Essentials Of Psychiatric Mental Health Nursing: A Communication Approach To Evidence-Based Care, 3rd Edition Test Bank

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1271220283543515867748594103111121131142151163171179186195204213221230Table of ContentsTable of ContentsChapter 01: Practicing the Science and the Art of Psychiatric NursingChapter 02: Mental Health and Mental IllnessChapter 03: Theories and TherapiesChapter 04: Biological Basis for Understanding PsychopharmacologyChapter 05: Settings for Psychiatric CareChapter 06: Legal and Ethical Basis for PracticeChapter 07: Nursing Process and QSEN: The Foundation for Safe and Effective CareChapter 08: Communication Skills: Medium for All Nursing PracticeChapter 09: Therapeutic Relationships and the Clinical InterviewChapter 10: Trauma and Stress-Related DisordersChapter 11: Anxiety, Anxiety Disorders, and Obsessive-Compulsive DisordersChapter 12: Somatic System Disorders and Dissociative DisordersChapter 13: Personality DisordersChapter 14: Eating DisordersChapter 15: Mood Disorders: DepressionChapter 16: Bipolar Spectrum DisordersChapter 17: Schizophrenia Spectrum Disorders and Other Psychotic DisordersChapter 18: Neurocognitive DisordersChapter 19: Substance-Related and Addictive DisordersChapter 20: Crisis and Mass DisasterChapter 21: Child, Partner, and Elder ViolenceChapter 22: Sexual ViolenceChapter 23: Suicidal Thoughts and BehaviorChapter 24: Anger, Aggression, and ViolenceChapter 25: Care for the Dying and Those Who GrieveChapter 26: Children and AdolescentsChapter 27: AdultsChapter 28: Older AdultsTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)1lOMoARcPSD|13778330

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Chapter 01: Practicing the Science and the Art of Psychiatric NursingMULTIPLE CHOICE1. Which outcome, focused on recovery, would be expected in the plan of care for a patient living in thecommunity 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: BRecovery emphasizes managing symptoms, reducing psychosocial disability, and improving role performance.The goal of recovery is to empower the individual with mental illness to achieve a sense of meaning andsatisfaction in life and to function at the highest possible level of wellness. The incorrect options focus on theclassic medical model rather than recovery.DIF: Cognitive Level: Application (Applying) REF: 2TOP: Nursing Process: Outcomes IdentificationMSC: NCLEX: Health Promotion and Maintenance2. In the shift-change report, an off-going nurse criticizes a patient who wears heavy makeup. Which commentby 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: DAccepting patients needs for self-expression and seeking to teach skills that will contribute to their well-beingdemonstrate respect and are important parts of advocacy. The on-coming nurse needs to take action to ensurethat others are not prejudiced against the patient. Humor can be appropriate within the privacy of a shift reportbut not at the expense of respect for patients. Judging the off-going nurse in a critical way will create conflict.Nurses must show compassion for each other.DIF: Cognitive Level: Application (Applying) REF: 8TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment3. A nurse assesses a newly admitted patient diagnosed with major depressive disorder. Which statement is anexample 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: DAttending is a technique that demonstrates the nurses commitment to the relationship and reduces feelings ofisolation. This technique shows respect for the patient and demonstrates caring. Generalizations, probing, andfalse reassurances are non-therapeutic.DIF: Cognitive Level: Application (Applying) REF: 8TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity4. A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Select thenurses 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?Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)2lOMoARcPSD|13778330

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ANS: AThe nurses communication should evidence caring and a commitment to work with the patient. Thiscommitment lets the patient know the nurse will help. Probing and advice are not helpful or therapeuticinterventions.DIF: Cognitive Level: Application (Applying) REF: 6TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity5. A patient shows the nurse an article from the Internet about a health problem. Which characteristic of theweb 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: BFinancial influences on a site are a clue that the information may be biased. .com at the end of the addressindicates that the site is a commercial one. .gov indicates that the site is maintained by a government entity..org indicates that the site is nonproprietary; the site may or may not have reliable information, but it does notprofit from its activities. .net can have multiple meanings.DIF: Cognitive Level: Comprehension (Understanding) REF: 5TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance6. A nurse says, When I was in school, I learned to call upset patients by name to get their attention; however, Iread a descriptive research study that says that this approach does not work. I plan to stop calling patients byname. 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: ADescriptive research findings provide evidence for practice but must be viewed in relation to other studiesbefore practice changes. One study is not enough. Descriptive studies are low on the hierarchy of evidence.Clinical algorithms use flow charts to manage problems and do not specify one response to a clinical problem.Classic tenets of practice should change as research findings provide evidence for change.DIF: Cognitive Level: Analysis (Analyzing) REF: 3TOP: Nursing Process: Evaluation MSC: NCLEX: Health Promotion and Maintenance7. 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 yourskills. 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 bebetter because of the nature of patients problems.b. Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensionalproblems. 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 tocontinue them after I graduate.d. Psychiatric nurses do not have to deal with as much pain and suffering as medical surgical nurses. Thatappeals to me.ANS: BThe practice of psychiatric nursing requires a different set of skills than medical surgical nursing, althoughsubstantial overlap does exist. Psychiatric nurses must be able to help patients with medical and mental healthproblems, reflecting the holistic perspective these nurses must have. Nurse-patient ratios and workloads inpsychiatric settings have increased, similar to other specialties. Psychiatric nursing involves clinical practice,Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)3lOMoARcPSD|13778330

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not simply documentation. Psychosocial pain is real and can cause as much suffering as physical pain.DIF: Cognitive Level: Application (Applying) REF: 3TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment8. Which research evidence would most influence a group of nurses to change their practice?a. Expert committee report of recommendations for practiceb. Systematic review of randomized controlled trialsc. Nonexperimental descriptive studyd. Critical pathwayANS: BResearch findings are graded using a hierarchy of evidence. A systematic review of randomized controlledtrials is Level A and provides the strongest evidence for changing practice. Expert committeerecommendations and descriptive studies lend less powerful and influential evidence. A critical pathway is notevidence; it incorporates research findings after they have been analyzed.DIF: Cognitive Level: Comprehension (Understanding) REF: 3TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment9. 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 havethe nurses fulfilled?a. Advocacyb. Attendingc. Recoveryd. Evidence-based practiceANS: AAn advocate defends or asserts anothers cause, particularly when the other person lacks the ability to do thatfor himself or herself. Examples of individual advocacy include helping patients understand their rights ormake decisions. On a community scale, advocacy includes political activity, public speaking, and publicationin the interest of improving the individuals with mental illness; the letter-writing campaign advocates for thatcause on behalf of patients who are unable to articulate their own needs.DIF: Cognitive Level: Comprehension (Understanding) REF: 8TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment10. An informal group of patients discuss their perceptions of nursing care. Which comment best indicates apatients 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: DCaring evidences empathic understanding, as well as competency. It helps change pain and suffering into ashared experience, creating a human connection that alleviates feelings of isolation. The incorrect options giveexamples of statements that demonstrate advocacy or giving advice.DIF: Cognitive Level: Application (Applying) REF: 3TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity11. A patient who immigrated to the United States from Honduras was diagnosed with schizophrenia. Thepatient took an antipsychotic medication for 3 weeks but showed no improvement. Which resource should thetreatment team consult for information on more effective medications for this patient?a. Clinical algorithmb. Clinical pathwayc. Clinical practice guidelineTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)4lOMoARcPSD|13778330

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d. International Statistical Classification of Diseases and Related Health Problems (ICD)ANS: AA clinical algorithm is a guideline that describes diagnostic and/or treatment approaches drawn from largedatabases of information. These guidelines help the treatment team make decisions cognizant of an individualpatients needs, such as ethnic origin, age, or gender. A clinical pathway is a map of interventions andtreatments related to a specific disorder. Clinical practice guidelines summarize best practices about specifichealth problems. The ICD classifies diseases.DIF: Cognitive Level: Application (Applying) REF: 5TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment12. Which historical nursing leader helped focus practice to recognize the importance of science in psychiatricnursing?a. Abraham Maslowb. Hildegard Peplauc. Kris Martinsend. Harriet BaileyANS: BAlthough all these leaders included science as an important component of practice, Hildegard Peplau mostinfluenced its development in psychiatric nursing. Maslow was not a nurse, but his theories influence hownurses prioritize problems and care. Bailey wrote a textbook in the 1930s on psychiatric nursing interventions.Kris Martinsen emphasized the importance of caring in nursing practice.DIF: Cognitive Level: Knowledge (Remembering) REF: 4TOP: Nursing Process: N/A MSC: NCLEX: Psychosocial Integrity13. A nurse consistently strives to demonstrate caring behaviors during interactions with patients. Whichreaction 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: BA patient is likely to respond to caring with a sense of connectedness with others. The absence of caring canmake patients feel distrustful, disconnected, uneasy, and discouraged.DIF: Cognitive Level: Comprehension (Understanding) REF: 7TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial IntegrityMULTIPLE RESPONSE1. An experienced nurse says to a new graduate, When youve practiced as long as I have, you will instantlyknow how to take care of psychotic patients. What is the new graduates best analysis of this comment? Selectall that apply.a. The experienced nurse may have lost sight of patients individuality, which may compromise the integrity ofpractice.b. New research findings must be continually integrated into a nurses practice to provide the most effectivecare.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 anderror.e. Effective psychiatric nurses should be continually guided by an intuitive sense of patients needs.ANS: A, BEvidence-based practice involves using research findings to provide the most effective nursing care. Evidenceis continually emerging; therefore, nurses cannot rely solely on experience. The effective nurse also maintainsTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)5lOMoARcPSD|13778330

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respect for each patient as an individual. Overgeneralization compromises that perspective. Intuition and trialand error are unsystematic approaches to care.DIF: Cognitive Level: Application (Applying) REF: 2TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment2. Which patient statements identify qualities of nursing practice with high therapeutic value? (Select all thatapply.) 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, EEach correct answer demonstrates caring is an example of appropriate nursing foci: communicating at a levelunderstandable to the patient, using holistic principles to guide care, and providing medication supervision.The incorrect options suggest a laissez-faire attitude on the part of the nurse, when the nurse should insteadprovide thoughtful feedback and help patients test alternative solutions or violate boundaries.DIF: Cognitive Level: Application (Applying) REF: 6TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial IntegrityTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)6lOMoARcPSD|13778330

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Chapter 02: Mental Health and Mental IllnessMULTIPLE CHOICE1. An 86-year-old, previously healthy and independent, falls after an episode of vertigo. Which behavior bythis 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: DResiliency is the ability to recover from or adjust to misfortune and change. The correct response indicates thatthe patient is hopeful and thinking positively about ways to adapt to the vertigo. Saying I knew this wouldhappen eventually and discontinuing healthy activities suggest a hopeless perspective on the health change.Refusing to use a walker indicates denial.DIF: Cognitive Level: Comprehension (Understanding) REF: 14TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity2. A patient is admitted to the psychiatric hospital. Which assessment finding best indicates that the patient hasa 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: BA patient who reports having a consistently negative mood is describing a mood alteration. The incorrectoptions describe mentally healthy behaviors and common problems that do not indicate mental illness.DIF: Cognitive Level: Application (Applying) REF: 11TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity3. 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: CThe patients ability to identify healthy coping behaviors indicates adaptive, healthy behavior and demonstratesan increased ability to recover from severe stress. Describing feelings associated with loss and stress does notmove the patient toward adaptation. The remaining options are maladaptive behaviors.DIF: Cognitive Level: Analysis (Analyzing) REF: 14TOP: Nursing Process: Outcomes IdentificationMSC: NCLEX: Psychosocial Integrity4. Which organization actively seeks to reduce the stigma associated with mental illness through publicpresentations 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: BStigma represents the bias and prejudice commonly held regarding mental illness. NAMI actively seeks toTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)7lOMoARcPSD|13778330

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dispel misconceptions about mental illness. NANDA-I defines approved nursing diagnoses. The APApublishes the DSM 5. The USDHHS regulates and administers health policies.DIF: Cognitive Level: Knowledge (Remembering) REF: 19TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment5. A nurse must assess several new patients at a community mental health center. Conclusions concerningcurrent 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: CBecause mental health and mental illness are relative concepts, assessment of functioning is made by using acontinuum. Mental health is not based on conformity; some mentally healthy individuals do not conform tosocietys norms. Most individuals occasionally display illogical or irrational thinking. The rate of intellectualand emotional growth is not the most useful criterion to assess mental health or mental illness.DIF: Cognitive Level: Application (Applying) REF: 11TOP: Nursing Process: Diagnosis| Nursing Process: AnalysisMSC: NCLEX: Psychosocial Integrity6. 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 textbookb. NANDA International (NANDA-I )c. A behavioral health reference manuald. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)ANS: DThe DSM-5 gives the criteria used to diagnose each mental disorder. The NANDA-I focuses on nursingdiagnoses. A psychiatric nursing textbook or behavioral health reference manual may not contain diagnosticcriteria.DIF: Cognitive Level: Application (Applying) REF: 12TOP: Nursing Process: Analysis| Nursing Process: DiagnosisMSC: NCLEX: Safe, Effective Care Environment7. 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 parentsmake decisions for me, and I go along with them. A nurse should identify interventions to improve thispatients:a. self-concept.b. overall happiness.c. appraisal of reality.d. control over behavior.ANS: AThe patient feels the need for multiple explanations of new tasks at work and, despite being 40 years of age,allows both parents to make all decisions. These behaviors indicate a poorly developed self-concept. Althoughthe patient reports being happy, the subsequent comments refute that self-appraisal. The patients comments donot indicate that he/she is out of touch with reality. The patients needs are broader than control over ownbehavior.DIF: Cognitive Level: Application (Applying) REF: 11TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity8. A patient tells a nurse, I have psychiatric problems and am in and out of hospitals all the time. Not one ofTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)8lOMoARcPSD|13778330

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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: DMental illness affects many people at various times in their lives. No class, culture, or creed is immune to thechallenges of mental illness. The correct response also demonstrates the use of reflection, a therapeuticcommunication technique. It is not true that mental illness affects 50% of the population in any given year.Asking patients if they blame themselves is an example of probing.DIF: Cognitive Level: Application (Applying) REF: 11TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity9. A critical care nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic andStatistical Manual of Mental Disorders (DSM-5) and a nursing diagnosis. Select the psychiatric nurses bestresponse.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 andpresent responses to actual mental health problems.d. The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identifyinterventions for problems a patient has or may experience.ANS: DThe medical diagnosis, defined according to the DSM-5, is concerned with the patients disease state, causes,and cures, whereas the nursing diagnosis focuses on the patients response to stress and possible caringinterventions. Both the DSM-5 and a nursing diagnosis consider culture. Nursing diagnoses also considerpotential problems.DIF: Cognitive Level: Application (Applying) REF: 16TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment10. The spouse of a patient diagnosed with schizophrenia says, I dont understand why childhood experienceshave anything to do with this disabling illness. Select the nurses response that will best help the spouseunderstand 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 andinvolvement of caregivers is very important.ANS: DMany of the most prevalent and disabling mental disorders have been found to have strong biologicalinfluences. Helping the spouse understand the importance of his or her role as a caregiver is also important.Empathy is important but does not increase the spouses level of knowledge about the cause of the patientscondition. Not all mental illnesses are the result of genetic factors. Psychological stress is not at the root ofmost mental disorders.DIF: Cognitive Level: Application (Applying) REF: 14TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance11. Which belief by a nurse supports the highest degree of patient advocacy during a multidisciplinary patientcare 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.Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)9lOMoARcPSD|13778330

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ANS: DA nurse who understands that a patients symptoms are influenced by culture will be able to advocate for thepatient to a greater degree than a nurse who believes that culture is of little relevance. All mental illnesses arenot culturally determined. Schizophrenia and bipolar disorder are cross-cultural disorders, but thisunderstanding has little relevance to patient advocacy. Symptoms of mental disorders change from culture toculture.DIF: Cognitive Level: Application (Applying) REF: 18TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment12. A patients history shows intense and unstable relationships with others. The patient initially idealizes anindividual and then devalues the person when the patients needs are not met. Which aspect of mental health isa problem?a. Effectiveness in workb. Communication skillsc. Productive activitiesd. Fulfilling relationshipsANS: DThe information provided centers on relationships with others, which are described as intense and unstable.The relationships of mentally healthy individuals are stable, satisfying, and socially integrated. Data are notpresent to describe work effectiveness, communication skills, or activities.DIF: Cognitive Level: Application (Applying) REF: 12TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity13. In the majority culture of the United States, which individual is at greatest risk to be incorrectly labeledmentally ill?a. Person who is usually pessimistic but strives to meet personal goalsb. Wealthy person who gives $20 bills to needy individuals in the communityc. Person with an optimistic viewpoint about life and getting his or her own needs metd. Person who attends a charismatic church and describes hearing Gods voiceANS: DHearing voices is generally associated with mental illness; however, in charismatic religious groups, hearingthe voice of God or a prophet is a desirable event. In this situation, cultural norms vary, making it moredifficult to make an accurate DSM-5 diagnosis. The individuals described in the other options are less likely tobe labeled as mentally ill.DIF: Cognitive Level: Application (Applying) REF: 17TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity14. A participant at a community education conference asks, What is the most prevalent type of mentaldisorder in the United States? Select the nurses best response.a. Why do you ask?b. Schizophreniac. Affective disordersd. Anxiety disordersANS: DThe prevalence for schizophrenia is 1.1% per year. The prevalence of all affective disorders (e.g., depression,dysthymic disorder, bipolar) is 9.5%. The prevalence of anxiety disorders is 13.3%.DIF: Cognitive Level: Comprehension (Understanding) REF: 15TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance15. A nurse wants to find a description of diagnostic criteria for a person diagnosed with schizophrenia. Whichresource should the nurse consult?Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)10lOMoARcPSD|13778330

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a. U.S. Department of Health and Human Servicesb. Journal of the American Psychiatric Associationc. North American Nursing Diagnosis Association International (NANDA-I)d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)ANS: DThe DSM-5 identifies diagnostic criteria for psychiatric diagnoses. The other sources have useful informationbut are not the best resources for finding a description of the diagnostic criteria for a psychiatric disorder.DIF: Cognitive Level: Application (Applying) REF: 12TOP: Nursing Process: Analysis| Nursing Process: DiagnosisMSC: NCLEX: Health Promotion and MaintenanceMULTIPLE RESPONSE1. A patient in the emergency department reports, I hear voices saying someone is stalking me. They want tokill me because I found the cure for cancer. I will stab anyone that threatens me. Which aspects of mentalhealth have the greatest immediate concern to a nurse? Select all that apply.a. Happinessb. Appraisal of realityc. Control over behaviord. Effectiveness in worke. Healthy self-conceptANS: B, C, EThe aspects of mental health of greatest concern are the patients appraisal of and control over behavior. Thepatients appraisal of reality is inaccurate, and auditory hallucinations are evident, as well as delusions ofpersecution and grandeur. In addition, the patients control over behavior is tenuous, as evidenced by the plan tostab anyone who seems threatening. A healthy self-concept is lacking. Data are not present to suggest that theother aspects of mental health (happiness and effectiveness in work) are of immediate concern.DIF: Cognitive Level: Application (Applying) REF: 12TOP: Nursing Process: Assessment MSC: NCLEX: Safe, Effective Care Environment2. 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, EStigma is represented by judgmental remarks that discount the reality and validity of mental illness. Manymental illnesses are genetically transmitted. Neuroimaging can show changes associated with some mentalillnesses.DIF: Cognitive Level: Analysis (Analyzing) REF: 19TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care EnvironmentTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)11lOMoARcPSD|13778330

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Chapter 03: Theories and TherapiesMULTIPLE CHOICE1. A 26-month-old child displays negative behaviors. The parent says, My child refuses toilet training andshouts, 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: AThese negative behaviors are typical of a child around the age of 2 years whose developmental task is todevelop autonomy. The incorrect options indicate the childs behavior is abnormal.DIF: Cognitive Level: Application (Applying) REF: 22TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance2. A 26-month-old child displays negative behavior, refuses toilet training, and often shouts, No! when givendirections. Using Freuds stages of psychosexual development, a nurse would assess the childs behavior isbased on which stage?a. Oralb. Analc. Phallicd. GenitalANS: BIn Freuds stages of psychosexual development, the anal stage occurs from age 1 to 3 years and has, as itsfocus, toilet training and learning to delay immediate gratification. The oral stage occurs between birth and 1year, the phallic stage occurs between 3 and 5 years, and the genital stage occurs between 13 and 20 years.DIF: Cognitive Level: Comprehension (Understanding) REF: 20TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance3. A 26-month-old child displays negative behavior, refuses toilet training, and often shouts, No! when givendirection. The nurses counseling with the parent should be based on the premise that the child is engaged inwhich of Eriksons psychosocial crises?a. Trust versus Mistrustb. Initiative versus Guiltc. Industry versus Inferiorityd. Autonomy versus Shame and DoubtANS: DThe crisis of Autonomy versus Shame and Doubt is related to the developmental task of gaining control of selfand environment, as exemplified by toilet training. This psychosocial crisis occurs during the period of earlychildhood. Trust versus Mistrust is the crisis of the infant, Initiative versus Guilt is the crisis of the preschooland early school-aged child, and Industry versus Inferiority is the crisis of the 6- to 12-year-old child.DIF: Cognitive Level: Comprehension (Understanding) REF: 22TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance4. A 4-year-old child grabs toys from siblings, saying, I want that toy now! The siblings cry, and the childsparent becomes upset with the behavior. Using the Freudian theory, a nurse can interpret the childs behavior asa product of impulses originating in the:a. id.b. ego.c. superego.d. preconscious.Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)12lOMoARcPSD|13778330

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ANS: AThe id operates on the pleasure principle, seeking immediate gratification of impulses. The ego acts as amediator of behavior and weighs the consequences of the action, perhaps determining that taking the toy is notworth the parents wrath. The superego would oppose the impulsive behavior as not nice. The preconscious is alevel of awareness.DIF: Cognitive Level: Application (Applying) REF: 20TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance5. The parent of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, andusing good manners. A nurse supports the use of praise because, according to the Freudian theory, thesequalities will likely be internalized and become part of the childs:a. id.b. ego.c. superego.d. preconscious.ANS: CIn the Freudian theory, the superego contains the thou shalts or moral standards internalized from interactionswith significant others. Praise fosters internalization of desirable behaviors. The id is the center of basicinstinctual drives, and the ego is the mediator. The ego is the problem-solving and reality-testing portion of thepersonality that negotiates solutions with the outside world. The preconscious is a level of awareness fromwhich material can be easily retrieved with conscious effort.DIF: Cognitive Level: Comprehension (Understanding) REF: 20TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance6. A nurse supports parental praise of a child who is behaving in a helpful way. When the individual behaveswith politeness and helpfulness in adulthood, which feeling will most likely result?a. Guiltb. Anxietyc. Lonelinessd. Self-esteemANS: DThe individual will be living up to the ego ideal, which will result in positive feelings about self. The otheroptions are incorrect; each represents a negative feeling.DIF: Cognitive Level: Comprehension (Understanding) REF: 22TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance7. 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 Guiltb. Trust versus Mistrustc. Autonomy versus Shame and Doubtd. Generativity versus Self-AbsorptionANS: CThese statements show severe self-doubt, indicating that the crisis of gaining control over the environment isnot being successfully met. Unsuccessful resolution of the crisis of Initiative versus Guilt results in feelings ofguilt. Unsuccessful resolution of the crisis of Trust versus Mistrust results in poor interpersonal relationshipsand suspicion of others. Unsuccessful resolution of the crisis of Generativity versus Self-Absorption results inself-absorption that limits the ability to grow as a person.DIF: Cognitive Level: Application (Applying) REF: 22TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance8. Which patient statement would lead a nurse to suspect that the developmental task of infancy was notTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)13lOMoARcPSD|13778330

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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: BAccording to Erikson, the developmental task of infancy is the development of trust. The patients statementthat he or she is afraid of becoming acquainted with others clearly shows a lack of ability to trust other people.Having warm and close friendships suggests the developmental task of infancy was successfully completed.Believing one is always right suggests rigidity rather than mistrust. Feelings of shame suggest failure to resolvethe crisis of Initiative versus Guilt.DIF: Cognitive Level: Analysis (Analyzing) REF: 22TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance9. 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. Oralb. Analc. Phallicd. GenitalANS: AAccording to Freud, each of the behaviors mentioned develops as the result of attitudes formed during the oralstage, when an infant first learns to relate to the environment. Anal stage traits include stinginess,stubbornness, orderliness, or their opposites. Phallic stage traits include flirtatiousness, pride, vanity, difficultywith authority figures, and difficulties with sexual identity. Genital stage traits include the ability to formsatisfying sexual and emotional relationships with members of the opposite sex, emancipation from parents,and a strong sense of personal identity.DIF: Cognitive Level: Application (Applying) REF: 22TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance10. An adult expresses the wish to be taken care of and often behaves in a helpless fashion. This adult hasneeds related to which of Freuds stages of psychosexual development?a. Latencyb. Phallicc. Anald. OralANS: DAccording to Freud, fixation at the oral stage sometimes produces dependent infantile behaviors in adults.Latency fixations often result in a difficulty identifying with others and developing social skills, resulting in asense of inadequacy and inferiority. Phallic fixations result in having difficulty with authority figures and poorsexual identity. Anal fixation sometimes results in retentiveness, rigidity, messiness, destructiveness, andcruelty.DIF: Cognitive Level: Application (Applying) REF: 22TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance11. 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 havetime to help others. These comments contrast which developmental tasks?a. Trust versus Mistrustb. Industry versus Inferiorityc. Intimacy versus Isolationd. Generativity versus Self-AbsorptionTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)14lOMoARcPSD|13778330

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ANS: DBoth retirees are in middle adulthood, when the developmental crisis to be resolved is Generativity versus Self-Absorption. One exemplifies generativity; the other embodies self-absorption. The developmental crisis ofTrust versus Mistrust would show a contrast between relating to others in a trusting fashion and beingsuspicious and lacking trust. Failure to negotiate the developmental crisis of Industry versus Inferiority wouldresult in a sense of inferiority or difficulty learning and working as opposed to the ability to work competently.Behaviors that would be contrasted in the crisis of Intimacy versus Isolation would be emotional isolation andthe ability to love and commit to oneself.DIF: Cognitive Level: Application (Applying) REF: 22TOP: Nursing Process: Assessment MSC: NCLEX: Health Promotion and Maintenance12. Cognitive therapy was provided for a patient who frequently said, Im stupid. Which statement by thepatient 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: DIm stupid is a cognitive distortion or irrational thought. A more rational thought is, Sometimes I do stupidthings. The latter thinking promotes emotional self-control. The incorrect options reflect irrational thinking.DIF: Cognitive Level: Application (Applying) REF: 26TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity13. A student nurse tells the instructor, I dont need to interact with my patients. I learn what I need to know byobservation. The instructor can best interpret the nursing implications of Sullivans theory to the student byresponding:a. Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonalskills.b. Observing patient interactions can help you formulate priority nursing diagnoses and appropriateinterventions.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: ASullivan believed that the nurses role includes educating patients and assisting them in developing effectiveinterpersonal relationships. Mutuality, respect for the patient, unconditional acceptance, and empathy arecornerstones of Sullivans theory. The nurse who does not interact with the patient cannot demonstrate thesecornerstones. Observations provide only objective data. Priority nursing diagnoses usually cannot be accuratelyestablished without subjective data from the patient. The third response pertains to Maslows theory. The fourthresponse pertains to behavioral theory.DIF: Cognitive Level: Application (Applying) REF: 21TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity14. A psychiatric technician says, Little of what takes place on the behavioral health unit seems to be theorybased. A nurse educates the technician by identifying which common use of Sullivans theory?a. Structure of the therapeutic milieu of most behavioral health unitsb. Frequent use of restraint and seclusion for behavior modificationc. Assessment tools based on age-appropriate versus arrested behaviorsd. Use of the nursing process to determine the best sequence for nursing actionsANS: AThe structure of the therapeutic environment has, as its foci, an accepting atmosphere and provision ofopportunities for practicing interpersonal skills. Both constructs are directly attributable to Sullivans theory ofinterpersonal relationships. Sullivans interpersonal theory did not specifically consider the use of restraint orseclusion. Assessment based on the developmental level is associated with Eriksons theories. The nursingTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)15lOMoARcPSD|13778330

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process applies concepts from multiple theories.DIF: Cognitive Level: Application (Applying) REF: 21TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment15. A nurse uses Maslows hierarchy of needs to plan care for a psychotic patient. Which problem will receivepriority? 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: AThe need for food and hygiene is physiological and therefore takes priority over psychological or meta-needsin care planning.DIF: Cognitive Level: Analysis (Analyzing) REF: 25TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment16. Operant conditioning will be used to encourage speech in a child who is nearly mute. Which techniquewould 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: COperant conditioning involves giving positive reinforcement for a desired behavior. Treats are rewards toreinforce speech. Ignoring the child will not change the behavior. Having the child observe others describesmodeling. Teaching relaxation techniques and then coaxing speech is an example of systematic desensitization.DIF: Cognitive Level: Application (Applying) REF: 25TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity17. The parent of a child diagnosed with schizophrenia tearfully asks a nurse, What could I have donedifferently 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 predicthow 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 learnto cope more effectively with the environment.c. Schizophrenia is a biological illness with similarities to diabetes and heart disease. You are not to blame foryour childs illness.d. Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting.ANS: CPatients and families need reassurance that the major mental disorders are biological in origin and are not thefault of parents. Knowing the biological nature of the disorder relieves feelings of guilt over being responsiblefor the illness. The incorrect responses are neither wholly accurate nor reassuring; they fall short of beingreassuring and place the burden of having faulty genes on the shoulders of the parents.DIF: Cognitive Level: Application (Applying) REF: 30TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity18. 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.Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)16lOMoARcPSD|13778330

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ANS: BThe nurse-patient relationship is structured to provide a model for adaptive interpersonal relationships that canbe generalized to others. Changing the patients perceptions about his- or herself would be appropriate forcognitive therapy. Reinforcing specific behaviors would be used in behavioral therapy. Using medications isthe focus of biological therapy.DIF: Cognitive Level: Application (Applying) REF: 28TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity19. 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 personalitychanges. Which type of therapy was used?a. Short-term dynamic psychotherapyb. Transactional analysisc. Cognitive therapyd. PsychoanalysisANS: DThe therapy described is traditional psychoanalysis. Short-term dynamic psychotherapy would last less than 1year. Neither transactional analysis nor cognitive therapy makes use of the techniques described.DIF: Cognitive Level: Comprehension (Understanding) REF: 20TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity20. An advanced practice nurse determines a group of patients would benefit from therapy in which peers andinterdisciplinary staff all have a voice in determining the level of the patients privileges. The nurse wouldarrange for:a. milieu therapyb. cognitive therapyc. short-term dynamic therapyd. systematic desensitizationANS: AMilieu therapy is based on the idea that all members of the environment contribute to the planning andfunctioning of the setting. The other therapies are all individual therapies that do not fit the description.DIF: Cognitive Level: Comprehension (Understanding) REF: 36TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity21. A nurse psychotherapist works with an anxious, dependent patient. The therapeutic strategy mostconsistent 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: DPositive or negative feelings of the patient toward the nurse or therapist represent transference. Transference isa psychoanalytic concept that can be used to explore previously unresolved conflicts. Emphasizing medicationcompliance is more related to biological therapy. Identifying patient strengths and assets would be consistentwith supportive psychotherapy. The use of psychoeducational materials is a common homework assignmentused in cognitive therapy.DIF: Cognitive Level: Application (Applying) REF: 21TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity22. A person tells a nurse, I was the only survivor in a small plane crash, but three business associates died. Igot anxious and depressed and saw a counselor three times a week for a month. We talked about my feelingsTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)17lOMoARcPSD|13778330

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related to being a survivor, and now Im fine, back to my old self. Which type of therapy was used?a. Milieu therapyb. Psychoanalysisc. Behavior modificationd. Interpersonal therapyANS: DInterpersonal therapy returns the patient to the former level of functioning by helping the patient come to termswith the loss of friends and guilt over being a survivor. Milieu therapy refers to environmental therapy.Psychoanalysis calls for a long period of exploration of unconscious material. Behavior modification focuseson changing a behavior rather than helping the patient understand what is going on in his or her life.DIF: Cognitive Level: Comprehension (Understanding) REF: 21TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity23. 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: CCognitive theory suggests that ones thought processes are the basis of emotions and behavior. Changing faultylearning makes the development of new adaptive behaviors possible. Revealing dream content would be usedin psychoanalytical therapy. Taking prescribed medications is an intervention associated with biologicaltherapy. A dependent patient needs to develop independence.DIF: Cognitive Level: Application (Applying) REF: 26TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance24. A single parent is experiencing feelings of inadequacy related to work and family since one teenaged childran away several weeks ago. The parent seeks the help of a therapist specializing in cognitive therapy. Thepsychotherapist 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: DCognitive therapy emphasizes the importance of changing erroneous ways people think about themselves.Once faulty thinking changes, the individuals behavior changes. Focusing on unconscious mental processes isa psychoanalytic approach. Negatively reinforcing undesirable behaviors is behavior modification, anddiscussing ego states relates to transactional analysis.DIF: Cognitive Level: Comprehension (Understanding) REF: 26TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity25. A person received an invitation to be in the wedding of a friend who lives across the country. Theindividual is afraid of flying. What type of therapy should the nurse recommend?a. Psychoanalysisb. Milieu therapyc. Systematic desensitizationd. Short-term dynamic therapyANS: CSystematic desensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fear offlying. Psychoanalysis and short-term dynamic therapy are aimed at uncovering conflicts. Milieu therapyinvolves environmental factors.Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)18lOMoARcPSD|13778330

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DIF: Cognitive Level: Analysis (Analyzing) REF: 25TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial IntegrityMULTIPLE RESPONSE1. A basic level registered nurse works with patients in a community setting. Which groups should this nurseexpect to lead? Select all that apply.a. Symptom managementb. Medication educationc. Family therapyd. Psychotherapye. Self-careANS: A, B, ESymptom management, medication education, and self-care groups represent psychoeducation, a serviceprovided by the basic level registered nurse. Advanced practice registered nurses provide family therapy andpsychotherapy.DIF: Cognitive Level: Application (Applying) REF: 34TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance2. A patient states, Im starting cognitive behavioral therapy. What can I expect from the sessions? Whichresponses 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, DCognitive therapists are active rather than passive during therapy sessions because they help patients to realitytest their thinking. Homework assignments are given and completed outside the therapy sessions. Homework isusually discussed at the next therapy session. The goals of cognitive therapy are to assist the patient to identifyinaccurate cognitions, to reality test their thinking, and to formulate new, accurate cognitions. Dreamdescribing applies to psychoanalysis, not cognitive behavioral therapy. The desired outcome of cognitivetherapy is to assist patients in increasing their objectivity, not subjectivity, about the cognitions that influencebehavior.DIF: Cognitive Level: Application (Applying) REF: 26TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial IntegrityTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)19lOMoARcPSD|13778330

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Chapter 04: Biological Basis for Understanding PsychopharmacologyMULTIPLE CHOICE1. A patient asks a nurse, What are neurotransmitters? My doctor says mine are out of balance. The best replywould 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: BStating that neurotransmitters are chemicals that pass messages between brain cells gives the most accurateinformation. Neurotransmitters are messengers in the central nervous system. They are released from the axonterminal, diffuse across the synapse, and attach to specialized receptors on the postsynaptic neuron. Theincorrect responses do not answer the patients question, are demeaning, and provide untrue and misleadinginformation.DIF: Cognitive Level: Comprehension (Understanding) REF: 39TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity2. 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 teenagerhave any metal implants?b. Its a special type of x-ray image that shows structures of the brain and whether a brain injury has everoccurred.c. PET is a scan that passes an electrical current through the brain and shows brain wave activity. PET can helpdiagnose seizures.d. PET is a special scan that shows blood flow and activity in the brain.ANS: DThe parent is seeking information about PET scans. It is important to use terms the parent can understand. Thecorrect option is the only reply that provides factual information relevant to PET scans. The incorrect responsesdescribe magnetic resonance imaging (MRI), computed tomographic (CT) scans, and electroencephalography(EEG).DIF: Cognitive Level: Application (Applying) REF: 38TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity3. A patient has dementia. The health care provider wants to make a differential diagnosis between Alzheimerdisease and multiple infarctions. Which diagnostic procedure should a nurse expect to prepare the patient forfirst?a. Computed tomography (CT) scanb. Positron emission tomography (PET) scanc. Functional magnetic resonance imaging (fMRI)d. Single-photon emission computed tomography (SPECT) scanANS: AA CT scan shows the presence or absence of structural changes, including cortical atrophy, ventricularenlargement, and areas of infarctioninformation that will be helpful to the health care provider. The other testsfocus on brain activity and are more expensive; they may be ordered later.DIF: Cognitive Level: Analysis (Analyzing) REF: 38TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity4. A patient has delusions and hallucinations. Before beginning treatment with a psychotropic medication, thehealth care provider wants to rule out the presence of a brain tumor. For which test will a nurse need to preparethe patient?Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)20lOMoARcPSD|13778330

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a. Cerebral arteriogramb. 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: CA CT scan and an MRI visualize neoplasms and other structural abnormalities. A PET scan, SPECT scan, andfMRI, which give information about brain function, are not indicated. An arteriogram would not beappropriate.DIF: Cognitive Level: Application (Applying) REF: 38TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity5. The nurse wants to assess for disturbances in circadian rhythms in a patient admitted for major depressivedisorder. 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: CMood changes throughout the day are related to circadian rhythms. Questions about sleep pattern would alsobe relevant to circadian rhythms. The question about seeing or hearing things is relevant to the assessment forillusions and hallucinations. The question about thinking is relevant to the assessment of thought processes.The other question is relevant to assessment of memory.DIF: Cognitive Level: Application (Applying) REF: 38TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity6. A nurse administers a medication that potentiates the action of gamma-aminobutyric acid (GABA). Whichfinding would be expected?a. Reduced anxietyb. Improved memoryc. More organized thinkingd. Fewer sensory perceptual alterationsANS: AIncreased levels of GABA reduce anxiety; thus any potentiation of GABA action should result in anxietyreduction. Memory enhancement is associated with acetylcholine and substance P. Thought disorganization isassociated with dopamine. GABA is not associated with sensory perceptual alterations.DIF: Cognitive Level: Application (Applying) REF: 48TOP: Nursing Process: Evaluation MSC: NCLEX: Physiological Integrity7. On the basis of current knowledge of neurotransmitter effects, a nurse anticipates that the treatment plan fora 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: DIncreased acetylcholine plays a role in learning and memory. Preventing the destruction of acetylcholine byacetylcholinesterase results in higher levels of acetylcholine, with the potential for improved memory. GABAis known to affect anxiety level rather than memory. Increased dopamine causes symptoms associated withschizophrenia or mania rather than improves memory. Decreasing dopamine at receptor sites is associated withParkinson disease rather than improving memory.DIF: Cognitive Level: Comprehension (Understanding) REF: 41Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)21lOMoARcPSD|13778330

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TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity8. A patient has disorganized thinking associated with schizophrenia. Neuroimaging would most likely showdysfunction in which part of the brain?a. Brainstemb. Cerebellumc. Temporal lobed. Prefrontal cortexANS: DThe prefrontal cortex is responsible for intellectual functioning. The temporal lobe is responsible for thesensation of hearing. The cerebellum regulates skeletal muscle coordination and equilibrium. The brainstemregulates internal organs.DIF: Cognitive Level: Application (Applying) REF: 35TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity9. A nurse should assess a patient taking a medication with anticholinergic properties for inhibited function ofthe:a. parasympathetic nervous system.b. sympathetic nervous system.c. reticular activating system.d. medulla oblongata.ANS: AAcetylcholine is the neurotransmitter found in high concentration in the parasympathetic nervous system.When acetylcholine action is inhibited by anticholinergic drugs, parasympathetic symptoms such as blurredvision, dry mouth, constipation, and urinary retention appear. The functions of the sympathetic nervous system,the reticular activating system, and the medulla oblongata are not affected by anticholinergic medications.DIF: Cognitive Level: Comprehension (Understanding)REF: 39TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity10. 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: AIf the reuptake of a substance is inhibited, then it accumulates in the synaptic gap and its concentrationincreases, permitting the ease of the transmission of impulses across the synaptic gap. Normal transmission ofimpulses across synaptic gaps is consistent with a normal rather than a depressed mood. The other options arenot associated with blocking neurotransmitter reuptake.DIF: Cognitive Level: Comprehension (Understanding) REF: 46TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity11. A patient taking medication for mental illness develops restlessness and an uncontrollable need to be inmotion. A nurse can correctly analyze that these symptoms are related to which drug action?a. Anticholinergic effectsb. Dopamine-blocking effectsc. Endocrine-stimulating effectsd. Ability to stimulate spinal nervesANS: BMedications that block dopamine often produce disturbances of movement such as akathisia because dopamineTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)22lOMoARcPSD|13778330

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affects neurons involved in both the thought processes and movement regulation. Anticholinergic effectsinclude dry mouth, blurred vision, urinary retention, and constipation. Akathisia is not caused by endocrinestimulation or spinal nerve stimulation.DIF: Cognitive Level: Application (Applying) REF: 46TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity12. A patient has anxiety, increased heart rate, and fear. The nurse would suspect the presence of a highconcentration of which neurotransmitter?a. GABAb. Histaminec. Acetylcholined. NorepinephrineANS: DNorepinephrine is the neurotransmitter associated with sympathetic nervous system stimulation, preparing theindividual for the fight or flight response. GABA is a mediator of anxiety level. A high concentration ofhistamine is associated with an inflammatory response. A high concentration of acetylcholine is associatedwith parasympathetic nervous system stimulation.DIF: Cognitive Level: Application (Applying) REF: 44TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity13. A patient has symptoms of acute anxiety related to the death of a parent in an automobile accident 2 hoursearlier. The nurse should anticipate administering a medication from which group?a. Tricyclic antidepressantsb. Atypical antipsychoticsc. Anticonvulsantsd. BenzodiazepinesANS: DBenzodiazepines provide anxiety relief. Tricyclic antidepressants are used to treat symptoms of depression.Anticonvulsants are used to treat bipolar disorder or seizures. Antipsychotic drugs are used to treat psychosis.DIF: Cognitive Level: Application (Applying) REF: 48TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity14. A patient is hospitalized for major depressive disorder. Of the medications listed, a nurse can expect toprovide the patient with teaching about:a. chlordiazepoxide (Librium).b. fluoxetine (Prozac).c. clozapine (Clozaril).d. tacrine (Cognex).ANS: BFluoxetine is a selective serotonin reuptake inhibitor (SSRI), an antidepressant that blocks the reuptake ofserotonin with few anticholinergic and sedating side effects; clozapine (Clozaril) is an antipsychoticmedication; chlordiazepoxide (Librium) is an anxiolytic drug; and tacrine (Cognex) is used to treat Alzheimerdisease.DIF: Cognitive Level: Application (Applying) REF: 42TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity15. A patient hospitalized with a mood disorder has aggression, agitation, talkativeness, and irritability. Anurse begins the care plan based on the expectation that the health care provider is most likely to prescribe amedication classified as a(n):a. anticholinergic.b. mood stabilizer.c. psychostimulant.Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)23lOMoARcPSD|13778330

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d. tricyclic antidepressant.ANS: BThe symptoms describe a manic attack. Mania is effectively treated by the antimanic drug lithium and selectedanticonvulsants such as carbamazepine, valproic acid, and lamotrigine. No drugs from the other classificationslisted are effective in the treatment of mania.DIF: Cognitive Level: Application (Applying) REF: 49TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity16. A drug causes muscarinic-receptor blockade. A nurse will assess the patient for:a. dry mouth.b. gynecomastia.c. pseudoparkinsonism.d. orthostatic hypotension.ANS: AMuscarinic-receptor blockade includes atropine-like side effects such as dry mouth, blurred vision, andconstipation. Gynecomastia is associated with decreased prolactin levels. Movement defects are associatedwith dopamine blockade. Orthostatic hypotension is associated with alpha1-receptor antagonism.DIF: Cognitive Level: Application (Applying) REF: 50TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Integrity17. A patient begins therapy with a phenothiazine medication. What teaching should a nurse provide related tothe drugs strong dopaminergic effect?a. Chew sugarless gum.b. Increase dietary fiber.c. Arise slowly from bed.d. Report muscle stiffness.ANS: DPhenothiazines are conventional antipsychotic medications that block dopamine receptors in both the limbicsystem and basal ganglia. Dystonia is likely to occur early in the course of treatment and is often heralded bysensations of muscle stiffness. Early intervention with an antiparkinsonian medication can increase the patientscomfort and prevent dystonic reactions.DIF: Cognitive Level: Application (Applying) REF: 50TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity18. 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: DFluphenazine, a first-generation antipsychotic medication, exerts muscarinic blockade, resulting in dry mouth,blurred vision, constipation, and urinary retention. Lithium therapy is more often associated with fluid balanceproblems, including polydipsia, polyuria, and edema. Risperidone therapy is more often associated withmovement disorders, orthostatic hypotension, and sedation. Buspirone is associated with anxiety reductionwithout major side effects.DIF: Cognitive Level: Application (Applying) REF: 50TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity19. 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.Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)24lOMoARcPSD|13778330

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c. Use water-based lotions for rashes.d. Avoid unprotected sex.ANS: AClozapine therapy may produce agranulocytosis; therefore signs of infection should be immediately reported tothe health care provider. In addition, the patient should have white blood cell levels measured weekly. Theother options are not relevant to clozapine administration.DIF: Cognitive Level: Application (Applying) REF: 51TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity20. 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: DPatients taking phenelzine, an MAOI, must be on a tyramine-free diet to prevent hypertensive crisis.DIF: Cognitive Level: Application (Applying) REF: 46TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity21. A nurse caring for a patient taking a serotonin reuptake inhibitor (SSRI) will develop outcome criteriarelated to:a. mood improvement.b. logical thought processes.c. reduced levels of motor activity.d. decreased extrapyramidal symptoms.ANS: ASSRIs affect mood, relieving depression in many patients. SSRIs do not act to reduce thought disorders. SSRIsreduce depression but have little effect on motor hyperactivity. SSRIs do not produce extrapyramidalsymptoms.DIF: Cognitive Level: Application (Applying) REF: 46TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity22. 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: BDepression is thought to be related to the lowered availability of the neurotransmitter serotonin. SSRIs act byblocking the reuptake of serotonin, leaving a higher concentration available at the synaptic cleft. They actuallyprevent the destruction of serotonin, have no effect on acetylcholine and dopamine production, and do notblock muscarinic or alpha1-norepinephrine receptors.DIF: Cognitive Level: Comprehension (Understanding) REF: 46TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity23. A patient has taken many conventional antipsychotic drugs over years. The health care provider, who isconcerned about early signs of tardive dyskinesia, prescribes risperidone (Risperdal). A nurse planning care forthis patient understands that atypical antipsychotics:a. are less costly.Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)25lOMoARcPSD|13778330

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b. have higher potency.c. are more readily available.d. produce fewer motor side effects.ANS: DAtypical antipsychotic drugs often exert their action on the limbic system rather than the basal ganglia. Thelimbic system is not involved in motor disturbances. Atypical antipsychotic medications are not more readilyavailable. They are not considered to be of higher potency; rather, they have different modes of action.Atypical antipsychotic drugs tend to be more expensive.DIF: Cognitive Level: Comprehension (Understanding) REF: 40TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity24. The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3and 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: AThese laboratory values indicate the possibility of agranulocytosis, a serious side effect of clozapine therapy.These results must be immediately reported to the health care provider. The drug should be withheld becausethe health care provider will discontinue it. The health care provider may repeat the laboratory test, but, in themeantime, the drug should be withheld. Giving aspirin and forcing fluids are measures that are less importantthan stopping the administration of the drug.DIF: Cognitive Level: Analysis (Analyzing) REF: 51TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity25. A nurse administering psychotropic medications should be prepared to intervene when giving a drug thatblocks 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: CSympathetic-mediated vasoconstriction is essential for maintaining normal blood pressure in the uprightposition. Blockage of alpha1 receptors leads to vasodilation and orthostatic hypotension. Orthostatichypotension may cause fainting and falls. Patients should be taught ways of minimizing this phenomenon.DIF: Cognitive Level: Application (Applying)REF: 39TOP: Nursing Process: Implementation MSC: NCLEX: Physiological IntegrityMULTIPLE RESPONSE1. 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 alsodiagnosed with which health problem? Select all that apply.a. Parkinson diseaseb. Graves diseasec. Osteoarthritisd. Epilepsye. DiabetesANS: A, D, EAntipsychotic medications may produce weight gain, which complicates the care of a patient with diabetes orTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)26lOMoARcPSD|13778330

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lowers the seizure threshold or both, which complicates the care of a patient with epilepsy. Parkinson diseaseinvolves changes in transmission of dopamine and acetylcholine; therefore these drugs also complicate the careof a patient with the disorder. Osteoarthritis and Graves disease should have no synergistic effect with thismedication.DIF: Cognitive Level: Analysis (Analyzing) REF: 50TOP: Nursing Process: Planning MSC: NCLEX: Physiological Integrity2. The spouse of a patient diagnosed with schizophrenia asks, Which neurotransmitters are more active when aperson has schizophrenia? The nurse should state, The current thinking is that the thought disturbances arerelated to increased activity of: (Select all that apply.)a. GABA.b. substance P.c. histamine.d. dopamine.e. norepinephrine.ANS: D, EDopamine plays a role in the integration of thoughts and emotions, and excess dopamine is implicated in thethought disturbances of schizophrenia. Increased activity of norepinephrine also occurs. Substance P is mostrelated to the pain experience. Histamine decrease is associated with depression. Increased GABA is associatedwith anxiety reduction.DIF: Cognitive Level: Application (Applying) REF: 40TOP: Nursing Process: Implementation MSC: NCLEX: Physiological Integrity3. An individual is experiencing problems associated with memory. Which cerebral structures are most likelyto be involved in this deficit? Select all that apply.a. Prefrontal cortexb. Occipital lobec. Temporal lobed. Parietal lobee. Basal gangliaANS: A, C, DThe prefrontal cortex, parietal, and temporal lobes of the cerebrum play a key role in the storage andprocessing of memories. The occipital lobe is predominantly involved with vision. The basal ganglia influencethe integration of physical movement, as well as some thoughts and emotions.DIF: Cognitive Level: Comprehension (Understanding) REF: 35TOP: Nursing Process: Assessment MSC: NCLEX: Physiological IntegrityTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)27lOMoARcPSD|13778330

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Chapter 05: Settings for Psychiatric CareMULTIPLE CHOICE1. Planning for patients with mental illness is facilitated by understanding that inpatient hospitalization isgenerally 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: AHospitalization is justified when the patient is a danger to self or others, has dangerously decompensated, orneeds intensive medical treatment. The incorrect options do not necessarily describe patients who requireinpatient treatment.DIF: Cognitive Level: Comprehension (Understanding) REF: 56TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment2. 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 dayof 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: CThe case manager should intervene by arranging temporary shelter for the patient until suitable housing can befound. This is part of the coordination and delivery of services that falls under the case manager role. The otheroptions are not viable alternatives.DIF: Cognitive Level: Application (Applying) REF: 56TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment3. A multidisciplinary health care team meets 12 hours after an adolescent is hospitalized after a suicideattempt. 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: ATreatment plans are formulated early in the course of treatment to streamline the treatment process and reducecosts. It is too early to determine the need for alternative post-discharge living arrangements. Neuroimaging isnot indicated for this scenario.DIF: Cognitive Level: Application (Applying) REF: 56TOP: Nursing Process: Outcomes IdentificationMSC: NCLEX: Safe, Effective Care Environment4. The relapse of a patient diagnosed with schizophrenia is related to medication noncompliance. The patient ishospitalized for 5 days, medication is restarted, and the patients thoughts are now more organized. The patientsfamily 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.Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)28lOMoARcPSD|13778330

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ANS: DPatients no longer stay in the hospital until every vestige of a symptom disappears. The nurse must assumeresponsibility to advocate for the patients right to the least restrictive setting as soon as the symptoms are undercontrol and for the right of citizens to control health care costs. The health care provider will use the samerationale. Shifting blame will not change the discharge. Calling security is unnecessary. The nurse can handlethis matter.DIF: Cognitive Level: Application (Applying) REF: 59TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment5. 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 observationsrelate to:a. management of milieu safety.b. coordinating care of patients.c. management of the interpersonal climate.d. use of therapeutic intervention strategies.ANS: AMembers of the nursing staff are responsible for all aspects of milieu management. The observationsmentioned in this question directly relate to the safety of the unit. The other options, although part of the nursesconcerns, are unrelated to the observations cited.DIF: Cognitive Level: Application (Applying) REF: 56TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment6. 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: DAdmission to the hospital would be justified by the risk of patient danger to self or others. The other patientshave issues that can be handled with less restrictive alternatives than hospitalization.DIF: Cognitive Level: Analysis (Analyzing) REF: 56TOP: Nursing Process: Analysis| Nursing Process: DiagnosisMSC: NCLEX: Safe, Effective Care Environment7. A student nurse prepares to administer oral medications to a patient diagnosed with major depressivedisorder, 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: CThe patient has the right to refuse medication in most cases. The patients reason for refusing should beascertained, and the refusal should be reported to a unit nurse. Sometimes refusals are based on unpleasant sideeffects that can be ameliorated. Threats and manipulation are inappropriate. Medication refusal should bereported to permit appropriate intervention.DIF: Cognitive Level: Application (Applying) REF: 59TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment8. A nurse surveys the medical records for violations of patients rights. Which finding signals a violation?Test Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)29lOMoARcPSD|13778330

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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: AThe patient has the right to have a treatment plan. Inspecting a patients belongings is a safety measure. Patientshave the right to a safe environment, including the right to be protected against impulses to harm self that occuras a result of a mental disorder.DIF: Cognitive Level: Application (Applying) REF: 56TOP: Nursing Process: Evaluation MSC: NCLEX: Safe, Effective Care Environment9. 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 notcompromised.ANS: AThe rule of using the least restrictive treatment or intervention possible to achieve the desired outcome is thepatients legal right. Planned interventions are nearly always preferable. Intervention may be necessary whenthe patient threatens harm to self.DIF: Cognitive Level: Application (Applying) REF: 56TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment10. To provide comprehensive care to patients, which competency is more important for a nurse who works ina community mental health center than a psychiatric nurse who works in an inpatient unit?a. Problem-solving skillsb. Calm and caring mannerc. Ability to cross service systemsd. Knowledge of psychopharmacologyANS: CA community mental health nurse must be able to work with schools, corrections facilities, shelters, health careproviders, and employers. The mental health nurse working in an inpatient unit needs only to be able to workwithin the single setting. Problem-solving skills are needed by all nurses. Nurses in both settings must haveknowledge of psychopharmacology.DIF: Cognitive Level: Analysis (Analyzing) REF: 54TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment11. A suspicious and socially isolated patient lives alone, eats one meal a day at a nearby shelter, and spendsthe 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: CAssessment of biopsychosocial needs and general ability to live in the community is called for before anyaction is taken. Both nutritional status and income adequacy are critical assessment parameters. A patient maybe able to maintain adequate nutrition while eating only one meal a day. Nurses assess before taking action.Hospitalization may not be necessary.DIF: Cognitive Level: Application (Applying) REF: 54TOP: Nursing Process: Assessment MSC: NCLEX: Physiological IntegrityTest Bank: Essentials of Psychiatric Mental Health Nursing (3rd Edition by Varcarolis)30lOMoARcPSD|13778330

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