Psychiatric Nursing Biological & Behavioral Concepts 2nd Edition By Deborah Antai-Otong -Test Bank

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Psychiatric Nursing Biological & Behavioral Concepts 2nd Edition By Deborah Antai-Otong -Test Bank

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Psychiatric Nursing Biological & Behavioral Concepts 2nd Edition By Deborah Antai-Otong -Test Bank

CHAPTER 2CONCEPTS OF PSYCHIATRIC CARE: THERAPEUTIC MODELS

 

MULTIPLE CHOICE

 

  1. A psychoanalytically oriented colleague tells you that the behavior of a client you are assigned to work with is driven by a strong thanatos. This client is most likely exhibiting which of the following behaviors?
a. aggression c. social isolation
b. intrusiveness d. sexual behaviors

 

 

ANS:  A

The psychoanalytic theory assumes that humans have two primary drives or forces: eros, or the drive toward life, and thanatos, which is the drive toward death. Thanatos is expressed as aggression or hate.

 

PTS:   1

 

  1. A client is informed by his family that they could not go on vacation because the cost of his mental health care prevented the family from having enough money for a vacation. Which of the following responses by the client would be the best example of the superego at work?
a. refusing further care c. getting angry at the family
b. having feelings of guilt d. ignoring this statement

 

 

ANS:  B

The superego is the conscience that rewards moral behavior and punishes actions that are not acceptable by creating guilt. An overly strict superego may lead to extremes of guilt and anxiety.

 

PTS:   1

 

  1. A client is thinking about suing the hospital and the doctor, even though he begins to admit to the nurse that his failure to comply with the treatment regimen may have caused his problems. He begins to share that he feels guilty about these thoughts of suing although he believes the hospital and doctor will settle out of court and he needs the money. The nurse understands that according to psychoanalytic theory, two parts of the clients personality or two drives are warring. What drive or part of the clients mind will mediate if the client is to come to a healthy decision?
a. id c. libido
b. ego d. superego

 

 

ANS:  B

The superego is the part of the client that is feeling guilty. It is the conscience. The id is the aggressive and sexual drive, which operates on the pleasure principle to reduce tension. The ego mediates between the drives, forces, or conflicts of the id and the superego.

 

PTS:   1

 

  1. The mother of a teenager asks the nurse at what age a childs personality is completely formed. A nurse applying psychoanalytic theory to this question would answer that the personality is almost completely formed by what age?
a. 5 c. 18
b. 8 d. 21

 

 

ANS:  A

According to psychoanalytic theory, the personality is almost completely formed by 5 years of age.

 

PTS:   1

 

  1. The nurse is working with a young adult client who has been in an automobile accident and is fully conscious but seems to have little recall of the event. The clients spouse asks the nurse why the client is not able to recall the event. The best answer by the nurse would be that the client is:
a. in a state of denial c. repressing details of the event
b. suffering from a concussion d. suppressing details of the event

 

 

ANS:  C

Repression is an unconscious process whereby unwanted, unacceptable, and/or painful memories are filed in the unconscious part of the mind. Repression is the first line of defense against such memories.

 

PTS:   1

 

  1. You determine that one of your assigned clients is using defense mechanisms, some of which are sublimation and projection. You realize that these defense mechanisms, sublimation and projection, are allowing the client to:
a. use other people in a way that is not healthy for them or for the client
b. postpone dealing with problems in an unhealthy way for a long period of time
c. keep unpleasant thoughts in the preconscious mind instead of the conscious mind
d. discharge some of the energy needed to keep unwanted thoughts out of awareness

 

 

ANS:  D

It takes energy to keep unwanted thoughts out of the conscious mind. Energy cannot be contained indefinitely. Some defense mechanisms such as reaction formation, projection, and sublimation allow for the energy to be discharged.

 

PTS:   1

 

  1. The nurse assesses an adult client who admits to being a nail-biter when the nurse observes extreme shortness and unevenness of the clients nails. The nurse recalls that people who bite their nails are said to be fixated at which of the following stages in Freuds stages of psychosexual growth and development?
a. oral c. genital
b. latency d. prepuberty

 

 

ANS:  A

The development of orally focused habits such as smoking and nail-biting are associated with fixation at the oral stage of development in Freuds theories of the stages of psychosexual growth and development.

 

PTS:   1

 

  1. The nursing instructor advises students who are learning how to communicate with clients with mental health problems not to ask questions beginning with Why did you for which of the following reasons?
a. It is an approach of authority.
b. It hurts the trusting relationship.
c. Often a person cannot identify unconscious motivation.
d. The question makes the person feel like a child being parented.

 

 

ANS:  C

Often the person cannot identify the motivation for his behavior because it is unconscious. There are more acceptable techniques to foster communication.

 

PTS:   1

 

  1. When you are working with a client who is very anxious and is using a defense mechanism, which of the following approaches would be best?
a. Advise the client to stop using the defense mechanism.
b. Discuss the defense mechanism and whether it is helpful or not.
c. Help the client identify some ways to reduce anxiety before other interventions.
d. Have the client weigh the advantages and disadvantages of the defense mechanism.

 

 

ANS:  C

Anxiety needs to be reduced before the defenses can be disengaged. Do not take away defense mechanisms until there are other ways to deal with anxiety.

 

PTS:   1

 

  1. One of your colleagues is basing his work with clients on the theories of Erikson. When explaining personality development, your colleague would say that personality is:
a. almost totally inherited
b. developed over the life span
c. completely developed by age 5
d. a result of experiences before age 18

 

 

ANS:  B

Erik Erikson identified 8 stages of psychosocial development and believed that personality development continues over the life span.

 

PTS:   1

 

  1. Erikson saw the major task of life as:
a. trust c. reproduction
b. identity d. self-actualization

 

 

ANS:  B

According to Erik Erikson, the task of identity is seen as the major task of life. All previous tasks are fundamental to self-discovery, and all adult tasks are predicated on comfortable resolution of identity.

 

PTS:   1

 

  1. A young adult on the psychiatric ward asks a nurse for a date. Although the nurse realizes this is inappropriate and declines, the nurse will also:
a. make certain the client suffers some appropriate consequences for this action
b. report this clients behavior to the administrator and refuse to work with the client
c. tell the client that this behavior is inappropriate with a professional nurse
d. recognize age-appropriate behavior and advise the client of the professional nature of the relationship

 

 

ANS:  D

The young adult is seeking a life mate and dealing with the task of intimacy versus isolation. Although it is inappropriate for the nurse in a professional relationship to develop an intimate relationship, the nurse needs to recognize the clients age-appropriate behavior.

 

PTS:   1

 

  1. A client is discussing some insights gained in therapy in the past and mentions archetypes of anima and animus. The nurse listening to this client realizes that this client received therapy based on the theories of:
a. Albert Ellis c. Carl Jung
b. Eric Berne d. Sigmund Freud

 

 

ANS:  C

Carl Jung discovered repeated common images he called archetypes. Two of the most popular were those of the anima, or feminine archetype in men, and the animus, the masculine archetype in women.

 

PTS:   1

 

  1. Closely following the beliefs of Harry Stack Sullivan, a psychiatric nurse working with clients would look closely at what Sullivan referred to as the persona, which is best described as the:
a. unconscious c. dark side
b. I or me d. best friend

 

 

ANS:  B

The persona is what one is talking about when referring to I or me. It could also be called self-concept and begins developing in infancy with the idea of good me and bad me.

 

PTS:   1

 

  1. The main focus of Sullivans work was on:
a. insight through gestalt c. interpersonal relationships
b. learned helplessness d. identifying a purpose in life

 

 

ANS:  C

Harry Stack Sullivan focused on interpersonal relationships. He looked at the development of the self-system, which he called personification. Personification includes all related attitudes, feelings, and concepts about self and another.

 

PTS:   1

 

  1. You are assigned to work with a client who describes a life of feeling isolated and helpless with many fears about dangers in the world. The client frequently demonstrates aggressive behavior or is verbally aggressive. Using Horneys theories, you would view this aggressive behavior as:
a. a failure to develop a healthy personality
b. incongruent with feeling helpless and isolated
c. a means to protect what little security they have
d. stemming from experiences with an aggressive mother

 

 

ANS:  C

Karen Horney believed that insecure, anxious children develop personality patterns to help them cope with feelings of isolation and helplessness. They may become aggressive as a means of protecting what little security they have.

 

PTS:   1

 

  1. Applying interpersonal theories in the nurse-client relationship, the most important goal for the nurse and client to set for therapy sessions would be for the client to:
a. identify the causes of failed relationships in the past
b. gain insight into how early relationships shape behavior
c. deal with repressed anger against self and against significant others in his life
d. verbalize a realistic and hopeful perspective of self in relationships with others

 

 

ANS:  D

In the nurse-client relationship where interpersonal theories are utilized, the client learns to separate past learning from present and to gain a realistic and hopeful perspective of self in relationships with others and society.

 

PTS:   1

 

  1. The nurse is caring for a young child in the hospital. As the childs visiting parent prepares to leave, the child appears anxious and begins to cry and cling to the parent. Using Bowlbys stages of separation anxiety to explain the childs behavior, the child can be said to be in a stage called:
a. anxiety c. despair
b. protest d. detachment

 

 

ANS:  B

John Bowlby described separation anxiety as a predictable process involving the stages of protest, despair, and detachment. Examples of protest behaviors include increasing anxiety, crying, clinging, throwing ones self down, and searching.

 

PTS:   1

 

  1. A couple is concerned about the amount of time they must spend away from their infant. Looking at the findings of Bowlby in his work on attachment, you would most help the clients by setting and meeting which one of the following goals?
a. Improve the quality of time and interactions.
b. Leave the child when the child is distracted.
c. Decrease the period of time between separations.
d. Increase the amount of overall time with the child.

 

 

ANS:  A

John Bowlby found that the amount of time spent with early caregivers is less significant than the quality of time and interactions between the child and caregivers. The nurse should focus on helping the clients to learn to use behaviors that reinforce the child-parent attachment.

 

PTS:   1

 

  1. When a child is in the final stages of separation anxiety as described by Bowlby and the primary caregiver returns to the child, the nurse should most likely expect the child to exhibit which of the following behaviors?
a. acting very excited c. clinging to caregiver
b. engaging in a tantrum d. withdrawing from caregiver

 

 

ANS:  D

The final stage of separation anxiety is detachment in which the child appears listless, apathetic, and socially isolates and withdraws from the caregiver even when the caregiver returns.

 

PTS:   1

 

  1. When the primary caregivers of a hospitalized infant cannot stay in the hospital with the infant, which of the following diagnoses would the nurse most likely include in the care plan?
a. caregiver role strain
b. interrupted family processes
c. risk for impaired parent-infant attachment
d. ineffective therapeutic regimen management

 

 

ANS:  C

An infant who is hospitalized and left alone by primary caregivers is likely to be at risk of developing attachment disturbances.

 

PTS:   1

 

  1. The systematic study of infant-caregiver attachment behaviors using the Strange Situation protocol was the work of which of the following persons?
a. Mary Ainsworth c. Karen Horney
b. John Bowlby d. Bruno Bettelheim

 

 

ANS:  A

Mary Ainsworth systematically studied infant-caregiver attachments by means of the Strange Situation protocol. This protocol has provided an empirical template for delineating and measuring John Bowlbys attachment theory and has spurred a plethora of clinical and scholarly contributions that transformed researchers and clinicians perceptions of early child-parent interactions.

 

PTS:   1

 

  1. In his theories, Skinner identified two types of behavior which he referred to as:
a. angelic and demonic c. good boy and bad boy
b. respondent and operant d. past oriented and future oriented

 

 

ANS:  B

  1. F. Skinner identified respondent behavior as occurring when a known and specific stimulus elicits a response and operant behaviors as those that obtain a response or reinforcement from another person or the environment.

 

PTS:   1

 

  1. A client comes to the psychiatric nurse for help with social situations. The client is not comfortable meeting with others. The nurse utilizes the theories of Bandura and Walters. Which of the following interventions by the nurse would most reflect application of Bandura and Walters theories and techniques?
a. Ask the client to do the opposite of the expected or desired behavior.
b. Use a gradually increasing schedule of social contact to desensitize the client.
c. Verbally reinforce the client for any attempt to increase socialization behavior.
d. Have the client study a person who is successful at socializing and imitate them.

 

 

ANS:  D

Albert Bandura and Richard Walters placed emphasis on the role of modeling in learning behaviors. The model can be a person, film, or cartoon. A person can take on new social behaviors quickly when imitating a role model.

 

PTS:   1

 

  1. When working with clients diagnosed with schizophrenia who have been hospitalized several times in the last year after failing to fill their prescriptions, the nurse applies the self-efficacy model. What is the nurses primary goal in this case?
a. Making certain a staff member supervises the clients taking the medication.
b. Reminding the clients daily through a phone call that the medication is due.
c. Finding a source that will pay for, pick up, and deliver the medication to the clients.
d. Convincing the clients they have the capacity to find a way to get the prescriptions filled.

 

 

ANS:  D

The primary goal of self-efficacy is to encourage or persuade the clients that they have the capacity to make adaptive behavioral changes in an identified problem area.

 

PTS:   1

 

  1. When trying to reinforce a behavior using behavior modification techniques, the most effective schedule of reinforcement is:
a. fixed-ratio c. fixed-interval
b. variable-ratio d. variable-interval

 

 

ANS:  A

A fixed-ratio schedule is used in industry when a workers pay depends upon the number of units produced or sold. For interval schedules, the reward is based upon the passage of time and not on the amount of behavior change.

 

PTS:   1

 

  1. Beck is best known for his theories about which of the following:
a. behavior modification c. cognitive patterns
b. interpersonal theories d. childhood development

 

 

ANS:  C

Aaron Beck is one of the best known proponents of cognitive psychology because of his writings on cognitive distortions or thinking errors.

 

PTS:   1

 

  1. You are working with a client who is upset because he believes one of his college classmates does not like him. If you were to apply the theories of Ellis, you would most likely respond:
a. Describe the feelings that you have toward this classmate.
b. Tell me what you have done to cause this classmate not to like you.
c. Lets examine this irrational thought that everyone should like you.
d. This is really something that is wrong with her and not with you at all.

 

 

ANS:  C

Albert Ellis developed what he referred to as rational emotive therapy. He believed that irrational thoughts cause maladaptive behavior and emotional distress. He identified the thinking that everyone should like you as an irrational thought.

 

PTS:   1

 

  1. When working with the mother of a young child who is in the later part of Piagets sensorimotor stage of development, you would teach the mother to do which of the following things to help the child move out of this stage?
a. play classical music frequently
b. play peek-a-boo and hide and seek
c. read the same book to the child every day
d. reward the child for attempts to use the potty

 

 

ANS:  B

In the first stage or sensorimotor stage of development from birth to about 2 years of age, the young child appears to think that only objects that can be seen are those that exist. As the child grows in experience, the child develops object permanence. Peek-a-boo and hide-and-seek prepare the child for realizing that things and people are still there even when they cannot be seen.

 

PTS:   1

 

  1. When you administer the atypical antipsychotic agents ordered by the psychiatrist to a client who has schizophrenia, you realize that this medication is most likely to do which of the following things?
a. increase the activity of dopamine
b. decrease the activity of dopamine
c. increase the reuptake of serotonin
d. have no effect on dopamine activity

 

 

ANS:  B

In schizophrenia and mania, there is hyperactivity of dopaminergic systems that must be tempered or reduced. In Parkinsons disease and depression, it is believed that the dopamine systems are hypoactive and, therefore, medications in those conditions increase dopamine availability to the body.

 

PTS:   1

 

  1. When giving antipsychotic medication and atypical antipsychotics to clients with a diagnosis of schizophrenia, because of the effect of the medication on a specific neurotransmitter, you would most need to be frequently assessing these clients for:
a. weight loss c. ringing in the ears
b. nausea and vomiting d. fine motor tremors

 

 

ANS:  D

Dopamine is primarily responsible for fine motor movement, sensory integration, and emotional behavior. These medications reduce dopamine so the client is apt to lose some of the fine motor movement and demonstrate tremors.

 

PTS:   1

 

  1. A client who is experiencing low levels of GABA or fewer GABA receptors is most vulnerable to which of the following disorders?
a. panic disorder c. conversion disorder
b. bipolar disorder d. antisocial personality disorder

 

 

ANS:  A

A person with low levels of GABA or fewer GABA receptors is more vulnerable to anxiety disorders or panic symptoms/disorders.

 

PTS:   1

 

  1. The latest and most popular theory of mental disorders is that the cause is most likely:
a. a combination of factors
b. genetically and chemically based
c. structural differences in the brain
d. a result of disturbed interpersonal interactions

 

 

ANS:  A

At the current time, researchers believe that mental disorders are most likely caused by a variety of factors. Some of the factors include structural differences in the brain and disturbed interpersonal interactions. Additionally, genetic propensity and chemical imbalance can be causative factors.

 

PTS:   1

 

  1. You are working with a client who has been playing tennis and has developed tendonitis. Which of the following remarks by the client would indicate function in an integrated way as identified by the theories of Dunn?
a. What other sport would be less injurious?
b. I will use heat on my elbow after playing tennis.
c. I will avoid activity and rest my elbow until it is healed.
d. An elbow brace will be a help in preventing further damage.

 

 

ANS:  C

Integrating involves using energy efficiently, such as taking measures to conserve energy so the physical resources needed to reduce swelling and pain are accessible.

 

PTS:   1

 

  1. Your client has shared a primary appraisal of a wedding he attended. Based on how he describes his experiences at the wedding, the appraisal could fall into any one of the three types of primary appraisal described by Lazarus. Which of the following statements by the client would place it into the benign positive type of appraisal?
a. It was all right I guess.
b. It was very tastefully done.
c. I felt real happy even if I felt guilty not taking a present.
d. It was a challenge to get there on time, but I did manage it.

 

 

ANS:  C

Benign appraisals are events with a genuinely positive appraisal. These events generate feelings of pleasure, joy, and happiness, but the feelings may also be accompanied by guilt or anxiety.

 

PTS:   1

 

  1. When working with clients using Orems nursing theories, you would be most interested in helping the clients to maximize their:
a. level of mental health c. spiritual dimension
b. interactions with others d. ability to care for self

 

 

ANS:  D

Orems model is a self-care model. Clients are assessed in terms of their self-care agencies. Nursing interventions are planned to maximize the clients ability to care for self. Specific nursing actions include actions to provide assistance to clients unable to meet their health-related self-care needs.

 

PTS:   1

 

  1. A basic assumption of Freuds psychoanalytic theory is that all behavior:
a. is learned c. is unconscious
b. has meaning d. is sexually oriented

 

 

ANS:  B

According to Freud, everything a person does has meaning.

 

PTS:   1

 

  1. A nurse who follows the therapeutic approach of Rogers, would most likely be using an approach focused on:
a. reality therapy c. client-centered therapy
b. directive therapy d. psychoanalytic therapy

 

 

ANS:  C

Carl Rogers focused primarily on empathy, warmth, and genuineness in relating. His form of therapy was coined client-centered therapy.

 

PTS:   1

 

  1. A common form of treatment on psychiatric inpatient units which focuses on the patients environment is known as:
a. milieu therapy c. encounter therapy
b. reality therapy d. client-centered therapy

 

 

ANS:  A

Milieu therapy is the treatment modality that uses the total physical and social environment to provide psychosocial rehabilitation. The term is sometimes used interchangeably with therapeutic milieu.

 

PTS:   1

 

  1. You are caring for a group of mental health patients, and you base your nursing practice on the belief that your clients should play a major role in their own self-care. These practices stem from the work of:
a. Martha Rogers c. Dorothea Orem
b. Hildegard Peplau d. Ida Jean Orlando

 

 

ANS:  C

According to Dorothea Orem, people have the ability to perform self-care activities they initiate and perform independently to maintain life, health, and well-being. She coined the term describing the ability to care for ones self, self-care agency.

 

PTS:   1

 

  1. Dialectical behavior therapy (DBT) was introduced by:
a. B. F. Skinner c. Albert Bandura
b. Sigmund Freud d. Marsha Linehan

 

 

ANS:  D

In 1987, Marsha Linehan introduced dialectical behavior therapy (DBT). This form of therapy is used to challenge distorted cognitions or schematas that produce enormous anxiety and stress in clients with borderline personality disorder.

 

PTS:   1

 

  1. One of your clients constantly complains of feeling nervous even though his medicines have been administered as prescribed. The doctor orders one sugar tablet between doses of regularly scheduled medications. After taking the sugar tablet, the client states That pill really worked. I feel much better now. This is known as the:
a. halo effect c. placebo effect
b. Skinner effect d. behavioral effect

 

 

ANS:  C

The placebo effect is an attitude of optimistic concern and belief in the efficacy of an intervention. It is one of the best reinforcements nurses can use.

 

PTS:   1

 

  1. Alterations in the seretonergic system or serotonin (5-hydroglyryptamine, 5HT) function along with NE have been implicated in the pathogenesis of:
a. schizophrenia c. depressive syndrome
b. eating disorders d. personality disorders

 

 

ANS:  C

Alterations in the serotonerginic system function along with NE have been implicated in the pathogenesis of depressive syndrome.

 

PTS:   1

 

  1. The nurse providing care to an alcoholic client administers Antabuse. The administration of Antabuse would be considered which form of behavioral therapy?
a. classic conditioning c. medical conditioning
b. operant conditioning d. cognitive conditioning

 

 

ANS:  B

Operant conditioning includes use of aversion techniques. One form of aversion therapy includes the use of Antabuse for the treatment of alcohol. Clients who ingest alcohol while on Antabuse will experience several very uncomfortable symptoms.

 

PTS:   1

 

  1. A nurse researcher is conducting a study to determine his clients capacity to recover or adjust to stressful or life-threatening situations. This ability is known as:
a. coping c. adaptability
b. resilience d. self-efficacy

 

 

ANS:  B

Resilience is the capacity to recover or adjust to stressful or life-threatening situations.

 

PTS:   1

 

MULTIPLE RESPONSE

 

  1. Which of the following are essential features of DBT? Select all that apply.
a. daily individual psychotherapy
b. weekly skills training
c. encouraging and coaching via telephone
d. consultation with client
e. short-term inpatient hospitalization
f. electroconvulsive therapy (ECT)

 

 

ANS:  B, C

Dialectical Behavior Therapy (DBT) has five essential features which include weekly individual psychotherapy, weekly skills training group, encouragement and coaching via telephone interactions between sessions, consultation with the client, and the development of a treatment environment by the DBT directors and case managers. ECT is not an essential feature of DBT.

 

PTS:   1

 

  1. When interviewing a client, which of the following statements would indicate that the client has distorted cognition? Select all that apply.
a. Im having a difficult time concentrating on my course work.
b. All of my teachers think Im hopeless because I did poorly on the last exam.
c. School is going well. I received an A on the last exam.
d. Id like to apply for graduate school when I complete the undergraduate program.
e. My classmates dont want to study with me.
f. Im going to try my best in school this semester.

 

 

ANS:  A, B, E

Cognitive distortions are characterized by statements

 

PTS:   1

 

  1. A nurse caring for a 9-year-old client would plan care based on the knowledge that according to Sullivans theory, clients between the ages of 8 and 11 are in the concrete operational stage. Because of this information, the nurses assessment would most likely reveal a client who can do which of the following? Select all that apply.
a. Think scientifically
b. Attained reversibility
c. Demonstrate mature cognitive structures
d. Solve complex verbal problems
e. Solve conservation problems
f. Demonstrate egocentric thought and language

 

 

ANS:  B, E

Children in the concrete operational stage can solve conservation problems and reversibility is retained. Egocentric thought and language are characteristic of the preoperational period (2 to 7 years). It is not until the stage of formal operations period (11 years to adulthood) that the cognitive structures are mature and the individual is able to think scientifically and solve complex verbal problems.

 

PTS:   1

 

 

CHAPTER 20THE CLIENT EXHIBITING AGGRESSION, HOSTILITY, AND VIOLENCE

 

MULTIPLE CHOICE

 

  1. According to Fernandez (1999), which group of health care workers is at greatest risk for physical assault?
a. receptionist c. social workers
b. female nurses d. male nurses and doctors

 

 

ANS:  D

According to Fernandez, male nurses and doctors are at the greatest risk for physical assault. Receptionists are at lowest risk.

 

PTS:   1

 

  1. Aggressive and violent behaviors are more common among clients experiencing:
a. anxiety disorders c. personality disorders
b. psychotic disorders d. substance abuse disorders

 

 

ANS:  B

Aggressive and violent behaviors are more common in clients experiencing psychotic disorders. These individuals are out of touch with reality and may be responding to auditory hallucinations. Clients who are paranoid may have delusions that others are out to harm them, and they may respond to nursing staff based on the belief that they are protecting themselves.

 

PTS:   1

 

  1. A nurse who practices with the belief that a clients aggressive behavior is a result of role modeling would most likely follow which psychodynamic theories?
a. biochemical theories c. psychodynamic theories
b. social learning theories d. neuroendocrine theories

 

 

ANS:  B

Social learning theory views aggression as a learned response that is based on the assumption that role modeling, identification, and human interactions shape learning and behavior. Aggression is believed to be learned through observation and imitation.

 

PTS:   1

 

  1. Contemporary neurophysiologic studies suggest which areas of the brain are linked to aggressive and violent behaviors?
a. frontal lobe c. occipital lobe
b. temporal lobe d. parietal lobe

 

 

ANS:  B

Contemporary neurophysiologic studies suggest that the temporal lobes of the brain are linked to aggressive and violent behaviors. EEGs of the brains of violent criminals have revealed left hemispheric (temporal lobe) abnormalities.

 

PTS:   1

 

  1. The prevalence and nature of a clients aggression and violence in health care:
a. is a recent occurrence
b. has decreased in the past 10 years
c. has long been minimized and neglected
d. has been a major topic of research since the early 20th century

 

 

ANS:  C

The prevalence and nature of a clients aggression and violence in health care has long been minimized and neglected. Client aggression occurs more often than client violence with a substantial number of psychiatric nurses being threatened. Today, more concern is placed on client aggression and violence perhaps because of the serious morbidity for clients and staff.

 

PTS:   1

 

  1. Which of the following statements is correct?
a. The incidence of client aggression and violence is equal.
b. Client aggression occurs more often than client violence.
c. Client violence occurs more often than client aggression.
d. Clients very seldom demonstrate aggression and violence.

 

 

ANS:  B

Client aggression occurs more often than client violence. Aggressive behaviors are those that are marked by combativeness readiness, driving forceful energy, or initiative. Violence is the act of kicking, spitting, beating, grabbing, choking, pushing, forcing sex, or using a weapon.

 

PTS:   1

 

  1. According to a 1999 study of health care workers in a Vancouver ED, respondents reported a 1-year prevalence rate of:
a. 52% for physical assault and 57% for physical threat
b. 61% for physical assault and 79% for physical threat
c. 75% for physical assault and 80% for physical threat
d. 92% for physical assault and 97% for physical threat

 

 

ANS:  D

According to the study, respondents reported a 1-year prevalence rate of 92% for physical assault and a 97% for physical threat. Additionally, 66% of the respondents reported verbal abuse at least once per shift.

 

PTS:   1

 

  1. Which is the priority when caring for potentially hostile, aggressive, or violent clients?
a. providing a safe environment for self, clients, and others
b. administering a prescribed medication to address the clients behavior
c. exploring with the client reasons for the hostility, aggression, or violence
d. assisting the client to develop alternative methods for expressing feelings

 

 

ANS:  A

The priority nursing intervention with a client who is potentially hostile, aggressive, or violent is to provide a safe environment for client, self, and others. The other interventions are all important and will be initiated, but safety is always the priority.

 

PTS:   1

 

  1. You have been caring for a client who previously was described by other nurses as being extremely hostile. If your client is moving towards recovery and recognizes the hostility, your assessment would most likely reveal which of the following?
a. Hostility will probably increase.
b. Hostility will probably decrease.
c. Hostility will remain unchanged.
d. Hostility will progress to violence.

 

 

ANS:  B

Assessment of a client who is moving toward recovery and recognizes the hostility would most likely reveal that the hostility is decreased.

 

PTS:   1

 

  1. The nurse on a psychiatric unit assessing a newly admitted client for potential violent behavior knows that when comparing violence among men and women with psychiatric disorders, research suggests that:
a. women are violent more often than men
b. men are violent more often than women
c. there is no gender difference in terms of violence
d. women use more physical aggression than men

 

 

ANS:  C

The research suggests that there is no gender difference in terms of violence between men and women with psychiatric disorders. Most researchers suggest that there is an overlap in the expression of violence and in the factors that contribute to its emergence in men and women, specifically psychosis and behavioral disturbances.

 

PTS:   1

 

  1. You are caring for a client who is very angry. The clients mental and motor activity have increased. Your assessment would reveal that the client is most likely experiencing which of the following?
a. hostility c. aggression
b. agitation d. impatience

 

 

ANS:  B

The client is most likely experiencing agitation. Agitation is a state of increased mental and motor activity. Clients exhibiting agitated states are often verbally and physically threatening and can become abruptly violent.

 

PTS:   1

 

  1. A nurse whose care is based on a belief that aggression is a basic drive (like thirst) would be following whose theories?
a. Erik Erikson c. Sigmund Freud
b. Dorothea Orem d. Abraham Maslow

 

 

ANS:  C

According to Freud, aggression is a basic drive (like thirst). From birth to death the person possesses two conflicting instincts. One instinct is a life instinct (eros) that encourages a person to grow and survive. The second instinct is a death instinct (thanatos) that drives the person to redirect the death instinct or self-destructiveness from self to others.

 

PTS:   1

 

  1. The psychiatric nurse planning care for clients is aware that violent behaviors occur:
a. across all age groups
b. most often with adolescents with juvenile records
c. less often with elderly clients experiencing dementia
d. most often with children who have developmental disorders

 

 

ANS:  A

Violent behavior can occur across all age groups. Research has documented acts of violence on pediatric units, adolescent units, adult units, and in geriatric settings.

 

PTS:   1

 

  1. Workplace violence occurs:
a. anywhere c. in any outpatient clinic
b. in the emergency room d. on the inpatient psychiatric unit

 

 

ANS:  A

Workplace violence can occur anywhere. Incidents have been documented on psychiatric units, emergency rooms, and basically any area of the hospital or clinic. Violence may be initiated by a client, family member, friend, or staff member.

 

PTS:   1

 

  1. A client becomes very agitated and begins to use profane language in a very loud tone of voice. The best response by the nurse is to:
a. ignore the client
b. yell back at the client
c. speak calmly and softly
d. tell the client the behavior is childish

 

 

ANS:  C

If a client becomes angry and begins to use profane language in a very loud tone, the nurses best response is to speak calmly and softly to the client. Ignoring the client, yelling at the client, or telling the client his behavior is childish will only escalate the situation.

 

PTS:   1

 

  1. You walk into an examination room only to realize that the client is holding a weapon. What should you do first?
a. Take the weapon away from the client.
b. Have security take the weapon away from the client.
c. Ask the client to place the weapon on a desk or on the floor.
d. Ignore the fact that the client has a weapon and continue to provide care.

 

 

ANS:  C

If you walk into an examination room and see a client with a weapon, you should ask the client to place the weapon on a desk or on the floor. You should never ignore the weapon. Neither you nor any other staff member should approach the client in an attempt to take the weapon.

 

PTS:   1

 

  1. An employers major responsibility is to:
a. provide a safe working environment
b. screen any client seeking service from the facility
c. install metal detectors at the entrance of the hospital
d. hire twice the number of security guards to assure safety

 

 

ANS:  A

The major responsibility of an employer is to provide a safe working environment for the employees. This can be accomplished by providing security to escort staff to parking lots at night. Employers should also provide training to all staff on the proper procedures to use during situations of aggression, hostility, and violence.

 

PTS:   1

 

MULTIPLE RESPONSE

 

  1. The nurse manager over an emergency department is conducting an in-service program on workplace violence. The nurse manager would evaluate the employees as understanding the causes of workplace violence if they identify which of the following? Select all that apply.
a. loud noises d. helpful and pleasant staff
b. long waiting periods e. poor environmental design
c. ignoring a clients request f. speaking calmly and softly

 

 

ANS:  A, B, C, E

Research has shown that common causes of workplace violence include loud noises, long waiting periods, ignoring a clients request, poor environmental design, crowdedness, and access to firearms. Other contributing factors are inadequately or inappropriately trained security or staff and lack of administrative support for zero tolerance of violence in the workplace. Speaking calmly and softly to a client and staff who are helpful and pleasant may reduce the potential for violence.

 

PTS:   1

 

  1. Hostile clients may demonstrate which of the following behaviors? Select all that apply.
a. rudeness d. faultfinding
b. sarcasm e. verbal threats
c. kindness f. physical violence

 

 

ANS:  A, B, D, E, F

Hostile clients may demonstrate rudeness, sarcasm, faultfinding, physical violence, or verbal threats. Hostile clients do not exhibit kindness.

 

PTS:   1

 

  1. You are the charge nurse on a psychiatric unit. One of the new clients is very angry and agitated. The client rushes into the nurses station where you are standing and begins to yell and curse at you. What interventions would be appropriate to de-escalate the situation? Select all that apply.
a. Use common sense.
b. Use active listening.
c. Give suggestions, not orders.
d. Be concerned about personal safety.
e. Avoid using threatening body language.
f. Remain calm and convey being in control.

 

 

ANS:  A, B, C, D, E, F

All of the above are correct interventions to implement in an attempt to de-escalate a potentially violent situation.

 

PTS:   1

 

  1. Data from several studies exploring the risk of violence in inpatient psychiatric facilities found that violence most likely occurs during which periods? Select all that apply.
a. mealtimes d. nursing report
b. visiting hours e. client transport
c. bathing hours f. during change of shifts

 

 

ANS:  A, C, E

Data from several studies exploring risk for violence in inpatient psychiatric facilities have found violence occurred during high activity and interaction with clients such as mealtimes, client transport, and bathing hours. During periods of visiting hours, nursing reports, or change of shifts there is less interaction between staff members and clients and a reduced possibility of violence.

 

PTS:   1

 

  1. Which of the following are true about hostility? Select all that apply.
a. It is a response to a threat.
b. It never results in violence.
c. It is always an inappropriate act.
d. It is a response to invasion of privacy.
e. It demonstrates a basic character flaw.
f. It is an atte

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