Test Bank For Varcarolis' Foundations Of Psychiatric Mental Health Nursing: A Clinical Approach, 7th Edition

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Chapter 01: Mental Health andMental IllnessChapter 01: Mental Health and Mental IllnessMULTIPLE CHOICE1.A staff nurse completes orientation to a psychiatric unit. This nurse may expect anadvanced practice nurse to perform which additional intervention?a.Conductmentalhealthassessments.c.Establishtherapeuticrelationsb.Prescribepsychotropicmedication.d.IndividualizenursingcareplaANS: BIn most states, prescriptive privileges are granted tomaster’s-prepared nursepractitioners who have taken special courses on prescribing medication. The nurseprepared at the basic level is permitted to perform mental health assessments,establish relationships, and provide individualized care planning.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 15 TOP: Nursing Process: ImplementationMSC: Client Needs: Safe, Effective Care Environment2.When a nursing student expresses concerns about how mental health nurses“loseall their nursingskills,”the best response by the mental health nurse is:a.“Psychiatricnursespracticeinsaferenvironmentsthanotherspecialties.Nurse-to-patientrbetterbecauseofthenatureofthepatients’problems.”b.“Psychiatricnursesusecomplexcommunicationskillsaswellascriticalthinkingtosolvemproblems.Iamchallengedbythosesituations.”c.“That’samisconception.Psychiatricnursesfrequentlyusehightechnologymonitoringequmanagecomplexintravenoustherapies.”d.“Psychiatricnursesdonothavetodealwithasmuchpainandsufferingasmedical-surgicaappealstome.”ANS: BThe practice of psychiatric nursing requires a different set of skills than medical-surgical nursing, though there is substantial overlap. Psychiatric nurses must be ableto help patients with medical as well as mental health problems, reflecting the holisticperspective these nurses must have. Nurse-patient ratios and workloads in psychiatricsettings have increased, just like other specialties. Psychiatric nursing involves clinical

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practice, not just documentation. Psychosocial pain and suffering are as real asphysical pain and suffering.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 10 | Page 13-14 TOP: Nursing Process: ImplementationMSC: Client Needs: Safe, Effective Care Environment3.When a new bill introduced in Congress reduces funding for care of persons withmental illness, a group of nurses writes letters to their elected representatives inopposition to the legislation. Which role have the nurses fulfilled?a.Recoveryc.Advocacyb.Attendingd.Evidence-basedpracticeANS: CAn advocate defends or assertsanother’scause, particularly when the other personlacks the ability to do that for self. Examples of individual advocacy include helpingpatients understand their rights or make decisions. On a community scale, advocacyincludes political activity, public speaking, and publication in the interest ofimproving the human condition. Since funding is necessary to deliver qualityprogramming for persons with mental illness, the letter- writing campaign advocatesfor that cause on behalf of patients who are unable to articulate their own needs.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 16 TOP: Nursing Process: ImplementationMSC: Client Needs: Safe, Effective Care Environment4.Which comment best indicates that a patient perceived the nurse was caring?“Mynurse:a.alwaysasksmewhichtypeofjuiceIwanttohelpmeswallowmymedication.”b.explainedmytreatmentplantomeandaskedformyideasabouthowtomakeitbetter.”c.spendstimelisteningtometalkaboutmyproblems.ThathelpsmefeellikeIamnotaloned.toldmethatifItakeallthemedicinesthedoctorprescribes,thenIwillgetdischargedsoonANS: CCaring evidences empathetic understanding as well as competency. It helps changepain and suffering into a shared experience, creating a human connection thatalleviates feelings of isolation. The distracters give examples of statements thatdemonstrate advocacy or giving advice.PTS: 1 DIF: Cognitive Level: Apply (Application)

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REF: Page 7 |Page 10 TOP: Nursing Process: EvaluationMSC: Client Needs: Psychosocial Integrity5.Which assessment finding most clearly indicates that a patient may be experiencinga mental illness? The patient:a.reportsoccasionalsleeplessnessandanxiety.b.reportsaconsistentlysad,discouraged,andhopelessmood.c.isabletodescribethedifferencebetween“asif”and“forreal.”d.perceivesdifficultymakingadecisionaboutwhethertochangejobs.ANS: BThe correct response describes a mood alteration, which reflects mental illness. Thedistracters describe behaviors that are mentally healthy or within the usual scope ofhuman experience.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 2-3 TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity6.Which finding best indicates that the goal“Demonstratementally healthy behavior”was achieved? A patient:a.seesselfascapableofachievingidealsandmeetingdemands.b.behaveswithoutconsideringtheconsequencesofpersonalactions.c.aggressivelymeetsownneedswithoutconsideringtherightsofothers.d.seekshelpfromotherswhenassumingresponsibilityformajorareasofownlife.ANS: AThe correct response describes an adaptive, healthy behavior. The distracters describemaladaptive behaviors.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 2-3 TOP: Nursing Process: EvaluationMSC: Client Needs: Psychosocial Integrity7.A nurse encounters an unfamiliar psychiatric disorder on a newpatient’sadmissionform. Which resource should the nurse consult to determine criteria used to establishthis diagnosis?a.InternationalStatisticalClassificationofDiseasesandRelatedHealthProblems(ICD-10)b.DiagnosticandStatisticalManualofMentalDisorders(DSM-5)

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c.Abehavioralhealthreferencemanuald.WikipediaANS: BTheDSM-5gives the criteria used to diagnose each mental disorder. The distractersmay not contain diagnostic criteria for a psychiatric illness.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 3-4 TOP: Nursing Process: AssessmentMSC: Client Needs: Safe, Effective Care Environment8.A nurse wants to find a description of diagnostic criteria for anxiety disorders.Which resource would have the most complete information?a.NursingOutcomesClassification(NOC)b.DiagnosticandStatisticalManualofMentalDisorders(DSM-5)c.TheANA’sPsychiatric-MentalHealthNursingScopeandStandardsofPracticed.InternationalStatisticalClassificationofDiseasesandRelatedHealthProblems(ICD-10)ANS: BTheDSM-5details the diagnostic criteria for psychiatric clinical conditions. The otherreferences are good resources but do not define the diagnostic criteria.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 10-12 TOP: Nursing Process: ImplementationMSC: Client Needs: Safe, Effective Care Environment9.Which individual is demonstrating the highest level of resilience? One who:a.isabletorepressstressors.b.becomesdepressedafterthedeathofaspouse.c.livesinashelterfortwoyearsafterthehomeisdestroyedbyfire.d.takesatemporaryjobtomaintainfinancialstabilityafterlossofapermanentjob.ANS: DResilience is closely associated with the process of adapting and helps people facingtragedies, loss, trauma, and severe stress. It is the ability and capacity for people tosecure the resources they need to support their well-being. Repression and depressionare unhealthy. Living in a shelter for two years shows a failure to move forward aftera tragedy. See related audience response question.PTS: 1 DIF: Cognitive Level: Apply (Application)

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REF: Page 3-4 TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity10.Complete this analogy. NANDA: clinical judgment:NIC: _________________a.patientoutcomesc.diagnosisb.nursingactionsd.symptomsANS: BAnalogies show parallel relationships. NANDA, the North American NursingDiagnosis Association, identifies diagnostic statements regarding human responses toactual or potential health problems. These statements represent clinicaljudgments.NIC(Nursing Interventions Classification) identifies actions provided bynurses that enhance patient outcomes. Nursing care activities may be direct orindirect.PTS: 1 DIF: Cognitive Level: Analyze (Analysis)REF: Page 13-14 TOP: Nursing Process: EvaluationMSC: Client Needs: Safe, Effective Care Environment11.A college student said,“Mostof the timeI’mhappy and feel good about myself. Ihave learned that what I get out of something is proportional to the effort I put intoit.”Which number on this mental health continuum should the nurse select?MentalIllnessMentalHealth1234a.1b.2c.3d.4e.5ANS: EThe student is happy and has an adequate self-concept. The student is reality-oriented,works effectively, and has control over own behavior. Mental health does not meanthat a person is always happy.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 2-3 (Figure 1-1) TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity

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12.Which disorder is a culture-bound syndrome?a.Epilepsyc.Runningamokb.Schizophreniad.MajordepressionANS: CCulture-bound syndromes occur in specific sociocultural contexts and are easilyrecognized by people in those cultures. A syndrome recognized in parts of SoutheastAsia is running amok, in which a person (usually a male) runs around engaging infurious, almost indiscriminate violent behavior.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 5-6 TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity13.The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies:a.deviantbehaviors.c.peoplewithmentaldisorders.b.presentdisabilityordistress.d.mentaldisorderspeoplehave.ANS: DThe DSM-5 classifies disorders people have rather than people themselves. Theterminology of the tool reflects this distinction by referring to individuals with adisorder rather than as a“schizophrenic”or“alcoholic,”for example. Deviantbehavior is not generally considered a mental disorder. Present disability or distress isonly one aspect of the diagnosis.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 10-12 TOP: Nursing Process: ImplementationMSC: Client Needs: Safe, Effective Care Environment14.A citizen at a community health fair asks the nurse,“Whatis the most prevalentmental disorder in the UnitedStates?”Select thenurse’sbest response.a.Schizophreniac.Dissociativefugueb.Bipolardisorderd.Alzheimer’sdiseaseANS: DThe 12-month prevalence forAlzheimer’sdisease is 10% for persons older than 65and 50% for persons older than 85. The prevalence of schizophrenia is 1.1% per year.The prevalence of bipolar disorder is 2.6%. Dissociative fugue is a rare disorder. Seerelated audience response question.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

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REF: Page 9-10 (Table 1-1) TOP: Nursing Process: ImplementationMSC: Client Needs: Health Promotion and Maintenance15.In the majority culture of the United States, which individual has the greatest riskto be labeled mentally ill? One who:a.describeshearingGod’svoicespeaking.b.isusuallypessimisticbutstrivestomeetpersonalgoals.c.iswealthyandgivesaway$20billstoneedyindividuals.d.alwayshasanoptimisticviewpointaboutlifeandhavingownneedsmet.ANS: AThe question asks about risk. Hearing voices is generally associated with mentalillness, but in charismatic religious groups, hearing the voice of God or a prophet is adesirable event. Cultural norms vary, which makes it more difficult to make anaccurate diagnosis. The individuals described in the other options are less likely to belabeled mentally ill.PTS: 1 DIF: Cognitive Level: Analyze (Analysis)REF: Page 4-5 TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity16.Apatient’srelationships are intense and unstable. The patient initially idealizes thesignificant other and then devalues him or her, resulting in frequent feelings ofemptiness. This patient will benefit from interventions to develop which aspect ofmental health?a.Effectivenessinworkc.Productiveactivitiesb.Communicationskillsd.FulfillingrelationshipsANS: DThe information given centers on relationships with others that are described asintense and unstable. The relationships of mentally healthy individuals are stable,satisfying, and socially integrated. Data are not present to describe work effectiveness,communication skills, or activities.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 2-3 (Figure 1-1) TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity17.Which belief will best support anurse’sefforts to provide patient advocacy duringa multidisciplinary patient care planning session?

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a.Allmentalillnessesareculturallydetermined.b.Schizophreniaandbipolardisorderarecross-culturaldisorders.c.Symptomsofmentaldisordersareunchangedfromculturetoculture.d.Assessmentfindingsinmentaldisordersreflectaperson’sculturalpatterns.ANS: DA nurse who understands that apatient’ssymptoms are influenced by culture will beable to advocate for the patient to a greater degree than a nurse who believes thatculture is of little relevance. The distracters are untrue statements.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 4-5 TOP: Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity18.A nurse is part of a multidisciplinary team working with groups of depressedpatients. Half the patients receive supportive interventions and antidepressantmedication. The other half receives only medication. The team measures outcomes foreach group. Which type of study is evident?a.Incidencec.Co-morbidityb.Prevalenced.ClinicalepidemiologyANS: DClinical epidemiologyis a broad field that addresses studies of the natural history (orwhat happens if there is no treatment and the problem is left to run its course) of anillness, studies of diagnostic screening tests, and observational and experimentalstudies of interventions used to treat people with the illness orsymptoms.Prevalencerefers to numbers of new cases.Co-morbidityrefers to havingmore than one mental disorder at a time.Incidencerefers to the number of new casesof mental disorders in a healthy population within a given period. See related audienceresponse question.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 9-10 TOP: Nursing Process: EvaluationMSC: Client Needs: Safe, Effective Care Environment19.The spouse of a patient diagnosed with schizophrenia says,“Idon’tunderstandhow events from childhood have anything to do with this disablingillness.”Whichresponse by the nurse will best help the spouse understand the cause of this disorder?a.“Psychologicalstressisthebasisofmostmentaldisorders.”

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b.“Thisillnessresultsfromdevelopmentalfactorsratherthanstress.”c.“Researchshowsthatthisconditionmorelikelyhasabiologicalbasis.”d.“Itmustbefrustratingforyouthatyourspouseissicksomuchofthetime.”ANS: CMany of the most prevalent and disabling mental disorders have strong biologicalinfluences. Genetics are only one part of biological factors. Empathy does not addressincreasing thespouse’slevel of knowledge about the cause of the disorder. The otherdistracters are not established facts.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 6-7 TOP: Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity20.A category 5 tornado occurred in a community of 400 people resulting indestruction of many homes and businesses. In the 2 years after this disaster, 140individuals were diagnosed with posttraumatic stress disorder (PTSD). Which termbest applies to these newly diagnosed cases?a.Prevalencec.Incidenceb.Co-morbidityd.ParityANS: CIncidence refers to the number of new cases of mental disorders in a healthypopulation within a given period of time. Prevalence describes the total number ofcases, new and existing, in a given population during a specific period of time,regardless of when they became ill. Parity refers to equivalence, and legislationrequired insurers that provide mental health coverage to offer annual and lifetimebenefits at the same level provided for medical/surgical coverage. Co-morbidity refersto having more than one mental disorder at a time.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 9-10 TOP: Nursing Process: Planning/Outcomes IdentificationMSC: Client Needs: Safe, Effective Care Environment21.Which component of treatment of mental illness is specifically recognized byQuality and Safety Education for Nurses (QSEN)?a.Allgenomesareunique.b.Careiscenteredonthepatient.

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c.Healthydevelopmentisvitaltomentalhealth.d.Recoveryoccursonacontinuumfromillnesstohealth.ANS: BThe key areas of care promoted by QSEN are patient-centered care, teamwork andcollaboration, evidence-based practice, quality improvement, safety, and informatics.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 8-9 TOP: Nursing Process: ImplementationMSC: Client Needs: Safe, Effective Care Environment22.Select the best response for the nurse who receives a question from another healthprofessional seeking to understand the difference between aDiagnostic and StatisticalManual of Mental Disorders (DSM-5)diagnosis and a nursing diagnosis.a.“Thereisnofunctionaldifferencebetweenthetwo.Bothidentifyhumandisorders.”b.“TheDSM-5diagnosisdisregardsculture,whereasthenursingdiagnosistakescultureintoc.TheDSM-5diagnosisdescribescausesofdisorderswhereasanursingdiagnosisdoesnoted.“TheDSM-5diagnosisguidesmedicaltreatment,whereasthenursingdiagnosisoffersafraidentifyinginterventionsforissuesapatientisexperiencing.”ANS: DThe medical diagnosis is concerned with thepatient’sdisease state, causes, and cures,whereas the nursing diagnosis focuses on the patient’sresponse to stress and possiblecaring interventions. Both tools consider culture. TheDSM-5is multiaxial. Nursingdiagnoses also consider potential problems.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 10-14 TOP: Nursing Process: ImplementationMSC: Client Needs: Safe, Effective Care Environment23.Which nursing intervention below is part of the scope of an advanced practicepsychiatric/mental health nurse only?a.Coordinationofcarec.Milieutherapyb.Healthteachingd.PsychotherapyANS: DPsychotherapy is part of the scope of practice of an advanced practice nurse. Thedistracters are within a staffnurse’sscope of practice.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 14-15 (Table 1-2) TOP: Nursing Process: Implementation

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MSC: Client Needs: Safe, Effective Care EnvironmentMULTIPLE RESPONSE1.An experienced nurse says to a new graduate,“Whenyou’vepracticed as long as Ihave, you instantly know how to take care of psychoticpatients.”What informationshould the new graduate consider when analyzing this comment?Select all that apply.a.Theexperiencednursemayhavelostsightofpatients’individuality,whichmaycompromiofpractice.b.Newresearchfindingsshouldbeintegratedcontinuouslyintoanurse’spracticetoprovideeffectivecare.c.Experienceprovidesmentalhealthnurseswiththeessentialtoolsandskillsneededforeffeprofessionalpractice.d.Experiencedpsychiatricnurseshavelearnedthebestwaystocareformentallyillpatientsterror.e.Anintuitivesenseofpatients’needsguideseffectivepsychiatricnurses.ANS: A, BEvidence-based practice involves using research findings and standards of care toprovide the most effective nursing care. Evidence is continuously emerging, so nursescannot rely solely on experience. The effective nurse also maintains respect for eachpatient as an individual. Overgeneralization compromises that perspective. Intuitionand trial and error are unsystematic approaches to care.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 7-9 TOP: Nursing Process: Diagnosis/AnalysisMSC: Client Needs: Safe, Effective Care Environment2.Which findings are signs of a person who is mentally healthy?Select all that apply.a.Says,“Ihavesomeweaknesses,butIfeelI’mimportanttomyfamilyandfriends.”b.Adheresstrictlytoreligiousbeliefsofparentsandfamilyoforigin.c.Spendsallholidaysalonewatchingoldmoviesontelevision.d.Considerspastexperienceswhendecidingaboutthefuture.e.Experiencesfeelingsofconflictrelatedtochangingjobs.ANS: A, D, EMental health is a state of well-being in which each individual is able to realize his orher own potential, cope with the normal stresses of life, work productively, and makea contribution to the community. Mental health provides people with the capacity for

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rational thinking, communication skills, learning, emotional growth, resilience, andself-esteem.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 2-3 (Figure 1-1) TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity3.A patient in the emergency department says,“Voicessay someone is stalking me.They want to kill me because I developed a cure for cancer. I have a knife and willstab anyone who is athreat.”Which aspects of thepatient’smental health have thegreatest and most immediate concern to the nurse?Select all that apply.a.Happinessb.Appraisalofrealityc.Controloverbehaviord.Effectivenessinworke.Healthyself-conceptANS: B, C, EThe aspects of mental health of greatest concern are thepatient’sappraisal of andcontrol over behavior. The appraisal of reality is inaccurate. There are auditoryhallucinations, delusions of persecution, and delusions of grandeur. In addition, thepatient’scontrol over behavior is tenuous, as evidenced by the plan to stab anyonewho seems threatening. A healthy self-concept is lacking, as evidenced by thedelusion of grandeur. Data are not present to suggest that the other aspects of mentalhealth (happiness and effectiveness in work) are of immediate concern.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 2-4 TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial IntegrityChapter 02: Relevant Theoriesand Therapies for NursingPracticeChapter 02: Relevant Theories and Therapies for Nursing PracticeMULTIPLE CHOICE

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1.A parent says,“My2-year-old child refuses toilet training and shouts‘No!’whengiven directions. What do you think iswrong?”Select thenurse’sbest reply.a.“Yourchildneedsfirmercontrol.Itisimportanttosetlimitsnow.”b.“Thisisnormalforyourchild’sage.Thechildisstrivingforindependence.”c.“Theremaybedevelopmentalproblems.Mostchildrenaretoilettrainedbyage2.”d.“Someundesirableattitudesaredeveloping.AchildpsychologistcanhelpyoudevelopapANS: BThis behavior is typical of a child around the age of 2 years, whose developmentaltask is to develop autonomy. The distracters indicate thechild’sbehavior is abnormal.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 22-23 (Table 2-2) TOP: Nursing Process: ImplementationMSC: Client Needs: Health Promotion and Maintenance2.A 26-month-old displays negative behavior, refuses toilet training, and often says,“No!”Which stage of psychosexual development is evident?a.Oralc.Phallicb.Anald.GenitalANS: BThe anal stage occurs from age 1 to 3 years and has as its focus toilet training andlearning 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 occursbetween age 13 and 20 years.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 21-22 (Table 2-1) TOP: Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance3.A 26-month-old displays negative behavior, refuses toilet training, and often says,“No!”Which psychosocial crisis is evident?a.Trustversusmistrustc.Industryversusinferiorityb.Initiativeversusguiltd.AutonomyversusshameandANS: DThe crisis of autonomy versus shame and doubt relates to the developmental task ofgaining control of self and environment, as exemplified by toilet training. Thispsychosocial crisis occurs during the period of early childhood. Trust versus mistrust

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is the crisis of the infant. Initiative versus guilt is the crisis of the preschool and early-school-aged child. Industry versus inferiority is the crisis of the 6- to 12-year-oldchild.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 22-23 (Table 2-2) TOP: Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance4.A 4-year-old grabs toys from siblings and says,“Iwant thatnow!”The siblings cry,and thechild’sparent becomes upset with the behavior. According to Freudian theory,this behavior is a product of impulses originating in which system of the personality?a.Idc.Superegob.Egod.PreconsciousANS: AThe id operates on the pleasure principle, seeking immediate gratification of impulses.The ego acts as a mediator of behavior and weighs the consequences of the action,perhaps determining that taking the toy is not worth themother’swrath. The superegowould oppose the impulsive behavior as“notnice.”The preconscious is a level ofawareness. This item relates to an audience response question.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 20-21 TOP: Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance5.The parent of a 4-year-old rewards and praises the child for helping a youngersibling, being polite, and using good manners. The nurse supports this use of praiserelated to these behaviors. These qualities are likely to be internalized and becomepart of which system of the personality?a.Idc.Superegob.Egod.PreconsciousANS: CThe superego contains the“thoushalts,”or moral standards internalized frominteractions with significant others. Praise fosters internalization of desirablebehaviors. The id is the center of basic instinctual drives, and the ego is the mediator.The ego is the problem-solving and reality-testing portion of the personality thatnegotiates solutions with the outside world. The preconscious is a level of awareness

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from which material can be retrieved easily with conscious effort. This item relates toan audience response question.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 20-21 TOP: Nursing Process: ImplementationMSC: Client Needs: Health Promotion and Maintenance6.A nurse supports a parent for praising a child behaving in a helpful way. When thischild behaves with politeness and helpfulness in adulthood, which feeling will mostlikely result?a.Guiltc.Humilityb.Anxietyd.Self-esteemANS: DThe individual will be living up to the ego ideal, which will result in positive feelingsabout self. The other options are incorrect because each represents a negative feeling.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 21 | Page 28 TOP: Nursing Process: ImplementationMSC: Client Needs: Health Promotion and Maintenance7.An adult says,“Inever know theanswers,”and“Myopiniondoesn’tcount.”Whichpsychosocial crisis was unsuccessfully resolved for this adult?a.Initiativeversusguiltc.Autonomyversusshameandb.Trustversusmistrustd.Generativityversusself-absorANS: CThese statements show severe self-doubt, indicating that the crisis of gaining controlover the environment was not met successfully. Unsuccessful resolution of the crisisof initiative versus guilt results in feelings of guilt. Unsuccessful resolution of thecrisis of trust versus mistrust results in poor interpersonal relationships and suspicionof others. Unsuccessful resolution of the crisis of generativity versus self-absorptionresults in self-absorption that limits the ability to grow as a person.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 22-23 (Table 2-2) TOP: Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance8.Which patient statement would lead the nurse to suspect unsuccessful completion ofthe developmental task of infancy?a.“Ihaveverywarmandclosefriendships.”

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b.“I’mafraidtoallowanyonetoreallygettoknowme.”c.“I’malwaysabsolutelyright,sodon’tbothersayingmore.”d.“I’mashamedthatIdidn’tdothingscorrectlyinthefirstplace.”ANS: BAccording to Erikson, the developmental task of infancy is the development of trust.The correct response is the only statement clearly showing lack of ability to trustothers. Warm, close relationships suggest the developmental task of infancy wassuccessfully completed; rigidity and self-absorption are reflected in the belief one isalways right; and shame for past actions suggests failure to resolve the crisis ofinitiative versus guilt.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 22-23 (Table 2-2) TOP: Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance9.A patient is suspicious and frequently manipulates others. To which psychosexualstage do these traits relate?a.Oralc.Phallicb.Anald.GenitalANS: AThe behaviors in the stem develop as the result of attitudes formed during the oralstage, when an infant first learns to relate to the environment. Anal-stage traits includestinginess, stubbornness, orderliness, or their opposites. Phallic-stage traits includeflirtatiousness, pride, vanity, difficulty with authority figures, and difficulties withsexual identity. Genital-stage traits include the ability to form satisfying sexual andemotional relationships with members of the opposite sex, emancipation from parents,a strong sense of personal identity, or the opposites of these traits.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 21-22 (Table 2-1) TOP: Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance10.A patient expresses a desire to be cared for by others and often behaves in ahelpless fashion. Which stage of psychosexual development is most relevant to thepatient’sneeds?a.Latencyc.Analb.Phallicd.Oral

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ANS: DFixation at the oral stage sometimes produces dependent infantile behaviors in adults.Latency fixations often result in difficulty identifying with others and developingsocial skills, resulting in a sense of inadequacy and inferiority. Phallic fixations resultin having difficulty with authority figures and poor sexual identity. Anal fixationsometimes results in retentiveness, rigidity, messiness, destructiveness, and cruelty.This item relates to an audience response question.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 21-22 (Table 2-1) TOP: Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance11.A nurse listens to a group of recent retirees. One says,“Ivolunteer with Meals onWheels, coach teen sports, and do churchvisitation.”Another laughs and says,“I’mtoo busy taking care of myself to volunteer to helpothers.”Which developmental taskdo these statements contrast?a.Trustandmistrustc.Industryandinferiorityb.Intimacyandisolationd.Generativityandself-absorptiANS: DBoth retirees are in middle adulthood, when the developmental crisis to be resolved isgenerativity versus self-absorption. One exemplifies generativity; the other embodiesself-absorption. This developmental crisis would show a contrast between relating toothers in a trusting fashion and being suspicious and lacking trust. Failure to negotiatethis developmental crisis would result in a sense of inferiority or difficulty learningand working as opposed to the ability to work competently. Behaviors that would becontrasted would be emotional isolation and the ability to love and commit oneself.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 22-23 (Table 2-2) TOP: Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance12.Although ego defense mechanisms and security operations are mainly unconsciousand designed to relieve anxiety, the major difference is that:a.defensemechanismsareintrapsychicandnotobservable.b.defensemechanismscausearrestedpersonaldevelopment.c.securityoperationsaremastermindedbytheidandsuperego.d.securityoperationsaddressinterpersonalrelationshipactivities.

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ANS: DSullivan’stheory explains that security operations are interpersonal relationshipactivities designed to relieve anxiety. Because they are interpersonal, they areobservable. Defense mechanisms are unconscious and automatic. Repression isentirely intrapsychic, but other mechanisms result in observable behaviors. Frequent,continued use of many defense mechanisms often results in reality distortion andinterference with healthy adjustment and emotional development. Occasional use ofdefense mechanisms is normal and does not markedly interfere with development.Security operations are ego-centered. This item relates to an audience responsequestion.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 33-34 (Table 2-6) TOP: Nursing Process: AnalysisMSC: Client Needs: Health Promotion and Maintenance13.A student nurse says,“Idon’tneed to interact with my patients. I learn what I needto know byobservation.”An instructor can best interpret the nursing implications ofSullivan’stheory to this student by responding:a.“Interactionsarerequiredinordertohelpyoudeveloptherapeuticcommunicationskills.”b.“Nursescannotbeisolated.Wemustinteracttoprovidepatientswithopportunitiestopracskills.”c.“Observingpatientinteractionswillhelpyouformulateprioritynursingdiagnosesandapprinterventions.”d.“Itisimportanttopayattentiontopatients’behavioralchanges,becausethesesignifyadjuspersonality.”ANS: BThenurse’srole includes educating patients and assisting them in developingeffective interpersonal relationships. Mutuality, respect for the patient, unconditionalacceptance, and empathy are cornerstones ofSullivan’stheory. The nurse who doesnot interact with the patient cannot demonstrate these cornerstones. Observationsprovide only objective data. Priority nursing diagnoses usually cannot be accuratelyestablished without subjective data from the patient. The other distracters relate toMaslow and behavioral theory. This item relates to an audience response question.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 33-34 (Table 2-6) TOP: Nursing Process: Implementation

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MSC: Client Needs: Health Promotion and Maintenance14.A nurse consistently encourages patient to do his or her own activities of dailyliving (ADLs). If the patient is unable to complete an activity, the nurse helps until thepatient is once again independent. Thisnurse’spractice is most influenced by whichtheorist?a.BettyNeumanc.DorotheaOremb.PatriciaBennerd.JoyceTravelbeeANS: COrem emphasizes the role of the nurse in promoting self-care activities of the patient;this has relevance to the seriously and persistently mentally ill patient.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 30-31 TOP: Nursing Process: PlanningMSC: Client Needs: Psychosocial Integrity15.A nurse usesMaslow’shierarchy of needs to plan care for a patient with mentalillness. Which problem will receive priority? The patient:a.refusestoeatorbathe.b.reportsfeelingsofalienationfromfamily.c.isreluctanttoparticipateinunitsocialactivities.d.isunawareofmedicationactionandsideeffects.ANS: AThe need for food and hygiene are physiological and therefore take priority overpsychological or meta-needs in care planning.PTS: 1 DIF: Cognitive Level: Analyze (Analysis)REF: Page 31-32 (Figure 2-5)TOP: Nursing Process: Planning/Outcomes IdentificationMSC: Client Needs: Safe, Effective Care Environment16.Operant conditioning is part of the treatment plan to encourage speech in a childwho is nearly mute. Which technique applies?a.Encouragethechildtoobserveotherstalking.b.Includethechildinsmallgroupactivities.c.Givethechildasmalltreatforspeaking.d.Teachthechildrelaxationtechniques.

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ANS: COperant conditioning involves giving positive reinforcement for a desired behavior.Treats are rewards and reinforce speech through positive reinforcement.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 27 (Fig 2-3) TOP: Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity17.The parent of a child diagnosed with schizophrenia tearfully asks the nurse,“Whatcould I have done differently to prevent thisillness?”Select thenurse’sbest response.a.“Althoughschizophreniaresultsfromimpairedfamilyrelationships,trynottofeelguilty.Npredicthowachildwillrespondtoparentalguidance.”b.“SchizophreniaisabiologicalillnessresultingfromchangesinhowthebrainandnervousYouarenottoblameforyourchild’sillness.”c.“Thereisstillhope.Changingyourparentingstylecanhelpyourchildlearntocopeeffectienvironment.”d.“Mostmentalillnessesresultfromgeneticinheritance.YourgenesaremoreatfaultthanyoANS: BTheparent’scomment suggests feelings of guilt or inadequacy. Thenurse’sresponseshould address these feelings as well as provide information. Patients and familiesneed reassurance that the major mental disorders are biological in origin and are notthe“fault”of parents. One distracter places the burden of having faulty genes on theshoulders of the parents. The other distracters are neither wholly accurate norreassuring.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 33 TOP: Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity18.A nurse influenced byPeplau’sinterpersonal theory works with an anxious,withdrawn patient. Interventions should focus on:a.rewardingdesiredbehaviors.b.useofassertivecommunication.c.changingthepatient’sself-concept.d.administeringmedicationstorelieveanxiety.ANS: B

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The nurse-patient relationship is structured to provide a model for adaptiveinterpersonal relationships that can be generalized to others. Helping the patient learnto use assertive communication will improve thepatient’sinterpersonal relationships.The distracters apply to theories of cognitive, behavioral, and biological therapy.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 21-22 TOP: Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity19.A patient had psychotherapy weekly for 5 months. The therapist used freeassociation, dream analysis, and facilitated transference to help the patient understandconflicts and foster change. Select the term that applies to this method.a.Rational-emotivebehaviortherapyc.Cognitive-behavioraltherapyb.Psychodynamicpsychotherapyd.OperantconditioningANS: BThe techniques are aspects of psychodynamic psychotherapy. The distracters useother techniques.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 20-21 | Page 34 (Table 2-6) TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity20.Consider this comment from a therapist:“Thepatient is homosexual but has keptthis preference secret. Severe anxiety and depression occur when the patientanticipates family reactions to this sexualorientation.”Which perspective is evident inthe speaker?a.Theoryofinterpersonalrelationshipsc.Psychosexualtheoryb.Classicalconditioningtheoryd.BehaviorismtheoryANS: AThe theory of interpersonal relationships recognizes the anxiety and depression asresulting from unmet interpersonal security needs. Behaviorism and classicalconditioning theories do not apply. A psychosexual formulation would focus onuncovering unconscious material that relates to the patient problem.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 24 | Page 34 (Table 2-6) TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity

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21.A psychotherapist works with an anxious, dependent patient. Which strategy ismost consistent with psychoanalytic psychotherapy?a.Identifyingthepatient’sstrengthsandassetsb.Praisingthepatientfordescribingfeelingsofisolationc.Focusingonfeelingsdevelopedbythepatienttowardthetherapistd.ProvidingpsychoeducationandemphasizingmedicationadherenceANS: CPositive or negative feelings of the patient toward the therapist indicate transference.Transference is a psychoanalytic concept that can be used to explore previouslyunresolved conflicts. The distracters relate to biological therapy and supportivepsychotherapy. Use of psychoeducational materials is a common“homework”assignment used in cognitive therapy.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 21-22 | Page 34 (Table 2-6) TOP: Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity22.A person says,“Iwas the only survivor in a small plane crash. Three businessassociates died. I got depressed and saw a counselor twice a week for 4 weeks. Wetalked about my feelings related to being a survivor, andI’mbetternow.”Which typeof therapy was used?a.Milieutherapyc.Behaviormodificationb.Psychoanalysisd.InterpersonalpsychotherapyANS: DInterpersonal psychotherapy returned the patient to his former level of functioning byhelping him come to terms with the loss of friends and guilt over being a survivor.Milieu therapy refers to environmental therapy. Psychoanalysis would call for a longperiod of exploration of unconscious material. Behavior modification would focus onchanging a behavior rather than helping the patient understand what is going on in hislife.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 24-25 | Page 34 (Table 2-6) TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity23.Which technique is most applicable to aversion therapy?a.Punishmentc.Rolemodeling

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b.Desensitizationd.PositivereinforcementANS: AAversion therapy is akin to punishment. Aversive techniques include pairing of amaladaptive behavior with a noxious stimulus, punishment, and avoidance training.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 28 TOP: Nursing Process: PlanningMSC: Client Needs: Psychosocial Integrity24.A patient says to the nurse,“Myfather has been dead for over 10 years, but talkingto you is almost as comforting as the talks he and I had when I was achild.”Whichterm applies to thepatient’scomment?a.Superegoc.Realitytestingb.Transferenced.Counter-transferenceANS: BTransference refers to feelings a patient has toward the health care workers that wereoriginally held toward significant others in his or her life. Counter-transference refersto unconscious feelings that the health care worker has toward the patient. Thesuperego represents the moral component of personality; it seeks perfection.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 21-22 TOP: Nursing Process: EvaluationMSC: Client Needs: Psychosocial Integrity25.A college student received an invitation to attend the wedding of a close friendwho lives across the country. The student is afraid of flying. Which type of therapywould be most helpful for this patient?a.Psychoanalysisc.Systematicdesensitizationb.Milieutherapyd.Short-termdynamictherapyANS: CSystematic desensitization is a type of therapy aimed at extinguishing a specificbehavior, such as the fear of flying. Psychoanalysis and short-term dynamic therapyseek to uncover conflicts. Milieu therapy involves environmental factors.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 27-28 TOP: Nursing Process: PlanningMSC: Client Needs: Psychosocial Integrity

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26.A patient would benefit from therapy in which peers as well as staff have a voicein determiningpatients’privileges and psychoeducational topics. Which approachwould be best?a.Milieutherapyc.Short-termdynamictherapyb.Cognitivetherapyd.SystematicdesensitizationANS: AMilieu therapy is based on the idea that all members of the environment contribute tothe planning and functioning of the setting. The distracters are individual therapiesthat do not fit the description.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 33 TOP: Nursing Process: PlanningMSC: Client Needs: Psychosocial Integrity27.A patient repeatedly stated,“I’mstupid.”Which statement by that patient wouldshow progress resulting from cognitive behavioral therapy?a.“SometimesIdostupidthings.”b.“Thingsalwaysgowrongforme.”c.“IalwaysfailwhenItrynewthings.”d.“I’mdisappointedinmylackofability.”ANS: A“I’mstupid”is a cognitive distortion. A more rational thought is“SometimesI dostupidthings.”The latter thinking promotes emotional self-control. The distractersreflect irrational or distorted thinking. This item relates to an audience responsequestion.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 29-31 (Table 2-5) TOP: Nursing Process: EvaluationMSC: Client Needs: Psychosocial Integrity28.A patient says,“Allmy lifeI’vebeen surrounded by stupidity. Everything I buybreaks because the entire American workforce isincompetent.”This patient isexperiencing a:a.self-esteemdeficit.c.deficitinmotivation.b.cognitivedistortion.d.deficitinloveandbelonging.ANS: B

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Automatic thoughts, or cognitive distortions,are irrational and lead to falseassumptions and misinterpretations. See related audience response question.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 29-31 (Table 2-5) TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity29.A patient is fearful of riding on elevators. The therapist first rides an escalator withthe patient. The therapist and patient then stand in an elevator with the door open forfive minutes and later with the elevator door closed for five minutes. Which techniquehas the therapist used?a.Classicpsychoanalytictherapyc.Rationalemotivetherapyb.Systematicdesensitizationd.BiofeedbackANS: BSystematic desensitization is a form of behavior modification therapy that involvesthe development of behavior tasks customized to thepatient’sspecific fears. Thesetasks are presented to the patient while using learned relaxation techniques. Thepatient is incrementally exposed to the fear.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 28 TOP: Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity30.A patient says,“Ialways feel good when I wear a size 2petite.”Which type ofcognitive distortion is evident?a.Disqualifyingthepositivec.Catastrophizingb.Overgeneralizationd.PersonalizationANS: BAutomatic thoughts, or cognitive distortions,are irrational and lead to falseassumptions and misinterpretations. The stem offers an example ofovergeneralization. See related audience response question.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 29-31 (Table 2-5) TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity31.Which comment best indicates a patient is self-actualized?a.“Ihavesucceededdespiteaworldfilledwithevil.”b.“Ihaveaplanformylife.IfIfollowit,everythingwillbefine.”

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c.“I’msuccessfulbecauseIworkhard.Noonehasevergivenmeanything.”d.“Myfavoriteleisureiswalkingonthebeach,hearingsoftsoundsofrollingwaves.”ANS: DThe self-actualized personality is associated with high productivity and enjoyment oflife. Self-actualized persons experience pleasure in being alone and an ability toreflect on events.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 31-32 (Box 2-1) TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity32.A nurse and patient discuss a problem the patient has kept secret for many years.Afterward the patient says,“Ifeel so relieved that I finally toldsomebody.”Whichterm best describes thepatient’sfeeling?a.Catharsisc.Cognitivedistortionb.Superegod.Counter-transferenceANS: AFreud initially used talk therapy, known as the cathartic method. Today we refer tocatharsis as“gettingthings off ourchests.”The superego represents the moralcomponent of personality.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 20 TOP: Nursing Process: EvaluationMSC: Client Needs: Psychosocial Integrity33.Which patient is the best candidate for brief psychodynamic therapy?a.Anaccountantwithalovingfamilyandsuccessfulcareerwhowasinvolvedinashortextrb.Anadultwithalonghistoryofmajordepressionwhowaschargedwithdrivingundertheic.Awomanwithahistoryofborderlinepersonalitydisorderwhorecentlycutbothwristsd.AnadultmalerecentlydiagnosedwithanorexianervosaANS: AThe best candidates for psychodynamic therapy are relatively healthy and well-functioning individuals, sometimes referred to as the“worriedwell,”who have aclearly circumscribed area of difficulty and are intelligent, psychologically minded,and well-motivated for change. Patients with psychosis, severe depression, borderline

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personality disorders, and severe character disorders are not appropriate candidates forthis type of treatment.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 21-22 TOP: Nursing Process: PlanningMSC: Client Needs: Psychosocial IntegrityMULTIPLE RESPONSE1.A patient states,“I’mstarting cognitive-behavioral therapy. What can I expect fromthesessions?”Which responses by the nurse would be appropriate?Select all thatapply.a.“Thetherapistwillbeactiveandquestioning.”b.“Youwillbegivensomehomeworkassignments.”c.“Thetherapistwillaskyoutodescribeyourdreams.”d.“Thetherapistwillhelpyoulookatyourideasandbeliefsaboutyourself.”e.“Thegoalistoincreasesubjectivityaboutthoughtsthatgovernyourbehavior.”ANS: A, B, DCognitive therapists are active rather than passive during therapy sessions becausethey help patients reality-test their thinking. Homework assignments are given andcompleted outside the therapy sessions. Homework is usually discussed at the nexttherapy session. The goal of cognitive therapy is to assist the patient in identifyinginaccurate cognitions and in reality- testing and formulating new, accurate cognitions.One distracter applies to psychoanalysis. Increasing subjectivity is not desirable.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 29-31 | Page 34 (Table 2-6) TOP: Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity2.Which comments by an elderly person best indicate successful completion of thedevelopmental task?Select all that apply.a.“Iamproudofmychildren’ssuccessesinlife.”b.“Ishouldhavegiventocommunitycharitiesmoreoften.”c.“Myrelationshipwithmyfathermadelifemoredifficultforme.”d.“Myexperiencesinthewarhelpedmeappreciatethemeaningoflife.”e.“IoftenwonderwhatwouldhavehappenedifIhadchosenadifferentcareer.”ANS: A, D

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The developmental crisis for an elderly person relates to integrity versus despair.Pride inone’soffspring indicates a sense of fulfillment. Recognition of the wisdomgained from difficult experiences (such as being in a war) indicates a sense ofintegrity. Blaming and regret indicate despair and unsuccessful resolution of the crisis.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 22-23 (Table 2-2) TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity3.Which comments by an adult best indicate self-actualization?Select all that apply.a.“Iamcontentwithagoodbook.”b.“IoftenwonderifIchosetherightcareer.”c.“SometimesIthinkabouthowmyparentswouldhavehandledproblems.”d.“It’simportantforourcountrytoprovidebasichealthcareservicesforeveryone.”e.“WhenIwaslostatseafor2days,Igainedanunderstandingofwhatisimportant.”ANS: A, D, ESelf-actualized persons enjoy privacy, have a sense of democracy, and show positiveoutcomes associated with peak experiences. Self-doubt, defensiveness, and blamingare not consistent with self-actualization.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 22 | Page 31-32 TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity4.Which activities represent the art of nursing?Select all that apply.a.Administeringmedicationsontimetoagroupofpatientsb.Listeningtoanewwidowgrieveherhusband’sdeathc.Helpingapatientobtaingroceriesfromafoodbankd.Teachingapatientaboutanewmedicatione.HoldingthehandofafrightenedpatientANS: B, C, EPeplau described the science and art of professional nursing practice. The artcomponent of nursing consists of the care, compassion, and advocacy nurses provideto enhance patient comfort and well-being. The science component of nursinginvolves the application of knowledge to understand a broad range of human problems

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and psychosocial phenomena, intervening to relievepatients’suffering and promotegrowth. See related audience response question.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 24-25 TOP: Nursing Process: ImplementationMSC: Client Needs: Psychosocial IntegrityChapter 03: Biological Basis forUnderstanding PsychiatricDisorders and TreatmentsChapter 03: Biological Basis for Understanding Psychiatric Disorders andTreatmentsMULTIPLE CHOICE1.A patient asks,“Whatare neurotransmitters? The doctor said mine areimbalanced.”Select thenurse’sbest response.a.“Howdoyoufeelabouthavingimbalancedneurotransmitters?”b.“Neurotransmittersprotectusfromharmfuleffectsoffreeradicals.”c.“Neurotransmittersaresubstancesweconsumethatinfluencememoryandmood.”d.“Neurotransmittersarenaturalchemicalsthatpassmessagesbetweenbraincells.”ANS: DThe patient asked for information, and the correct response is most accurate.Neurotransmitters are chemical substances that function as messengers in the centralnervous system. They are released from the axon terminal, diffuse across the synapse,and attach to specialized receptors on the postsynaptic neuron. The distracters eitherdo not answer thepatient’squestion or provide untrue, misleading information.PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Page 38 TOP: Nursing Process: ImplementationMSC: Client Needs: Physiological Integrity2.The parent of an adolescent diagnosed with schizophrenia asks the nurse,“Mychild’sdoctor ordered a PET. What kind of test isthat?”Select thenurse’sbest reply.a.“Thistestusesamagneticfieldandgammawavestoidentifyproblemareasinthebrain.Dteenagerhaveanymetalimplants?”

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b.“PETmeanspositron-emissiontomography.Itisaspecialtypeofscanthatshowsbloodflothebrain.”c.“APETscanpassesanelectricalcurrentthroughthebrainandshowsbrain-waveactivity.diagnoseseizures.”d.“It’saspecialx-raythatshowsstructuresofthebrainandwhethertherehaseverbeenabraANS: BThe parent is seeking information about PET scans. It is important to use terms theparent can understand, so the nurse should identify what the initials mean. The correctresponse is the only option that provides information relevant to PET scans. Thedistracters describe MRI, CT scans, and EEG. See relationship to audience responsequestion.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 44-47 (Table 3-2) TOP: Nursing Process: ImplementationMSC: Client Needs: Physiological Integrity3.A patient with a long history of hypertension and diabetes now develops confusion.The health care provider wants to make a differential diagnosis betweenAlzheimer’sdisease and multiple infarcts. Which diagnostic procedure should the nurse expect toprepare the patient for first?a.Skullx-raysb.Computedtomography(CT)scanc.Positron-emissiontomography(PET)d.Single-photonemissioncomputedtomography(SPECT)ANS: BA CT scan shows the presence or absence of structural changes, including corticalatrophy, ventricular enlargement, and areas of infarct, information that would behelpful to the health care provider. PET and SPECT show brain activity rather thanstructure and may occur later. See relationship to audience response question.PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 44-47 (Table 3-2) TOP: Nursing Process: PlanningMSC: Client Needs: Physiological Integrity4.Apatient’shistory shows drinking 4 to 6 liters of fluid and eating more than 6,000calories per day. Which part of the central nervous system is most likely dysfunctionalfor this patient?

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