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Test Bank Psychiatric Nursing Contemporary Practice 5th Edition, Boyd
Chapter 1- Introduction to Psychiatric-Mental Health Nursing
1. A group of nursing students are reviewing information about the evolution of mental health care and are discussing the recommendations of the final report of the Joint Commission on Mental Illness and Health. The students demonstrate understanding of this information when they identify that the report recommended an increase in which of the following?
A) Numbers of mental health hospitals
B) State funding for mental health care
C) Clinics supplemented by general hospital units
D) Use of psychotherapy by psychiatrists
2. A nurse is reviewing the American Nurses Associations Statement on Psychiatric Nursing Practice published in 1967, which sanctioned the involvement of psychiatricmental health nurses in the provision of holistic nursing care. Integrating knowledge of the various theories and views of mental health and illness, the nurse identifies which of the following as most strongly linked to this holistic approach?
A) Sigmund Freuds psychoanalytic theory
B) Florence Nightingales Notes on Nursing
D) Clifford Beers A Mind That Found Itself
E) Peplaus Interpersonal Relations in Nursing
3. A nursing instructor is preparing a presentation about key events and people that influenced the development of contemporary mental health and illness care. When describing the effects of World War II, which of the following would the instructor include?
A) People began to view mental illness as more commonplace and acceptable.
B) The biologic understanding of mental illness was almost fully developed.
C) Deinstitutionalization occurred in response to the community health movement.
D) Mental illnesses became categorized as psychoses or neuroses.
4. A nursing student is presenting a discussion of the history of psychiatricmental health nursing and its place within nursing history. Which of the following would be most appropriate to include?
A) Certification for the psychiatricmental health nursing specialty was first emphasized by Mary Adelaide Nutting.
B) Psychiatric nurses played a part in seeing that all deinstitutionalized patients got treatment at community mental health centers.
C) There is a historical link between the first nursing program to admit male students and the first training school for psychiatric nursing.
D) The first graduate program in psychiatric nurses was established in response to the publication of psychiatric nursing specialty journals.
5. Two nursing students are discussing psychiatricmental health nursing and the role it has played in nursings overall history. Which statement is most accurate?
A) The importance of using therapeutic communication was stressed by Nightingale.
B) The use of self-care to enhance the immune system was taught by Dorothea Dix.
C) The moral treatment of mental illness was a primary focus of deinstitutionalization.
D) Peplau was the first nurse to stress the importance of therapeutic communication.
6. When reviewing the evolution of mental health and illness care, which event is associated with mental disorders beginning to be viewed as illnesses requiring treatment?
A) Establishment of Pennsylvania Hospital in Philadelphia
B) Quaker establishment of asylums
C) Creation of the state hospital system
D) Freuds views on the causes of mental illnesses
7. A psychiatricmental health nurse is working on a committee that is developing programs that integrate the objectives for mental health and mental disorders as identified in Healthy People 2020. Which type of program would be least appropriate?
A) Single substance abuse treatment programs
B) Depression screening programs for primary care providers
C) Mental health programs for the homeless population
D) Employment programs for those with serious mental illness
8. A nursing instructor is describing the concept of evidence-based practice in psychiatricmental health nursing. Which of the following would the instructor include as being important? Select all that apply.
A) Research findings
B) Expert opinion
C) Clinical experiences
D) Patient data
E) Established routines
9. The following events are important in the development of psychiatricmental health nursing practice. Which event occurred first?
A) Publication of Standards of Psychiatric-Mental Health Nursing by the ANA
B) Publication of Standards of Child and Adolescent Psychiatric and Mental Health Nursing Practice
C) Establishment of the first graduate program in psychiatric nursing at Rutgers University
D) Publication of the first psychiatric nursing text, Nursing Mental Disease, by Harriet Bailey
10. A nurse is preparing a presentation about the current status of mental health services in the United States. Which statement would the nurse include as the most reflective of this status?
A) Mental health care in the United States is equally accessible to individuals.
B) Mental illness ranks second in terms of causing disability in comparison.
C) Mental health care primarily focuses on the cure of mental illness.
D) Mental health care services are inadequate and fragmented.
Chapter 2- Mental Health and Mental Disorders
1. A nursing instructor is describing the DSM-IV-TR to a group of nursing students. Which of the following would the instructor include as the primary purpose of this classification?
A) Provide a commonly understood diagnostic category for clinical practice.
B) Describe treatment modalities for psychiatric disorders and mental illnesses.
C) Identify various etiologies for mental disorders based on family histories.
D) Provide optimal outcomes for treatment for individuals with mental illnesses.
2. A nurse is providing care to a patient with a mental disorder classified by the DSM-IV-TR. The nurse understands that although the first three axes appear to contain all the diagnostic information about a patient, a truly accurate picture of the client is incomplete without considering other factors such as an estimate of current functioning and:
A) Life stressors
B) Cultural background
C) Marital status
D) Genetic history
3. A patients global assessment functioning reveals that he has minimal symptoms with good functioning in all areas. Which score would the nurse correlate with these findings?
4. A female patient was admitted to the hospital with pneumonia, and in the course of her treatment, it was determined that she was experiencing alcohol dependence because she began experiencing alcohol withdrawal while she was in the hospital. When the psychiatrist who was called in as a consultant documented the patients mental disorder, he identified her alcohol dependence on which axis?
A) Axis I
B) Axis II
C) Axis III
D) Axis IV
5. A 25-year-old woman who recently had abdominal surgery was admitted to the psychiatric unit, where it was determined that she had a borderline personality disorder. During the first week on the unit, it was determined that she also has diabetes. Her diabetes mellitus would be listed in which axis of her DSM-IV-TR diagnosis?
A) Axis I
B) Axis II
C) Axis III
D) Axis IV
6. As part of a class activity, nursing students are engaged in a small group discussion about the epidemiology of mental illness. Which statement best explains the importance of epidemiology in understanding the impact of mental disorders?
A) Epidemiology helps promote understanding of the patterns of occurrence associated with mental disorders.
B) Epidemiology helps explain research findings about the neurophysiology that causes mental disorders.
C) Epidemiology provides a thorough theoretical explanation of why specific mental disorders occur.
D) Epidemiology predicts when a specific psychiatric client will recover from a specific mental disorder.
7. A nurse is working in a community mental health center that provides care to a large population of Asian descent. When developing programs for this community, which of the following would be most important for the nurse to address?
A) Public stigma
C) Label avoidance
D) Negative life events
8. A group of students are reviewing the multiaxial diagnostic system of the DSM-IV-TR. The students demonstrate understanding of the axes when they identify that each axis represents which of the following?
A) An evidence-based research finding
B) An experimental design to guide care
C) A domain of information
D) A laboratory test finding
9. A nursing student is assigned to care for a patient diagnosed with schizophrenia. When talking about this patient in a clinical postconference, the student would use which terminology when referring to the patient?
A) Committed patient
C) Schizophrenic patient
D) Person with schizophrenia
10. Mrs. Green is a patient on a psychiatric unit. At the time of her admission, her dog was killed when a car accidentally ran over it; in addition to that, she just found out that her mother has been diagnosed with colon cancer. This information would be addressed in which DSM-IV axis?
A) Axis I
B) Axis II
C) Axis III
D) Axis IV
Chapter 3- Cultural and Spiritual Issues Related to Mental Health Care
1. When reviewing several studies about Hispanic Americans and their use of mental health care facilities, the nurse notes that this cultural group tends to use all other resources before seeking help from mental health professionals. Which of the following would the nurse identify as a reason for this belief about many mental health facilities?
A) Require periods of hospitalization
B) Do not provide 24-hour emergency services
C) Are not reimbursed by third party payers
D) Do not accommodate their cultural needs
2. A nurse is preparing a presentation about mental health problems associated with specific cultural groups. When describing mental health problems associated with Asian Americans, Polynesians, and Pacific Islanders, the nurse would address high rates of which of the following?
B) Manic disorders
3. The nurse is doing an assessment interview of a patient. During the interview, the patient comments, Our people are connected with nature. Our world, our seasons, and our weatherthey all have many lessons to teach us. The nurse interprets the patients statement as an expression of which of the following?
B) Tribal law
D) Ecological values
4. A psychiatricmental health nurse is providing care to a patient who has recently emigrated to the United States from Eastern Europe. Which of the following would be least effective in providing culturally competent care?
A) Demonstrating a genuine interest in the patient
B) Avoiding assumptions about the patients culture
C) Speaking to the patient in his native language.
D) Acquiring information about the patients country.
5. A psychiatricmental health nurse working in a Veterans Administration Medical Center is meeting with a military wife who is an Asian American. The woman is to be joining a support group for wives of veterans who have posttraumatic stress syndrome. When asking her to describe her husbands mental health problems, which response would the nurse most likely expect?
A) Oh, he may seem depressed, but it is just a vitamin deficiency. It runs in his family.
B) I know the war messed his mind up. Hell never be the same.
C) Sometimes he hallucinates that he is back in Vietnam.
D) He just stays to himself; he never talks to me about what is bothering him.
6. A psychiatricmental health nurse is working with a patient who is being treated for depression. Which patient statement would indicate that her spirituality is intact?
A) My church friends came to visit me this past Sunday afternoon.
B) Nothing will ever be the same again; my life is not worth living.
C) I know I am as well off as I can be under the circumstances.
D) I know God must be punishing me for all my sins.
7. A patient is being treated for prostate cancer; his prognosis is very poor. The patient has a strong faith, and he has been active in his church for many years. He is concerned about his health and the challenges he faces as his cancer progresses. Which comment by the nurse reflects the most appropriate spiritual nursing intervention for the patient?
A) Ill take you to visit my church if you can get a pass.
B) You have to belong to the same church I do if youre going to go to heaven.
C) Would you like me to bring you a guided imagery audiotape?
D) We can pray together if youd like.
8. A psychiatricmental health nurse is teaching a class about social factors associated with mental illness at a community health center. When describing the influence of poverty and effects of the downward economic spiral on mental health, which population would the nurse identify as being the most at risk?
A) Older adults
B) Individuals with physical disabilities
C) Single-parent families
D) Homeless individuals
9. During an assessment, the patient states, We rely on our large extensive family for moral support and help and we treat our elders with a great deal of respect. If someone gets sick, the family takes care of him. The nurse interprets this as indicating which of the following?
B) Cultural identity
C) Cultural competence
D) Linguistic competence
10. Within the context of the culture of poverty, which of the following most clearly describes why individuals who are part of this culture become trapped in a downward economic spiral?
A) Unemployment causes poverty; a lack of willpower and motivation can, in turn, cause unemployment in people who do not have a strong work ethic.
B) Individuals lack the finances to pay rent, so they eventually do not have an address to use in filling out job applications.
C) Characteristics of poverty (joblessness and lack of financial independence) can, in turn, contribute to attributes (feelings of powerlessness and low self-esteem) that sustain poverty.
D) Poverty is passed on from generation to generation; individuals learn at an early age that there is no way to escape living in poverty.
Chapter 4- Patient Rights and Legal Issues
1. A nurse is explaining advance care directives, or living wills, to a patient and the patients spouse. Which of the following would the nurse include in the description?
A) The document tells what treatment is to be omitted if the patient is unable to make the decision.
B) It requires that the patient sign the living will document while an attorney is present.
C) The patients physician must act as a witness when the patient signs the document.
D) An attorney draws up the papers to be given to the patient and his or her family.
2. A psychiatricmental health nurse determines that a patient is competent when he is able to do which of the following?
A) Speak coherent English.
B) Communicate his or her choices.
C) Write a living will.
D) Comply with the medical regimen.
3. A patient receives a court order for commitment. Which of the following best exemplifies the concept of least restrictive environment?
A) Involuntary commitment to an outpatient community mental health center
B) Medication administration for sedation so the patient cannot get out of bed
C) Placing the patient in a locked padded room in response to threats of self-harm
D) Allowing the patient to make the decision about whether treatment is necessary
4. A nurse is caring for a patient who is hospitalized for a mental disorder. The nurse is legally obligated to breach the patients confidentiality if the patient states which of the following?
A) I think that the federal government is spying on me.
B) I get really turned on by your appearance.
C) That doctor I had today really made me angry.
D) When I get out of here, Im going to kill my neighbor.
5. Which patient would the nurse determine to be the most likely a candidate for involuntary commitment?
A) The client who refuses to take the prescribed medication
B) The client who is screaming in the street disturbing neighbors
C) The client who refuses to participate in the planned therapy
D) The client with a mental disorder who is homeless
6. The nurse is providing care to a male patient who is hospitalized with a diagnosis of schizophrenia. Which of the following would be appropriate for the nurse to include in the patients medical record?
A) Patient states that he had a good night with no complaints.
B) Complained of being unable to sleep because he heard voices throughout the night.
C) Had a typical night without incidence of insomnia or nightmares.
D) Acted crazily throughout the night; kept hearing voices and noises.
7. A nurse working on the psychiatric unit receives a telephone call from the employer of one of the patients on the unit. The employer asks to be sent a copy of Mr. Murrays latest laboratory work and psychological testing results so Mr. Murrays medical records in employee health can be kept up to date. Based on the nurses knowledge about issues surrounding breach of confidentiality, which response would be the most appropriate?
A) Im sorry; were not allowed to give out that information about our patient.
B) Ill have to get the patients signed consent before we can send that information to you.
C) I am unable to acknowledge whether or not a Mr. Murray is a patient on this unit.
D) Sure, give me your address, and I will see that the information is sent to you.
8. A patient is going to be discharged this afternoon from the mental health unit. The patient asks the nurse if a copy of his medical record could be sent to the psychologist he will be seeing on an outpatient basis. Which response by the nurse would be most appropriate?
A) Sure, well have that information sent out in todays mail.
B) You will need to sign written authorization for us before we can do this.
C) I think it would just be best if you just told your psychologist everything he needs to know.
D) How are you feeling about being discharged this afternoon?
9. A patients psychiatrist informs her that he thinks she needs to participate in a 3-month outpatient aftercare program after her discharge. Which of the following would protect the patients right to request a second opinion before agreeing to this suggestion?
B) Least restrictive environment
D) Mandates to inform
10. A nurse is preparing to administer an as-needed (PRN) medication. Which of the following would the nurse need to keep in mind when documenting administration?
A) It requires a separate entry that includes reason for administration, dosage, route, and response to the medication the first time it is administered to a patient.
B) It requires a separate entry that includes reason for administration, dosage, route, and response to the medication every time it is administered to a patient.
C) It requires a separate entry that includes reason for administration, dosage, and route the first time it is administered to a patient.
D) It requires a separate entry that includes reason for administration, dosage, and route every time it is administered to a patient.
Chapter 5- Mental Health Care in the Community
1. A nursing instructor is explaining the concept of the continuum of care to a group of students. Which of the following would the nurse include in this description?
A) Care provided in episodic intervals
B) System of care that focuses primarily on wellness
C) A single organization as responsible for care delivery
D) Integrated system spanning illness to wellness states
2. The nurse is employed by a long-term residential treatment center that provides care to a variety of patients with chronic mental disorders. Which role would the nurse primarily assume when working with these patients?
B) Medication administrator
3. A patient has threatened to kill his wife, and it is not anticipated that this crisis will resolve itself. The patient is to be admitted to an inpatient psychiatric unit on an involuntary basis. When explaining to the family about this plan, the nurse would identify which of the following as the focus of care?
A) Long-term therapy
B) Rehabilitative services
C) Acute symptom stabilization
D) 24-hour supervision
4. A nurse is reviewing information about the various types of outpatient mental health care programs. The nurse demonstrates understanding of these types when identifying which of the following as involved in providing the most intensive outpatient nursing care?
A) Partial hospitalization programs
B) Crisis intervention programs
C) Outpatient detoxification programs
D) Rehabilitation programs
5. A patient who has attempted suicide with a drug overdose has been released from an inpatient setting and has returned to school. The patient continues to need routine psychiatric services. The nurse anticipates that this patient will most likely be referred to which of the following?
A) Partial hospitalization program
B) In-home mental health care
C) Intensive outpatient program
D) Crisis center in the community
6. The nurse is caring for a group of patients in a partial hospitalization program. The nurse would most likely be involved in which of the following activities?
A) Facilitating a drug abuse prevention group
B) Providing spiritual assessment and related interventions
C) Teaching patients how to plan a menu and to shop for groceries
D) Providing an educational group about the nutritional content of canned foods
7. A nurse is providing in-home mental health care and determines that the care was effective when the patient demonstrated which of the following?
A) A need for continued intensive monitoring in the home
B) A need for crisis intervention services on an ongoing basis
C) A decrease in admission frequency to inpatient psychiatric hospitals
D) A dependence on parents to participate in the patients care
8. A patient with a psychiatric disorder is considering joining a clubhouse with other patients who have mental disorders. The patient asks the nurse to explain what services the clubhouses provide. Which response by the nurse would be most accurate?
A) They are open 24 hours a day to provide care and support for the clubhouse members.
B) They are run entirely by psychiatric mental health nurses.
C) Their primary focus is on providing ongoing intensive psychotherapy for patients in a group setting.
D) They are predominately run by psychiatric patients with minimal assistance from mental health staff.
9. The nurse is working as part of the interdisciplinary staff of a psychiatric inpatient facility who are developing discharge plans for a patient who requires alternative housing arrangements. The patient will be referred to a personal care home. When explaining this housing arrangement to the patient, which of the following would the nurse include?
A) Youll be living with a family in their home, and the family will help supervise and support you.
B) Youll be living in an apartment with a roommate, and a staff member will come by to check on you.
C) Youll be living in a house with about 50 other people and receive 24-hour supervision and assistance.
D) Youll be living in a house with about six to 10 other people, and a health care attendant will provide 24-hour supervision.
10. A nurse is developing a community education program for a local womens club on the topic of managed care in mental health. Which of the following would the nurse include as the main focus?
A) Cost savings
B) Consistent third-party reimbursement
C) Improved access to less costly services
D) Individualized care for additional inpatient stays
Chapter 6- Ethics, Standards, and Nursing Frameworks
1. When applying the biopsychosocial model to client care, the nurse integrates the psychological domain when involved with which of the following?
A) Behavior therapy
B) Family support
C) Nutritional therapy
D) Sleep hygiene measures
2. A nursing instructor is describing the impact of technology and electronic health records on psychiatricmental health care. Which of the following would the instructor identify as a major challenge associated with it?
A) Maintaining confidentiality
B) Establishing educational models
C) Decreasing fragmented care
D) Defining professional standards more clearly
3. A psychiatric nursing class is discussing current trends in mental health care. A student voices the opinion that there should be equitable access to mental health care and resources for those who live in rural areas, for those without health insurance, and for those with very little income. The student nurses opinion most closely reflects which ethical principle?
4. A nursing student is initiating a relationship with an assigned patient. After meeting and spending approximately 20 minutes talking with the patient, the student makes arrangements to visit again after lunch. After lunch, fellow classmates invite the student to go to the gym with them and a group of patients to play volleyball. The student starts to go with them but then remembers the promise to meet with the patient. The student decides to stay behind and talk to with her patient. The students decision reflects which ethical principle?
5. In a postclinical conference, a group of students are engaged in a discussion with their instructor. The instructor repeatedly has the students analyze and evaluate the nursing interventions implemented throughout the clinical experience. The students are engaged in which of the following?
A) Therapeutic use of self
B) Critical thinking
C) Interdisciplinary care
D) Planning care
6. A group of students is reviewing the functions of psychiatric nurses. The students demonstrate understanding of the information when they identify which of the following as an advanced practice level function?
A) Milieu therapy
B) Promotion of self-care
C) Psychopharmacology interventions
D) Health promotion activities
7. A nursing instructor has prepared a lecture about the scope and standards of practice of psychiatric nurses. The instructor determines that the teaching was effective when the students identify which of the following as common to both basic and advanced level practice?
A) Case management
B) Program development
C) Clinical supervision
D) Community interventions
8. A nurse is working on developing ways to meet the challenge of knowledge development. Which of the following would be most appropriate?
A) Access new information through continuing education programs.
B) Improve access to community psychiatric care for all populations.
C) Reduce the burden of mental illness by fighting stigma.
D) Provide culturally competent, high-quality nursing care.
9. A 22-year-old patient with schizophrenia is refusing his antipsychotic medication. He states, I dont like the dopey way it makes me feel. I feel like Im walking under water when I take it. The nurse explains to him, Your schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. You need to take it so your symptoms will get better. This conversation reflects a conflict between which two types of ethical principles?
A) Autonomy and justice
B) Paternalism and veracity
C) Justice and nonmaleficence
D) Autonomy and beneficence
10. A nurse is faced with an ethical dilemma involving a patient. Which question would be most important for the nurse to ask first when engaging in the process of ethical decision making?
A) What are my own feelings about the situation?
B) What assumptions am I making that need more data?
C) What do I know about the situation?
D) What do I know about the patients values?
Chapter 7- Psychosocial Theoretic Basis of Psychiatric Nursing
1. A group of nursing students are reviewing information about Freuds personality structure. The students demonstrate understanding of this information when they identify the ability to form mutually satisfying relationships as a function of which of the following?
A) Defense mechanisms
2. When describing the influence of Harry Stack Sullivan on psychiatricmental health nursing, which of the following would the instructor address as a major concept?
A) Interpersonal relations
B) Harmony between the individual and society
C) Collective unconscious
D) Unconditional positive regard
3. A nursing student is to provide a class presentation about interpersonal and psychoanalytic theories. As part of this presentation, the student is planning to address the major way these two categories differ. Which of the following would the student include as key to interpersonal theories?
A) Human relationships
D) Potential for goodness
4. A psychiatricmental health nurse is integrating Carl Rogers theory into the plan of care for a patient with a mental illness. The nurse incorporates understanding of this theory by acknowledging that the therapist accomplishes which of the following?
A) Provide validation of the terminology used during the session.
B) Focus on the clients instinctual drives.
C) Recognize an understanding of the clients basic needs.
D) Develop unconditional positive regard for the client.
5. A nurse is demonstrating behaviors that the treatment team is attempting to get the patient to develop. The nurse is integrating which theory?
A) Eriksons model of psychosocial development
B) Albert Banduras social cognitive theory
C) Skinners operant conditioning
D) Freuds psychoanalytic model
6. An instructor is preparing a class discussion on the various theoretical models used in psychiatricmental health nursing. When describing cognitive theories, which statement would the instructor include?
A) The theories attempt to explain the mental processes development and effects on behavior.
B) The theories attempt to describe how people learn and act.
C) The theories attempt to link internal thought processes with behavior.
D) The theories attempt to explain normal human growth and development.
7. When integrating the Neuman systems model while caring for a patient with a mood disorder, the nurse would focus on which of the following about the patient?
C) Self-care activities
8. The nurse is integrating Peplaus model when providing care to a patient with a mental illness. Which of the following would the nurse identify as a key component?
D) Nonverbal behaviors
9. A group of nursing students are reviewing information about the various nursing theorists and their application to psychiatricmental health nursing. The students demonstrate understanding when they identify which theorist as responsible for developing the theory of cultural care diversity and universality?
A) Madeleine Leininger
B) Sister Calista Roy
C) Hildegard Peplau
D) Dorothea Orem
10. A patient is being discharged from the psychiatric unit this afternoon, and the nurse needs to teach the patient about discharge medications. The patient is exhibiting signs of moderate anxiety about the upcoming discharge. Based on Peplaus views regarding anxiety, the nurse would expect to implement the teaching plan at which time?
A) When his anxiety stabilizes at its current level
B) When his anxiety decreases to a mild level
C) When he is completely free of anxiety
D) When his anxiety escalates to the panic level
Chapter 8- Biologic Foundations of Psychiatric Nursing
1. A nurse is teaching a medication class to a group of psychiatric patients. One of them asks the nurse why he has so much more trouble learning now when hes in his 60s than he did when he was younger. Which of the following concepts would the nurse integrate into the response?
A) The extrapyramidal motor system
B) The amygdala
2. Which of the following would a nursing instructor identify when describing the area of the brain involved with verbal language function, including areas for both receptive and expressive speech?
A) Right hemisphere
B) Parietal lobe
C) Occipital lobe
D) Left hemisphere
3. A nurse is developing a plan of care for a patient experiencing expressive aphasia. The nurse incorporates knowledge that the patient most likely has sustained damage to which of the following?
A) The postcentral gyrus
B) Brocas area
C) Basal ganglia
D) The hippocampus
4. The nurse is caring for an older adult who has experienced damage to the frontal lobe after an automobile accident. The nurse anticipates that the patient will have difficulty with which of the following?
B) Concept formation
C) Receptive speech
5. The nurse is caring for a patient who has experienced damage to the parietal lobes of the brain. The nurse anticipates that the patient with have difficulty with which of the following?
A) Perceiving sensory input
B) Calculating a math problem
C) Seeing objects in front of him
D) Speaking fluently
6. A patient has been diagnosed with memory dysfunction associated with Alzheimers disease. The nurse determines that damage to the patients brain includes deterioration of temporal lobe structures and the nerves of which of the following?
A) Basal ganglia
B) Limbic system
C) Frontal lobe
7. The nurse is caring for a hospitalized patient who has a disorder of the hypothalamus. When developing the patients plan of care, in which of the following areas would the nurse anticipate a problem?
D) Motor activity
8. A patient who is scheduled to undergo a sleep deprivation electroencephalogram (EEG) in the morning is experiencing moderate anxiety about the procedure. Based on an understanding of this test, which of the following would the nurse avoid?
A) Explaining in depth what to expect during the upcoming procedure
B) Administering a benzodiazepine medication prescribed for anxiety
C) Taking a thorough history of her use of prescribed and illicit drugs
D) Giving her a noncaffeinated beverage of her choice
9. A nursing instructor asks a student to explain the influence of chronobiology on depression. Which of the following would the student include when responding?
A) The exact location of genes leads to identifying the gene responsible for causing depression.
B) A break in the corpus coliseum blocks information exchange between the right and left hemispheres.
C) Damage to the posterior areas of the parietal lobe leads to altered discriminative sensory function.
D) Internal and external triggers can elicit biologic rhythm changes indicative of clinical depression.
10. When describing the various neurotransmitters, which of the following would the nurse identify as the primary cholinergic neurotransmitter?
Chapter 9- Communication and the Therapeutic Relationship
1. A nurse has engaged in self-awareness and has come to understand his own personal beliefs and attitudes and has recognized some prejudicial ideas. Based on this understanding, which of the following would the nurse now be able to accomplish?
A) Have a therapeutic relationship with a patient.
B) Influence patients with certain biases.
C) Change learned behaviors.
D) Formulate values and morals.
2. When engaged in therapeutic communication in a therapeutic relationship with a patient with a mental health problem, which of the following would be most important for the nurse to keep in mind?
A) The nurse should self-disclose when indicated.
B) The patient is the primary focus of the interaction.
C) The nurse should have an empathetic relationship with the patient.
D) The patients conversations should be recorded.
3. A hospitalized patient diagnosed with depression asks the nurse, Should I go home this weekend? Which response by the nurse uses the technique of reflection?
A) Should you go home for the weekend?
B) Home means what to you?
C) It sounds as if you dont want to go home this weekend.
D) I doubt that you really should go home this weekend.
4. A patient who is hospitalized with depression tells the nurse, I dont want to take the medication because Im afraid Ill become suicidal. Which response by the nurse would be most appropriate?
A) Have you ever thought about hurting yourself?
B) Its important that you take this medication.
C) I agree with you. I wouldnt want to take this medication either.
D) Another patient took that medication, and he really felt better.
5. A female psychiatric patient is talking to the nurse about her reasons for being hospitalized. She begins to discuss her relationship with her female significant other. The patient is describing the things in her relationship that are making her uncomfortable, and she asks the nurse, Should I break up with my partner? Which response by the nurse would be most effective in building rapport between the patient and nurse?
A) Of course you should; being a lesbian is just not natural.
B) Yes, I think you should pursue building a relationship with a man.
C) It sounds like youre beginning to be uncomfortable in this relationship.
D) You need to focus on yourself rather than the relationship right now.
6. A patient is talking to the nurse about the recent death of her grandmother. She is obviously very sad, and a tear rolls down her cheek as she talks. The nurse remembers how she felt when her own grandmother died the previous summer. The nurse puts her hand on the patients shoulder and says, This must be very difficult for you. The nurse is demonstrating empathy based on which of the following?
A) The response comment reflects an attempt to communicate understanding of patients feelings.
B) The nurses response and use of reassuring touch reinforce the nurses concern for the patient.
C) The nurse demonstrates understanding of how the patient feels because of her own grandmothers death.
D) The nurses statement expresses compassion and kindness toward the patient.
7. A nurse engaged in an interaction with a patient recognizes body space zones. Which of the following would the nurse identify as the individuals personal zone?
A) Beginning at the boundary of the intimate zone and ending at the social zone
B) Extending outward from the border to the public zone
C) Surrounding and protecting an individual from others, especially outsiders
D) The most distant boundary that can be used for recognizing intruders
8. The nurse is in the orientation phase of the nursepatient relationship with a patient diagnosed with a mental disorder. When interviewing the patient during this first encounter, which information would be most important for the nurse to obtain about the patient?
A) Known allergies
B) Recent hospitalizations
C) Perception of the problem
D) Family history
9. A patient is a successful insurance salesman; however, because of market changes, his level of sales has dropped. His boss tells him he will consequently be receiving a $2,000 per year cut in his salary. When the patient arrives home from work, the family dog runs to greet him as he always does, barking and jumping up and down and begging for attention. The patient yells at the dog, Get away from me; I cant take your barking right now. The patients response reflects a defense mechanism because it was which of the following?
A) An intentional behavior performed to let the dog know his behavior was inappropriate
B) Automatic, protecting the patient from the anxiety related to his upcoming pay cut
C) Implemented to keep the patient from having to cope with his upcoming pay cut
D) Implemented so the patient could rationalize his upcoming pay cut
10. Termination takes place during the resolution phase of a nursepatient relationship. During the termination process, a patient brings up resolved problems and presents them as new issues to work toward. The nurse interprets the patients action as indicating which of the following?
A) The patient is angry that the nurse is abandoning him.
B) The patient requires additional therapy.
C) The patient is unhappy that the therapy was ineffective
D) The patient is attempting to prolong the nursepatient relationship.
Chapter 10- The Psychiatric Nursing Process
1. Which of the following questions would be most helpful in beginning an initial assessment interview for a patient who has just been admitted to a psychiatric inpatient unit?
A) Have you had any previous psychiatric admissions?
B) What brings you into the hospital today?
C) Have you had any thoughts about trying to harm yourself?
D) How would you describe your relationship with your spouse?
2. A patient is being admitted to the psychiatric unit. While explaining his reason for seeking admission, he describes how his 32-year-old son recently died of a heart attack. Which response by the nurse would enhance the effectiveness of this interview?
A) How is your wife handling your sons death?
B) Do you have any other living children that can help you cope with this loss?
C) This must be a very difficult time for you.
D) I know exactly how youre feeling; my 23-year-old son died unexpectedly last year.
3. A patient was admitted to the hospital after a suicide attempt made after his daughter was killed in an automobile accident during which he had been driving and survived with only minor injuries. Even though the accident was unavoidable, he feels responsible. During the assessment interview, the patient begins to describe the last conversation he had with his daughter before he lost control of the automobile. As he speaks about his daughter, his voice trembles, and a silent tear rolls down his face. He makes a visible attempt to straighten up and smiles superficially at the nurse, stating, Ill get over this. I just need to keep a stiff upper lip. I think all I need to do is stay overnight. Ill be as good as new by tomorrow. Which response by the nurse would be most appropriate?
A) Tell me about your daughter. How would you describe the relationship you had with her?
B) Im sure you are right; a good nights rest should make a big difference.
C) As good as new?
D) You made a serious attempt on your life; you will not be ready go home by tomorrow.
4. After assessing a patient, the nurse noted the following: he was tearful, he tried to kill himself before coming into the hospital, he had no immediate plan for another suicide attempt, he was unable to concentrate, and he reported having trouble sleeping and having little or no appetite. The nurse also noted that the patients appearance was unkempt, that he spoke in a low monotone, and that he was unable to establish and maintain eye contact. Based on this information, which nursing diagnoses would be the most appropriate?
A) Ineffective Role Performance
B) Risk for Infection
C) Risk for Suicide
D) Risk for Self-Mutilation
5. A staff nurse on a psychiatric unit knows that patients often have trouble sleeping because of their psychiatric conditions. Which of the following would reflect a psychiatric nursing intervention to appropriately address this problem?
A) Limiting amounts of evening snacks and beverages
B) Involving patients in a volleyball game immediately before bedtime
C) Enforcing the rule that all patients be in bed with lights out by 10:30 PM
D) Encouraging patients to take short naps in the afternoons
6. The nurse is determining the success of a patients plan of care by evaluating outcome indicators. The nurse understands that these indicators are usually determined initially at which time?
A) On the day of discharge
B) During the assessment process
C) At the initial interview
D) With goal-setting process
7. Based on assessment data, the nurse formulates the nursing diagnosis for a patient as sleep pattern disturbance. After teaching the patient how to relax before bedtime, the nurse determines that the teaching was effective by which outcome?
A) Discusses feelings about not being able to fall asleep
B) Reports feeling rested on awakening in the morning within 3 days
C) Requests sleeping medication each night before bedtime
D) Is able to sleep for short intervals throughout the night
8. A patient was brought to the emergency department for an injury he received while working as a migrant worker. It soon becomes evident that the patient cannot speak English. A nurse on duty offers to find an interpreter so the patient can communicate with the medical staff. The nurses offer is an example of which type of nursing intervention?
A) Milieu therapy
B) Conflict resolution
C) Cultural brokering
D) Structured interaction
9. A home health nurse is making a home visit to a psychiatric patient who was recently discharged from a mental health unit. During the visit, the nurse plans on clarifying with the patient when she will return for the next home visit. During which stage would the nurse discuss the next home visit with the patient?
A) Closure stage
B) Service implementation
C) Greeting stage
D) Focus establishment
10. The nurse is reviewing the assessment data of a patient diagnosed with a mental illness. The patient is to be prescribed medication to treat the illness. The nurse would identify changes in which laboratory values as being the least significant?
B) Alanine aminotransferase (ALT)
C) Blood urea nitrogen (BUN) level
D) Serum creatinine
Chapter 11- Psychopharmacology, Dietary Supplements
1. A nurse is performing an admission assessment. The patient complains that it has been taking larger and larger amounts of medication to get the desired effect. Based on this information, the nurse interprets this as suggesting which of the following?
C) Therapeutic index
2. An older adult is complaining of anxiety is prescribed diazepam (Valium) by a family physician. The physician asks the office nurse to explain the problematic side effects of this medication to the patient. Which instruction would be most important for the nurse to emphasize about this drug?
A) You may experience minor urine incontinence from time to time.
B) You may find that you have temporary memory disturbances.
C) You need to use this medication cautiously because it can cause dependence.
D) You may feel dizzy and be prone to falls after taking this medication.
3. A nurse is caring for a psychiatric patient who is receiving an antacid that contains aluminum salts. Which action by the nurse would be most appropriate?
A) Give the antacid 1 hour before the antipsychotic medication.
B) Give the antacid at the same time as the antipsychotic medication.
C) Administer the antacid 1 hour after the antipsychotic medication.
D) Administer the antacid just before the patient goes to sleep.
4. A patient is prescribed medication for a psychiatric disorder. After 3 days, the patient tells the nurse that he or she has been constipated. Which instruction would the nurse give the patient?
A) You need to eat more high-protein foods such as meat and peanut butter.
B) You need to eat more fruits and vegetables and drink more water.
C) Ask your psychiatrist to prescribe a stool softener for you.
D) This side effect should disappear within a week or so.
5. The nurse is caring for a 70-year-old psychiatric patient who has been prescribed a number of medications. When teaching the patient about the medications, which explanation would be most appropriate?
A) Your stomach empties more quickly as you age; therefore, you may feel the effect of your medications almost immediately.
B) Your entire GI system speeds up, so your medications are digested much more quickly. Therefore, it is important that you not drive after you take your medications.
C) Because of your age and related changes in liver functioning, you may have medication levels in your system with the potential to be toxic.
D) Because of age-related circulation changes, your body will be able to deliver therapeutic doses of your medication to select body sites more quickly.
6. During the stabilization phase of drug therapy for a patient who is hospitalized with a psychiatric disorder, which action would be most appropriate?
A) Discussing the timing of tapering the medication
B) Instructing the patient about relapse prevention
C) Determining if the medication is losing its effect
D) Assessing the patient for target symptoms and side effects
7. A patient has been prescribed clozapine for treatment of schizophrenia. Which of the following would the nurse include in the teaching plan for this patient and family?
A) You may experience hypertension while taking this medication.
B) One of the side effects of this medication is breast engorgement.
C) People taking this medication often experience dermatitis.
D) You may experience noticeable weight gain while taking this medication.
8. A patient who has been taking clozapine for 6 weeks visits the clinic complaining of fever, sore throat, and mouth sores. The nurse notifies the patients physician because the nurse suspects which of the following?
A) Severe anemia
B) Neuroleptic malignant syndrome
9. A hospitalized patient who has been taking an antipsychotic medication for 2 weeks begins pacing and walking throughout the unit. He tells the nurse that he cannot sit still. The nurse documents this finding as which of the following?
10. The nurse observes an older adult patient who has been taking antipsychotic medications for 8 months. The patient is smacking her lips and blinking her eyes rapidly. The nurse also observes a protruding tongue. Which action by the nurse would be most appropriate?
A) Ask if the patient has been experiencing side effects.
B) Contact the patients physician for a different medication order.
C) Document the patients symptoms of tardive dyskinesia.
D) Instruct the patient to begin tapering off the medication.
Chapter 12- Cognitive Interventions
1. A nurse is assessing a patient with a psychiatric illness. The nurse interprets which patient statement as reflecting the concept of cognitive triad?
A) I always mess things up. No matter what I do, my whole world is a mess, and my future will be a big mess, too.
B) My sister is always the pretty one, her world is free of problems, and shell have a perfect future.
C) My bosses think they know it all, that they can control the worlds future, and that the entire planet is dependent on them.
D) My mother used to always tell me bad things happen in threeslike when someone you know dies, you just know two other people you know will die.
2. A nursing instructor is preparing a class lecture about cognitive behavioral therapy (CBT). Which of the following would the instructor use to best describe this process?
A) Solving patients problems for them by determining how they need to change their thoughts and actions and developing a plan that will help them do so.
B) Using techniques to modify a patients behavior shaping it into behavior that is appropriate in order to help the patient experience a more positive future.
C) Reinforcing distorted beliefs so they can play a major part in changing a patients behavior for the better and improving his or her quality of life.
D) Working in a trusting and collaborative relationship to help patients focus on solving their own problems by changing the way they think and behave.
3. A nurse is working as part of an interdisciplinary treatment team caring for patients with psychiatric disorders. Based on the nurses understanding of cognitive behavioral therapy (CBT) and its limitations cited by critics, the nurse would identify which patient as an inappropriate candidate for CBT?
A) A client diagnosed with substance abuse
B) A client diagnosed with depression
C) A client diagnosed with schizophrenia
D) A client diagnosed with an eating disorder
4. A student does poorly on the first class exam of the semester. Although there are three more tests plus a final exam that will be given during the rest of the semester, the student believes that he will fail the course because of doing so poorly on the one exam. The students belief reflects which type of irrational belief?
A) Low frustration tolerance
B) Absolute thinking
D) A demand
5. A person was supposed to meet a friend at a local theatre to see a movie. The friend never showed up. The persons initial thought was, My friend didnt come because she doesnt like me. This automatic thought was most likely inferred from which irrational belief?
A) Im worthless, so no one could really want to be my friend.
B) Movies are a waste of time and money anyway.
C) Im sure she just got confused and thought we were going to a different movie.
D) Im so forgetful and confused sometimes; I probably wrote down the wrong time.
6. During a staff meeting, a therapist mentions planning to use bibliotherapy with a patient. Later that morning, the patient approaches the nurse and says his therapist just talked to him but that he is having trouble understanding what his therapist wants him to do. When the nurse asks him to clarify his concern, he asks what bibliotherapy really means. Which response by the nurse would be most appropriate?
A) It entails listing books about your diagnosis alphabetically in a reference list in case you ever want to read about your diagnosis.
B) It is a new form of coping technique associated with shopping in a bookstore that works to help lift your depression.
C) It is a form of therapy based on your therapist teaching you knowledge that is crucial to your recovery that he has collected from a variety of books.
D) It is a form of therapy that entails you reading books about ways of perceiving and responding to life events in a different way.
7. A nurse is working with an adolescent girl who describes herself as a compulsive overeater and presents with a history of using food to cope with stress. The nurse decides to use journaling as an intervention for this patient based on the rationale that journaling will help the patient identify which of the following?
A) How often she eats compulsively in response to stress she encounters on a daily basis
B) Patterns in her daily schedule that may be contributing to her compulsive eating
C) Behaviors in others that trigger her compulsion to eat in when she experiences stress
D) Changes in her self-perception and responses to stress that she might otherwise not notice
8. A nurse who is working with a patient being treated for depression is using solution-focused brief therapy (SFBT) during the patients brief psychiatric hospitalization. The nurse decides to use an exception question. Which question would the nurse most likely use?
A) When did you first feel depressed?
B) When do you not feel depressed?
C) What feelings contribute to your depression?
D) What has to happen for you to feel depressed?
9. A group of nursing students is reviewing the history of the development of cognitive therapies over the years. The students demonstrate understanding of the information when they identify which individual as being responsible for first developing cognitive therapy interventions?
A) Aaron Beck
B) Sigmund Freud
C) Albert Ellis
D) de Shazer and Berg
10. During a solution-focused behavior therapy session, the therapist asks a patient to use his imagination based on a scenario in which a patient awakens and all his problems have disappeared. The therapist then asks the patient, How would your life be different? Which type of question is the therapist using?
A) Exception question
B) Miracle question
C) Relationship question
D) Scaling question
Chapter 13- Group Interventions
1. The nurse is preparing to form a group in an inpatient psychiatric setting for patients who have experienced trauma. In addition to the group leader, the nurse would anticipate including how many patients?
A) Three or four
B) Five or six
C) Seven or eight
D) Nine or 10
2. While participating in a group therapy session, one group member consistently asks for clarification of the topic the group is discussing. The nurse leading the group interprets this behavior as reflecting which group role?
C) Information seeker
D) Standard setter
3. While leading a small group, the nurse sets up the ground rules at the beginning of the groups first meeting. One of the rules established is that the group will always start at the specified time rather than waiting to start until after everyone has arrived. This rule reflects which of the following?
A) Group norms
B) Group cohesion
C) Group think
D) Group process
4. The nurse has begun group counseling sessions for several hospitalized patients in the psychiatric facility. Which of the following would be most effective for the nurse to do to promote group cohesiveness?
A) Use team-building exercises.
B) Encourage task completion by members.
C) Spend time with each member individually.
D) Be consistent with the group themes.
5. In an initial group therapy session, the nurse observes that one group member continually tries to monopolize the conversation. The nurse interprets this behavior as reflecting which of the following in the patient?
6. The nurse is leading a small group of hospitalized patients diagnosed with psychiatric disorders. One group member has asked for advice and often agrees with suggestions by other group members but then adds, Yes, but . . . to every suggestion offered. Which response by the nurse would be most appropriate?
A) Things would probably work out better if you joined a different group.
B) Do you realize you say, Yes, but . . . to every suggestion the group has for you?
C) I suggest you stop and think about why you always respond to suggestions with Yes, but . . .
D) What solution do you think would work best for you?
7. A patient has been placed in an anger management group because he has trouble controlling his angry outbursts. The nurse interprets this type group as an example of which of the following?
D) Supportive therapy
8. A nurse is leading a group in which members are encouraged to discuss their feelings and emotions. The group session is just starting when a patient stomps into the room, slams his notebook down on a table, and sits down. His affect is one of anger and hostility. Which response by the nurse would be most appropriate?
A) Keep the focus off the patient so his anger has time to de-escalate.
B) Suggest the patient make a private counseling appointment to address his anger issues.
C) Ask the patient to leave the group until he is calmer.
D) Encourage the patient to discuss his anger with the group.
9. A nurse is leading a group on an adolescent psychiatric unit. A new member in the group is from out of state; his accent and his way of dressing set him apart from the other patients; and it is obvious that the group, for the most part, dislikes this patient. During the group session, the nurse has the members draw the emotion they are feeling and then has them present their drawings and explain them to the group. Which of the following would be the most effective way to address the groups dislike for the new member?
A) Skip him when it is his turn to present his drawing.
B) Let the patient talk last so the others will not have time to make fun of him.
C) Compliment the patient when he presents his drawing.
D) Demand that each member of the group tell the patient why they dislike him.
10. A group of nursing students is reviewing information about the different types of group. The students demonstrate understanding of the information when they identify which of the following as a characteristic of a self-help group that differentiates it from a supportive therapy group?
A) The group is led by a professional.
B) The group is led by a consumer.
C) There is no identified leader.
D) The group is focused on a specific problem.
Chapter 14- Family Assessment and Interventions
1. While caring for a family, the nurse determines that first-order changes have occurred with which of the following?
A) The children are all in school, and the parent returns to work.
B) The daughter leaves home to attend college.
C) The son marries his long-time sweetheart and moves into his own home.
D) The grandmother who has been living in the household dies.
2. The nurse is assessing a family system applying the family system framework model. Which assessment would be important for the nurse?
A) Acceptance of the family rules
B) Adjustment to the family boundaries
C) Degree of enmeshment in the system
D) Interpersonal differentiation
3. While assessing a family system, the nurse uses the structural family system model by Minuchin. The nurse focuses the assessment on which of the following about the family members?
B) Emotional cutoff
C) Sibling position
D) Family projection process
4. A female patient is an adolescent who recently tried to overdose because her boyfriend broke up with her. Her father is a single parent, and he has been drinking excessively to cope with his stress. The patient tells the nurse that whenever she needs to talk to her father, he is always drunk or away drinking with his drinking buddies. Based on this information, which nursing diagnosis would be most appropriate for this patients family?
A) Ineffective Family Therapeutic Regimen Management
B) Compromised Family Coping
C) Ineffective Denial
D) Caregiver Role Strain
5. A family has recently lost all their belongings when their house burned down. They have been living in temporary housing. Although the parents were previously very supportive and able to help their young children with their homework in the evenings, they have been unable to do so under their present circumstances. Based on this information, which nursing diagnosis would be most appropriate for this family?
A) Interrupted Family Processes
B) Compromised Family Coping
C) Ineffective Family Therapeutic Regimen Management
D) Caregiver Role Strain
6. A male patient has recently been diagnosed with type II diabetes. His family is having trouble incorporating the dietary and exercise regimen prescribed by his physician into their daily routines. They tell the nurse that they are all tired when they return home from school and work and that the last thing any of them want to do is go on a walk. In addition, the patients wife discloses that she is unable to prepare any sugar-free or low-sugar foods that her husband enjoys eating. Based on this information, which nursing diagnosis would be
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