Essentials of Psychiatric Mental Health Nursing 8th Edition Concepts of Care in Evidence- Based Practice 8th Edition Morgan Townsend Test Bank

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Multiple Choice 1. A nurse is assessing a client who is experiencing occasional feelings ofsadness because of therecent death of a beloved pet. The clients appetite, sleep patterns, and daily routin ... e have not changed. How should the nurse interpret the clients behaviors? 1. The clients behaviors demonstrate mental illness in the form ofdepression. 2. The clients behaviors are extensive, which indicates the presenceof mental illness. 3. Theclients behaviors arenotcongruent withculturalnorms. 4. Theclients behaviors demonstrateno functional impairment, indicating no mental illness. ANS: 4 Rationale: Thenurseshouldassess that theclients dailyfunctioning is not impaired. Theclientwho experiences feelings of sadness after the loss of a pet is responding within normal expectations. Without significant impairment, the clients distress does not indicate a mental illness. Cognitive Level: Analysis Integrated Process: Assessment 2. At whatpointshould the nursedetermine thataclient is at risk fordeveloping a mentalillness? 1. When thoughts, feelings, and behaviors are notreflectiveof the DSM-5 criteria. 2. When maladaptive responses to stress arecoupled with interference indaily functioning. 3. Whenaclient communicates significant distress. 4. Whenaclientuses defense mechanisms as egoprotection. ANS:2 Rationale: The nurse should determine that the client is at risk for mental illness when responsesto stress are maladaptive and interfere with daily functioning. The DSM-5 indicates that in orderto be diagnosed with a mental illness, daily functioning must be significantly impaired. The clients ability to communicate distress would be considered a positive attribute. CognitiveLevel: Application Integrated Process: Assessment 3. A nurse is assessing asetof 15-year-old identical twins who respond verydifferently to stress.One twin becomes anxious and irritable, and the other withdraws and cries. How should the nurse explain these different stress responses to the parents? 1. Reactions to stress arerelative rather thanabsolute; individual responses to stress vary. 2. It is abnormal for identical twins to reactdifferentlyto similar stressors. 3. Identical twins should share the same temperamentand respondsimilarly to stress. 4. Environmental influences to stress weigh moreheavily thangenetic influences. ANS: 1 Rationale: The nurse should explain to the parents that, although the twins have identical DNA,there are severalother factors thataffect reactions to stress. Mentalhealth is a stateofbeing thatis relative to the individual client. Environmental influences and temperament can affect stress reactions. Cognitive Level: Application Integrated Process: Implementation 4. Whichclientshould the nurseanticipate to be mostreceptive to psychiatric treatment? 1. A Jewish, female social worker. 2. A Baptist, homeless male. 3. A Catholic, black male. 4. A Protestant, Swedishbusiness executive. ANS: 1 Rationale: The nurse should anticipate that the client of Jewish culture would place a high importance on preventative health care and would consider mental health as equally important asphysical health. Women are also more likely to seek treatment for mental health problems than men. CognitiveLevel: Application Integrated Process: Planning 5. A psychiatric nurse internstates, This clients use ofdefense mechanisms should be eliminated.Which is a correctevaluation of this nurses statement? 1. Defense mechanisms canbeappropriate responses to stress andneed notbeeliminated. 2. Defense mechanisms are a maladaptive attemptof the ego to manage anxietyand shouldalways be eliminated. 3. Defense mechanisms,used byindividuals with weakego integrity, should bediscouragedandnot eliminated. 4. Defense mechanismscausedisintegration of the egoand should be fostered and encouraged. ANS: 1 Rationale: The nurseshoulddetermine thatdefense mechanisms canbeappropriate during timesof stress. The client with no defense mechanisms may have a lower tolerance for stress, thus leading to anxiety disorders. Defense mechanisms should be confronted when they impede the client from developing healthycoping skills. Cognitive Level: Application Integrated Process:Evaluation 6. During an intake assessment, anurseasks bothphysiologicaland psychosocialquestions. Theclient angrily responds, Im here for my heart, not my head problems. Which is the nurses best response? 1. Its justa routine partofour assessment. Allclients are asked these same questions. 2. Whyare you concerned about these types ofquestions? 3. Psychological factors, likeexcessive stress, have been found to affect medicalconditions. 4. Wecanskip thesequestions, if you like. It isnt imperative that wecomplete this section. ANS: 3 Rationale: The nurse should attempt to educate the clienton the negative effects ofexcessivestress on medical conditions. It is not appropriate to skip physiological and psychosocial questions, as this would lead to an inaccurate assessment. Cognitive Level: Application Integrated Process: Implementation 7. Anemployee uses the defense mechanism ofdisplacement when the boss openlydisagreeswith suggestions. Whatbehavior would be expected from this employee? 1. Theemployeeassertivelyconfronts the boss. 2. The employee leaves the staff meeting to workout in thegym. 3. The employee criticizes a coworker. 4. The employee takes the boss out to lunch. ANS: 3 Rationale: The nurseshouldexpect that theclientusing thedefense mechanism displacementwould criticize a coworker after being confronted by the boss. Displacement refers to transferring feelings from one target to a neutralor less-threatening target. Cognitive Level: Analysis Integrated Process: Assessment 8. A fourth-grade boyteases and makes jokes abouta cutegirl in his class. This behavior shouldbe identified bya nurse as indicative of which defense mechanism? 1. Displacement 2. Projection 3. Reaction formation 4. Sublimation ANS: 3 Rationale: The nurse should identify that the boy is using reaction formation as a defense mechanism. Reaction formation is the attempt to prevent undesirable thoughts from being expressed by expressing opposite thoughts or behaviors. Displacement refers to transferring feelings from one target to another. Rationalization refers to making excuses to justifybehavior.Projection refers to the attributionof unacceptable feelings orbehaviors to another person. Sublimationrefers to channeling unacceptabledrives or impulses into moreconstructive,acceptable activities. CognitiveLevel: Application Integrated Process: Assessment 9. Which nursingstatementabout theconceptofneurosis is mostaccurate? 1. An individualexperiencing neurosis is unaware thathe orshe is experiencing distress. 2. An individualexperiencingneurosis feels helpless to change his orher situation. 3. An individual experiencing neurosis is aware ofpsychologicalcauses ofhis or herbehavior. 4. An individualexperiencing neurosis has a loss ofcontact with reality. ANS:2 Rationale: Thenurseshould define the conceptofneurosis with the followingcharacteristics: The client feels helpless to change his or her situation, the client is aware thathe or she is experiencing distress, the client is aware the behaviors are maladaptive, the client is unaware of thepsychological causes of the distress, and the clientexperiences no loss ofcontact withreality. CognitiveLevel: Application Integrated Process: Assessment 10. Which nursingstatement regarding theconceptofpsychosis is mostaccurate? 1. Individuals experiencingpsychoses areaware that theirbehaviors are maladaptive. 2. Individuals experiencing psychoses experience littledistress. 3. Individuals experiencingpsychoses areaware ofexperiencing psychologicalproblems. 4. Individuals experiencing psychoses arebased inreality. ANS:2 Rationale: The nurse should understand that the client with psychosis experiences little distressowing to his or her lack ofawareness of reality. The client with psychosis is unaware that his orher behavior is maladaptive or thathe or she has a psychologicalproblem. CognitiveLevel: Application Integrated Process: Assessment 11. When under stress, a client routinely uses alcohol to excess. Finding her drunk, her husband yells at the clientabouther chronic alcoholabuse. Whichaction alerts the nurse to the clients useof the defense mechanism ofdenial? 1. Theclienthides liquor bottles inacloset. 2. Theclient yells ather sonfor slouching inhis chair. 3. The clientburns dinner onpurpose. 4. Theclientsays to the spouse, I dontdrink too much! ANS: 4 Rationale: The clients statement I dont drink too much! alerts the nurse to the use of the defense mechanism of denial. The client is refusing to acknowledge the existence of a real situation and the feelings associated with it. CognitiveLevel: Application Integrated Process: Assessment 12. Devastated by a divorce from an abusive husband, a wife completes grief counseling. Whichstatement bythe wifeshould indicate to anurse that theclient is in the acceptance stageofgrief? 1. Ifonly we could have tried again, things mighthave workedout. 2. Iam so mad that the childrenand I had to put up with him as long as wedid. 3. Yes, it was adifficult relationship, but I think Ihave learned from the experience. 4. I stilldont have anyappetite and continue to lose weight. ANS: 3 Rationale: The nurse should evaluate that the client is in the acceptance stage of grief because during this stage of the griefprocess, the client would be able to focus onthe realityof the lossand its meaning in relation to life. Cognitive Level: Analysis Integrated Process:Evaluation 13. A nurse is performing a mental health assessment on an adult client. According to Maslows hierarchy of needs, which client action would demonstrate the highest achievement in terms of mental health?1. Maintaininga long-term, faithful, intimaterelationship.2. Achievingasenseofself-confidence.3. Possessing a feeling of self-fulfillment and realizing full potential.4. Developing a sense ofpurpose and the ability to directactivities. ANS: 3 Rationale: The nurse should identify that the client who possesses a feeling of self-fulfillmentand realizes his orher fullpotentialhas achieved self-actualization, the highest levelon Maslowshierarchyofneeds. CognitiveLevel: Application Integrated Process: Assessment 14. According to Maslows hierarchy of needs, which situation on an in-patient psychiatric unit would require priority intervention by a nurse?1. A client rudely complaining about limited visitinghours.2. A clientexhibiting aggressive behavior towardanother client.3. A clientstatingthatno one cares. 4. A client verbalizing feelings of failure.ANS: 2 Rationale: Thenurseshould immediatelyintervene whenaclient exhibits aggressive behaviortoward another client. Safety and security are considered lower-level needs according to Maslows hierarchy of needs and must be fulfilled before other higher-level needs can be met. Clients who complain, have feelings of failure, or state that no one cares are struggling with higher-levelneeds suchas the need for love and belonging or the need for self-esteem. Cognitive Level: Analysis Integrated Process:Evaluation 15. How would a nurse best complete the new DSM-5 definition of a mental disorder? A health condition characterizedbysignificantdysfunction in an individuals cognitions, orbehaviors thatreflects a disturbance in the 1. psychosocial,biological,ordevelopmentalprocessunderlying mental functioning. 2. psychological, cognitive,ordevelopmentalprocessunderlying mental functioning. 3. psychological, biological,ordevelopmentalprocess underlying mental functioning. 4. psychological, biological, orpsychosocialprocess underlying mental functioning. ANS: 3 Rationale: A health condition characterized by significant dysfunction in an individuals cognitions, or behaviors that reflects a disturbance in the psychological, biological, or developmentalprocess underlying mental functioning, is the new DSM 5 definitionofa mentaldisorder. CognitiveLevel: Application Integrated Process: Assessment Multiple Response 16. A nurse is assessing a client who appears to be experiencing some anxiety during questioning. Which symptoms might the client demonstrate that would indicate anxiety? (Select all that apply.) 1. Fidgeting 2. Laughing inappropriately 3. Palpitations 4. Nail biting 5. Limited attention span ANS: 1, 2, 4 Rationale: The nurse should assess that fidgeting, laughing inappropriately, and nail biting are indicative of heightened stress levels. The client would not be diagnosed with mental illness unless there is significant impairment in other areas of daily functioning. Other indicators of more serious anxiety are restlessness, difficulty concentrating, muscle tension, and sleep disturbance. Cognitive Level: Application Integrated Process: Assessment Fill-in-the-Blank 17. is a diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness. ANS: Anxiety Rationale: The definition of anxiety is a diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness. Townsend considers this a core concept. Cognitive Level: Application Integrated Process: Assessment 18. is a subjective state of emotional, physical, and social responses to the loss of a valued entity. ANS: Grief Rationale: The definition of grief is a subjective state of emotional, physical, and social responses to the loss of a valued entity. Townsend considers this a core concept. Chapter 2. Biological Implications Multiple Choice 1. A depressed client states, I have a chemical imbalance in my brain. I have no control over my behavior. Medications are my only hope to feel normal again. Which nursing response is appropriate?1. Medications only address biological factors. Environmental and interpersonal factors must also be considered.2. Because biological factors are the sole cause of depression, medications will improve your mood.3. Environmental factors have been shown to exert the most influence in the development of depression.4. Researchers have been unable to demonstrate a link between nature (biology and genetics) and nurture (environment). ANS: 1 Rationale: The nurse should advise the client that medications address biological factors, but there are other factors that affect mood. The nurse should educate the client on environmental and interpersonal factors that can lead to depression. Cognitive Level: Analysis Integrated Process: Implementation 2. A client diagnosed with major depressive disorder asks, What part of my brain controls my emotions? Which nursing response is appropriate?1. The occipital lobe governs perceptions, judging them as positive or negative.2. The parietal lobe has been linked to depression.3. The medulla regulates key biological and psychological activities.4. The limbic system is largely responsible for ones emotional state. ANS: 4 Rationale: The nurse should explain to the client that the limbic system is largely responsible for ones emotional state. This system if often called the emotional brain and is associated with feelings, sexuality, and social behavior. The occipital lobes are the area of visual reception and interpretation. Somatosensory input (touch, taste, temperature, etc.) occurs in the parietal lobes. The medulla contains vital centers that regulate heart rate and reflexes. Cognitive Level: Application Integrated Process: Implementation 3. Which part of the nervous system should a nurse identify as playing a major role during stressful situations? 1. Peripheral nervous system 2. Somatic nervous system 3. Sympathetic nervous system 4. Parasympathetic nervous system ANS: 3 Rationale: The nurse should identify that the sympathetic nervous system plays a major role during stressful situations. The sympathetic nervous system prepares the body for the fight-orflight response. The parasympathetic nervous system is dominant when an individual is in a nonstressful state. Cognitive Level: Comprehension Integrated Process: Assessment 4. Which client statement reflects an understanding of circadian rhythms in psychopathology?1. When I dream about my mothers horrible train accident, I become hysterical. 2. I get really irritable during my menstrual cycle.3. Im a morning person. I get my best work done before noon. 4. Every February, I tend to experience periods ofsadness. ANS: 3 Rationale: By stating, I am a morning person, the client demonstrates an understanding that circadian rhythms may influence a variety of regulatory functions, including the sleep-wake cycle, regulation of body temperature, and patterns of activity. Most humans follow a 24-hour cycle that is largely affected by lightness and darkness. Cognitive Level: Analysis Integrated Process: Evaluation 5. Which types of adoption studies should a nurse recognize as providing useful information for the psychiatric community? 1. Studies in which children with mentally ill biological parents are raised by adoptive parents who were mentally healthy.2. Studies in which children with mentally healthy biological parents are raised by adoptive parents who were mentally ill. 3. Studies in which monozygotic twins from mentally ill parents were raised separately by different adoptive parents.4. Studies in which monozygotic twins were raised together by mentally ill biological parents. 5. All of the above. ANS: 5 Rationale: The nurse should determine that all of the studies could possibly benefit the psychiatric community. The studies may reveal research findings relating genetic links to mental illness. Adoption studies allow comparisons to be made of the influences of the environment versus genetics. Cognitive Level: Analysis Integrated Process: Evaluation 6. Six months after her husband and children were killed in a car accident, a client is diagnosed with ulcerative colitis. The nurse should recognize that this situation validates which study perspective? 1. Neuroendocrinology 2. Psychoimmunology3. Diagnostic technology4. Neurophysiology ANS: 2 Rationale: Psychoimmunology is the branch of medicine that studies the effects of social and psychological factors on the functioning of the immune system. Studies of the biological response to stress hypothesize that individuals become more susceptible to physical illness following exposure to stressful stimuli. Cognitive Level: Application Integrated Process: Evaluation 7. A withdrawn client, diagnosed with schizophrenia, expresses little emotion and refuses to attend group therapy. What altered component of the nervous system should a nurse recognize as being responsible for this behavior? 1. Dendrites2. Axons3. Neurotransmitters4. Synapses ANS: 3 Rationale: The nurse should recognize that neurotransmitters play an essential function in the role of human emotion and behavior. Neurotransmitters are targeted and affected by many psychotropic medications. Cognitive Level: Comprehension Integrated Process: Evaluation 8. An instructor is teaching nursing students about neurotransmitters. Which best explains the process of how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron?1. Regeneration2. Reuptake3. Recycling4. Retransmission ANS: 2 Rationale: The nursing instructor should explain that the process by which neurotransmitters are released into the synaptic cleft and returned to the presynaptic neuron is termed reuptake. Reuptake is the process by which neurotransmitters are stored for reuse. Cognitive Level: Comprehension Integrated Process: Implementation 9. A nurse concludes that a restless, agitated client is manifesting a fight- or-flight response. The nurse should associate this response with which neurotransmitter?1. Acetylcholine2. Dopamine3. Serotonin4. Norepinephrine ANS: 4 Rationale: The nurse should associate the neurotransmitter norepinephrine with the fight-orflight response. Norepinephrine produces activity in the sympathetic postsynaptic nerve terminal and is associated with the regulation of mood, cognition, perception, locomotion, and sleep and arousal. Cognitive Level: Comprehension Integrated Process: Assessment 10. A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the clients neurotransmitters should a nurse expect to be elevated?1. Serotonin 2. Dopamine 3. Gamma-aminobutyric acid (GABA) 4. Histamine ANS: 2 Rationale: The nurse should expect that elevated dopamine levels might be an attributing factor to the clients current level of functioning. Dopamine functions include regulation of movements and coordination, emotions, and voluntary decision-making ability. Cognitive Level: Application Integrated Process: Assessment 11. A clients wife of 34 years dies unexpectedly. The client cries often and becomes socially isolated. The clients therapist encourages open discussion of feelings, proper nutrition, and exercise. What is the best rationale for the therapists recommendations? 1. The therapist is using an interpersonal approach.2. The client has an alteration in neurotransmitters. 3. It is routine practice to remind clients about nutrition, exercise, and rest.4. The client is susceptible to illness because of effects of stress on the immune system. ANS: 4 Rationale: The therapists recommendations should be based on the knowledge that the client has been exposed to stressful stimuli and is at an increased risk to develop illness because of the effects of stress on the immune system. The study of this branch of medicine is called psychoimmunology. Cognitive Level: Application Integrated Process: Planning 12. Which mental illness should a nurse identify as being associated with a decrease in prolactin hormone level? 1. Major depressive episode2. Schizophrenia 3. Anorexia nervosa4. Alzheimers disease ANS: 2 Rationale: Although the exact mechanism is unknown, there may be some correlation between decreased levels of the hormone prolactin and schizophrenia. Cognitive Level: Application Integrated Process: Evaluation 13. Which cerebral structure should a nursing instructor describe to students asthe emotional brain?1. The cerebellum2. The limbic system3. The cortex4. The left temporal lobe ANS: 2 Rationale: The limbic system is often referred to as the emotional brain. The limbic system is largely responsible for ones emotional state and is associated with feelings, sexuality, and social behavior. Cognitive Level: Comprehension Integrated Process: Implementation 14. A nurse understands that the abnormal secretion of growth hormone may play a role in which illness?1. Acute mania2. Schizophrenia3. Anorexia nervosa4. Alzheimers disease ANS: 3 Rationale: The nurse should understand that research has found a correlation between abnormal levels of growth hormone and anorexia nervosa. The growth hormone is responsible for growth in children, as well as continued protein synthesis throughout life. Cognitive Level: Comprehension Integrated Process: Assessment 15. A client is admitted to an emergency department experiencing memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the production of these symptoms? 1. Abnormal levels of serotonin2. Decreased levels of dopamine3. Increased levels of norepinephrine 4. Decreased levels of acetylcholine ANS: 4 Rationale: The nurse should correlate memory deficits and decreased motor function with decreased levels of acetylcholine. Acetylcholine is a major effector chemical of the autonomic nervous system. Functions of acetylcholine include sleep regulation, pain perception, the modulation and coordination of movement, and memory. Cognitive Level: Application Integrated Process: Assessment 16. A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness?1. Bipolar disorder: mania2. Schizophrenia spectrum disorder3. Generalized anxiety disorder4. Major depressive episode ANS: 4 Rationale: The nurse should recognize that a decrease in norepinephrine level would play a significant role in the development of major depressive disorder. The functions of norepinephrine include the regulation of mood, cognition, perception, locomotion, cardiovascular functioning, and sleep and arousal. Cognitive Level: Application Integrated Process: Evaluation 17. A nurse should expect that an increase in dopamine activity might play a significant role in the development of which mental illness?1. Schizophrenia spectrum disorder2. Major depressive disorder3. Body dysmorphic disorder4. Parkinsons disease [Show More]

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