NUR 2488 Mental Health exam 1 (Latest 2020 / 2021) Rasmussen

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NUR 2488 Mental Health exam 1 Chapter 01: Practicing the Science and the Art of Psychiatric Nursing MULTIPLE CHOICE 1. Which outcome, focused on recovery, would be expected in the plan of car... e for a patient living in the community and diagnosed with serious and persistent mental illness? Within 3 months, the patient will: a. deny suicidal ideation. b. report a sense of well-being. c. take medications as prescribed. d. attend clinic appointments on time. ANS: B 2. In the shift-change report, an off-going nurse criticizes a patient who wears heavy makeup. Which comment by the nurse who receives the report best demonstrates advocacy? a. This is a psychiatric hospital. Craziness is what we are all about. b. Lets all show acceptance of this patient by wearing lots of makeup too. c. Your comments are inconsiderate and inappropriate. Keep the report objective. d. Our patients need our help to learn behaviors that will help them get along in society. ANS: D 3. A nurse assesses a newly admitted patient diagnosed with major depressive disorder. Which statement is an example of attending? a. We all have stress in life. Being in a psychiatric hospital isnt the end of the world. b. Tell me why you felt you had to be hospitalized to receive treatment for your depression. c. You will feel better after we get some antidepressant medication started for you. d. Id like to sit with you a while so you may feel more comfortable talking with me. ANS: D 4. A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Select the nurses most caring comment. a. Lets discuss some means of coping other than suicide when you have these feelings. b. I understand why youre so depressed. When I got divorced, I was devastated too. c. You should forget about your marriage and move on with your life. d. How did you get so depressed that hospitalization was necessary? ANS: A 5. A patient shows the nurse an article from the Internet about a health problem. Which characteristic of the web sites address most alerts the nurse that the site may have biased and prejudiced information? a. Address ends in .org. b. Address ends in .com. c. Address ends in .gov. d. Address ends in .net. ANS: B 6. A nurse says, When I was in school, I learned to call upset patients by name to get their attention; however, I read a descriptive research study that says that this approach does not work. I plan to stop calling patients by name. Which statement is the best appraisal of this nurses comment? a. One descriptive research study rarely provides enough evidence to change practice. b. Staff nurses apply new research findings only with the help from clinical nurse specialists. c. New research findings should be incorporated into clinical algorithms before using them in practice. d. The nurse misinterpreted the results of the study. Classic tenets of practice do not change. ANS: A 7. Two nursing students discuss career plans after graduation. One student wants to enter psychiatric nursing. The other student asks, Why would you want to be a psychiatric nurse? All they do is talk. You will lose your skills. Select the best response by the student interested in psychiatric nursing. a. Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of patients problems. b. Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensional problems. Im challenged by those situations. c. I think I will be good in the mental health field. I do not like clinical rotations in school, so I do not want to continue them after I graduate. d. Psychiatric nurses do not have to deal with as much pain and suffering as medical surgical nurses. That appeals to me. ANS: B 8. Which research evidence would most influence a group of nurses to change their practice? a. Expert committee report of recommendations for practice b. Systematic review of randomized controlled trials c. Nonexperimental descriptive study d. Critical pathway ANS: B 9. A bill introduced in Congress would reduce funding for the care of people diagnosed with mental illnesses. A group of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Advocacy b. Attending c. Recovery d. Evidence-based practice ANS: A 10. An informal group of patients discuss their perceptions of nursing care. Which comment best indicates a patients perception that his or her nurse is caring? a. My nurse always asks me which type of juice I want to help me swallow my medication. b. My nurse explained my treatment plan to me and asked for my ideas about how to make it better. c. My nurse told me that if I take all the medicines the doctor prescribes I will get discharged soon. d. My nurse spends time listening to me talk about my problems. That helps me feel like Im not alone. ANS: D 11. A patient who immigrated to the United States from Honduras was diagnosed with schizophrenia. The patient took an antipsychotic medication for 3 weeks but showed no improvement. Which resource should the treatment team consult for information on more effective medications for this patient? a. Clinical algorithm b. Clinical pathway c. Clinical practice guideline d. International Statistical Classification of Diseases and Related Health Problems (ICD) ANS: A 12. Which historical nursing leader helped focus practice to recognize the importance of science in psychiatric nursing? a. Abraham Maslow b. Hildegard Peplau c. Kris Martinsen d. Harriet Bailey ANS: B 13. A nurse consistently strives to demonstrate caring behaviors during interactions with patients. Which reaction by a patient indicates this nurse is effective? A patient reports feeling: a. distrustful of others. b. connected with others. c. uneasy about the future. d. discouraged with efforts to improve. ANS: B Select All That Apply: 1. An experienced nurse says to a new graduate, When youve practiced as long as I have, you will instantly know how to take care of psychotic patients. What is the new graduates best analysis of this comment? Select all that apply. a. The experienced nurse may have lost sight of patients individuality, which may compromise the integrity of practice. b. New research findings must be continually integrated into a nurses practice to provide the most effective care. c. Experience provides mental health nurses with the tools and skills needed for effective professional practice. d. Experienced psychiatric nurses have learned the best ways to care for psychotic patients through trial and error. e. Effective psychiatric nurses should be continually guided by an intuitive sense of patients needs. ANS: A, B 2. Which patient statements identify qualities of nursing practice with high therapeutic value? (Select all that apply.) My nurse: a. talks in language I can understand. b. helps me keep track of my medications. c. is willing to go to social activities with me. d. lets me do whatever I choose without interfering. e. looks at me as a whole person with different needs. ANS: A, B, E Chapter 02: Mental Health and Mental Illness MULTIPLE CHOICE 1. An 86-year-old, previously healthy and independent, falls after an episode of vertigo. Which behavior by this patient best demonstrates resilience? The patient: a. says, I knew this would happen eventually. b. stops attending her weekly water aerobics class. c. refuses to use a walker and says, I dont need that silly thing. d. says, Maybe some physical therapy will help me with my balance. ANS: D 2. A patient is admitted to the psychiatric hospital. Which assessment finding best indicates that the patient has a mental illness? The patient: a. describes coping and relaxation strategies used when feeling anxious. b. describes mood as consistently sad, discouraged, and hopeless. c. can perform tasks attempted within the limits of own abilities. d. reports occasional problems with insomnia. ANS: B 3. The goal for a patient is to increase resiliency. Which outcome should a nurse add to the plan of care? Within 3 days, the patient will: a. describe feelings associated with loss and stress. b. meet own needs without considering the rights of others. c. identify healthy coping behaviors in response to stressful events. d. allow others to assume responsibility for major areas of own life. ANS: C 4. Which organization actively seeks to reduce the stigma associated with mental illness through public presentations such as In Our Own Voice (IOOV)? a. American Psychiatric Association (APA) b. National Alliance on Mental Illness (NAMI) c. United States Department of Health and Human Services (USDHHS) d. North American Nursing Diagnosis Association International (NANDA-I) ANS: B 5. A nurse must assess several new patients at a community mental health center. Conclusions concerning current functioning should be made on the basis of: a. the degree of conformity of the individual to societys norms. b. the degree to which an individual is logical and rational. c. a continuum from mentally healthy to unhealthy. d. the rate of intellectual and emotional growth. ANS: C 6. A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a patients insurance form. Which resource should the nurse consult to discern the criteria used to establish this diagnosis? a. A psychiatric nursing textbook b. NANDA International (NANDA-I ) c. A behavioral health reference manual d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ANS: D 7. A 40-year-old adult living with parents states, Im happy but I dont socialize much. My work is routine. When new things come up, my boss explains them a few times to make sure I understand. At home, my parents make decisions for me, and I go along with them. A nurse should identify interventions to improve this patients: a. self-concept. b. overall happiness. c. appraisal of reality. d. control over behavior. ANS: A 8. A patient tells a nurse, I have psychiatric problems and am in and out of hospitals all the time. Not one of my friends or relatives has these problems. Select the nurses best response. a. Comparing yourself with others has no real advantages. b. Why do you blame yourself for having a psychiatric illness? c. Mental illness affects 50% of the adult population in any given year. d. It sounds like you are concerned that others dont experience the same challenges as you. ANS: D 9. A critical care nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and a nursing diagnosis. Select the psychiatric nurses best response. a. No functional difference exists between the two diagnoses. Both serve to identify a human deviance. b. The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis includes cultural variables. c. The DSM-5 diagnosis profiles present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems. d. The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience. ANS: D 10. The spouse of a patient diagnosed with schizophrenia says, I dont understand why childhood experiences have anything to do with this disabling illness. Select the nurses response that will best help the spouse understand this condition. a. Psychological stress is actually at the root of most mental disorders. b. We now know that all mental illnesses are the result of genetic factors. c. It must be frustrating for you that your spouse is sick so much of the time. d. Although this disorder more likely has a biological rather than psychological origin, the support and involvement of caregivers is very important. ANS: D 11. Which belief by a nurse supports the highest degree of patient advocacy during a multidisciplinary patient care planning session? a. All mental illnesses are culturally determined. b. Schizophrenia and bipolar disorder are cross-cultural disorders. c. Symptoms of mental disorders are constant from culture to culture. d. Some symptoms of mental disorders may reflect a persons cultural patterns. ANS: D 12. A patients history shows intense and unstable relationships with others. The patient initially idealizes an individual and then devalues the person when the patients needs are not met. Which aspect of mental health is a problem? a. Effectiveness in work b. Communication skills c. Productive activities d. Fulfilling relationships ANS: D 13. In the majority culture of the United States, which individual is at greatest risk to be incorrectly labeled mentally ill? a. Person who is usually pessimistic but strives to meet personal goals b. Wealthy person who gives $20 bills to needy individuals in the community c. Person with an optimistic viewpoint about life and getting his or her own needs met d. Person who attends a charismatic church and describes hearing Gods voice ANS: D 14. A participant at a community education conference asks, What is the most prevalent type of mental disorder in the United States? Select the nurses best response. a. Why do you ask? b. Schizophrenia c. Affective disorders d. Anxiety disorders ANS: D 15. A nurse wants to find a description of diagnostic criteria for a person diagnosed with schizophrenia. Which resource should the nurse consult? a. U.S. Department of Health and Human Services b. Journal of the American Psychiatric Association c. North American Nursing Diagnosis Association International (NANDA-I) d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5) ANS: D MULTIPLE RESPONSE 1. A patient in the emergency department reports, I hear voices saying someone is stalking me. They want to kill me because I found the cure for cancer. I will stab anyone that threatens me. Which aspects of mental health have the greatest immediate concern to a nurse? Select all that apply. a. Happiness b. Appraisal of reality c. Control over behavior d. Effectiveness in work e. Healthy self-concept ANS: B, C, E 2. Which statements most clearly reflect the stigma of mental illness? Select all that apply. a. Many mental illnesses are hereditary. b. Mental illness can be evidence of a brain disorder. c. People claim mental illness so they can get disability checks. d. If people with mental illness went to church, they would be fine. e. Mental illness is a result of the breakdown of the American family. ANS: C, D, E Chapter 03: Theories and Therapies MULTIPLE CHOICE 1. A 26-month-old child displays negative behaviors. The parent says, My child refuses toilet training and shouts, No! when given direction. What do you think is wrong? Select the nurses best reply. a. This is normal for your childs age. The child is striving for independence. b. The child needs firmer control. Punish the child for disobedience and say, No. c. There may be developmental problems. Most children are toilet trained by age 2 years. d. Some undesirable attitudes are developing. A child psychologist can help you develop a remedial plan. ANS: A 2. A 26-month-old child displays negative behavior, refuses toilet training, and often shouts, No! when given directions. Using Freuds stages of psychosexual development, a nurse would assess the childs behavior is based on which stage? a. Oral b. Anal c. Phallic d. Genital ANS: B 3. A 26-month-old child displays negative behavior, refuses toilet training, and often shouts, No! when given direction. The nurses counseling with the parent should be based on the premise that the child is engaged in which of Eriksons psychosocial crises? a. Trust versus Mistrust b. Initiative versus Guilt c. Industry versus Inferiority d. Autonomy versus Shame and Doubt ANS: D 4. A 4-year-old child grabs toys from siblings, saying, I want that toy now! The siblings cry, and the childs parent becomes upset with the behavior. Using the Freudian theory, a nurse can interpret the childs behavior as a product of impulses originating in the: a. id. b. ego. c. superego. d. preconscious. ANS: A 5. The parent of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, and using good manners. A nurse supports the use of praise because, according to the Freudian theory, these qualities will likely be internalized and become part of the childs: a. id. b. ego. c. superego. d. preconscious. ANS: C 6. A nurse supports parental praise of a child who is behaving in a helpful way. When the individual behaves with politeness and helpfulness in adulthood, which feeling will most likely result? a. Guilt b. Anxiety c. Loneliness d. Self-esteem ANS: D 7. A patient comments, I never know the right answer and My opinion is not important. Using Eriksons theory, which psychosocial crisis did the patient have difficulty resolving? a. Initiative versus Guilt b. Trust versus Mistrust c. Autonomy versus Shame and Doubt d. Generativity versus Self-Absorption ANS: C 8. Which patient statement would lead a nurse to suspect that the developmental task of infancy was not successfully completed? a. I have very warm and close friendships. b. Im afraid to let anyone really get to know me. c. I am always right and confident about my decisions. d. Im ashamed that I didnt do it correctly in the first place. ANS: B 9. A nurse assesses that a patient is suspicious and frequently manipulates others. Using the Freudian theory, these traits are related to which psychosexual stage? a. Oral b. Anal c. Phallic d. Genital ANS: A 10. An adult expresses the wish to be taken care of and often behaves in a helpless fashion. This adult has needs related to which of Freuds stages of psychosexual development? a. Latency b. Phallic c. Anal d. Oral ANS: D 11. A nurse listens to a group of recent retirees. One says, I volunteer with Meals on Wheels, coach teen sports, and do church visitation. Another laughs and says, Im too busy taking care of myself to volunteer. I dont have time to help others. These comments contrast which developmental tasks? a. Trust versus Mistrust b. Industry versus Inferiority c. Intimacy versus Isolation d. Generativity versus Self-Absorption ANS: D 12. Cognitive therapy was provided for a patient who frequently said, Im stupid. Which statement by the patient indicates the therapy was effective? a. Im disappointed in my lack of ability. b. I always fail when I try new things. c. Things always go wrong for me. d. Sometimes I do stupid things. ANS: D 13. A student nurse tells the instructor, I dont need to interact with my patients. I learn what I need to know by observation. The instructor can best interpret the nursing implications of Sullivans theory to the student by responding: a. Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills. b. Observing patient interactions can help you formulate priority nursing diagnoses and appropriate interventions. c. I wonder how accurate your assessment of the patients needs can be if you do not interact with the patient. d. Noting patient behavioral changes is important because these signify changes in personality. ANS: A 14. A psychiatric technician says, Little of what takes place on the behavioral health unit seems to be theory based. A nurse educates the technician by identifying which common use of Sullivans theory? a. Structure of the therapeutic milieu of most behavioral health units b. Frequent use of restraint and seclusion for behavior modification c. Assessment tools based on age-appropriate versus arrested behaviors d. Use of the nursing process to determine the best sequence for nursing actions ANS: A 15. A nurse uses Maslows hierarchy of needs to plan care for a psychotic patient. Which problem will receive priority? The patient: a. refuses to eat or bathe. b. reports feelings of alienation from family. c. is reluctant to participate in unit social activities. d. needs to be taught about medication action and side effects. ANS: A 16. Operant conditioning will be used to encourage speech in a child who is nearly mute. Which technique would a nurse include in the treatment plan? a. Ignore the child for using silence. b. Have the child observe others talking. c. Give the child a small treat for speaking. d. Teach the child relaxation techniques, then coax speech. ANS: C 17. The parent of a child diagnosed with schizophrenia tearfully asks a nurse, What could I have done differently to prevent this illness? Select the nurses most caring response. a. Although schizophrenia is caused by impaired family relationships, try not to feel guilty. No one can predict how a child will respond to parental guidance. b. Most of the damage is done, but there is still hope. Changing your parenting style can help your child learn to cope more effectively with the environment. c. Schizophrenia is a biological illness with similarities to diabetes and heart disease. You are not to blame for your childs illness. d. Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting. ANS: C 18. A nurse uses Peplaus interpersonal therapy while working with an anxious, withdrawn patient. Interventions should focus on: a. changing the patients perceptions about self. b. improving the patients interactional skills. c. using medications to relieve anxiety. d. reinforcing specific behaviors. ANS: B 19. A patient underwent psychotherapy weekly for 3 years. The therapist used free association, dream analysis, and facilitated transference to help the patient understand unconscious processes and foster personality changes. Which type of therapy was used? a. Short-term dynamic psychotherapy b. Transactional analysis c. Cognitive therapy d. Psychoanalysis ANS: D 20. An advanced practice nurse determines a group of patients would benefit from therapy in which peers and interdisciplinary staff all have a voice in determining the level of the patients privileges. The nurse would arrange for: a. milieu therapy b. cognitive therapy c. short-term dynamic therapy d. systematic desensitization ANS: A 21. A nurse psychotherapist works with an anxious, dependent patient. The therapeutic strategy most consistent with the framework of psychoanalytic psychotherapy is: a. emphasizing medication compliance. b. identifying the patients strengths and assets. c. offering psychoeducational materials and groups. d. focusing on feelings developed by the patient toward the nurse. ANS: D 22. A person tells a nurse, I was the only survivor in a small plane crash, but three business associates died. I got anxious and depressed and saw a counselor three times a week for a month. We talked about my feelings related to being a survivor, and now Im fine, back to my old self. Which type of therapy was used? a. Milieu therapy b. Psychoanalysis c. Behavior modification d. Interpersonal therapy ANS: D 23. A cognitive strategy a nurse could use to assist a very dependent patient would be to help the patient: a. reveal dream content. b. take prescribed medications. c. examine thoughts about being autonomous. d. role model ways to ask for help from others. ANS: C 24. A single parent is experiencing feelings of inadequacy related to work and family since one teenaged child ran away several weeks ago. The parent seeks the help of a therapist specializing in cognitive therapy. The psychotherapist who uses cognitive therapy will treat the patient by: a. discussing ego states. b. focusing on unconscious mental processes. c. negatively reinforcing an undesirable behavior. d. helping the patient identify and change faulty thinking. ANS: D 25. A person received an invitation to be in the wedding of a friend who lives across the country. The individual is afraid of flying. What type of therapy should the nurse recommend? a. Psychoanalysis b. Milieu therapy c. Systematic desensitization d. Short-term dynamic therapy ANS: C MULTIPLE RESPONSE 1. A basic level registered nurse works with patients in a community setting. Which groups should this nurse expect to lead? Select all that apply. a. Symptom management b. Medication education c. Family therapy d. Psychotherapy e. Self-care ANS: A, B, E 2. A patient states, Im starting cognitive behavioral therapy. What can I expect from the sessions? Which responses by the nurse are appropriate? Select all that apply. a. The therapist will be active and questioning. b. You may be given homework assignments. c. The therapist will ask you to describe your dreams. d. The therapist will help you look at ideas and beliefs you have about yourself. e. The goal is to increase your subjectivity about thoughts that govern your behavior. ANS: A, B, D Chapter 04: Biological Basis for Understanding Psychopharmacology MULTIPLE CHOICE 1. A patient asks a nurse, What are neurotransmitters? My doctor says mine are out of balance. The best reply would be: a. You must feel relieved to know that your problem has a physical basis. b. Neurotransmitters are chemicals that pass messages between brain cells. c. It is a high-level concept to explain. You should ask the doctor to tell you more. d. Neurotransmitters are substances we eat daily that influence memory and mood. ANS: B 2. The parent of an adolescent diagnosed with schizophrenia asks a nurse, My childs doctor ordered a positron-emission tomography (PET) scan. What is that? Select the nurses best reply. a. PET uses a magnetic field and gamma waves to identify problems areas in the brain. Does your teenager have any metal implants? b. Its a special type of x-ray image that shows structures of the brain and whether a brain injury has ever occurred. c. PET is a scan that passes an electrical current through the brain and shows brain wave activity. PET can help diagnose seizures. d. PET is a special scan that shows blood flow and activity in the brain. ANS: D 3. A patient has dementia. The health care provider wants to make a differential diagnosis between Alzheimer disease and multiple infarctions. Which diagnostic procedure should a nurse expect to prepare the patient for first? a. Computed tomography (CT) scan b. Positron emission tomography (PET) scan c. Functional magnetic resonance imaging (fMRI) d. Single-photon emission computed tomography (SPECT) scan ANS: A 4. A patient has delusions and hallucinations. Before beginning treatment with a psychotropic medication, the health care provider wants to rule out the presence of a brain tumor. For which test will a nurse need to prepare the patient? a. Cerebral arteriogram b. Functional magnetic resonance imaging (fMRI) c. Computed tomography (CT) scan or magnetic resonance imaging (MRI) d. Positron emission tomography (PET) or single-photon emission computed tomography (SPECT) ANS: C 5. The nurse wants to assess for disturbances in circadian rhythms in a patient admitted for major depressive disorder. Which question best implements this assessment? a. Do you ever see or hear things that others do not? b. Do you have problems with short-term memory? c. What are your worst and best times of day? d. How would you describe your thinking? ANS: C 6. A nurse administers a medication that potentiates the action of gamma-aminobutyric acid (GABA). Which finding would be expected? a. Reduced anxiety b. Improved memory c. More organized thinking d. Fewer sensory perceptual alterations ANS: A 7. On the basis of current knowledge of neurotransmitter effects, a nurse anticipates that the treatment plan for a patient with memory difficulties may include medications designed to: a. inhibit GABA production. b. increase dopamine sensitivity. c. decrease dopamine at receptor sites. d. prevent destruction of acetylcholine. ANS: D 8. A patient has disorganized thinking associated with schizophrenia. Neuroimaging would most likely show dysfunction in which part of the brain? a. Brainstem b. Cerebellum c. Temporal lobe d. Prefrontal cortex ANS: D 9. A nurse should assess a patient taking a medication with anticholinergic properties for inhibited function of the: a. parasympathetic nervous system. b. sympathetic nervous system. c. reticular activating system. d. medulla oblongata. ANS: A 10. The therapeutic action of monoamine oxidase inhibitors (MAOIs) blocks neurotransmitter reuptake, causing: a. increased concentration of neurotransmitters in the synaptic gap. b. decreased concentration of neurotransmitters in serum. c. destruction of receptor sites. d. limbic system stimulation. ANS: A 11. A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. A nurse can correctly analyze that these symptoms are related to which drug action? a. Anticholinergic effects b. Dopamine-blocking effects c. Endocrine-stimulating effects d. Ability to stimulate spinal nerves ANS: B 12. A patient has anxiety, increased heart rate, and fear. The nurse would suspect the presence of a high concentration of which neurotransmitter? a. GABA b. Histamine c. Acetylcholine d. Norepinephrine ANS: D 13. A patient has symptoms of acute anxiety related to the death of a parent in an automobile accident 2 hours earlier. The nurse should anticipate administering a medication from which group? a. Tricyclic antidepressants b. Atypical antipsychotics c. Anticonvulsants d. Benzodiazepines ANS: D 14. A patient is hospitalized for major depressive disorder. Of the medications listed, a nurse can expect to provide the patient with teaching about: a. chlordiazepoxide (Librium). b. fluoxetine (Prozac). c. clozapine (Clozaril). d. tacrine (Cognex). ANS: B 15. A patient hospitalized with a mood disorder has aggression, agitation, talkativeness, and irritability. A nurse begins the care plan based on the expectation that the health care provider is most likely to prescribe a medication classified as a(n): a. anticholinergic. b. mood stabilizer. c. psychostimulant. d. tricyclic antidepressant. ANS: B 16. A drug causes muscarinic-receptor blockade. A nurse will assess the patient for: a. dry mouth. b. gynecomastia. c. pseudoparkinsonism. d. orthostatic hypotension. ANS: A 17. A patient begins therapy with a phenothiazine medication. What teaching should a nurse provide related to the drugs strong dopaminergic effect? a. Chew sugarless gum. b. Increase dietary fiber. c. Arise slowly from bed. d. Report muscle stiffness. ANS: D 18. A nurse can anticipate anticholinergic side effects are likely to occur when a patient is taking: a. lithium (Lithobid). b. buspirone (BuSpar). c. risperidone (Risperdal). d. fluphenazine (Prolixin). ANS: D 19. Priority teaching for a patient taking clozapine (Clozaril) should include which instruction? a. Report sore throat and fever immediately. b. Avoid foods high in polyunsaturated fat. c. Use water-based lotions for rashes. d. Avoid unprotected sex. ANS: A 20. A nurse cares for patients taking various medications, including buspirone (BuSpar), haloperidol (Haldol), trazodone (Desyrel), and phenelzine (Nardil). The nurse will order a special diet for the patient taking: a. buspirone. b. haloperidol. c. trazodone. d. phenelzine. ANS: D 21. A nurse caring for a patient taking a serotonin reuptake inhibitor (SSRI) will develop outcome criteria related to: a. mood improvement. b. logical thought processes. c. reduced levels of motor activity. d. decreased extrapyramidal symptoms. ANS: A 22. A patients spouse, who is a chemist, asks a nurse how serotonin reuptake inhibitors (SSRIs) lift depression. The nurse should explain that SSRIs: a. destroy increased amounts of neurotransmitters. b. make more serotonin available at the synaptic gap. c. increase production of acetylcholine and dopamine. d. block muscarinic and alpha1-norepinephrine receptors. ANS: B 23. A patient has taken many conventional antipsychotic drugs over years. The health care provider, who is concerned about early signs of tardive dyskinesia, prescribes risperidone (Risperdal). A nurse planning care for this patient understands that atypical antipsychotics: a. are less costly. b. have higher potency. c. are more readily available. d. produce fewer motor side effects. ANS: D 24. The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3 and a granulocyte count of 1500 mm3. The nurse should: a. report the laboratory results to the health care provider. b. give the next dose as prescribed. c. administer aspirin and force fluids. d. repeat the laboratory tests. ANS: A 25. A nurse administering psychotropic medications should be prepared to intervene when giving a drug that blocks the attachment of norepinephrine to alpha1 receptors because the patient may experience: a. increased psychotic symptoms. b. severe appetite disturbance. c. orthostatic hypotension. d. hypertensive crisis. ANS: C MULTIPLE RESPONSE 1. A nurse prepares to administer an antipsychotic medication to a patient diagnosed with schizophrenia. Additional monitoring of the medications effects and side effects will be most important if the patient is also diagnosed with which health problem? Select all that apply. a. Parkinson disease b. Graves disease c. Osteoarthritis d. Epilepsy e. Diabetes ANS: A, D, E 2. The spouse of a patient diagnosed with schizophrenia asks, Which neurotransmitters are more active when a person has schizophrenia? The nurse should state, The current thinking is that the thought disturbances are related to increased activity of: (Select all that apply.) a. GABA. b. substance P. c. histamine. d. dopamine. e. norepinephrine. ANS: D, E 3. An individual is experiencing problems associated with memory. Which cerebral structures are most likely to be involved in this deficit? Select all that apply. a. Prefrontal cortex b. Occipital lobe c. Temporal lobe d. Parietal lobe e. Basal ganglia ANS: A, C, D Chapter 05: Settings for Psychiatric Care MULTIPLE CHOICE 1. Planning for patients with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for patients who: a. present a clear danger to self or others. b. are noncompliant with medications at home. c. have no support systems in the community. d. develop new symptoms during the course of an illness. ANS: A 2. A patient is hospitalized for a reaction to a psychotropic medication and then is closely monitored for 24hours. During a predischarge visit, the case manager learns the patient received a notice of eviction on the day of admission. The most appropriate intervention for the case manager is to: a. cancel the patients discharge from the hospital. b. contact the landlord who evicted the patient to discuss the situation. c. arrange a temporary place for the patient to stay until new housing can be arranged. d. document that the adverse medication reaction was feigned because the patient had nowhere to live. ANS: C 3. A multidisciplinary health care team meets 12 hours after an adolescent is hospitalized after a suicide attempt. Members of the team report their assessments. What outcome can be expected from this meeting? a. A treatment plan will be formulated. b. The health care provider will order neuroimaging studies. c. The team will request a court-appointed advocate for the patient. d. Assessment of the patients need for placement outside the home will be undertaken. ANS: A 4. The relapse of a patient diagnosed with schizophrenia is related to medication noncompliance. The patient is hospitalized for 5 days, medication is restarted, and the patients thoughts are now more organized. The patients family members are upset and say, Its too soon for discharge. Hospitalization is needed for at least a month. The nurse should: a. call the psychiatrist to come explain the discharge rationale. b. explain that health insurance will not pay for a longer stay for the patient. c. call security to handle the disturbance and escort the family off the unit. d. explain that the patient will continue to improve if medication is taken regularly. ANS: D 5. A nurse assesses an inpatient psychiatric unit, noting that exits are free from obstruction, no one is smoking, the janitors closet is locked, and all sharp objects are being used under staff supervision. These observations relate to: a. management of milieu safety. b. coordinating care of patients. c. management of the interpersonal climate. d. use of therapeutic intervention strategies. ANS: A 6. The following patients are seen in the emergency department. The psychiatric unit has one bed available. Which patient should the admitting officer recommend for admission to the hospital? The patient who: a. is experiencing dry mouth and tremor related to side effects of haloperidol (Haldol). b. is experiencing anxiety and a sad mood after a separation from a spouse of 10 years. c. self-inflicted a superficial cut on the forearm after a family argument. d. is a single parent and hears voices saying, Smother your infant. ANS: D 7. A student nurse prepares to administer oral medications to a patient diagnosed with major depressive disorder, but the patient refuses the medication. The student nurse should: a. tell the patient, Ill get an unsatisfactory grade if I dont give you the medication. b. tell the patient, Refusing your medication is not permitted. You are required to take it. c. discuss the patients concerns about the medication, and report to the staff nurse. d. document the patients refusal of the medication without further comment. ANS: C 8. A nurse surveys the medical records for violations of patients rights. Which finding signals a violation? a. No treatment plan is present in record. b. Patient belongings are searched at admission. c. Physical restraint is used to prevent harm to self. d. Patient is placed on one-to-one continuous observation. ANS: A 9. Which principle takes priority for the psychiatric inpatient staff when addressing behavioral crises? a. Resolve behavioral crises using the least restrictive intervention possible. b. Rights of the majority of patients supersede the rights of individual patients. c. Swift intervention is justified to maintain the integrity of the therapeutic milieu. d. Allow patients opportunities to regain control without intervention if the safety of other patients is not compromised. ANS: A 10. To provide comprehensive care to patients, which competency is more important for a nurse who works in a community mental health center than a psychiatric nurse who works in an inpatient unit? a. Problem-solving skills b. Calm and caring manner c. Ability to cross service systems d. Knowledge of psychopharmacology ANS: C 11. A suspicious and socially isolated patient lives alone, eats one meal a day at a nearby shelter, and spends the remaining daily food allowance on cigarettes. Select the community psychiatric nurses best initial action. a. Report the situation to the manager of the shelter. b. Tell the patient, You must stop smoking to save money. c. Assess the patients weight; determine the foods and amounts eaten. d. Seek hospitalization for the patient while a new plan is being formulated. ANS: C 12. A patient diagnosed with schizophrenia has been stable in the community. Today, the spouse reports the patient is expressing delusional thoughts. The patient says, Im willing to take my medicine, but I forgot to get my prescription refilled. Which outcome should the nurse add to the plan of care? a. Nurse will obtain prescription refills every 90 days and deliver them to the patient. b. Patients spouse will mark dates for prescription refills on the family calendar. c. Patient will report to the hospital for medication follow-up every week. d. Patient will call the nurse weekly to discuss medication-related issues. ANS: B 13. A community mental health nurse has worked for 6 months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and stopped taking medications because of inadequate money. The patient says, Only a traitor would make me go to the hospital. Which solution is best? a. Arrange a bed in a local homeless shelter with nightly onsite supervision. b. Negotiate a way to provide medication so the patient can remain at home. c. Hospitalize the patient until the symptoms have stabilized. d. Seek inpatient hospitalization for up to 1 week. ANS: B 14. A community psychiatric nurse facilitates medication compliance for a patient by having the health care provider prescribe depot medications by injection every 3 weeks at the clinic. For this plan to be successful, which factor will be of critical importance? a. Attitude of significant others toward the patient b. Nutritional services in the patients neighborhood c. Level of trust between the patient and the nurse d. Availability of transportation to the clinic ANS: D 15. Which assessment finding for a patient living in the community requires priority intervention by the nurse? The patient: a. receives Social Security disability income plus a small check from a trust fund. b. lives in an apartment with two patients who attend day hospital programs. c. has a sibling who is interested and active in care planning. d. purchases and uses marijuana on a frequent basis. ANS: D 16. A patient tells the nurse at the clinic, I havent been taking my antidepressant medication as directed. I leave out the midday dose. I have lunch with friends and dont want them to ask me about the pills. Select the nurses most appropriate intervention. a. Investigate the possibility of once-daily dosing of the antidepressant. b. Suggest to the patient to take the medication when no one is watching. c. Explain how taking each dose of medication on time relates to health maintenance. d. Add the following nursing diagnosis to the plan of care: Ineffective therapeutic regimen management, related to lack of knowledge. ANS: A 17. A community psychiatric nurse assesses that a patient diagnosed with a mood disorder is more depressed than on the previous visit a month ago; however, the patient says, I feel the same. Which intervention supports the nurses assessment while preserving the patients autonomy? a. Arrange for a short hospitalization. b. Schedule weekly clinic appointments. c. Refer the patient to the crisis intervention clinic. d. Call the family and ask them to observe the patient closely. ANS: B 18. A patient hurriedly tells the community mental health nurse, Everythings a disaster! I cant concentrate. My disability check didnt come. My roommate moved out, and I cant afford the rent. My therapist is moving away. I feel like Im coming apart. Which nursing diagnosis applies? a. Decisional conflict, related to challenges to personal values b. Spiritual distress, related to ethical implications of treatment regimen c. Anxiety, related to changes perceived as threatening to psychological equilibrium d. Impaired environmental interpretation syndrome, related to solving multiple problems affecting security needs ANS: C 19. Which patient would a nurse refer to partial hospitalization? An individual who: a. spent yesterday in the 24-hour supervised crisis care center and continues to be actively suicidal. b. because of agoraphobia and panic episodes needs psychoeducation for relaxation therapy. c. has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up. d. states, Im not sure I can avoid using alcohol when my spouse goes to work every morning. ANS: D 20. Which employers health plan is required to include parity provisions related to mental illnesses? a. Employer with more than 50 employees b. Cancer thrift shop staffed by volunteers c. Daycare center that employs 7 teachers d. Church that employs 15 people ANS: A MULTIPLE RESPONSE 1. A nurse can best address factors of critical importance to successful community treatment for persons with mental illness by including assessments related to which of the following? Select all that apply. a. Housing adequacy and stability b. Income adequacy and stability c. Family and other support systems d. Early psychosocial development e. Substance abuse history and current use ANS: A, B, C, E 2. A community member asks a nurse, People diagnosed with mental illnesses used to go to a state hospital. Why has that changed? Select the nurses accurate responses. Select all that apply. a. Science has made significant improvements in drugs for mental illness, so now many people may live in their communities. b. A better selection of less restrictive settings is now available in communities to care for individuals with mental illness. c. National rates of mental illness have declined significantly. The need for state institutions is actually nolonger present. d. Most psychiatric institutions were closed because of serious violations of patients rights and unsafe conditions. e. Federal legislation and payment for treatment of mental illness have shifted the focus to community rather than institutional settings. ANS: A, B, E Chapter 07: Nursing Process and QSEN: The Foundation for Safe and Effective Care MULTIPLE CHOICE 1. A new staff nurse completes orientation to the psychiatric unit. This nurse will expect to ask an advanced practice nurse to perform which action for patients? a. Perform mental health assessment interviews. b. Establish therapeutic relationships. c. Prescribe psychotropic medications. d. Individualize nursing care plans. ANS: C 2. A newly admitted patient with major depressive disorder has lost 20 pounds over the past month and has suicidal ideation. The patient has taken an antidepressant medication for 1 week without remission of symptoms. Select the priority nursing diagnosis. a. Imbalanced nutrition: Less than body requirements b. Chronic low self-esteem c. Risk for suicide d. Hopelessness ANS: C 3. A patient with major depressive disorder has lost 20 pounds in one month has chronic low self-esteem and a plan for suicide. The patient has taken an antidepressant medication for 1 week. Which nursing intervention is most directly related to this outcome: Patient will refrain from gestures and attempts to harm self? a. Implement suicide precautions. b. Frequently offer high-calorie snacks and fluids. c. Assist the patient to identify three personal strengths. d. Observe patient for therapeutic effects of antidepressant medication. ANS: A 4. A patients nursing diagnosis is Insomnia. The desired outcome is: Patient will sleep for a minimum of 5 hours nightly by October 31. On November 1, a review of the sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. Which evaluation should be documented? a. Consistently demonstrated b. Often demonstrated c. Sometimes demonstrated d. Never demonstrated ANS: D 5. A patients nursing diagnosis is Insomnia. The desired outcome is: Patient will sleep for a minimum of 5 hours nightly by October 31. On November 1, a review of the sleep data shows the patient sleeps an average of 4 hours nightly and takes a 2-hour afternoon nap. What is the nurses next action? a. Continue the current plan without changes. b. Remove this nursing diagnosis from the plan of care. c. Write a new nursing diagnosis that better reflects the problem. d. Revise the outcome target date and interventions. ANS: D 6. A patient begins a new program to assist with building social skills. In which part of the plan of care should a nurse record the item Encourage patient to attend one psychoeducational group daily? a. Assessment b. Analysis c. Planning d. Implementation e. Evaluation ANS: D 7. Before assessing a new patient, a nurse is told by another health care worker, I know that patient. No matter how hard we work, there isnt much improvement by the time of discharge. The nurses responsibility is to: a. document the other workers assessment of the patient. b. assess the patient based on data collected from all sources. c. validate the workers impression by contacting the patients significant other. d. discuss the workers impression with the patient during the assessment interview. ANS: B 8. A nurse works with a patient to establish outcomes. The nurse believes that one outcome suggested by the patient is not in the patients best interest. What is the nurses best action? a. Remain silent. b. Educate the patient that the outcome is not realistic. c. Explore with the patient possible consequences of the outcome. d. Formulate a more appropriate outcome without the patients input. ANS: C 9. A patient states, Im not worth anything. I have negative thoughts about myself. I feel anxious and shaky all the time. Sometimes I feel so sad that I want to go to sleep and never wake up. Which nursing intervention should have the highest priority? a. Self-esteembuilding activities b. Anxiety self-control measures c. Sleep enhancement activities d. Suicide precautions ANS: D 10. Select the best outcome for a patient with this nursing diagnosis: Impaired social interaction, related to sociocultural dissonance as evidenced by stating, Although Id like to, I dont join in because I dont speak the language very well. The patient will: a. demonstrate improved social skills. b. express a desire to interact with others. c. become more independent in decision making. d. select and participate in one group activity per day. ANS: D 11. Nursing behaviors associated with the implementation phase of the nursing process are concerned with: a. participating in the mutual identification of patient outcomes. b. gathering accurate and sufficient patient-centered data. c. comparing patient responses and expected outcomes. d. carrying out interventions and coordinating care. ANS: D 12. Which statement made by a patient during an initial assessment interview should serve as the priority focus for the plan of care? a. I can always trust my family. b. It seems like I always have bad luck. c. You never know who will turn against you. d. I hear evil voices that tell me to do bad things. ANS: D 13. Which entry in the medical record best meets the requirement for problem-oriented charting? a. A: Pacing and muttering to self. P: Sensory perceptual alteration, related to internal auditory stimulation. I: Given fluphenazine (Prolixin) 2.5 mg at 0900, and went to room to lie down. E: Calmer by 0930. Returned to lounge to watch TV. b. S: States, I feel like Im ready to blow up. O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol (Haldol) 2 mg. I: (Haldol) 2 mg at 0900. E: Returned to lounge at 0930 and quietly watched TV. c. Agitated behavior. D: Patient muttering to self as though answering an unseen person. A: Given haloperidol (Haldol) 2 mg and went to room to lie down. E: Patient calmer. Returned to lounge to watch TV. d. Pacing hall and muttering to self as though answering an unseen person. haloperidol (Haldol) 2 mg administered at 0900 with calming effect in 30 minutes. Stated, Im no longer bothered by the voices. ANS: B 14. A nurse assesses an older adult patient brought to the emergency department by a family member. The patient was wandering outside, saying, I cant find my way home. The patient is confused and unable to answer questions. Select the nurses best action. a. Document the patients mental status. Obtain other assessment data from the family member. b. Record the patients answers to questions on the nursing assessment form. c. Ask an advanced practice nurse to perform the assessment interview. d. Call for a mental health advocate to maintain the patients rights. ANS: A 15. A nurse asks a patient, If you had fever and vomiting for 3 days, what would you do? Which aspect of the mental status examination is the nurse assessing? a. Behavior b. Cognition c. Affect and mood d. Perceptual disturbances ANS: B 16. An adolescent asks a nurse conducting an assessment interview, Why should I tell you anything? Youll just tell my parents whatever you find out. Select the nurses best reply. a. That is not true. What you tell us is private and held in strict confidence. Your parents have no right to know. b. Yes, your parents may find out what you say, but it is important that they know about your problems. c. What you say about feelings is private, but some things, like suicidal thinking, must be reported to the treatment team. d. It sounds as though you are not really ready to work on your problems and make changes. ANS: C 17. A nurse assessing a new patient asks, What is meant by the saying, You cant judge a book by its cover? Which aspect of cognition is the nurse assessing? a. Mood b. Attention c. Orientation d. Abstraction ANS: D 18. When a nurse assesses an older adult patient, the patients answers seem vague or unrelated to the questions. The patient also leans forward and frowns, listening intently to the nurse. An appropriate question for the nurse to ask would be: a. Are you having difficulty hearing when I speak? b. How can I make this assessment interview easier for you? c. I notice you are frowning. Are you feeling annoyed with me? d. Youre having trouble focusing on what Im saying. What is distracting you? ANS: A 19. At one point in an assessment interview a nurse asks, How does your faith help you in stressful situations? This question would be asked during the assessment of: a. childhood growth and development. b. substance use and abuse. c. educational background. d. coping strategies. ANS: D 20. When a new patient is hospitalized, a nurse takes the patient on a tour, explains the rules of the unit, and discusses the daily schedule. The nurse is engaged in: a. counseling. b. health teaching. c. milieu management. d. psychobiologic intervention. ANS: C 21. After formulating the nursing diagnoses for a new patient, what is the next action a nurse should take? a. Design interventions to include in the plan of care. b. Determine the goals and outcome criteria. c. Implement the nursing plan of care. d. Complete the spiritual assessment. ANS: B 22. Select the most appropriate label to complete this nursing diagnosis: , related to feelings of shyness and poorly developed social skills as evidenced by watching television alone at home every evening. a. Deficient knowledge b. Ineffective coping c. Powerlessness d. Social isolation ANS: D 23. The acronym QSEN refers to: a. Qualitative Standardized Excellence in Nursing. b. Quality and Safety Education for Nurses. c. Quantitative Effectiveness in Nursing. d. Quick Standards Essential for Nurses. ANS: B 24. A nurse documents: Patient is mute, despite repeated efforts to elicit speech. Makes no eye contact. Is inattentive to staff. Gazes off to the side or looks upward rather than at the speaker. Which nursing diagnosis should be considered? a. Defensive coping b. Decisional conflict c. Risk for other-directed violence d. Impaired verbal communication ANS: D MULTIPLE RESPONSE 1. A nurse assesses a patient who reluctantly participates in activities, answers questions with minimal responses, and rarely makes eye contact. What information should be included when documenting the assessment? Select all that apply. a. Uncooperative patient b. Patients subjective responses c. Only data obtained from the patients verbal responses d. Description of the patients behavior during the interview e. Analysis of why the patient is unresponsive during the interview ANS: B, D 2. A nurse performing an assessment interview for a patient with a substance abuse disorder decides to use a standardized rating scale. Which scales are appropriate? Select all that apply. a. Addiction Severity Index (ASI) b. Brief Drug Abuse Screen Test (B-DAST) c. Abnormal Involuntary Movement Scale (AIMS) d. Cognitive Capacity Screening Examination (CCSE) e. Recovery Attitude and Treatment Evaluator (RAATE) ANS: A, B, E 3. What information is conveyed by nursing diagnoses? Select all that apply. a. Medical judgments about the disorder b. Goals and outcomes for the plan of care c. Unmet patient needs currently present d. Supporting data that validate the diagnoses e. Probable causes that will be targets for nursing interventions ANS: C, D, E 4. A patient is very suspicious and states, The FBI has me under surveillance. Which strategies should a nurse use when gathering initial assessment data about this patient? Select all that apply. a. Tell the patient that medication will help this type of thinking. b. Ask the patient, Tell me about the problem as you see it. c. Seek information about when the problem began. d. Tell the patient, Your ideas are not realistic. e. Reassure the patient, You are safe here. ANS: B, C, E Chapter 08: Communication Skills: Medium for All Nursing Practice MULTIPLE CHOICE 1. A patient says to the nurse, I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadnt rested well. Which comment would be appropriate if the nurse seeks clarification? a. It sounds as though you were uncomfortable with the content of your dream. b. I understand what youre saying. Bad dreams leave me feeling tired, too. c. So, all in all, you feel as though you had a rather poor nights sleep? d. Can you give me an example of what you mean by stoned? ANS: D 2. A patient diagnosed with schizophrenia tells the nurse, The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say. Which response by the nurse would be most therapeutic? a. Lets talk about something other than the CIA. b. It sounds like youre concerned about your privacy. c. The CIA is prohibited from operating in health care facilities. d. You have lost touch with reality, which is a symptom of your illness. ANS: B 3. The patient says, My marriage is just great. My spouse and I usually agree on everything. The nurse observes the patients foot moving continuously as the patient twirls a shirt button. What conclusion can the nurse draw? The patients communication is: a. clear. b. mixed. c. precise. d. inadequate. ANS: B 4. A nurse interacts with a newly hospitalized patient. Select the nurses comment that applies the communication technique of offering self. a. Ive also had traumatic life experiences. Maybe it would help if I told you about them. b. Why do you think you had so much difficulty adjusting to this change in your life? c. I hope you will feel better after getting accustomed to how this unit operates. d. Id like to sit with you for a while to help you get comfortable talking to me. ANS: D 5. Which technique will best communicate to a patient that the nurse is interested in listening? a. Restate a feeling or thought the patient has expressed. b. Ask a direct question, such as, Did you feel angry? c. Make a judgment about the patients problem. d. Say, I understand what youre saying. ANS: A 6. A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate? a. What are the common elements here? b. Tell me again about your experiences. c. Am I correct in understanding that?8?? d. Tell me everything from the beginning. ANS: C 7. A patient tells the nurse, I dont think I will ever get out of here. Select the nurses most therapeutic response. a. Dont talk that way. Of course you will leave here! b. Keep up the good work and you certainly will. c. You dont think youre making progress? d. Everyone feels that way sometimes. ANS: C 8. Documentation in a patients chart shows, Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, I enjoy spending time with you. Which analysis is most accurate? a. Patient is giving positive feedback about the nurses communication techniques. b. Nurse is viewing the patients behavior through a cultural filter. c. Patients verbal and nonverbal messages are incongruent. d. Patient is demonstrating psychotic behaviors. ANS: C 9. While talking with a patient with severe depression, a nurse notices the patient is unable to maintain eye contact. The patients chin lowers to the chest while the patient looks at the floor. Which aspect of communication has the nurse assessed? a. Nonverbal communication b. A message filter c. A cultural barrier d. Social skills ANS: A 10. During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patients hand. Select the correct analysis of the nurses behavior. a. It shows empathy and compassion. It will encourage the patient to continue to express feelings. b. The gesture is premature. The patients cultural and individual interpretation of touch is unknown. c. The patient will perceive the gesture as intrusive and overstepping boundaries. d. The action is inappropriate. Patients in a psychiatric setting should not be touched. ANS: B 11. A Mexican-American patient puts a picture of the Virgin Mary on the bedside table. Under which section of the assessment should the nurse document this behavior? a. Culture b. Ethnicity c. Verbal communication d. Nonverbal communication ANS: A 12. An African-American patient says to a Caucasian nurse, Theres no sense talking. You wouldnt understand because you live in a white world. The nurses best action would be to: a. explain, Yes, I do understand. Everyone goes through the same experiences. b. say, Please give an example of something you think I wouldnt understand. c. reassure the patient that nurses interact with people from all cultures. d. change the subject to one that is less emotionally disturbing. ANS: B 13. A Filipino-American patient had this nursing diagnosis: Situational low self-esteem, related to poor social skills as evidenced by lack of eye contact. Interventions were used to raise the patients self-esteem; however, after 3 weeks, the patients eye contact did not improve. What is the most accurate analysis of this scenario? a. The patients eye contact should have been directly addressed by role-playing to increase comfort with eye contact. b. The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient. c. The patients poor eye contact is indicative of anger and hostility that remain unaddressed. d. The nurse should have assessed the patients culture before making this diagnosis and plan. ANS: D 14. When a female Mexican-American patient and a female nurse sit together, the patient often holds the nurses hand. The patient also links arms with the nurse when they walk. The nurse is uncomfortable with this behavior and thinks the patient is homosexual. Which alternative is a more accurate assessment? a. The patient is accustomed to touch during conversations, as are members of many Hispanic subcultures. b. The patient understands that touch makes the nurse uncomfortable and controls the relationship based on that factor. c. The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted. d. The nurse is homophobic. ANS: A 15. A Puerto RicanAmerican patient uses dramatic body language when describing emotional discomfort. Which analysis most likely explains the patients behavior? The patient: a. likely has a histrionic personality disorder. b. believes dramatic body language is sexually appealing. c. wishes to impress staff with the degree of emotional pain. d. belongs to a culture in which dramatic body language is the norm. ANS: D 16. During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. The nurse should respond by saying: a. Youve turned the tables on me. b. Nurses direct the interviews with patients. c. Do not ask questions about my personal life. d. The time we spend together is to discuss your concerns. ANS: D 17. Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions? a. Nurses are responsible for breaking silences. b. Patients withdraw if silences are prolonged. c. Silence can provide meaningful moments for reflection. d. Silence helps patients know that what they said is understood. ANS: C 18. A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies? Giving advice: a. is rarely helpful. b. fosters independence. c. lifts the burden of personal decision making. d. helps the patient develop feelings of personal adequacy. ANS: A 19. The relationship between a nurse and patient as it relates to status and power is best described by which term? a. Symmetric b. Complementary c. Incongruent d. Paralinguistic ANS: B 20. A patient with severe depression states, God is punishing me for my past sins. What is the nurses best response? a. Why do you think that? b. You sound very upset about this. c. You believe God is punishing you for your sins? d. If you feel this way, you should talk to a member of your clergy. ANS: B MULTIPLE RESPONSE 1. A patient cries as the nurse explores the patients relationship with a deceased parent. The patient says, I shouldnt be crying like this. It happened a long time ago. Which responses by the nurse will facilitate communication? Select all that apply. a. Why do you think you are so upset? b. I can see that you feel sad about this situation. c. The loss of your parent is very painful for you. d. Crying is a way of expressing the hurt youre experiencing. e. Lets talk about something else because this subject is upsetting you. ANS: B, C, D 2. Which benefits are most associated with the use of telehealth? Select all that apply. a. Cost savings for patients b. Maximization of care management c. Access to services for patients in rural areas d. Prompt reimbursement by third-party payers e. Rapid development of trusting relationships with patients ANS: A, B, C Chapter 09: Therapeutic Relationships and the Clinical Interview MULTIPLE CHOICE 1. A nurse assesses a confused older adult. The nurse experiences sadness and reflects, The patient is like one of my grandparents . . . so helpless. What feelings does the nurse describe? a. Transference b. Countertransference c. Catastrophic reaction d. Defensive coping reaction ANS: B 2. Which statement shows a nurse has empathy for a patient who made a suicide attempt? a. You must have been very upset when you tried to hurt yourself. b. It makes me sad to see you going through such a difficult experience. c. If you tell me what is troubling you, I can help you solve your problems. d. Suicide is a drastic solution to a problem that may not be such a serious matter. ANS: A 3. After several therapeutic encounters with a patient who recently attempted suicide, which occurrence should cause the nurse to consider the possibility of countertransference? a. The patients reactions toward the nurse seem realistic and appropriate. b. The patient states, Talking to you feels like talking to my parents. c. The nurse feels unusually happy when the patients mood begins to lift. d. The nurse develops a trusting relationship with the patient. ANS: C 4. A patient says, Please dont share information about me with the other people. How should the nurse respond? a. I wont share information with others without your permission, but I will share information about you with other staff members. b. A therapeutic relationship is just between the nurse and the patient. Its up to you to tell others what you want them to know. c. It really depends on what you choose to tell me. I will be glad to disclose at the end of each session what I will report to others. d. I cannot tell anyone about you. It will be as though I am talking about my own problems, and we can help each other by keeping it between us. ANS: A 5. A nurse is talking with a patient, and 5 minutes remain in the session. The patient has been silent for most of the session. Another patient comes to the door of the room, interrupts, and says to the nurse, I really need to talk to you right now. The nurse should: a. say to the interrupting patient, I am not available to talk with you at the present time. b. end the unproductive session with the current patient and spend time with the patient who has just interrupted. c. invite the interrupting patient to join in the session with the current patient. d. tell the patient who interrupted, This session is 5 more minutes; then, I will talk with you. ANS: D 6. Termination of a therapeutic nurse-patient relationship with a patient has been successful when the nurse: a. avoids upsetting the patient by shifting focus to other patients before the discharge. b. gives the patient a personal telephone number and permission to call after discharge. c. discusses with the patient changes that have happened during the relationship and evaluates the outcomes. d. offers to meet the patient for coffee and conversation three times a week after discharge. ANS: C 7. What is the desirable outcome for the orientation stage of a nurse-patient relationship? The patient will demonstrate behaviors that indicate: a. great sense of independence. b. rapport and trust with the nurse. c. self-responsibility and autonomy. d. resolution of feelings of transference. ANS: B 8. During which phase of the nurse-patient relationship can the nurse anticipate that identified patient issues will be explored and resolved? a. Preorientation b. Orientation c. Working d. Termination ANS: C 9. At what point in the nurse-patient relationship should a nurse plan to first address termination? a. In the orientation phase b. During the working phase c. In the termination phase d. When the patient initially brings up the topic ANS: A 10. A nurse should introduce the matter of a contract during the first session with a new patient because contracts: a. specify what the nurse will do for the patient. b. spell out the participation and responsibilities of each party. c. indicate the feeling tone established between the participants. d. are binding and prevent either party from prematurely ending the relationship. ANS: B 11. As a nurse escorts a patient being discharged after treatment for major depressive disorder, the patient gives the nurse a gold necklace with a heart pendant and says, Thank you for helping mend my broken heart. Which is the nurses best response? a. Accepting gifts violates the policies and procedures of the facility. b. Im glad you feel so much better now. Thank you for the beautiful necklace. c. Im glad I could help you, but I cant accept the gift. My reward is seeing you with a renewed sense of hope. d. Helping people is what nursing is all about. Its rewarding to me when patients recognize how hard we work. ANS: C 12. Which remark by a patient indicates passage from the orientation phase to the working phase of a nurse- patient relationship? a. I dont have any problems. b. It is so difficult for me to talk about my problems. c. I dont know how talking about things twice a week can help. d. I want to find a way to deal with my anger without becoming violent. ANS: D 13. A nurse explains to the family of a patient who is mentally ill how the nurse-patient relationship differs from social relationships. Which is the best explanation? a. The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient. b. The focus shifts from nurse to patient as the relationship develops. Advice is given by both, and solutions are implemented. c. The focus of the relationship is socialization. Mutual needs are met, and feelings are openly shared. d. The focus is the creation of a partnership in which each member is concerned with the growth and satisfaction of the other. ANS: A 14. A nurse wants to demonstrate genuineness with a patient diagnosed with schizophrenia. The nurse should: a. restate what the patient says. b. use congruent communication strategies. c. use self-disclosure in patient interactions. d. consistently interpret the patients behaviors. ANS: B 15. A nurse caring for a withdrawn, suspicious patient recognizes the development of feelings of anger toward the patient. The nurse should: a. suppress the angry feelings. b. express the anger openly and directly with the patient. c. tell the nurse manager to assign the patient to another nurse. d. discuss the anger with a clinician during a supervisory session. ANS: D 16. A nurse wants to enhance the growth of a patient by showing positive regard. The action consistent with this wish is: a. making rounds daily. b. staying with a tearful patient. c. administering daily medication as prescribed. d. examining personal feelings about a patient. ANS: B 17. A patient says, Ive done a lot of cheating and manipulating in my relationships. Select a nonjudgmental response by the nurse. a. How do you feel about that? b. Its good that you realize this. c. Thats not a good way to behave. d. Have you outgrown that type of behavior? ANS: A 18. A patient says, People should be allowed to commit suicide without interference from others. A nurse replies, Youre wrong. Nothing is bad enough to justify death. What is the best analysis of this interchange? a. The patient is correct. b. The nurse is correct. c. Neither person is totally correct. d. Differing values are reflected in the two statements. ANS: D 19. Which issues should a nurse address during the first interview with a patient diagnosed with a psychiatric disorder? a. Trust, congruence, attitudes, and boundaries b. Goals, resistance, unconscious motivations, and diversion c. Relationship parameters, the contract, confidentiality, and termination d. Transference, countertransference, intimacy, and developing resources ANS: C 20. During the first interview, a nurse notices that the patient does not make eye contact. The nurse can correctly analyze that: a. the patient is not truthful. b. the patient is feeling sad. c. the patient has a poor self-concept. d. more information is needed to draw a conclusion. ANS: D 21. Which behavior shows that a nurse values autonomy? The nurse: a. sets limits on a patients romantic overtures toward the nurse. b. suggests one-on-one supervision for a patient who is suicidal. c. informs a patient that the spouse will not be in during visiting hours. d. discusses available alternatives and helps the patient weigh the consequences. ANS: D 22. As a nurse discharges a patient, the patient gives the nurse a card of appreciation made in an arts and crafts group. What is the nurses best action? a. Recognize the effectiveness of the relationship and patients thoughtfulness. Accept the card. b. Inform the patient that accepting gifts violates the policies of the facility. Decline the card. c. Acknowledge the patients transition through the termination phase but decline the card. d. Accept the card and invite the patient to return to participate in other arts and crafts groups. ANS: A 23. A patient says, Im still on restriction, but I want to attend some off-unit activities. Would you ask the doctor to change my privileges? What is the nurses best response? a. Why are you asking me when youre able to speak for yourself? b. I will be glad to address it when I see your doctor later today. c. Thats a good topic for you to take up with your doctor. d. Do you think you cant speak to a doctor? ANS: C 24. A community mental health nurse has worked with a patient for 3 years but is moving out of the city and terminates the relationship. A new nurse who begins work with this patient will: a. begin at the orientation phase. b. resume the working relationship. c. enter into a social relationship. d. return to the emotional catharsis phase. ANS: A 25. As a patient diagnosed with mental illness is being discharged from a facility, a nurse invites the patient to the annual staff picnic. What is the best analysis of this scenario? a. The invitation facilitates dependency on the nurse. b. The nurses action blurs the boundaries of the therapeutic relationship. c. The invitation is therapeutic for the patients diversional activity deficit. d. The nurses action assists the patients integration into community living. ANS: B 26. A nurse says, I am the only one who truly understands this patient. Other staff members are too critical. The nurses statement indicates: a. boundary blurring. b. sexual harassment. c. positive regard. d. advocacy. ANS: A MULTIPLE RESPONSE 1. Which descriptors exemplify consistency regarding therapeutic nurse-patient relationships? Select all that apply. a. Having the same nurse care for a patient on a daily basis b. Encouraging a patient to share initial impressions of staff c. Providing a schedule of daily activities to a patient d. Setting a time for regular sessions with a patient e. Offering solutions to a patients problems ANS: A, C, D 2. A nurse ends a relationship with a patient. Which actions by the nurse should be included in the termination phase? Select all that apply. a. Focus dialog with the patient on problems that may occur in the future. b. Help the patient express feelings about the relationship with the nurse. c. Help the patient prioritize and modify socially unacceptable behaviors. d. Reinforce expectations regarding the parameters of the relationship. e. Help the patient identify strengths, limitations, and problems. ANS: A, B 3. A new psychiatric nurse has a parent diagnosed with bipolar disorder. This nurse angrily recalls embarrassing events concerning the parents behavior in the community. Select the best ways for this nurse to cope with these feelings. Select all that apply. a. Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses. b. Recognize that these feelings are unhealthy, and try to suppress them when working with patients. c. Recognize that psychiatric nursing is not an appropriate career choice, and explore other nursing specialties. d. Begin new patient relationships by saying, My own parent had mental illness, so I accept it without stigma. e. Recognize that the feelings may add sensitivity to the nurses practice, but supervision is important. ANS: A, E 4. A new nurse tells a mentor, I want to convey to my patients that I am interested in them and that I want to listen to what they have to say. Which behaviors are helpful in meeting the nurses goal? Select all that apply. a. Sitting behind a desk, facing the patient. b. Introducing self to a patient and identifying own role. c. Using facial expressions that convey interest and encouragement. d. Assuming an open body posture and sometimes mirror imaging. e. Maintaining control of the topic under discussion by asking direct questions. ANS: B, C, D Chapter 06: Legal and Ethical Basis for Practice MULTIPLE CHOICE 1. A psychiatric nurse best implements the ethical principle of autonomy when he or she: a. intervenes when a self-mutilating patient attempts to harm self. b. stays with a patient who is demonstrating a high level of anxiety. c. suggests that two patients who are fighting be restricted to the unit. d. explores alternative solutions with a patient, who then makes a choice. ANS: D 2. Which action by a psychiatric nurse best supports a patients right to be treated with dignity and respect? a. Consistently addressing a patient by title and surname. b. Strongly encouraging a patient to participate in the unit milieu. c. Discussing a patients condition with another health care provider in the elevator. d. Informing a treatment team that a patient is too drowsy to participate in care planning. ANS: A 3. Two hospitalized patients fight when they are in the same room. During a team meeting, a nurse asserts that safety is of paramount importance and therefore the treatment plans should call for both patients to be secluded to prevent them from injuring each other. This assertion: a. reveals that the nurse values the principle of justice. b. reinforces the autonomy of the two patients. c. violates the civil rights of the two patients. d. represents the intentional tort of battery. ANS: C 4. In a team meeting a nurse says, Im concerned whether we are behaving ethically by using restraint to prevent one patient from self-mutilation while the care plan for another patient who has also self-mutilated calls for one-on-one supervision. Which ethical principle most clearly applies to this situation? a. Beneficence b. Autonomy c. Fidelity d. Justice ANS: D 5. Which scenario is an example of a tort? a. The primary nurse does not complete the plan of care for a patient within 24 hours of the patients admission. b. An advanced practice nurse recommends that a patient who is dangerous to self and others be voluntarily hospitalized. c. A patients admission status is changed from involuntary to voluntary after the patients hallucinations subside. d. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent violence because a unit is short staffed. ANS: D 6. A nurses neighbor asks, Why arent people with mental illness kept in state institutions anymore? What is the nurses best response? a. Many people are still in psychiatric institutions. Inpatient care is needed because many people who are mentally ill are violent. b. Less restrictive settings are now available to care for individuals with mental illness. c. Our nation has fewer persons with mental illness; therefore fewer hospital beds are needed. d. Psychiatric institutions are no longer popular as a consequence of negative stories in the press. ANS: B 7. Which nursing intervention demonstrates false imprisonment? a. A confused and combative patient says, Im getting out of here and no one can stop me. The nurse restrains this patient without a health care providers order and then promptly obtains an order. b. A patient has been irritating, seeking the attention of nurses most of the day. Now a nurse escorts the patient down the hall, saying, Stay in your room or youll be put in seclusion. c. An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. A nurse rushes after the patient and convinces the patient to return to the unit. d. An involuntarily hospitalized patient with suicidal ideation attempts to leave the unit. A nurse calls the security team and uses established protocols to prevent the patient from leaving. ANS: B 8. A patient should be considered for involuntary commitment for psychiatric care when he or she: a. is noncompliant with the treatment regimen. b. sells and distributes illegal drugs. c. threatens to harm self and others. d. fraudulently files for bankruptcy. ANS: C 9. A nurse at the mental health center prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot) to a patient with schizophrenia. As the nurse swabs the site, the patient shouts, Stop! I dont want to take that medicine anymore. I hate the side effects. Select the nurses best initial action. a. Stop the medication administration procedure and say to the patient, Tell me more about the side effects youve been having. b. Say to the patient, Since Ive already drawn the medication in the syringe, Im required to give it, but lets talk to the doctor about skipping next months dose. c. Proceed with the injection but explain to the patient that other medications are available that may help reduce the unpleasant side effects. d. Notify other staff members to report to the room for a show of force and proceed with the injection, using restraint if necessary. ANS: A 10. Several nurses are concerned that agency policies related to restraint and seclusion are inadequate. Which statement about the relationship of substandard institutional policies and individual nursing practice should guide nursing practice? a. The policies do not absolve an individual nurse of the responsibility to practice according to the professional standards of nursing care. b. Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care. c. In an institution with substandard policies, the nurse has a responsibility to inform the supervisor and leave the premises. d. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted. ANS: A 11. A newly admitted patient who is acutely psychotic is a private patient of the senior psychiatrist. To whom does the psychiatric nurse who is assigned to this patient owe the duty of care? a. Health care provider b. Profession c. Hospital d. Patient ANS: D 12. An example of a breach of a patients right to privacy occurs when a nurse: a. asks a family to share information about a patients prehospitalization behavior. b. discusses the patients history with other staff members during care planning. c. documents the patients daily behaviors during hospitalization. d. releases information to the patients employer without consent. ANS: D 13. An adolescent hospitalized after a violent physical outburst tells the nurse, Im going to kill my father, but you cant tell anyone. Select the nurses best response. a. Youre right. Federal law requires me to keep that information private. b. Those kinds of thoughts will make your hospitalization longer. c. You really should share this thought with your psychiatrist. d. I am required to share information with the treatment team. ANS: D 14. A voluntarily hospitalized patient tells the nurse, Get me the forms for discharge against medical advice so I can leave now. What is the nurses best initial response? a. I cant give you those forms without your health care providers knowledge. b. I will get them for you, but lets talk about your decision to leave treatment. c. Since you signed your consent for treatment, you may leave if you desire. d. Ill get the forms for you right now and bring them to your room. ANS: B 15. The family of a patient whose insurance will not pay for continuing hospitalization considers transferring the patient to a public psychiatric hospital. The family expresses concern that the patient will never get any treatment. Which reply by the nurse would be most helpful? a. Under the law, treatment must be provided. Hospitalization without treatment violates patients rights. b. Thats a justifiable concern because the right to treatment extends only to the provision of food, shelter, and safety. c. Much will depend on other patients, because the right to treatment for a psychotic patient takes precedence over the right to treatment of a patient who is stable. d. All patients in public hospitals have the right to choose both a primary therapist and a primary nurse. ANS: A 16. Which individual with a mental illness may need emergency or involuntary hospitalization for mental illness? The individual who: a. resumes using heroin while still taking methadone. b. reports hearing angels playing harps during thunderstorms. c. throws a heavy plate at a waiter at the direction of command hallucinations. d. does not show up for an outpatient appointment with the mental health nurse. ANS: C 17. A patient being treated in an alcohol rehabilitation unit reveals to the nurse, I feel terrible guilt for sexually abusing my 6-year-old child before I was admitted. Based on state and federal law, the best action for the nurse to take is to: a. anonymously report the abuse by telephone to the local child abuse hotline. b. reply, Im glad you feel comfortable talking to me about it. c. respect the nurse-patient relationship of confidentiality. d. file a written report on the agency letterhead. ANS: A 18. The spouse of a patient who has delusions asks the nurse, Are there any circumstances under which the treatment team is justified in violating the patients right to confidentiality? The nurse must reply that confidentiality may be breached: a. under no circumstances. b. at the discretion of the psychiatrist. c. when questions are asked by law enforcement. d. if the patient threatens the life of another person. ANS: D 19. A nurse cares for an older adult patient admitted for treatment of depression. The health care provider prescribes an antidepressant medication, but the dose is more than the usual adult dose. The nurse should: a. implement the order. b. consult a drug reference. c. give the usual geriatric dosage. d. hold the medication and consult the health care provider. ANS: D 20. A patient diagnosed with schizophrenia believes evil spirits are being summoned by a local minister and verbally threatens to bomb a local church. The psychiatrist notifies the minister. The psychiatrist has: a. released information without proper authorization. b. demonstrated the duty to warn and protect. c. violated the patients confidentiality. d. avoided charges of malpractice. ANS: B 21. After leaving work, a staff nurse realizes that documentation of the administration of a medication to a patient was omitted. This off-duty nurse telephones the unit and tells the nurse, Please document the administration of the medication I forgot to do. My password is alpha1. The nurse should: a. fulfill the request. b. refer the matter to the charge nurse to resolve. c. access the record and document the information. d. report the request to the patients health care provider. ANS: B 22. A patient diagnosed with mental illness asks a psychiatric technician, Whats the matter with me? The technician replies, Your wing nuts need tightening. The nurse who overheard the exchange should take action based on: a. violation of the patients right to be treated with dignity and respect. b. the nurses obligation to report caregiver negligence. c. preventing defamation of the patients character. d. supervisory liability. ANS: A 23. Which documentation of a patients behavior best demonstrates a nurses observations? a. Isolates self from others. Frequently fell asleep during group. Vital signs stable. b. Calmer and more cooperative. Participated actively in group. No evidence of psychotic thinking. c. Appeared to hallucinate. Patient frequently increased volume on television, causing conflict with others d. Wears four layers of clothing. States, I need protection from dangerous bacteria trying to penetrate my skin. ANS: D MULTIPLE RESPONSE 1. A nurse volunteers for a committee that must revise the hospital policies and procedures for suicide precautions. Which resources would provide the best guidance? Select all that apply. a. Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5) b. States nurse practice act c. State and federal regulations that govern hospitals d. Summary of common practices of several local hospitals e. American Nurses Association Scope and Standards of Practice for PsychiatricMental Health Nursing ANS: C, E 2. In which situations does a nurse have a duty to intervene and report? Select all that apply. a. A peer is unable to write behavioral outcomes. b. A health care provider consults the Physicians Desk Reference. c. A peer tries to provide patient care in an alcohol-impaired state. d. A team member has violated the boundaries of a vulnerable patient. e. A patient refuses a medication prescribed by a licensed health care provider. ANS: C, D 3. Which situations qualify as abandonment on the part of a nurse? (Select all that apply.) The nurse: a. allows a patient with acute mania to refuse hospitalization without taking further action. b. terminates employment without referring a seriously mentally ill for aftercare. c. calls police to bring a suicidal patient to the hospital after a suicide attempt. d. refers a patient with persistent paranoid schizophrenia to community treatment. e. asks another nurse to provide a patients care because of concerns about countertransference. ANS: A, B [Show More]

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