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Test Bank Essentials Psychiatric Mental Health Nursing 2nd Edition, Elizabeth
Chapter 1: Practicing the Science and Art of Psychiatric Nursing
1. Which outcome, focused on recovery, would be expected in the plan of care for a patient living in the community and diagnosed with serious and persistent mental illness? Within 3 months, the patient will:
a. deny suicidal ideation.
b. report a sense of well-being.
c. take medications as prescribed.
d. attend clinic appointments on time.
2. A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Select the nurses most caring comment.
a. Lets discuss some means of coping other than suicide when you have these feelings.
b. I understand why youre so depressed. When I got divorced, I was devastated too.
c. You should forget about your marriage and move on with your life.
d. How did you get so depressed that hospitalization was necessary?
3. In the shift-change report, an off-going nurse criticizes a patient who wears heavy makeup. Which comment by the nurse who receives the report best demonstrates advocacy?
a. This is a psychiatric hospital. Craziness is what we are all about.
b. Lets all show acceptance of this patient by wearing lots of makeup too.
c. Your comments are inconsiderate and inappropriate. Keep the report objective.
d. Our patients need our help to learn behaviors that will help them get along in society.
4. A nurse assesses a newly admitted patient diagnosed with major depressive disorder. Which statement is an example of attending?
a. We all have stress in life. Being in a psychiatric hospital isnt the end of the world.
b. Tell me why you felt you had to be hospitalized to receive treatment for your depression.
c. You will feel better after we get some antidepressant medication started for you.
d. Id like to sit with you a while so you may feel more comfortable talking with me.
5. A patient shows the nurse an article from the Internet about a health problem. Which characteristic of the web sites address most alerts the nurse that the site may have biased and prejudiced information?
a. Address ends in .org.
b. Address ends in .com.
c. Address ends in .gov.
d. Address ends in .net.
6. A nurse says, When I was in school, I learned to call upset patients by name to get their attention; however, I read a descriptive research study that says that this approach does not work. I plan to stop calling patients by name. Which statement is the best appraisal of this nurses comment?
a. One descriptive research study rarely provides enough evidence to change practice.
b. Staff nurses apply new research findings only with the help from clinical nurse specialists.
c. New research findings should be incorporated into clinical algorithms before using them in practice.
d. The nurse misinterpreted the results of the study. Classic tenets of practice do not change.
7. Two nursing students discuss career plans after graduation. One student wants to enter psychiatric nursing. The other student asks, Why would you want to be a psychiatric nurse? All they do is talk. You will lose your skills. Select the best response by the student interested in psychiatric nursing.
a. Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of patients problems.
b. Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensional problems. Im challenged by those situations.
c. I think I will be good in the mental health field. I do not like clinical rotations in school, so I do not want to continue them after I graduate.
d. Psychiatric nurses do not have to deal with as much pain and suffering as medical surgical nurses. That appeals to me.
8. Which research evidence would most influence a group of nurses to change their practice?
a. Expert committee report of recommendations for practice
b. Systematic review of randomized controlled trials
c. Nonexperimental descriptive study
d. Critical pathway
9. A bill introduced in Congress would reduce funding for the care of people diagnosed with mental illnesses. A group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled?
d. Evidence-based practice
10. An informal group of patients discuss their perceptions of nursing care. Which comment best indicates a patients perception that his or her nurse is caring?
a. My nurse always asks me which type of juice I want to help me swallow my medication.
b. My nurse explained my treatment plan to me and asked for my ideas about how to make it better.
c. My nurse told me that if I take all the medicines the doctor prescribes I will get discharged soon.
d. My nurse spends time listening to me talk about my problems. That helps me feel like Im not alone.
Chapter 2: Mental Health and Mental Illness
1. An 86-year-old, previously healthy and independent, falls after an episode of vertigo. Which behavior by this patient best demonstrates resilience? The patient:
a. says, I knew this would happen eventually.
b. stops attending her weekly water aerobics class.
c. refuses to use a walker and says, I dont need that silly thing.
d. says, Maybe some physical therapy will help me with my balance.
2. Which organization actively seeks to reduce the stigma associated with mental illness through public presentations such as In Our Own Voice (IOOV)?
a. American Psychiatric Association (APA)
b. National Alliance on Mental Illness (NAMI)
c. United States Department of Health and Human Services (USDHHS)
d. North American Nursing Diagnosis Association International (NANDA-I)
3. A patient is admitted to the psychiatric hospital. Which assessment finding best indicates that the patient has a mental illness? The patient:
a. describes coping and relaxation strategies used when feeling anxious.
b. describes mood as consistently sad, discouraged, and hopeless.
c. can perform tasks attempted within the limits of own abilities.
d. reports occasional problems with insomnia.
4. The goal for a patient is to increase resiliency. Which outcome should a nurse add to the plan of care? Within 3 days, the patient will:
a. describe feelings associated with loss and stress.
b. meet own needs without considering the rights of others.
c. identify healthy coping behaviors in response to stressful events.
d. allow others to assume responsibility for major areas of own life.
5. A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a patients insurance form. Which resource should the nurse consult to discern the criteria used to establish this diagnosis?
a. A psychiatric nursing textbook
b. NANDA International (NANDA-I )
c. A behavioral health reference manual
d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
6. A nurse must assess several new patients at a community mental health center. Conclusions concerning current functioning should be made on the basis of:
a. the degree of conformity of the individual to societys norms.
b. the degree to which an individual is logical and rational.
c. a continuum from mentally healthy to unhealthy.
d. the rate of intellectual and emotional growth.
7. A 40-year-old adult living with parents states, Im happy but I dont socialize much. My work is routine. When new things come up, my boss explains them a few times to make sure I understand. At home, my parents make decisions for me, and I go along with them. A nurse should identify interventions to improve this patients:
b. overall happiness.
c. appraisal of reality.
d. control over behavior.
8. A patient tells a nurse, I have psychiatric problems and am in and out of hospitals all the time. Not one of my friends or relatives has these problems. Select the nurses best response.
a. Comparing yourself with others has no real advantages.
b. Why do you blame yourself for having a psychiatric illness?
c. Mental illness affects 50% of the adult population in any given year.
d. It sounds like you are concerned that others dont experience the same challenges as you.
9. A critical care nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and a nursing diagnosis. Select the psychiatric nurses best response.
a. No functional difference exists between the two diagnoses. Both serve to identify a human deviance.
b. The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis includes cultural variables.
c. The DSM-5 diagnosis profiles present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems.
d. The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience.
10. The spouse of a patient diagnosed with schizophrenia says, I dont understand why childhood experiences have anything to do with this disabling illness. Select the nurses response that will best help the spouse understand this condition.
a. Psychological stress is actually at the root of most mental disorders.
b. We now know that all mental illnesses are the result of genetic factors.
c. It must be frustrating for you that your spouse is sick so much of the time.
d. Although this disorder more likely has a biological rather than psychological origin, the support and involvement of caregivers is very important.
Chapter 3: Theories and Therapies
1. A 26-month-old child displays negative behaviors. The parent says, My child refuses toilet training and shouts, No! when given direction. What do you think is wrong? Select the nurses best reply.
a. This is normal for your childs age. The child is striving for independence.
b. The child needs firmer control. Punish the child for disobedience and say, No.
c. There may be developmental problems. Most children are toilet trained by age 2 years.
d. Some undesirable attitudes are developing. A child psychologist can help you develop a remedial plan.
2. A 26-month-old child displays negative behavior, refuses toilet training, and often shouts, No! when given directions. Using Freuds stages of psychosexual development, a nurse would assess the childs behavior is based on which stage?
3. A 26-month-old child displays negative behavior, refuses toilet training, and often shouts, No! when given direction. The nurses counseling with the parent should be based on the premise that the child is engaged in which of Eriksons psychosocial crises?
a. Trust versus Mistrust
b. Initiative versus Guilt
c. Industry versus Inferiority
d. Autonomy versus Shame and Doubt
4. A 4-year-old child grabs toys from siblings, saying, I want that toy now! The siblings cry, and the childs parent becomes upset with the behavior. Using the Freudian theory, a nurse can interpret the childs behavior as a product of impulses originating in the:
5. The parent of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, and using good manners. A nurse supports the use of praise because, according to the Freudian theory, these qualities will likely be internalized and become part of the childs:
6. A nurse supports parental praise of a child who is behaving in a helpful way. When the individual behaves with politeness and helpfulness in adulthood, which feeling will most likely result?
7. A patient comments, I never know the right answer and My opinion is not important. Using Eriksons theory, which psychosocial crisis did the patient have difficulty resolving?
a. Initiative versus Guilt
b. Trust versus Mistrust
c. Autonomy versus Shame and Doubt
d. Generativity versus Self-Absorption
8. Which patient statement would lead a nurse to suspect that the developmental task of infancy was not successfully completed?
a. I have very warm and close friendships.
b. Im afraid to let anyone really get to know me.
c. I am always right and confident about my decisions.
d. Im ashamed that I didnt do it correctly in the first place.
9. A nurse assesses that a patient is suspicious and frequently manipulates others. Using the Freudian theory, these traits are related to which psychosexual stage?
10. An adult expresses the wish to be taken care of and often behaves in a helpless fashion. This adult has needs related to which of Freuds stages of psychosexual development?
Chapter 4: Biological Basis for Understanding Psychopharmacology
1. A patient asks a nurse, What are neurotransmitters? My doctor says mine are out of balance. The best reply would be:
a. You must feel relieved to know that your problem has a physical basis.
b. Neurotransmitters are chemicals that pass messages between brain cells.
c. It is a high-level concept to explain. You should ask the doctor to tell you more.
d. Neurotransmitters are substances we eat daily that influence memory and mood.
2. The parent of an adolescent diagnosed with schizophrenia asks a nurse, My childs doctor ordered a positron-emission tomography (PET) scan. What is that? Select the nurses best reply.
a. PET uses a magnetic field and gamma waves to identify problems areas in the brain. Does your teenager have any metal implants?
b. Its a special type of x-ray image that shows structures of the brain and whether a brain injury has ever occurred.
c. PET is a scan that passes an electrical current through the brain and shows brain wave activity. PET can help diagnose seizures.
d. PET is a special scan that shows blood flow and activity in the brain.
3. A patient has dementia. The health care provider wants to make a differential diagnosis between Alzheimer disease and multiple infarctions. Which diagnostic procedure should a nurse expect to prepare the patient for first?
a. Computed tomography (CT) scan
b. Positron emission tomography (PET) scan
c. Functional magnetic resonance imaging (fMRI)
d. Single-photon emission computed tomography (SPECT) scan
4. A patient has delusions and hallucinations. Before beginning treatment with a psychotropic medication, the health care provider wants to rule out the presence of a brain tumor. For which test will a nurse need to prepare the patient?
a. Cerebral arteriogram
b. Functional magnetic resonance imaging (fMRI)
c. Computed tomography (CT) scan or magnetic resonance imaging (MRI)
d. Positron emission tomography (PET) or single-photon emission computed tomography (SPECT)
5. The nurse wants to assess for disturbances in circadian rhythms in a patient admitted for major depressive disorder. Which question best implements this assessment?
a. Do you ever see or hear things that others do not?
b. Do you have problems with short-term memory?
c. What are your worst and best times of day?
d. How would you describe your thinking?
6. A nurse administers a medication that potentiates the action of gamma-aminobutyric acid (GABA). Which finding would be expected?
a. Reduced anxiety
b. Improved memory
c. More organized thinking
d. Fewer sensory perceptual alterations
7. On the basis of current knowledge of neurotransmitter effects, a nurse anticipates that the treatment plan for a patient with memory difficulties may include medications designed to:
a. inhibit GABA production.
b. increase dopamine sensitivity.
c. decrease dopamine at receptor sites.
d. prevent destruction of acetylcholine.
8. A patient has disorganized thinking associated with schizophrenia. Neuroimaging would most likely show dysfunction in which part of the brain?
c. Temporal lobe
d. Prefrontal cortex
9. A nurse should assess a patient taking a medication with anticholinergic properties for inhibited function of the:
a. parasympathetic nervous system.
b. sympathetic nervous system.
c. reticular activating system.
d. medulla oblongata.
10. The therapeutic action of monoamine oxidase inhibitors (MAOIs) blocks neurotransmitter reuptake, causing:
a. increased concentration of neurotransmitters in the synaptic gap.
b. decreased concentration of neurotransmitters in serum.
c. destruction of receptor sites.
d. limbic system stimulation.
Chapter 5: Settings for Psychiatric Care
1. Planning for patients with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for patients who:
a. present a clear danger to self or others.
b. are noncompliant with medications at home.
c. have no support systems in the community.
d. develop new symptoms during the course of an illness.
2. A patient is hospitalized for a reaction to a psychotropic medication and then is closely monitored for 24 hours. During a predischarge visit, the case manager learns the patient received a notice of eviction on the day of admission. The most appropriate intervention for the case manager is to:
a. cancel the patients discharge from the hospital.
b. contact the landlord who evicted the patient to discuss the situation.
c. arrange a temporary place for the patient to stay until new housing can be arranged.
d. document that the adverse medication reaction was feigned because the patient had nowhere to live.
3. A multidisciplinary health care team meets 12 hours after an adolescent is hospitalized after a suicide attempt. Members of the team report their assessments. What outcome can be expected from this meeting?
a. A treatment plan will be formulated.
b. The health care provider will order neuroimaging studies.
c. The team will request a court-appointed advocate for the patient.
d. Assessment of the patients need for placement outside the home will be undertaken.
4. The relapse of a patient diagnosed with schizophrenia is related to medication noncompliance. The patient is hospitalized for 5 days, medication is restarted, and the patients thoughts are now more organized. The patients family members are upset and say, Its too soon for discharge. Hospitalization is needed for at least a month. The nurse should:
a. call the psychiatrist to come explain the discharge rationale.
b. explain that health insurance will not pay for a longer stay for the patient.
c. call security to handle the disturbance and escort the family off the unit.
d. explain that the patient will continue to improve if medication is taken regularly.
5. A nurse assesses an inpatient psychiatric unit, noting that exits are free from obstruction, no one is smoking, the janitors closet is locked, and all sharp objects are being used under staff supervision. These observations relate to:
a. management of milieu safety.
b. coordinating care of patients.
c. management of the interpersonal climate.
d. use of therapeutic intervention strategies.
6. The following patients are seen in the emergency department. The psychiatric unit has one bed available. Which patient should the admitting officer recommend for admission to the hospital? The patient who:
a. is experiencing dry mouth and tremor related to side effects of haloperidol (Haldol).
b. is experiencing anxiety and a sad mood after a separation from a spouse of 10 years.
c. self-inflicted a superficial cut on the forearm after a family argument.
d. is a single parent and hears voices saying, Smother your infant.
7. A student nurse prepares to administer oral medications to a patient diagnosed with major depressive disorder, but the patient refuses the medication. The student nurse should:
a. tell the patient, Ill get an unsatisfactory grade if I dont give you the medication.
b. tell the patient, Refusing your medication is not permitted. You are required to take it.
c. discuss the patients concerns about the medication, and report to the staff nurse.
d. document the patients refusal of the medication without further comment.
8. A nurse surveys the medical records for violations of patients rights. Which finding signals a violation?
a. No treatment plan is present in record.
b. Patient belongings are searched at admission.
c. Physical restraint is used to prevent harm to self.
d. Patient is placed on one-to-one continuous observation.
9. Which principle takes priority for the psychiatric inpatient staff when addressing behavioral crises?
a. Resolve behavioral crises using the least restrictive intervention possible.
b. Rights of the majority of patients supersede the rights of individual patients.
c. Swift intervention is justified to maintain the integrity of the therapeutic milieu.
d. Allow patients opportunities to regain control without intervention if the safety of other patients is not compromised.
10. To provide comprehensive care to patients, which competency is more important for a nurse who works in a community mental health center than a psychiatric nurse who works in an inpatient unit?
a. Problem-solving skills
b. Calm and caring manner
c. Ability to cross service systems
d. Knowledge of psychopharmacology
Chapter 6: Legal and Ethical Basis for Practice
1. A psychiatric nurse best implements the ethical principle of autonomy when he or she:
a. intervenes when a self-mutilating patient attempts to harm self.
b. stays with a patient who is demonstrating a high level of anxiety.
c. suggests that two patients who are fighting be restricted to the unit.
d. explores alternative solutions with a patient, who then makes a choice.
2. Which action by a psychiatric nurse best supports a patients right to be treated with dignity and respect?
a. Consistently addressing a patient by title and surname.
b. Strongly encouraging a patient to participate in the unit milieu.
c. Discussing a patients condition with another health care provider in the elevator.
d. Informing a treatment team that a patient is too drowsy to participate in care planning.
3. Two hospitalized patients fight when they are in the same room. During a team meeting, a nurse asserts that safety is of paramount importance and therefore the treatment plans should call for both patients to be secluded to prevent them from injuring each other. This assertion:
a. reveals that the nurse values the principle of justice.
b. reinforces the autonomy of the two patients.
c. violates the civil rights of the two patients.
d. represents the intentional tort of battery.
4. In a team meeting a nurse says, Im concerned whether we are behaving ethically by using restraint to prevent one patient from self-mutilation while the care plan for another patient who has also self-mutilated calls for one-on-one supervision. Which ethical principle most clearly applies to this situation?
5. Which scenario is an example of a tort?
a. The primary nurse does not complete the plan of care for a patient within 24 hours of the patients admission.
b. An advanced practice nurse recommends that a patient who is dangerous to self and others be voluntarily hospitalized.
c. A patients admission status is changed from involuntary to voluntary after the patients hallucinations subside.
d. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent violence because a unit is short staffed.
6. A nurses neighbor asks, Why arent people with mental illness kept in state institutions anymore? What is the nurses best response?
a. Many people are still in psychiatric institutions. Inpatient care is needed because many people who are mentally ill are violent.
b. Less restrictive settings are now available to care for individuals with mental illness.
c. Our nation has fewer persons with mental illness; therefore fewer hospital beds are needed.
d. Psychiatric institutions are no longer popular as a consequence of negative stories in the press.
7. Which nursing intervention demonstrates false imprisonment?
a. A confused and combative patient says, Im getting out of here and no one can stop me. The nurse restrains this patient without a health care providers order and then promptly obtains an order.
b. A patient has been irritating, seeking the attention of nurses most of the day. Now a nurse escorts the patient down the hall, saying, Stay in your room or youll be put in seclusion.
c. An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. A nurse rushes after the patient and convinces the patient to return to the unit.
d. An involuntarily hospitalized patient with suicidal ideation attempts to leave the unit. A nurse calls the security team and uses established protocols to prevent the patient from leaving.
8. A patient should be considered for involuntary commitment for psychiatric care when he or she:
a. is noncompliant with the treatment regimen.
b. sells and distributes illegal drugs.
c. threatens to harm self and others.
d. fraudulently files for bankruptcy.
9. A nurse at the mental health center prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot) to a patient with schizophrenia. As the nurse swabs the site, the patient shouts, Stop! I dont want to take that medicine anymore. I hate the side effects. Select the nurses best initial action.
a. Stop the medication administration procedure and say to the patient, Tell me more about the side effects youve been having.
b. Say to the patient, Since Ive already drawn the medication in the syringe, Im required to give it, but lets talk to the doctor about skipping next months dose.
c. Proceed with the injection but explain to the patient that other medications are available that may help reduce the unpleasant side effects.
d. Notify other staff members to report to the room for a show of force and proceed with the injection, using restraint if necessary.
10. Several nurses are concerned that agency policies related to restraint and seclusion are inadequate. Which statement about the relationship of substandard institutional policies and individual nursing practice should guide nursing practice?
a. The policies do not absolve an individual nurse of the responsibility to practice according to the 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. In an institution with substandard policies, the nurse has a responsibility to inform the supervisor and leave the premises.
d. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.
Chapter 7: Nursing Process and QSEN: The Foundation for Safe and Effective Care
1. A new staff nurse completes 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. Establish therapeutic relationships.
c. Prescribe psychotropic medications.
d. Individualize nursing care plans.
2. A newly admitted patient with major depressive disorder has lost 20 pounds over the past month 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: Less than body requirements
b. Chronic low self-esteem
c. Risk for suicide
3. A patient with major depressive disorder 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 is most directly related to this outcome: Patient will refrain from gestures and attempts to harm self?
a. Implement suicide precautions.
b. Frequently offer high-calorie snacks and fluids.
c. Assist the patient to identify three personal strengths.
d. Observe patient for therapeutic effects of antidepressant medication.
4. A patients nursing diagnosis is Insomnia. The desired outcome is: Patient will sleep for a minimum of 5 hours nightly by October 31. On November 1, a review of the sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. Which evaluation should be documented?
a. Consistently demonstrated
b. Often demonstrated
c. Sometimes demonstrated
d. Never demonstrated
5. A patients nursing diagnosis is Insomnia. The desired outcome is: Patient will sleep for a minimum of 5 hours nightly by October 31. On November 1, a review of the sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. What is the nurses 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. Revise the outcome target date and interventions.
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?
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 isnt much improvement by the time of discharge. The nurses responsibility is to:
a. document the other workers assessment of the patient.
b. assess the patient based on data collected from all sources.
c. validate the workers impression by contacting the patients significant other.
d. discuss the workers impression with the patient during the assessment interview.
8. A nurse works with a patient to establish outcomes. The nurse believes that one outcome suggested by the patient is not in the patients best interest. What is the nurses best action?
a. Remain silent.
b. Educate the patient that the outcome is not realistic.
c. Explore with the patient possible consequences of the outcome.
d. Formulate a more appropriate outcome without the patients input.
9. A patient states, Im 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-esteembuilding activities
b. Anxiety self-control measures
c. Sleep enhancement activities
d. Suicide precautions
10. Select the best outcome for a patient with this nursing diagnosis: Impaired social interaction, related to sociocultural dissonance as evidenced by stating, Although Id like to, I dont join in because I dont speak the language very well. The patient will:
a. demonstrate improved social skills.
b. express a desire to interact with others.
c. become more independent in decision making.
d. select and participate in one group activity per day.
Chapter 8: Communication Skills: Medium for All Nursing Practice
1. A patient says to the nurse, I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadnt rested well. Which comment would be appropriate if the nurse seeks clarification?
a. It sounds as though you were uncomfortable with the content of your dream.
b. I understand what youre saying. Bad dreams leave me feeling tired, too.
c. So, all in all, you feel as though you had a rather poor nights sleep?
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. Lets talk about something other than the CIA.
b. It sounds like youre 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 usually agree on everything. The nurse observes the patients foot moving continuously as the patient twirls a shirt button. What conclusion can the nurse draw? The patients communication is:
4. A nurse interacts with a newly hospitalized patient. Select the nurses comment that applies the communication technique of offering self.
a. Ive 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. Id 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. Restate a feeling or thought the patient has expressed.
b. Ask a direct question, such as, Did you feel angry?
c. Make a judgment about the patients problem.
d. Say, I understand what youre 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?8??
d. Tell me everything from the beginning.
7. A patient tells the nurse, I dont think I will ever get out of here. Select the nurses most therapeutic response.
a. Dont talk that way. Of course you will leave here!
b. Keep up the good work and you certainly will.
c. You dont think youre making progress?
d. Everyone feels that way sometimes.
8. Documentation in a patients 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. Patient is giving positive feedback about the nurses communication techniques.
b. Nurse is viewing the patients behavior through a cultural filter.
c. Patients verbal and nonverbal messages are incongruent.
d. Patient is demonstrating psychotic behaviors.
9. While talking with a patient with severe depression, a nurse notices the patient is unable to maintain eye contact. The patients chin lowers to the chest while the patient looks at the floor. Which aspect of communication has the nurse assessed?
a. Nonverbal communication
b. A message filter
c. A cultural barrier
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 patients hand. Select the correct analysis of the nurses behavior.
a. It shows empathy and compassion. It will encourage the patient to continue to express feelings.
b. The gesture is premature. The patients 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. Patients in a psychiatric setting should not be touched.
Chapter 9: Therapeutic Relationships and the Clinical Interview
1. A nurse assesses a confused older adult. The nurse experiences sadness and reflects, The patient is like one of my grandparents . . . so helpless. What feelings does the nurse describe?
c. Catastrophic reaction
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 patients 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 patients mood begins to lift.
d. The nurse develops a trusting relationship with the patient.
4. A patient says, Please dont share information about me with the other people. How should the nurse respond?
a. I wont share information with others without your permission, but I will share information about you with other staff members.
b. A therapeutic relationship is just between the nurse and the patient. Its up to you to tell others what you want them to know.
c. It really 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 for 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 right now. The nurse should:
a. say to the interrupting patient, I am not available to talk with you at the present time.
b. end the unproductive session with the current patient and spend time with the patient who has just interrupted.
c. invite the interrupting patient to join in the session with the current patient.
d. tell the patient who interrupted, This session is 5 more minutes; then, I will talk with you.
6. Termination of a therapeutic nurse-patient relationship with a patient 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 have happened during the relationship and evaluates the 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. great sense of independence.
b. rapport and trust with the nurse.
c. self-responsibility and autonomy.
d. resolution of feelings of transference.
8. During which phase of the nurse-patient relationship can the nurse anticipate that identified patient issues will be explored and resolved?
9. At what point in the nurse-patient relationship should a nurse plan to first address termination?
a. In the orientation phase
b. During the working phase
c. In the termination phase
d. When the patient initially brings up the topic
10. A nurse should introduce 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 10: Stress and Stress-Related Disorders
1. Which scenario best demonstrates an example of eustress? An individual:
a. loses a beloved family pet.
b. prepares to take a 1 week vacation to a tropical island with a group of close friends.
c. receives a bank notice there were insufficient funds in their account for a recent rent payment.
d. receives notification that their current employer is experiencing financial problems and some workers will be terminated.
2. A patient diagnosed with liver failure has been on the transplant waiting list 8 months. The patient says, Why is it taking so long to have the surgery? Maybe Im meant to die for all the bad things Ive done. The nurse should document the patients comment in which section of the assessment?
3. A person with a fear of heights drives across a high bridge. Which structure will stimulate a response from the autonomic nervous system?
b. Parietal lobe
d. Pituitary gland
4. A person with a fear of heights drives across a high bridge. Which division of the autonomic nervous system is stimulated in response to this experience?
a. Limbic system
b. Peripheral nervous system
c. Sympathetic nervous system
d. Parasympathetic nervous system
5. A patient is brought to the emergency department after a motorcycle accident. The patient is alert, responsive, and diagnosed with a broken leg. The patients vital signs are temperature (T), 98.6 F; pulse (P), 72 beats per minute (bpm); and respirations (R), 16 breaths per minute. After being informed that surgery is required for the broken leg, which vital sign readings would be expected?
a. T, 98.6; P, 64; R, 14
b. T, 98.6; P, 68; R, 12
c. T, 98.6; P, 62; R, 16
d. T, 98.6; P, 84; R, 22
6. As part of the stress response, the HPA axis is stimulated. Which structures make up this system?
a. Hippocampus, parietal lobe, and amygdala
b. Hypothalamus, pituitary gland, and adrenal glands
c. Hind brain, pyramidal nervous system, and anterior cerebrum
d. Hepatic artery, parasympathetic nervous system, and acoustic nerve
7. Cortisol is released in response to a patients prolonged stress. Which initial effect would the nurse expect to result from the increased cortisol level?
a. Diuresis and electrolyte imbalance
b. Focused and alert mental status
c. Drowsiness and lethargy
d. Restlessness and anxiety
8. A soldier returns to the United States from active duty in a combat zone in Afghanistan. The soldier is diagnosed with post-traumatic stress disorder (PTSD). The nurses highest priority is to screen this soldier for which problem?
a. Major depressive disorder
b. Bipolar disorder
9. A soldier returns to the United States from active duty in a combat zone in Afghanistan. The soldier is diagnosed with post-traumatic stress disorder (PTSD). Which comment by the soldier requires the nurses immediate attention?
a. Its good to be home. I missed my family and friends.
b. I saw my best friend get killed by a roadside bomb. It should have been me instead.
c. Sometimes I think I hear bombs exploding, but its just the noise of traffic in my hometown.
d. I want to continue my education but Im not sure how I will fit in with other college students.
10. A soldier returned home from active duty in a combat zone in Afghanistan and was diagnosed with post-traumatic stress disorder (PTSD). The soldier says, If theres a loud noise at night, I get under my bed because I think were getting bombed. What type of experience has the soldier described?
d. Auditory hallucination
Chapter 11: Anxiety, Anxiety Disorders, and Obsessive-Compulsive Disorders
1. A nurse wishes to teach alternative coping strategies to a patient experiencing severe anxiety. The nurse will first need to:
a. Verify the patients learning style.
b. Create outcomes and a teaching plan.
c. Lower the patients current anxiety level.
d. Assess how the patient uses defense mechanisms.
2. A patient approaches the nurse and impatiently blurts out, Youve got to help me! Something terrible is happening. My heart is pounding. The nurse responds, Its almost time for visiting hours. Lets get your hair combed. Which approach has the nurse used?
a. Bringing up an irrelevant topic
b. Responding to physical needs
c. Addressing false cognitions
3. A patient experiencing moderate anxiety says, I feel undone. An appropriate response for the nurse would be:
a. Why do you suppose you are feeling anxious?
b. What would you like me to do to help you?
c. Im not sure I understand. Give me an example.
d. You must get your feelings under control before we can continue.
4. A patient with a high level of motor activity runs from chair to chair and cries, Theyre coming! Theyre coming! The patient does not follow instructions or respond to verbal interventions from staff. The initial nursing intervention of highest priority is to:
a. provide for patient safety.
b. increase environmental stimuli.
c. respect the patients personal space.
d. encourage the clarification of feelings.
5. A patient with a high level of motor activity runs from chair to chair and cries, Theyre coming! Theyre coming! The patient is unable to follow instructions or respond to verbal interventions from staff. Which nursing diagnosis has the highest priority?
a. Risk for injury
b. Self-care deficit
c. Disturbed energy field
d. Disturbed thought processes
6. A supervisor assigns a worker a new project. The worker initially agrees but feels resentful. The next day, when asked about the project, the worker says, Ive been working on other things. When asked 4 hours later, the worker says, Someone else was using the copier, so I couldnt finish it. The workers behavior demonstrates:
a. acting out.
d. passive aggression.
7. A patient is undergoing diagnostic tests. The patient says, Nothing is wrong with me except a stubborn chest cold. The spouse reports that the patient smokes, coughs daily, has recently lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using?
8. A patient with a mass in the left upper lobe of the lung is scheduled for a biopsy. The patient has difficulty understanding the nurses comments and asks, What are they going to do? Assessment findings include a tremulous voice, respirations 28 breaths per minute, and pulse rate 110 beats per minute. What is the patients level of anxiety?
9. A patient who is preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is appropriate?
a. Reassure the patient that all nurses are skilled in providing postoperative care.
b. Describe the procedure again in a calm manner, using simple language.
c. Tell the patient that the staff is prepared to promote recovery.
d. Encourage the patient to express feelings to his or her family.
10. A nurse encourages an anxious patient to talk about feelings and concerns. What is the rationale for this intervention?
a. Offering hope allays and defuses the patients anxiety.
b. Concerns stated aloud become less overwhelming and help problem solving to 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 12: Somatoform Disorders and Dissociative Disorders
1. A medical-surgical nurse works with a patient diagnosed with a somatic system 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.
2. A patient has blindness related to a functional neurological (conversion) disorder but is unconcerned about this problem. Which understanding should guide the nurses planning for this patient? The patient is:
a. suppressing accurate feelings regarding the problem.
b. relieving anxiety through the physical symptom.
c. meeting needs through hospitalization.
d. refusing to disclose genuine fears.
3. A patient has blindness related to a functional neurological (conversion) 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 himself or herself after explaining the arrangement of the food on the tray.
c. direct the patient to locate items on the tray independently and feed himself or herself unassisted.
d. address the needs of other patients in the dining room, and then feed this patient.
4. A patient with blindness related to a functional neurological (conversion) disorder says, All the doctors and nurses in this hospital stop by often to check on me. Too bad people outside the hospital dont find me interesting. Which nursing diagnosis is most relevant?
a. Social isolation
b. Chronic low self-esteem
c. Interrupted family processes
d. Ineffective health maintenance
5. To assist a patient diagnosed with a somatic system disorder, a nursing intervention of high priority is to:
a. imply that somatic symptoms are not real.
b. help the patient suppress feelings of anger.
c. shift the focus from somatic symptoms to feelings.
d. investigate each physical symptom as soon as it is reported.
6. A patient who fears serious heart disease was referred to the mental health center by a cardiologist after diagnostic evaluation showed no physical illness. The patient says, My heart misses beats. Im frequently absent from work. I dont go out much because I need to rest. Which health problem is most likely?
a. Body dysmorphic disorder
b. Antisocial personality disorder
c. Illness anxiety disorder (hypochondriasis)
d. Persistent depressive disorder (dysthymia)
7. A nurse assessing a patient diagnosed with a somatic system disorder is most likely to note that the patient:
a. readily sees a relationship between symptoms and interpersonal conflicts.
b. rarely derives personal benefit from the symptoms.
c. has little difficulty communicating emotional needs.
d. has unmet needs related to comfort and activity.
8. To plan effective care for patients diagnosed with somatic system disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms:
a. are generally chronic in nature.
b. have a physiological basis.
c. can be voluntarily controlled.
d. provide relief from health anxiety.
9. A patient diagnosed with a somatic symptom disorder has the nursing diagnosis: Interrupted family processes, related to patients disabling symptoms as evidenced by the spouse and children assuming roles and tasks that previously belonged to patient. An appropriate outcome is that the patient will:
a. assume roles and functions of the other family members.
b. demonstrate a resumption of former roles and tasks.
c. focus energy on problems occurring in the family.
d. rely on family members to meet his or her personal needs.
10. A woman wears a size 7 shoe. She says, My feet are huge. Ive asked three orthopedists to surgically reduce my feet. The patient 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. Dissociative amnesia with fugue
b. Illness anxiety disorder
c. Body dysmorphic disorder
d. Dissociative identity disorder
Chapter 13: Personality Disorders
1. A therapist recently convicted of multiple counts of Medicare fraud says, Sure I overbilled. Why not? Everyone takes advantage of the government, so I did too. These statements show:
c. superficial remorse.
d. lack of guilt feelings.
2. Which intervention is appropriate for a patient diagnosed with an antisocial personality disorder who frequently manipulates others?
a. Refer the patients requests and questions to the case manager.
b. Explore the patients feelings of fear and inferiority.
c. Provide negative reinforcement for acting-out behavior.
d. Ignore, rather than confront, inappropriate behavior.
3. As a nurse prepares to administer a medication to a patient diagnosed with a borderline personality disorder, the patient says, Just leave it on the table. Ill take it when I finish combing my hair. What is the nurses best response?
a. Reinforce this assertive action by the patient. Leave the medication on the table as requested.
b. Respond to the patient, Im worried that you might not take it. I will come back later.
c. Say to the patient, I must watch you take the medication. Please take it now.
d. Ask the patient, Why dont you want to take your medication now?
4. What is an appropriate initial outcome for a patient diagnosed with a personality disorder who frequently manipulates others? The patient will:
a. identify when feeling angry.
b. use manipulation only to get legitimate needs met.
c. acknowledge manipulative behavior when it is called to his or her attention.
d. accept fulfillment of his or her requests within an hour rather than immediately.
5. Consider these comments made to three different nurses by a patient diagnosed with an antisocial personality disorder: Youre a better nurse than the day shift nurse said you were; Another nurse said you dont do your job right; You think youre perfect, but Ive seen you make three mistakes. Collectively, these interactions can be assessed as:
d. guilt producing.
6. A nurse reports to the interdisciplinary team that a patient diagnosed with an antisocial personality disorder lies to other patients, verbally abuses a patient diagnosed with dementia, and flatters the primary nurse. This patient is detached and superficial during counseling sessions. Which behavior most clearly warrants limit setting?
a. Flattering the nurse
b. Lying to other patients
c. Verbal abuse of another patient
d. Detached superficiality during counseling
7. A patient diagnosed with borderline personality disorder has a history of self-mutilation and suicide attempts. The patient reveals feelings of depression and anger with life. The psychiatrist suggests the use of a medication. Which type of medication should the nurse expect?
a. Selective serotonin reuptake inhibitor (SSRI)
b. Monoamine oxidase inhibitor (MAOI)
8. A persons spouse filed charges of battery. The person has a long history of acting-out behaviors and several arrests. Which statement by the person suggests an antisocial personality disorder?
a. I have a quick temper, but I can usually keep it under control.
b. Ive done some stupid things in my life, but Ive learned a lesson.
c. Im feeling terrible about the way my behavior has hurt my family.
d. I hit because Im tired of being nagged. My spouse deserved the beating.
9. What is the priority nursing diagnosis for a patient diagnosed with antisocial personality disorder who has made threats against staff, ripped art off the walls, and thrown objects?
a. Disturbed sensory perceptionauditory
b. Risk for other-directed violence
c. Ineffective denial
d. Ineffective coping
10. A patient diagnosed with a personality disorder has used manipulation to get his or her needs met. The staff decides to apply limit-setting interventions. What is the correct rationale for this action?
a. It provides an outlet for feelings of anger and frustration.
b. It respects the patients wishes so assertiveness will develop.
c. External controls are necessary while internal controls are developed.
d. Anxiety is reduced when staff members assume responsibility for the patients behavior.
Chapter 14: Eating Disorders
1. Over the past year, a woman has cooked gourmet meals for her family but eats only tiny servings. She wears layered, loose clothing and now has amenorrhea. Her current weight is 95 pounds, a loss of 35 pounds. Which medical diagnosis is most likely?
a. Binge eating disorder
b. Anorexia nervosa
c. Bulimia nervosa
2. Disturbed body image is the nursing diagnosis for a patient diagnosed with an eating disorder. Which outcome indicator is most appropriate to monitor?
a. Weight, muscle, and fat are congruent with height, frame, age, and sex.
b. Calorie intake is within the required parameters of the treatment plan.
c. Weight reaches the established normal range for the patient.
d. Patient expresses satisfaction with body appearance.
3. A patient who is referred to the eating disorders clinic has lost 35 pounds in the past 3 months. To assess the patients oral intake, the nurse should ask:
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 has 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 am grossly underweight, but thats what I want.
d. I am 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 has lost 25% of body weight. The patients current serum potassium is 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 malnutrition 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 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 priority as a patient diagnosed with anorexia nervosa begins to gain weight?
a. Assess for depression and anxiety.
b. Observe for adverse effects of re-feeding.
c. Communicate empathy for the patients feelings.
d. Help the patient balance energy expenditure and 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 must be routinely collected.
b. Patient involvement in decision-making increases a sense of control and promotes compliance with the treatment.
c. A team approach to planning the diet ensures that physical and emotional needs of the patient are met.
d. Because of increased risk for physical problems with re-feeding, obtaining patient permission is required.
9. The nursing care plan for a patient diagnosed with anorexia nervosa includes the intervention Monitor for complications of re-feeding. Which body system should a nurse closely monitor for dysfunction?
c. Central nervous
10. A psychiatric clinical nurse specialist uses cognitive therapy techniques with 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 the food 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 does not seem to solve your problems. You are thin now but still unhappy.
Chapter 15: Mood Disorders: Depression
1. A patient became severely depressed when the last of six children moved out of the home 4 months ago. The patient repeatedly says, No one cares about me. Im 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. The staff here cares about you and wants to try to help you get better.
c. It is difficult for others to care about you when you repeatedly say negative things about yourself.
d. Ill sit with you for 10 minutes now and return for 10 minutes at lunchtime and again at 2:30 this afternoon.
2. A patient became depressed after the last of six children moved out of the home 4 months ago. The patient has been self-neglectful, slept poorly, lost weight, and repeatedly says, No one cares about me anymore. Im not worth anything. Select an appropriate 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. consent to take 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 nurse wants to reinforce positive self-esteem for a patient diagnosed with major depressive disorder. Today, the patient is wearing a new shirt and has neat, clean hair. Which remark is most appropriate?
a. You look nice this morning.
b. You are wearing a new shirt.
c. I like the shirt youre wearing.
d. You must be feeling better today.
4. An adult diagnosed with major depressive disorder 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
b. Relaxation training classes
c. Use of complementary therapy
d. Learning desensitization techniques
5. A priority nursing intervention for a patient diagnosed with major depressive disorder is:
a. distracting the patient from self-absorption.
b. carefully and inconspicuously observing the patient around the clock.
c. allowing the patient to spend long periods alone in self-reflection.
d. offering opportunities for the patient to assume a leadership role in the therapeutic milieu.
6. When counseling patients diagnosed with major depressive disorder, 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 does not have any happiness in it anymore. I once enjoyed holidays, but now theyre just another day.
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