Test Bank For Psychiatric Nursing Biological And Behavioral Concepts 2nd Edition By Antai-Otong

Test Bank For Psychiatric Nursing Biological And Behavioral Concepts 2nd Edition By Antai-Otong

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WITH ANSWERS

 

Antai-Otong Psychiatric Nursing Biological 2nd Edition

 

CHAPTER 1HISTORY OF PSYCHIATRIC NURSING

 

MULTIPLE CHOICE

 

1. The major driving force behind current mental health treatment models is which of the following forces?

a.	potential to cause harm
b.	managed care principles
c.	availability of improved neuroleptic medications
d.	concern for humane treatment of the mentally ill

 

 

ANS:  B

Because of the dramatic influence of managed care on health care delivery systems, acutely ill clients are most likely to be diverted from hospitalization or receive shorter lengths of stay.

 

PTS:   1

 

2. Persons experiencing an acute crisis related to a mental illness are most likely to receive which of the following types of care?

a.	long-term commitment to a state hospital
b.	brief care in the least restrictive environment
c.	intensive psychotherapy with a private practitioner
d.	14 days of treatment in a private psychiatric hospital

 

 

ANS:  B

Because of the dramatic influence of managed care on health care delivery systems, acutely ill clients are most likely to be diverted from hospitalization or receive shorter lengths of stay.

 

PTS:   1

 

3. Pinel is best known for which of the following major changes in mental health treatment?

a.	removing the chains from the mentally ill and providing humane treatment
b.	discovering the benefit of chlorpromazine (Thorazine) for treating the mentally ill
c.	promoting the use of better trained personnel in hospitals for the mentally ill
d.	moving the treatment of the mentally ill from the large state institutions to the community

 

 

ANS:  A

Philippe Pinel was placed in charge of Bicetre, a large hospital for the mentally ill. He demonstrated that the mentally ill improved when released from their chains and provided humane treatment. His work brought sweeping changes in French institutions for the mentally ill.

 

PTS:   1

 

4. A student nurse is suffering from test anxiety and is referred to a mental health professional, who provides a variety of treatment modalities. Which of the following treatments would the student be able to attribute to the early work of Mesmer?

a.	hypnosis	c.	dream analysis
b.	paradoxical intention	d.	desensitization

 

 

ANS:  A

Franz Mesmer used techniques that were a form of hypnotism and which stemmed from the ancient use of trances. His work later became the basis of hypnosis.

 

PTS:   1

 

5. Dix is noted for which of the following contributions to improvement of the care of the mentally ill in the United States?

a.	worked with the poor and mentally ill in the tenements of New York City
b.	encouraged states to establish full service community mental health centers
c.	spoke to state legislatures and was instrumental in getting state hospitals built
d.	established the first school of nursing which included psychiatric nursing care

 

 

ANS:  C

Dorothea Lynde Dix brought attention to the deplorable conditions in the mental institutions to various state legislatures. Renewed legislative concern led to the proliferation of state hospitals.

 

PTS:   1

 

6. Beers wrote a classic work entitled A Mind That Found Itself, published in 1908. This work was based on which of the following experiences of Beers?

a.	work with mentally ill inmates in jails and prisons
b.	shared stories of mentally ill private clients of Clifford Beers
c.	tormenting personal experiences as a patient in mental institutions
d.	work with clients who were under hypnosis and their recall of the past

 

 

ANS:  C

Clifford Beers had been treated for mental illness and contributed to preventive care through his classic work entitled A Mind That Found Itself. This work provided a descriptive account of Beers tormenting experiences in mental institutions.

 

PTS:   1

 

7. Richards is noted for which of the following accomplishments?

a.	publishing the first textbook on psychiatric nursing
b.	being the first graduate psychiatric nurse in the United States
c.	serving as the first director of nursing of a state mental hospital
d.	developing the first educational course for psychiatric technicians

 

 

ANS:  B

In 1873, Linda Richards was the first graduate psychiatric nurse in the United States.

 

PTS:   1

 

8. When working with a client who has a diagnosis of schizophrenia, you will likely assess for the presence of the four As of schizophrenia, as identified by Bleuler. You would assess your client for associative looseness, autism, ambivalence, and which of the following symptoms beginning with the letter A?

a.	acrogeria	c.	apathy
b.	anodynia	d.	acuity

 

 

ANS:  C

The four, as identified by Eugen Bleuler, are associative looseness, autism, ambivalence, and affect impairment. Clients with affect impairment exhibit flattened or inappropriate affect to situations. Apathy is a form of affect impairment.

 

PTS:   1

 

9. The Diagnostic and Statistical Manual of Mental Disorders was first published in what year?

a.	1868	c.	1944
b.	1896	d.	1952

 

 

ANS:  D

The American Psychiatric Association published the Diagnostic and Statistical Manual of Mental Disorders in 1952. The current version DSM-IV-TR is a direct consequence of several revisions.

 

PTS:   1

 

10. A masters prepared nurse, who is certified as a clinical specialist by the American Nurses Association, is working with a client using a treatment modality based on the interpersonal theory developed by a theorist who postulated that anxiety can be reduced through a meaningful relationship that stresses effective communication. This nurse is most probably using the theories and methods of which of the following theorists?

a.	Sigmund Freud	c.	Karen Horney
b.	Karl Gustav Jung	d.	Harry Stack Sullivan

 

 

ANS:  D

Harry Stack Sullivan postulated the hypothesis of interpersonal theory. He believed that anxiety interfered with the ability to cope and communicate effectively resulting in mental illness. He believed that anxiety could be lessened by a meaningful interpersonal relationship that stressed the process of effective communication.

 

PTS:   1

 

11. When working in any setting, a nurse following the theories of Peplau would focus most on doing which of the following things when entering a clients room or meeting with a client?

a.	checking for any threats to safety
b.	identifying the roles of significant others
c.	assessing the clients strengths and limitations
d.	building a relationship of mutual understanding

 

 

ANS:  D

Hildegard Peplau wrote Interpersonal Relations in Nursing: A Conceptual Framework of Reference for Psychodynamic Nursing. She asserted that all nurse-client interactions are opportunities to build a mutual understanding and that identifying goals has an impact on client outcomes and responses.

 

PTS:   1

 

12. The first psychotropic medication to be used widely in the treatment of mental illness was which one of the following medications?

a.	Elavil (amitriptyline)	c.	Eskalith (lithium carbonate)
b.	Haldol (Haloperidol)	d.	Thorazine (chlorpromazine)

 

 

ANS:  D

Psychotropics emerged in the 1950s with the introduction of Thorazine (chlorpromazine) to reduce psychiatric symptoms. While Haldol (Haloperidol) is a psychotropic, it was not introduced until the 1970s. Elavil (amitriptyline) is tricyclic used for depression, and Eskalith (lithium carbonate) is used for bipolar disorder.

 

PTS:   1

 

13. The Community Mental Health Movement was generated mainly by:

a.	psychiatrists and psychiatric nurses educating politicians and the public
b.	optimism over new psychodynamic approaches and the major tranquilizers
c.	patients in large psychiatric hospitals demanding a less restrictive treatment
d.	family and friends of persons with mental illness who wanted them at home

 

 

ANS:  B

The optimism generated by new psychodynamic approaches and major tranquilizers led to the Community Mental Health Movement of the 1960s. This resulted in the deinstitutionalization of many chronically ill who were referred to community resources for less restrictive treatment.

 

PTS:   1

 

14. Nurses working with the mentally ill prior to community based care of the mentally ill focused their interventions mainly on:

a.	illness	c.	rehabilitation
b.	primary prevention	d.	managed care

 

 

ANS:  A

Prior to community based care, the care in mental hospitals focused on illness and custodial care. Little attention was placed on primary prevention or tertiary prevention (rehabilitation). Managed care is a much newer concept.

 

PTS:   1

 

15. The focus of psychotherapies in the 1960s is best described as centered on:

a.	transference	c.	the here and now
b.	long-term analysis	d.	early childhood experiences

 

 

ANS:  C

The psychotherapies of the 1960s were developed by Maslow, Berne, Pearls, and others who broke away from traditional long-term psychotherapy and focused on self-actualization therapy that put clients in touch with themselves and focused more on the here and now and not on early life experiences. Transference, long-term analysis, and early childhood experiences are fundamental concepts which relate to psychoanalytic therapies supported by such individuals as Freud and Jung.

 

PTS:   1

 

16. Psychiatric nurses working with clients needing community mental health services most often find community mental health services to be fragmented with lack of coordination in aftercare and rehabilitation services for the mentally ill. Which of the following factors most accounts for this fragmentation and lack of coordination of mental health services?

a.	decrease in the interest of the community in the mentally ill
b.	lack of adequate numbers of masters prepared psychiatric nurses
c.	federal government no longer funding Community Mental Health Centers
d.	lack of demand for services due to newer psychotropic medications

 

 

ANS:  C

By 1984 the federal government had stopped funding the Community Mental Health Centers and there was an overall lack of adequate funding. This led to fragmentation of community mental health services and a lack of coordination in aftercare or rehabilitation.

 

PTS:   1

 

17. Telemedicine presents many challenges to the health care profession. What is the most important challenge to the nurse who is telecommunicating from a distant location and is assisting in the care of a client who is at home?

a.	developing and maintaining a trusting relationship with the client
b.	coordinating the care of the client with the rest of the health care team
c.	getting the client to comply fully with changes in the treatment regimen
d.	finding out about relationships with significant others in the household

 

 

ANS:  A

Despite the advantages of telemedicine and other informational systems, the disadvantage is difficulty in forming trusting interactions with the family and client when not face-to-face.

 

PTS:   1

 

18. When working with a client who is being cared for at home, the client shares that she is taking an herbal medicine purchased from the health food store. The best action on the part of the nurse would be to:

a.	accept the clients right to take any medicine she chooses to take at home
b.	assist the client in researching the benefits and risks of this herbal medicine
c.	make a note of the herbal medicine as well as the dosage amount and frequency
d.	insist the client stop all herbal medicine immediately and stay away from them

 

 

ANS:  B

The growing number of consumers using complementary therapies suggests that psychiatric nurses must familiarize themselves with the advantages and potential risks of these approaches. The client, as an informed consumer and partner with the nurse in her care, needs to be informed as well.

 

PTS:   1

 

19. When working as a psychiatric nurse in todays changing society, you would most need to do which of the following things to meet the needs of individual clients and the community?

a.	become culturally competent
b.	keep up with diagnostic changes
c.	be aware of new drug study results
d.	communicate with clients by e-mail

 

 

ANS:  A

While it is important for psychiatric nurses to recognize the importance of the Internet and informational systems, a more important need is for nurses to have cultural competency skills in order to respond to individual clients and to meet global and community health needs of diverse client populations.

 

PTS:   1

 

20. The mentally ill who were patients in mental institutions in the United States in the last two decades of the 1800s and received care from nurses who had been educated in the first formal training program for nursing of the mentally ill in this country could expect the nurses to provide care centered on:

a.	love and belonging needs	c.	safety and physical needs
b.	developing psychosocial skills	d.	rehabilitation back into society

 

 

ANS:  C

The first formal training for nurses of the mentally ill in the United States was organized in 1882 and focused primarily on custodial care which included the provision of safety and physical needs. This training placed little emphasis on developing psychosocial skills or addressing love and belonging needs. Rehabilitation back into society was not a focus of mental health care until the late 1950s and early 1960s.

 

PTS:   1

 

21. Which of the following had the most impact on changing the nursing role of psychiatric nurses caring for the mentally ill from that of a custodial role to a role focused on therapeutic and preventative perspectives?

a.	American Nurses Association
b.	National Mental Health Act of 1946
c.	National Alliance for the Mentally Ill
d.	World War I work with mentally ill soldiers

 

 

ANS:  B

Increased funding as a result of the National Mental Health Act of 1946 allowed university nursing schools to increase the number of trained psychiatric-mental health nurses available in order to promote the quality of psychiatric nursing education in undergraduate schools. Nursing schools changed from teaching a custodial role to teaching a role with therapeutic and preventative perspectives.

 

PTS:   1

 

22. The significance of psychiatric-mental health nursing practice to the nursing profession was most increased shortly after 1952 by which of the following actions by the National League of Nursing (NLN)?

a.	offering nursing scholarships for study of psychiatric nursing at the masters level
b.	offering certification for qualified psychiatric mental health nursing clinical specialists
c.	requiring accredited nursing schools to have a psychiatric-mental health nursing course
d.	requiring schools of nursing seeking accreditation to limit clinical experiences at night

 

 

ANS:  C

The National League for Nursing (NLN) required that the schools they accredited have an identifiable psychiatric-mental health nursing course. This requirement supported and advanced the significance of psychiatric-mental health nursing practice to the nursing profession. Currently a branch of the NLN, the National League for Nursing Accrediting Commission (NLNAC) is responsible for accrediting nursing programs.

 

PTS:   1

 

23. If you were to work as a psychiatric nurse and fulfill the major functions of a psychiatric nurse as described by Tudor, you would find yourself focusing on which of the following activities?

a.	facilitating communication, social interaction, and self-care
b.	forming an alliance with the client and increasing compliance
c.	orienting the client, reducing any psychosis, and keeping the client safe
d.	teaching the client about mental illness and medication benefits and risks

 

 

ANS:  A

Gwen Tudor stressed the importance of the interpersonal therapeutic relationship between client and nurse. She described the three major functions of the psychiatric nurse to be facilitator of communication, social interaction, and self-care. In addition, she stressed the significance of social context and its impact on the nurses attitude and responses.

 

PTS:   1

 

24. Psychiatric Mental Health nurses most often guide their practice with standards for their specialty published by which of the following entities?

a.	American Nurses Association
b.	The National Institutes of Health
c.	Department of Health and Human Services
d.	National League for Accreditation of Nursing, Inc.

 

 

ANS:  A

The ANA began publishing psychiatric-mental health nursing standards in 1967 with a recent version entitled Psychiatric Mental Health: Scope and Standards of Practice published in 2000. It was developed from the input of nurses in the psychiatric-mental health nursing specialty and addresses each step of the nursing process.

 

PTS:   1

 

25. The Mental Health Act of 1980 and the National Plan for the Chronically Ill in 1981 had which of the following impacts on psychiatric nursing staff in inpatient treatment facilities?

a.	Psychiatric nursing staff were now reimbursed for college tuition.
b.	Medications could no longer be given without a client consent form.
c.	Nurses were replaced by other health care professionals and attendants.
d.	Nurses were now required to have psychiatric-mental health nursing courses.

 

 

ANS:  C

The Mental Health Act of 1980 and the National Plan for the Chronically Ill in 1981 focused on increasing remission and decreasing exacerbation of symptoms through continuity of care in the communities and health care organizations. The result was that nurses were replaced with other health care professionals and attendants to run units and direct client care.

 

PTS:   1

 

26. Psychiatric-mental health nurses interested in promoting the survival of the psychiatric-mental health specialty will recognize which of the following things as most critical to the survival of this specialty?

a.	education of the public in regard to the treatment of mental illness
b.	private practice groups of several psychiatric nursing clinical specialists
c.	integration of holistic and evidence-based health care concepts into practice
d.	contributions to groups lobbying for the advancement of psychiatric nursing

 

 

ANS:  C

Understanding that evidence-based health care is the driving force behind treatment approaches, client responses, treatment efficacy, and the integration of holistic health care concepts into practice are crucial to the survival of the psychiatric-mental health specialty.

 

PTS:   1

 

27. Which of the following categorical systems was developed by Caplan and provide a helpful framework for the work of psychiatric-mental health nurses and other professionals in community-based mental health care, long term inpatient care, and other types of treatment for the mentally ill?

a.	primary, secondary, and tertiary care
b.	the well, the sick, and the worried well
c.	inpatient, outpatient, and partial hospitalization
d.	custodial care, psychosocial programming, and community reentry

 

 

ANS:  A

Gerald Caplan developed and wrote about primary, secondary, and tertiary care in the late 1950s and early 1960s just as hospitals were discharging large numbers of patients into the community and nurses as well as other mental health professionals began to work on primary prevention in the community.

 

PTS:   1

 

28. If psychiatric nurses were to follow McBrides advice of the 1990s, nursing research and reading of research would focus on which of the following areas?

a.	the cost of community based care compared with inpatient care
b.	the effects of interactions with significant others on recidivism rates
c.	the benefits of complementary therapies in treatment of mental illness
d.	increasing nursing knowledge about the neurobiology of mental illness

 

 

ANS:  D

In 1990, Angela McBride wrote that the research agenda for psychiatric nurses is an important component of integrating biological concepts into practice and areas that need change include closing the gap of nursing knowledge regarding the relevance of the neurobiology of mental illness.

 

PTS:   1

 

29. Psychiatric mental health nurses who followed the theories of Horney, a prominent psychoanalyst (1885-1952), would have looked to which of the following as most important in the development of personality and maladaptive responses?

a.	biological drives	c.	id, ego, and superego
b.	genetic inheritance	d.	interpersonal relationships

 

 

ANS:  D

Karen Horney was a Neo-Freudian who objected to Freuds idea that neurosis and personality development is based on biological drives. Neo-Freudians stressed the impact of disturbed interpersonal relationships in maladaptive responses and minimized the biological factors of mental illness.

 

PTS:   1

 

30. In 1989, Congress proclaimed the 1990s as the decade of:

a.	the brain	c.	discovery
b.	neuroscience	d.	technology

 

 

ANS:  A

On July 25, 1989, the United States Congress proclaimed the 1990s as the decade of the brain.

 

PTS:   1

 

31. What ratio of clients seeking conventional health care was also using complementary therapies according to the study conducted by Eisenberg and colleagues?

a.	1 in 3	c.	1 in 7
b.	1 in 5	d.	1 in 10

 

 

ANS:  A

The research of David Eisenberg and colleagues (1993) suggests that one in three clients seeking conventional health care was also using complementary therapies.

 

PTS:   1

 

32. Which nursing theorist promoted the therapeutic use of self?

a.	Martha Rogers	c.	Hildegard Peplau
b.	Imogene King	d.	Dorothea Orem

 

 

ANS:  C

The importance of the nurses therapeutic use of self was advanced in 1952 by Hildegard Peplaus text, Interpersonal Relations in Nursing: A Conceptual Frame of Reference for Psychodynamic Nursing.

 

PTS:   1

 

33. In the late 18th century, the role of the psychiatric nurse was:

a.	essentially nonexistent
b.	emphasized the nursing process and research
c.	involved use of various psychotherapeutic interventions
d.	focused on providing a safe, kind, and clean environment

 

 

ANS:  A

In the late 18th century, the role of the nurse was essentially nonexistent.

 

PTS:   1

 

34. Psychiatric nurses planning to serve as disaster relief personnel should base their decisions on the fact that the effects of terrorism as well as man-made and natural disasters:

a.	are not an important issue in the United States
b.	do not require nurses to have any special training
c.	can result in a short- and long-term traumatic sequel
d.	usually do not require the services of a psychiatric nurse

 

 

ANS:  C

Recent studies indicate that terrorism and man-made and natural disasters can result in a short- or long-term sequel.

 

PTS:   1

 

35. Which organization established the first certification of psychiatric nurses?

a.	National League for Nursing
b.	American Nurses Association
c.	National Institute of Mental Health
d.	National Center for Nursing Research

 

 

ANS:  B

In 1973, the American Nurses Association established the first certification program for psychiatric nurses.

 

PTS:   1

 

36. Which of the following stressed preventive care and the need for formal training in child psychiatry?

a.	Sigmund Freud	c.	Adolph Meyer
b.	Clifford Beers	d.	Harry Stack Sullivan

 

 

ANS:  C

Adolph Meyer stressed preventive care and the need for formal training in child psychiatry.

 

PTS:   1

 

MULTIPLE RESPONSE

 

1. The Alliance of Psychiatric Mental Health Nurses is composed of which organizations? Select all that apply.

a.	National League for Nursing
b.	Coalition of Psychiatric Nurses
c.	Nurses in Action for Better Mental Health
d.	American Association of Colleges of Nursing
e.	American Psychiatric Nurses Association
f.	International Society of Psychiatric-Mental Health Nurses

 

 

ANS:  B, E, F

The Alliance of Psychiatric Mental Health Nurses is composed of the American Psychiatric Nurses Association (APNA), Coalition of Psychiatric Nurses (CPA), and the International Society of Psychiatric-Mental Health Nurses (ISPN).

 

PTS:   1

 

2. Mental health nurses working in clinics which support the use of complementary therapies must familiarize themselves with the advantages and potential risks of which of the following? Select all that apply.

a.	herbs
b.	biofeedback
c.	acupuncture
d.	aroma therapy
e.	massage therapy
f.	nutritional approaches

 

 

ANS:  A, B, C, D, E, F

Complementary therapies include the use of herbs, biofeedback, acupuncture, aroma therapy, massage therapy, and nutritional approaches.

 

PTS:   1

 

3. Which statements regarding the deinstitutionalization of the mentally ill are correct? Select all that apply.

a.	occurred during the 19th Century
b.	occurred during the 20th Century
c.	involved only secondary prevention
d.	was a result of better treatment in the state hospitals
e.	offered services to clients, families, and communities
f.	was a result of the Community Mental Health Centers Act

 

 

ANS:  B, E, F

Deinstitutionalization resulted from the Community Mental Health Centers Act of 1963. Services were provided to clients, families, communities, and various cultures.

 

PTS:   1

 

4. Which of the following were true about the treatment of mental illness during ancient times? Select all that apply.

a.	Mental illness was seen as incurable.
b.	Custodial care was provided in asylums.
c.	Bloodletting was a common practice.
d.	Insanity was associated with sin and demonic possession.
e.	Herbs, precious stones, and ointments were used for treatment.
f.	The mentally ill were treated with patience and understanding.

 

 

ANS:  A, D, E

During ancient times, mental illness was associated with sin and demonic possess, and it was thought to be incurable. Healers used herbs, precious stones, and ointments when treating these individuals.

 

PTS:   1

CHAPTER 3INTERFACING BIOLOGICAL-BEHAVIORAL CONCEPTS INTO PSYCHIATRIC NURSING PRACTICE

 

MULTIPLE CHOICE

 

1. If you were to work with the family of a person who has had mental illness for many years and you asked the family how they felt about neurobiological and genetic research findings, the most likely answer would be:

a.	relief that family interactions are no longer thought to be the major cause of mental illness
b.	happy that their family member will soon be able to be cured of mental illness
c.	upset that findings indicate that some illnesses are due to structural changes
d.	frightened that the person with mental illness will be taking newer, less tested drugs

 

 

ANS:  A

In the past, parents and siblings were thought to be responsible for many mental illnesses, and they have felt demoralized and blamed for their loved ones illness. With current research demonstrating that the cause of mental illness is more complex and may include neurobiological and genetic factors, the burden of blame and guilt is reduced.

 

PTS:   1

 

2. Which of the following ideas held by Hippocrates in the 14th century are still valid in psychiatric-mental health work today?

a.	The hypothalamic-pituitary-adrenal axis has a great deal to do with mental disorders.
b.	The brain gives rise to emotions and contributes to disturbances in affect or mood.
c.	There is a tenuous balance of four humors in the body that contribute to mood.
d.	All persons with mental disorders need to be treated kindly in a relaxing setting.

 

 

ANS:  B

Hippocrates surmised that the brain gives rise to pleasure, joy, pain, and grief, and it contributes to disturbances in affect and mood. Hippocrates early description of the tenuous balance of four humors (blood, phlegm, and yellow and black bile) and their relationship to mood disorders proved inaccurate.

 

PTS:   1

 

3. You are administering medications to a group of clients in treatment for various mental illnesses. Which of the following medications in your medication cart is a selective serotonergic reuptake blocking agent?

a.	fluoxetine (Prozac)	c.	clozapine (Clozaril)
b.	quetiapine (Seroquel)	d.	haloperidol (Haldol)

 

 

ANS:  A

Prozac is one of the serotonergic reuptake blocking agents. Other SSRIs include paroxetine (Paxil), sertraline (Zoloft), and fluvoxamine (Luvox). Clozaril is an atypical antipsychotic and Haldol is one of the older major psychotropics (antipsychotics).

 

PTS:   1

 

4. You are preparing to administer medications to two of your assigned clients. One has an eating disorder and the other has an anxiety disorder. These two clients are on the same medications. You look up their medications to review appropriate usage as well as side effects. Which of the following medications would be most appropriate for treatment of both these clients and others with these two different diagnoses?

a.	sertraline (Zoloft)
b.	loxapine (Loxitane)
c.	olanzapine (Zyprexa)
d.	fluphenazine decanoate (Prolix Decanoate)

 

 

ANS:  A

Both patients could receive Zoloft because it is a selective serotonergic reuptake blocking agent (SSRI). These medications have been found to be effective in treating major depression as well as eating, impulsivity, and anxiety disorders. Olanzapine (Zyprexa) is an atypical antipsychotic. Loxapine (Loxitane) and fluphenazine decanoate (Prolix Decanoate) are both typical antipsychotics.

 

PTS:   1

 

5. An elderly client is very concerned that she is aging and will become forgetful because she has heard that there are many changes in the brain as you age. Which of the following statements could you use in teaching this client about aging and the brain that would be true?

a.	The brain gets bigger due to excess fluid as you age.
b.	There is very little loss of neurons after the fifth decade.
c.	There is no definitive evidence of mental decline with aging.
d.	If you are going to become forgetful, it usually happens by age 60.

 

 

ANS:  C

The brain does get smaller and there is significant loss of neurons after the fifth decade. There is no definitive evidence of mental decline with aging.

 

PTS:   1

 

6. Which of the following statements best describes the cause of mental illness?

a.	neurotransmitter dysfunction
b.	a variety of contributing factors
c.	a failure of the immunological system
d.	underlying structural defects in the brain

 

 

ANS:  B

A variety of factors are implicated in the cause of mental illness. (No one cause has been found.) These factors include abnormalities in structure of the brain, neurotransmitter production or absorption, neuroendocrine responses, immune responses, and genetic predisposition. All have been found to contribute to mental disorders.

 

PTS:   1

 

7. When working with a client with a diagnosis of major depression, it is most important to assess these clients for any signs or symptoms of which one of following problems that has been shown by research to have adverse outcomes closely associated with depression?

a.	astrocytomas	c.	liver disease
b.	paresthesias	d.	heart disease

 

 

ANS:  D

The link between mood disturbances, such as depression, and adverse outcomes in heart disease, specifically myocardial infarction, is well documented and accounts for half of the cases of depression in those recovering from myocardial infarction. Literature supports the fact that there is an arrhythmic mechanism that is the link between psychological factors and sudden cardiac death.

 

PTS:   1

 

8. When working with a client who is being treated for hypertension with a regimen of medications, exercise, and lifestyle changes, which of the following conditions would you set as a top priority to periodically assess?

a.	a change in sexual functioning
b.	uncontrollable coughing at times
c.	effect of exercise on the clients mood
d.	any change in mood, especially depression

 

 

ANS:  D

Many medications used to treat medical conditions contribute to a depressed mood, and this is possible with some medications used to treat hypertension. While it would be helpful to know the effect of exercise on mood, changes in sexual functioning, and problems with coughing associated with the medication, it is most important to assess for and treat any depression.

 

PTS:   1

 

9. When assessing a client with depression, you would most want to assess for which of the following problems that is often associated with depression?

a.	bulimia	c.	ringing in the ears
b.	nervous leg syndrome	d.	cognitive impairment

 

 

ANS:  D

For years, health providers have recognized that cognitive impairment may be linked with depressive disorders. Negative self-reverent cognitions, which are related to perceptions of loss, are believed to be a mediator of depressive symptoms.

 

PTS:   1

 

10. Researchers have suggested that the brain adapts to aging by preserving an abundance of nerve cells rich in which of the following substances that are linked to higher cortical functioning?

a.	GABA	c.	acetylcholine
b.	dopamine	d.	norepinephrine

 

 

ANS:  C

Some researchers have found that the brain adapts to aging by preserving an abundance of nerve cells rich in acetylcholine in neurotransmitter pathways between the hippocampus and the cerebral cortex. These changes are linked to higher cortical functioning.

 

PTS:   1

 

11. Which of the following signs or symptoms would you most likely find when assessing a client with frontotemporal dementia (FTD) which is primarily affecting the left frontotemporal lobe?

a.	Jacksonian seizures	c.	occasional inappropriate affect
b.	childlike silliness	d.	progressive speech difficulties

 

 

ANS:  D

Frontotemporal dementia is characterized with symptoms similar to AD with progressive speech difficulties associated particularly with FTD when it affects primarily the left frontotemporal lobe.

 

PTS:   1

 

12. While reading the chart of a newly assigned client, you find that the physician has ordered donepezil (Aricept). In reviewing this drug, you will find that the expected action of this drug is to:

a.	stimulate the production of cortisone
b.	stimulate the respiratory center of the brain
c.	regulate the production of thyroid hormones
d.	prolong the life of existing cholinergic neurons

 

 

ANS:  D

Drugs that prolong the life of existing cholinergic neurons include donepezil (Aricept) which is given to clients with Alzheimers disease.

 

PTS:   1

 

13. Which of the following drugs is given in hopes it will delay the clinical decline of clients with a diagnosis of Alzheimers disease?

a.	aurothioglucose (Sogonal)
b.	ceftuzixime sodium (Cefizox)
c.	clonidine hydrochloride (Duraclon)
d.	galantamine hydrobromide (Reminyl)

 

 

ANS:  D

Like donepezil (Aricept), the drug galantamine hydrobromide (Reminyl) prolongs the life of existing cholinergic neurons and may delay the clinical decline in clients with Alzheimers disease.

 

PTS:   1

 

14. Which of the following neurotransmitters is classified as an inhibitory transmitter?

a.	serotonin	c.	norepinephrine
b.	acetylcholine	d.	gamma-aminobutyric acid

 

 

ANS:  D

Scientists have identified norepinephrine, dopamine, acetylcholine, and serotonin as excitatory transmitters. They have identified gamma-aminobutyric acid as an example of an inhibitory transmitter.

 

PTS:   1

 

15. One of your clients describes being able to move a heavy car off the body of a friend to save the friends life. The client most likely was able accomplish this due to:

a.	weeks of workouts with weight lifting
b.	the release of large amounts of glucagon
c.	the hypothalamic-pituitary-adrenal response
d.	ability to control the mind with specific thoughts

 

 

ANS:  C

The hypothalamic-pituitary-adrenal axis will respond when a person is subjected to stress including threats of harm or danger to self or others.

 

PTS:   1

 

16. Abnormalities in the hypothalamic-pituitary-adrenal axis have been found to contribute to and to be diagnostic of which of the following conditions?

a.	myasthenia gravis	c.	functional psychosis
b.	conversion disorder	d.	systemic lupus erythematosus

 

 

ANS:  C

Abnormalities in the HPA axis are known to contribute to and are diagnostic of functional psychosis, phobias, bipolar disorder, depressive disorder, and anxiety disorder.

 

PTS:   1

 

17. The relatively new field of psychoneuroimmunology is a developing knowledge concerned with:

a.	proving a connection between AIDS and the development of depression
b.	interconnections between the nervous system and the immune system
c.	providing clients at high risk for mental illness with preventative measures
d.	immunizing clients with psychiatric illness against neurological problems

 

 

ANS:  B

Psychoneuroimmunology is a developing knowledge concerned with the interconnections between the nervous system and the immune system.

 

PTS:   1

 

18. A client with systemic lupus erythematosus (SLE) asks the nurse to talk about the cause of this disease. Which of the following responses by the nurse would be most accurate?

a.	There is a deficiency in dopamine and/or specific dopamine receptors.
b.	It is caused by a systemic virus that is most likely carried by a mosquito.
c.	This involves the destruction of the myelin sheath and problems in conduction.
d.	The immune system has attacked itself in a failure to recognize its own cells as self.

 

 

ANS:  D

When the immune system fails to differentiate self from nonself, it can attack itself as in autoimmune diseases like systemic lupus erythematosus (SLE).

 

PTS:   1

 

19. The family of a young adult who has panic disorder asks you about recent research related to the cause of panic disorders. Which of the following statements would you share with the family as a true statement?

a.	New research points to a relationship to thyroid dysfunction.
b.	Panic disorders have been recently linked to immune dysfunction.
c.	Early childhood experiences coupled with genetic defects are implicated.
d.	This disorder is most likely a learned behavior according to recent research.

 

 

ANS:  B

Recently, psychiatric illnesses, notably affective disorders and panic disorders, have been linked to immune dysfunction.

 

PTS:   1

 

20. Genetic theories regarding the cause of schizophrenia began during which of the following times?

a.	early 1900s	c.	the Korean conflict
b.	World War II	d.	mid-1970s

 

 

ANS:  A

Genetic theories regarding the cause of schizophrenia date back to Kraepelin in the early 1900s. Kraepelin observed that bizarre behavior was commonly found in families of clients with schizophrenia.

 

PTS:   1

 

21. Twin, adoption, and family studies of people with schizophrenia have supported which of the following premises?

a.	Schizophrenia is most likely a group of related genetic disorders.
b.	Lack of family support is the major cause of relapse and recidivism.
c.	Environmental factors are just as relevant as genetic processes.
d.	It is unlikely that the cause of schizophrenia is genetic in nature.

 

 

ANS:  C

Twin, adoption, and family studies to determine the impact of environmental factors on genetic expression have shown that environmental factors are just as important as molecular-based genetic processes. Environmental factors include parental treatment or caregiving patterns, family structures, age spacing, and gender. These factors may buffer or protect genetically vulnerable clients.

 

PTS:   1

 

22. When trying to identify clients at risk for alcoholism and other addictions, the nurse most needs to keep in mind which of the following factors that place certain individuals at greatest risk?

a.	living with a friend or relative who is an alcoholic
b.	being in a location where there is access to alcohol
c.	having an alcoholic parent or grandparent and being in college
d.	suffering from bipolar disorder and having visual hallucinations

 

 

ANS:  C

The role of genetic factors and alcoholism has been well supported by twin, family, and adoption studies. Some people with a genetic predisposition to alcoholism do not drink alcohol or abuse substances because they have seen the harm it does to an individual and the family. Affect and mood disorders are not as great a risk as having genetic markers and environmental factors such as peer pressure and access.

 

PTS:   1

 

23. A popular explanation for substance abuse lies in the mesolimbic-mesocortical areas of the brain and mainly involves which of the following neurotransmitters and receptors?

a.	GABA	c.	acetylcholine
b.	dopamine	d.	norepinephrine

 

 

ANS:  B

The mesolimbic-mesocortical areas of the brain contain the various types of dopamine receptors including those that generate reward and reinforcement behaviors. Clients with a biochemical predisposition to alcoholism will gain reinforcement directly from the alcohol and its interaction with specific dopamine receptors.

 

PTS:   1

 

24. One area of newer technological advances is in the area of stem cell research. What is the hope of medicine in regard to stem cells?

a.	They can be used to prolong the expected life span.
b.	They can be used to control negative emotions.
c.	Stem cells can be used as universal donor cells.
d.	Use of stem cells will cure quicker and cheaper than drugs.

 

 

ANS:  C

As universal donor cells, stem cells could offer cures to currently incurable diseases such as childhood diabetes, Alzheimers, and spinal cord injury.

 

PTS:   1

 

25. The psychiatric nurse will find that the use of herbal medicines in the past decade has done which of the following things?

a.	sharply decreased	c.	increased a small amount
b.	stayed about the same	d.	increased sharply

 

 

ANS:  D

The use of herbal medicines has risen sharply over the past decade from 3% to 12%. Herbal therapy use exists across age, gender, culture, and ethnic groups. The most cited health problems addressed by this form of therapy include chronic pain, anxiety, arthritis, chronic fatigue syndrome, and headaches. One reason for the increased use of herbal medicine is that it is readily available on the Internet, pharmacies, and health food stores.

 

PTS:   1

 

26. Recent studies of lithium and valproate acid have found that these substances regulate which of the following things?

a.	acetycholinesterase levels
b.	adrenal hormonal production
c.	protein kinase C (PKC) activities
d.	dopamine receptor site receptivity

 

 

ANS:  C

Lithium and valproate acid regulate protein kinase C (PKC) activities and have efficacy in the treatment of acute mania. PKC is a group of calcium and phospholipid-dependent enzymes and is found to be elevated during acute mania. Treatment with lithium and valproate acid depresses PKC activity during mania.

 

PTS:   1

 

27. Which of the following examples of your c

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