Varcarolis' Foundations of Psychiatric-Mental Health Nursing: A Clinical Approach 8th Edition Test Bank

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Chapter 01: Mental Health and Mental IllnessHalter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A ClinicalApproach, 8th EditionMULTIPLE CHOICE1.A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advancedpractice nurse to perform which additional intervention?a.Conduct mental health assessments.b.Prescribe psychotropic medication.c.Establish therapeutic relationships.d.Individualize nursing care plans.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)REF:Page 1-23TOP:Nursing Process: ImplementationMSC:Client Needs: Safe, Effective Care Environment2.A nursing student expresses concerns that mental health nurses “lose all their clinical nursingskills.”Select the best response by the mental health nurse.a.“Psychiatric nurses practice in safer environments than other specialties.Nurse-to-patient ratios must be better because of the nature of the patients’problems.”b.“Psychiatric nurses use complex communication skills as well as critical thinkingto solve multidimensional problems. I am challenged by those situations.”c.“That’s a misconception. Psychiatric nurses frequently use high technologymonitoring equipment and manage complex intravenous therapies.”d.“Psychiatric nurses do not have to deal with as much pain and suffering asmedical–surgical nurses do. That appeals 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 patientswith medical as well as mental health problems, reflecting the holistic perspective thesenurses must have. Nurse–patient ratios and workloads in psychiatric settings have increased,just like other specialties. Psychiatric nursing involves clinical practice, not justdocumentation. Psychosocial pain and suffering are as real as physical pain and suffering.PTS:1DIF:Cognitive Level: Apply (Application)REF:Pages 1-2, 21TOP: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?

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a.Recoveryb.Attendingc.Advocacyd.Evidence-based practiceANS:CAn advocate defends or asserts another’s cause, particularly when the other person lacks theability to do that for self. Examples of individual advocacy include helping patientsunderstand their rights or make decisions. On a community scale, advocacy includes politicalactivity, public speaking, and publication in the interest of improving the human condition.Since funding is necessary to deliver quality programming for persons with mental illness, theletter-writing campaign advocates for that cause on behalf of patients who are unable toarticulate their own needs.PTS:1DIF:Cognitive Level: Understand (Comprehension)REF:Page 1-26TOP:Nursing Process: EvaluationMSC:Client Needs: Safe, Effective Care Environment4.A family has a long history of conflicted relationships among the members. Which familymember’s comment best reflects a mentally healthy perspective?a.“I’ve made mistakes but everyone else in this family has also.”b.“I remember joy and mutual respect from our early years together.”c.“I will make some changes in my behavior for the good of the family.”d.“It’s best for me to move away from my family. Things will never change.”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)REF:Pages 1-2, 3, 32 (Figure 1-1)TOP:Nursing Process: AssessmentMSC:Client Needs: Psychosocial Integrity5.Which assessment finding most clearly indicates that a patient may be experiencing a mentalillness? The patienta.reports occasional sleeplessness and anxiety.b.reports a consistently sad, discouraged, and hopeless mood.c.is able to describe the difference between “as if” and “for real.”d.perceives 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)REF:Pages 1-2 to 4TOP:Nursing Process: AssessmentMSC:Client Needs: Psychosocial Integrity

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6.Which finding best indicates that the goal“Demonstrate mentally healthy behavior” wasachieved for an adult patient? The patienta.sees self as capable of achieving ideals and meeting demands.b.behaves without considering the consequences of personal actions.c.aggressively meets own needs without considering the rights of others.d.seeks help from others when assuming responsibility for major areas of own life.ANS:AThe correct response describes an adaptive, healthy behavior. The distracters describemaladaptive behaviors.PTS:1DIF:Cognitive Level: Apply (Application)REF:Pages 1-2 to 4TOP:Nursing Process: EvaluationMSC:Client Needs: Psychosocial Integrity7.A nurse encounters an unfamiliar psychiatric disorder on a new patient’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.The ANA’s Psychiatric-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: Apply (Application)REF:Pages 1-18, 19TOP: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.The ANA’s Psychiatric-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)REF:Pages 1-18, 19TOP:Nursing Process: ImplementationMSC:Client Needs: Safe, Effective Care Environment9.Which individual is demonstrating the highest level of resilience? One whoa.is able to repress stressors.b.becomes depressed after the death of a spouse.c.lives in a shelter for 2 years after the home is destroyed by fire.

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d.takes a temporary job to maintain financial stability after loss of a permanent job.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 to secure theresources they need to support their well-being. Repression and depression are unhealthy.Living in a shelter for 2 years shows a failure to move forward after a tragedy. See relatedaudience response question.PTS:1DIF:Cognitive Level: Apply (Application)REF:Pages 1-5, 6TOP:Nursing Process: AssessmentMSC:Client Needs: Psychosocial Integrity10.Complete this analogy. NANDA: clinical judgment:NIC: _________________a.patient 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 patient outcomes. Nursingcare activities may be direct or indirect.PTS:1DIF:Cognitive Level: Analyze (Analysis)REF:Pages 1-21, 22TOP:NursingProcess: 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 IllnessMental Health12345a.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)REF:Pages 1-2, 3, 32 (Figure 1-1)TOP:Nursing Process: AssessmentMSC:Client Needs: Psychosocial Integrity

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12.Which disorder is an example of a culture-bound syndrome?a.Epilepsyb.Schizophreniac.Running amokd.Major depressive disorderANS: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)REF:Page 1-7TOP:Nursing Process: AssessmentMSC:Client Needs: Psychosocial Integrity13.TheDSM-Vclassifies:a.deviant behaviors.b.present disability or distress.c.people with mental disorders.d.mental disorders people have.ANS: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)REF:Pages 1-18, 19TOP:Nursing Process: ImplementationMSC:Client Needs: Safe, Effective Care Environment14.A citizen at a community health fair asks the nurse, “What is the most prevalent mentaldisorder in the United States?” Select the nurse’s correct response.a.Schizophreniab.Bipolar disorderc.Dissociative fugued.Alzheimer’s diseaseANS:DThe 12-month prevalence for Alzheimer’s disease is 10% for persons older than 65% and50% for persons older than 85. The prevalence of schizophrenia is 1.1% per year. Theprevalence of bipolar disorder is 2.6%. Dissociative fugue is a rare disorder.PTS:1DIF:Cognitive Level: Understand (Comprehension)REF:Page 1-33 (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 risk to belabeled mentally ill? One whoa.describes hearing God’s voice speaking.b.is usually pessimistic but strives to meet personal goals.

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c.is wealthy and gives away $20 bills to needy individuals.d.always has an optimistic viewpoint about life and having own needs met.ANS: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.PTS:1DIF:Cognitive Level: Analyze (Analysis)REF:Pages 1-3, 4TOP:Nursing Process: AssessmentMSC:Client Needs: Psychosocial Integrity16.A patient’s relationships are intense and unstable. The patient initially idealizes the significantother and then devalues him or her, resulting in frequent feelings of emptiness. This patientwill benefit 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)REF:Page 1-32 (Figure 1-1)TOP:Nursing Process: PlanningMSC:Client Needs: Psychosocial Integrity17.Which belief will best support a nurse’s efforts to provide patient advocacy during amultidisciplinary patient care planning session?a.All mental illnesses are culturally determined.b.Schizophrenia and bipolar disorder are cross-cultural disorders.c.Symptoms of mental disorders are unchanged from culture to culture.d.Assessment findings in mental illness reflect a person’s cultural patterns.ANS:DSymptoms must be understood in terms of a person’s cultural background. A nurse whounderstands that a patient’s symptoms are influenced by culture will be able to advocate forthe patient 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)REF:Page 1-27TOP:Nursing Process: ImplementationMSC:Client Needs: Psychosocial Integrity18.A nurse is part of a multidisciplinary team working with groups of depressed patients. Onegroup of patients receives supportive interventions and antidepressant medication. The othergroup receives only medication. The team measures outcomes for each group. Which type ofstudy is evident?

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a.Incidenceb.Prevalencec.Comorbidityd.Clinical epidemiologyANS:DClinical epidemiologyis a broad field that addresses studies of the natural history (or whathappensif 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)REF:Page 1-17TOP:Nursing Process: EvaluationMSC:Client Needs: Safe, Effective Care Environment19.The spouse of a patient diagnosed with schizophrenia says, “I don’t understand how eventsfrom childhood have anything to do with this disabling illness.” Which response by the nursewill best help the spouse understand the cause of this disorder?a.“Psychological stress is the basis of most mental disorders.”b.“This illness results from developmental factors rather than stress.”c.“Research shows that this condition more likely has a biological basis.”d.“It must be frustrating for you that your spouse is sick so much of the time.”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)REF:Pages 1-5, 6TOP: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:C

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Incidence refers to the number of new cases of mental disorders in a healthy populationwithina 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)REF:Page 1-16TOP:Nursing Process: Planning/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)?a.All genomes are unique.b.Care is centered on the patient.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 patient-centered care, teamwork andcollaboration, evidence-based practice, quality improvement, safety, and informatics.PTS:1DIF:Cognitive Level: Understand (Comprehension)REF:Page 1-14TOP:Nursing Process: ImplementationMSC:Client Needs: Safe, Effective Care Environment22.Select the best response for the nurse to a question from another health professional regardingthe difference between a diagnosis inDSM-Vand a nursing diagnosis.a.“There is no functional difference between the two. Both identify humandisorders.”b.“TheDSM-Vdiagnosis disregards culture, whereas the nursing diagnosis takesculture into account.”c.“TheDSM-Vdiagnosis describes causes of disorders whereas a nursing diagnosisdoes not explore etiology.”d.“TheDSM-Vdiagnosis guides medical treatment, whereas the nursing diagnosisoffers a framework for identifying interventions for issues a patient isexperiencing.”ANS:DThe medical diagnosis is concerned with the patient’s disease state, causes, and cures,whereas the nursing diagnosis focuses on the patient’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)REF:Page 1-21TOP: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 care

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b.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 scope of practice.PTS:1DIF:Cognitive Level: Understand (Comprehension)REF:Pages 1-23, 35 (Table 1-2)TOP:Nursing Process: ImplementationMSC:Client Needs: Safe, Effective Care EnvironmentMULTIPLE RESPONSE1.An experienced nurse says to a new graduate, “When you’ve practiced as long as Ihave, youautomatically know how to take care of patients experiencing psychosis.” Which factorsshould the new graduate consider when analyzing this comment? (Select all that apply.)a.The experienced nurse may have lost sight of patients’ individuality, which maycompromise the integrity of practice.b.New research findings should be integrated continuously into a nurse’s practice 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 illpatients through trial and error.e.An intuitive sense of patients’ 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 patient as an individual.Overgeneralization compromises that perspective. Intuition and trial and error areunsystematic approaches to care.PTS:1DIF:Cognitive Level: Apply (Application)REF:Page 1-14TOP: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, “I have some weaknesses, but I feel I’m important to my family and friends.”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.

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PTS:1DIF:Cognitive Level: Apply (Application)REF:Pages 1-2, 3, 32 (Figure 1-1)TOP:Nursing Process: AssessmentMSC:Client Needs: Psychosocial Integrity3.A patient in the emergency department says, “Voices say someone is stalking me. They wantto kill me because I developed a cure for cancer. I have a knife and will stab anyone who is athreat.” Which aspects of the patient’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-conceptANS:B, C, EThe aspects of mental health of greatest concern are the patient’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 patient’s control over behavior istenuous, as evidenced by the plan to stab anyone who seems threatening. A healthyself-concept is lacking, as evidenced by the delusion of grandeur. Data are not present tosuggest that the other aspects of mental health (happiness and effectiveness in work) are ofimmediate concern.PTS:1DIF:Cognitive Level: Apply (Application)REF:Pages 1-3, 4TOP:Nursing Process: AssessmentMSC:Client Needs: Psychosocial Integrity

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Chapter 02: Theories and TherapiesHalter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach,8th EditionMULTIPLE CHOICE1.A parent says, “My 2-year-old child refuses toilet training and shouts‘No!’when givendirections. What do you think is wrong?” Select the nurse’s best reply.a.“Your child needs firmer control. It is important to set limits now.”b.“This is normal for your child’s age. The child is striving for independence.”c.“There may be developmental problems. Most children are toilet trained by age 2.”d.“Some undesirable attitudes are developing. A child psychologist can help youdevelop a plan.”ANS:BThis behavior is conventional of a child around the age of 2 years, whose developmentaltask is to develop autonomy. The distracters indicate the child’s behavior is abnormal.PTS:1DIF:Cognitive Level: Apply (Application)REF:Page 2-52 (Table 2-6)TOP:Nursing Process: ImplementationMSC:Client Needs: Health Promotion and Maintenance2.A nurse wants to find information on current evidence-based research, programs,andpractices regarding mental illness and addictions. Which resource should the nurse consult?a.American Psychiatric Associationb.American Psychological Association (APA)c.Clinician’s Quick 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.New therapies 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)REF:Page 2-32TOP: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:D

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The crisis of autonomy versus shame and doubt relates to the developmental taskof 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.PTS:1DIF:Cognitive Level: Understand (Comprehension)REF:Page 2-52 (Table 2-6)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 whichsystem of 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 “not nice.” The preconscious is a level of awareness rather than anaspect of personality.PTS:1DIF:Cognitive Level: Understand (Comprehension)REF:Pages 2-4, 5TOP: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,and using good manners. These qualities are likely to be internalized and become part ofwhich system 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 centerof basic 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.The preconscious 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)REF:Pages 2-4, 5TOP:Nursing Process: ImplementationMSC:Client Needs: Health Promotion and Maintenance

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6.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 mostlikely result?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.PTS:1DIF:Cognitive Level: Understand (Comprehension)REF:Pages 2-4, 5TOP:Nursing Process: ImplementationMSC:Client Needs: Health Promotion and Maintenance7.An adult says, “I never know the answers,” and “My opinion does not count.” 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 overthe environment 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)REF:Page 2-52 (Table 2-6)TOP:Nursing Process: AssessmentMSC:Client Needs: Health Promotion and Maintenance8.Which statement by a patient would lead the nurse to suspect unsuccessful completion of thepsychosocial developmental task of infancy?a.“I know how to do things right, so I prefer jobs where I work alone rather than on ateam.”b.“I do not allow other people to truly get to know me.”c.“I depend on frequent praise from others to feel good about myself.”d.“I usually need to do things several times before I get 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 suggestsfailure to resolve the crisis of initiative versus guilt.

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PTS:1DIF:Cognitive Level: Analyze (Analysis)REF:Pages 2-28, 29, 52 (Table 2-6)TOP:Nursing Process: AssessmentMSC:Client Needs: Health Promotion and Maintenance9.A patient is suspicious and frequently manipulates others. To which psychosexual stage dothese traits relate?a.Oralb.Analc.Phallicd.GenitalANS:AThe behaviors in the stem develop as the result of attitudes formed during the oral stage,when an infant first learns to relate to the environment. Anal-stage traits include stinginess,stubbornness, orderliness, or their opposites. Phallic-stage traits include flirtatiousness,pride, vanity, difficulty with authority figures, and difficulties with sexual identity.Genital-stage traits include the ability to form satisfying sexual and emotional relationshipswith members of the opposite sex, emancipation from parents, a strong sense of personalidentity, or the opposites of these traits.PTS:1DIF:Cognitive Level: Understand (Comprehension)REF:Pages 2-4, 5, 40 (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 a helplessfashion. Which stage of psychosexual development is most relevant to the patient’s needs?a.Latencyb.Phallicc.Anald.OralANS:DFixation at the oral stage sometimes produces dependent infantile behaviors in adults.Latency fixations often result in difficulty identifying with others and developing socialskills, resulting in a sense of inadequacy and inferiority. Phallic fixations result in havingdifficulty with authority figures and poor sexual identity. Anal fixation sometimes results inretentiveness, rigidity, messiness, destructiveness, and cruelty. This item relates to anaudience response question.PTS:1DIF:Cognitive Level: Understand (Comprehension)REF:Page 2-40 (Table 2-1)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 help others.” Which psychosocial developmental task do thesestatements contrast?a.Trust and mistrustb.Intimacy and isolation

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c.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 embodiesself-absorption. This developmental crisis would show a contrast between relating to othersin a trusting fashion and being suspicious and lacking trust. Failure to negotiate thisdevelopmental crisis would result in a sense of inferiority or difficulty learning and workingas opposed to the ability to work competently. Behaviors that would be contrasted would beemotional isolation and the ability to love and commit oneself.PTS:1DIF:Cognitive Level: Understand (Comprehension)REF:Page 2-52 (Table 2-6)TOP:Nursing Process: AssessmentMSC:Client Needs: Health Promotion and Maintenance12.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.“Of all of us, I am the most experienced with planning these types of events.”b.“Funerals are supposed to be conducted quietly, respectfully, and according to asocial protocol.”c.“This death was unfair but I hope we can plan a service that everyone feels is acelebration of life.”d.“This death was probably the consequence of years of selfish and inconsideratebehavior by our sibling.”ANS:CThe correct response shows an accurate perception of reality as well as a focus on solvingthe problem in a way that involves others. These factors are characteristic ofself-actualization. The incorrect responses demonstrate self-centeredness, rigidity, andblaming which are characteristic of a failure to achieve self-actualization.PTS:1DIF:Cognitive Level: Apply (Application)REF:Pages 2-24, 62 (Box 2-1)TOP:Nursing Process: AssessmentMSC:Client Needs: Health Promotion and Maintenance13.A student nurse says, “I don’t need to interact with my patients. I learn what I need to knowby observation.” An instructor can best interpret the nursing implications of Sullivan’stheory to this student by responding:a.“Interactions are required in order to help you develop therapeutic communicationskills.”b.“Nurses cannot be isolated. We must interact to provide patients with opportunitiesto practice interpersonal skills.”c.“Observing patient interactions will help you formulate priority nursing diagnosesand appropriate interventions.”d.“It is important to pay attention to patients’ behavioral changes, because thesesignify adjustments in personality.”ANS:B

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