills of a 28-year-old patient. The nurse ascertains that the patient has poor personal hygiene and has never assumed responsibility or management of any aspect of self-care. Based on the data, the nurse makes the assessment that the patient:
a. has low readiness for function in the community.
b. will be too much of a burden to live in a foster setting.
c. is too psychotic to be considered for community placement.
d. requires stabilization to profit from psychiatric rehabilitation.
Chapter 15: Anxiety Responses and Anxiety Disorders
1. When assessing a patient who gives the impression of being anxious, a nurse seeks to validate this impression because anxiety is:
a. necessary for survival.
b. communicated interpersonally.
c. an emotion without a specific object.
d. a subjective experience of the individual.
2. A nurse determines that a patient is able to follow directions but appears to experience a narrowed perceptual field and focus on immediate concerns. The nurse determines that the patient is experiencing anxiety at which level?
3. A patient has significant non-goal–directed motor activity, seems terror stricken, and experiences both distorted perceptions and disordered thoughts. When the nurse attempts to calm the patient, the patient does not respond. The level of patient anxiety can be assessed as:
4. A psychiatric patient is experiencing panic-level anxiety. The initial intervention of highest priority is:
a. provide for the patient’s safety.
b. reduce all environmental stimuli.
c. respect the patient’s personal space.
d. encourage the patient to discuss the anxious feelings.
5. A patient is experiencing panic-level anxiety. Of these medications listed on the patient’s prn medication administration record, which should be given?
a. Buspirone (BuSpar)
b. Lorazepam (Ativan)
c. Phenytoin (Dilantin)
d. Fluoxetine (Prozac)
6. A nurse explains a patient’s behavior by stating, “The patient’s anxiety stemmed from being unable to attain a desired goal.” Which theory is the nurse basing the response upon?
7. A patient whose current behavior includes pacing and cursing tells a nurse, “I’m feeling edgy and can’t concentrate.” The nurse can assess the patient’s level of anxiety as:
8. During a staff conflict, one of your nursing peers defends her actions and asserts her own rights among the professional staff. Defending one’s actions and asserting one’s rights typify the coping mechanism of:
a. emotion or ego focused.
b. problem or task focused.
c. physiological conversion.
d. psychological conversion.
9. Defense mechanisms:
a. involve some degree of self-deception.
b. are rarely used by mentally healthy people.
c. seldom make the person feel more comfortable.
d. are rarely effective in resolving basic conflicts.
10. A patient tends to use the defense mechanism of displacement. When the patient’s spouse accuses the patient of being disorganized and flighty, the patient is most likely to react by:
a. burning the spouse’s dinner.
b. scolding the paperboy for being late.
c. telling the spouse, “I’m so angry with you.”
d. promising the spouse to try be more organized and calm.
Chapter 16: Psychophysiological Responses and Somatoform and Sleep Disorders
1. Which patient is most likely exhibiting a somatization disorder?
a. A person with chronic pain in the right ankle after a skiing injury
b. A person who experiences occasional chest pain after a myocardial infarction
c. A college graduate who cannot maintain steady employment because of multiple vague complaints
d. A person who dislikes going out to social events with large groups because of embarrassment about facial acne
2. Which patient is most likely exhibiting a conversion disorder?
a. A toddler with frequent ear infections
b. An athlete with exercise-induced asthma
c. A night guard who suddenly goes blind
d. An older adult whose fractured foot is not healing well
3. A patient is diagnosed with conversion disorder that is evidenced by paralysis of the right hand. Which nursing intervention should be implemented?
a. Focus discussions on the patient’s inability to fulfill usual roles.
b. Focus discussions on the patient’s unusual and unexplainable physical symptom.
c. Spend time with the patient to give recognition for positive qualities and strengths.
d. Spend time with the patient when the patient is helpless to perform self-care activities because of paralysis.
4. Which intervention should a nurse select to help a patient cope more effectively with chronic pain disorder?
a. Mild opioids
c. Relaxation techniques
d. Response prevention
5. Which patient would be at greatest risk of encountering the exhaustion phase of the general adaptation syndrome?
a. A patient who is scheduled for knee replacement surgery
b. A patient who has high self-efficacy and has recently accepted a job promotion
c. A patient who has had elective rhinoplasty to correct a prominent hump in the bridge of the nose
d. A person who has severe osteoarthritis and was admitted to a nursing home after the death of a caretaker spouse 2 months ago
6. A nurse plans care for a patient at risk for development of a psychophysiological disorder associated with multiple stressors. In the assessment of the patient’s coping resources, which factor would the nurse consider initially?
a. The social support available to the patient
b. Whether there has been sustained grief over a recent loss
c. Whether the patient is overworked with too many commitments
d. Strain associated with the patient’s parenting duties
7. A patient diagnosed with essential hypertension reports feeling pressured by the demands made by family, friends, and an employer. Which role-play situation, as part of a patient education plan for coping with stress, would most likely help the patient develop effective stress-reduction skills?
a. Patient offering to help a friend organize a church group activity
b. Patient saying “no” to a request made by the employer to work overtime
c. Patient accepting a verbal demonstration of caring and concern from spouse
d. Patient asking a work subordinate to be prepared to come to work on time
8. A patient has been instructed to use crutches in order to rest an injured foot. At a follow-up appointment, the patient admits to beginning a walking program. A nurse can assess this behavior as evidence the patient is employing:
9. A patient has had two rhinoplasties but continues to seek further surgery. The patient has been told repeatedly that further surgery is not indicated. The patient tells a nurse, “My life will be ruined unless my appearance can be improved.” The patient’s thinking suggests:
b. conversion disorder.
c. somatization disorder.
d. body dysmorphic disorder.
10. A patient diagnosed with body dysmorphic disorder says, “I’m seriously dissatisfied with the appearance of my nose. It’s ruining my life.” A possible nursing diagnosis to consider for this patient is:
b. disturbed body image.
c. ineffective coping skills.
d. ineffective role performance.
Chapter 17: Self-Concept Responses and Dissociative Disorders
1. Which individual would be at greatest risk for self-esteem disturbance?
a. A 5-year-old starting school
b. A 16-year-old high school junior
c. A 26-year-old licensed practical nurse (LPN) entering a college nursing program
d. A 45-year-old working toward a master’s degree in business administration
2. A patient tells a nurse, “I am a weak person.” The patient feels inadequate and vulnerable and states often feeling helpless and frightened. The nursing diagnosis most likely to fit this situation is:
a. personal identity disturbance.
b. chronic low self-esteem.
c. personality fusion.
3. A patient reports feeling detached and says, “It feels as though I’m watching a movie as life unfolds. I’m isolated, on the outside and not involved. I really don’t feel anything. I don’t know if I’m alive or dead, awake or sleeping.” The nurse can determine that the patient is describing:
d. boundary violations.
4. Which individual is most in need of measures to reduce the risk for self-concept disturbance associated with health-illness transition?
a. A 15-year-old with Crohn disease who states, “An ileostomy will mean I won’t be able to do stuff with my friends.”
b. An 18-year-old with an above-the-knee double amputation who states, “I guess I’ll be a wheelchair athlete instead of a marathon runner.”
c. A 30-year-old with blindness caused by glaucoma who states, “My spouse will help me learn Braille.”
d. A 52-year-old with breast cancer who states, “My life is more valuable than any body part.”
5. A patient is acutely psychotic and withdrawn. The patient claims to be a robot, stating, “I can’t relate to others. I have no feelings. I can’t talk because I have no ideas in my head.” Acceptance is shown when the nurse remarks to this patient:
a. “May I sit here with you for a while?”
b. “May I help you loosen up and be less rigid?”
c. “I’ll help you get in touch with the feelings you’re trying to deny.”
d. “I’ll make decisions for you regarding your needs until you regain control.”
6. A patient who is acutely psychotic and withdrawn claims to be a robot. An early intervention designed to help this patient expand self-awareness would be to:
a. confirm the patient’s identity.
b. set up a daily schedule for the patient.
c. introduce the patient to two other withdrawn patients.
d. explain to the patient the need to express feelings more openly.
7. A patient is acutely psychotic, withdrawn, claims to be a robot, and cannot think of how to take a shower. Which response by the nurse is best?
a. “If you can’t shower independently, the staff will give you a bed bath.”
b. “I will turn on the water for you and provide you with step-by-step directions.”
c. “You must shower, or you’ll risk having people actively avoid being around you.”
d. “We can put off the shower for another day because you don’t have any body odor.”
8. A patient who was abused as a child tells a nurse of the abuse in a stilted, unemotional manner. Which intervention would encourage the patient to examine feelings associated with childhood abuse?
a. “You poor thing! I feel deeply sorry for what you endured.”
b. “When you described this relationship, you didn’t tell me how you felt.”
c. “You must be feeling so angry with your parents that you’d like to harm them.”
d. “If I experienced that as a child, I would feel betrayed, confused, and frightened.”
9. During the process of self-exploration, it is important for a nurse to convey the message that the patient:
a. may be the victim of circumstances that created unsolvable psychosocial problems.
b. is responsible for his or her own behavior, including maladaptive coping responses.
c. cannot hope to make any changes without some professional, therapeutic guidance.
d. needs to focus on changing the attitudes and behaviors of significant others.
10. When working with a patient with self-concept disturbance, which type of communication would initially be most useful?
Chapter 18: Emotional Responses and Mood Disorders
1. According to the Stuart Stress Adaptation Model, which person can be assessed as being the closest to the maladaptive responses end of the continuum of emotional responses?
a. A patient whose child died of sudden infant death syndrome (SIDS) 2 weeks ago, who states, “I can’t believe I’ll never hold my baby in my arms again.”
b. A patient whose spouse died 2 years ago, who states, “Strong people don’t mourn. I’ve kept busy and focused on supporting the kids.”
c. A patient whose spouse died 6 months ago, who states, “I hate the fact that my spouse died and left me alone after all the years we shared.”
d. A patient whose fiancée died 6 weeks ago, who tells the nurse, “My life will never be the same. I find myself crying every day when I think of my fiancée.”
2. The initial response of a steelworker who was fired from a job was disbelief. At home the steelworker told family members about the firing but retreated to the bedroom, saying, “I’m too choked up to talk about it right now.” These behaviors are characteristic of:
c. normal grief reaction.
d. delayed grief reaction.
3. Which coping mechanism should a nurse expect to see a patient initially use to mourn the death of a spouse?
4. A patient was widowed 8 months ago. The patient has never cried and speaks of the spouse as if they were still together. The prominent defense mechanism exhibited by the patient is:
5. A patient’s husband is distraught over his wife’s behavior since their child died in a car accident 1 month ago. He says, “She still cries herself to sleep each night. Help my wife control herself.” The nurse’s most therapeutic response would be:
a. “I wonder why it is that you are so bothered by her crying.”
b. “I’m more concerned that you don’t seem to be grieving.”
c. “I’ll spend some time with her to help her see that crying is counterproductive.”
d. “It’s hard to see her so upset, but crying is one way of expressing her feelings.”
6. While talking with a nurse, a patient remarks, “My father’s been dead for months. I think Mom needs to get on with her life.” The most appropriate response by the nurse is:
a. “Giving her support will be more helpful than being critical.”
b. “Have you thought of ways you might help her find more pleasure in her life?”
c. “It’s possible that she still needs more time. Grieving often takes 1 year or more.”
d. “A death is usually a crisis for the whole family. How has his death affected you?”
7. A patient shares, “My mood is really low, and even though I get plenty of sleep, I’m tired all the time. It seems like it happens every fall and winter.” This patient is most likely experiencing:
a. poor REM sleep.
b. acute depression.
c. chronic depression.
d. seasonal affective disorder.
8. The critical element a nurse must consider when completing a behavioral assessment of a patient with a mood disturbance is:
a. the level of anxiety present.
b. the degree of agitation noted.
c. the depth of depression reported.
d. a change in usual patterns and responses.
9. A patient hospitalized 3 weeks ago with major depressive disorder presented with suicidal ideations but no suicide plan. Sertraline (Zoloft) was prescribed, and the patient now reports that the feelings of depression have somewhat lessened. The guiding factor the nurse considers when planning care is that there is:
a. little risk for injury if the patient has no plan.
b. an increased risk for suicide as the depression lifts.
c. little suicide risk after 3 weeks on an antidepressant.
d. an increase in patient compliance with sertraline (Zoloft).
10. A patient paces continuously while repeatedly mumbling, “I’m worthless. It’s all hopeless.” Which nursing measure would be most helpful in establishing a relationship with this patient?
a. Greet the patient with a cheerful smile.
b. Insist that the patient go to a room to talk with the nurse.
c. Walk with the patient, and make occasional empathic observations.
d. Tell the patient, “I don’t agree with your assessment of worthlessness.”
Chapter 19: Self-Protective Responses and Suicidal Behavior
1. A patient who _____ should be assessed as using indirect self-destructive behavior.
a. scratches both wrists with safety pins
b. drinks nearly 1 quart of whiskey per day
c. took an overdose of sedative-hypnotic drugs
d. calls a friend when contemplating suicide
2. What nursing diagnosis should be considered when caring for a patient who has engaged in direct or indirect self-destructive behavior?
a. Death anxiety
b. Chronic low self-esteem
c. Disturbed body image
d. Disturbed personal identity
3. A nurse assessing a patient who has been noncompliant with the prescribed diabetic diet and exercise regimen should consider planning strategies to overcome patient use of:
4. A nurse is caring for a patient who has been noncompliant with the prescribed diabetic diet and exercise regimen. The nurse promotes compliance by enhancing the patient’s:
a. sense of control.
b. sense of well-being.
c. fear of the sequelae of illness.
d. dependence on health care workers.
5. The major difference between self-injury and suicide lies in whether the patient has:
a. a need to control or a need to be controlled.
b. the wish to relieve tension or the wish to die.
c. been diagnosed with a developmental disorder or psychosis.
d. a tendency toward indirect or direct expression of self-destructive urges.
6. A patient with depression tells a nurse, “I hope someone will make sure my family gets my jewelry when I’m gone.” This statement can be assessed as a suicide:
7. The nursing diagnosis for a patient who is depressed and suicidal at admission is “risk for suicide.” The most appropriate outcome for this diagnosis at discharge from the hospital is, “The patient will:
a. increase feelings of self-worth.”
b. not harm self while hospitalized.”
c. be able to problem solve effectively.”
d. develop a trusting relationship with one staff member.”
Chapter 20: Neurobiological Responses and Schizophrenia and Psychotic Disorders
1. A patient diagnosed with schizophrenia has difficulty completing tasks and seems forgetful and disinterested in activities. A nurse can best select successful strategies by understanding that these behaviors are due to:
a. a lack of self-esteem.
b. manipulative tendencies.
c. shyness and embarrassment.
d. problems in cognitive functioning.
2. A patient diagnosed with schizophrenia is standing naked after showering and appears dazed and indecisive. The nursing intervention that will be most helpful to promote dressing would be:
a. saying, “These are your clothes. Please get dressed.”
b. saying, “These are your underpants. I’ll help you put them on.”
c. asking, “Which of these two outfits would you like to wear now?”
d. asking, “Is something the matter with your clothes that makes you not want to dress?”
3. During occupational therapy a patient diagnosed with schizophrenia sits staring at a piece of paper. Which response is most therapeutic at this time?
a. “If you prefer to sit and stare for a time, it is acceptable for you to leave.”
b. “You seem immobilized by anxiety. Is there anything I can do to help?”
c. “Are you having trouble deciding where you want to glue that piece?”
d. “Rub the glue stick on the back of the paper.”
4. A patient diagnosed with schizophrenia reveals to the nurse that voices have warned of danger and adds, “They’re so loud they frighten me. Do you hear them?” The nurse’s best initial response would be:
a. “I know these voices are very real to you, but I don’t hear them.”
b. “Don’t worry. You’re safe in the hospital. I won’t let anything happen to you.”
c. “Tell me more about the voices. Are they men or women? How many are there?”
d. “What do you do in order to keep yourself occupied so you don’t hear the voices?”
5. What part of the brain is dysfunctional in persons with schizophrenia? Research has implicated the:
a. medulla and cortex.
b. cerebellum and cerebrum.
c. hypothalamus and medulla.
d. prefrontal and limbic cortices.
6. A severely withdrawn patient diagnosed with schizophrenia will spend time in the dayroom but will not speak to staff or other patients. The most therapeutic nursing intervention in response to this behavior would be to:
a. seat the patient with a group of patients who are talking to each other.
b. ignore the silence and talk about superficial topics such as the weather.
c. point out that the patient makes others uncomfortable by refusing to speak.
d. plan time for staff members to sit with the patient even though the patient does not talk with them.
7. A novice nurse asks the assigned mentor, “Why should I avoid telling the patient that his ideas are bizarre and simply not logical?” The mentor responds, “If you do that:
a. it will give the patient the basis for beginning to self-reflect on the delusions.”
b. the patient will probably incorporate you into the delusions as a persecutor.”
c. it will be difficult to use empathy and calmness to foster the patient’s trust.”
d. you will have little chance of gaining the patient’s cooperation.”
8. A patient who has been hospitalized for 2 days remains anxious and continues to be preoccupied with paranoid delusions. What intervention will best help the patient focus less on the delusions?
a. Schedule time for the patient to read and listen to music.
b. Plan activities that require physical skills and constructive use of time.
c. Begin planning for discharge by engaging the patient in psychoeducation.
d. Discuss personal goals related to improved socialization with the patient.
9. A most useful strategy for helping a patient with schizophrenia prevent a potential relapse is to:
a. have the patient attend group therapy.
b. educate the patient on the need to take prescribed medication daily.
c. teach the patient and family about behaviors that indicate impending relapse.
d. schedule appointments for blood tests to determine serum medication levels.
10. Which teaching point will have the most positive effect on patients diagnosed with schizophrenia and their families concerning the risk of relapses?
a. Patients who take their medications will not relapse.
b. Caffeine and nicotine can reduce the effectiveness of antipsychotic drugs.
c. With support, education, and adherence to treatment, patients will not relapse.
d. Schizophrenia is a chronic disorder that is characterized by repeated relapses.
AND MUCH MORE