Essentials of Psychiatric Mental Health Nursing 7th Edition By Mary C-Test Bank

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Essentials of Psychiatric Mental Health Nursing 7th Edition By Mary C-Test Bank

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Essentials of Psychiatric Mental Health Nursing 7th Edition By Mary C-Test Bank

Chapter 2: Biological Implications

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   A depressed client states, I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again. Which nursing response is appropriate?

1. Medications only address biological factors. Environmental and interpersonal factors must also be considered.
2. Because biological factors are the sole cause of depression, medications will improve your mood.
3. Environmental factors have been shown to exert the most influence in the development of depression.
4. Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment).

 

 

____    2.   A client diagnosed with major depressive disorder asks, What part of my brain controls my emotions? Which nursing response is appropriate?

1. The occipital lobe governs perceptions, judging them as positive or negative.
2. The parietal lobe has been linked to depression.
3. The medulla regulates key biological and psychological activities.
4. The limbic system is largely responsible for ones emotional state.

 

 

____    3.   Which part of the nervous system should a nurse identify as playing a major role during stressful situations?

1. Peripheral nervous system
2. Somatic nervous system
3. Sympathetic nervous system
4. Parasympathetic nervous system

 

 

____    4.   Which client statement reflects an understanding of circadian rhythms in psychopathology?

1. When I dream about my mothers horrible train accident, I become hysterical.
2. I get really irritable during my menstrual cycle.
3. Im a morning person. I get my best work done before noon.
4. Every February, I tend to experience periods of sadness.

 

 

____    5.   Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community?

1. Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy
2. Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill
3. Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents
4. Studies in which monozygotic twins were raised together by mentally ill biological parents
5. All of the above

 

 

____    6.   Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective?

1. Neuroendocrinology
2. Psychoneuroimmunology
3. Diagnostic technology
4. Neurophysiology

 

 

____    7.   A withdrawn client, diagnosed with schizophrenia, expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being responsible for this behavior?

1. Dendrites
2. Axons
3. Neurotransmitters
4. Synapses

 

 

____    8.   An instructor is teaching nursing students about neurotransmitters. Which best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron?

1. Regeneration
2. Reuptake
3. Recycling
4. Retransmission

 

 

____    9.   A nurse concludes that a restless, agitated client is manifesting a fight-or-flight response. The nurse should associate this response with which neurotransmitter?

1. Acetylcholine
2. Dopamine
3. Serotonin
4. Norepinephrine

 

 

____  10.   A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the clients neurotransmitters should a nurse expect to be elevated?

1. Serotonin
2. Dopamine
3. Gamma-aminobutyric acid (GABA)
4. Histamine

 

 

____  11.   A clients wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The clients therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapists recommendations?

1. The therapist is using an interpersonal approach.
2. The client has an alteration in neurotransmitters.
3. It is routine practice to remind clients about nutrition, exercise, and rest.
4. The client is susceptible to illness because of effects of stress on the immune system.

 

 

____  12.   Which mental illness should a nurse identify as being associated with an increase in prolactin hormone level?

1. Major depressive episode
2. Schizophrenia
3. Anorexia nervosa
4. Alzheimers disease

 

 

____  13.   Which cerebral structure should a nursing instructor describe to students as the emotional brain?

1. The cerebellum
2. The limbic system
3. The cortex
4. The left temporal lobe

 

 

____  14.   A nurse understands that the abnormal secretion of growth hormone may play a role in which illness?

1. Acute mania
2. Schizophrenia
3. Anorexia nervosa
4. Alzheimers disease

 

 

____  15.   A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the production of these symptoms?

1. Abnormal levels of serotonin
2. Decreased levels of dopamine
3. Increased levels of norepinephrine
4. Decreased levels of acetylcholine

 

 

____  16.   A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness?

1. Bipolar disorder: mania
2. Schizophrenia spectrum disorder
3. Generalized anxiety disorder
4. Major depressive episode

 

 

____  17.   A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness?

1. Schizophrenia spectrum disorder
2. Major depressive disorder
3. Body dysmorphic disorder
4. Parkinsons disease

 

 

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

 

____  18.   Which of the following information should a nurse include when explaining causes of anorexia nervosa to a client? (Select all that apply.)

1. There is a possible correlation between abnormal secretion of growth hormone and anorexia nervosa.
2. There is a possible correlation between antidiuretic hormone levels and anorexia nervosa.
3. There is a possible correlation between low levels of gonadotropin and anorexia nervosa.
4. There is a possible correlation between increased levels of prolactin and anorexia nervosa.
5. There is a possible correlation between altered levels of oxytocin and anorexia nervosa.

 

 

____  19.   Which of the following symptoms should a nurse associate with the development of decreased levels of thyroid-stimulating hormone (TSH) in a newly admitted client? (Select all that apply.)

1. Depression
2. Fatigue
3. Increased libido
4. Mania
5. Hyperexcitability

 

 

Completion

Complete each statement.

 

  1. ____________________________ is the study of the biological foundations of cognitive, emotional, and behavioral processes.

 

 

Chapter 2: Biological Implications

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  1

Chapter: Chapter 2, Biological Implications

Objective: Recognize various theorized influences in the development of psychiatric disorders including brain physiology, genetics, endocrine function, immune system, and psychosocial, and environmental factors.

Page: 1519

Headings: The Parietal Lobes, The Occipital Lobes, Limbic System, Medulla

Integrated Processes: Teaching and Learning

Client Need: Psychosocial Integrity

Cognitive Level: Analysis [Analyzing]

Concept: Mood

Difficulty: Easy

 

  Feedback
1 The nurse should advise the client that medications address biological factors, but there are other factors that affect mood. The nurse should educate the client on environmental and interpersonal factors that can lead to depression.
2 The statement is false because biological factors are not the sole cause of depression.
3 It is false that environmental factors have been shown to exert the most influence in the development of depression.
4 Researchers have demonstrated a link between nature and nurture.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  4

Chapter: Chapter 2, Biological Implications

Objective: Identify gross anatomical structures of the brain and describe their functions.

Page: 16

Headings: The Nervous System: An Anatomical Review > The Brain

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 The occipital lobes are the area of visual reception and interpretation.
2 Somatosensory input (touch, taste, temperature, etc.) occurs in the parietal lobes.
3 The medulla contains vital centers that regulate heart rate and reflexes.
4 The nurse should explain to the client that the limbic system is largely responsible for ones emotional state. This system is often called the emotional brain and is associated with feelings, sexuality, and social behavior.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  3

Chapter: Chapter 2, Biological Implications

Objective: Discuss the physiology of neurotransmission in the central nervous system.

Page: 21

Heading: Autonomic Nervous System

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Comprehension [Understanding]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 The peripheral nervous system does not play a major role during stressful situations.
2 The somatic nervous system is part of the peripheral nervous system.
3 The nurse should identify that the sympathetic nervous system plays a major role during stressful situations. The sympathetic nervous system prepares the body for the fight-or-flight response.
4 The parasympathetic nervous system is dominant when an individual is in a nonstressful state.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  3

Chapter: Chapter 2, Biological Implications

Objective: Discuss the physiology of neurotransmission in the central nervous system.

Page: 2930

Heading: Circadian Rhythms

Integrated Processes: Teaching and Learning

Client Need: Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Analysis [Analyzing]

Concept: Sleep and Rest

Difficulty: Moderate

 

  Feedback
1 This statement does not indicate understanding of circadian rhythms.
2 The menstrual cycle is not affected by the circadian rhythm.
3 By stating, I am a morning person, the client demonstrates an understanding that circadian rhythms may influence a variety of regulatory functions, including the sleep-wake cycle, regulation of body temperature, and patterns of activity. Most humans follow a 24-hour cycle that is largely affected by lightness and darkness.
4 Experiencing periods of sadness is not indicative of the circadian rhythm.

 

 

PTS:   1                    CON:  Sleep and Rest

 

  1. ANS:  5

Chapter: Chapter 2, Biological Implications

Objective: Discuss the implications of psychobiological concepts to the practice of psychiatric/mental health nursing.

Page: 31

Heading: Genetics > Adoptions Studies

Client Need: Physiological Integrity: Physiological Adaptation

Concept: Evidence-based Practice

Cognitive Level: Analysis [Analyzing]

Integrated Processes: Teaching and Learning

Difficulty: Moderate

 

  Feedback
1 This type of adoption study can provide information on children with mentally ill biological parents who are raised by adoptive parents who are mentally healthy parents.
2 This type of adoption study can provide information on children with mentally healthy biological parents who are raised by adoptive parents who are mentally ill.
3 This type of adoption study provides important information on monozygotic twins from mentally ill parents who were raised separately by different adoptive parents.
4 This type of adoption study provides important information on monozygotic twins who were raised together by mentally ill biological parents.
5 The nurse should determine that all of the studies could possibly benefit the psychiatric community. The studies may reveal research findings relating genetic links to mental illness. Adoption studies allow comparisons to be made of the influences of the environment versus genetics.

 

 

PTS:   1                    CON:  Evidence-based Practice

 

  1. ANS:  2

Chapter: Chapter 2, Biological Implications

Objective: Discuss the influence of psychological factors on the immune system.

Page: 31

Heading: Psychoneuroimmunology > Implications of the Immune System in Psychiatric Illness

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Stress

Difficulty: Moderate

 

  Feedback
1 Neuroendocrinology is the study of the interaction between the nervous system and the endocrine system.
2 Psychoneuroimmunology is the branch of medicine that studies the effects of social and psychological factors on the functioning of the immune system. Studies of the biological response to stress hypothesize that individuals become more susceptible to physical illness following exposure to stressful stimuli.
3 Diagnostic testing assists in diagnosing.
4 Neurophysiology is the physiology of the nervous system.

 

 

PTS:   1                    CON:  Stress

 

  1. ANS:  3

Chapter: Chapter 2, Biological Implications

Objective: Describe the role of neurotransmitters in the central nervous system.

Page: 21

Heading: The Nervous System: An Anatomical Review > Neurotransmitters

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Comprehension [Understanding]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 Dendrites are processes that transmit impulses toward the cell body.
2 Axons transmit impulses away from the cell body. A junction between two neurons is a synapse.
3 The nurse should recognize that neurotransmitters play an essential function in the role of human emotion and behavior. Neurotransmitters are targeted and affected by many psychotropic medications.
4 A junction between two neurons is a synapse.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  2

Chapter: Chapter 2, Biological Implications

Objective: Describe the role of neurotransmitters in the central nervous system.

Page: 21

Heading: The Nervous System: An Anatomical Review > Neurotransmitters

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Comprehension [Understanding]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 Regeneration is incorrect wording to describe this process.
2 The nursing instructor should explain that the process by which neurotransmitters are released into the synaptic cleft and returned to the presynaptic neuron is termed reuptake. Reuptake is the process by which neurotransmitters are stored for reuse.
3 Recycling is incorrect wording to describe this process.
4 Retransmission is incorrect wording to describe this process.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  4

Chapter: Chapter 2, Biological Implications

Objective: Describe the role of neurotransmitters in the central nervous system.

Page: 21

Heading: Monoamines > Norepinephrine

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Comprehension [Understanding]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 Acetylcholine functions include pain, arousal, and pain perception.
2 Dopamine functions include regulation of movement and coordination.
3 Serotonin plays a role in sleep, libido, and appetite.
4 The nurse should associate the neurotransmitter norepinephrine with the fight-or-flight response. Norepinephrine produces activity in the sympathetic postsynaptic nerve terminal and is associated with the regulation of mood, cognition, perception, locomotion, and sleep and arousal.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  2

Chapter: Chapter 2: Biological Implications

Objective: Describe the role of neurotransmitters in the central nervous system.

Page: 21

Heading: Monoamines > Norepinephrine

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 Serotonin plays a role in sleep, libido, and appetite.
2 The nurse should expect that elevated dopamine levels might be an attributing factor to the clients current level of functioning. Dopamine functions include regulation of movements and coordination, emotions, and voluntary decision-making ability.
3 GABA prevents postsynaptic excitation.
4 Histamine mediates allergic and inflammatory reactions.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  4

Chapter: Chapter 2: Biological Implications

Objective: Discuss the influence of psychological factors on the immune system.

Page: 31

Heading: Psychoneuroimmunology > Implications of the Immune System in Psychiatric Illness

Integrated Processes: Planning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Stress

Difficulty: Moderate

 

  Feedback
1 This approach is not proven by evidence-based research.
2 This rationale is not proven by evidence-based research.
3 Reminding clients about nutrition, exercise and rest is routine but is not proven by evidence-based research.
4 The therapists recommendations should be based on the knowledge that the client has been exposed to stressful stimuli and is at an increased risk to develop illness because of the effects of stress on the immune system. The study of this branch of medicine is called psychoneuroimmunology.

 

 

PTS:   1                    CON:  Stress

 

  1. ANS:  2

Chapter: Chapter 2, Biological Implications

Objective: Recognize various theorized influences in the development of psychiatric disorders including brain physiology, genetics, endocrine function, immune system, and psychosocial, and environmental factors.

Page: 29

Heading: Psychoneuroimmunology > Prolactin

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Stress

Difficulty: Moderate

 

  Feedback
1 There is no known correlation between increased levels of prolactin and major depressive disorder.
2 Although the exact mechanism is unknown, there may be some correlation between increased levels of the hormone prolactin and schizophrenia.
3 There is no known correlation between increased levels of prolactin and anorexia nervosa.
4 There is no known correlation between increased levels of prolactin and Alzheimers disease.

 

 

PTS:   1                    CON:  Stress

 

  1. ANS:  2

Chapter: Chapter 2, Biological Implications

Objective: Identify gross anatomical structures of the brain and describe their functions.

Page: 19

Heading: The Nervous System: An Anatomical Review > Limbic System

Integrated Processes: Teaching and Learning

Client Need: Psychosocial Integrity

Cognitive Level: Comprehension [Understanding]

Concept: Mood

Difficulty: Easy

 

  Feedback
1 The cerebellum is concerned with involuntary movement, posture, and equilibrium.
2 The limbic system is often referred to as the emotional brain. The limbic system is largely responsible for ones emotional state and is associated with feelings, sexuality, and social behavior.
3 The cortex is identified by numerous folds called gyri and sulci.
4 The left temporal lobe is concerned with auditory functions.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  3

Chapter: Chapter 2, Biological Implications

Objective: Discuss the association of endocrine functioning to the development of psychiatric disorders.

Page: 31

Heading: Psychoneuroimmunology > Growth Hormone

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Comprehension [Understanding]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 There is no correlation between abnormal levels of growth hormone and acute mania.
2 There is no correlation between abnormal levels of growth hormone and schizophrenia.
3 The nurse should understand that research has found a correlation between abnormal levels of growth hormone and anorexia nervosa. The growth hormone is responsible for growth in children, as well as continued protein synthesis throughout life.
4 There is no correlation between abnormal levels of growth hormone and Alzheimers Disease.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  4

Chapter: Chapter 2, Biological Implications

Objective: Describe the role of neurotransmitters in human behavior.

Page: 31

Heading: Psychoneuroimmunology > Acetylcholine

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 Abnormal levels of serotonin do not cause memory deficits and decreased motor functions.
2 Abnormal levels of dopamine do not cause memory deficits and decreased motor functions.
3 Abnormal levels of norepinephrine do not cause memory deficits and decreased motor functions.
4 The nurse should correlate memory deficits and decreased motor function with decreased levels of acetylcholine. Acetylcholine is a major chemical effector of the autonomic nervous system. Functions of acetylcholine include sleep regulation, pain perception, the modulation and coordination of movement, and memory.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  4

Chapter: Chapter 2, Biological Implications

Objective: Discuss the physiology of neurotransmitters in human behavior.

Page: 21

Heading: Monoamines > Norepinephrine

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 A decrease in norepinephrine would not lead to mania.
2 A decrease in norepinephrine would not lead to schizophrenia.
3 A decrease in norepinephrine would not lead to generalized anxiety disorder.
4 The nurse should recognize that a decrease in norepinephrine level would play a significant role in the development of major depressive disorder. The functions of norepinephrine include the regulation of mood, cognition, perception, locomotion, cardiovascular functioning, and sleep and arousal.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  1

Chapter: Chapter 2, Biological Implications

Objective: Discuss the physiology of neurotransmitters in human behavior.

Page: 21, 24

Heading: Psychoneuroimmunology > Dopamine

Integrated Processes: Nursing Process

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1 The nurse should expect that an increase in dopamine activity might play a significant role in the development of schizophrenia spectrum disorder. Functions of dopamine include regulation of emotions, coordination, and voluntary decision-making ability. Increased dopamine activity is also associated with mania.
2 Increased dopamine activity is not associated with major depressive disorder.
3 Increased dopamine activity is not associated with body dysmorphic disorder.
4 Increased dopamine activity is not associated with Parkinsons disease.

 

 

PTS:   1                    CON:  Mood

 

MULTIPLE RESPONSE

 

  1. ANS:  1, 3

Chapter: Chapter 2, Biological Implications

Objective: Discuss the association of endocrine functioning to the development of psychiatric disorders.

Page: 29

Headings: Growth Hormone > Gonadotropic Hormones

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1. The nurse should explain to the client that there is a possible correlation between anorexia nervosa and decreased levels of growth hormones.
2. There is no correlation between anorexia nervosa and antidiuretic hormone levels.
3. Research shows that there is possible correlation between low levels of gonadotropin and anorexia nervosa.
4. There is no correlation between anorexia nervosa and increased prolactin levels.
5. There is no correlation between anorexia nervosa and altered levels of oxytocin.

 

 

PTS:   1                    CON:  Mood

 

  1. ANS:  1, 2

Chapter: Chapter 2, Biological Implications

Objective: Discuss the association of endocrine functioning to the development of psychiatric disorders.

Page: 28

Heading: Neuroendocrinology > The Anterior Pituitary (Adenohypophysis)

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

  Feedback
1. The nurse should associate depression with decreased levels of TSH.
2. The nurse should associate fatigue with decreased levels of TSH.
3. Decreased libido is associated with decreased levels of TSH.
4. Mania is not associated with decreased levels of TSH.
5. Hyperexcitability is not associated with decreased levels of TSH.

 

 

PTS:   1                    CON:  Mood

 

COMPLETION

 

  1. ANS:

Psychobiology

Chapter: Chapter 2 Biological Implications

Objective: Discuss the implications of psychobiological concepts to the practice of psychiatric/mental health nursing.

Page: 15

Heading: Introduction

Integrated Processes: Teaching and Learning

Client Need: Physiological Integrity: Physiological Adaptation

Cognitive Level: Application [Applying]

Concept: Mood

Difficulty: Moderate

 

Feedback: Psychobiology is the study of the biological foundations of cognitive, emotional, and behavioral processes. In recent years, a greater emphasis has been placed on the study of the organic basis for psychiatric illness.

 

PTS:   1                    CON:  Mood

Chapter 10: Intervening in Crises

 

Multiple Choice

Identify the choice that best completes the statement or answers the question.

 

____    1.   A new mother is concerned about her ability to perform her parental role. She is quite anxious and ambivalent about leaving the postpartum unit. To offer effective client care, a nurse should be familiar with what information about this type of crisis?

1. This type of crisis is precipitated by unexpected external stressors.
2. This type of crisis is precipitated by preexisting psychopathology.
3. This type of crisis is precipitated by an acute response to an external situational stressor.
4. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

 

 

____    2.   A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, I cant function any longer under all this stress. Which type of crisis is the client experiencing?

1. Maturational/developmental crisis
2. Psychiatric emergency crisis
3. Anticipated life transition crisis
4. Traumatic stress crisis

 

 

____    3.   A client comes to a psychiatric clinic experiencing sudden extreme fatigue and decreased sleep and appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. What long-term outcome is realistic in addressing this clients crisis?

1. The client will change his type-A personality traits to more adaptive ones by one week.
2. The client will list five positive self-attributes.
3. The client will examine how childhood events led to his overachieving orientation.
4. The client will return to previous adaptive levels of functioning by week six.

 

 

____    4.   A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the priority nursing diagnosis for this client?

1. Ineffective coping R/T situational crisis AEB powerlessness
2. Anxiety R/T fear of failure
3. Risk for self-directed violence R/T hopelessness
4. Risk for low self-esteem R/T loss events AEB suicidal ideations

 

 

____    5.   After threatening to jump off of a bridge, a client is brought to an emergency department by police. To assess for suicide potential, which question should a nurse ask first?

1. Are you currently thinking about harming yourself?
2. Why do you want to harm yourself?
3. Have you thought about the consequences of your actions?
4. Who is your emergency contact person?

 

 

____    6.   An involuntarily committed client, when offered a dinner tray, pushes it off the bedside table onto the floor. Which nursing intervention should a nurse implement to address this behavior?

1. Initiate forced medication protocol.
2. Help the client to explore the source of anger.
3. Ignore the act to avoid reinforcing the behavior.
4. With staff support and a show of solidarity, set firm limits on the behavior.

 

 

____    7.   A college student, who was nearly raped while jogging, completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met?

1. Youve really been helpful. Can I count on you for continued support?
2. I work out in the college gym rather than jogging outdoors.
3. Im really glad I didnt go home. It would have been hard to come back.
4. I carry mace when I jog. It makes me feel safe and secure.

 

 

____    8.   A despondent client who has recently lost her husband of 30 years tearfully states, Ill feel a lot better if I sell my house and move away. Which nursing response is most appropriate?

1. Im confident you know whats best for you.
2. This may not be the best time for you to make such an important decision.
3. Your children will be terribly disappointed.
4. Tell me why you want to make this change.

 

 

____    9.   An inpatient client with a known history of violence suddenly begins to pace. Which additional client behavior should alert a nurse to escalating anger and aggression?

1. The client requests prn medications.
2. The client has a tense facial expression and body language.
3. The client refuses to eat lunch.
4. The client sits in group with back to peers.

 

 

____  10.   What is the best nursing rationale for holding a debriefing session with clients and staff after a take-down intervention has taken place in an inpatient unit?

1. Reinforce unit rules with the client population.
2. Create protocols for the future release of tensions associated with anger.
3. Process client feelings and alleviate fears of undeserved seclusion and restraint.
4. Discuss the situation that led to inappropriate expressions of anger.

 

 

____  11.   A nursing instructor is teaching about the Roberts Seven-stage Crisis Intervention Model. Which nursing action should be identified with Stage IV?

1. Collaboratively implement an action plan.
2. Help the client identify the major problems or crisis precipitants.
3. Help the client deal with feelings and emotions.
4. Collaboratively generate and explore alternatives.

 

 

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

 

____  12.   Which of the following nursing statements or questions represent appropriate communication to assess an individual in crisis? (Select all that apply.)

1. Tell me what happened.
2. What coping methods have you used, and did they work?
3. Describe to me what your life was like before this happened.
4. Lets focus on the current problem.
5. Ill assist you in selecting functional coping strategies.

 

 

____  13.   Which of the following interventions should a nurse use when caring for an inpatient client who expresses anger inappropriately? (Select all that apply.)

1. Maintain a calm demeanor.
2. Clearly delineate the consequences of the behavior.
3. Use therapeutic touch to convey empathy.
4. Set limits on the behavior.
5. Teach the client to avoid I statements related to expression of feelings.

 

 

____  14.   Which of the following are behavior assessment categories in the Broset Violence Checklist? (Select all that apply.)

1. Confusion
2. Paranoia
3. Boisterousness
4. Panic
5. Irritability

 

 

Other

 

  1. Order the following stages of Roberts Seven-stage Crisis Intervention Model.

________ Deal with feelings and emotions.

________ Generate and explore alternatives.

________ Rapidly establish rapport.

________ Psychosocial and lethality assessment.

________ Identify the major problems or crisis precipitants.

________ Follow up.

________ Implement an action plan.

 

Completion

Complete each statement.

 

  1. A sudden event in ones life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem, can be defined as a ______________________.

 

 

Chapter 10: Intervening in Crises

Answer Section

 

MULTIPLE CHOICE

 

  1. ANS:  4

Chapter: Chapter 10, Crisis Intervention

Objective: Identify types of crisis that occur in peoples lives.

Page: 196

Heading: Types of Crises > Class 2: Crises of Anticipated Life Transitions

Integrated Processes: Teaching and Learning

Client Need: Safe and Effective Care Environment: Management of Care

Cognitive Level: Application [Applying]

Concept: Health Promotion

Difficulty: Moderate

 

  Feedback
1 This type of stress is not caused by unexpected external stressors.
2 This type of stress is not caused by preexisting psychopathology.
3 This type of stress is not caused by an acute response to an external situational stressor.
4 The nurse should understand that this type of crisis is precipitated by normal life-cycle transitions that overwhelm the client. Reassurance and guidance should be provided as needed, and the client should be referred to services that can provide assistance.

 

 

PTS:   1                    CON:  Health Promotion

 

  1. ANS:  2

Chapter: Chapter 10, Crisis Intervention

Objective: Identify types of crisis that occur in peoples lives.

Page: 197

Heading: Types of Crises > Class 6: Psychiatric Emergencies

Integrated Processes: Nursing Process

Client Need: Safe and Effective Care Environment: Management of Care

Cognitive Level: Application [Applying]

Concept: Health Promotion

Difficulty: Moderate

 

  Feedback
1 The client is not experiencing a maturational/developmental crisis.
2 The nurse should determine that the client is experiencing a psychiatric emergency crisis. Psychiatric emergencies occur when crisis situations result in severe impairment, incompetence, or an inability to assume personal responsibility.
3 The client is not experiencing an anticipated life transition crisis.
4 The client is not experiencing a traumatic stress crisis.

 

 

PTS:   1                    CON:  Health Promotion

 

  1. ANS:  4

Chapter: Chapter 10, Crisis Intervention

Objective: Describe the steps in crisis intervention.

Page: 197

Heading: Types of Crises > Class 5: Crisis Reflecting Psychopathology

Integrated Processes: Nursing Process

Client Need: Safe and Effective Care Environment: Management of Care

Cognitive Level: Application [Applying]

Concept: Health Promotion

Difficulty: Moderate

 

  Feedback
1 Changing his type-A personality traits to more adaptive ones by one week may be unrealistic for this client.
2 Listing five positive self-attributes may not be realistic for this client.
3 Examining childhood events may not be realistic for this client.
4 The nurse should identify that a realistic long-term outcome for this client is to return to previous adaptive levels of functioning. The nurse should work with the client to develop attainable outcomes that reflect immediacy of the situation.

 

 

PTS:   1                    CON:  Health Promotion

 

  1. ANS:  3

Chapter: Chapter 10, Crisis Intervention

Objective: Describe the steps in crisis intervention.

Page: 201202

Heading: Table 10-1. Nursing Diagnosis: Risk for Self-directed or Other Directed Violence

Integrated Processes: Nursing Process

Client Need: Safe and Effective Care Environment: Management of Care

Cognitive Level: Analysis [Analyzing]

Concept: Health Promotion

Difficulty: Moderate

 

  Feedback
1 Ineffective coping R/T situational crisis AEB powerlessness is inappropriate because safety is a priority.
2 Anxiety R/T fear of failure is inappropriate because safety is a priority.
3 The priority nursing diagnosis for this client is risk for self-directed violence R/T hopelessness. Nurses should prioritize diagnoses and outcomes based on potential safety risk to the client or others.
4 Risk for low self-esteem R/T loss events AEB suicidal ideations is inappropriate because safety is a priority.

 

 

PTS:   1                    CON:  Health Promotion

 

  1. ANS:  1

Chapter: Chapter 10, Crisis Intervention

Objective: Identify the role of the nurse in crisis intervention.

Page: 203

Heading: Phases of Crises Intervention: The Role of the Nurse > Phase 1: Assessment

Integrated Processes: Nursing Process

Client Need: Safe and Effective Care Environment: Management of Care

Cognitive Level: Analysis [Analyzing]

Concept: Health Promotion

Difficulty: Moderate

 

  Feedback
1 The nurse should first assess the client for current harmful or suicidal thoughts to minimize risk of harm to the client and provide appropriate interventions. A suicidal client is experiencing a psychiatric emergency. The crisis teams priority is to assess client safety.
2 This question is important after the immediate risk of harm has been ruled out.
3 This question should be addressed after the client is safe.
4 The clients safety should be assessed prior to asking this question.

 

 

PTS:   1                    CON:  Health Promotion

 

  1. ANS:  4

Chapter: Chapter 10, Crises Intervention

Objective: Identify the role of the nurse in crisis intervention.

Page: 205

Heading: Phases of Crises Intervention: The Role of the Nurse > Phase 3: Intervention

Integrated Processes: Nursing Process

Client Need: Safe and Effective Care Environment: Management of Care

Cognitive Level: Application [Applying]

Concept: Health Promotion

Difficulty: Moderate

 

  Feedback
1 Pushing food onto the floor should not warrant forced medication. This intervention may be too restrictive, considering the behavior.

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