Test Bank For Psychiatric Mental Health Nursing, 6th Edition

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Page 11.The nurse understands that crises are self-limiting. This implies that upon evaluation ofcrisis intervention, the nurse should assess for which outcome?A)The patient will identify possible causes for the crisis.B)The patient will discover a new sense of self-sufficiency in coping.C)The patient will resume the precrisis level of functioning.D)The patient will express anger regarding the crisis event.Ans:CFeedback:Crises usually exist for 4 to 6 weeks. At the end of that time, the crisis is resolved in oneof three ways. In the first two, the person either returns to his or her precrisis level offunctioning or begins to function at a higher level; both are positive outcomes for theindividual. The third resolution is that the person's functioning stabilizes at a level lowerthan precrisis functioning, which is a negative outcome for the individual. Assisting theperson to use existing supports or helping the individual find new sources of support candecrease the feelings of being alone or overwhelmed. The patient may develop guilt ifhe or she examines possible causes for the crisis. Expression of anger at 4 to 6 weeksindicates a less than favorable outcome of crisis intervention.2.A patient who has been working on controlling impulsive behavior shows astrengthening ego through which of the following behaviors?A)Going to therapy only when there is nothing more desirable to doB)Weighing the advantages and disadvantages before making a decisionC)Telling others in the group the right way to actD)Reporting having fun at a recent social eventAns:BFeedback:The id is the part of one's nature that reflects basic or innate desires such as pleasure-seeking behavior, aggression, and sexual impulses. The id seeks instant gratification,causes impulsive unthinking behavior, and has no regard for rules or social convention.The superego is the part of a person's nature that reflects moral and ethical concepts,values, and parental and social expectations; therefore, it is in direct opposition to the id.The third component, the ego, is the balancing or mediating force between the id and thesuperego. The ego represents mature and adaptive behavior that allows a person tofunction successfully in the world.

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Page 23.A patient has just been told she has cervical cancer. When asked about how this isimpacting her, she states, ìIt's just an infection; it will clear up.î The statement indicatesthat this patientA)needs education on cervical cancer.B)is unable to express her true emotions.C)should be immediately referred to a cancer support group.D)is using denial to protect herself from an emotionally painful thought.Ans:DFeedback:Ego defense mechanisms are methods of attempting to protect the self and cope withbasic drives or emotionally painful thoughts, feelings, or events. Most defensemechanisms operate at the unconscious level of awareness, so people are not aware ofwhat they are doing and often need help to see the reality. Education and referrals arepremature at this point in the patient's ability to cope.4.A teenage patient defies the nurse's repeated requests to turn off the video game and goto sleep. The teen says angrily, ìYou sound just like my mother at home!î and continuesto play the video game. The nurse understands that this statement likely indicatesA)the need of stricter discipline at home.B)early signs of oppositional defiant disorder.C)viewing the nurse as her mother.D)expression of developing autonomy.Ans:CFeedback:Transference occurs when the client displaces onto the therapist attitudes and feelingsthat the client originally experienced in other relationships. Transference patterns areautomatic and unconscious in the therapeutic relationship. The occurrence oftransference does not indicate ineffective parenting or disciplinary practices, nor is itindicative of a disorder. Autonomy is developed much earlier in the toddler years.5.A patient reports a pattern of being suspicious and mistrusting of others, causingdifficulty in sustaining lasting relationships. Which stage according to Erikson'spsychosocial development was not successfully completed?A)TrustB)AutonomyC)InitiativeD)IndustryAns:AFeedback:The formation of trust is essential: mistrust, the negative outcome of this stage, willimpair the person's development throughout his or her life.

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Page 36.The nurse has established a therapeutic relationship with a patient. The patient isbeginning to share feelings openly with the nurse. The relationship has entered whichphase according to Peplau's theory?A)OrientationB)IdentificationC)ExploitationD)ResolutionAns:BFeedback:The orientation phase is directed by the nurse and involves engaging the client intreatment, providing explanations and information, and answering questions. Theidentification phase begins when the client works interdependently with the nurse,expresses feelings, and begins to feel stronger. In the exploitation phase, the clientmakes full use of the services offered. In the resolution phase, the client no longer needsprofessional services and gives up dependent behavior and the relationship ends.7.A nurse is meeting with a crisis support group. In efforts to help patients identify withone another, the nurse explains which of the following about the crisis experience?A)ìEven happy events can cause a crisis if the stress is overwhelming.îB)ìOnly people who have unfortunate life events will experience a crisis.îC)ìA person has no control over how a crisis will affect him or her.îD)ìPeople can prevent all crises if they develop good coping skills early.îAns:AFeedback:Not all events that result in crisis are ìnegativeî in nature. Events like marriage,retirement, and childbirth are often desirable for the individual but may still presentoverwhelming challenges. All individuals can experience a crisis when they confrontsome life circumstance or stressor that they cannot effectively manage through use oftheir customary coping skills. A number of factors can influence how a personexperiences a crisis.

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Page 48.Which of the following theories could be classified as humanistic theories? Select allthat apply.A)Cognitive therapyB)Maslow's hierarchy of needsC)Gestalt therapyD)Rogers' client-centered therapyE)Rational emotive therapyF)Piaget's cognitive stages of developmentAns:B, DFeedback:Humanism represents a significant shift away from the psychoanalytic view of theindividual as a neurotic, impulse-driven person with repressed psychic problems andaway from the focus on and examination of the client's past experiences. Humanistictheories include Maslow's hierarchy of needs and Rogers' client-centered therapy.Cognitive therapy is an existential therapy that focuses on immediate thoughtprocessingóhow a person perceives or interprets his or her experience and determineshow he or she feels and behaves. Gestalt therapy is an existential therapy thatemphasizes the person's feelings and thoughts in the here and now. Rational emotivetherapy is an existential theory that looks at irrational beliefs and automatic thoughtsthat make people unhappy. Piaget's cognitive stages of development is a developmentaltheory.9.Which of the following are examples of adventitious crises? Select all that apply.A)Death of a loved oneB)Natural disastersC)Violent crimesD)WarE)Leaving home for the first timeAns:B, C, DFeedback:Adventitious crises include natural disasters like floods, earthquakes, or hurricanes; war,terrorist attacks; riots; and violent crimes such as rape or murder. Maturational ordevelopmental crises are predictable events in the normal course of life, such as leavinghome for the first time, getting married, having a baby, and beginning a career.Situational crises are unanticipated or sudden events that threaten the individual'sintegrity, such as the death of a loved one, loss of a job, and physical or emotionalillness in the individual or family member.

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Page 510.A nursing supervisor reprimands an employee for being chronically late for work. If theemployee handles the reprimand using the defense mechanism of displacement, hewould most likely do which of the following?A)Argue with the supervisor that he is usually on timeB)Make a special effort to be on time tomorrowC)Tell fellow employees that the supervisor is picking on himD)Tell the unit housekeeper that his work is sloppyAns:DFeedback:Displacement involves venting feelings toward another, less threatening person.Arguing is denial. Making a special effort is compensation. Telling fellow employeesthat the supervisor is picking on him is projection.11.The nurse is assessing a client who is talking about her son's recent death but whoshows no emotion of any kind. The nurse recognizes this behavior as which of thefollowing defense mechanisms?A)DissociationB)DisplacementC)IntellectualizationD)SuppressionAns:CFeedback:The client is aware of the facts of the situation but does not show the emotionsassociated with the situation. Dissociation involves dealing with emotional conflict by atemporary alteration in consciousness or identity. Displacement is the ventilation ofintense feelings toward a person less threatening than the one who aroused thosefeelings. Suppression is replacing the desired gratification with one that is more readilyavailable.

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Page 612.A college student decides to go to a party the night before a major exam instead ofstudying. After receiving a low score on the exam, the student tells a fellow student, ìIhave to work too much and don't have time to study. It wouldn't matter anyway becausethe teacher is so unreasonable.î The defense mechanisms the student is using areA)denial and displacementB)rationalization and projectionC)reaction formation and resistanceD)regression and compensationAns:BFeedback:When stating that it wouldn't matter if the student studied, the student is usingrationalization, which is excusing own behavior to avoid guilt, responsibility, conflict,anxiety, or loss of self-respect. When stating that the teacher is unreasonable, the studentis using projection or the unconscious blaming of unacceptable inclinations or thoughtsas an external object. Denial is the failure to acknowledge an unbearable condition.Displacement is the ventilation of intense feelings toward persons less threatening thanthe one who aroused those feelings. Reaction formation is acting the opposite of whatone thinks or feels. Resistance is overt or covert antagonism toward remembering orprocessing anxiety-producing information. Regression is moving back to a previousdevelopmental stage to feel safe or have needs met. Compensation is overachievementin one area to offset real or perceived deficiencies in another area.13.A client is supposed to be ambulating ad lib. Instead, he refuses to get out of bed, asksfor a bed bath, and makes many demands of the nurses. He also yells that they are lazyand incompetent. The client's behavior is an example of which of the following defensemechanisms?A)IntrojectionB)ProjectionC)RationalizationD)Reaction formationAns:BFeedback:Projection is blaming unacceptable thoughts on others; the client cannot accept the factthat he may be lazy or incompetent to care for himself. Introjection is accepting anotherperson's attitudes, beliefs, and values as one's own. Rationalization is excusing one'sown behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-concept.Reaction formation is acting the opposite of what one thinks or feels.

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Page 714.A client begins to take stock of his life and look into the future. The nurse assesses thatthis client is in which of Erikson's developmental stages?A)Identity versus role confusionB)Industry versus inferiorityC)Integrity versus despairD)Generativity versus stagnationAns:CFeedback:Erikson's stage of integrity versus despair is when an adult begins to reflect on his or herlife. Identity versus role confusion occurs in adolescence when the person is forming asense of self and belonging. Integrity versus despair occurs in maturity; acceptingresponsibility for oneself and life is the corresponding task. Generativity versusstagnation occurs in middle adulthood, which includes the tasks of being creative andproductive and establishing the next generation.15.A basic assumption of Freud's psychoanalytic theory is thatA)all human behavior can be caused and can be explained.B)human behavior is entirely unconscious.C)free association is the key to understanding.D)sexuality does not relate to behavior.Ans:AFeedback:Freud believed that everything we do has meaning, whether it is conscious orunconscious. Freud believed that human behavior can be motivated by subconsciousthoughts and feelings but could also be in the preconscious or unconscious. Freud basedhis theory of childhood development on the belief that sexual energy, termed libido, wasthe driving force of human behavior.16.Which of the following is a major developmental task of middle adulthood?A)Developing intimacyB)Learning to manage conflictC)Reexamining life goalsD)Resolving the pastAns:CFeedback:An important task for middle-aged adults is to examine life goals, ideally with somesatisfaction. Developing intimacy occurs in young adulthood. Learning to manageconflict occurs in preschool. Resolving the past and accepting responsibility for oneselfand life occur in maturity.

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Page 817.Which cognitive mode, according to Harry Stack Sullivan, begins in early childhood asthe child begins to connect experiences in sequence?A)Prototaxic modeB)Parataxic modeC)Bitaxic modeD)Syntaxic modeAns:BFeedback:The parataxic mode begins in early childhood as the child begins to connect experiencesin sequence. The child may not make logical sense of the experiences, although he orshe may not understand what he or she is doing. The prototaxic mode involves brief,unconnected experiences that have no relationship to one another. In the syntaxic mode,the person begins to perceive himself or herself and the world within the context of theenvironment and can analyze experiences in a variety of settings. There is not a bitaxicmode.18.Group members are actively discussing a common topic. Members are sharing that theyidentify with what others are saying. The nurse leader recognizes that the group is inwhich stage of group development?A)PlanningB)InitialC)WorkingD)TerminationAns:CFeedback:The working stage of group development begins as members begin to focus theirattention on the purpose or task the group is trying to accomplish. The beginning stageof group development, or the initial stage, commences as soon as the group begins tomeet. Members introduce themselves, a leader can be selected, the group purpose isdiscussed, and rules and expectations for group participation are reviewed. The finalstage, or termination, of the group occurs before the group disbands. The work of thegroup is reviewed, with the focus on group accomplishments or growth of groupmembers.

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Page 919.The family members of a patient with bipolar disorder express frustration with theunpredictable behaviors of their loved one. Which group should the nurse suggest asmost helpful to this family?A)Family therapy groupB)Family education groupC)Psychotherapy groupD)Self-help support groupAns:BFeedback:Family education discusses the clinical treatment of mental illnesses and teaches theknowledge and skills that family members need to cope more effectively. The goals offamily therapy groups include understanding how family dynamics contribute to theclient's psychopathology, mobilizing the family's inherent strengths and functionalresources, restructuring maladaptive family behavioral styles, and strengthening familyproblem-solving behaviors. The goal of a psychotherapy group is for members to learnabout their behavior and to make positive changes in their behavior by interacting andcommunicating with others. In a self-help group, members share a common experience,but the group is not a formal or structured therapy group.20.A student nurse attends a self-help group as part of a class assignment. While there thestudent recognizes a family friend. Upon returning home, the student talks about theexperience with the family. The student's actions can be described asA)appropriate; persons familiar with group members are allowed self-help groupmembership.B)appropriate; self-help groups are not professional and therefore are open to publicknowledge.C)inappropriate; most self-help groups have a rule of confidentiality.D)inappropriate; the student should not have been allowed to attend the group.Ans:CFeedback:Most self-help groups have a rule of confidentiality: whoever is seen and whatever issaid at the meetings cannot be divulged to others or discussed outside the group. Inmany 12-step programs, such as Alcoholics Anonymous and Gamblers Anonymous,people use only their first names, so their identities are not divulged (although in somesettings, group members do know one another's names).

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Page 1021.The nurse would recommend individual therapy for the patient who expresses a desiretoA)bring about personal changes.B)gain a sense of belonging.C)develop leadership skills.D)learn more about treatment.Ans:AFeedback:People generally seek individual psychotherapybased on their desire to understandthemselves and their behavior, to make personal changes, to improve interpersonalrelationships, or to get relief from emotional pain or unhappiness. Groups arerecommended for persons to accomplish tasks that require cooperation, collaboration, orworking together.22.Which one of the following statements is most accurate regarding the cohesiveness of agroup in group therapy?A)It is commonly present in the first meeting of the group.B)It is necessary for the group to have maximum cohesiveness, the more the better.C)Group cohesiveness is the degree to which members think alike and many thingsare left unspoken.D)Cohesiveness is a desirable group characteristic that is associated with positivegroup outcomes.Ans:DFeedback:Cohesiveness is a desirable group characteristic that is associated with positive groupoutcomes. It is not common for the group to be cohesive during the first meeting of thegroup. During the first meeting, or the initial stage, members introduce themselves andthe parameters of the group are established. Group members begin to ìcheck outî oneanother and the leaders as they determine their levels of comfort in the group setting.Cohesiveness is associated with the working stage of a group that may take two or threesessions in a therapy group because members must develop some level of trust beforesharing personal feelings or difficult situations. If a group is ìoverly cohesive,î in thatuniformity and agreement become the group's implicit goals, there may be a negativeeffect on the group outcome as members may not offer needed feedback and this maythwart critical thinking and creative problem solving. Group cohesiveness is the degreeto which members work together cooperatively to accomplish the purpose.

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Page 1123.Which one of the following is an important characteristic of an effective therapistñclientrelationship in individual psychotherapy?A)Homogeneity between the client and the therapist.B)Mutual benefit for the client and the therapist.C)The client must adapt to the therapist's style of therapy and theoretical beliefs.D)Match between the theoretical beliefs and style of therapy and the client's needsand expectations of therapy.Ans:BFeedback:Compatibility between the therapist and the client is required for therapy to be effective.The client must select a therapist whose theoretical beliefs and style of therapy arecongruent with the client's needs and expectations of therapy. It is not required that theclient and therapist be the same. The client's benefit is the most important consideration.The client also may have to try different therapists to find a good match.24.Which of the following is most essential when planning care for a client who isexperiencing a crisis?A)Explore previous coping strategiesB)Explore underlying personality dynamicsC)Focus on emotional deficitsD)Offer a referral to a self-help groupAns:AFeedback:Crisis intervention focuses on using the person's strengths, such as previous copingskills, and providing support to deal with the current situation. Exploring underlyingpersonality dynamics and focusing on emotional deficits would not help the client in thecrisis situation. When the client is in a crisis situation, offering a self-help group wouldnot be appropriate.25.During the initial interview with a client in crisis, the initial priority is toA)assess the adequacy of the support system.B)assess for substance use.C)determine the precrisis level of functioning.D)evaluate the potential for self-harm.Ans:DFeedback:Safety is always the priority; clients in crisis may be suicidal. Assessing the adequacy ofthe support system, assessing for substance use, and determining the precrisis level offunctioning would be important assessments but not as high priority as evaluating thepotential for self-harm.

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Page 1226.Patients on an inpatient psychiatric unit can earn off-unit privileges for daily use ofsocially appropriate behavior. This is an example of employing which concept ofbehavior modification?A)Systematic desensitizationB)Negative reinforcementC)Classical conditioningD)Operant conditioningAns:DFeedback:The theory of operant conditioning says people learn their behavior from their history orpast experiences, particularly those experiences that were repeatedly reinforced.Behavior that is rewarded with reinforcers tends to recur. Positive reinforcers thatfollow a behavior increase the likelihood that the behavior will recur. In classicalconditioning, behavior can be changed through conditioning with external orenvironmental conditions or stimuli. Negative reinforcement involves removing astimulus immediately after a behavior occurs so that the behavior is more likely to occuragain. In systematic desensitization, the client learns and practices relaxation techniquesto decrease and manage anxiety. He or she is then exposed to the least anxietyprovoking situation and uses the relaxation techniques to manage the resulting anxiety.27.A patient states, ìI hate spending time with my family. They're always on my back aboutsomething! I won't doanythingthey ask me to do.î Which response by the nurse reflectsa behavioral perspective?A)ìLet's play like I'm your parent, and we'll practice some better ways tocommunicate that won't result in an argument.îB)ìSome medicines really help with anger. Are you interested in talking to yourphysician about starting you on something?îC)ìThat's probably your way of getting back at them for being strict with you whenyou were younger.îD)ìIf you agree to start doing what your parents request, then they have agreed torespect your privacy more.îAns:DFeedback:Behaviorism is a school of psychology that focuses on observable behaviors and whatone can do externally to bring about behavior changes. It does not attempt to explainhow the mind works. Behavior can be changed through a system of rewards andpunishments. Practicing communication is a psychotherapy technique to improveinterpersonal relationships. Use of medications is not grounded in behavioralperspective. Analyzing the reasons for the behavior is not grounded in behavioralperspective.

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Page 1328.A nurse is working with a patient with an eating disorder who refuses to eat a muffin.The nurse asks the patient ìIs there any way that you could see the muffin as just flourand water, basic nutrients your body needs?î In this statement, the nurse is using whichtype of therapy?A)Rational emotive therapyB)Cognitive therapyC)Gestalt therapyD)Reality therapyAns:BFeedback:Cognitive therapy focuses on immediate thought processing, or how a person perceivesor interprets his or her experience and determines how he or she behaves. Rationalemotive therapy considers not only thoughts but feelings associated with thoughts.Gestalt therapy focuses on the person's thoughts and feelings in the here and now.Reality therapy challenges people to examine how behavior interferes with life goals.29.A patient is blaming his impending divorce on the fact that his wife goes out frequentlywith her girlfriends. If using reality therapy, the nurse would help the patient with whichof the following responses?A)ìIf you really love her, she should love you as well.îB)ìWhat does being divorced mean for you?îC)ìHow do you feel about your marriage ending?îD)ìWhat role do you think you have played in the end of your marriage?îAns:DFeedback:Reality therapy challenges clients to examine the ways in which their own behaviorthwarts their attempts to achieve life goals. Others are often assigned the blame whenpeople hold onto irrational thinking. The search for meaning is associated withlogotherapy. Exploring feelings are associated with gestalt therapy.

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Page 1430.A nurse is assisting a patient who is working on the technique of systematicdesensitization. When the patient feels anxious, the nurse can best use the principles ofthis technique by stating,A)ìUse the deep breathing techniques we practiced yesterday.îB)ìWhat is the worst that will happen if you confront this fear?îC)ìTell me how you are feeling right now.îD)ìI can see you are anxious. Let's stop for a minute.îAns:AFeedback:Systematic desensitization can be used to help clients overcome irrational fears andanxiety associated with phobias. The client learns and practices relaxation techniques todecrease and manage anxiety. He or she is then exposed to the least anxiety provokingsituation and uses the relaxation techniques to manage the resulting anxiety.Confronting irrational thoughts is part of rational emotive therapy. Encouragingexpression of feelings is associated with gestalt therapy.31.The nurse is working with a client who has a history of inflicting spousal abuse.Although the nurse does not condone domestic violence, the nurse treats the client withunconditional positive regard through which of the following?A)The nurse tries to understand the feelings that might have led to violent behavior.B)The nurse uses honest emotional expression in relating to client.C)The client is still viewed as someone worthy of respect and assistance.D)The nurse relates to the client as if he were her own spouse.Ans:CFeedback:Unconditional positive regard involves nonjudgmental caring for the client that is notdependent on the client's behavior. Genuineness is a realness or congruence betweenwhat the therapist feels and what he or she says to the client. Empathetic understandingis when the therapist senses the feelings and personal meaning from the client andcommunicates this understanding to the client.

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Page 1532.A patient is being admitted to an inpatient unit for treatment of anorexia nervosa. Of thefollowing assessment data, which should the nurse place as highest priority in the planof care?A)Weight 24% below normal for heightB)Distorted body imageC)Feelings of inadequacyD)Frequent vomiting after mealsAns:DFeedback:Maslow's hierarchy of needs hypothesizes that the basic needs at the bottom of thepyramid dominate the person's behavior until those needs were met, at which time thenext level of needs would become dominant. Vomiting threatens fluid and electrolytebalance and poses a more acute threat to survival than low weight. Once basic physicalneeds are met, the higher level needs such as body image and self-esteem can beaddressed.33.The primary purpose for generalist nurses to develop skills with psychosocialinterventions isA)psychosocial interventions are included on the nursing licensure examinations.B)psychosocial interventions are needed in all nursing practice settings.C)nurses will be consulted to assist in the care of psychiatric patients in acute caresettings.D)there are a growing number of nursing practice opportunities in mental healthsettings.Ans:BFeedback:Nurses often use psychosocial interventions to help meet clients' needs and achieveoutcomes in all practice settings, not just mental health. Psychosocial interventions areincluded on the licensing exam, but that is not the primary reason for developingproficiency. Any health-care personnel will care for psychiatric patients in acute caresettings. Current trends reflect a decline in mental health services and employmentopportunities.

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Page 1634.Which of the following considerations should have the most influence in the nurse'schoice of the treatment for the client?A)The client's feelings and perceptions about his or her situationB)The nurse's beliefs about the theories of psychosocial developmentC)The nurse's familiarity with the type of treatmentD)Any approach to treatment should work with any client.Ans:AFeedback:The client's feelings and perceptions about his or her situation are the most influentialfactors in determining his or her response to therapeutic interventions, rather than whatthe nurse believes the client should do. The nurse must examine his or her beliefs aboutthe theories of psychosocial development and realize that many treatment approachesare available. Different treatments may work for different clients: no one approachworks for everyone. Becoming familiar with the variety of psychosocial approaches forworking with clients will increase the nurse's effectiveness in promoting the client'shealth and well-being.35.Which approach to therapy is most effective when planning for a client with negativethinking?A)Behavior modificationB)Client-centered therapyC)Cognitive therapyD)Reality therapyAns:CFeedback:Cognitive therapy focuses on changing the client's thinking first, in the belief that thenfeelings and behavior can change as well. Behavior modification is a method ofattempting to strengthen a desired behavior or response by reinforcement, either positiveor negative. Client-centered therapy focuses on the role of the client, rather than thetherapist, as the key to the healing process. Reality therapy focuses on the person'sbehavior and how that behavior keeps him or her from achieving life goals.

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Page 11.Which of the following factors is primarily responsible for the changes in inpatienthospital treatment between the 1980s and the present?A)Progress in treatment options for mentally ill personsB)The growth of managed careC)Less stigma associated with mental illnessD)The current use of milieu therapyAns:BFeedback:Managed care exerts cost-control measures such as recertification of admissions,utilization review, and case managementóall of which have altered inpatient treatmentsignificantly. There has been some progress in treatment options for mentally illpersons, but that is not the primary factor that has changed mental health inpatienthospital care. There is lesser stigma associated with mental illness, but that is not theprimary factor that has changed mental health inpatient hospital care. In the 1980s, atypical psychiatric unit emphasized milieu therapy, which required long lengths of staybecause clients with more stable conditions helped to provide structure and support fornewly admitted clients with more acute conditions.2.The factor having the most influence on the current trend in treatment settings is the factin recent years,A)funding for community programs has been inadequate.B)laws have enabled more people to be committed to treatment.C)state hospitals have expanded to meet the demand.D)community programs have been fully developed to meet treatment needs.Ans:AFeedback:Adequate funding has not kept pace with the need for community programs andtreatment. Commitment laws have led to deinstitutionalization. Large state hospitalsemptied as a result. Treatment in the community was intended to replace much of statehospital inpatient care, but funding has been inadequate.

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Page 23.A patient who has continuously experienced severe symptoms of schizoaffectivedisorder for the past 17 years is experiencing an acute psychotic episode. Which level ofcare is most appropriate for this patient at this time?A)Partial hospitalizationB)Residential treatmentC)Inpatient hospital treatmentD)ClubhouseAns:CFeedback:Long-stay clients in an inpatient setting are people with severe and persistent mentalillness who continue to require acute care services despite the current emphasis ondecreased hospital stays. This population includes clients who were hospitalized beforedeinstitutionalization and remain hospitalized despite efforts at community placement. Italso includes clients who have been hospitalized consistently for long periods despiteefforts to minimize their hospital stays. Partial hospitalization is designed for patientstransitioning to independent living. Residential treatment and clubhouse model providesupervised independent living.4.A patient with depression is admitted to an inpatient hospital unit for treatment. Thetype of therapy most likely provided in this setting includesA)leisure skills.B)self-monitoring of treatment.C)skills for daily living.D)talk therapy.Ans:DFeedback:A typical psychiatric unit emphasizes talk therapy,or one-on-one interactions betweenresidents and staff, and milieu therapy, meaning the total environment and its effect onthe client's treatment. Partial hospitalization programs teach skills for daily living.Clubhouse models provide patients opportunities for leisure activities and self-monitoring of treatment.5.Which of the following is the highest priority for admission to inpatient care?A)Confusion or disorientationB)Need for medication changesC)Safety of self or othersD)Withdrawal from alcohol or other drugsAns:CFeedback:Safety is a priority; the inpatient setting provides for the safety of the client and/orothers. Confusion or disorientation, need for medication changes, and withdrawal fromalcohol or other drugs may also require inpatient care but the priority is safety.

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Page 36.The priority of inpatient care for people with severe mental illness isA)family issues.B)insight into illness.C)social skills.D)symptom management.Ans:DFeedback:Rapid assessment, stabilization of symptoms, and discharge planning are the focus ofinpatient care today. Family issues, insight into illness, and social skills would not bepriorities of care for clients with severe mental illness.7.Discharge planning from inpatient care for people with severe mental illness mustaddress which of the following to be effective? Select all that apply.A)Finding housing for the clientB)Finding a job for the clientC)Finding transportation for the clientD)Improving family supportE)Identifying ideal recreational activitiesAns:A, CFeedback:Clinicians help clients recognize symptoms, identify coping skills, and choose dischargesupports in the inpatient setting. People are able to remain in the community for longerperiods of time when discharge planning addresses environmental supports, housing,transportation, and access to community support services. Finding a job for the clientmay be helpful if appropriate but may not be appropriate for the individual at the time ofdischarge from inpatient care. Improving family support and identifying idealrecreational activities are desirable but not essential for successful reintegration with thecommunity.

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Page 48.Which type of community residential treatment setting is most likely to be permanent inany state?A)Halfway houseB)Respite housingC)Independent living programsD)Evolving consumer householdAns:DFeedback:Because the evolving consumer household is a permanent living arrangement, iteliminates the problem of relocation. Halfway houses usually serve as temporaryplacements that provide support as the clients prepare for independence. Clients who areserved by respite housing are those who live in group homes or independently most ofthe time but have a need for ìrespiteî from their usual residences when the clientexperiences a crisis, feels overwhelmed, or cannot cope with problems or emotions.Independent living programs are available in many states, but may vary a great deal inregard to services provided with some agencies providing a broad range of services orshelter but few services.9.A patient is being transferred from a group home to an evolving consumer household.The goal of this transition is for the patient to eventuallyA)meet with a therapist on a weekly basis.B)resolve crises within a shorter time period.C)fulfill daily responsibilities without supervision.D)use the increased emotional support of paid staff.Ans:CFeedback:The evolving consumer household is a group-living situation in which the residentsmake the transition from a traditional group home to a residence where they fulfill theirown responsibilities and function without onsite supervision from paid staff.

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Page 510.What is an important role of the nurse with regard to residents opposing plans toestablish a group home or residential facility in their neighborhood?A)To provide information to correct misinformation related to stereotypes of personswith mental illnessesB)To persuade neighborhood residents that mentally ill people need safe, affordable,and desirable housingC)To provide for the safety and security of the neighborhoodD)To ensure the security of persons in the group homeAns:AFeedback:Frequently, residents oppose plans to establish a group home or residential facility intheir neighborhood. They argue that having a group home will decrease their propertyvalues, and they may believe that people with mental illness are violent, will actbizarrely in public, or will be a menace to their children. These people have stronglyingrained stereotypes and a great deal of misinformation. Local residents must be giventhe facts, and nurses are in a position to advocate for clients by educating members ofthe community. The neighborhood residents who object to the establishment of a grouphome or residential setting may not be motivated to understand the needs of mentally illpeople. It is not the responsibility for the nurse to provide for the safety and security ofthe neighborhood or protect the safety and security of persons in the group home.11.What are the two essential components of transitional care discharge model that is usedin Canada and Scotland?A)Peer support and bridging staffB)Collaboration and fundingC)Relapse and hospitalizationD)Poverty and entitlementsAns:AFeedback:Two essential components of the transitional care discharge model are peer support andbridging staff. Peer support is provided by a consumer now living successfully in thecommunity. Bridging staff refers to an overlap between hospital and communitycareóhospital staff do not terminate their therapeutic relationship with the client until atherapeutic relationship has been established with the community care provider. Thismodel requires collaboration, administrative support, and adequate funding toeffectively promote the patient's health and well-being and prevent relapse andrehospitalization. Poverty among people with mental illness is a significant barrier tomaintaining housing. Mentally ill persons often rely on government entitlements fortheir income which forces people to have to choose continuation of the entitlement anddependence versus working inconsistently in unskilled, part-time, and low-paying jobswith no health insurance.

Test Bank For Psychiatric Mental Health Nursing, 6th Edition - Page 23 preview image

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Page 612.Some residential treatment settings are transitional. This means that clients areeventually expected toA)become self-sufficient.B)find employment.C)no longer need medication.D)relocate to another setting.Ans:DFeedback:Transitional housing is temporary; clients are expected to move to another residentialsetting. Clients using transitional treatment settings are not expected to become totallyself-sufficient, find employment, or not be in need of medication.13.The primary advantage of an evolving consumer household is that clientsA)are provided with adequate income to combat poverty.B)do not have to relocate as they become more independent.C)have on-site staff supervision 24 hours a day.D)receive on-site medical care.Ans:BFeedback:An evolving consumer household is a permanent living situation, eliminating the needto change residential settings as clients gain independence. Many clients in evolvingconsumer households rely on Social Security Insurance or Social Security DisabilityInsurance. Clients function without onsite supervision.14.The primary goal of a psychiatric rehabilitation program is to promoteA)return to prior level of functioning.B)medication compliance.C)complete recovery from mental illness.D)stabilization and management of symptoms.Ans:CFeedback:Psychiatric rehabilitation goes beyond management of symptoms and medicationmanagement to include personal growth, reintegration into the community,empowerment, increased independence, and improved quality of life. It is not a goal ofpsychiatric rehabilitation to return to the prior level of functioning that may have beendysfunctional. It may not be realistic for the client to completely recover from mentalillness, but rehabilitation can improve the quality of life for the client.

Test Bank For Psychiatric Mental Health Nursing, 6th Edition - Page 24 preview image

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Page 715.What is required for a transitional care model to be most effective in promoting theclient's health and well-being and prevent relapse and rehospitalization? Select all thatapply.A)CollaborationB)Administrative supportC)Adequate fundingD)Family supportE)Completely different providersF)Isolation from peers who successfully live in the communityAns:A, B, CFeedback:Two essential components of transitional care model are peer support and bridging staff.Peer support is provided by a consumer now living successfully in the community.Bridging staff refers to an overlap between hospital and community careóhospital staffdo not terminate their therapeutic relationship with the client until a therapeuticrelationship has been established with the community care provider. This model requirescollaboration, administrative support, and adequate funding to effectively promote thepatient's health and well-being and prevent relapse and rehospitalization.16.A patient has just begun daily participation in a community-based partial hospitalizationprogram. The patient can expect the staff to assist with which of the following treatmentgoals? Select all that apply.A)Stabilizing psychiatric symptomsB)Finding a better jobC)Improving activities of daily livingD)Learning to structure timeE)Improved family supportF)Developing social skillsAns:A, C, D, FFeedback:Partial hospitalization programs are designed to help clients make a gradual transitionfrom being inpatients to living independently and to prevent repeat admissions. In daytreatment programs, clients return to home at night; evening programs are just thereverse. Partial hospitalization programs provide assistance with stabilizing psychiatricsymptoms, monitoring drug effectiveness, stabilizing living environment, improvingactivities of daily living, learning to structure time, developing social skills, obtainingmeaningful work, paid employment, or a volunteer position, and providing follow-up ofany health concerns. Finding a better job and improving family support are not goals ofpartial hospitalization programs.

Test Bank For Psychiatric Mental Health Nursing, 6th Edition - Page 25 preview image

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Page 817.A patient has just been referred to a psychosocial rehabilitation program. The nurseexplains that the benefits of being involved in such a program include: Select all thatapply.A)continuous monitoring of symptoms.B)increased independence.C)increased involvement in treatment decisions.D)recovery from mental illness.E)increased community integration.F)greater opportunities for personal growth.Ans:B, D, EFeedback:Goals of psychosocial rehabilitation programs include recovery from mental illness,personal growth, quality of life, community reintegration, empowerment, increasedindependence, decreased hospital admissions, improved social functioning, improvedvocational functioning, continuous treatment, increased involvement in treatmentdecisions, improved physical health, and a recovered sense of self. Monitoring ofsymptoms and medication education are major foci of partial hospitalization programs18.Which type of psychiatric rehabilitation relies on intentional communities andrehabilitation alliances?A)Clubhouse modelB)Assertive community treatmentC)Group homesD)Respite housingAns:AFeedback:The clubhouse model of psychiatric rehabilitation relies on intentional communities andrehabilitation alliances. Assertiveness community treatment (ACT) has a problem-solving orientation, and staff members who are in the community attend to specific lifeissues of the client. Group homes are a residential form of treatment for mental illnessbut do not provide complete psychiatric rehabilitation. Respite housing is temporaryhousing for mentally ill persons and does not provide complete psychiatricrehabilitation.

Test Bank For Psychiatric Mental Health Nursing, 6th Edition - Page 26 preview image

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Page 919.Which is the orientation of assertive community treatment (ACT)?A)Setting limits on mundane life issuesB)Making a wide range of referralsC)Providing services in officesD)Problem-solving orientationAns:DFeedback:An ACT program has a problem-solving orientation: Staff members attend to specificlife issues, no matter how mundane. ACT programs provide most services directlyrather than relying on referrals to other programs or agencies, and they implement theservices in the clients' homes or communities, not in offices.20.Which of the following are advantages of a crisis resolution team or home treatmentteam? Select all that apply.A)It is a residential treatment setting.B)It is more likely to help a client to perceive his or her situation more accurately.C)It is designed to assist clients in dealing with mental health crises withouthospitalization.D)The client may feel better about asking for help.E)The client must meet multiple criteria to receive this type of care.Ans:B, C, DFeedback:Crisis resolution or respite care is a type of care for clients who have a perception ofbeing in crisis and needing a more structured environment. A client having access torespite services is more likely to perceive his or her situation more accurately, feel betterabout asking for help, and avoid hospitalization.21.A nurse is meeting with the city council to advocate for mentally ill persons and theestablishment of a group home in a neighborhood where the plans have been stronglyopposed by the neighbors. The nurse can effectively educate the public on the realitiesof group home by citing research that indicatesA)property values quickly rebound in neighborhoods that have group homes.B)police surveillance will be increased to avert any violence by residents.C)most people with mental illness do not represent a significant danger to others.D)neighborhoods that provide park areas provide children a centralized and safeplace to play.Ans:CFeedback:Frequently, residents oppose plans to establish a group home in their neighborhood,arguing that having a group home will decrease their property values, and they maybelieve that people with mental illness are violent, will act bizarrely in public, or will bea menace to their children. These people have strongly ingrained stereotypes and a greatdeal of misinformation.

Test Bank For Psychiatric Mental Health Nursing, 6th Edition - Page 27 preview image

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Page 1022.A patient with bipolar disorder has a long history of both hospitalizations andincarcerations. The patient has no permanent residence and has infrequent contact withhis family. Upon admission to the inpatient psychiatric unit for stabilization, the nursedocuments all of the following in the record. Which of the following data most suggestsa positive outcome for this patient?A)Reporting meeting with the same case manager monthly for the last 3 yearsB)History of residential stays at several local homeless sheltersC)Last contact with siblings 4 years agoD)Income from day labor for 10 days last monthAns:AFeedback:Results are positive when personal connections with case managers are established. Themost recent report from the ACCESS project found frequent shifts between the street,programs, and institutions worsen the lives of the homeless. The degree of socialsupport and employment has direct influence on quality of life.23.A nurse is orienting to a new position working the infirmary in the state penitentiary.When working with prisoners who are also mentally ill, the nurse examines her ownattitudes. Which of the following beliefs should the nurse discuss with her supervisorbefore caring for incarcerated patients?A)People with mental illness are inherently violent.B)The mentally ill can get better treatment in prison than in the community.C)People with mental illness are more vulnerable to victimization whenincarcerated.D)Many mentally ill would not be in prison if they were stabilized on medication.Ans:AFeedback:Although it is true that people with major mental illnesses who do not take prescribedmedication are at increased risk for being violent, most people with mental illness donot represent a significant danger to others. Criminalization of mental illnessrefers tothe practice of arresting and prosecuting mentally ill offenders, even for misdemeanors,at a rate four times that of the general population in an effort to contain them in sometype of institution where they might receive needed treatment. People with a mentalillness are more likely to be the victims of violence, both in prisons and in thecommunity.

Test Bank For Psychiatric Mental Health Nursing, 6th Edition - Page 28 preview image

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Page 1124.The nurse is part of a group setting up a mobile crisis service in conjunction with thelocal police department. Community education on which of the following this team willfocus includes?A)Teaching police officers counseling skillsB)Crisis counseling services to be provided in the prison systemC)Educating about the dangers of the mentally ill in the communityD)Assisting police officers to recognize mental illnessAns:DFeedback:Mobile crisis services are linked to police departments. These professionals are called tothe scene when police officers believe mental health issues are involved. Frequently, thementally ill individual can be diverted to crisis counseling services or to the hospital, ifneeded, instead of being arrested and going to jail. Often, these same professionalsprovide education to police to help them recognize mental illness and perhaps changetheir attitude about mentally ill offenders. They do not provide direct counselingtraining to police officers.25.Which of the following are core skill areas that are needed of any effective teammember of an interdisciplinary team? Select all that apply.A)Interpersonal skillsB)Teamwork skillsC)Communication skillsD)The ability to work independentlyE)Risk assessment and risk management skillsAns:A, B, C, EFeedback:The core skill areas that are needed to function as an effective team member of aninterdisciplinary team include interpersonal skills, such as tolerance, patience, andunderstanding; humanity, such as warmth, acceptance, empathy, genuineness, andnonjudgmental attitude; knowledge base about mental disorders, symptoms, andbehavior; communication skills; personal qualities, such as consistency, assertiveness,and problem-solving abilities; teamwork skills, such as collaborating, sharing, andintegrating; risk assessment and risk management skills. Members of aninterdisciplinary group must work interdependently, not independently.

Test Bank For Psychiatric Mental Health Nursing, 6th Edition - Page 29 preview image

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Page 1226.A patient has been started on antidepressants. The interdisciplinary team member mostresponsible for monitoring effectiveness and side effects of this new medication is theA)pharmacist.B)psychiatrist.C)psychiatric nurse.D)psychologist.Ans:CFeedback:The nurse is also an essential team member in evaluating the effectiveness of medicaltreatment, particularly medications. The pharmacist has a working knowledge ofmedications but has limited contact with the patient. The primary function of thepsychiatrist is diagnosis of mental disorders and prescription of medical treatments. Theclinical psychologist practices therapy.27.A patient is encouraged to join in daily outdoor games with peers on the unit. Theinterdisciplinary team member who will monitor the patient's involvement will be theA)occupational therapist.B)recreation therapist.C)vocational rehabilitation therapist.D)psychiatric nurse.Ans:BFeedback:The recreation therapist helps the client to achieve a balance of work and play in his orher life and provides activities that promote constructive use of leisure or unstructuredtime. Occupational therapy focuses on the functional abilities of the client and ways toimprove client functioning. Vocational rehabilitation includes determining clients'interests and abilities and matching them with vocational choices. The nurse has a solidfoundation in health promotion, illness prevention, and rehabilitation in all areas,allowing him or her to view the client holistically. The nurse is also an essential teammember in evaluating the effectiveness of medical treatment, particularly medications.

Test Bank For Psychiatric Mental Health Nursing, 6th Edition - Page 30 preview image

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Page 1328.A patient with bipolar disorder taking lithium returns from a walk outside and reportsfeeling shaky and dizzy. The nurse suspects the patient is experiencing a toxic reactionto the lithium and immediately notifies theA)psychiatrist.B)psychologist.C)nurse manager.D)recreation therapist.Ans:AFeedback:The primary function of the psychiatrist is diagnosis of mental disorders andprescription of medical treatments. Psychologists participate in the design of therapyprograms for groups of individuals. The nurse is an essential team member in evaluatingthe effectiveness of medical treatment particularly medications. The recreation therapisthelps the client to achieve a balance of work and play.29.A nurse documents that a patient has successfully acquired a job performing janitorialservices at a local manufacturing company. The goal of which of the following levels ofprevention has been achieved?A)Primary preventionB)Secondary preventionC)Tertiary preventionD)Community preventionAns:CFeedback:Nurses work to provide mental health prevention services to reduce risks to the mentalhealth of persons, families, and communities. Examples include primary prevention,such as stress management education; secondary prevention, such as early identificationof potential mental health problems; and tertiary prevention, such as monitoring andcoordinating rehabilitation services for the mentally ill.

Test Bank For Psychiatric Mental Health Nursing, 6th Edition - Page 31 preview image

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Page 1430.A psychiatric nurse is planning an educational program addressing primary preventionstrategies in the community. The nurse explores current research regarding whichhealth-care need?A)Influencing schizophrenic patients to adhere to medication regimensB)Assisting high school students to effectively manage stressC)Coaching patients with depression to obtain employmentD)Teaching parents the early signs of attention deficit disorder in childrenAns:BFeedback:Nurses work to provide mental health prevention services to reduce risks to the mentalhealth of persons, families, and communities. Examples include primary prevention,such as stress management education; secondary prevention, such as early identificationof potential mental health problems; and tertiary prevention, such as monitoring andcoordinating rehabilitation services for the mentally ill.31.A psychiatric nurse is planning activities aimed at secondary prevention of mentalillness. Which activity would be most appropriate to develop?A)Self-esteem building with a local after-school programB)Social skills training for chronic schizophrenicsC)Parenthood classes at a local community centerD)Depression screening in an assisted living facilityAns:DFeedback:Nurses work to provide mental health prevention services to reduce risks to the mentalhealth of persons, families, and communities. Examples include primary prevention,such as stress management education; secondary prevention, such as early identificationof potential mental health problems; and tertiary prevention, such as monitoring andcoordinating rehabilitation services for the mentally ill.32.Which element would be present in an assertive community treatment (ACT) program?A)24-hour-a-day servicesB)Infrequent contact with clientsC)Many clients to each staff memberD)Limited length of serviceAns:AFeedback:ACT includes a 24-hour-a-day service, many staff members for each client, in-home orcommunity services, intense and frequent contact, and unlimited length of service.

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