Test Bank for Varcarolis' Foundations of Psychiatric-Mental Health Nursing, 9th Edition (Chapters 1-36)

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Test Bank ForVarcarolis' Foundations of Psychiatric-Mental Health Nursing 9thEdition By Margaret Jordan HalterTable Of ContentsUNIT I: Foundations in TheoryChapter 1. Mental Health and Mental IllnessChapter 2. Theories and TherapiesChapter 3. Psychobiology and PsychopharmacologyUNIT II: Foundations for PracticeChapter 4. Treatment SettingsChapter 5. Cultural ImplicationsChapter 6. Legal and Ethical ConsiderationsUNIT III: Psychosocial Nursing ToolsChapter 7. The Nursing Process and Standards of CareChapter 8. Therapeutic RelationshipsChapter 9. Therapeutic CommunicationChapter 10. Stress Responses and Stress ManagementUNIT IV: Psychobiological DisordersChapter 11. Childhood and Neurodevelopmental DisordersChapter 12. Schizophrenia Spectrum DisordersChapter 13. Bipolar and Related DisordersChapter 14. Depressive DisordersChapter 15. Anxiety and Obsessive-Compulsive DisordersChapter 16. Trauma, Stressor-Related, and Dissociative DisordersChapter 17. Somatic Symptom DisordersChapter 18. Eating and Feeding DisordersChapter 19. Sleep-Wake DisordersChapter 20. Sexual Dysfunction, Gender Dysphoria, and Paraphilic DisordersChapter 21. Impulse Control DisordersChapter 22. Substance-Related and Addictive DisordersChapter 23. Neurocognitive DisordersChapter 24. Personality DisordersUNIT V: Trauma InterventionsChapter 25. Suicide and Non-suicidal Self-InjuryChapter 26. Crisis and DisasterChapter 27. Anger, Aggression, and ViolenceChapter 28. Child, Older Adult, and Intimate Partner ViolenceChapter 29. Sexual AssaultUNIT VI: Interventions for Special PopulationsChapter 30. Dying, Death, and GrievingChapter 31. Older AdultsChapter 32. Serious Mental IllnessChapter 33. Forensic NursingUNIT VII: Other Intervention ModalitiesChapter 34. Therapeutic GroupsChapter 35. Family InterventionsChapter 36. Integrative Care

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Chapter 01: Mental Health and Mental IllnessHalter:Varcarolis’Foundations of Psychiatric-Mental Health Nursing: A ClinicalApproach, 9th EditionMULTIPLE CHOICE1.The scope of practiced for an advanced nurse practitioner would include which intervention?a.Conducting a mental health assessment.b.Prescribing psychotropic medication.c.Establishing a therapeutic relationship.d.Individualizing a nursing care plan.ANS: BIn most states, prescriptive privileges are granted to master’s-prepared nurse practitioners andclinical nurse specialists who have taken special courses on prescribing medication. The nurseprepared at the basic level is permitted to perform mental health assessments, establishrelationships, and provide individualized care planning.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Safe, Effective Care Environment2.A nursing student expresses concerns that mental health nurses“loseall their clinical nursingskills.”Select the best response by the mental health nurse.a.“Psychiatricnurses practice in safer environments than other specialties. Nurse-to-client ratios must be better because of the nature of theclients’problems.”b.“Psychiatricnurses use complex communication skills as well as critical thinkingto solve multidimensional problems. I am challenged by thosesituations.”c.“That’sa misconception. Psychiatric nurses frequently use high technologymonitoring equipment and manage complexintravenous therapies.”d.“Psychiatricnurses do not have to deal with as much pain and suffering asmedical–surgical nurses do. Thatappeals to me.”ANS: BThe practice of psychiatric nursing requires a different set of skills than medical–surgicalnursing, though there is substantial overlap. Psychiatric nurses must be able to help clientswith medical as well as mental health problems, reflecting the holistic perspective these nursesmust have. Nurse–client ratios and workloads in psychiatric settings have increased, just likeother specialties. Psychiatric nursing involves clinical practice, not just documentation.Psychosocial pain and suffering are as real as physical pain and suffering.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: ImplementationMSC: Client Needs: Safe, Effective Care Environment3.When a new bill introduced in Congress reduces funding for care of persons diagnosed withmental illness, a group of nurses write letters to their elected representatives in opposition tothe legislation. Which role have the nurses fulfilled?a.Recoveryb.Attendingc.Advocacyd.Evidence-based practice

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ANS: CAn advocate defends or asserts another’s cause, particularly when the other personlacks theability to do that for self. Examples of individual advocacy include helping clients understandtheir rights or make decisions. On a community scale, advocacy includes political activity,public speaking, and publication in the interest of improving the human condition. Sincefunding is necessary to deliver quality programming for persons with mental illness, the letter-writing campaign advocates for that cause on behalf of clients who are unable to articulatetheir own needs.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: EvaluationMSC: Client Needs: Safe, Effective Care Environment4.A family has a long history of conflicted relationships among the members. Which familymember’scomment best reflects a mentally healthy perspective?a.“I’vemade mistakes but everyone else in this family hasalso.”b.“Iremember joy and mutual respect from our early yearstogether.”c.“Iwill make some changes in my behavior for the good of thefamily.”d.“It’sbest for me to move away from my family. Things will neverchange.”ANS: CThe correct response demonstrates the best evidence of a healthy recognition of theimportance of relationships. Mental health includes rational thinking, communication skills,learning, emotional growth, resilience, and self-esteem. Recalling joy from earlier in life maybe healthy, but the correct response shows a higher level of mental health. The other incorrectresponses show blaming and avoidance.PTS:1DIF:Cognitive Level: Analyze (Analysis)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity5.Which assessment finding most clearly indicates that a client may be experiencing a mentalillness?a.reporting occasional sleeplessness and anxiety.b.reporting a consistently sad, discouraged, and hopeless mood.c.being able to describe the difference between“asif”and“forreal.”d.experiencing difficulty making a decision about whether to change jobs.ANS: BThe correct response describes a mood alteration, which reflects mental illness. The distractersdescribe behaviors that are mentally healthy or within the usual scope of human experience.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity6.Which finding best indicates that the goal“Demonstrate mentally healthy behavior”wasachieved for an adult client?a.being willing to work towards achieving ideals and meeting demands.b.behaving without considering the consequences of personal actions.c.aggressively meeting personal needs without considering the rights of others.d.seeking help from others to avoid assuming responsibility for major areas of ownlife.

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ANS: AMental health is a state of well-being in which individuals reach their own potential, copewith the normal stresses of life, work productively, and contribute to the community. Mentalhealth provides people with the capacity for rational thinking, communication skills, learning,emotional growth, resilience, and self-esteem. The correct response describes an adaptive,healthy behavior. The distracters describe maladaptive behaviors.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: EvaluationMSC: Client Needs: Psychosocial Integrity7.A nurse encounters an unfamiliar psychiatric disorder on a new client’s admission form.Which resource should the nurse consult to determine criteria used to establish this diagnosis?a.International Statistical Classification of Diseases and Related Health Problems(ICD-10)b.TheANA’sPsychiatric-Mental Health Nursing Scope and Standards of Practicec.Diagnostic and Statistical Manual of Mental Disorders (DSM-V)d.A behavioral health reference manualANS: CTheDSM-Vgives the criteria used to diagnose each mental disorder. It is the official guidelinefor diagnosing psychiatric disorders. The distracters may not contain diagnostic criteria for apsychiatric illness.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: AssessmentMSC: Client Needs: Safe, Effective Care Environment8.A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resourcewould have the most complete information?a.Nursing Outcomes Classification (NOC)b.DSM-Vc.TheANA’sPsychiatric-Mental Health Nursing Scope and Standards of Practiced.ICD-10ANS: BTheDSM-Vdetails the diagnostic criteria for psychiatric clinical conditions. It is the officialguideline for diagnosing psychiatric disorders. The other references are good resources but donot define the diagnostic criteria.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Safe, Effective Care Environment9.Which individual behavior demonstrates resilience?a.Repress stressors associated with a divorce.b.Continuing to grieve the death of a spouse for 5 years.c.Continuing to live in a shelter for 2 years after the home is destroyed by fire.d.Taking a temporary job to maintain financial stability after loss of a permanentjob.ANS: D

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Resilience is closely associated with the process of adapting and helps people facing tragedies,loss, trauma, and severe stress. It is the ability and capacity for people to secure the resourcesthey need to support their well-being. Repression and protracted grief are unhealthy. Living ina shelter for 2 years shows a failure to move forward after a tragedy. See related audienceresponse question.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity10.The relationship of the North American Nursing Diagnosis Association (NANDA) is toclinical judgment asNursing Interventions Classification (NIC)is to what?a.client outcomes.b.nursing actions.c.diagnosis.d.symptoms.ANS: BAnalogies show parallel relationships. NANDA, the North American Nursing DiagnosisAssociation, identifies diagnostic statements regarding human responses to actual or potentialhealth problems. These statements represent clinical judgments.NIC(Nursing InterventionsClassification) identifies actions provided by nurses that enhance client outcomes. Nursingcare activities may be direct or indirect.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: EvaluationMSC: Client Needs: Safe, Effective Care Environment11.An adult says, “Most of the time I’m happy and feel good about myself. I have learned thatwhat I get out of something is proportional to the effort I put into it.” Which number on thismental health continuum should the nurse select?Mental Illness Mental Health1 2 3 4 5a.1b.2c.3d.4e.5ANS: EThe adult is generally happy and has an adequate self-concept. The statement indicates theadult is reality-oriented, works effectively, and has control over own behavior. Mental healthdoes not mean that a person is always happy.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity12.Which disorder is an example of a culture-bound syndrome?a.Epilepsyb.Schizophreniac.Running amokd.Major depressive disorder

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ANS: CCulture-bound syndromes occur in specific sociocultural contexts and are easily recognizedby people in those cultures. A syndrome recognized in parts of Southeast Asia is runningamok, in which a person (usually a male) runs around engaging in furious, almostindiscriminate violent behavior.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity13.What does theDSM-Vclassify?a.deviant behaviorsb.present disability or distressc.people with mental disordersd.mental disordersANS: DTheDSM-Vclassifies disorders people have rather than people themselves. The terminologyof the tool reflects this distinction by referring to individuals with a disorder rather than as a“schizophrenic” or “alcoholic,”for example. Deviant behavior is not generally considered amental disorder. Present disability or distress is only one aspect of the diagnosis.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Safe, Effective Care Environment14.A citizen at a community health fair asks the nurse,“Whatis the most prevalent mentaldisorder in the UnitedStates?”Select thenurse’scorrect response.a.Schizophreniab.Bipolar disorderc.Dissociative fugued.Alzheimer’s diseaseANS: DThe 12-month prevalence forAlzheimer’sdisease is 10% for persons older than 65% and 50%for persons older than 85. The prevalence of schizophrenia is 1.1% per year. The prevalenceof bipolar disorder is 2.6%. Dissociative fugue is a rare disorder.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Health Promotion and Maintenance15.In the majority culture of the United States, which individual has the greatest risk to belabeled mentally ill?a.One who describes hearingGod’svoice speaking.b.One who is usually pessimistic but strives to meet personal goals.c.One who is wealthy and gives away $20 bills to needy individuals.d.One who always has an optimistic viewpoint about lifeANS: AThe question asks about risk. Hearing voices is generally associated with mental illness, but incharismatic religious groups, hearing the voice of God or a prophet is a desirable event.Cultural norms vary, which makes it more difficult to make an accurate diagnosis. Theindividuals described in the other options are less likely to be labeled mentally ill.

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PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity16.A client’s relationships are intense and unstable. The client initially idealizes the significantother and then devalues him or her, resulting in frequent feelings of emptiness. This client willbenefit from interventions to develop which aspect of mental health?a.Effectiveness in workb.Communication skillsc.Productive activitiesd.Fulfilling relationshipsANS: DThe information given centers on relationships with others that are described as intense andunstable. The relationships of mentally healthy individuals are stable, satisfying, and sociallyintegrated. Data are not present to describe work effectiveness, communication skills, oractivities.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: PlanningMSC: Client Needs: Psychosocial Integrity17.Which belief will best support anurse’sefforts to provide client advocacy during amultidisciplinary client care planning session?a.All mental illnesses are culturally determined.b.Schizophrenia and bipolar disorder are cross-cultural disorders.c.Symptoms of mental disorders are unchanged from culture to culture.d.Assessment findings in mental illness reflect aperson’scultural patterns.ANS: DSymptoms must be understood in terms of a person’s cultural background. A nurse whounderstands that aclient’ssymptoms are influenced by culture will be able to advocate for theclient to a greater degree than a nurse who believes that culture is of little relevance. Thedistracters are untrue statements.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity18.A nurse is part of a multidisciplinary team working with groups of depressed clients. Onegroup of clients receives supportive interventions and antidepressant medication. The othergroup receives only medication. The team measures outcomes for each group. Which type ofstudy is evident?a.Incidenceb.Prevalencec.Comorbidityd.Clinical epidemiologyANS: D

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Clinical epidemiologyis a broad field that addresses studies of the natural history (or whathappens if there is no treatment and the problem is left to run its course) of an illness, studiesof diagnostic screening tests, and observational and experimental studies of interventions usedto treat people with the illness or symptoms.Prevalencerefers to numbers of new cases.Comorbidityrefers to having more than one mental disorder at a time.Incidencerefers to thenumber of new cases of mental disorders in a healthy population within a given period. Seerelated audience response question.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: EvaluationMSC: Client Needs: Safe, Effective Care Environment19.The spouse of a client diagnosed with schizophrenia says, “I don’t understand how eventsfrom childhood have anything to do with this disablingillness.”Which response by the nursewill best help the spouse understand the cause of this disorder?a.“Psychologicalstress is the basis of most mentaldisorders.”b.“Thisillness results from developmental factors rather thanstress.”c.“Researchshows that this condition more likely has a biologicalbasis.”d.“Itmust be frustrating for you that your spouse is sick so much of thetime.”ANS: CMany of the most prevalent and disabling mental disorders have strong biological influences.Genetics are only one part of biological factors. Empathy does not address increasing thespouse’s level of knowledge about the cause of the disorder. The other distracters are notestablished facts.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity20.A category 5 tornado occurred in a community of 400 people. Many homes and businesseswere destroyed. In the 2 years following the disaster, 140 individuals were diagnosed withposttraumatic stress disorder (PTSD). Which term best applies to these newly diagnosedcases?a.Prevalenceb.Comorbidityc.Incidenced.ParityANS: CIncidence refers to the number of new cases of mental disorders in a healthy population withina given period of time. Prevalence describes the total number of cases, new and existing, in agiven population during a specific period of time, regardless of when they became ill. Parityrefers to equivalence, and legislation required insurers that provide mental health coverage tooffer annual and lifetime benefits at the same level provided for medical–surgical coverage.Comorbidity refers to having more than one mental disorder at a time.PTS:1DIF: Cognitive Level: Understand (Comprehension)TOP: Nursing Process: Planning | Nursing Process: Outcomes IdentificationMSC: Client Needs: Safe, Effective Care Environment21.Which component of treatment of mental illness is specifically recognized by Quality andSafety Education for Nurses (QSEN)?

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a.All genomes are unique.b.Care is centered on the client.c.Healthy development is vital to mental health.d.Recovery occurs on a continuum from illness to health.ANS: BThe key areas of care promoted by QSEN are client-centered care, teamwork andcollaboration, evidence-based practice, quality improvement, safety, and informatics.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Safe, Effective Care Environment22.What is the best response for the nurse to provide to a question from another healthprofessional regarding the difference between a diagnosis inDSM-Vand a nursing diagnosis.a.“Thereis no functional difference between the two. Both identify humandisorders.”b.“TheDSM-Vdiagnosis disregards culture, whereas the nursing diagnosis takescultureinto account.”c.“TheDSM-Vdiagnosis describes causes of disorders whereas a nursing diagnosisdoes not exploreetiology.”d.“TheDSM-Vdiagnosis guides medical treatment, whereas the nursing diagnosisoffers a framework for identifying interventions for issues a client isexperiencing.”ANS: DThe medical diagnosis is concerned with theclient’sdisease state, causes, and cures, whereasthe nursing diagnosis focuses on the client’s response to stress and possible caringinterventions. Both tools consider culture. TheDSM-Vis multiaxial. Nursing diagnoses alsoconsider potential problems.PTS:1DIF:Cognitive Level: Apply (Application)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 rather than a basic level registered nurse?a.Coordination of careb.Health teachingc.Milieu therapyd.PsychotherapyANS: DPsychotherapy is part of the scope of practice of an advanced practice nurse. The distractersare within a basic level registerednurse’s scopeof practice.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Safe, Effective Care EnvironmentMULTIPLE RESPONSE

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1.An experienced nurse says to a new graduate, “When you’ve practiced as long as I have, youautomatically know how to take care of clients experiencingpsychosis.”Which factors shouldthe new graduate consider when analyzing this comment? (Select all that apply.)a.The experienced nurse may have lost sight ofclients’individuality, which maycompromise the integrity of practice.b.New research findings should be integrated continuously into anurse’spractice toprovide the most effective care.c.Experience provides mental health nurses with the essential tools and skills neededfor effective professional practice.d.Experienced psychiatric nurses have learned the best ways to care for mentally illclients through trial and error.e.An intuitive senseof clients’needs guides effective psychiatric nurses.ANS: A, BEvidence-based practice involves using research findings and standards of care to provide themost effective nursing care. Evidence is continuously emerging, so nurses cannot rely solelyon experience. The effective nurse also maintains respect for each client as an individual.Overgeneralization compromises that perspective. Intuition and trial and error areunsystematic approaches to care.PTS:1DIF:Cognitive Level: Apply (Application)TOP: Nursing Process: Diagnosis | Nursing Process: AnalysisMSC: Client Needs: Safe, Effective Care Environment2.Which findings are signs of a person who is mentally healthy? (Select all that apply.)a.Says,“Ihave some weaknesses, but I feelI’m importantto my family andfriends.”b.Adheres strictly to religious beliefs of parents and family of origin.c.Spends all holidays alone watching old movies on television.d.Considers past experiences when deciding about the future.e.Experiences feelings of conflict related to changing jobs.ANS: A, D, EMental health is a state of well-being in which each individual is able to realize his or her ownpotential, cope with the normal stresses of life, work productively, and make a contribution tothe community. Mental health provides people with the capacity for rational thinking,communication skills, learning, emotional growth, resilience, and self-esteem.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity3.A client in the emergency department says,“Voicessay someone is stalking me. They want tokill me because I developed a cure for cancer. I have a knife and will stab anyone who is athreat.” Which aspects of the client’s mental health have the greatest and most immediateconcern to the nurse? (Select all that apply.)a.Happinessb.Appraisal of realityc.Control over behaviord.Effectiveness in worke.Healthy self-concept

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ANS: B, C, EThe aspects of mental health of greatest concern are the client’s appraisal of and control overbehavior. The appraisal of reality is inaccurate. There are auditory hallucinations, delusions ofpersecution, and delusions of grandeur. In addition, the client’s control over behavior istenuous, as evidenced by the plan to stab anyone who seems threatening. A healthy self-concept is lacking, as evidenced by the delusion of grandeur. Data are not present to suggestthat the other aspects of mental health (happiness and effectiveness in work) are of immediateconcern.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity

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Chapter 02: Theories and TherapiesHalter:Varcarolis’Foundations of Psychiatric-Mental Health Nursing: A ClinicalApproach, 9th EditionMULTIPLE CHOICE1.A parent says,“My2-year-old child refuses toilet training and shouts‘No!’when givendirections. What do you think iswrong?”What is thenurse’sbest reply?a.“Yourchild needs firmer control. It is important to set limitsnow.”b.“Thisis normal for yourchild’sage. The child is striving forindependence.”c.“Theremay be developmental problems. Most children are toilet trained by age2.”d.“Some undesirable attitudes are developing. A child psychologist can help youdevelop aplan.”ANS: BThis behavior is conventional of a child around the age of 2 years, whose developmental taskis to develop autonomy. The distracters indicate thechild’sbehavior is abnormal.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: ImplementationMSC: Client Needs: Health Promotion and Maintenance2.A nurse wants to find information on current evidence-based research, programs, and practicesregarding mental illness and addictions. Which resource should the nurse consult?a.American Psychiatric Associationb.American Psychological Association (APA)c.Clinician’sQuick Guide to Interpersonal Psychotherapyd.Substance Abuse and Mental Health Services Administration (SAMHSA)ANS: DThe SAMHSA maintains a National Registry of Evidence-based Practices and Programs. Newtherapies are entered into the database on a regular basis. The incorrect responses areresources but do not focus on evidence-based information.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: PlanningMSC: Client Needs: Management of Care3.A 26-month-old displays negative behavior, refuses toilet training, and often says,“No!”Which psychosocial crisis is evident?a.Trust versus mistrustb.Initiative versus guiltc.Industry versus inferiorityd.Autonomy versus shame and doubtANS: DThe crisis of autonomy versus shame and doubt relates to the developmental task of gainingcontrol of self and environment, as exemplified by toilet training. This psychosocial crisisoccurs during the period of early childhood. Trust versus mistrust is the crisis of the infant.Initiative versus guilt is the crisis of the preschool and early-school-aged child. Industryversus inferiority is the crisis of the 6- to 12-year-old child.

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PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance4.A 4-year-old grabs toys from other children and says, “I want that now!” From apsychoanalytic perspective, this behavior is a product of impulses originating in which systemof the personality?a.Idb.Egoc.Superegod.PreconsciousANS: AThe id operates on the pleasure principle, seeking immediate gratification of impulses. Theego acts as a mediator of behavior and weighs the consequences of the action, perhapsdetermining that taking the toy is not worth the mother’s wrath. The superego would opposethe impulsive behavior as“notnice.”The preconscious is a level of awareness rather than anaspect of personality.PTS:1DIF:Cognitive Level: Understand (Comprehension)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 sibling, being polite, andusing good manners. These qualities are likely to be internalized and become part of whichsystem of the personality?a.Idb.Egoc.Superegod.PreconsciousANS: CThe superego contains the “shoulds,” or moral standards internalized from interactions withsignificant others. Praise fosters internalization of desirable behaviors. The id is the center ofbasic instinctual drives, and the ego is the mediator. The ego is the problem-solving andreality-testing portion of the personality that negotiates solutions with the outside world. Thepreconscious is a level of awareness from which material can be retrieved easily withconscious effort. This item relates to an audience response question.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Health Promotion and Maintenance6.A nurse supports a parent for praising a child who behaves in helpful ways to others. Whenthis child behaves with politeness and helpfulness in adulthood, which feeling will most likelyresult?a.Guiltb.Anxietyc.Humilityd.Self-esteemANS: DThe individual will be living up to the ego ideal, which will result in positive feelings aboutself. The other options are incorrect because each represents a negative feeling.

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PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Health Promotion and Maintenance7.An adult says,“Inever know theanswers,”and “Myopinion does notcount.”Whichpsychosocial crisis was unsuccessfully resolved for this adult?a.Initiative versus guiltb.Trust versus mistrustc.Autonomy versus shame and doubtd.Generativity versus self-absorptionANS: CThese statements show severe self-doubt, indicating that the crisis of gaining control over theenvironment was not met successfully. Unsuccessful resolution of the crisis of initiativeversus guilt results in feelings of guilt. Unsuccessful resolution of the crisis of trust versusmistrust results in poor interpersonal relationships and suspicion of others. Unsuccessfulresolution of the crisis of generativity versus self-absorption results in self-absorption thatlimits the ability to grow as a person.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance8.Which statement by a client would lead the nurse to suspect unsuccessful completion of thepsychosocial developmental task of infancy?a.“Iknow how to do things right, so I prefer jobs where I work alone rather than onateam.”b.“Ido not allow other people to trulyget to know me.”c.“Idepend on frequent praise from others to feel good aboutmyself.”d.“Iusually need to do things several times before Iget them right.”ANS: BAccording to Erikson, the developmental task of infancy is the development of trust. Thecorrect response is the only statement clearly showing lack of ability to trust others. Aninability to work with others, coupled with a sense of superiority, suggests unsuccessfulcompletion of the task of intimacy versus isolation. Relying on praise from others suggestsunsuccessful completion of the task of identity versus role confusion. Shame suggests failureto resolve the crisis of initiative versus guilt.PTS:1DIF:Cognitive Level: Analyze (Analysis)TOP:Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance9.A client is suspicious and is frequently sarcastic toward others. To which psychosexual stagedo these traits relate?a.Oralb.Analc.Phallicd.GenitalANS: A

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The behaviors in the stem develop as the result of attitudes formed during the oral stage, whenan infant first learns to relate to the environment. Anal-stage traits include stinginess,stubbornness, orderliness, or their opposites. Phallic-stage traits include flirtatiousness, pride,vanity, difficulty with authority figures, and difficulties with sexual identity. Genital-stagetraits include the ability to form satisfying sexual and emotional relationships with membersof the opposite sex, emancipation from parents, a strong sense of personal identity, or theopposites of these traits.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance10.A client expresses a desire to be cared for by others and often behaves in a helpless fashion.Which stage of psychosexual development is most relevant to theclient’s needs?a.Latencyb.Phallicc.Anald.OralANS: DFixation at the oral stage sometimes produces dependent infantile behaviors in adults. Latencyfixations often result in difficulty identifying with others and developing social skills,resulting in a sense of inadequacy and inferiority. Phallic fixations result in having difficultywith authority figures and poor sexual identity. Anal fixation sometimes results inretentiveness, rigidity, messiness, destructiveness, and cruelty. This item relates to an audienceresponse question.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance11.A nurse listens to a group of recent retirees. One says, “I volunteer with Meals on Wheels,coach teen sports, and do church visitation.” Another laughs and says, “I’m too busy takingcare of myself to volunteer to helpothers.”Which psychosocial developmental task do thesestatements contrast?a.Trust and mistrustb.Intimacy and isolationc.Industry and inferiorityd.Generativity and self-absorptionANS: DBoth retirees are in middle adulthood, when the developmental crisis to be resolved isgenerativity versus self-absorption. One exemplifies generativity; the other embodies self-absorption. This developmental crisis would show a contrast between relating to others in atrusting fashion and being suspicious and lacking trust. Failure to negotiate this developmentalcrisis would result in a sense of inferiority or difficulty learning and working as opposed to theability to work competently. Behaviors that would be contrasted would be emotional isolationand the ability to love and commit oneself.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance

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12.An adult dies in a tragic accident. Afterward, the siblings plan a funeral service. Whichstatement by a sibling best indicates a sense of self-actualization?a.“Ofall of us, I am the most experienced with planning these types ofevents.”b.“Funeralsare supposed to be conducted quietly, respectfully, and according to asocialprotocol.”c.“Thisdeath was unfair, but I hope we can plan a service that everyone feels is acelebration oflife.”d.“Thisdeath was probably the consequence of years of selfish and inconsideratebehavior byour sibling.”ANS: CThe correct response shows an accurate perception of reality as well as a focus on solving theproblem in a way that involves others. These factors are characteristic of self-actualization.The incorrect responses demonstrate self-centeredness, rigidity, and blaming which arecharacteristic of a failure to achieve self-actualization.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Health Promotion and Maintenance13.A student nurse says,“Idon’tneed to interact with my clients. I learn what I need to know byobservation.” An instructor can best interpret the nursing implications of Sullivan’s theory tothis student by providing what response?a.“Interactionsare required in order to help you develop therapeutic communicationskills.”b.“Nursescannot be isolated. We must interact to provide clients with opportunitiesto practice interpersonalskills.”c.“Observingclient interactions will help you formulate priority nursing diagnosesandappropriate interventions.”d.“Itis important to pay attention toclients’behavioral changes, because thesesignifyadjustments in personality.”ANS: BThe nurse’s role includes educating clients and assisting them in developing effectiveinterpersonal relationships. Mutuality, respect for the client, unconditional acceptance, andempathy are cornerstones ofSullivan’stheory. The nurse who does not interact with the clientcannot demonstrate these cornerstones. Observations provide only objective data. Prioritynursing diagnoses usually cannot be accurately established without subjective data from theclient. The other distracters relate to Maslow and behavioral theory. This item relates to anaudience response question.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: ImplementationMSC: Client Needs: Health Promotion and Maintenance14.A nurse consistently encourages client to do his or her own activities of daily living. If theclient is unable to complete an activity, the nurse helps until the client is once againindependent.This nurse’s practiceis most influenced by which theorist?a.Betty Neumanb.Patricia Bennerc.Dorothea Oremd.Joyce Travelbee

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ANS: COrem emphasizes the role of the nurse in promoting self-care activities of the client; this hasrelevance to the seriously and persistently mentally ill client.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: EvaluationMSC: Client Needs: Psychosocial Integrity15.A nurse usesMaslow’shierarchy of needs to plan care for a client diagnosed with mentalillness. Which problem will receive priority?a.Refusal to eat or bathe.b.Reporting feelings of alienation from family.c.Reluctance to participate in unit social activities.d.Being unaware of medication action and side effects.ANS: AThe need for food and hygiene are physiological and therefore take priority overpsychological or meta-needs in care planning.PTS:1DIF:Cognitive Level: Analyze (Analysis)TOP: Nursing Process: Planning | Nursing Process: Outcomes IdentificationMSC: Client Needs: Safe, Effective Care Environment16.Operant conditioning is part of the treatment plan to encourage speech in a child who is nearlymute. Which technique applies?a.Encourage the child to observe others talking.b.Include the child in small group activities.c.Give the child a small treat for speaking.d.Teach the child relaxation techniques.ANS: COperant conditioning involves giving positive reinforcement for a desired behavior. Treats arerewards and reinforce speech through positive reinforcement.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity17.The parent of a child diagnosed with schizophrenia tearfully asks the nurse,“Whatcould Ihave done differently to prevent thisillness?”What is thenurse’sbest response?a.“Althoughschizophrenia results from impaired family relationships, try not to feelguilty. No one can predict how a child will respond to parentalguidance.”b.“Schizophreniais a biological illness resulting from changes in how the brain andnervous system function. You are not to blame for yourchild’sillness.”c.“Thereis still hope. Changing your parenting style can help your child learn tocope effectively with theenvironment.”d.“Mostmental illnesses result from genetic inheritance. Your genes are more atfault thanyour parenting.”ANS: B

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The parent’s comment suggests feelings of guilt or inadequacy. The nurse’s response shouldaddress these feelings as well as provide information. Clients and families need reassurancethat the major mental disorders are biological in origin and are not the“fault”of parents. Onedistracter places the burden of having faulty genes on the shoulders of the parents. The otherdistracters are neither wholly accurate nor reassuring.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity18.A nurse influenced byPeplau’sinterpersonal theory works with an anxious, withdrawn client.What principle will the interventions be focused on?a.Rewarding desired behaviors.b.Using assertive communication.c.Changing theclient’sself-concept.d.Administering medications to relieve anxiety.ANS: BThe nurse–client relationship is structured to provide a model for adaptive interpersonalrelationships that can be generalized to others. Helping the client learn to use assertivecommunication will improve theclient’sinterpersonal relationships. The distracters apply totheories of cognitive, behavioral, and biological therapy.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity19.A client participated in psychotherapy weekly for 5 months. The therapist used freeassociation, dream analysis, and facilitated transference to help the client understand conflictsand foster change. What is the term that applies to this method?a.Rational-emotive behavior therapyb.Psychodynamic psychotherapyc.Cognitive-behavioral therapyd.Operant conditioningANS: BThe techniques are aspects of psychodynamic psychotherapy. The distracters use othertechniques.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity20.Consider this comment from a therapist: “The client is homosexual but has kept thispreference secret. Severe anxiety and depression occur when the client anticipates familyreactions to this sexualorientation.”Which perspective is evident in the speaker?a.Theory of interpersonal relationshipsb.Classical conditioning theoryc.Psychosexual theoryd.Behaviorism theoryANS: A

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The theory of interpersonal relationships recognizes the anxiety and depression as resultingfrom unmet interpersonal security needs. Behaviorism and classical conditioning theories donot apply. A psychosexual formulation would focus on uncovering unconscious material thatrelates to the client problem.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity21.A psychotherapist works with an anxious, dependent client. Which strategy is most consistentwith psychoanalytic psychotherapy?a.Identifying theclient’sstrengths and assetsb.Praising the client for describing feelings of isolationc.Focusing on feelings developed by the client toward the therapistd.Providing psychoeducation and emphasizing medication adherenceANS: CPositive or negative feelings of the client toward the therapist indicate transference.Transference is a psychoanalytic concept that can be used to explore previously unresolvedconflicts. The distracters relate to biological therapy and supportive psychotherapy. Use ofpsychoeducational materials is a common“homework”assignment used in cognitive therapy.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity22.A person says,“Iwas the only survivor in a small plane crash. Three business associates died.I got depressed and saw a counselor twice a week for 4 weeks. We talked about my feelingsrelated to being a survivor, andI’mbetternow.”Which type of therapy was used?a.Systematic desensitizationb.Psychoanalysisc.Behavior modificationd.Interpersonal psychotherapyANS: DInterpersonal psychotherapy returned the client to his former level of functioning by helpinghim come to terms with the loss of friends and guilt over being a survivor. Systematicdesensitization is a type of therapy aimed at extinguishing a specific behavior, such as the fearof flying. Psychoanalysis would call for a long period of exploration of unconscious material.Behavior modification would focus on changing a behavior rather than helping the clientunderstand what is going on in his life.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity23.Which technique is most applicable to aversion therapy?a.Punishmentb.Desensitizationc.Role modelingd.Positive reinforcementANS: AAversion therapy is akin to punishment. Aversive techniques include pairing of a maladaptivebehavior with a noxious stimulus, punishment, and avoidance training.

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PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: PlanningMSC: Client Needs: Psychosocial Integrity24.A client says to the nurse, “My father has been dead for over 10 years but talking to you isalmost as comforting as the talks he and I had when I was achild.”Which term applies to theclient’scomment?a.Superegob.Transferencec.Reality testingd.CountertransferenceANS: BTransference refers to feelings a client has toward the health care workers that were originallyheld toward significant others in his or her life. Countertransference refers to unconsciousfeelings that the health care worker has toward the client. The superego represents the moralcomponent of personality; it seeks perfection.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: EvaluationMSC: Client Needs: Psychosocial Integrity25.A college student received an invitation to attend the wedding of a close friend who livesacross the country. The student is afraid of flying. Which type of therapy would be mosthelpful for this client?a.Psychoanalysisb.Aversion therapyc.Systematic desensitizationd.Short-term dynamic therapyANS: CSystematic desensitization is a type of therapy aimed at extinguishing a specific behavior,such as the fear of flying. Psychoanalysis and short-term dynamic therapy seek to uncoverconflicts. Aversion therapy involves use of a noxious stimulus, punishment, and avoidance.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: PlanningMSC: Client Needs: Psychosocial Integrity26.A client repeatedly stated,“I’mstupid.”Which statement by that client would show progressresulting from cognitive-behavioral therapy?a.“SometimesI do stupidthings.”b.“Thingsalways go wrong for me.”c.“Ialways fail when I try newthings.”d.“I’mdisappointed in my lack ofability.”ANS: A“I’mstupid”is a cognitive distortion. A more rational thought is“SometimesI do stupidthings.”The latter thinking promotes emotional self-control. The distracters reflect irrationalor distorted thinking. This item relates to an audience response question.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: EvaluationMSC: Client Needs: Psychosocial Integrity

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27.A client says,“Allmy lifeI’ve been surrounded by stupidity. Everything I buy breaks becausethe entire American workforce is incompetent.” This client is experiencing what type ofreaction?a.self-esteem deficit.b.cognitive distortion.c.deficit in motivation.d.deficit in love and belonging.ANS: BAutomatic thoughts, or cognitive distortions, are irrational and lead to false assumptions andmisinterpretations. See related audience response question.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity28.A client is fearful of riding on elevators. The therapist first rides an escalator with the client.The therapist and client then stand in an elevator with the door open for 5 minutes and laterwith the elevator door closed for 5 minutes. Which technique has the therapist used?a.Classic psychoanalytic therapyb.Systematic desensitizationc.Rational emotive therapyd.BiofeedbackANS: BSystematic desensitization is a form of behavior modification therapy that involves thedevelopment of behavior tasks customized to the client’s specific fears. These tasks arepresented to the client while using learned relaxation techniques. The client is incrementallyexposed to the fear.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity29.A client says,“Ialways feel good when I wear a size 2petite.”Which type of cognitivedistortion is evident?a.Disqualifying the positiveb.Overgeneralizationc.Catastrophizingd.PersonalizationANS: BAutomatic thoughts, or cognitive distortions, are irrational and lead to false assumptions andmisinterpretations. The stem offers an example of overgeneralization. See related audienceresponse question.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity30.Which comment best indicates a client is self-actualized?a.“Ihave succeeded despite a world filledwith evil.”b.“Ihave a plan for my life. If I follow it, everything will befine.”c.“I’msuccessful because I work hard. No one has ever given meanything.”d.“Myfavorite leisure is walking on the beach, hearing soft sounds of rolling

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waves.”ANS: DThe self-actualized personality is associated with high productivity and enjoyment of life.Self-actualized persons experience pleasure in being alone and an ability to reflect on events.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity31.A nurse presents a community education program about mental illness. Which comment by aparticipant best demonstrates a correct understanding of mental illness from a biologicalperspective?a.“Somepeople experience life events so traumatic that they cannot be overcome.”b.“Disturbedand conflicted family relationships are usually a starting place formentalillness.”c.“Myfriend has had bipolar disorder for years and many problems have resulted.It’snot herfault.”d.“Mentalillness is the result of developmental complications that cause a personnot to grow to theirfull potential.”ANS: CThe correct response demonstrates an understanding that mental illness is physical in origin.The physical origins of mental illness are aspects of the biological model. The incorrectresponses assign the origins of mental illness to interpersonal relationships and traumaticevents.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: EvaluationMSC: Client Needs: Physiological Integrity32.Which client is the best candidate for brief psychodynamic therapy?a.An accountant with a loving family and successful career who was involved in ashort extramarital affairb.An adult with a long history of major depression who was charged with drivingunder the influencec.A woman with a history of borderline personality disorder who recently cut bothwristsd.An adult male recently diagnosed with anorexia nervosaANS: AThe best candidates for psychodynamic therapy are relatively healthy and well-functioningindividuals, sometimes referred to as the “worried well,” who have a clearly circumscribedarea of difficulty and are intelligent, psychologically minded, and well-motivated for change.Clients with psychosis, severe depression, borderline personality disorders, and severecharacter disorders are not appropriate candidates for this type of treatment.PTS:1DIF:Cognitive Level: Analyze (Analysis)TOP:Nursing Process: PlanningMSC: Client Needs: Psychosocial IntegrityMULTIPLE RESPONSE

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1.A client states,“I’mstarting cognitive-behavioral therapy. What can I expect from thesessions?”Which responses by the nurse would be appropriate? (Select all that apply.)a.“Thetherapist will be active andquestioning.”b.“Youwill be given some homeworkassignments.”c.“Thetherapist will ask you to describe yourdreams.”d.“Thetherapist will help you look at your ideas and beliefs aboutyourself.”e.“Thegoal is to increase subjectivity about thoughts that govern yourbehavior.”ANS: A, B, DCognitive therapists are active rather than passive during therapy sessions because they helpclient’s reality-test their thinking. Homework assignments are given and completed outsidethe therapy sessions. Homework is usually discussed at the next therapy session. The goal ofcognitive therapy is to assist the client in identifying inaccurate cognitions and in reality-testing and formulating new, accurate cognitions. One distracter applies to psychoanalysis.Increasing subjectivity is not desirable.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity2.Which comments by an elderly person best indicate successful completion of theindividual’spsychosocial developmental task? (Select all that apply.)a.“Iam proud of mychildren’ssuccesses inlife.”b.“Ishould have given to community charities moreoften.”c.“Myrelationship with my father made life more difficult forme.”d.“Myexperiences in the war helped me appreciate the meaning oflife.”e.“Ioften wonder what would have happened if I had chosen a differentcareer.”ANS: A, DThe developmental crisis for an elderly person relates to integrity versus despair. Pride inone’s offspring indicates a sense of fulfillment. Recognition of the wisdom gained fromdifficult experiences (such as being in a war) indicates a sense of integrity. Blaming and regretindicate despair and unsuccessful resolution of the crisis.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity3.Which comments by an adult best indicate self-actualization? (Select all that apply.)a.“Iam content with agood book.”b.“Ioften wonder if I chose the rightcareer.”c.“SometimesI think about how my parents would have handledproblems.”d.“It’simportant for our country to provide basic health care services foreveryone.”e.“WhenI was lost at sea for 2 days, I gained an understanding of what isimportant.”ANS: A, D, ESelf-actualized persons enjoy privacy, have a sense of democracy, and show positiveoutcomes associated with peak experiences. Self-doubt, defensiveness, and blaming are notconsistent with self-actualization.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity

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4.Which activities represent the caring foundation of nursing? (Select all that apply.)a.Administering medications on time to a group of clientsb.Listening to a new widow grieve herhusband’sdeathc.Helping a client obtain groceries from a food bankd.Teaching a client about a new medicatione.Holding the hand of a frightened clientANS: B, C, EPatricia Benner described caring as the foundation professional nursing practice. Bennerencourages nurses to provide caring and comforting interventions. She emphasizes theimportance of the nurse-client relationship and the importance of teaching and coaching theclient and bearing witness to suffering as the client deals with illness.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Psychosocial Integrity5.Which therapies involve electrical brain stimulation for treatment of mental illness? (Select allthat apply.)a.Aversion therapyb.Operant conditioningc.Systematic desensitizationd.Electroconvulsive therapy (ECT)e.Transcranial magnetic stimulation (TMS)ANS: D, EECT and TMS are therapies that use electrical stimulation of the brain as a form of treatmentfor mental illness. The incorrect responses are therapies that are interpersonal in nature.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Physiological Integrity

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Chapter 03: Psychobiology and PsychopharmacologyHalter:Varcarolis’Foundations of Psychiatric-Mental Health Nursing: A ClinicalApproach, 9th EditionMULTIPLE CHOICE1.A client asks,“Whatare neurotransmitters? My doctor said mine areimbalanced.”What is thenurse’sbest response?a.“Howdo you feel about having imbalancedneurotransmitters?”b.“Neurotransmittersprotect us from harmful effects of freeradicals.”c.“Neurotransmittersare substances we consume that influence memory andmood.”d.“Neurotransmittersare natural chemicals that pass messages betweenbrain cells.”ANS: DThe client asked for information, and the correct response is most accurate. Neurotransmittersare chemical substances that function as messengers in the central nervous system. They arereleased from the axon terminal, diffuse across the synapse, and attach to specialized receptorson the postsynaptic neuron. The distracters either do not answer the client’s question orprovide untrue, misleading information.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Physiological Integrity2.The parent of an adolescent diagnosed with schizophrenia asks the nurse,“Mychild’sdoctorordered a PET. What kind of test isthat?”What isthe nurse’sbest reply?a.“Thistest uses a magnetic field and gamma waves to identify problem areas in thebrain. Does your teenager have any metalimplants?”b.“PETmeanspositron-emission tomography.It is a special type of scan that showsblood flow and activity in thebrain.”c.“APET scan passes an electrical current through the brain and shows brain-waveactivity. It can help diagnoseseizures.”d.“It’sa special x-ray that shows structures of the brain and whether there has everbeen abrain injury.”ANS: BThe parent is seeking information about PET scans. It is important to use terms the parent canunderstand, so the nurse should identify what the initials mean. The correct response is theonly option that provides information relevant to PET scans. The distracters describe magneticresonance image (MRI), computed tomography (CT) scans, and EEG. See relationship toaudience response question.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Physiological Integrity3.A client with a long history of hypertension and diabetes now develops confusion. The healthcare provider wants to make a differential diagnosis betweenAlzheimer’sdisease and multiplecerebral infarcts. Which diagnostic procedure should the nurse expect to prepare the client forfirst?a.Skull x-raysb.Computerized axial tomography (CT) scan

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c.Positron-emission tomography (PET)d.Single photon emission computed tomography (SPECT)ANS: BA CT scan shows the presence or absence of structural changes, including cortical atrophy,ventricular enlargement, and areas of infarct, information that would be helpful to the healthcare provider. PET and SPECT show brain activity rather than structure and may occur later.See relationship to audience response question.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: PlanningMSC: Client Needs: Physiological Integrity4.Aclient’shistory shows drinking 4 to 6 L of fluid and eating more than 6,000 calories per day.Which part of the central nervous system is most likely dysfunctional for this client?a.Amygdalab.Parietal lobec.Hippocampusd.HypothalamusANS: DThe hypothalamus, a small area in the ventral superior portion of the brainstem, plays a vitalrole in such basic drives as hunger, thirst, and sex. See relationship to audience responsequestion.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: AssessmentMSC: Client Needs: Physiological Integrity5.The nurse prepares to assess a client diagnosed with major depressive disorder fordisturbances in circadian rhythms. Which question should the nurse ask this client?a.“Haveyou ever seen or heard things that others donot?”b.“Whatare your worst and best times of theday?”c.“Howwould you describe yourthinking?”d.“Doyou think your memory isfailing?”ANS: BMood changes throughout the day may be related to circadian rhythm disturbances. Questionsabout sleep pattern are also relevant to circadian rhythms. The distracters apply to assessmentfor illusions and hallucinations, thought processes, and memory.PTS:1DIF: Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity6.The nurse administers a medication that potentiates the action of ã-aminobutyric acid(GABA). Which effect would be expected?a.Reduced anxietyb.Improved memoryc.More organized thinkingd.Fewer sensory perceptual alterationsANS: A

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Increased levels of GABA reduce anxiety. Acetylcholine and substance P are associated withmemory enhancement. Thought disorganization is associated with dopamine. GABA is notassociated with sensory perceptual alterations. See relationship to audience response question.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: EvaluationMSC: Client Needs: Physiological Integrity7.A nurse would anticipate that treatment for a client with memory difficulties might includemedications designed to do what?a.inhibit GABA.b.prevent destruction of acetylcholine.c.reduce serotonin metabolism.d.increase dopamine activity.ANS: BIncreased acetylcholine plays a role in learning and memory. Preventing destruction ofacetylcholine by acetylcholinesterase would result in higher levels of acetylcholine, with thepotential for improved memory. GABA affects anxiety rather than memory. Increaseddopamine would cause symptoms associated with schizophrenia or mania rather than improvememory. Decreasing dopamine at receptor sites is associated with Parkinson’s disease ratherthan improving memory.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: PlanningMSC: Client Needs: Physiological Integrity8.A client has disorganized thinking associated with schizophrenia. Neuroimaging would likelyshow dysfunction in which part of the brain?a.Hippocampusb.Frontal lobec.Cerebellumd.BrainstemANS: BThe frontal lobe is responsible for intellectual functioning. The hippocampus is involved inemotions and learning. The cerebellum regulates skeletal muscle coordination andequilibrium. The brainstem regulates internal organs.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: AssessmentMSC: Client Needs: Physiological Integrity9.The nurse should assess a client taking a drug with anticholinergic properties for inhibitedfunction of which system or structure?a.parasympatheticb.sympatheticc.reticular activatingd.medulla oblongata.ANS: AAcetylcholine is the neurotransmitter found in high concentration in the parasympatheticnervous system. When anticholinergic drugs inhibit acetylcholine action, blurred vision, drymouth, constipation, and urinary retention commonly occur.

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PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: AssessmentMSC: Client Needs: Physiological Integrity10.The therapeutic action of neurotransmitter inhibitors that block reuptake bring about whatresponse?a.decreased concentration of the blocked neurotransmitter in the central nervoussystem.b.increased concentration of the blocked neurotransmitter in the synaptic gap.c.destruction of receptor sites specific to the blocked neurotransmitter.d.limbic system stimulation.ANS: BIf the reuptake of a substance is inhibited, it accumulates in the synaptic gap, and itsconcentration increases, permitting ease of transmission of impulses across the synaptic gap.Normal transmission of impulses across synaptic gaps is consistent with normal rather thandepressed mood. The other options are not associated with blocking neurotransmitterreuptake.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: ImplementationMSC: Client Needs: Physiological Integrity11.A client taking medication for mental illness develops restlessness and an uncontrollable needto be in motion. Which drug action causes these symptoms to develop?a.Anticholinergic effectsb.Dopamine-blocking effectsc.Endocrine-stimulating effectsd.Ability to stimulate spinal nervesANS: BMedication that blocks dopamine often produces disturbances of movement, such as akathisia,because dopamine affects neurons involved in both thought processes and movementregulation. Anticholinergic effects include dry mouth, blurred vision, urinary retention, andconstipation. Akathisia is not caused by endocrine stimulation or spinal nerve stimulation.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: AssessmentMSC: Client Needs: Physiological Integrity12.A fearful client has an increased heart rate and blood pressure. The nurse suspects increasedactivity of which neurotransmitter?a.GABAb.Norepinephrinec.Acetylcholined.HistamineANS: BNorepinephrine is the neurotransmitter associated with sympathetic nervous systemstimulation, preparing the individual for “fight or flight.” GABA is a mediator of anxietylevel. A high concentration of histamine is associated with an inflammatory response. A highconcentration of acetylcholine is associated with parasympathetic nervous system stimulation.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: AssessmentMSC: Client Needs: Physiological Integrity

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13.A client has acute anxiety related to an automobile accident 2 hours ago. The nurse shouldteach the client about medication from which group?a.Tricyclic antidepressantsb.Antipsychotic drugsc.Mood stabilizersd.BenzodiazepinesANS: DBenzodiazepines provide anxiety relief. Tricyclic antidepressants are used to treat symptomsof depression. Mood stabilizers are used to treat bipolar disorder. Antipsychotic drugs are usedto treat psychosis.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: PlanningMSC: Client Needs: Physiological Integrity14.A client is hospitalized for severe major depressive disorder. The nurse can expect to providethe client with teaching about what medication?a.chlordiazepoxide.b.clozapine.c.sertraline.d.tacrine.ANS: CSertraline is a selective serotonin reuptake inhibitor (SSRI). This antidepressant blocks thereuptake of serotonin, with few anticholinergic and sedating side effects. Clozapine is anantipsychotic. Chlordiazepoxide is an anxiolytic. Tacrine treatsAlzheimer’sdisease.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: PlanningMSC: Client Needs: Physiological Integrity15.A client diagnosed with bipolar disorder displays aggressiveness, agitation, talkativeness, andirritability. The nurse expects the health care provider to prescribe a medication from whichgroup?a.Psychostimulantsb.Mood stabilizersc.Anticholinergicsd.AntidepressantsANS: BThe symptoms describe mania, which is effectively treated by mood stabilizers, such aslithium, and selected anticonvulsants (carbamazepine, valproic acid, and lamotrigine). Drugsfrom the other classifications listed are not effective in the treatment of mania.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: PlanningMSC: Client Needs: Physiological Integrity16.A drug causes muscarinic receptor blockade. The nurse will assess the client for what sideeffect?a.dry mouth.b.gynecomastia.c.pseudoparkinsonism.

Test Bank for Varcarolis' Foundations of Psychiatric-Mental Health Nursing, 9th Edition (Chapters 1-36) - Page 31 preview image

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d.orthostatic hypotension.ANS: AMuscarinic receptor blockade includes atropine-like side effects, such as dry mouth, blurredvision, and constipation. Gynecomastia is associated with decreased prolactin levels.Movement defects are associated with dopamine blockade. Orthostatic hypotension isassociated with á1antagonism.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: AssessmentMSC: Client Needs: Physiological Integrity17.A client begins therapy with a phenothiazine medication. What teaching should the nurseprovide related to thedrug’sstrong dopaminergic effect?a.Chew sugarless gum.b.Increase dietary fiber.c.Arise slowly from bed.d.Report changes in muscle movement.ANS: DPhenothiazines block dopamine receptors in both the limbic system and basal ganglia.Movement disorders and motor abnormalities (extrapyramidal side effects), such asparkinsonism, akinesia, akathisia, dyskinesia, and tardive dyskinesia, are likely to occur earlyin the course of treatment. They are often heralded by sensations of muscle stiffness. Earlyintervention with antiparkinsonism medication can increase the client’s comfort and preventdystonic reactions. The distracters are related to anticholinergic effects.PTS:1DIF:Cognitive Level: Apply (Application)TOP:Nursing Process: ImplementationMSC: Client Needs: Physiological Integrity18.A client tells the nurse, “My doctor prescribed paroxetine for my depression. Iassume I’llhave side effects like I had when I was takingimipramine.”Thenurse’sreply should be basedon the knowledge that paroxetine is included in what class of medication?a.selective norepinephrine reuptake inhibitor (SNRI).b.tricyclic antidepressant.c.monoamine oxidase (MAO) inhibitor.d.selective serotonin reuptake inhibitors (SSRIs)ANS: DParoxetine is an SSRI and will not produce the same side effects as imipramine, a tricyclicantidepressant. The client will probably not experience dry mouth, constipation, or orthostatichypotension.PTS:1DIF:Cognitive Level: Understand (Comprehension)TOP:Nursing Process: PlanningMSC: Client Needs: Physiological Integrity19.A nurse can anticipate anticholinergic side effects are likely when a client is prescribed whichmedication?a.lithium.b.buspirone.c.imipramine.d.risperidone.

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