TEST BANK for Psychiatric Nursing Contemporary Practice 6th Edition Mary Ann Boyd by ACADEMIAMILL

Psychiatric Nursing Contemporary Practice 6th Edition Boyd Test Bank Chapter 1- Introduction to Psychiatric-MentalHealth Nursing A group of nursing students are reviewing information about the evolution of mental health care and are discussing the recommendations of the final report of the Joint Commission on Mental Illness and Health. The students demonstrate understanding of this information when they identify that the report recommended an increase in which of 1. the following? A)

Numbers of mental health hospitals

State funding for mental health care

Clinics supplemented by general hospital units

Use of psychotherapy by psychiatrists A nurse is reviewing the American Nurses Association’s Statement on Psychiatric Nursing Practice publishedTinE1S9T6B 7,AwNhK icS hEsaLnL ctE ioRn. edCtO heMinvolvement of psychiatric mental health nurses in the provision of holistic nursing care. Integrating knowledge of the various theories and views of mental health and illness, the nurse

2. identifies which of the following as most strongly linked to this holistic approach? A)

Sigmund Freud’s psychoanalytic theory

Florence Nightingale’s Notes on Nursing

Hildegarde

Clifford Beers’ A Mind That Found Itself

Peplau’s Interpersonal Relations in Nursing A nursing instructor is preparing a presentation about key events and people that influenced the development of contemporary mental health and illness care. When describing the effects of World War II, which of the following would the instructor

3. include?

People began to view mental illness as more commonplace and acceptable.

The biologic understanding of mental illness was almost fully developed.

Deinstitutionalization occurred in response to the community health movement.

Mental illnesses became categorized as psychoses or neuroses. A nursing student is presenting a discussion of the history of psychiatric mental health nursing and its place within nursing history. Which of the following would be most

4. appropriate to include? Certification for the psychiatric mental health nursing specialty was first A)

emphasized by Mary Adelaide Nutting. Psychiatric nurses played a part in seeing that all deinstitutionalized patients got

treatment at community mental health centers. There is a historical link between the first nursing program to admit male students

and the first training school for psychiatric nursing. The first graduate program in psychiatric nurses was established in response to the

publication of psychiatric nursing specialty journals. Two nursing students are discussing psychiatric mental health nursing and the role it has

5. played in nursing’s overall history. Which statement is most accurate? A)

The importance of using therapeutic communication was stressed by Nightingale.

The use of self-care to enhance the immune system was taught by Dorothea Dix.

The moral treatment of mental illness was a primary focus of deinstitutionalization.

Peplau was the first nurse to stress the importance of therapeutic communication. When reviewing the evolution of mental health and illness care, which event is associated

6. with mental disorders beginning to be viewed as illnesses requiring treatment? A)

Establishment of Pennsylvania Hospital in Philadelphia

Quaker establishment of asylums

Creation of the state hospital system

Freud’s views on the causes of mental illnesses A psychiatric mental health nurse is working on a committee that is developing programs that integrate the objectives for mental health and mental disorders as identified

7. in Healthy People 2020. Which type of program would be least appropriate? A)

Single substance abuse treatment programs

Depression screening programs for primary care providers

Mental health programs for the homeless population

Employment programs for those with serious mental illness A nursing instructor is describing the concept of evidence-based practice in psychiatric mental health nursing. Which of the following would the instructor include

8. as being important? Select all that apply. A)

Research findings

Expert opinion

Clinical experiences

Patient data

Established routines The following events are important in the development of psychiatric mental health

9. nursing practice. Which event occurred first? A)

Publication of Standards of Psychiatric-Mental Health Nursing by the ANA Publication of Standards of Child and Adolescent Psychiatric and Mental Health

Nursing Practice Establishment of the first graduate program in psychiatric nursing at Rutgers

University Publication of the first psychiatric nursing text, Nursing Mental Disease, by Harriet

Bailey

10. A nurse is preparing a presentation about the current status of mental health services in

the United States. Which statement would the nurse include as the most reflective of this status? A)

Mental health care in the United States is equally accessible to individuals.

Mental illness ranks second in terms of causing disability in comparison.

Mental health care primarily focuses on the cure of mental illness.

Mental health care services are inadequate and fragmented. A group of students are reviewing the goals identified by the New Freedom Commission on Mental Health. The students demonstrate understanding of this report when they

11.1 identify which of the following as a goal? 1 .

Mental health is viewed as one component of overall health.

The consumer and family are the driving forces for mental health care.

Screening is of greater importance than assessment and referral for services.

Disparities in mental health services are decreased.

TESTBANKSELLER.COM

The following are important legislative and policy efforts influencing current mental 12. health care. Which of the following is the most recent? A)

Mental Health: A Report of the Surgeon General

New Freedom Commission on Mental Health

Action for Mental Health Mental Retardation Facilities and Community Mental Health Centers Construction

Act As part of a career day presentation to a group of nursing students, a psychiatric mental health nurse plans to describe how this specialty developed. Which individual would the nurse describe as playing a major role in the development of specialty training programs

13. for psychiatric nurses? A)

Mary Adelaide Nutting

Hildegarde Peplau

Harriet Bailey

Linda Richards A psychiatric mental health nurse is asked to be a guest speaker at a community fundraising event for mental health services. Which of the following would the nurse

14. emphasize as the primary goal of mental health services? A)

Access to affordable mental health care

Removal of exclusions because of preexisting conditions

Recovery from mental illness

Effective treatment for mental health care needs

A psychiatric mental health nurse is implementing evidence-based practice. The nurse 15. understands that this approach is developed by doing which of the following first? A)

Conducting research

B) C)

Identifying a clinical question Determining outcomes

Collaborating with the patient A group of students are reviewing information about mental health care after World War II. The students demonstrate understanding of this information when they identify which

16. of the following as a result of the National Mental Health Act? A)

Discovery of psychopharmacology

Passage of the Hill-Burton Act

Establishment of the National Institute of Mental Health

Development of community mental health centers When providing care to a patient, the psychiatric mental health nurse is implementing the therapeutic use of self. The nurse is applying the concepts based on the work of which

17. individual? A)

Hildegarde Peplau

Florence Nightingale

Dorothea Dix

Sigmund Freud After teaching a class to a group of nursing students about the historical perspectives of mental health care, the instructor determines that the group has understood the information when they identify which of the following as a common belief about mental

18. illness during the medieval period? A)

Mental illness in an individual was the result of being possessed by demons.

A person was removed from a contaminated environment to protect him or her. Exorcisms were used as primary mode of treatment to cleanse the person of his or

her sins.

The focus was on moral treatment to promote the individual’s safety and comfort.

Answer Key 1. C 2. B 3. A 4. C 5. A 6. A 7. A 8. A, B, C, D 9. D 10. D 11. B 12. A

13. B 14. C 15. B 16. C 17. A 18. B

Chapter 2- Mental Health and Mental Disorders A nursing instructor is describing the DSM-IV-TR to a group of nursing students. Which 1. of the following would the instructor include as the primary purpose of this classification? A)

Provide a commonly understood diagnostic category for clinical practice.

Describe treatment modalities for psychiatric disorders and mental illnesses.

Identify various etiologies for mental disorders based on family histories.

Provide optimal outcomes for treatment for individuals with mental illnesses. A nurse is providing care to a patient with a mental disorder classified by the DSM-IVTR. The nurse understands that although the first three axes appear to contain all the diagnostic information about a patient, a truly accurate picture of the client is incomplete

2. without considering other factors such as an estimate of current functioning and: A)

Life stressors

Cultural background

Marital status

Genetic history A patient’s global assessment functioning reveals that he has minimal symptoms with

3. good functioning in all areas. Which score would the nurse correlate with these findings? A)

4. A female patient was admitted to the hospital with pneumonia, and in the course of her treatment, it was determined that she was experiencing alcohol dependence because she began experiencing alcohol withdrawal while she was in the hospital. When the

psychiatrist who was called in as a consultant documented the patient’s mental disorder, he identified her alcohol dependence on which axis? A)

Axis I

Axis II

Axis III

Axis IV A 25-year-old woman who recently had abdominal surgery was admitted to the psychiatric unit, where it was determined that she had a borderline personality disorder. During the first week on the unit, it was determined that she also has diabetes. Her

5. diabetes mellitus would be listed in which axis of her DSM-IV-TR diagnosis? A)

Axis I

Axis II

Axis III

Axis IV As part of a class activity, nursing students are engaged in a small group discussion about the epidemiology of mental illness. Which statement best explains the importance of

6. epidemiology in understanding the impact of mental disorders? Epidemiology helps promote understanding of the patterns of occurrence associated A)

with mental disorders. Epidemiology helps explain research findings about the neurophysiology that causes

mental disorders. Epidemiology provides a thorough theoretical explanation of why specific mental

disorders occur. Epidemiology predicts when a specific psychiatric client will recover from a specific

mental disorder.

A nurse is working in a community mental health center that provides care to a large population of Asian descent. When developing programs for this community, which of 7. the following would be most important for the nurse to address? A)

Public stigma

Self-stigma

Label avoidance

Negative life events A group of students are reviewing the multiaxial diagnostic system of the DSM-IV-TR. The students demonstrate understanding of the axes when they identify that each axis

8. represents which of the following? A)

An evidence-based research finding

An experimental design to guide care

A domain of information

A laboratory test finding A nursing student is assigned to care for a patient diagnosed with schizophrenia. When talking about this patient in a clinical postconference, the student would use which

9. terminology when referring to the patient? A)

Committed patient

Schizophrenic

Schizophrenic patient

Person with schizophrenia Mrs. Green is a patient on a psychiatric unit. At the time of her admission, her dog was killed when a car accidentally ran over it; in addition to that, she just found out that her mother has been diagnosed with colon cancer. This information would be addressed in

10. which DSM-IV axis?

Axis I

Axis II

Axis III

Axis IV A nursing student is reviewing journal articles about major depression. One of the articles describes the number of persons newly diagnosed with the disorder during the past year.

11. The student interprets this as which of the following? A)

Rate

Prevalence

Point prevalence

Incidence While working in a community mental health treatment center, the nurse overhears one of the receptionists saying that one of the patients is really psycho. Later in the day, the nurse talks with the receptionist about the comment. This action by the nurse

12. demonstrates an attempt to address which issue? A)

Lack of knowledge

Public stigma

Label avoidance

Self-stigma After teaching a group of students about mental health and mental illness, the instructor determines that the teaching was successful when the group identifies which of the

13. following as reflecting mental disorders? A)

Capacity to interact with others

Ability to deal with ordinary stress

Alteration in mood or thinking

Lack of impaired functioning

A nurse is preparing a presentation for a local community group about mental disorders and plans to include how mental disorders are different from medical disorders. Which 14.1 statement would be most appropriate for the nurse to include? 4 Mental disorders are defined by an underlying biological pathology. . A)

Numerous laboratory tests are used to aid in the diagnosis of mental disorders.

Cluster of behaviors, thoughts, and feelings characterize mental disorders.

Manifestations of mental disorders are within normal, expected parameters.

Which of the following would a nurse identify as being categorized as Axis I in theDSMIV-TR? Select all that apply.

15.1 5 . A)

Paranoid personality disorder

Posttraumatic stress disorder

Anorexia nervosa

Mental retardation

Unemployment

Coronary artery disease A psychiatric mental health nurse is providing care for a patient with a mental disorder. The patient is participating in the decision-making process. The nurse interprets this as

16. which component of recovery? A)

Self-direction

Empowerment

Person-centered

Holistic A nurse is explaining recovery to the family of a patient diagnosed with a mental disorder. Which statement would be most appropriate for the nurse to include about this

17.1 process? 7 It is a step-by-step process from being ill to being well. . A)

The patient focuses mainly on the emotional aspects of his condition.

The patient is helped to live a meaningful life to his fullest potential.

Although peer support is important, the self-acceptance is essential. A psychiatric mental health nurse is preparing a presentation about recovery for a group of newly hired nurses for the mental health facility. Which of the following would the

18. nurse identify as one of the most important concepts? A)

Self-direction

Peer support

Respect

Hope The nurse is reviewing the medical record of a patient and notes the information below.

19. Which of the following would be found on Axis III? Select all that apply. A)

Cocaine dependence

Bipolar I disorder

Chronic obstructive pulmonary disorder

Cellulitis

Homelessness

Arrest for cocaine possession with intent to sell A college-aged student and his friend arrive at the student health center. The friend reports that the patient has been having difficulties concentrating, remembering, and thinking. He’s had quite a few research papers due this past week. After ruling out other problems, the nurse determines that the patient is experiencing a culture-bound

20. syndrome. Which of the following would the nurse most likely suspect? A)

Ataque de nervios

Brain fog

Mal de ojo

Shenjing shuairo

Answer Key 1. A 2. A 3. B 4. A 5. C 6. A 7. C 8. C 9. D 10. D 11. D 12. B 13. C 14. C 15. B, C 16. B 17. C 18. D 19. C, D 20. B

Chapter 3- Cultural and Spiritual Issues Related to Mental Health Care When reviewing several studies about Hispanic Americans and their use of mental health care facilities, the nurse notes that this cultural group tends to use all other resources before seeking help from mental health professionals. Which of the following would the 1. nurse identify as a reason for this belief about many mental health facilities? A)

Require periods of hospitalization

Do not provide 24-hour emergency services

Are not reimbursed by third party payers

Do not accommodate their cultural needs A nurse is preparing a presentation about mental health problems associated with specific cultural groups. When describing mental health problems associated with Asian Americans, Polynesians, and Pacific Islanders, the nurse would address high rates of

2. which of the following? A)

Schizophrenia

Manic disorders

Dementia

Suicide The nurse is doing an assessment interview of a patient. During the interview, the patient comments, Our people are connected with nature. Our world, our seasons, and our weather they all have many lessons to teach us. The nurse interprets the patient’s

3. statement as an expression of which of the following? A)

Religiousness

Tribal law

Spirituality

Ecological values A psychiatric mental health nurse is providing care to a patient who has recently emigrated to the United States from Eastern Europe. Which of the following would be

4. least effective in providing culturally competent care? A)

Demonstrating a genuine interest in the patient

Avoiding assumptions about the patient’s culture

Speaking to the patient in his native language.

Acquiring information about the patient’s country. A psychiatric mental health nurse working in a Veteran’s Administration Medical Center is meeting with a military wife who is an Asian American. The woman is to be joining a support group for wives of veterans who have posttraumatic stress syndrome. When asking her to describe her husband’s mental health problems, which response would the

5. nurse most likely expect? Oh, he may seem depressed, but it is just a vitamin deficiency. It runs in his A)

family.

I know the war messed his mind up. He’ll never be the same.

Sometimes he hallucinates that he is back in Vietnam.

He just stays to himself; he never talks to me about what is bothering him. A psychiatric mental health nurse is working with a patient who is being treated for

6. depression. Which patient statement would indicate that her spirituality is intact? A)

My church friends came to visit me this past Sunday afternoon.

Nothing will ever be the same again; my life is not worth living.

I know I am as well off as I can be under the circumstances.

I know God must be punishing me for all my sins.

A patient is being treated for prostate cancer; his prognosis is very poor. The patient has a strong faith, and he has been active in his church for many years. He is concerned about his health and the challenges he faces as his cancer progresses. Which comment by the 7. nurse reflects the most appropriate spiritual nursing intervention for the patient? A)

I’ll take you to visit my church if you can get a pass.

You have to belong to the same church I do if you’re going to go to heaven.

Would you like me to bring you a guided imagery audiotape?

We can pray together if you’d like. A psychiatric mental health nurse is teaching a class about social factors associated with mental illness at a community health center. When describing the influence of poverty and effects of the downward economic spiral on mental health, which population would

8. the nurse identify as being the most at risk? A)

Older adults

Individuals with physical disabilities

Single-parent families

Homeless individuals During an assessment, the patient states, We rely on our large extensive family for moral support and help and we treat our elders with a great deal of respect. If someone gets sick, the family takes care of him. The nurse interprets this as indicating which of

9. the following? A)

Acculturation

Cultural identity

Cultural competence

Linguistic competence

10. Within the context of the culture of poverty, which of the following most clearly

describes why individuals who are part of this culture become trapped in a downward economic spiral? Unemployment causes poverty; a lack of willpower and motivation can, in turn, A)

cause unemployment in people who do not have a strong work ethic. Individuals lack the finances to pay rent, so they eventually do not have an address

to use in filling out job applications. Characteristics of poverty (joblessness and lack of financial independence) can, in turn, contribute to attributes (feelings of powerlessness and low self-esteem) that

sustain poverty. Poverty is passed on from generation to generation; individuals learn at an early age

that there is no way to escape living in poverty. A group of nursing students are reviewing information about spirituality and religiousness. The group deT mE onSsT trB atA esNuKnS deErsLtaLnE diRn. gC ofOtM hese concepts when they

11.1 identify religiousness as which of the following? 1 . A) Feeling of connectedness B)

Way of interpreting life events

Relationship with a unifying force

Community participation in common worship A nursing instructor is preparing a class about rural cultures and the influence on mental health problems. Which of the following would the instructor include as impacting the

12. use of mental health services for this group? Select all that apply. A)

Limited access to care

Lack of available resources

Geographical similarities

Diverse cultural groups

Consistency in treatment approaches A psychiatric mental health nurse is working on developing cultural competence. Which

13.1 of the following would be most appropriate for the nurse to do? 3 Research information about the cultures of the population being served after . assessing the patients. A)

Recognize that one’s own culture is the predominant way of addressing a patient’s health care needs.

Assume that any individual of a racial or ethnic group is the same as another individual in that group.

Demonstrate an appreciation of and a genuine interest in the individual and his or her cultural beliefs.

During assessment, a patient tells the nurse that he follows Buddhist beliefs. The nurse would integrate understandiTnE gS ofTwBhAicNhKoS fE thL eL foEllR ow when developing the patient’s .iCngOM plan of care?

14.1 4 . A)

Desire is the cause of all human suffering and misery.

Self-indulgence is necessary to reach nirvana.

Present behavior is based on current unhappiness.

Salvation is achieved through faith and humility. After teaching a group of students about the beliefs associated with the major religions, the instructor determines that additional teaching is needed when the students identify

15. which belief as associated with Confucianism? A)

People are born good.

People are assigned to castes.

Authority figures are respected.

Self-responsibility leads to improvement.

During an interview, a patient states, God does not exist for me. The nurse interprets 16. this statement as reflecting which of the following? A)

Animism

Agnosticism

Atheism

Polytheism After reviewing the major beliefs of Hinduism, a nursing student identifies the following castes. The student demonstrates understanding by identifying which of the following as

17. the highest caste? A)

Kshatriyas

Vaisyas

Brahmans

Untouchables

TESTBANKSELLER.COM

The nurse is assessing an Asian American patient. During the interview, the nurse 18.1 determines that the patient likely follows Taoism based on which statement? 8 Purity and balance guide all of my actions. . A)

I strive to be in happy harmony with nature.

Nature’s powers must be respected in life.

God is worshipped out of love, not fear.

Answer Key 1. D 2. D 3. C 4. C

5. A

6. C 7. D 8. D 9. B 10. C 11. D 12. A, B, D 13. D 14. A 15. B 16. C 17. C 18. B

Chapter 4- Patient Rights and Legal Issues A nurse is explaining advance care directives, or living wills, to a patient and the 1. patient’s spouse. Which of the following would the nurse include in the description? The document tells what treatment is to be omitted if the patient is unable to make A)

the decision. It requires that the patient sign the living will document while an attorney is

present.

The patient’s physician must act as a witness when the patient signs the document.

An attorney draws up the papers to be given to the patient and his or her family. A psychiatric mental health nurse determines that a patient is competent when he is able

2. to do which of the following? A)

Speak coherent English.

Communicate his or her choices.

Write a living will.

Comply with the medical regimen. A patient receives a court order for commitment. Which of the following best exemplifies

3. the concept of least restrictive environment? A)

Involuntary commitment to an outpatient community mental health center

Medication administration for sedation so the patient cannot get out of bed

Placing the patient in a locked padded room in response to threats of self-harm

Allowing the patient to make the decision about whether treatment is necessaryA nurse is caring for a patient who is hospitalized for a mental disorder. The nurse is legally obligated to breach the patient’s confidentiality if the patient states which of the

4. following?

I think that the federal government is spying on me.

I get really ‘turned on’ by your appearance.

That doctor I had today really made me angry.

When I get out of here, I’m going to kill my neighbor. Which patient would the nurse determine to be the most likely a candidate for involuntary

5. commitment? A)

The client who refuses to take the prescribed medication

The client who is screaming in the street disturbing neighbors

The client who refuses to participate in the planned therapy

The client with a mental disorder who is homeless The nurse is providing care to a male patient who is hospitalized with a diagnosis of schizophrenia. Which of the following would be appropriate for the nurse to include in

6. the patient’s medical record? A)

TESTBANKSELLER.COM

Patient states that he had a good night with no complaints. Complained of being unable to sleep because he heard voices throughout the

night.

Had a typical night without incidence of insomnia or nightmares.

Acted crazily throughout the night; kept hearing voices and noises. A nurse working on the psychiatric unit receives a telephone call from the employer of one of the patients on the unit. The employer asks to be sent a copy of Mr. Murray’s latest laboratory work and psychological testing results so Mr. Murray’s medical records in employee health can be kept up to date. Based on the nurse’s knowledge about issues

7. surrounding breach of confidentiality, which response would be the most appropriate? A)

I’m sorry; we’re not allowed to give out that information about our patient.

I’ll have to get the patient’s signed consent before we can send that information to

you. I am unable to acknowledge whether or not a Mr. Murray is a patient on this C) D)

unit. Sure, give me your address, and I will see that the information is sent to you. A patient is going to be discharged this afternoon from the mental health unit. The patient asks the nurse if a copy of his medical record could be sent to the psychologist he will be

8. seeing on an outpatient basis. Which response by the nurse would be most appropriate? A)

Sure, we’ll have that information sent out in today’s mail.

You will need to sign written authorization for us before we can do this. I think it would just be best if you just told your psychologist everything he needs

to know.

How are you feeling about being discharged this afternoon? A patient’s psychiatrist informs her that he thinks she needs to participate in a 3-month outpatient aftercare program after her discharge. Which of the following would protect

9. the patient’s right to request a second opinion before agreeing to this suggestion? A)

Self-determinism

Least restrictive environment

Confidentiality

Mandates to inform A nurse is preparing to administer an as-needed (PRN) medication. Which of the

10.1 following would the nurse need to keep in mind when documenting administration? 0 It requires a separate entry that includes reason for administration, dosage, route, and . response to the medication the first time it is administered to a patient. A)

It requires a separate entry that includes reason for administration, dosage, route, and response to the medication every time it is administered to a patient.

It requires a separate entry that includes reason for administration, dosage, and route C)

the first time it is administered to a patient. It requires a separate entry that includes reason for administration, dosage, and route

every time it is administered to a patient. A nursing instructor is preparing a class discussion on the topic of self-determinism.

11.1 Which of the following would the instructor expect to include? Select all that apply. 1 . A)

Personal autonomy as a key value

Choices based on pleasing others

Activities reflect personal goals

Right to refuse treatment

Lack of empowerment A group of nursing students are reviewing information about internal rights protection systems. The students demonstrate understanding of this information when they identify

12. which of the following as an example? A)

American Hospital Association

American Public Health Association

State mental health provider

The Joint Commission After teaching a class about competency and how it is assessed, the nursing instructor determines the need for additional instruction when the class identifies which ability as

13. being evaluated? A)

Communication of choices

Understanding of relevant information

Appreciation for situation and consequences

Discussion of what is right and wrong

14. A patient is involuntarily committed without a court order. The nurse understands that the

emergency short-term hospitalization can occur for which time frame? A)

A maximum of 24 hours

48 to 92 hours

3 to 5 days

One week A nurse is explaining the distinction between confidentiality and privacy. Which of the

15. following would the nurse include as reflecting privacy? A)

Part of personal life not governed by society’s laws

Ethical duty for nondisclosure

Involvement of two individuals

Knowledge of treatment costs and benefits A psychiatric mental health patient has an advance care directive on his medical record. A clinician provides treatment that disregards the patient’s directive. The clinician would

TESTBANKSELLER.COM

16. be liable for which of the following? A)

Assault

Battery

Medical battery

False imprisonment A group of students are preparing a class presentation about negligence. Which of the following would the group include as an element required for proving negligence? Select

17. all that apply. A)

Duty to provide care

Proximate cause

Resultant damages

Breach of duty

Cause in fact

Evidence of mistake A psychiatric mental health nurse is documenting information in a patient’s medical

18.1 record. Which of the following would be least likely to increase the nurse’s legal liability? 8 Patient reported that he was feeling better today than yesterday. . A)

Administered haloperidol 10 mg IM stat as ordered for agitation.

Patient was talking with another staff member and started screaming.

Applied restraints to all four patient extremities.

After teaching a class of nursing students about the rights of persons receiving mental health services, the instructor determines a need for additional instruction when the students identify which of the following as a right?

19.1 9 . A)

Freedom from restraints or seclusion

Access to one’s own mental health records on request

An individualized written treatment plan

Refuse treatment during an emergency situation

Answer Key 1. A 2. B 3. A 4. D 5. B 6. B 7. C 8. B 9. A 10. B 11. A, C, D

TESTBANKSELLER.COM

12. C 13. D 14. B 15. A 16. C 17. A, B, C, D, E 18. B 19. D

Chapter 5- Mental Health Care in the Community A nursing instructor is explaining the concept of the continuum of care to a group of 1. students. Which of the following would the nurse include in this description? A)

Care provided in episodic intervals

System of care that focuses primarily on wellness

A single organization as responsible for care delivery

Integrated system spanning illness to wellness states The nurse is employed by a long-term residential treatment center that provides care to a variety of patients with chronic mental disorders. Which role would the nurse primarily

2. assume when working with these patients? A)

Therapist

Medication administrator

Mediator

Educator A patient has threatened to kill his wife, and it is not anticipated that this crisis will resolve itself. The patient is to be admitted to an inpatient psychiatric unit on an involuntary basis. When explaining to the family about this plan, the nurse would identify

3. which of the following as the focus of care? A)

Long-term therapy

Rehabilitative services

Acute symptom stabilization

24-hour supervision

4. A nurse is reviewing information about the various types of outpatient mental health care

programs. The nurse demonstrates understanding of these types when identifying which of the following as involved in providing the most intensive outpatient nursing care? A)

Partial hospitalization programs

Crisis intervention programs

Outpatient detoxification programs

Rehabilitation programs A patient who has attempted suicide with a drug overdose has been released from an inpatient setting and has returned to school. The patient continues to need routine psychiatric services. The nurse anticipates that this patient will most likely be referred to

5. which of the following? A)

Partial hospitalization program

In-home mental health care

Intensive outpatient program

Crisis center in the community The nurse is caring for a group of patients in a partial hospitalization program. The nurse

6. would most likely be involved in which of the following activities? A)

Facilitating a drug abuse prevention group

Providing spiritual assessment and related interventions

Teaching patients how to plan a menu and to shop for groceries

Providing an educational group about the nutritional content of canned foodsA nurse is providing in-home mental health care and determines that the care was

7. effective when the patient demonstrated which of the following? A)

A need for continued intensive monitoring in the home

A need for crisis intervention services on an ongoing basis

A decrease in admission frequency to inpatient psychiatric hospitals

A dependence on parents to participate in the patient’s care

A patient with a psychiatric disorder is considering joining a clubhouse with other patients who have mental disorders. The patient asks the nurse to explain what services 8. the clubhouses provide. Which response by the nurse would be most accurate? They are open 24 hours a day to provide care and support for the clubhouse A)

members.

They are run entirely by psychiatric mental health nurses. Their primary focus is on providing ongoing intensive psychotherapy for patients

in a group setting. They are predominately run by psychiatric patients with minimal assistance from

mental health staff. The nurse is working as part of the interdisciplinary staff of a psychiatric inpatient facility who are developing discharge plans for a patient who requires alternative housing arrangements. The patient wTiE ll S beTrBeA feN rrK edStE oL aL peErR so.nC alOcM are home. When explaining this

9. housing arrangement to the patient, which of the following would the nurse include? You’ll be living with a family in their home, and the family will help supervise A)

and support you. You’ll be living in an apartment with a roommate, and a staff member will come

by to check on you. You’ll be living in a house with about 50 other people and receive 24-hour

supervision and assistance. You’ll be living in a house with about six to 10 other people, and a health care

attendant will provide 24-hour supervision. A nurse is developing a community education program for a local women’s club on the topic of managed care in mental health. Which of the following would the nurse include

10.

as the main focus?

Cost savings

Consistent third-party reimbursement

Improved access to less costly services

Individualized care for additional inpatient stays

11. When working within the continuum of care, which of the following occurs first? A)

Referral

Transfer

Assessment

Discharge planning A nurse who is working as part of an interdisciplinary team is looking at potential outpatient services for a patient. The patient requires a setting that provides a program of about 4 hours per day, three times per week with a 24-hour crisis and consultation service.

12. The nurse would identify which of the following as appropriate? A)

Primary care setting

Ambulatory level one

Ambulatory level two

Multimodal outpatient setting After teaching a group of students about the service and patient variables used when determining settings along the continuum of behavioral care, the instructor determines that the teaching was successful when the students identify which of the following as a

13. service variable? A)

Signs and symptoms

Milieu

Risk

Social support

14. The parents of a young adult diagnosed with schizophrenia are providing care for the

patient in their home. During a home visit, the parents state, It’s been so difficult taking care of our son. We need a break. But he needs constant supervision. Which of the following would be appropriate for the nurse to suggest? A)

Partial hospitalization

Acute inpatient care

Respite residential care

Intensive outpatient program A patient is referred to a psychosocial rehabilitation program. When explaining this type

15. of care to the patient, the nurse would emphasize which of the following? A)

Intensive treatment that prepares the patient to live in the community

Services that promote the patient’s reintegration into the community

Detoxification services for alcohol and drugs in an outpatient setting

Frequent monitoring within a therapeutic milieu for relapse prevention

TESTBANKSELLER.COM

As part of an interdisciplinary team, a nurse is assisting with a patient assessment to determine the most appropriate setting for treatment. The team decides that an acute ambulatory setting would be most appropriate. Which of the following would support the 16. team’s decision? A)

The patient exhibits moderate to severe symptoms.

The patient demonstrates marked impairment in two areas of daily life

The patient is unable to contract for treatment beyond initial care.

The patient demonstrates a limited ability to seek support.

Answer Key 1. D 2. D 3. C

4. A 5. C 6. C 7. C 8. D 9. D 10. C 11. C 12. C 13. B 14. C 15. B 16. C

Chapter 6- Ethics, Standards, and Nursing Frameworks When applying the biopsychosocial model to client care, the nurse integrates the 1. psychological domain when involved with which of the following? A)

Behavior therapy

Family support

Nutritional therapy

Sleep hygiene measures A nursing instructor is describing the impact of technology and electronic health records on psychiatric mental health care. Which of the following would the instructor identify

2. as a major challenge associated with it? A)

Maintaining confidentiality

Establishing educational models

Decreasing fragmented care

Defining professional standards more clearly A psychiatric nursing class is discussing current trends in mental health care. A student voices the opinion that there should be equitable access to mental health care and resources for those who live in rural areas, for those without health insurance, and for those with very little income. The student nurse’s opinion most closely reflects which

3. ethical principle? A)

Nonmaleficence

Paternalism

Veracity

Justice

A nursing student is initiating a relationship with an assigned patient. After meeting and spending approximately 20 minutes talking with the patient, the student makes arrangements to visit again after lunch. After lunch, fellow classmates invite the student to go to the gym with them and a group of patients to play volleyball. The student starts to go with them but then remembers the promise to meet with the patient. The student decides to stay behind and talk to with her patient. The student’s decision reflects which 4. ethical principle? A)

Autonomy

Beneficence

Fidelity

Veracity In a postclinical conference, a group of students are engaged in a discussion with their instructor. The instructor reT peEaS teT dlB yA haNsKthSeEsL tuLdE enRts.aCnO alM yze and evaluate the nursing interventions implemented throughout the clinical experience. The students are engaged

5. in which of the following? A)

Therapeutic use of self

Critical thinking

Interdisciplinary care

Planning care A group of students is reviewing the functions of psychiatric nurses. The students demonstrate understanding of the information when they identify which of the following

6. as an advanced practice level function? A)

Milieu therapy

Promotion of self-care

Psychopharmacology interventions

Health promotion activities A nursing instructor has prepared a lecture about the scope and standards of practice of psychiatric nurses. The instructor determines that the teaching was effective when the students identify which of the following as common to both basic and advanced level

7. practice? A)

Case management

Program development

Clinical supervision

Community interventions A nurse is working on developing ways to meet the challenge of knowledge development.

8. Which of the following would be most appropriate? A)

Access new information through continuing education programs.

Improve access to community psychiatric care for all populations.

Reduce the burden of mental illness by fighting stigma.

Provide culturally competent, high-quality nursing care. A 22-year-old patient with schizophrenia is refusing his antipsychotic medication. He states, I don’t like the dopey way it makes me feel. I feel like I’m walking under water when I take it. The nurse explains to him, Your schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. You need to take it so your symptoms will get better. This conversation reflects a

9. conflict between which two types of ethical principles? A)

Autonomy and justice

Paternalism and veracity

Justice and nonmaleficence

Autonomy and beneficence

A nurse is faced with an ethical dilemma involving a patient. Which question would be most important for the nurse to ask first when engaging in the process of ethical decision 10. making? A)

What are my own feelings about the situation?

What assumptions am I making that need more data?

What do I know about the situation?

What do I know about the patient’s values? A psychiatric mental health nurse is adhering to the standards of practice. When engaging in clinical decision making, the nurse is integrating which of the following as

11. the foundation? A)

Developmental issues

Nursing process

Commitment

Accountability A group of nursing students are reviewing the standards of professional performance. The students demonstrate understanding when they identify which as a standard of

12. professional performance? A)

Prescriptive authority

Consultation

Planning

Collegiality A psychiatric mental health nurse is providing care to patients with a mental illness and is investigating factors related to the patient safety, delivery of care services, and cost

13. effectiveness. The nurse is involved with which area of professional performance? A)

Education

Quality of practice

Resource utilization

Collaboration An instructor is preparing a class for a group of students about professional organizations and the leadership provided. Which of the following would the instructor include as an

14. important function of the International Society of Psychiatric-Mental Health Nurses? A)

Advocating for mental health nursing practice through liaison activities

Advancing psychiatric mental health nursing practice

Improving mental health care for culturally diverse individuals

Providing a strong voice for psychiatric mental health nurses When applying the biopsychosocial model for a patient with a mental health problem, the

15. nurse addresses the psychological domain when assessing which of the following? A)

Sleep patterns

Feelings

Family functioning

Cultural groups A nurse had developed a plan of care for a patient with depression. Which nursing

16. diagnosis would reflect the social domain? A)

Imbalanced Nutrition, Less Than Body Requirements related to lack of appetite.

Powerlessness related to feelings of lack of control over the situation.

Ineffective Role Performance related to inability to participate as family provider

Risk for Suicide related to depressed mood and feelings of oneself as a failureThe plan of care for a patient with schizophrenia identifies the following outcomes. Which of the following would the nurse identify as addressing the biologic domain?

17. Select all that apply. A)

Improving problem-solving skills

Promoting economic stability

Minimizing adverse effects of drug therapy

Improving nutritional status

Providing family education

18. A nurse is engaged in exercises to develop self-awareness. The nurse is using which tool? A)

Interdisciplinary care

Reflection

Plan of care

Clinical reasoning

Answer Key 1. A 2. A 3. D 4. C 5. B 6. C 7. A 8. A 9. D 10. C 11. B 12. D 13. C 14. D 15. B 16. C 17. C, D

18. B

Chapter 7- Psychosocial Theoretic Basis of Psychiatric Nursing A group of nursing students are reviewing information about Freud’s personality structure. The students demonstrate understanding of this information when they identify the ability to form mutually satisfying relationships as a function of which of the 1. following? A)

Defense mechanisms

Unconscious

Ego When describing the influence of Harry Stack Sullivan on psychiatric mental health

2. nursing, which of the following would the instructor address as a major concept? A)

Interpersonal relations

Harmony between the individual and society

Collective unconscious

Unconditional positive regard A nursing student is to provide a class presentation about interpersonal and psychoanalytic theories. As part of this presentation, the student is planning to address the major way these two categories differ. Which of the following would the student include

3. as key to interpersonal theories? A)

Human relationships

Instincts

Drives

Potential for goodness

A psychiatric mental health nurse is integrating Carl Rogers’ theory into the plan of care for a patient with a mental illness. The nurse incorporates understanding of this theory by 4. acknowledging that the therapist accomplishes which of the following? A)

Provide validation of the terminology used during the session.

Focus on the client’s instinctual drives.

Recognize an understanding of the client’s basic needs.

Develop unconditional positive regard for the client. A nurse is demonstrating behaviors that the treatment team is attempting to get the patient

5. to develop. The nurse is integrating which theory? A)

Erikson’s model of psychosocial development

Albert Bandura’s social cognitive theory

Skinner’s operant conditioning

Freud’s psychoanalytic model

TESTBANKSELLER.COM

An instructor is preparing a class discussion on the various theoretical models used in psychiatric mental health nursing. When describing cognitive theories, which statement 6. would the instructor include? The theories attempt to explain the mental processes development and effects on A)

behavior.

The theories attempt to describe how people learn and act.

The theories attempt to link internal thought processes with behavior.

The theories attempt to explain normal human growth and development. When integrating the Neuman systems model while caring for a patient with a mood

7. disorder, the nurse would focus on which of the following about the patient? A)

Behaviors

Relationships

Self-care activities

Stressors The nurse is integrating Peplau’s model when providing care to a patient with a mental

8. illness. Which of the following would the nurse identify as a key component? A)

Suffering

Anxiety

Self-care

Nonverbal behaviors A group of nursing students are reviewing information about the various nursing theorists and their application to psychiatric mental health nursing. The students demonstrate understanding when they identify which theorist as responsible for developing the theory

9. of cultural care diversity and universality? A)

Madeleine Leininger

Sister Calista Roy

Hildegard Peplau

Dorothea Orem A patient is being discharged from the psychiatric unit this afternoon, and the nurse needs to teach the patient about discharge medications. The patient is exhibiting signs of moderate anxiety about the upcoming discharge. Based on Peplau’s views regarding

10. anxiety, the nurse would expect to implement the teaching plan at which time? A)

When his anxiety stabilizes at its current level

When his anxiety decreases to a mild level

When he is completely free of anxiety

When his anxiety escalates to the panic level

11. A nursing instructor is integrating Piaget’s theory of cognitive development into the discussion of learning and mental health issues affecting adolescents. The instructor

would identify this age group as in which stage? A)

Concrete operations

Preoperational

Formal operations

Sensorimotor While working with an older male patient, the nurse begins to think that the patient reminds the nurse of her grandfather and responds as if she was the granddaughter. The

12. nurse is developing which of the following? A)

Empathy

Transference

Countertransference

Modeling A psychiatric mental health nurse is working on an inpatient unit that uses a privilege

TESTBANKSELLER.COM

13. system. The nurse understands that this intervention integrates which group of theories? A)

Behavioral

Developmental

Humanistic

Cognitive A group of nursing students are reviewing the various theories that form the basis for psychiatric mental health nursing. The students demonstrate understanding of these theories when they identify which theorist as addressing female development? Select all

14. that apply. A)

Maslow

Gilligan

Bandura

Miller

Thorndike When describing the major concepts of Jean Watson’s theory to a group of nursing

15. students, which of the following would the nurse expect to include? Select all that apply. A)

Freedom

Paradox

Carative factors

Rhythmicity

Caritas field

Mystery A nurse is applying King’s model to a nurse patient interaction by identifying the

16. outcome as which of the following? A)

Transaction

Adaptation

Transpersonal caring

Self-system The nurse is assessing a young adult and determines that the individual has achieved successful resolution of the previous stage of growth and development, evidenced by

17. demonstrating which of the following? A)

Drive and hope

Direction and purpose

Devotion and fidelity

Production and care A group of nursing students are reviewing information about psychodynamic theories. The students demonstrate a need for additional study when they identify which of the

18. following as a humanistic theorist? A)

Carl Jung

Carl Rogers

Abraham Maslow

Frederick Perls The nurse is assessing a patient with anxiety and observes the patient yelling and screaming. The nurse, integrating Peplau’s theory, interprets this behavior as which of the

19. following? A)

Panic behaviors

Relief behaviors

Empathetic linkage

Social distance The nurse is watching a video that depicts a patient and therapist interacting. The patient is asked to say whatever comes to his mind. The nurse identifies this as which of the

20.2 following? 0 . A) Dream work B)

Free associations

Gestalt therapy

Classical conditioning A nurse is developing a plan of care integrating Maslow’s hierarchy of needs. Which of

21. the following would the nurse identify as the priority? A)

Activity level

Predictable social environment

Acceptance from family

Positive self-image

Answer Key 1. D

2. A 3. A 4. D 5. B 6. C 7. D 8. B 9. A 10. B 11. C 12. C 13. A 14. B, D 15. C, E 16. A 17. C 18. A 19. B 20. B 21. A

Chapter 8- Biologic Foundations of Psychiatric Nursing A nurse is teaching a medication class to a group of psychiatric patients. One of them asks the nurse why he has so much more trouble learning now when he’s in his 60s than he did when he was younger. Which of the following concepts would the nurse integrate into the 1. response? A)

The extrapyramidal motor system

The amygdala

Neuroplasticity

Psychoneuroimmunology Which of the following would a nursing instructor identify when describing the area of the brain involved with verbal language function, including areas for both receptive and

2. expressive speech? A)

Right hemisphere

Parietal lobe

Occipital lobe

Left hemisphere A nurse is developing a plan of care for a patient experiencing expressive aphasia. The nurse incorporates knowledge that the patient most likely has sustained damage to which

3. of the following? A)

The postcentral gyrus

Broca’s area

Basal ganglia

The hippocampus

The nurse is caring for an older adult who has experienced damage to the frontal lobe after an automobile accident. The nurse anticipates that the patient will have difficulty 4. with which of the following? A)

Smell

Concept formation

Receptive speech

Hearing The nurse is caring for a patient who has experienced damage to the parietal lobes of the brain. The nurse anticipates that the patient with have difficulty with which of the

5. following? A)

Perceiving sensory input

Calculating a math problem

Seeing objects in front of him

Speaking fluently A patient has been diagnosed with memory dysfunction associated with Alzheimer’s disease. The nurse determines that damage to the patient’s brain includes deterioration of

6. temporal lobe structures and the nerves of which of the following? A)

Basal ganglia

Limbic system

Frontal lobe

Hippocampus The nurse is caring for a hospitalized patient who has a disorder of the hypothalamus. When developing the patient’s plan of care, in which of the following areas would the

7. nurse anticipate a problem? A)

Sleep

Constipation

Speech

Motor activity A patient who is scheduled to undergo a sleep deprivation electroencephalogram (EEG) in the morning is experiencing moderate anxiety about the procedure. Based on an

8. understanding of this test, which of the following would the nurse avoid? A)

Explaining in depth what to expect during the upcoming procedure

Administering a benzodiazepine medication prescribed for anxiety

Taking a thorough history of her use of prescribed and illicit drugs

Giving her a noncaffeinated beverage of her choice A nursing instructor asks a student to explain the influence of chronobiology on

9. depression. Which of the following would the student include when responding? The exact location of genes leads to identifying the gene responsible for causing A)

depression. A break in the corpus coliseum blocks information exchange between the right and

left hemispheres. Damage to the posterior areas of the parietal lobe leads to altered discriminative

sensory function. Internal and external triggers can elicit biologic rhythm changes indicative of

clinical depression. When describing the various neurotransmitters, which of the following would the nurse

10.1 identify as the primary cholinergic neurotransmitter? 0 . A)

Dopamine

Acetylcholine

Norepinephrine

Serotonin

11. A group of nursing students are reviewing the various neurotransmitters. The students

demonstrate understanding when they identify which of the following as a neuropeptide? A)

Melatonin

Serotonin

Glutamate

Gamma-aminobutyric acid The nurse is assessing a patient experiencing anxiety and observes increased sweating and

12. gooseflesh. The nurse understands that these are the result of which substance? A)

Acetylcholine

Norepinephrine

Serotonin

Histamine A nurse is developing a plan of care for a patient diagnosed with schizophrenia. The nurse integrates knowledge of this disorder, identifying which neurotransmitter as being

13.1 primarily involved? 3 . A)

Acetylcholine

Dopamine

Norepinephrine

Serotonin A group of students are reviewing information about neurotransmitter subtypes. The group demonstrates understanding of the information when they identify which

14. neurotransmitter as having muscarinic and nicotinic receptors? A)

Serotonin

Gamma-aminobutyric acid (GABA)

Dopamine

Acetylcholine

15. A nurse is involved in gathering information about the inheritance of mental disorders

using population genetics. Which of the following would the nurse be least likely to be evaluating? A)

Concordance rates

Occurrence in first-degree relatives

Risk factor analysis

Adoptions studies A nurse is reading a journal article about psychoneuroimmunology. Which information

16. would the nurse most likely find? Select all that apply. A)

Neurotoxin’s role in receptor site damage

Hypothalamic pituitary thyroid axis disruption

Static activity of natural killer cells in response to stress

Hypothalamic damage leading to immune dysfunction

Interruption in the typical circadian rhythm cycle

ELhiLcE A patient is scheduled for aTcE haSllT enBgA eN teK stS .W hR of.tC heOfM ollowing would the nurse 17. include when explaining this test to the patient? A)

Intravenous administration of a substance to induce symptoms

Application of electrodes to the scalp for monitoring

Evaluation electrical impulses recorded on graph paper

Exposure to a flashing strobe light to elicit abnormal activity A patient with depression tells the nurse that he is to have a test that involves the recording of an electroencephalogram (EEG) throughout the night. The nurse most

18. likely identifies this testing as which of the following? A)

Sleep deprivation EEG

Polysomnography

Evoked potentials

Functional magnetic resonance imaging

A group of nursing students are reviewing the role of serotonin in psychiatric disorders. The students demonstrate a need for additional study when they identify which disorder 19. as being associated with its dysfunction? A)

Depression

Obsessive-compulsive disorder

Panic disorder

Schizophrenia When describing neuronal transmission, an instructor describes the area where the electrical intracellular signal becomes a chemical one. The instructor is describing which

20. of the following? A)

Soma

Synaptic cleft

Terminal

Receptor site

Answer Key 1. C 2. D 3. B 4. B 5. B 6. D 7. A 8. B 9. D 10. B

11. A 12. B 13. B 14. D 15. C 16. A, B, D 17. A 18. B 19. D 20. B

Chapter 9- Communication and the Therapeutic Relationship A nurse has engaged in self-awareness and has come to understand his own personal beliefs and attitudes and has recognized some prejudicial ideas. Based on this 1. understanding, which of the following would the nurse now be able to accomplish? A)

Have a therapeutic relationship with a patient.

Influence patients with certain biases.

Change learned behaviors.

Formulate values and morals. When engaged in therapeutic communication in a therapeutic relationship with a patient with a mental health problem, which of the following would be most important for the

2. nurse to keep in mind? A)

The nurse should self-disclose when indicated.

The patient is the primary focus of the interaction.

The nurse should have an empathetic relationship with the patient.

The patient’s conversations should be recorded. A hospitalized patient diagnosed with depression asks the nurse, Should I go home this

3. weekend? Which response by the nurse uses the technique of reflection? A)

Should you go home for the weekend?

Home means what to you?

It sounds as if you don’t want to go home this weekend.

I doubt that you really should go home this weekend.

4. A patient who is hospitalized with depression tells the nurse, I don’t want to take the medication because I’m afraid I’ll become suicidal. Which response by the nurse

would be most appropriate? A)

Have you ever thought about hurting yourself?

It’s important that you take this medication.

I agree with you. I wouldn’t want to take this medication either.

Another patient took that medication, and he really felt better. A female psychiatric patient is talking to the nurse about her reasons for being hospitalized. She begins to discuss her relationship with her female significant other. The patient is describing the things in her relationship that are making her uncomfortable, and she asks the nurse, Should I break up with my partner? Which response by the nurse

5. would be most effective in building rapport between the patient and nurse? A)

Of course you should; being a lesbian is just not natural.

Yes, I think you should pursue building a relationship with a man.

It sounds like you’re beginning to be uncomfortable in this relationship.

You need to focus on yourself rather than the relationship right now. A patient is talking to the nurse about the recent death of her grandmother. She is obviously very sad, and a tear rolls down her cheek as she talks. The nurse remembers how she felt when her own grandmother died the previous summer. The nurse puts her hand on the patient’s shoulder and says, This must be very difficult for you. The

6. nurse is demonstrating empathy based on which of the following? The response comment reflects an attempt to communicate understanding of A)

patient’s feelings. The nurse’s response and use of reassuring touch reinforce the nurse’s concern for

the patient. The nurse demonstrates understanding of how the patient feels because of her own

grandmother’s death.

The nurse’s statement expresses compassion and kindness toward the patient. A nurse engaged in an interaction with a patient recognizes body space zones. Which of

7. the following would the nurse identify as the individual’s personal zone? A)

Beginning at the boundary of the intimate zone and ending at the social zone

Extending outward from the border to the public zone

Surrounding and protecting an individual from others, especially outsiders

The most distant boundary that can be used for recognizing intruders The nurse is in the orientation phase of the nurse patient relationship with a patient diagnosed with a mental disorder. When interviewing the patient during this first encounter, which information would be most important for the nurse to obtain about the

8. patient? A)

Known allergies

Recent hospitalizations

Perception of the problem

Family history A patient is a successful insurance salesman; however, because of market changes, his level of sales has dropped. His boss tells him he will consequently be receiving a $2,000 per year cut in his salary. When the patient arrives home from work, the family dog runs to greet him as he always does, barking and jumping up and down and begging for attention. The patient yells at the dog, Get away from me; I can’t take your barking right now. The patient’s response reflects a defense mechanism because it was which

9. of the following? An intentional behavior performed to let the dog know his behavior was A)

inappropriate

Automatic, protecting the patient from the anxiety related to his upcoming pay cut

C) D)

Implemented to keep the patient from having to cope with his upcoming pay cut Implemented so the patient could rationalize his upcoming pay cut Termination takes place during the resolution phase of a nurse patient relationship. During the termination process, a patient brings up resolved problems and presents them as new issues to work toward. The nurse interprets the patient’s action as indicating which

10. of the following? A)

The patient is angry that the nurse is abandoning him.

The patient requires additional therapy.

The patient is unhappy that the therapy was ineffective

The patient is attempting to prolong the nurse patient relationship. When engaged in a nontherapeutic relationship, which of the following would the nurse

11. identify as occurring first? A)

Failure to recognize the patient as a person with a need

Patient avoiding the nurse

The nurse being perceived as rude

Patient feeling hopeless and frustrated While providing care to a patient with a mental disorder, the patient asks the nurse, Does mental illness run in your family? Which response by the nurse would be most

12.1 inappropriate? 2 Mental illnesses do run in families, and I’ve had a lot of experience caring for . people with mental illness. A)

It sounds like you are concerned that there may be a family connection to your current problem?

Yes, it does. I have a sister who was diagnosed several years ago with severe major depression.

Mental illness can be family related. Let’s focus the discussion on you and how D)

you’re doing today. A nursing instructor is describing the nurse patient relationship to a group of nursing students. Which of the following would the instructor emphasize as crucial for

13. establishing and maintaining the relationship? A)

Rapport

Empathy

Self-awareness

Values A group of students are reviewing the process of verbal communication. The students demonstrate understanding of the information when they identify which of the following

14. as the first component of the process? A)

Formulation of an idea

Message encoding

Transmission of message

Message reception A nurse responds to a patient’s statement with silence based on the rationale that this

15. technique is used primarily to do which of the following? A)

Allow the nurse to determine an appropriate response

Permit the patient to gather his or her thoughts

Encourage self-reflection by the nurse

Demonstrate passive listening

16. A group of nursing students are preparing a class presentation on therapeutic and nontherapeutic techniques of communication. The students demonstrate understanding of the information when they select which techniques to demonstrate as therapeutic? Select

all that apply. A)

Confrontation

Open-ended statements

Reflection

Reassurance

Agreement

Challenges When communicating with a patient, which of the following would the nurse use to

17. convey positive body language? A)

Sitting erect with back against the chair

Crossing the arms over the chest

Sitting at the patient’s eye level

Keeping the feet flat on the floor with the legs crossed During an interview, a patieTnE t tS elT lsBthAeNnKuS rsE eL thL atEhRe.wCasOrMecently let go from his job. As the interaction continues, the patient states, I was really overqualified for that position anyway. It was definitely below my area of expertise. The nurse interprets this

18. information as reflecting which of the following? A)

Denial

Intellectualization

Projection

Passive aggression The nurse is engaged in a therapeutic nurse patient relationship. The relationship is in the working phase. With which of the following would the patient be involved? Select all that

19. apply. A)

Beginning to identify a need

Testing new ways for problem solving

Testing the relationship

Discussing problems related to needs

Examining personal issues A nurse is engaged in active listening. Which of the following would the nurse use?

20. Select all that apply. A)

Changing the subject to gather more information

Responding indirectly to statements

Using open-ended statements

Concentrating on what patient says

Allowing the patient to talk as he wishes

Answer Key 1. C 2. B 3. A 4. A 5. C 6. A 7. A 8. C 9. B 10. D 11. A 12. C 13. C 14. A 15. B

16. A, B, C 17. C 18. B 19. B, D, E 20. B, C, D

Chapter 10- The Psychiatric Nursing Process Which of the following questions would be most helpful in beginning an initial assessment interview for a patient who has just been admitted to a psychiatric inpatient 1. unit? A)

Have you had any previous psychiatric admissions?

What brings you into the hospital today?

Have you had any thoughts about trying to harm yourself?

How would you describe your relationship with your spouse? A patient is being admitted to the psychiatric unit. While explaining his reason for seeking admission, he describes how his 32-year-old son recently died of a heart attack.

2. Which response by the nurse would enhance the effectiveness of this interview? A)

How is your wife handling your son’s death?

Do you have any other living children that can help you cope with this loss?

This must be a very difficult time for you. I know exactly how you’re feeling; my 23-year-old son died unexpectedly last

year.

3. A patient was admitted to the hospital after a suicide attempt made after his daughter was killed in an automobile accident during which he had been driving and survived with only minor injuries. Even though the accident was unavoidable, he feels responsible. During the assessment interview, the patient begins to describe the last conversation he had with his daughter before he lost control of the automobile. As he speaks about his daughter, his voice trembles, and a silent tear rolls down his face. He makes a visible attempt to straighten up and smiles superficially at the nurse, stating, I’ll get over this. I just

need to keep a stiff upper lip. I think all I need to do is stay overnight. I’ll be as good as new by tomorrow. Which response by the nurse would be most appropriate? Tell me about your daughter. How would you describe the relationship you had A)

with her?

I’m sure you are right; a good night’s rest should make a big difference.

As good as new? You made a serious attempt on your life; you will not be ready go home by

tomorrow. After assessing a patient, the nurse noted the following: he was tearful, he tried to kill himself before coming into the hospital, he had no immediate plan for another suicide attempt, he was unable to concentrate, and he reported having trouble sleeping and having little or no appetite. The nurse also noted that the patient’s appearance was unkempt, that he spoke in a low monotoneT, E anSdTthBaAt N heKw naEbR le.toCeOsM tablish and maintain eye contact. SaEsLuL

4. Based on this information, which nursing diagnoses would be the most appropriate? A)

Ineffective Role Performance

Risk for Infection

Risk for Suicide

Risk for Self-Mutilation A staff nurse on a psychiatric unit knows that patients often have trouble sleeping because of their psychiatric conditions. Which of the following would reflect a psychiatric nursing

5. intervention to appropriately address this problem? A)

Limiting amounts of evening snacks and beverages

Involving patients in a volleyball game immediately before bedtime

Enforcing the rule that all patients be in bed with lights out by 10:30 PM

Encouraging patients to take short naps in the afternoons

The nurse is determining the success of a patient’s plan of care by evaluating outcome indicators. The nurse understands that these indicators are usually determined initially at 6. which time? A)

On the day of discharge

During the assessment process

At the initial interview

With goal-setting process Based on assessment data, the nurse formulates the nursing diagnosis for a patient as sleep pattern disturbance. After teaching the patient how to relax before bedtime, the

7. nurse determines that the teaching was effective by which outcome? A)

Discusses feelings about not being able to fall asleep

Reports feeling rested on awakening in the morning within 3 days

Requests sleeping medication each night before bedtime

Is able to sleep for short intervals throughout the night A patient was brought to the emergency department for an injury he received while working as a migrant worker. It soon becomes evident that the patient cannot speak English. A nurse on duty offers to find an interpreter so the patient can communicate with

8. the medical staff. The nurse’s offer is an example of which type of nursing intervention? A)

Milieu therapy

Conflict resolution

Cultural brokering

Structured interaction

9. A home health nurse is making a home visit to a psychiatric patient who was recently discharged from a mental health unit. During the visit, the nurse plans on clarifying with the patient when she will return for the next home visit. During which stage would the

nurse discuss the next home visit with the patient? A)

Closure stage

Service implementation

Greeting stage

Focus establishment The nurse is reviewing the assessment data of a patient diagnosed with a mental illness. The patient is to be prescribed medication to treat the illness. The nurse would identify

10. changes in which laboratory values as being the least significant? A)

Hemoglobin

Alanine aminotransferase (ALT)

Blood urea nitrogen (BUN) level

Serum creatinine A nurse is performing a biopsychosocial assessment of a patient with depression. Which

TESTBANKSELLER.COM

of the following would the nurse assess as part of the psychological domain? Select all 11. that apply. A)

Abstract reasoning

Medication use

Mood

Orientation

Self-care During assessment, the nurse asks a patient to explain what the following means: A

12. penny saved is a penny earned. The nurse is assessing which of the following? A)

Affect

Attention

Concentration

Abstract reasoning

The nurse is reviewing the drawing that a patient completed as a self-portrait. The nurse observes that the drawing lacks arms and feet. The nurse interprets this as indicating 13. which of the following? Select all that apply. A)

Low self-esteem

Powerlessness

Insecurity

Inadequacy A nurse identifies a nursing diagnosis of chronic low self-esteem. Which statement by a

14.1 patient would support this nursing diagnosis? 4 I feel so ugly.’ . A)

No one wants to date me.

I’m so fat, like a cow.

I never do anything right.

TESTBANKSELLER.COM

A nurse is assessing a patient’s spirituality. Which question would be most appropriate to

15.1 ask? 5 Have you ever tried to harm yourself? . A)

How important is your family to you?

How do you define good and evil?

What gives your life meaning?

D) A nurse is assisting a patient in using simple relaxation techniques. Which of the 16. following would the nurse do first? A)

Have the patient assume a relaxed position.

Advise the patient to let the sensations happen.

Ensure a quiet, nondisrupting environment.

Instruct the patient to take an initial slow, deep breath.

17. A group of nursing students are reviewing information about counseling interventions.

The students demonstrate a need for additional review when they identify counseling interventions as involving which of the following? A)

Specific, time-limited intervention

Focus on coping improvement

Goal of regaining functional abilities

Prevention of disability A patient is engaged in bibliotherapy and begins to express his feelings because he closely associates his experience with that provided by the reading material. The nurse

18. interprets this as which of the following? A)

Insight

Catharsis

Anxiety reduction

Problem solving

TESTBANKSELLER.COM

After teaching a group of nursing students about milieu therapy, the instructor determines that additional teaching is needed when the students identify which of the following as a 19. key concept of milieu therapy? A)

Structure interaction

Open communication

Validation

De-escalation The nurse is assessing a patient’s immediate and short-term memory. Which of the

20.2 following would be most appropriate? 0 Questioning the patient about an event that has occurred within the past several . months A)

Giving the patient a simple scenario and having him identify what would be the best response

Giving the patient three words and asking him to recite them now and then in 5 C)

minutes

Asking the patient to tell the nurse the date, time, and current location

Answer Key 1. B 2. C 3. D 4. C 5. A 6. B 7. B 8. C 9. A 10. A 11. A, C, D 12. D 13. B, D 14. D 15. D 16. C 17. C 18. B 19. D 20. C

Chapter 11- Psychopharmacology, Dietary Supplements A nurse is performing an admission assessment. The patient complains that it has been taking larger and larger amounts of medication to get the desired effect. Based on this 1. information, the nurse interprets this as suggesting which of the following? A)

Desensitization

Tolerance

Therapeutic index

Toxicity An older adult is complaining of anxiety is prescribed diazepam (Valium) by a family physician. The physician asks the office nurse to explain the problematic side effects of this medication to the patient. Which instruction would be most important for the nurse to

2. emphasize about this drug? A)

You may experience minor urine incontinence from time to time.

You may find that you have temporary memory disturbances.

You need to use this medication cautiously because it can cause dependence.

You may feel dizzy and be prone to falls after taking this medication. A nurse is caring for a psychiatric patient who is receiving an antacid that contains

3. aluminum salts. Which action by the nurse would be most appropriate? A)

Give the antacid 1 hour before the antipsychotic medication.

Give the antacid at the same time as the antipsychotic medication.

Administer the antacid 1 hour after the antipsychotic medication.

Administer the antacid just before the patient goes to sleep.

4. A patient is prescribed medication for a psychiatric disorder. After 3 days, the patient tells

the nurse that he or she has been constipated. Which instruction would the nurse give the patient? A)

You need to eat more high-protein foods such as meat and peanut butter.

You need to eat more fruits and vegetables and drink more water.

Ask your psychiatrist to prescribe a stool softener for you.

This side effect should disappear within a week or so. The nurse is caring for a 70-year-old psychiatric patient who has been prescribed a number of medications. When teaching the patient about the medications, which

5. explanation would be most appropriate? Your stomach empties more quickly as you age; therefore, you may feel the effect A)

of your medications almost immediately. Your entire GI system speeds up, so your medications are digested much more quickly. Therefore, it is important that you not drive after you take your

medications. Because of your age and related changes in liver functioning, you may have

medication levels in your system with the potential to be toxic. Because of age-related circulation changes, your body will be able to deliver

therapeutic doses of your medication to select body sites more quickly. During the stabilization phase of drug therapy for a patient who is hospitalized with a

6. psychiatric disorder, which action would be most appropriate? A)

Discussing the timing of tapering the medication

Instructing the patient about relapse prevention

Determining if the medication is losing its effect

Assessing the patient for target symptoms and side effects

7. A patient has been prescribed clozapine for treatment of schizophrenia. Which of the

following would the nurse include in the teaching plan for this patient and family? A)

You may experience hypertension while taking this medication.

One of the side effects of this medication is breast engorgement.

People taking this medication often experience dermatitis.

You may experience noticeable weight gain while taking this medication. A patient who has been taking clozapine for 6 weeks visits the clinic complaining of fever, sore throat, and mouth sores. The nurse notifies the patient’s physician because the

8. nurse suspects which of the following? A)

Severe anemia

Neuroleptic malignant syndrome

Encephalitis

Agranulocytosis A hospitalized patient who has been taking an antipsychotic medication for 2 weeks

TESTBANKSELLER.COM

begins pacing and walking throughout the unit. He tells the nurse that he cannot sit 9. still. The nurse documents this finding as which of the following? A)

Akinesia

Dystonia

Pseudoparkinsonism

Akathisia The nurse observes an older adult patient who has been taking antipsychotic medications for 8 months. The patient is smacking her lips and blinking her eyes rapidly. The nurse

10. also observes a protruding tongue. Which action by the nurse would be most appropriate? A)

Ask if the patient has been experiencing side effects.

Contact the patient’s physician for a different medication order.

Document the patient’s symptoms of tardive dyskinesia.

Instruct the patient to begin tapering off the medication.

A nurse is working as part of a team involved with the testing of a new psychiatric medication. The drug is currently being used in multiple clinical trials at various different 11. sites. The nurse is engaged in which phase of testing? A)

Phase I

Phase II

Phase III

Phase IV A nursing instructor is teaching a class on the pharmacodynamics of psychiatric medications. The instructor determines that additional teaching is needed when the

12. students identify which of the following as a site of action? A)

Receptor

Ion channels

Neurotransmitters

Enzymes A nurse is reviewing information about a psychiatric medication that describes the amount of the drug that actually reaches systemic circulation unchanged. The nurse

13. identifies this as which of the following? A)

First-pass effect

Bioavailability

Solubility

Biotransformation A patient receiving an antipsychotic agent develops acute extrapyramidal symptoms.

14.1 Which response by the nurse would be most appropriate? 4 These symptoms are not real; the medication makes your brain think they are . real. A) B)

You have developed an allergy to the medication, so we need to change it.

These are the results of the drug that can be treated; your illness is not getting C)

worse. The sunlight together with the medication has caused these symptoms; just stay

indoors. A group of nursing students are reviewing information related to drug therapy for mood disorders. The students demonstrate understanding of the information when they identify

15.1 which agent as the gold standard for treating bipolar disorder? 5 . A)

Carbamazepine

Lithium

Valproate

Lamotrigine A nurse administers a prescribed dose of lithium at 8 PM. The nurse would schedule a

16.1 specimen to be obtained for a blood level at which time? 6 . A) 10 PM B)

12 AM

4 AM

8 AM A nurse is preparing a continuing education presentation for a group of psychiatric mental health nurses about various psychopharmacologic agents. The nurse is planning to discuss selective serotonin reuptake inhibitors. Which agents would the

17. nurse include in this group? Select all that apply. A)

Fluoxetine

Duloxetine

Sertraline

Venlafaxine

Bupropion

Amoxapine A patient is brought to the emergency department by her brother, who reports that the patient became very agitated and started hallucinating. Further assessment reveals tachycardia, incoordination, vomiting, and diarrhea. The brother states that the patient is taking paroxetine for depression. Which of the following would the nurse most likely

18. suspect? A)

Neuroleptic malignant syndrome

Acute dystonic reaction

Serotonin syndrome

Hypothyroidism After teaching a patient who is prescribed imipramine about the drug, the nurse

19.1 determines that the teaching was effective when the patient states which of the following? 9 I need to be careful because the drug can make me sleepy. . A)

I don’t have to worry about getting dizzy when I get up from lying down.

I might notice some excess saliva in my mouth at different times.

I need to avoid foods with fiber because diarrhea can occur.

A patient with depression asks the nurse about possible herbal supplements. Which of the following would the nurse identify as being commonly used?

20.2 0 . A)

Valerian

St. John’s wort

Kava

Melatonin A nurse is preparing a patient for electroconvulsive therapy. Which of the following

21. would the nurse include in the patient’s plan of care? Select all that apply.

Ensuring that there is a signed informed consent on the patient’s chart

Telling the patient he can have fluids but no food before the procedure

Alerting the patient to the possibility of confusion after the treatment

Informing the patient that he can leave his dentures in place for the treatment

Ensuring that the patient is closely supervised for at least the first 12 hours afterwardThe nurse is reviewing the medical records of several patients receiving antipsychotic agents. Which factors, if noted, would the nurse identify as placing a patient at greater

22. risk for tardive dyskinesia? A)

Male gender

Age 30 to 45 years

History of depression

Short duration of treatment A patient is experiencing hallucinations and delusions. The nurse would expect the

23. physician to order which class of drug? A)

Mood stabilizer

Antipsychotic

Antianxiety agent

Stimulant After teaching a patient who is receiving phenelzine, the nurse determines that the

24. teaching was successful when the patient states the need to avoid which of the following? A)

Fresh cottage cheese

Cooked sliced ham

Tap beers

Soy milk A group of nursing students are reviewing the various drug classes used to treat psychiatric disorders. The students demonstrate understanding when they identify which

25. of the following as examples of antianxiety medications? Select all that apply. A)

Selegiline

Lorazepam

Buspirone

Zolpidem

Methylphenidate

Answer Key 1. B 2. D 3. A 4. B 5. C 6. D 7. D 8. D 9. D 10. C 11. C 12. C 13. B 14. C 15. B 16. D 17. A, C 18. C 19. A 20. B 21. A, C, E

22. C 23. B 24. C 25. B, C

Chapter 12- Cognitive Interventions A nurse is assessing a patient with a psychiatric illness. The nurse interprets which patient 1. statement as reflecting the concept of cognitive triad? I always mess things up. No matter what I do, my whole world is a mess, and my A)

future will be a big mess, too. My sister is always the pretty one, her world is free of problems, and she’ll have a

perfect future. My bosses think they know it all, that they can control the world’s future, and that

the entire planet is dependent on them. My mother used to always tell me bad things happen in threes like when

someone you know dies, you just know two other people you know will die. A nursing instructor is preparing a class lecture about cognitive behavioral therapy

2. (CBT). Which of the following would the instructor use to best describe this process? Solving patients’ problems for them by determining how they need to change their A)

thoughts and actions and developing a plan that will help them do so. Using techniques to modify a patient’s behavior shaping it into behavior that is

appropriate in order to help the patient experience a more positive future. Reinforcing distorted beliefs so they can play a major part in changing a patient’s

behavior for the better and improving his or her quality of life. Working in a trusting and collaborative relationship to help patients focus on solving

their own problems by changing the way they think and behave.

3. A nurse is working as part of an interdisciplinary treatment team caring for patients with psychiatric disorders. Based on the nurse’s understanding of cognitive behavioral therapy

(CBT) and its limitations cited by critics, the nurse would identify which patient as an inappropriate candidate for CBT? A)

A client diagnosed with substance abuse

A client diagnosed with depression

A client diagnosed with schizophrenia

A client diagnosed with an eating disorder A student does poorly on the first class exam of the semester. Although there are three more tests plus a final exam that will be given during the rest of the semester, the student believes that he will fail the course because of doing so poorly on the one exam. The

4. student’s belief reflects which type of irrational belief? A)

Low frustration tolerance

Absolute thinking

Catastrophizing

A demand A person was supposed to meet a friend at a local theatre to see a movie. The friend never showed up. The person’s initial thought was, My friend didn’t come because she doesn’t like me. This automatic thought was most likely inferred from which irrational

5. belief? A)

I’m worthless, so no one could really want to be my friend.

Movies are a waste of time and money anyway.

I’m sure she just got confused and thought we were going to a different movie. I’m so forgetful and confused sometimes; I probably wrote down the wrong

time.

6. During a staff meeting, a therapist mentions planning to use bibliotherapy with a patient. Later that morning, the patient approaches the nurse and says his therapist just talked to

him but that he is having trouble understanding what his therapist wants him to do. When the nurse asks him to clarify his concern, he asks what bibliotherapy really means. Which response by the nurse would be most appropriate? It entails listing books about your diagnosis alphabetically in a reference list in A)

case you ever want to read about your diagnosis. It is a new form of coping technique associated with shopping in a bookstore that

works to help lift your depression. It is a form of therapy based on your therapist teaching you knowledge that is

crucial to your recovery that he has collected from a variety of books. It is a form of therapy that entails you reading books about ways of perceiving

and responding to life events in a different way. A nurse is working with an adolescent girl who describes herself as a compulsive overeater and presents wT ithE S aT hiB stA orNyKoS f uEsL inLgEfoRo.dCtoOcMope with stress. The nurse decides to use journaling as an intervention for this patient based on the rationale that

7. journaling will help the patient identify which of the following? How often she eats compulsively in response to stress she encounters on a daily A)

basis

Patterns in her daily schedule that may be contributing to her compulsive eating

Behaviors in others that trigger her compulsion to eat in when she experiences stress Changes in her self-perception and responses to stress that she might otherwise not

notice A nurse who is working with a patient being treated for depression is using solutionfocused brief therapy (SFBT) during the patient’s brief psychiatric hospitalization. The nurse decides to use an exception question. Which question would the nurse most

8. likely use?

When did you first feel depressed?

When do you not feel depressed?

What feelings contribute to your depression?

What has to happen for you to feel depressed? A group of nursing students is reviewing the history of the development of cognitive therapies over the years. The students demonstrate understanding of the information when they identify which individual as being responsible for first developing cognitive therapy

9. interventions? A)

Aaron Beck

Sigmund Freud

Albert Ellis

de Shazer and Berg During a solution-focused behavior therapy session, the therapist asks a patient to use his imagination based on a scenario in which a patient awakens and all his problems have disappeared. The therapist then asks the patient, How would your life be different?

10. Which type of question is the therapist using? A)

Exception question

Miracle question

Relationship question

Scaling question A nursing instructor is preparing a class presentation for a group of nursing students about cognitive behavioral therapy. Which of the following would the instructor be least likely

11. to include? A)

An event is the underlying issue causing the disturbance.

An individual has a belief regardless of how it developed.

Practice can help to alter the belief causing the problem.

Negative inaccurate thoughts can be replaced. A nurse is preparing to reinforce the use of cognitive behavior therapy with a patient.

12. When interacting with the patient, which of the following would be appropriate? A)

Having the nurse establish the agenda

Focusing primarily on behavior

Using a future-oriented goal focus

Identifying the problem from the nurse’s perspective A patient is being treated in an interdisciplinary clinic. During interactions with a patient who is receiving cognitive behavior therapy, which of the following would the nurse

13. concentrate on first? A)

Identifying alternative explanations of an event

Exploring evidence to support or refute the beliefs

Identifying the underlying beliefs

Examining the real implications if the beliefs are true

TESTBANKSELLER.COM

A group of nursing students is reviewing information about cognitive processes and the development of mental disorders. The students demonstrate a need for additional review 14. when they identify which of the following as being involved? A)

Cognitive triad

Cognitive distortions

Schema

Compliments When engaged in rational emotive behavior therapy, which of the following would be

15. addressed during the activating event sequence? A)

Teaching the connection between beliefs and consequences

Assessing the consequences of the problem

Facilitating the working-through process

Preparing patient to deepen conviction in rational beliefs A group of nursing students is preparing a class presentation comparing the different types of cognitive therapies. When describing solution-focused brief therapy, which of the

16. following would the students identify as being different from the other therapies? A)

Focus on functional aspects of the patient

Challenge about the existence of problems

Assumption that change is not constant

View of the past rather than the present During a therapy session, a patient is asked to rate the intensity of his current issue from 1 to 10 with 1 being complete absence of the issue and 10 being the most intense. The

17. patient is being asked which type of question? A)

Relationship

Miracle

Scaling

Exception A nurse is reading a journal article about cognitive behavior therapy techniques used in various settings. In which setting would the nurse expect to find solution-focused therapy

18. being used? A)

Acute inpatient setting

Community setting

Clinic setting

Home care setting

Answer Key 1. A 2. D

3. C 4. C 5. A 6. D 7. D 8. B 9. C 10. B 11. A 12. C 13. C 14. D 15. B 16. A 17. C 18. A

Chapter 13- Group Interventions The nurse is preparing to form a group in an inpatient psychiatric setting for patients who have experienced trauma. In addition to the group leader, the nurse would anticipate 1. including how many patients? A)

Three or four

Five or six

Seven or eight

Nine or 10 While participating in a group therapy session, one group member consistently asks for clarification of the topic the group is discussing. The nurse leading the group interprets

2. this behavior as reflecting which group role? A)

Coordinator

Recorder

Information seeker

Standard setter While leading a small group, the nurse sets up the ground rules at the beginning of the group’s first meeting. One of the rules established is that the group will always start at the specified time rather than waiting to start until after everyone has arrived. This rule

3. reflects which of the following? A)

Group norms

Group cohesion

Group think

Group process

4. The nurse has begun group counseling sessions for several hospitalized patients in the

psychiatric facility. Which of the following would be most effective for the nurse to do to promote group cohesiveness? A)

Use team-building exercises.

Encourage task completion by members.

Spend time with each member individually.

Be consistent with the group themes. In an initial group therapy session, the nurse observes that one group member continually tries to monopolize the conversation. The nurse interprets this behavior as reflecting

5. which of the following in the patient? A)

Anxiety

Anger

Rebellion

Fear

TESTBANKSELLER.COM

The nurse is leading a small group of hospitalized patients diagnosed with psychiatric disorders. One group member has asked for advice and often agrees with suggestions by other group members but then adds, Yes, but . . . to every suggestion offered. Which 6. response by the nurse would be most appropriate? A)

Things would probably work out better if you joined a different group. Do you realize you say, ‘Yes, but . . .’ to every suggestion the group has for

you? I suggest you stop and think about why you always respond to suggestions with

‘Yes, but . . .’

What solution do you think would work best for you?

7. A patient has been placed in an anger management group because he has trouble controlling his angry outbursts. The nurse interprets this type group as an example of

which of the following? A)

Psychotherapy

Self-help

Psychoeducation

Supportive therapy A nurse is leading a group in which members are encouraged to discuss their feelings and emotions. The group session is just starting when a patient stomps into the room, slams his notebook down on a table, and sits down. His affect is one of anger and hostility.

8. Which response by the nurse would be most appropriate? A)

Keep the focus off the patient so his anger has time to de-escalate. Suggest the patient make a private counseling appointment to address his anger

issues.

Ask the patient to leave the group until he is calmer.

Encourage the patient to discuss his anger with the group. A nurse is leading a group on an adolescent psychiatric unit. A new member in the group is from out of state; his accent and his way of dressing set him apart from the other patients; and it is obvious that the group, for the most part, dislikes this patient. During the group session, the nurse has the members draw the emotion they are feeling and then has them present their drawings and explain them to the group. Which of the following

9. would be the most effective way to address the group’s dislike for the new member? A)

Skip him when it is his turn to present his drawing.

Let the patient talk last so the others will not have time to make fun of him.

Compliment the patient when he presents his drawing.

Demand that each member of the group tell the patient why they dislike him.

10. A group of nursing students is reviewing information about the different types of group.

The students demonstrate understanding of the information when they identify which of the following as a characteristic of a self-help group that differentiates it from a supportive therapy group? A)

The group is led by a professional.

The group is led by a consumer.

There is no identified leader.

The group is focused on a specific problem. A nurse is preparing to lead an older adult group. Which of the following would the nurse

11. need to keep in mind when leading this group? A)

Focusing the group to promote learning of new information

Keeping the pace of the group meetings slow

Discouraging the use of life review strategies

Teaching entirely new methods for coping

TESTBANKSELLER.COM

A group of nursing students is reviewing information about open and closed groups. The students demonstrate understanding of the information when they identify which of the 12. following as an example of an open group? A)

Outpatient smoking cessation group

Community clinic psychoeducation group

Ambulatory psychotherapy group

Inpatient anger management group A nurse is deciding about the size of the group. The nurse determines that a large group

13. would be best based on which of the following? A)

Transference and countertransference issues will be moderate to minimal.

Group cohesiveness will be strong with greater interpersonal experiences.

The number of potential interactions and relationships is limited.

The group is effective for dealing with a specific issue.

A nurse is acting as the leader of a newly formed group that is in the beginning stage of 14. development. Which of the following would the nurse expect to do? Select all that apply. A)

Develop rapport with the group members

Anticipate members testing one another

Work with members to develop norms

Promote sharing of feelings

Facilitate verbal and nonverbal communication After teaching a class about formal and informal roles of group members, the instructor determines that the teaching was successful when the class identifies which of the

15. following as a formal role? Select all that apply. A)

Coordinator

Leader

Member

Harmonizer

Information seeker While leading a group, a nurse leader says to a patient, This is the fourth time that you’ve changed the subject when we have talked about child abuse. Is something going

16. on? The nurse is using which technique? A)

Support

Confrontation

Summarizing

Clarification During a group session, one of the members states, Let’s keep this discussion going so that everyone can participate, but let’s keep the time each person speaks to about 3

17. minutes. The leader interprets this member as acting in which role? A)

Group observer

Gatekeeper

Encourager

Energizer When leading a group, the nurse determines that several of the group members have assumed roles that may be interfering with the group’s function. Which roles might be

18. involved? Select all that apply. A)

Self-confessor

Follower

Dominator

Elaborator

Playboy

Compromiser A group of nursing students is reviewing the factors associated with group psychotherapy

TESTBANKSELLER.COM

through which therapeutic changes occur. The student’s demonstrate understanding when 19. they identify which of the following as a factor? Select all that apply. A)

Altruism

Catharsis

Repressed behavior

Universality

Hopelessness A psychiatric mental health nurse is preparing to lead a medication group. Which of the

20. following would be most important for the nurse to assess? Select all that apply. A)

Cognitive abilities

Medication knowledge

Reading skills

Writing abilities

Use of a specific medication

Answer Key 1. C 2. C 3. A 4. A 5. A 6. D 7. C 8. D 9. C 10. B 11. B 12. D 13. D 14. A, B 15. B, C 16. B 17. B 18. A, C, E 19. A, B, D 20. A, B, C, D

Chapter 14- Family Assessment and Interventions While caring for a family, the nurse determines that first-order changes have occurred 1. with which of the following? A)

The children are all in school, and the parent returns to work.

The daughter leaves home to attend college.

The son marries his long-time sweetheart and moves into his own home.

The grandmother who has been living in the household dies. The nurse is assessing a family system applying the family system framework model.

2. Which assessment would be important for the nurse? A)

Acceptance of the family rules

Adjustment to the famT ilyES boTuB ndAaN riK esSELLER.COM

Degree of enmeshment in the system

Interpersonal differentiation While assessing a family system, the nurse uses the structural family system model by Minuchin. The nurse focuses the assessment on which of the following about the family

3. members? A)

Boundaries

Emotional cutoff

Sibling position

Family projection process

4. A female patient is an adolescent who recently tried to overdose because her boyfriend broke up with her. Her father is a single parent, and he has been drinking excessively to cope with his stress. The patient tells the nurse that whenever she needs to talk to her

father, he is always drunk or away drinking with his drinking buddies. Based on this information, which nursing diagnosis would be most appropriate for this patient’s family? A)

Ineffective Family Therapeutic Regimen Management

Compromised Family Coping

Ineffective Denial

Caregiver Role Strain A family has recently lost all their belongings when their house burned down. They have been living in temporary housing. Although the parents were previously very supportive and able to help their young children with their homework in the evenings, they have been unable to do so under their present circumstances. Based on this information, which

5. nursing diagnosis would be most appropriate for this family? A)

Interrupted Family Processes

Compromised Family Coping

Ineffective Family Therapeutic Regimen Management

Caregiver Role Strain A male patient has recently been diagnosed with type II diabetes. His family is having trouble incorporating the dietary and exercise regimen prescribed by his physician into their daily routines. They tell the nurse that they are all tired when they return home from school and work and that the last thing any of them want to do is go on a walk. In addition, the patient’s wife discloses that she is unable to prepare any sugar-free or lowsugar foods that her husband enjoys eating. Based on this information, which nursing

6. diagnosis would be most appropriate for this family? A)

Interrupted Family Processes

Ineffective Denial

Caregiver Role Strain

Ineffective Family Therapeutic Regimen Management A couple who have a 7-year-old son have been experiencing growing tension and anxiety in their relationship. However, the tension and anxiety between them lessened when the mother began focusing most of her attention on the son. When applying the family systems therapy model concept of triangulation, which of the following would the nurse

7. expect to assess in the child? A)

Enjoying his mother’s increasing attention and growing even closer to her

Growing distant from his father and blaming him for all of the family’s problems

Developing problematic symptoms in response to his mother’s increasing attention

Resenting mother for her suffocating attention and his father’s growing distance A nursing instructor is developing a teaching plan for a class about families. Which of the

8. following would the instructor be most likely to include? A)

Families are primarily determined by blood.

New members are added by birth, marriage, or adoption.

In the United States, family size has been on the increase.

Families are less mobile today than in the past. A group of nursing students is reviewing information about the changing family structure and its effect on mental health and illness. The students demonstrate understanding of this

9. information when they identify which of the following? A)

Middle-aged childless adults are more vulnerable to loneliness and depression. In stepfamilies, caring for the children often is a primary stressor to the marital

partners.

Separation because of relocation provides additional support from extended family.

Same-sex families typically demonstrate lower rates for depression and stress.

10. A nurse is planning a support group for the families of patients with psychiatric disorders.

The nurse integrates knowledge of which of the following as the primary underlying issue related to stress that the families experience? A)

Severity of the patient’s symptoms

Barriers faced by the patient

Stigma associated with the diagnosis

Risk for relapse A nurse is assessing a family of a patient with a persistent mental disorder. In comparing this family to one without a member who has a mental disorder, which function would the

11. nurse expect this family to serve? Select all that apply. A)

Providing support

Providing socialization

Advocating for services

Providing information

Monitoring services A nurse is engaged in developing a relationship with a family during a family assessment.

12. Which of the following would be important? Select all that apply. A)

Demonstrating culturally competent nursing skills

Completing the assessment efficiently in the first meeting

Identifying the family’s immediate needs

Exhibiting a professional image

Investigating the adherence to the medication regimen A nurse is constructing a genogram of a family. Which of the following would the nurse

13. do? A)

Use circles to represent the male members.

Use horizontal lines to connect the parents with children.

Use horizontal lines to show marriages.

Use asterisks to denote ages listed at the bottom. Assessment of a family reveals that the youngest child has moved out of the family home to live by herself. One of the other two children is married, and the other child has just gotten engaged. The nurse interprets this family to be in which stage of the family life

14. cycle? A)

Families with adolescents

Launching children and moving on

Families in later life

Leaving home: single young adults A nurse is assessing the communication patterns in the family. When observing the interaction, which of the following would be important to keep in mind? Select all that

15. apply. A)

Who sits next to who?

Which topics are not addressed?

Which situations are identified as stressful?

Who makes the decisions for child care?

How does the family handle conflict? A group of nursing students is reviewing system models used in caring for families. The students demonstrate understanding of the information when they identify which of the

16. following as characteristic of the Calgary Family Model? A)

Differentiation of self

Sibling position

Family development

Subsystems A nurse is using a genogram as an intervention strategy based on the understanding of

17. which of the following?

It provides information about appropriate methods for problem solving.

It allows the family to view its evolution over several generations.

It permits a subjective yet factual perspective of family relationships.

It provides a means for identifying the family’s beliefs about mental illness. A nurse is working with a family and using the Calgary Family Model. Problems have

18. been identified, and the family being in which stage of the model? A)

Engagement

Assessment

Intervention

Termination

Answer Key 1. A 2. D 3. A 4. B 5. A 6. D 7. C 8. B 9. B 10. C 11. A, C, D, E 12. A, C, D 13. C 14. B 15. A, B

16. C 17. B 18. B

Chapter 15- Mental Health Promotion for Children and Adolescents While caring for a family who lost a 10-year-old son in a car accident, the nurse should 1. instruct the parents to tell the 4-year-old sister which of the following about her brother? A)

He died and is not coming back.

He passed on to the other side.

He departed on a long journey.

He has gone to see the Lord above. The nurse is counseling a family with a 10-year-old child after the death of a favorite uncle. The nurse provides guidance to the parents, informing them that the child may

2. exhibit which of the following as a response? A)

Talk about scary, morbid novels all the time.

Complain of aches and pains, stomachaches, that sort of thing.

Suddenly become afraid of leaving home to go to school.

Become obsessed with religious rituals, Bible verses, and prayer. The nurse is counseling a family with two parents and two children, ages 8 and 10 years. The mother complains that the children are constantly fighting and have intense sibling rivalry. When statement would be most appropriate when advising the parents about how

3. to respond to the sibling rivalry? Try reacting to each as unique individuals with talents and interests distinctly A)

their own.

Be firm about telling the children they have to cooperate with one another.

Slowly decrease the amount of attention and control shown to the older child.

Make sure they have a quiet, subdued home environment to avoid stimulating

conflict. A 3-year-old child has been admitted to the hospital after an automobile accident. Which statement by the nurse would be most appropriate when discussing the type of behavior 4. the parents can expect their child to display while hospitalized? Your child may not be able to accept how the injury has changed your child’s A)

appearance.

Your child may seem unduly anxious in the presence of strangers.

Your child may experience some guilt feelings associated with the accident. Your child will exhibit intermittent periodic mood swings, but these should be

brief. A nurse is providing care to several chronically ill children. Which of the following

5. would the nurse identify as having the greatest risk for developing a psychiatric problem? A)

12 year-old with diabetes mellitus

5 year-old with cerebral palsy

8 year-old who has chronic renal disease

10 year-old with a heart murmur The nurse is planning a counseling session with a group of at-risk adolescents on

6. the topic of drug abuse. Which teaching strategy would be most effective? Handing out educational pamphlets and showing slides of car accidents related to A)

teen drug use. Showing informational videotapes and providing Internet addresses on the topic of

drug addiction. Giving information by lecturing and using pre- and posttest quizzing about the

information.

Involving peers in teaching the effective group problem-solving skills.

The nurse is counseling a family with a child who has been abused by adult family friend in the past. When explaining about the child’s needs, which of the following would be 7. most important for the nurse to stress? A)

A supportive relationship with an adult

Long-term psychotherapy

Antidepressant medications

Short-term separation from the parents The nurse is planning an initial therapy session with a 20-year-old patient whose parents had alcoholism. The nurse anticipates that the patient would most likely exhibit symptoms

8. of which of the following? A)

Delusions

Paranoid delusions

Low self-concept

Extroversion A home-health nurse is working with a poverty-stricken family that has two small children, ages 2 and 3 years. The family lives in an isolated rural area. The family’s home has a dirt floor, and there are chickens living in the house with the family. Because of a recent wind storm, there is a sizeable hole in the roof that lets rain and snow into the

9. house. Which nursing intervention would be the highest priority in this situation? Make immunization appointments for the children in a nearby town’s public health A)

clinic. Help the family find funding and manpower to patch and repair the roof of their

home.

Determine the educational readiness of the two children.

Report the family for child abuse because of neglect.

While engaging in a discussion with a group of teens about risk behaviors, one of the teens says, That will never happen to me. The nurse interprets this as which of the 10. following? A)

Invincibility fable

Formal operations

Egocentric thinking

Relational aggression A nurse is working with a family in which the parents have just gotten divorced. After teaching the parents about measures to reduce the risk of emotional problems for the

11.1 children, which statement by the parents indicates a need for additional teaching? 1 We will try to alter their routines so they don’t think about the past. . A)

We will make sure that they understand that they did not cause the divorce.

We will develop a regular and consistent schedule for visitation.

We will make sure that we are consistent in the limit that we set.

A group of nursing students is reviewing information about the differences that occur with grieving in children, adolescents, and adults. The students demonstrate understanding of this information when they identify which of the following as characteristic of adolescents?

12.1 2 . A)

View death as reversible

Mourn by talking about the loss

Need repeated explanations to understand the loss

Express a time limit for socially acceptable grieving A nurse is working with a child for which an out-of-home placement has occurred. Which

13. of the following would the nurse anticipate as the child’s initial response? A)

Despair

Withdrawal

Protest

Detachment The nurse is working with a child who has engaged in bullying. Which of the following

14. would be most effective for the nurse to implement? A)

Psychoeducation

Bibliotherapy

Early intervention program

Social skills training A nurse is developing a plan of care for a family who is experiencing problems related to their child’s chronic illness. The nurse plans to have the family read a group of short stories written by parents of children with chronic illnesses. The nurse will be using

15. which technique? A)

Psychoeducation

Social skills training

Bibliotherapy

Assertiveness training After teaching a class about childhood and adolescent mental health, the instructor determines that additional teaching is needed when the class identifies which of the

16. following as promoting mental health in children? A)

Difficult temperament

Age-appropriate physical development

Secure attachment

Normal psychosocial development A nurse is providing teaching to a group of parents with children and adolescents who have experienced losses. The nurse determines that the teaching was successful when the

17. group states which of the following?

Children grieve in similar ways regardless of their age.

Children often use fantasy to fill in their gaps in understanding.

Families tend to grieve at similar times after the loss.

Children and adults grieve much in the same manner.

Answer Key 1. A 2. B 3. A 4. B 5. B 6. D 7. A 8. C 9. B 10. A 11. A 12. B 13. C 14. D 15. C 16. A 17. B

Chapter 16- Mental Health Promotion for Young and Middle-Aged Adults A female patient, who is in her late 30s, is describing her home life to the nurse. The nurse determines that the patient is a member of the sandwich generation based on which 1. of the following? She has a young adult child at home and an elderly parent to care for at the same A)

time.

She has a young adult child who is married and currently living away from home.

She has a young adult child away at college and without any living parents.

She has no responsibilities associated with her young adult children or her parents.A nurse is teaching a class at a community health center on the topic of attributes that influence good health in the adult population. Which of the following would the nurse

2. correlated with being married? A)

Engaging in more health risking behaviors

Having more serious psychological stress if a married middle-aged woman

Consuming more alcohol and smoking more cigarettes

Having a higher incidence of being overweight or obese if a middle-aged man A nurse is participating in a neighborhood health fair and is screening participants for depression. Which individual would the nurse anticipate as being at increased risk for

3. depression? A middle-aged man who is providing care for his disabled mother who has A)

paraplegia

A middle-aged man who is a single parent of a teenage boy who is still living at

home C) D)

A woman who is single and has no children of her own A young adult who is living at home with his parents and is unable to find work A school nurse is teaching a class of adolescents about healthy behaviors. Which of the following activities include as a means for preventing anxiety and depression when they

4. are middle-aged adults? A)

Restricting their sugar and fat intake

Refraining from smoking or doing drugs

Engaging in physical activity and exercise

Becoming active in local church activities A psychiatric mental health nurse is responsible for performing admission assessments of a population that primarily involves young and middle-aged adults. When performing

5. these assessments, which area would be a priority? A)

Coping skills

Cognition

Self-esteem

Suicide risk A nurse is developing a presentation for a local community group of young and middleaged adults about common psychosocial problems. Which of the following would be least

6. appropriate for the nurse need to integrate into the presentation? A)

The age range for individuals in this category is from 18 to 65 years of age.

These categories are specific to Western culture secondary to a lengthened lifespan. Longer periods of development for this group have become the norm throughout the

world. These categories apply primarily in the United States because of superior

technologic advances.

A 72-year-old woman is participating in a health fair that is being held at a local community center. Basic psychiatric screening will be provided by mental health 7. professionals. Which of the following problems would this screening most likely reveal? A)

Anxiety Disorder

Psychosocial Impairment

Mood Disorder

Cognitive Impairment A nurse is participating as a speaker in a public workshop on the topic of promoting mental health in young and middle-aged adults. The nurse tells the audience that age, unemployment, and lower education are risk factors associated with mental illness. A woman raises her hand and asks, Does that mean because I only have a 10th grade education and am unemployed that I will develop a mental illness? Which response by

prE opSrT iaB teA ? NKSELLER.COM 8. the nurse would be most apT No, not necessarily; it just means that there is an increased chance that you A)

might. Of course not; we live in a rural area, and these statistics are based on large

cities. Yes, I am afraid so, but with early detection, we can prevent the illness from

worsening. It probably does, but we have developed advanced medications to treat mental

illness. A nurse is preparing a presentation for mental health promotion for young and middleaged adults and is planning to address changes in family structure. Which of the following

9. would the nurse include as reflecting marriage? A)

The peak marriage age is between 28 to 32 years.

Those marrying in their teens are more likely to get divorced.

Middle-aged adults are most likely to be married.

People who marry between the ages of 23 to 27 years are likely to get divorced. A nurse is providing an in service program for a group of nurses who are providing home care to middle-aged adults. When describing the typical caregiver, which characteristics

10. would the nurse include? Select all that apply. A)

Female gender

Average age of 40 years

Married

Working within the home

Median income of $20,000/year A nurse is assessing a middle-aged adult for possible biologic risk factor associated with mental illness. Which of the following would the nurse identify as placing this patient at

11.1 increased risk? Select all that apply. 1 . A)

Changes in skin tone and moisture leading to the development of wrinkles

Enhanced respiratory efficiency leading to preference for less activity

Loss of lens elasticity leading which can affect a person’s self-esteem

Changes in brain structure leading to changes in cognition

Decreased basal metabolic rate leading to weight gain and low activity A group of nursing students is reviewing the results of the Behavioral Risk Factor Surveillance System. The students demonstrate understanding of this information when they identify which group as experiencing the greatest number of sad, blue, or depressed

12. days (SBDD)? A)

Women

Men

Young adults

Older adults A psychiatric mental health nurse is assessing a woman for possible factors related to

13. suicide. Which of the following would the nurse be least likely to identify? A)

Smoking

Poor self-rated health

Low education

Drug use A nurse is providing teaching to a young adult about measures to promote mental health.

14.1 Which statement by the patient would indicate a need for additional teaching? 4 I will make sure that I eat foods that are nutritious. . A)

I need to allow some time for relaxation every day.

I will make sure I have the support of two really good friends.

I have to work to make sure that I get enough sleep every night. After

teaching a group of stT udEeS ntTs B abAoN utKpSroEtL ecLtiE veRf. acCtoOrM s for mental illness, the instructor determines that the teaching was successful when the students identify which of the following?

15.1 5 . A)

Unemployment

Younger age

Single status

Social support When describing mental health to a community group ranging in age between 25 and 50 years, the nurse includes information about the developmental concepts that are often readdressed when life stresses occur. Which developmental concept would the nurse be

16. least likely to address?

Identity

Ego integrity

Generativity

Intimacy

Answer Key 1. A 2. D 3. A 4. C 5. D 6. C 7. D 8. A 9. C 10. A, C 11. A, C, E 12. C 13. A 14. C 15. D 16. B

Chapter 17- Mental Health Promotion for Older Adults The nurse is preparing to assess a 78-year-old patient who has been diagnosed with major 1. depression. Which of the following would the nurse expect to assess as a normal finding? A)

Decrease in body fat

Increased muscle mass

Dulled taste sensation

Enhanced visual acuity A group of nursing students is reviewing the physical changes that occur in older adults. The students demonstrate understanding of the information when they identify which of

2. the following as contributing the patient’s risk for drug toxicity? A)

Reduced liver function

Reduce brain gray matter volume

Lower metabolic rate at rest

Decreased body water An older patient tells the nurse that she is becoming more forgetful. The nurse explains to

3. the patient that this is most likely related to which of the following? A)

Anxiety

Organic brain syndrome

Plaques in the brain tissue

Medications While assessing an older adult, the nurse allows ample time for the patient to respond

4. based on the understanding of which of the following? A)

Ample time ensures that the correct answer is given.

The patient is most likely experiencing irreversible memory impairment.

The patient is experiencing decreased cerebral oxygen flow from reduced activity. Ample time is needed to weigh the pros and cons of the perceived risk for

answering. The nurse is planning a presentation to a group of older adults on the topic of suicide in the population. One of the group participants asks who has the highest risk of suicide.

5. Which response by the nurse would be most appropriate? Older adults who have multiple prescriptions from a variety of different A)

pharmacies.

Older adults who are experiencing a deep and profound depression.

Older adult women who are divorced or widowed.

Men over the age of 75 years who are divorced or widowed. The nurse is working with a patient whose mobility is impaired secondary to a fall that resulted in a broken hip. In addition, the patient, who has diabetes, is developing problems with vision and hearing. The patient seems increasingly withdrawn and depressed. The nurse determines that the patient is at risk for spiritual distress. Which

6. intervention would be most appropriate? A)

Encourage the patient to talk about significant childhood religious experiences.

Offer to take the patient to a revival the nurse’s church is holding in the community. Read to the patient Bible passages that seem particularly relevant to the patient’s

C) D)

case. Explore what the mobility, sight, and hearing changes mean to the patient. After checking a patient’s blood pressure, he asks the nurse what changes he should expect in himself as he grows older. Which response by the nurse would be most

7. appropriate?

You don’t have anything to worry about; you will basically stay the same. Your personality will stay the same, but your intelligence level will lessen

somewhat.

Usually, you can anticipate that you will begin to react to things more slowly.

You will become increasingly childlike, and your personality will change. A nurse is reviewing the medical records of several older adult patients. The nurse determines that which individual would have the least chance of developing mental health

8. problems with aging? A man who is single, has an eighth grade education, and walks to the mailbox and A)

back every day A woman who is married with graduate education, eats nutritionally balanced meals,

and exercises for 20 minutes each day A man who is married, has a high school education, eats mostly fast food, and walks

a mile each day A woman who is single, has a college degree and watches what she eats but really

does not exercise The nurse is presenting a community educational program focusing on older adults and mental health protective factors. One of the participants asks what the influence of coparenting one’s grandchild has on the mental health of the grandparent. Which response

9. by the nurse would be most appropriate? The well-being of grandmothers is statistically more significant when they coA)

parent their grandchildren. Although there are stresses involved with grandparenting, the positive benefits

appear to outweigh the negatives.

White grandmothers experience less well-being when they co-parent their

grandchildren. The perceived well-being of grandfathers who co-parent their grandchildren D)

significantly changes in a positive direction. A nursing student is reading an article about protective factors for mental illness with older adults. The article mentions the individual’s ability to adapt successfully to stress,

10.1 trauma, or chronic adversity. The student identifies this as which of the following? 0 . A)

Functional status

Gerotransendence

Resilience

Empty nest A nurse is reviewing the medical records of several older adult patients who have come to the clinic for evaluation. The nurse would classify a patient of which age as being in the

11.1 middle-old stage? 1 . A) 66-year-old adult B)

70-year-old adult

78-year-old adult

86-year-old adult While assessing an older adult patient for mental health issues, the nurse pays special attention to the patient’s sensory function based on the understanding of which of the

12.1 following? 2 Most older adults follow a specific pattern of decline in functioning leading to . gradual onset of problems. A)

Sensory decline may affect the individual’s ability to process information, possible influencing the findings of the mental status examination.

B) C)

Diminished sensory function can lead to changes in other body systems that may

affect the individual’s reaction to prescribed medications. Changes in the senses can result in changes in cognitive abilities that mimic the D)

manifestations of mental disorders. A group of nursing students is reviewing information about the course of aging in future older adults and qualities that contribute to successful aging. The students demonstrate understanding of this information when they identify which of the following as least

13.1 important? 3 . A)

Capacity to adapt to change

Engagement in life

Stability with reliable social support

Physical health A nurse is preparing to conduct an assessment of a 79-year-old woman who has come to the clinic for evaluation. When performing this assessment, which of the following would

14.1 be most appropriate for the nurse to do? Select all that apply. 4 . A)

Dim any lights that appear too bright.

Face the patient from the side.

Use short, simple sentences.

Focus on one topic at a time.

Speak slowly in a shouting tone. A nursing instructor is preparing for a class discussion on polypharmacy and older adults.

15. Which of the following would the instructor expect to include? A)

The risk for drug abuse, although present, is fairly rare in this population.

Older adults often experience a greater risk for adverse reactions. Medications are usually prescribed in higher doses initially and then gradually

reduced.

Age-related pharmacokinetic changes enhance the drug’s therapeutic effectiveness.

A group of nursing students is reviewing risk and protective factors associated for mental disorders in the older adult population. The students demonstrate understanding of the 16. information when they identify which of the following as a protective factor? A)

Poverty

Education

Loss

Chronic illness The nurse is working as part of a team to help reduce the stigma attached to mental health treatment for the older adult population. Which of the following would be most

17. appropriate to do to achieve this outcome? A)

Provide education about mental health and mental disorders.

Initiate screening programs for symptoms.

Ensure older adults received integrated community care.

Institute a wide range of social support services. A nurse is developing a plan for establishing appropriate supportive community care services for older adults to promote independence. Which services would the nurse be

18. most likely to include? Select all that apply. A)

Transportation

Homemakers

Legal

Housing

Child care

Answer Key 1. C 2. A

3. D 4. A 5. D 6. D 7. C 8. B 9. B 10. C 11. C 12. B 13. D 14. A, C, D 15. B 16. B 17. A 18. A, B, C, D

Chapter 18- Stress and Mental Health A nurse is performing an assessment interview with a patient. The patient tells the nurse that he has a type A personality. Based on the nurse’s interpretation, the nurse would 1. expect which behavior by the patient? A)

Appearing relaxed and easygoing throughout the interview

Wanting the interview to be over as quickly as possible

Being pleased with the overall pace of the interview

Speaking slowly, requiring time to consider his answers A nurse is assessing a patient and the patient’s social networks. When evaluating this area, the nurse integrates knowledge that which of the following is an important

2. component? A)

Blood relationships

Bonding with one another

Reciprocity

Emotional support A patient visits the clinic and tells the nurse about being under a great deal of stress on the job for the past month. Applying the factors that determine the stress response, which

3. question would be most appropriate for the nurse to ask? A)

What effect is the stress having on your job performance?

How would you describe the social network within your family?

What is the specific event that you find most stressful?

When did you first become aware of experiencing this stress?

4. The nurse is caring for a patient with chronic stress for the past month because of job loss and financial difficulties. When evaluating the patient’s assessment findings, the nurse

would anticipate finding an elevated antibody titer to which of the following? A)

Herpes simplex viruses

Herpes zoster viruses

Acquired immune deficiency viruses

Influenza viruses The nurse is caring for a patient who has been under severe stress while caring for her elderly mother who is in the advanced stages of Alzheimer’s disease. The nurse explains that the patient is adapting to the stress is she is experiencing because of which of the

5. following? A)

Ability to survive in the midst of severe stress

Acceptance of others’ help in caring for her mother

Success at being able to solve problems

Capability in setting reasonable personal goals

TESTBANKSELLER.COM

The nurse is preparing to care for a patient under severe stress resulting from caring for her elderly aunt diagnosed with leukemia. When assessing the patient’s psychological 6. domain, which question would the nurse ask first? A)

Let’s talk about what you have been feeling.

Tell me about your depressed moods.

How long have you been caring for your aunt?

Are you feeling overwhelmed by caring for your aunt?

7. A patient has come to the clinic to discuss the stress she is experiencing because of failing two exams at school. Initially, she described her failures as the worst thing that has ever happened to me, and she stated, “There is absolutely nothing I can do to pass this course now. In response to the nurse’s questions, the nurse finds out there are three more equally weighted exams scheduled for the course in question. The nurse and patient

collaborate and decide to use interventions to facilitate emotion-focused coping. Which additional comment from the patient would the nurse identify as providing support for this decision? A)

You’ve got to figure out something for me to do to get me out of this situation! This is a waste of time because absolutely nothing you or I can do will make it

any better.

I overreacted; surely together we can figure out something for me to do.

This is the worst thing that could ever happen to me. I’m nothing but a failure. A nurse is reviewing the assessment findings of several patients. Which patient would the

8. nurse identify as having a type D personality? A man who threatens the receptionist in the emergency department with bodily harm A)

if a doctor does not see him right away A woman who sits quietly reading in a waiting room before seeing her doctor for her

annual physical examination A quiet teen who drinks a six pack of beer against his better judgment because of

peer pressure A man who reacts negatively to almost everything but never discusses his feelings

with anyone A patient is talking to the nurse about her friendship with another person. She comments, That person is always there for me, and I am always there for her. We help each other out; sometimes she’s helping me, and sometimes I am helping her. The nurse interprets

9. the patient’s statements about her social network as reflecting which of the following? A)

Denseness

Reciprocity

Social support

Constraints After interviewing a patient about social supports, the nurse determines that the patient is

10.1 experiencing emotional support from these social supports based on which statement? 0 I’m glad I have someone that I can talk to. . A)

The person who cut my lawn was great!

I received a small community grant for groceries.

The senior center gave me a booklet about my medications.

A nurse is assessing a patient and uses the Recent Life Changes Questionnaire as part of the assessment. The nurse determines that the patient has experienced major life crisis with which score on the questionnaire?

11.1 1 . A)

150

250

350

450 A group of students are reviewing the events associated with the fight-or-flight response. They demonstrate understanding of the information when they identify which of the

12. following results from sympathetic nervous stimulation? A)

Hypoglycemia

Tachycardia

Hypotension

Hypercoagulability During an interview, a patient states, I feel so guilty, and I’m so ashamed of what I

13. did. The nurse interprets this as which of the following? A)

Negative emotion

Positive emotion

Borderline emotion

Nonemotion A group of nursing students is reviewing information about emotional responses to stress and the themes associated with them. The students demonstrate understanding of the information when they identify which emotion as associated with being moved by

14. another’s suffering and wanting to help? A)

Relief

Hope

Compassion

Love A nurse has completed an assessment of a patient who is experiencing significant stress. The assessment revealed intense anger and acting out behaviors along with statements of

15. negative emotions. Which nursing diagnosis would be most appropriate? A)

Disturbed though processes

Low self-esteem

Hopelessness

Ineffective coping A nurse is conducting an assessment of a patient’s social network. Which of the following

16.1 would the nurse assess? Select all that apply. 6 How big is your network of contacts? . A)

What benefits do you receive from these people?

Who is responsible for providing the support?

Do any of the members know one another?

D) E)

What services do you think might be helpful? After teaching a group of students about appraisal and the stress response, the instructor determines that additional teaching is needed when the students identify which of the following as part of the primary appraisal?

17.1 7 .

Relevance of the goal

Consistency of goal with values

Personal commitment

Outcome explanation While leading a student class presentation about general adaptation syndrome and its

18. stages, which of the following would the student describe as the final stage? A)

Perception of a threat

Use of coping mechanisms

Physiologic response

Exhaustion When describing the concept of allostatic load to a group of students, which of the following would the instructor identify as abnormalities of which of the following as

19. indicative of the overall changes?

TESTBANKSELLER.COM

Nuclear imaging studies

Laboratory test results

Bone radiographs

Cardiac studies A nurse is providing an in-service presentation on coping and adaptation. Which of the

20. following would the nurse most likely include? Select all that apply. A)

Most coping strategies are similar in their approach.

Coping when effective leads to adaptation.

Reappraisal occurs simultaneously with coping.

The same coping strategy is used in each situation.

Coping is a deliberate and planned effort to mange stress.

Answer Key

1. B 2. C 3. A 4. A 5. A 6. A 7. C 8. D 9. B 10. A 11. D 12. B 13. A 14. C 15. D 16. A, B, C, D 17. D 18. D 19. B 20. B, E

Chapter 19- Management of Anger, Aggression, and Violence The nurse is caring for an older patient in a residential care facility. The patient has been extremely irritable the entire day. When modifying the patient’s plan of care, which of the 1. following would be an appropriate snack to offer the patient to decrease the irritability? A)

Chocolate candy bar

Handful of raisins

Granola bar

Glass of milk The nurse is assessing a group of patients on an inpatient psychiatric unit. The patient’s history for which of the following would the nurse identify as the strongest indicator of

2. risk for violence? A)

Panic disorder

Problematic anxiety

Somatoform disorder

Violent behavior A son brings his father to the clinic and tells the nurse that his father has begun to act strangely in the past few days and has unprovoked outbursts of anger. After the incidents, the father expresses remorse for his outburst. The son says, I’ve never seen him act this

3. way. Which question would be most appropriate for the nurse to ask next? A)

Does your father have a history of an anxiety disorder such as panic disorder?

Has your father exhibited previous problems expressing anger appropriately?

Has your father suffered any traumatic injury to his brain recently?

Has your father injured the back of his head or next in the past week?

The nurse is caring for an older adult patient who has no history of violence but is agitated and appears ready to strike out at a staff member. The nurse would assess the 4. patient for which of the following? A)

Panic disorder

Epilepsy

Bipolar disorder

Sensory losses A patient has been admitted to the detoxification unit after binge drinking. Even though the patient is not currently intoxicated, he is combative and exhibits altered thought

5. processes. Which nursing diagnosis would be the priority? A)

Risk for Injury related to effects of alcohol abuse

Risk for Self-Mutilation related to alcohol withdrawal and altered thought processes

Risk for Other-Directed Violence related to alcohol withdrawal

Risk for Delayed Development related to chronic effects of alcohol intoxication The nurse is working with a potentially violent patient in a community clinic. Which of

6. the following would the nurse implement to minimize personal risk? A)

Using protective devices

Staying close to a door

Keeping the door closed to ensure privacy

Wearing inexpensive jewelry to distract the patient The nurse is caring for a family whose older father with dementia is living in their home. The nurse has instructed the family about how to decrease the father’s agitation. The nurse determines that the son has understood the nurse’s instructions when he states

7. which of the following? A)

Restraints can help reduce my father’s agitation.

I should place my father in the bedroom with me so I can watch him more

closely. C)

It’s important that he gets out shopping with me or my wife.

If I simplify our home environment, my father may be less agitated. A nursing instructor is teaching a class of nursing students about anger, aggression, and

8. violence. Which statement by the instructor would be most appropriate to include? A)

Anger, aggression, and violence are points along a continuum.

The terms used to describe anger are very precise.

Anger is a knee-jerk reaction to external events.

Women experience anger as frequently as men do. A group of nursing students is reviewing information about maladaptive anger. The students demonstrate a need for additional study when they identify which condition as

9. being linked to suppressed anger? A)

Coronary heart disease

Arthritis

Hypertension

Breast cancer While interviewing a patient, a nurse asks, What do you do when you get angry? Which patient response would indicate to the nurse that the patient engages in anger

10.1 suppression? 0 I’ve been known to fly off the handle when I’m angry. . A)

People say I withdraw and pout about the problem.

I usually approach the person directly to talk about it.

I try to discuss how I’m feeling about it with a close friend.

The plan of a care for a patient with anger includes behavioral interventions. Which of the following would the nurse be likely to find?

11.1 1 . A)

Self-monitoring of cues

Anger management

Relaxation training

Response disruption The nurse is reviewing the medical record of a patient who is experiencing aggressive and violent behavior for possible risk factors. Which of the following would the nurse

12. identify? Select all that apply. A)

Damage to the frontal lobe of the brain

Low testosterone levels

Family history of aggression

Gender

High level of competitiveness When assessing a patient experiencing aggression, the nurse applies the general aggression model. Which of the following would the nurse assess as the person factors?

13. Select all that apply. A)

Patient’s personality traits

Insult initiating the behavior

Previous behavior patterns

Patient’s shouting

Patient’s mood

Patient’s gender A nurse is presenting an in-service program about aggression and violence to a group of newly hired nurses who will be working in an inpatient psychiatric facility. When describing characteristics that may predict the risk for violence and aggression in patients,

14. which of the following would the nurse include? Select all that apply. A)

Age

Impulsivity

Substance withdrawal

Gender

Suspiciousness A unit in an inpatient psychiatric facility is experiencing an increase in violence episodes by patients. A group of nurses working on this unit is developing a plan to address this issue. When developing this plan which of the following would the nurses most likely

15. address as the problem areas? Select all that apply. A)

Inconsistent unit activities

Medication power struggles

Empathetic staff response

Clear set boundaries

Little patient participation in treatment plan While talking with a patient who has been experiencing aggression and intense anger, the nurse identifies that the patient feels isolation and anxious. Which statement by the nurse

16.1 would be most appropriate? 6 This must be scary for you. . A)

Once you relax, things will improve.

I really understand how you feel.

If you calm down, I can help you.

After working with a patient who has a history of violent behavior to identify possible clues that suggest that his behavior is escalating, the nurse and patient develop a plan for prevention. Which strategy would they be least likely to include?

17.1 7 . A)

Counting to 10

Taking slow deep breaths

Turning up the music loud

Taking a voluntary time out

An advanced practice psychiatric nurse is preparing to conduct a support group for psychiatric mental health nurses who have been assaulted by patients. Which of the 18. following would the nurse need to keep in mind with this group? A)

Nurses experience a conflict between the role of caregiver and victim.

Nurses who are victims often go on to prosecute the patient attackers.

Nurses actively express the feelings associated with patient assaults.

Nurses as victims of patient assaults rarely experience guilt or shame.

Answer Key 1. D 2. D 3. C 4. D 5. C 6. B 7. D 8. D 9. A 10. B 11. B 12. A, C, E 13. A, F 14. B, C, E 15. A, B, E 16. A 17. C 18. A

Chapter 20- Crisis, Grief, and Disaster Management The nurse is assessing a 35-year-old woman who is seeking assistance at a local community counseling center. Which of the following statements made by the woman 1. would indicate that she is experiencing a crisis? A)

I’m so upset; my husband has never left me like this before.

I’m confused and hurt; I have lost my best friend and my lover.

I don’t understand; I can’t seem to function like I usually do.

No matter what I do, I am still overcome by these sad feelings. A patient’s 5-year-old poodle ran in front of a car and was killed. The patient continues to be upset by her pet’s death, and she explains to a community counseling center nurse that she can’t stop crying because, My Precious meant the world to me, and now my world will never be the same! If the nurse were to determine that the patient was

2. experiencing a crisis, which of the following types of crisis would it most likely be? A)

Maturational

Situational

Traumatic

Developmental A 62-year-old man experienced the loss of his 87-year-old father a week ago. The hospice nurse is making a follow-up visit to determine how he is handling his father’s death. Which of the following statements made indicates to the hospice nurse that patient is in

3. the acute mourning stage of bereavement? A)

I keep thinking about my father; I have trouble believing he’s dead. I feel guilty

because I didn’t go to the nursing home to visit him last week! I’ve been grieving my father; losing him is a tremendous loss, but I have to get on B)

with my life. My father was a saint. I am so angry at God for taking him away! I’m crying all

the time; I haven’t been able to work for days. I’m going to spend the weekend with my children; they understand what I’ve

been going through, and I can relax around them. A 25-year-old legal secretary is seeking counseling because she recently lost her job unexpectedly. Which question would be most appropriate for the nurse to use in assessing

4. the patient’s response to losing her job? A)

What happened to cause you to lose your job?

How did you feel immediately after being told you no longer had a job?

How do you expect yourself to be able to handle this situation?

How have you responded to previous stressful situations? An individual is seeking employment as a nurse in a crisis center. The interviewer asks the person what he would ask someone who called the crisis hotline to determine whether

5. the caller was experiencing a crisis. Which response would be most appropriate? A)

To what extent are you involved in a crisis situation?

Tell me about what you are experiencing and what it means to you.

How would you rate your level of functioning on a scale from 1 to 10?

Why do you think you are in a crisis situation? A Red Cross nurse is working with tornado victims. The nurse is interviewing a woman whose house was totally destroyed during the night by the tornado; the woman’s pet poodle died as a result of the tornado. Which of following would the nurse most likely

6. expect to hear from the woman?

I don’t know. I can’t feel anything right now. Nothing seems real. Devastated. ....... I just feel totally devastated. I don’t know how I can go on

living. I just want my insurance man to get here so I can file a claim. Everything I had is

gone. I always thought my dog would die peacefully in my arms. Now I’ll never be able

to hold her again. A nurse is part of team working with hurricane victims. One of the hurricane victims is staying in a temporary shelter provided by the Red Cross. To determine the extent to which this victim can cognitively cope with his situation and how much support he needs,

7. which question would be most appropriate for the nurse to ask? A)

What kind of help do you need from us?

What are your thouT ghEtsSaTbB ouAtNwKhS atEyL ouLE wR ill.dCoOdM uring the next few days?

How are you feeling about all that you have gone through? Are you feeling guilty because you survived and some of your neighbors did

not? A family has just lost their home in a fire. An on-call nurse from a community counseling center has been called in to the emergency department to help them with this traumatic

8. event. Which of the following would the nurse identify as the priority for this family? A)

Arranging for follow-up therapy to deal with the crisis

Completing a family genogram to determine family patterns

Assessing the impact of the loss on their lifestyle

Arranging for emergency shelter and food supplies

9. A nursing instructor who is lecturing to students about how to respond to individuals who are in the midst of a disaster. Which statement would be most appropriate to include

about initial nursing interventions for such individuals? You should ask them to give you a brief medical history so their physical needs A)

can be met. Focus on safety needs and provide simple, clear instructions to help them

function effectively. Help them determine what their long-term goals will be so they can maintain a

sense of hope. Try to redirect their attention away from the problems at hand so you can

decrease their anxiety. A nurse is working as part of a community disaster response team. When responding to a community disaster, the nurse integrates understanding of individuals’ responses,

10.1 anticipating which of the following? 0 . A)

People can become agT grEesSsT ivB eA anNdKvS ioEleLnL tw ir basic needs are threatened. EhRe.nCthOeM People involved in the disaster will always put the welfare of others before their

own.

Losses incurred during the disaster have little, if any, long-term effect on victims.

The psychological distress associated with disasters is felt immediately. A group of nursing students is reviewing information about the types of crisis. The students demonstrate understanding of the information when they identify which of the

11. following as a developmental crisis? A)

Going away to college

Obtaining a job promotion

Loss of a pet

Earthquake

12. As part of a community program on crisis prevention, a nurse is describing the phases of

crisis. Which of the following would the nurse identify as occurring first? A)

Problem stimulating usual problem solving

Trial and error attempts to alleviate problem

Automatic relief behaviors take over

Serious personality disorganization A nurse is assessing the parents of a 6-year-old child who has died from leukemia. The nurse is integrating the dual process model for the assessment. Which of the following

13. would the nurse identify as reflecting the parents loss-oriented coping? A)

Engaging in new activities

Denying the grief

Developing new relationships

Thinking about the lost child A nursing instructor is describing uncomplicated grief to a class. Which of the following

TESTBANKSELLER.COM

14. would the instructor most likely include in the discussion? A)

Uncomplicated grief differs from normal grief because it lasts longer.

Most bereaved persons experience uncomplicated grief.

Uncomplicated grief is primarily loss associated with death

This type of grief is less painful and disruptive than normal grief. Assessment of a patient indicates complicated grief. Which statements would the nurse

15.1 identify as supporting this reaction? Select all that apply. 5 It’s been 2 months, and I still want my son back. . A)

I still wait for him to come right through the door every day.

I’m really struggling with trusting anybody anymore.

I wish I could go back to the days before he died.

Life seems so empty now that he’s gone. What will I do?

E) 16. A patient is experiencing traumatic grief resulting from the suicide of a family member.

In addition to the usual emotions experienced with bereavement and grief, which of the following would the person most likely exhibit? Select all that apply. A)

Acceptance of the loss

Sense of rejection

Disgust

Stigmatization

Self-blame After teaching a group of nursing students about crisis, the instructor determines that the

17.1 teaching was successful when the students state which of the following? 7 Crisis triggers maladaptive responses. . A)

Crisis is a time-limited event.

Chronic crisis is a real situation.

Events causing a crisis are similar for everyone.

The nurse is providing folloTwEuSpTcB arA eN toKvSicEtiL mLs E ofRa.dCisOaM ster that occurred several months ago. Assessment of which of the following would lead the nurse to suspect that the victims are experiencing possible aftereffects of the disaster?

18.1 8 . A)

Tachycardia

Profuse perspiration

Unexplained gastrointestinal disturbance

Tremors A nurse is working with a patient who is in crisis. Which of the following would be least

19. appropriate for the nurse to do? A)

Support the patient’s cultural beliefs about expressing feelings.

Encourage the patient to focus on one aspect at a time.

Provide the patient with an understanding that everything will be okay.

Explain information clearly to clarify any misconceptions or myths.

A group of nursing students is reviewing information about grief and bereavement. The students demonstrate understanding of the information when they identify which of the 20. following? A)

Grief and bereavement are used interchangeably as responses to loss.

Bereavement is the process of mourning and grief is the emotional reaction.

Grief involves confronting the stress, but bereavement helps avoid the stresses.

Bereavement is influenced by culture, but grief is not.

Answer Key 1. C 2. B 3. C 4. D 5. B 6. A 7. B 8. D 9. B 10. A 11. A 12. A 13. D 14. B 15. B, C, D, E 16. B, D, E 17. B 18. C

19. C 20. B

Chapter 21- Suicide Prevention- Screening, Assessment, and Intervention The nurse is caring for a group of hospitalized patients with various psychiatric diagnoses. The nurse identifies which patient as having the greatest risk for a suicide 1. attempt? A)

Man with bipolar I disorder

Woman with acute stress disorder

Man with major depressive disorder

Woman with somatoform disorder The nurse is reviewing the medical records of several patients diagnosed with major

2. depression. The nurse identifies which patient as least likely to commit suicide? A)

Divorced man

Widowed woman

Single woman

Married man A family member of an adolescent who has expressed a desire to commit suicide asks the nurse, What might predict the possibility of future suicide attempts? Which of the

3. following would the nurse include in the response? A)

Unemployment

Death of a spouse

Previous suicide attempt

Polydrug use

4. A nurse is completing an admission assessment of a young adult woman who has a history of depression and who was brought to the hospital by her boyfriend. In response

to the nurse’s question regarding suicidal ideation, the patient discloses that the she is thinking about killing herself. Which question would be most appropriate for the nurse to ask next? A)

What does your boyfriend think about your desire to kill yourself?

What are your spiritual beliefs about suicide?

What will killing yourself accomplish?

What thoughts have you had about how you would kill yourself? A nurse is with an adolescent who tells the nurse that she has nothing to live for and she

5. just wishes she was dead. Which nursing action would be the priority? A)

Going to the patient’s psychiatrist to tell him of the girl’s suicidal ideation

Staying with the patient to explore more of her thoughts about suicide

Putting the patient in seclusion with a staff assigned to watch her at all times

Ascertaining the client’s beliefs about what happens when you die

TESTBANKSELLER.COM

The nurse is caring for a 30-year-old white man whose wife has recently died. The patient has been diagnosed with clinical depression and is demonstrating insufficient coping 6. skills. Which action by the nurse would be most important? A)

Refer the patient for long-term psychotherapy.

Determine the patient’s risk of psychosis.

Determine if anyone in the patient’s family has had depression.

Ask the patient if he is thinking about killing himself. The nurse is providing a presentation for a group of health professionals about suicide. Which of the following would the nurse address as a major contributing factor to the

7. rising suicide rate among men? A)

Substance abuse

Media influences

Lack of conflict resolution skills

Parenting practices A nurse has just completed a suicide risk assessment of a 76-year-old widowed man. In addition to documenting the presence or absence of suicidal thoughts, plan, and means,

8. the nurse would also document which of the following? A)

Use of substances 6 hours before the assessment

Speech patterns

Availability of support resources

Amount of sleep in past 24 hours A patient was admitted to the psychiatric unit 3 days ago because of suicidal ideation. His suicidal risk has lessened considerably, and he currently denies having any desire to kill himself. In addition, he is able to identify reasons why he wants to be alive. Which

9. nursing intervention would be most appropriate at this time? A)

Assigning nursing staff to stay with him during his suicidal crisis

Developing a personal plan for managing suicidal thoughts when they occur

Advising the patient that he should consider electroconvulsive therapy treatments

Administering psychotropic drugs that decrease the patient’s serotonin levels A nurse is presenting a discussion for a local community group about suicide. Which

10.1 0 . A) B) C) D)

11.1 1

co cates the need to clarify the information? mm Warning signs about the person’s intention often occur. ent fro People who are suicidal are undecided about living or dying. m Suicides more often occur during the holiday seasons. an aud People who talk about suicide need to taken seriously. ienc e A group of nursing students is reviewing information about suicide and associated me mb concepts. The group demonstrates understanding of the information when they identify er indi which of the following as the probability that a person will successfully complete suicide? A)

Parasuicide

Suicidal ideation

Suicidality

Lethality After teaching a class about factors that enhance the risk of suicide, the instructor determines the need for additional teaching when the class identifies which of the

12. following? A)

Family member committing suicide

Cautiousness

Delusions

Loss A nurse is reviewing the medical record of a patient who has attempted suicide. Which of

13. the following would the nurse identify as relating to a psychological cause? A)

History of childhood trauma

Cluster B personality disorder

Social isolation

Suicide contagion

TESTBANKSELLER.COM

A patient comes to the clinic for an evaluation of headache, fatigue, and an overall feelings of being down. When assessing the patient, which statement by the patient 14.1 would alert the nurse to suspect possible suicide? Select all that apply. 4 I’ve been drinking about three or four more beers every night. . A)

I’ve been going out with my friends about once or twice a week.

I’m so tired that all I ever want to do is sleep all the time.

Most times, I feel like I’m trapped with no way out.

I’m looking for a new job because my job is so stressful.

The nurse determines that a patient is at imminent risk for suicide. Which of the following would be least appropriate to include in the patient’s plan of care?

15.1 5 .

Listening intently and nonjudgmentally

Validating the patient’s feelings and experience

Instituting strict restriction on the patient’s activity

Using cognitive interventions to foster hope A patient who has attempted suicide has an underlying diagnosis of depression. Which of

16. the following would the nurse anticipate being ordered for the patient? A)

Selective serotonin reuptake inhibitor

Mood stabilizer

Tricyclic antidepressant

Atypical antipsychotic The nurse is working with a patient who will be signing a commitment to treatment statement. After teaching the patient about this statement, the nurse determines the need

17.1 for additional instruction when the patient states which of the following? 7 TESTBANKSELLER.COM Signing this statement means that I will not commit suicide. . A)

I am agreeing to get emergency treatment if I have suicidal thoughts.

I will be open and honest about my feelings about treatment.

I am agreeing to participate in the necessary treatment for my condition

A nurse is performing an assessment of a patient with suicidal ideation. Which question would the nurse most likely ask to determine the degree of planning?

18.1 8 . A)

How seriously do you want to die? Have you attempted suicide before? Could you stop yourself from killing yourself? How much do the thoughts distress you?

B) C) D) 19. A nurse determines that a patient has poor social skills that have interfered with his ability to engage others, which has contributed to his feelings of purposelessness, hopelessness, and withdrawal. Which of the following would be most important to assist the patient in

beginning to social skills? A)

Self-help group

Recovery group

Nurse patient relationship

Limit setting After teaching a group of students about the various concepts involving suicide, the instructor determines that the teaching was successful when the students describe

20. parasuicide as which of the following? A)

Voluntary act of killing oneself

All suicide related behaviors and suicidal thoughts

Nonfatal act with the intent to die

Voluntary attempt without death as the aim

Answer Key 1. C 2. D 3. C 4. D 5. B 6. D 7. A 8. A 9. B 10. C 11. D 12. B 13. B

14. A, C, D 15. C 16. A 17. A 18. C 19. C 20. D

Chapter 22- Schizophrenia and Related Disorders The nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, he repeats what they are saying word for 1. word. The nurse interprets this finding and documents it as which of the following? A)

Echopraxia

Neologisms

Tangentiality

Echolalia While caring for a hospitalized client with schizophrenia, the nurse observes that the client is listening to the radio. The client tells the nurse that the radio commentator is

2. speaking directly to him. The nurse interprets this finding as which of the following? A)

Autistic thinking

Concrete thinking

Referential thinking

Illusional thinking A client has been diagnosed with schizophrenia. Assessment reveals that the client lives alone. His clothing is disheveled, his hair is uncombed and matted, and his body has a strange odor. During an interview, the client’s family voices a desire for the client to live with them when he is discharged. Based on the assessment findings, which nursing

3. diagnosis would be the priority? A)

Ineffective Role Performance related to symptoms of schizophrenia.

Social Isolation related to auditory hallucinations.

Dysfunctional Family Processes related to psychosis.

Bathing Self-Care Deficit related to symptoms of schizophrenia. The nurse is caring for an elderly client who has been taking an antipsychotic medication for 1 week. The nurse notifies the physician when he observes that the client has muscle rigidity that resembles Parkinson’s disease. Which agent would the nurse expect the

4. physician to prescribe? A)

Anticholinergic

Anxiolytic

Benzodiazepine

Beta-blocker The nurse is caring for a hospitalized client who has schizophrenia. The client has been taking antipsychotic medications for 1 week when the nurse observes that the client’s

5. eyes are fixed on the ceiling. The nurse interprets this finding as which of the following? A)

Akathisia

Oculogyric crisis

Retrocollis

Tardive dyskinesia A hospitalized client with schizophrenia is receiving antipsychotic medications. While assessing the client, the nurse identifies signs and symptoms of a dystonic reaction.

6. Which agent would the nurse expect to administer? A)

Diphenhydramine (Benadryl)

Propranolol (Inderal)

Risperidone (Risperdal)

Aripiprazole (Abilify)

7. The nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client

for which of the following? A)

Weight loss

Torticollis

Hypoglycemia

Tardive dyskinesia A client hospitalized for treatment of schizophrenia has been receiving olanzapine (Zyprexa) for the past 2 months. The nurse would be especially alert for which of the

8. following? A)

Weight loss

Hypertension

Diarrhea

Diabetes The nurse is caring for a client who has been taking clozapine (Clozaril) for 2 weeks. The

TESTBANKSELLER.COM

client tells the nurse, My throat is sore, and I feel weak. The nurse assesses the client’s vital signs and finds that the client has a fever. The nurse notifies the physician, 9. expecting an order to obtain which laboratory test? A)

A white blood cell count

Liver function studies

Serum potassium level

Serum sodium level A client is being released from the inpatient psychiatric unit with a diagnosis of schizophrenia and treatment with antipsychotic medications. After teaching the client and family about managing the disorder, the nurse determines that the teaching was effective

10. when they state which of the following should be reported immediately? A)

Elevated temperature

Tremor

Decreased blood pressure

Weight gain A nurse is preparing an in-service program for a group of psychiatric mental health nurses about schizophrenia. Which of the following would the nurse include as a major

11. reason for relapse? A)

Lack of family support

Accessibility to community resources

Non-adherence to prescribed medications

Stigmatization of mental illness While assessing a client with schizophrenia, the client states, Everywhere I turn, the government is watching me because I know too much. They are afraid that I might go public with the information about all those conspiracies. The nurse interprets this

12.1 statement as indicating which type of delusion? 2 . A) Grandiose B)

Nihilistic

Persecutory

Somatic The nurse is interviewing a client with schizophrenia when the client begins to say, Kite, night, right, height, fright. The nurse documents this as which of the

13. following? A)

Clang association

Stilted language

Verbigeration

Neologisms

14. A nurse is providing care to a client just recently diagnosed with schizophrenia during an inpatient hospital stay. Throughout the day, the nurse observes the client drinking from

the water fountain quite frequently as well as carrying cans of soda and bottles of water with him wherever he goes. Upon entering the client’s room, the nurse sees numerous empty cups that had been filled with fluids on his table and in the trash can. The room has an odor of urine. The nurse suspects which of the following? A)

Diabetes mellitus

Disordered water balance

Tardive dyskinesia

Orthostatic hypotension A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they

15. identify which neurotransmitter as being responsible for hallucinations and delusions? A)

Dopamine

Serotonin

Norepinephrine

Gamma-amino butyric acid (GABA) After teaching a class on antipsychotic agents, the instructor determines that the teaching was successful when the class identifies which of the following as an example of a

16. second-generation antipsychotic agent? A)

Fluphenazine (Prolixin)

Thiothixene (Navane)

Quetiapine (Seroquel)

Chlorpromazine (Thorazine) When assessing a client for possible disordered water balance, the nurse checks the client’s urine specific gravity. Which result would lead the nurse to suspect that the client

17. is experiencing severe disordered water balance?

1.020

1.011

1.005

1.002 A client with schizophrenia tells the nurse, I’m being watched constantly by the FBI

18.1 because of my job. Which response by the nurse would be most appropriate? 8 Tell me more about how you are being watched. . A)

It must be frightening to feel like you’re always been watched.

You’re not being watched; it’s all in your mind.

C) D)

You are experiencing a delusion because of your illness. A nurse is working with a group of clients diagnosed with schizophrenia in a community setting. Which of the following would least likely be a priority?

19.1 9 . A)

Improving the quality of life

Instilling hope

Managing psychosis

Preventing relapse A client with schizophrenia is prescribed clozapine because other prescribed medications have been ineffective. After teaching the client and family about the drug, the nurse

20.2 determines that the teaching was successful when they state which of the following? 0 He needs to have an electrocardiogram periodically when taking this drug. . A)

We’ll need to make sure that he has his blood count checked at least weekly.

He might develop toxic levels of the drug if he smokes cigarettes.

We need to watch to make sure that he doesn’t lose too much weight.

Which of the following would be most important for the nurse to keep in mind when establishing the nurse patient relationship with a client with schizophrenia to promote

21. recovery?

The relationship typically develops over a short period of time.

Decisions about care are the responsibility of interdisciplinary team.

Short, time-limited interactions are best for the client experiencing psychosis.

Typically, clients with schizophrenia readily engage in a therapeutic relationship.A nurse is developing a teaching plan for a client with schizophrenia. Which method

22. would the nurse use to be most effective? A)

Engaging the client the trial and error learning Having the client write down information after directly being given the correct

information

Asking the client questions that encourage the client to guess at the correct answer

Using visual aids that are very colorful and full of descriptive graphic images Assessment of a client with schizophrenia reveals that he is hearing voices that tell him that people are staring at him and illusions. When developing the plan of care for this

23.2 client, which nursing diagnosis would be most appropriate? 3 . A)

Disturbed thought processes

Risk for self-directed violence

Disturbed sensory perception

Ineffective coping A nursing instructor is preparing a class lecture about schizophrenia and outcomes focusing on recovery. Which of the following would the instructor include as a major

24. goal? A)

Continuity of care

Shorter in-patient stays

Immediate crisis stabilization

Social engagement

25. After assessing a client with schizophrenia, the nurse suspects that the client is

experiencing an anticholinergic crisis. Which of the following would the nurse most likely have assessed? Select all that apply. A)

Dilated reactive pupils

Blurred vision

Ataxia

Coherent speech

Facial pallor

Disorientation

Answer Key 1. D 2. C 3. D 4. A 5. B 6. A 7. D 8. D 9. A 10. A 11. C 12. C 13. A 14. B 15. A 16. C 17. D

18. B 19. C 20. B 21. C 22. B 23. C 24. A 25. B, C, F

Chapter 23- Depression- Management of Depressive Moods and Suicidal Behavior The nurse makes a home visit to a client who has dysthymic disorder. Which of the 1. following would the nurse expect to assess? A)

Low energy

Intense concentration

Agitation

Normal appetite A client has been diagnosed with major depression. The client reports that he often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as

2. suggesting which of the following? A)

Initial insomnia

Terminal insomnia

Hypersomnia

Middle insomnia The nurse is caring for a client in the outpatient setting who has been diagnosed with a depressive disorder. Before the client is given a prescription for a tricyclic antidepressant,

3. assessment for which of the following would be most important? A)

Suicide

Hypersomnia

Cardiac arrhythmia

Erectile dysfunction

4. A client diagnosed with major depression was prescribed imipramine (Tofranil) and has been taking this medication for 1 week. The client took his last dose of imipramine

(Tofranil) at 9:00 PM. The client is scheduled to have blood drawn to monitor the medication level the next morning. The nurse should instruct the client to have his blood drawn as close as possible to which time? A)

6:00 AM

7:00 AM

8:00 AM

9:00 AM The nurse is caring for a client with major depression. The client tells the nurse that she just isn’t sure that life is worth living. The nurse documents which nursing

5. diagnosis as the priority? A)

Self-esteem, Low, related to depressive episode

Hopelessness related to symptoms of depression

Anxiety related to lack of energy for self-care activities

Thought Processes, Disturbed, related to memory loss and depression A client is prescribed phenelzine (Nardil) to treat her depression. She is at a local café for lunch with a friend. Which of the following items on the menu would be least appropriate

6. for the client to order? A)

Roast beef, mashed potatoes, and gravy

A Cobb salad with blue cheese and Roquefort salad dressing

Scrambled eggs, toast, and grape jelly

Medium-well steak, French fries, and broccoli A 34-year-old client with depression is admitted to an inpatient psychiatric unit. The nurse enters her room and initiates interaction with the client. When talking with the

7. client, which approach would be least appropriate? A)

Quiet and empathetic manner

Animated and cheerful manner

Matter-of-fact manner

Respectful, direct manner A client is hospitalized on a psychiatric unit secondary to a suicide attempt. He has been diagnosed with depression. He has been consistently depressed. When assessing the client, which of the following would alert the nurse that the client’s suicidal risk has

8. worsened? A)

He tells the nurse that he feels more depressed than ever.

He is lethargic, remaining isolated from other clients.

He says he feels better as he interacts more with other clients.

His energy level and degree of depression remain the same. A group of nursing students is reviewing information about the epidemiology of depressive disorders. The students demonstrate understanding of the information when

9. they identify which of the following as possible risk factors? Select all that apply. A)

History of substance abuse as a teenager

Little social support

Inadequate coping skills

Prior episode of anxiety disorder

Concomitant medical illnesses A nursing instructor is preparing a class discussion about major depression. Which of the

10. following would the instructor expect to include? A)

Depression in children is manifested in the same manner as in adults.

The risk for suicide is especially high during the mid-adolescent years.

Response to treatment in older adults is slower than that for younger adults.

People older than age 65 years have the lowest suicide rates of any age group.

Episodes of depression tend to occur more frequently over time.

Depressive disorders are most often treated in the primary care setting.

After teaching a group of nursing students about the neurobiologic theories of depression, the instructor determines the need for additional teaching when the students identify 11. which neurotransmitter as playing a role? A)

Gamma-amino butyric acid (GABA)

Norepinephrine

Serotonin

Dopamine A nurse is preparing to assess a middle-aged male client who was brought to the emergency department by his wife. She reports that the client has been extremely depressed lately. When assessing this client, which of the following would be a priority

12. assessment? A)

Changes in sleeping patterns

Thoughts of self-harm

Appetite changes

Level of fatigue A client with depression is prescribed fluoxetine. On a return visit to the clinic, the client tells the nurse that he also just started taking St. John’s wort to feel better. The nurse

13. assesses the client for which of the following? A)

Water intoxication

Increased depressive symptoms

Serotonin syndrome

Hypertensive crisis

14. A client comes to the emergency department complaining of a severe pounding headache in the temples and a stiff neck. The client is flushed and diaphoretic, and his pulse is racing. The client states that he is being treated for depression with selegiline. Which

question by the nurse would be most important to ask at this time? A)

When did you last have blood drawn to check your drug level?

What have you had to eat or drink today?

Are you having any chest pain?

Do you use any herbal remedies? The nurse is developing a teaching plan for a client who is prescribed escitalopram. Which of the following side effects would the nurse include in this plan? Select all that

15.1 apply. 5 . A)

Weight gain

Decreased sexual interest

Sedation

Blurred vision

Urinary retention

Dry mouth The nurse is preparing a client for treatment with repetitive transcranial magnetic stimulation. When teaching the client about this procedure, which of the following would

16.1 the nurse include? Select all that apply. 6 You will receive a short-acting anesthetic to relax you. . A)

You will be awake and alert during the procedure.

You can resume your normal activities right after the treatment.

We will need to shave your scalp at the area where the magnet is placed.

D) E)

You might feel a moderate amount of stinging at the site. When assessing a client with depression, the client states, I just feel so sad and hopeless. I just don’t care anymore. I don’t even enjoy doing the crossword puzzles like I

17. used to. The nurse documents this finding as indicative of which of the following? A)

Dysthymic disorder

Anhedonia

Delusion

Psychosis The plan of care for a client diagnosed with depression includes cognitive interventions.

18. The nurse would expect to assist with which of the following? A)

Social skills training

Activity scheduling

Thought stopping

Interpersonal therapy A nurse is preparing a presentation for family members of clients who have been diagnosed with depression. When describing the family response to depression, which of

19. the following would the nurse include? A)

Family members typically can understand how disabling depression can be.

Depression in one family member affects the entire family.

Abuse of the depressed person is a rare occurrence in families.

TESTBANKSELLER.COM

Families of women older than 55 years of age with depression experience the D)

majority of problems. The nurse is reviewing the medical record of a client diagnosed with depression and notes that the client has been prescribed mirtazapine. The nurse interprets this information,

20.2 identifying this agent as which type? 0 . A)

Selective serotonin reuptake inhibitor

Cyclic antidepressant

Norepinephrine dopamine reuptake inhibitor

Alpha-2 antagonist

Answer Key

1. A 2. D 3. A 4. D 5. B 6. B 7. B 8. C 9. B, C, E 10. B, C, E, F 11. A 12. B 13. C 14. B 15. A, B 16. B, C 17. B 18. C 19. B 20. D

Chapter 24- Bipolar Disorders- Management of Mood Lability A client diagnosed with bipolar disorder and experiencing mania is admitted to the inpatient psychiatric setting. During the acute phase of mania, which medication would 1. the nurse expect to most likely administer? A)

Lithium carbonate (Lithium)

Haloperidol lactate (Haldol)

Fluoxetine (Prozac)

Paroxetine (Paxil) A client asks the nurse if he needs to alter any of his activities because he is taking

lithium carbonate. Which of the following responses would be most appropriate? A)

Increase your salt intake if an activity causes you to perspire heavily.

Wear sunscreen when you are going to be outdoors in the summer time.

Drink less fluid than usual now because you are taking this drug.

No changes are necessary for strenuous activities you do outdoors. The nurse is assessing a client with bipolar disorder who is experiencing mania. The client states, I’m just so beautiful. Everyone just stops and stares at how gorgeous I am. Men constantly want to have sex with me. The nurse interprets these statements as

3. indicative of which type of mood? A)

Irritable

Elevated

Expansive

Euphoric

4. The nurse is reviewing the medical record of a client with bipolar disorder. The nurse

would most likely expect to find a history of which of the following? A)

Panic disorder

Schizophrenia

Delusional disorder

Posttraumatic stress disorder A nurse is developing a presentation for families who have members that have been diagnosed with bipolar disorders. When describing this condition to the group, which of

5. the following would the nurse most likely include? A)

As the person ages, the episodes tend to decrease over time.

Environmental stressors are a key cause of these disorders.

The risk for suicide is high with either depression or mania.

Risk-taking behaviors are more common with a depressive episode. A client is to receive lithium therapy as part of the treatment plan for bipolar disorder.

TESTBANKSELLER.COM

When reviewing the client’s medication history, which agents would alert the nurse to the 6. possibility that a decrease in lithium dosage may be needed? Select all that apply. A)

Lisinopril

Hydrochlorothiazide

Indomethacin

Caffeine

Aspirin A client with bipolar disorder is receiving divalproex sodium as part of the treatment plan. When monitoring the client’s blood level for this drug, which level would alert the nurse

7. to the need to change the dosage? A)

30 ng/mL

55 ng/mL

75 ng/mL

115 ng/mL A client with bipolar disorder having experienced a depressive episode is prescribed lamotrigine. After teaching the client about this medication, the nurse determines that the

8. teaching was successful when the client states which of the following? A)

I need to notify my physician if I develop a skin rash.

I need to have my blood tested about once a month.

I have to watch how much salt I use every day.

This drug can affect my liver function. A nurse is preparing to administer medications to a female client with bipolar disorder who is experiencing acute mania. Which of the following would be most appropriate for

9. the nurse to do? A)

Tell the client firmly that she must take her medication.

Allow the client to participate in the treatment decision.

Restrain the client before administering the medication.

Notify the physician about the client’s refusal of the medication. A client who is receiving lithium comes to the clinic for an evaluation. During the visit, the client reports a fine hand tremor. Which action by the nurse would be most

10. appropriate? A)

Immediately obtain a specimen to determine the client’s blood drug level.

Suggest that the client take the medication with meals or snacks.

Assist the client in minimizing exposure to stressors.

Encourage the client to elevate the affected hand on a pillow. A client’s blood level of carbamazepine is increased. When reviewing the client’s

11. medication history, which of the following would alert the nurse to a possible interaction? A)

Phenobarbital

Primidone

Phenytoin

Diltiazem A client is brought to the emergency department by his brother. The client has a history of bipolar disorder for which he is taking divalproex. The brother reports that he watched his brother take the medication about 2 hours ago. He stated, A little while ago, he got very disoriented and agitated. The nurse suspects toxicity based on assessment of

12. which of the following? Select all that apply. A)

Tachypnea

Bradycardia

Hypotension

Nystagmus

Vomiting A client with bipolar disorder has a lithium drug level of 1.2 mEq/L. Which of the

13. following would the nurse expect to assess? Select all that apply. A)

Metallic taste

Ataxia

Diarrhea

Slurred speech

Fasciculations

Muscle weakness The nurse is preparing a teaching plan for the family of a client who has been diagnosed with bipolar disorder. After teaching them about potential indicators for relapse, the nurse determines that the teaching was effective when they identify which of the following as

14. suggesting mania? Select all that apply. A)

Avoiding people

Sleeping more than usual

Talking faster than usual

Being hungry all the time

Reading several books at once A client with bipolar disorder has had a history of multiple episodes and states, I’m so frustrated with what’s happened because of these episodes. Which of the following

15. would the nurse encourage to help support this client’s recovery? A)

Codependence

Hope

Self-control

Independent decision making

Answer Key 1. B 2. A 3. C 4. A 5. C 6. A, B, C 7. A 8. A 9. B 10. C 11. D 12. C, D, E 13. A, C, F 14. C, D, E 15. B

Chapter 25- Anxiety Disorders- Management of Anxiety and Panic The nurse is planning a presentation to a group of nursing students on the topic of anxiety disorders. Which of the following would the nurse include when describing panic 1. disorder? A)

Individuals may believe they are having a heart attack when a panic attack occurs.

People with panic attacks often have fewer attacks if they also have agoraphobia.

Typically, individuals experience this disorder after the age of 30 years.

Persons rarely have an underlying comorbid condition of depression. A client comes to the emergency department because he thinks he is having a heart attack. Further assessment determines that the client is not having a heart attack but is having a panic attack. When beginning to interview the client, which question would be most

2. appropriate for the nurse to use? A)

Are you feeling much better now that you are lying down?

What did you experience just before and during the attack?

Do you think you will be able to drive home?

What do you think caused you to feel this way? A client with a panic disorder has been prescribed a benzodiazepine medication. Which of

3. the following would the nurse emphasize as a risk associated with using this medication? A)

Dietary restrictions

Withdrawal symptoms

Agitation

Fecal impaction

4. A female client is diagnosed with panic disorder. The client tells the nurse that she hasn’t

left her house in more than a month because she was afraid of another attack. She visited the mental health clinic today only because her son brought her. Which nursing diagnosis would be a priority for this client? A)

Powerlessness related to symptoms of anxiety

Decisional Conflict related to fear of leaving the house

Ineffective Family Coping related to symptoms of anxiety

Social Isolation related to fear of recurrence of anxiety symptoms The nurse has instructed a client with panic disorder about how to use the technique of positive self-talk. The nurse determines that the client has understood the instructions

5. when the client verbalizes which statement to use during an impending panic attack? A)

I am feeling very nervous right now.

I can handle this anxiety; it will be over shortly.

I am taking medication to eliminate these symptoms.

Relax your muscles, relax your muscles. A client who has been diagnosed with panic disorder visits the clinic and experiences a panic attack. The client tells the nurse, I’m so nervous. My hands are shaking, and I’m sweating. I feel as if I’m having a stroke right now. Which of the following would the

6. nurse do first? A)

Stay with the client while remaining calm.

Move the client to a safe environment.

Tell the client that the attack will soon pass.

Teach the client deep breathing techniques to calm her. A client with obsessive-compulsive disorder has been taking fluoxetine for 1 month. The client tells the nurse, These pills are making me sick. I think I’m getting a brain tumor

7. because of the headaches. Which response by the nurse would be most appropriate?

Let’s talk about how often you have been performing the rituals lately.

Tell me how many times you have washed your hands today.

Have you been practicing your deep breathing and relaxation exercises?

These medications have side effects that can cause increased headaches. A nurse who has worked with a client diagnosed with generalized anxiety disorder (GAD) when he was an inpatient on the psychiatric unit sees the client in the waiting room of the outpatient psychiatric clinic. The client motions to the nurse to come over so he can tell the nurse how things have been going since he was discharged. While talking with the client, the nurse determines that the client’s therapy has been effective when the client

8. states which of the following? I am still experiencing quite a bit of stress at home and at work; things are A)

different at home than they were in the hospital. When my mother-inT-E laS wTcB om ow oO ouMt to my workshop and work on AeNsKoSveErLnL E,RI.gC

one of my projects.

I’m still drinking coffee; I can’t quit after drinking it all these years.

I’ve learned having a beer after I get home from work helps me relax. The nurse is caring for a client who is being treated in the emergency department for a

9. panic attack. Which of the following nursing interventions would be most appropriate? A)

Demonstrate empathy for the client by trying to mimic the client’s state of anxiety. Tell the client that you must leave to go report his symptoms to the psychiatrist on

duty. Tell the client this is an acute exacerbation with a positive prognosis and low

morbidity.

Stay with the client, emphasizing that he is safe and that you will remain with him.

10. A nurse determines that a client who is experiencing anxiety is using relief behaviors. The

nurse determines that the client is experiencing which degree of anxiety? A)

Mild

Moderate

Severe

Panic A group of students is reviewing information about anxiety disorders in preparation for a class examination. The students demonstrate understanding of the material when they

11. state which of the following? A)

Anxiety disorders rank second to depression in psychiatric illnesses being treated.

Women experience anxiety disorders more often than do men. Most anxiety disorders tend to be short term with individuals achieving full

recovery.

Anxiety disorders are more common in children than in adolescents.

TESTBANKSELLER.COM

While interviewing a client, the client reports an intense fear of spiders, stating, I can’t be near them. I get so upset. I start to sweat and hyperventilate if I see one. The nurse 12. documents this finding as which of the following? A)

Algophobia

Entomophobia

Arachnophobia

Cynophobia After teaching a class about the biochemical theories associated with panic disorder, the instructor determines a need for additional teaching when the students identify which

13. neurotransmitter as being implicated? A)

Dopamine

Serotonin

Norepinephrine

Gamma-aminobutyric acid (GABA) A nurse is preparing an in-service presentation about panic disorders and associated theories related to the cause. When describing the cognitive behavioral concepts associated with panic disorders, which of the following would the nurse expect to

14. address? A)

Personal losses

Conditioned response

Early separation

Dysfunctional family communication A nurse is developing the plan of care for a client with panic disorder that will include pharmacologic therapy. Which of the following would the nurse most likely expect to

15. administer? A)

Benzodiazepine

Selective serotonin reuptake inhibitor (SSRI)

Monoamine oxidase inhibitor (MAOI)

Tricyclic antidepressant (TCA) A client with panic disorder who has been prescribed sertraline in conjunction with alprazolam comes to the clinic for a follow-up. The client states, I stopped taking the alprazolam about 2 days ago. I was feeling really sleepy and tired. Which of the

16. following would alert the nurse to suspect possible withdrawal? Select all that apply. A)

Metallic taste

Irritability

Dry, flushed skin

Tremor

Muscle flaccidity

17. A client with obsessive-compulsive disorder (OCD) is using cue cards to help restructure

thought patterns. Which statements would be appropriate to include on a cue card? Select all that apply. A)

These are the OCD thoughts.

Trust myself.

Keep on checking.

Safety is the key.

I did it right the first time. A client is diagnosed with obsessive-compulsive disorder (OCD) and is to receive medication therapy. Which of the following agents might the nurse expect to be

18.1 prescribed? Select all that apply. 8 . A)

Clomipramine

Lithium

Sertraline

Fluvoxamine

Paroxetine

Alprazolam A woman diagnosed with obsessive-compulsive disorder comes to the clinic with her husband. During the visit, the husband states, She’s always checking and rechecking to make sure that all of the appliances are turned off before we go out. It’s nerve-wracking. We can never get out of the house on time. Isn’t checking once enough? An understanding of which of the following would the nurse need to incorporate into the

19. response? A)

The client is attempting to exert control over the situation.

The client performs the ritual to relieve anxiety temporarily.

The woman’s behavior reflects a need for safety.

The woman is attempting to use thought stopping to decrease her behavior.

A group of students is reviewing information about the etiology of generalized anxiety disorder (GAD). The students demonstrate understanding of this information when they identify which of the following as representing the psychoanalytic theory for this 20. disorder? A)

Inaccurate environmental danger assessment

Exposure to multiple stressful life events

Kindling caused by overstimulation

Unresolved unconscious conflicts A nurse is developing a teaching plan for a client with generalized anxiety disorder, focusing on nutrition. Which of the following would the nurse encourage the client to

21. avoid? Select all that apply. A)

Coffee

Ginseng

Milk products

Citrus juices

Aged cheese The nurse is assessing a client with posttraumatic stress disorder (PTSD). Which of the

22. following would the nurse categorize as reflecting intrusion? Select all that apply. A)

Irritability

Difficulty sleeping

Flashbacks

Short-term memory deficits

Dissociation A group of students is reviewing information about social phobia in preparation for an oral class presentation on this topic. Which of the following would the students expect to

23. include when describing a person with this condition? Select all that apply.

Fear that others will judge them negatively

Openly speak up in crowds to reduce fear

Are insensitive to other’s criticism

Demonstrate a distorted view of their own strengths

Exaggerate personal flaws A group of students is reviewing the signs and symptoms associated with anxiety. The students demonstrate an understanding of the information when they identify which of the

24. following as cognitive symptoms? Select all that apply. A)

Edginess

Feelings of unreality

Difficulty concentrating

Tunnel vision

Apprehensiveness

Speech dysfluency A client is diagnosed with generalized anxiety disorder and is prescribed medication therapy. Which agent would the nurse expect to administer to the client to obtain the

25. quickest relief from anxiety symptoms? A)

Buspirone

Venlafaxine

Alprazolam

Imipramine

Answer Key 1. A 2. B 3. B

4. D 5. B 6. A 7. D 8. B 9. D 10. C 11. B 12. C 13. A 14. B 15. B 16. A, B, D 17. A, B, E 18. A, C, D, E 19. B 20. D 21. A, B 22. C, D 23. A, D, E 24. B, C, D 25. C

Chapter 26- Obsessive Compulsive and Related Disorders 1. A nurse wants to teach alternative coping strategies to a patient

experiencing severe anxiety. Which action should the nurse perform first? a .

Verify the patients learning style.

b .

Lower the patients current anxiety.

c .

Create outcomes and a teaching plan.

d Assess how the patient uses defense mechanisms. . ANS: B

A patient experiencing severe anxiety has a markedly narrowed perceptual field and difficulty attending to events in the environment. A patient experiencing severe anxiety will not learn readily. Determining preferred LdLEcR modes of learning, devisingTEoS uT tcBoA mNeKsS ,E an on.sCtO ruMcting teaching plans are relevant to the task but are not the priority measure. The nurse has already assessed the patients anxiety level. Use of defense mechanisms does not apply. 2. A woman is 57, 160 lbs, and wears a size 8 shoe. She says, My feet are huge. Ive asked three orthopedists to surgically reduce my feet. This person tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely? a .

Social anxiety disorder

b .

Body dysmorphic disorder

c .

Separation anxiety disorder

d Obsessive-compulsive disorder due to a medical condition . ANS: B

Body dysmorphic disorder refers to a preoccupation with an imagined defect in appearance in a normal-appearing person. The patients feet are proportional to the rest of the body. In obsessive-compulsive or related

disorder due to a medical condition, the individuals symptoms of obsessions and compulsions are a direct physiological result of a medical condition. Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others. People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. 3. A patient experiencing moderate anxiety says, I feel undone. An appropriate response for the nurse would be: a .

What would you like me to do to help you?

b .

Why do you suppose you are feeling anxious?

c .

Im not sure I understand. Give me an example.

d You must get your feelings under control before we can continue. . ANS: C

Increased anxiety results in scattered thoughts and an inability to articulate clearly. Clarifying helps the patient identify thoughts and feelings. Asking the Rr.aCpO patient why he or she feelsTaEnSxTioBuAsNiK s SnEoL nL -tE he eM utic; the patient likely does not have an answer. The patient may be unable to determine what he or she would like the nurse to do in order to help. Telling the patient to get his or her feelings under control is a directive the patient is probably unable to accomplish. 4. A patient fearfully runs from chair to chair crying, Theyre coming! Theyre coming! The patient does not follow the staffs directions or respond to verbal interventions. The initial nursing intervention of highest priority is to: a .

provide for the patients safety.

b .

encourage clarification of feelings.

c .

respect the patients personal space.

d offer an outlet for the patients energy. . ANS: A

Safety is of highest priority because the patient experiencing panic is at high risk for self-injury related to increased non-goal-directed motor activity, distorted perceptions, and disordered thoughts. Offering an outlet for the

patients energy can occur when the current panic level subsides. Respecting the patients personal space is a lower priority than safety. Clarification of feelings cannot take place until the level of anxiety is lowered. 5. A patient fearfully runs from chair to chair crying, Theyre coming! Theyre coming! The patient does not follow the staffs directions or respond to verbal interventions. Which nursing diagnosis has the highest priority? a .

Fear

b Risk for injury . ANS: B

c .

Self-care deficit

d .

Disturbed thought processes

A patient experiencing panic-level anxiety is at high risk for injury related to increased non-goal-directed motor activity, distorted perceptions, and disordered thoughts. Data are not present to support a nursing diagnosis of self-care deficit or disturbed thought processes. The patient may have fear, but the risk for injury has a higher priority. 6. A patient checks and rechecks electrical cords related to an obsessive thought that the house may burn down. The nurse and patient explore the likelihood of an actual fire. The patient states this event is not likely. This counseling demonstrates principles of: a TESTBANKSELLERc.COM flooding. relaxation technique. . . b desensitization. . ANS: D

d .

cognitive restructuring.

Cognitive restructuring involves the patient in testing automatic thoughts and drawing new conclusions. Desensitization involves graduated exposure to a feared object. Relaxation training teaches the patient to produce the opposite of the stress response. Flooding exposes the patient to a large amount of an undesirable stimulus in an effort to extinguish the anxiety response. 7. A patient undergoing diagnostic tests says, Nothing is wrong with me except a stubborn chest cold. The spouse reports the patient smokes, coughs daily, lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using? a .

Displacement

b Regression . ANS: D

c .

Projection

d .

Denial

Denial is an unconscious blocking of threatening or painful information or feelings. Regression involves using behaviors appropriate at an earlier stage

of psychosexual development. Displacement shifts feelings to a more neutral person or object. Projection attributes ones own unacceptable thoughts or feelings to another. 8. A patient with an abdominal mass is scheduled for a biopsy. The patient

has difficulty understanding the nurses comments and asks, What do you mean? What are they going to do? Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patients level of anxiety? a .

Mild

b Moderate . ANS: B

c .

Severe

d .

Panic

Moderate anxiety causes the individual to grasp less information and reduces problem-solving ability to a less-than-optimal level. Mild anxiety heightens attention and enhances problem solving. Severe anxiety causes great reduction in the perceptual field. Panic-level anxiety results in disorganized behavior. 9. A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is most appropriate? Reassure the patient that all nurses are skilled in providing postoperative a care. . b .

Present the information again in a calm manner using simple language.

c .

Tell the patient that staff is prepared to promote recovery.

d Encourage the patient to express feelings to family. . ANS: B

Giving information in a calm, simple manner will help the patient grasp the important facts. Introducing extraneous topics as described in the distracters will further scatter the patients attention. 10. A patient is experiencing moderate anxiety. The nurse encourages the patient to talk about feelings and concerns. What is the rationale for this intervention? a .

Offering hope allays and defuses the patients anxiety.

b .

Concerns stated aloud become less overwhelming and help problem solving begin.

c .

Anxiety is reduced by focusing on and validating what is occurring in the environment.

Encouraging patients to explore alternatives increases the sense of control d and lessens anxiety. . ANS: B All principles listed are valid, but the only rationale directly related to the intervention of assisting the patient to talk about feelings and concerns is the one that states that concerns spoken aloud become less overwhelming and help problem solving begin. 11. A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder. Which question would be most appropriate for the nurse to ask? a .

Have you been a victim of a crime or seen someone badly injured or killed?

b .

Do you feel especially uncomfortable in social situations involving people?

c .

Do you repeatedly do certain things over and over again?

d Do you find it difficuTltEtSoTcBoAnNtrKoS l yEoLuLrEwRo.rC ryOinMg? . ANS: D

Patients with generalized anxiety disorder frequently engage in excessive worrying. They are less likely to engage in ritualistic behavior, fear social situations, or have been involved in a highly traumatic event. 12. A patient in the emergency department shows disorganized behavior and incoherence after a friend suggested a homosexual encounter. In which room should the nurse place the patient? a .

An interview room furnished with a desk and two chairs

b .

A small, empty storage room with no windows or furniture

c .

A room with an examining table, instrument cabinets, desk, and chair

d The nurses office, furnished with chairs, files, magazines, and bookcases . ANS: A

Individuals experiencing severe to panic-level anxiety require a safe environment that is quiet, non-stimulating, structured, and simple. A room with a desk and two chairs provides simplicity, few objects with which the patient could cause self-harm, and a small floor space in which the patient can move

about. A small, empty storage room without windows or furniture would feel like a jail cell. The nurses office or a room with an examining table and instrument cabinets may be over-stimulating and unsafe. 13. A person has minor physical injuries after an auto accident. The person is unable to focus and says, I feel like something awful is going to happen. This person has nausea, dizziness, tachycardia, and hyperventilation. What is the persons level of anxiety? a .

Mild

b Moderate . ANS: C

c .

Severe

d .

Panic

The person whose anxiety is severe is unable to solve problems and may have a poor grasp of what is happening in the environment. Somatic symptoms such as those described are usually present. The individual with mild anxiety is only mildly uncomfortable and may even find his or her performance enhanced. The individual with moderate anxiety grasps less information about a situation and has some difficulty with problem solving. The individual in panic will demonstrate markedly disturbed behavior and may lose touch with reality. 14. Two staff nurses applieT dEfo ch eLnLuErsRe.p SrTaBA NaKrSgE CoOsMition. After the promotion was announced, the nurse who was not promoted said, The nurse manager had a headache the day I was interviewed. Which defense mechanism is evident? a .

Introjection

b Conversion . ANS: C

c .

Projection

d .

Splitting

Projection is the hallmark of blaming, scapegoating, prejudicial thinking, and stigmatizing others. Conversion involves the unconscious transformation of anxiety into a physical symptom. Introjection involves intense, unconscious identification with another person. Splitting is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image. 15. A patient tells a nurse, My new friend is the most perfect person one could imagine: kind, considerate, and good-looking. I cant find a single flaw. This patient is demonstrating: a .

denial.

c .

idealization.

b .

projection.

d .

compensation.

ANS: C

Idealization is an unconscious process that occurs when the individual attributes exaggerated positive qualities to another. Denial is an unconscious process that would call for the nurse to ignore the existence of the situation. Projection operates unconsciously and would result in blaming behavior. Compensation would result in the nurse unconsciously attempting to make up for a perceived weakness by emphasizing a strong point. 16. A patient experiences a sudden episode of severe anxiety. Of these medications in the patients medical record, which is most appropriate to give as a prn anxiolytic? a .

buspirone (BuSpar)

b lorazepam (Ativan) . ANS: B

c .

amitriptyline (Elavil)

d .

desipramine (Norpramin)

Lorazepam is a benzodiazepine used to treat anxiety. It may be given as a prn medication. Buspirone is long acting and is not useful as a prn drug. Amitriptyline and desipramine are tricyclic antidepressants and considered second- or third-line agents. 17. Two staff nurses applied for promotion to nurse manager. The nurse not promoted initially had feelinTgEsSoTfBlo he bC ecOaMme supportive of the new AsNsKbSuEtLtL EnR. manager by helping make the transition smooth and encouraging others. Which term best describes the nurses response? a .

Altruism

b Suppression . ANS: A

c .

Intellectualization

d .

Reaction formation

Altruism is the mechanism by which an individual deals with emotional conflict by meeting the needs of others and receiving gratification vicariously or from the responses of others. The nurses reaction is conscious rather than unconscious. There is no evidence of suppression. Intellectualization is a process in which events are analyzed based on remote, cold facts and without passion, rather than incorporating feeling and emotion into the processing. Reaction formation is when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite behavior or emotion. 18. A person who feels unattractive repeatedly says, Although Im not beautiful, I am smart. This is an example of: a .

repression.

c .

identification.

b devaluation. . ANS: D

d .

compensation.

Compensation is an unconscious process that allows us to make up for deficits in one area by excelling in another area to raise self-esteem. Repression unconsciously puts an idea, event, or feeling out of awareness. Identification is an unconscious mechanism calling for imitation of mannerisms or behaviors of another. Devaluation occurs when the individual attributes negative qualities to self or others. 19. A person speaking about a rival for a significant others affection says in an emotional, syrupy voice, What a lovely person. Thats someone I simply adore. The individual is demonstrating: a .

reaction formation.

b repression. . ANS: A

c .

projection.

d .

denial.

Reaction formation is an unconscious mechanism that keeps unacceptable feelings out of awareness by using the opposite behavior. Instead of expressing hatred for the other person, the individual gives praise. Denial operates unconsciously to TaE lloSw ieLtyL-EpR ro.dCuOcM ing idea, feeling, or TBaAnNaKnSxE situation to be ignored. Projection involves unconsciously disowning an unacceptable idea, feeling, or behavior by attributing it to another. Repression involves unconsciously placing an idea, feeling, or event out of awareness. 20. An individual experiences sexual dysfunction and blames it on a partner by calling the person unattractive and unromantic. Which defense mechanism is evident? a .

Rationalization

b Compensation . ANS: A

c .

Introjection

d .

Regression

Rationalization involves unconsciously making excuses for ones behavior, inadequacies, or feelings. Regression involves the unconscious use of a behavior from an earlier stage of emotional development. Compensation involves making up for deficits in one area by excelling in another area. Introjection is an unconscious, intense identification with another person.

Chapter 27- Trauma- and Stressor-Related Disorders 1. A nurse works with a patient diagnosed with posttraumatic stress disorder

who has frequent flashbacks as well as persistent symptoms of arousal. Which intervention should be included in the plan of care? Trigger flashbacks intentionally in order to help the patient learn to cope with a them. . b .

Explain that the physical symptoms are related to the psychological state.

c .

Encourage repression of memories associated with the traumatic event.

d Support numbing as a temporary way to manage intolerable feelings. . ANS: B

Persons with posttraumatic stress disorder often experience somatic symptoms or sympathetic nervous system arousal that can be confusing and distressing. Explaining thatTtEhS eT seBA aN reKtShEeLbLoEdRy. s CreOsMponses to psychological trauma helps the patient understand how such symptoms are part of the illness and something that will respond to treatment. This decreases powerlessness over the symptoms and helps instill a sense of hope. It also helps the patient to understand how relaxation, breathing exercises, and imagery can be helpful in symptom reduction. The goal of treatment for posttraumatic stress disorder is to come to terms with the event so treatment efforts would not include repression of memories or numbing. Triggering flashbacks would increase patient distress. 2. Four teenagers died in an automobile accident. One week later, which

behavior by the parents of these teenagers most clearly demonstrates resilience? The parents who: a .

visit their teenagers grave daily.

b .

return immediately to employment.

c .

discuss the accident within the family only.

d .

create a scholarship fund at their childs high school.

ANS: D

Resilience refers to positive adaptation or the ability to maintain or regain mental health despite adversity. Loss of a child is among the highest-risk situations for maladaptive grieving. The parents who create a scholarship fund are openly expressing their feelings and memorializing their child. The other parents in this question are isolating themselves and/or denying their feelings. Visiting the grave daily shows active continued mourning but is not as strongly indicative of resilience as the correct response. 3. After the sudden death of his wife, a man says, I cant live without hershe was my whole life. Select the nurses most therapeutic reply. a .

Each day will get a little better.

b .

Her death is a terrible loss for you.

c .

Its important to recognize that she is no longer suffering.

d Your friends will help you cope with this change in your life. . ANS: B

Adjustment disorders may be associated with grief. A statement that validates ES a bereaved persons loss isTm orTeBhAeNlK pfSuEl L thLaEnRf. alCsO eMreassurances and clichs. It signifies understanding. 4. A woman just received notification that her husband died. She approaches the nurse who cared for him during his last hours and says angrily, If you had given him your undivided attention, he would still be alive. How should the nurse analyze this behavior? a .

The comment suggests potential allegations of malpractice.

b .

In some cultures, grief is expressed solely through anger.

c .

Anger is an expected emotion in an adjustment disorder.

d The patient had ambivalent feelings about her husband. . ANS: C

Symptoms of adjustment disorder run the gamut of all forms of distress including guilt, depression, and anger. Anger may protect the bereaved from facing the devastating reality of loss. 5. A wife received news that her husband died of heart failure and called her family to come to the hospital. She angrily tells the nurse who cared for him,

He would still be alive if you had given him your undivided attention. Select the nurses best intervention. Say to the wife, I understand you are feeling upset. I will stay with you until a your family comes. . b .

Say to the wife, Your husbands heart was so severely damaged that it could no longer pump.

c .

Say to the wife, I will call the health care provider to discuss this matter with you.

d Hold the wifes hand in silence until the family arrives. . ANS: A

The nurse builds trust and shows compassion in the face of adjustment disorders. Therapeutic responses provide comfort. The nurse should show patience and tact while offering sympathy and warmth. The distracters are defensive, evasive, or placating. 6. A child drowned while swimming in a local lake 2 years ago. Which behavior indicates the childs parents have adapted to their loss? The parents: a .

visit their childs grave daily.

b .

maintain their childs room as the child left it 2 years ago.

c .

keep a place set for the dead child at the family dinner table.

d throw flowers on the lake at each anniversary date of the accident. . ANS: D

Resilience refers to positive adaptation or the ability to maintain or regain mental health despite adversity. Loss of a child is among the highest-risk situations for an adjustment disorder and maladaptive grieving. The parents who throw flowers on the lake on each anniversary date of the accident are openly expressing their feelings. The other behaviors are maladaptive because of isolating themselves and/or denying their feelings. After 2 years, the frequency of visiting the grave should have decreased. 7. A store clerk was killed during a robbery 2 weeks ago. His widow, who has a long history of schizoaffective disorder, cries spontaneously when talking about his death. Select the nurses most therapeutic response. a .

Are you taking your medications the way they are prescribed?

This loss is harder to accept because of your mental illness. Do you think

you should be hospitalized?

c .

Im worried about how much you are crying. Your grief over your husbands death has gone on too long.

The unexpected death of your husband is very painful. Im glad you are able d to talk about your feelings. . ANS: D The patient is expressing feelings related to the loss, and this is an expected and healthy behavior. This patient is at risk for a maladaptive response because of the history of a serious mental illness, but the nurses priority intervention is to form a therapeutic alliance and support the patients expression of feelings. Crying at 2 weeks after his death is expected and normal. 8. Which scenario demonstrates a dissociative fugue? After being caught in an extramarital affair, a man disappeared but then reappeared months later with no memory of what occurred while he was a missing. . b .

A man is extremely anxious about his problems and sometimes experiences dazed periods of several minutes passing without conscious awareness of them.

c .

A woman finds unfamiliar clothes in her closet, is recognized when she goes to new restaurants, and complains of blackouts despite not drinking.

A woman reports that when she feels tired or stressed, it seems like her d body is not real and is somehow growing smaller. . ANS: A The patient in a dissociative fugue state relocates and lacks recall of his life before the fugue began. Often fugue states follow traumatic experiences and sometimes involve assuming a new identity. Such persons at some point find themselves in their new surroundings, unable to recall who they are or how they got there. A feeling of detachment from ones body or from the external reality is an indication of depersonalization disorder. Losing track of several minutes when highly anxious is not an indication of a dissociative disorder and is common in states of elevated anxiety. Finding evidence of having bought clothes or gone to restaurants without any explanation for these is suggestive of dissociative identity disorder, particularly when periods are lost to the patient (blackouts). See relationship to audience response question. 9. The nurse who is counseling a patient with dissociative identity disorder should understand that the assessment of highest priority is: a .

risk for self-harm.

c .

memory impairment.

b cognitive function. . ANS: A

d .

condition of self-esteem.

Assessments that relate to patient safety take priority. Patients with dissociative disorders may be at risk for suicide or self-mutilation, so the nurse must be alert for indicators of risk for self-injury. The other options are important assessments but rank below safety. Treatment motivation, while an important consideration, is not necessarily a part of the nursing assessment. 10. A patient states, I feel detached and weird all the time. It is as though I am looking at life through a cloudy window. Everything seems unreal. It really messes up things at work and school. This scenario is most suggestive of which health problem? a .

Acute stress disorder

b .

Dissociative amnesia

c .

Depersonalization disorder

d Disinhibited social engagement disorder . ANS: C

Depersonalization disorder involves a persistent or recurrent experience of feeling detached from and outside oneself. Although reality testing is intact, the experience causes significant impairment in social or occupational functioning and distress to the individual. Dissociative amnesia involves memory loss. Children with disinhibited social engagement disorder demonstrate no normal fear of strangers and are unusually willing to go off with strangers. Individuals with ASD experience three or more dissociative symptoms associated with a traumatic event, such as a subjective sense of numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of surroundings; derealization; depersonalization or dissociative amnesia. In the scenario, the patient experiences only one symptom. 11. The unlicensed assistive personnel (UAP) says to the nurse, That patient with amnesia looks fine, but when I talk to her, she seems vague. What should I be doing for her? Select the nurses best reply. a .

Spend as much time with her as you can and ask questions about her life.

b .

Use short, simple sentences and keep the environment calm and protective.

Provide more information about her past to reduce the mysteries that are

causing anxiety.

Structure her time with activities to keep her busy, stimulated, and regaining d concentration. . ANS: B Disruptions in ability to perform activities of daily living, confusion, and anxiety are often apparent in patients with amnesia. Offering simple directions to promote activities of daily living and reduce confusion helps increase feelings of safety and security. A calm, secure, predictable, protective environment is also helpful when a person is dealing with a great deal of uncertainty. Recollection of memories should proceed at its own pace, and the patient should only gradually be given information about her past. Asking questions that require recall that the patient does not possess will only add frustration. Quiet, undemanding activities should be provided as the patient tolerates them and should be balanced with rest periods; the patients time should not be loaded with demanding or stimulating activities. 12. A patient diagnosed with depersonalization disorder tells the nurse, Its starting again. I feel as though Im going to float away. Which intervention would be most appropriate at this point? a . b . c .

Notify the health care provider of this change in the patients behavior. Engage the patient in a physical activity such as exercise. Isolate the patient until the sensation has diminished.

d Administer a PRN dose of anti-anxiety medication. . ANS: B

Helping the patient apply a grounding technique, such as exercise, assists the patient to interrupt the dissociative process. Medication can help reduce anxiety but does not directly interrupt the dissociative process. Isolation would allow the sensation to overpower the patient. It is not necessary to notify the health care provider. 13. A person runs from a crowded nightclub after a pyrotechnics show causes the building to catch fire. Which division of the autonomic nervous system will be stimulated in response to this experience? a .

Limbic system

b Peripheral nervous system . ANS: C

c .

Sympathetic nervous system

d .

Parasympathetic nervous system

The autonomic nervous system is comprised of the sympathetic (fight or flight response) and parasympathetic nervous system (relaxation response). In times of stress, the sympathetic nervous system is stimulated. A person would experience stress associated with the experience of being in danger. The peripheral nervous system responds to messages from the sympathetic nervous system. The limbic system processes emotional responses but is not specifically part of the autonomic nervous system. 14. The gas pedal on a persons car stuck on a busy interstate highway, causing the car to accelerate rapidly. For 20 minutes, the car was very difficult to control. Afterward, this persons cortisol regulation was compromised. Which assessment finding would the nurse expect associated with the dysregulation of cortisol? a .

Weight gain

b Flashbacks . ANS: B

c .

Headache

d .

Diuresis

Cortisol is a hormone released in response to stress. Severe dissociation or mindflight occurs for those who have suffered significant trauma. The episodic failure of dissociation causes intrusive symptoms such as flashbacks, thus dysregulating cortisol. TheTcEoS rtT isBoA l lNeK ve ayER g. oCuOpMor down, so diuresis SlEm LL and/or weight gain may or may not occur. Answering this question correctly requires that the student apply prior learning regarding the effects of cortisol. 15. A soldier returns to the United States from active duty in a combat zone in Afghanistan. The soldier is diagnosed with posttraumatic stress disorder (PTSD). The nurses highest priority is to screen this soldier for: a .

bipolar disorder.

b schizophrenia. . ANS: C

c .

depression.

d .

dementia.

Comorbidities for adults with PTSD include depression, anxiety disorders, sleep disorders, and dissociative disorders. Incidence of the disorders identified in the distracters is similar to the general population. 16. Two weeks ago, a soldier returned to the U.S. from active duty in a combat zone in Afghanistan. The soldier was diagnosed with posttraumatic stress disorder (PTSD). Which comment by the soldier requires the nurses immediate attention? a .

Its good to be home. I missed my home, family, and friends.

b .

I saw my best friend get killed by a roadside bomb. I dont understand why it wasnt me.

c .

Sometimes I think I hear bombs exploding, but its just the noise of traffic in my hometown.

I want to continue my education, but Im not sure how I will fit in with other d college students. . ANS: B The correct response indicates the soldier is thinking about death and feeling survivors guilt. These emotions may accompany suicidal ideation, which warrants the nurses follow-up assessment. Suicide is a high risk among military personnel diagnosed with posttraumatic stress disorder. One distracter indicates flashbacks, common with persons with PTSD, but not solely indicative that further problems exist. The other distracters are normal emotions associated with returning home and change. 17. A soldier returned home from active duty in a combat zone in Afghanistan and was diagnosed with posttraumatic stress disorder (PTSD). The soldier says, If theres a loud noise at night, I get under my bed because I think were getting bombed. What type of experience has the soldier described? a .

Illusion

c TESTBANKSELLER. .COMNightmare

b Flashback . ANS: B

d .

Auditory hallucination

Flashbacks are dissociative reactions in which an individual feels or acts as if the traumatic event were recurring. Illusions are misinterpretations of stimuli, and although the experience is similar, it is better termed a flashback because of the diagnosis of PTSD. Auditory hallucinations have no external stimuli. Nightmares commonly accompany PTSD, but this experience was stimulated by an actual environmental sound. 18. A soldier returned 3 months ago from Afghanistan and was diagnosed with posttraumatic stress disorder (PTSD). Which social event would be most disturbing for this soldier? a .

Halloween festival with neighborhood children

b .

Singing carols around a Christmas tree

c .

A family outing to the seashore

d .

Fireworks display on July 4th

ANS: D

The exploding noises associated with fireworks are likely to provoke exaggerated responses for this soldier. The distracters are not associated with offensive sounds. 19. A soldier served in combat zones in Iraq during 2010 and was deployed to Afghanistan in 2013. When is it most important for the nurse to screen for signs and symptoms of posttraumatic stress disorder (PTSD)? a .

Immediately upon return to the U.S. from Afghanistan

b .

Before departing Afghanistan to return to the U.S.

c .

One year after returning from Afghanistan

d Screening should be on-going . ANS: D

PTSD can have a very long lag time, months to years. Screening should be on-going. 20. A soldier in a combat zone tells the nurse, I saw a child get blown up over a year ago, and I still keep seeing bits of flesh everywhere. I see something AN L.LW ERh. red, and the visions race bT acEkStToBm y KmSiE nd icChOpMhenomenon associated with posttraumatic stress disorder (PTSD) is the soldier describing? a .

Reexperiencing

b Hyperarousal . ANS: A

c .

Avoidance

d .

Psychosis

Spontaneous or cued recurrent, involuntary, and intrusive distressing memories of the traumatic events are often associated with PTSD. The soldier has described intrusive thoughts and visions associated with reexperiencing the traumatic event. This description does not indicate psychosis, hypervigilance, or avoidance.

Chapter 28- Personality and Borderline Personality Disorder The nurse is assessing a client who is diagnosed with borderline personality disorder. 1. Which client statement indicates the client is at risk for self-injurious behavior? A)

I have felt so down lately. I don’t enjoy doing anything anymore.

I do what I do because others tell me to do so.

When I feel extremely anxious, it is like my mind goes somewhere else.

It is almost as if as soon as I think of doing something, I immediately do it. A woman with borderline personality disorder has been admitted to the inpatient unit because she has been engaging in wrist cutting. The client’s sister is visiting, and the sister asks the nurse to explain why her sister sometimes does this to herself. Which

2. response by the nurse would be most appropriate? A)

Sometimes the self-injurious behavior is undertaken to relieve stress.

Self-injurious behavior often calms and sedates people with this diagnosis.

Sometimes they do it to avoid the onslaught of delusional thinking.

The self-mutilation often slows the mood swings your sister experiences. The nurse has explained some of the biologic theories of causation to a client diagnosed with borderline personality disorder and his family. The nurse determines that the client

3. and family have understood the instructions when they state which of the following? A)

The disorder may be caused by increased serotonin activity.

The disorder is caused by decreased dopamine activity in my brain.

A frontal lobe dysfunction may be causing this condition.

A decrease in hormonal substances increases the risk for this illness.

4. The nurse is assessing a client who has borderline personality disorder. Which of the

following would be a priority? A)

Nutrition patterns

Personal hygiene practices

Physical functioning

Somatic complaints A client diagnosed with borderline personality disorder tells the nurse that she

5. frequently spaces out. Which response by the nurse would be most appropriate? A)

Do you feel stressed most of the time?

Does this frighten you when it happens?

What’s happening around you when this occurs?

Do you feel as if you are out of your body? The nurse is caring for a client diagnosed with borderline personality disorder. The nurse has instructed the client about using the communication triad. The nurse determines that

TESTBANKSELLER.COM

6. the client has understood this technique when he states which of the following? A)

I should start by stating my feelings as an ‘I’ statement.

Maybe I should start by describing the situation that has me upset. I should first tell the other person what I’d like to be different about the

situation.

I should begin by telling the other person what has triggered my emotion. A client with borderline personality disorder tells the nurse, I’m afraid to get on a train because we’ll probably get into a wreck. Which response by the nurse would be most

7. appropriate? A)

“Have you had a bad experience riding a train?

What are the chances of that actually happening?

Now you know that won’t happen.

Have you thought about going by automobile?

A nursing instructor is preparing a class discussion on personality disorders and characteristics. Which term would the instructor include to differentiate personality 8. disorders from normal personality? Select all that apply. A)

Inflexible

Short term

Pervasive

Unstable over time

Distressing A group of nursing students is reviewing possible risk factors for development of borderline personality disorder. The students demonstrate understanding of the information when they identify which of the following as a risk factor? Select all that

9. apply. A)

Childhood sexual abuse

Parental loss

Substance abuse

Family history

Genetics A nurse is observing a client diagnosed with borderline personality disorder on the

10. inpatient unit. Which of the following would the nurse most likely note? A)

Actively participating in several different groups

Openly verbalizing feelings

Participating in relationships in which the client has control

Adhering to the personal boundaries of others A nurse is assessing a client with borderline personality disorder. Which question would

11.1 A) 1 .

b e m o s t a p p r o p r i a t e t o a s s e s s t h e c l i e n t ’ s l e v e l

of impulsivity? What things bother you and make you feel happy?

Have you ever felt sorry after acting as you did on the spur of the moment?

How do you view other people around you?

Have you ever felt like you were separated from your body? As part of a client’s treatment plan for borderline personality disorder, the client is engaged in dialectical behavior therapy. As part of the therapy, the client is learning how to control and change behavior in response to events. The nurse identifies the client as

12.1 learning which type of skills? 2 . A)

Emotion regulation skills

Mindfulness skills

Distress tolerance skills

Self-management skills A client with borderline personality disorder has difficulty maintaining boundaries of the professional relationship. Which of the following would be most effective for the nurse to

13. do? Select all that apply. A)

Punish the client with seclusion for violating established boundaries.

Respond to the client’s arrogance in a neutral, nonconfrontational manner.

Discuss the purpose of the limits in the therapeutic relationship.

State the parameters of the limits and boundaries clearly.

Ensure that any established limits are maintained consistently. A nurse is engaged in role-playing with a client with borderline personality disorder to assist the client in learning how to communicate effectively. Which of the following

14.1 would the nurse encourage the client to use? Select all that apply. 4 Me statements . A) B)

Validating perceptions with others

Paraphrasing before responding

Listening passively

Compromising A nurse is assisting a client with borderline personality disorder in how to manage transient psychotic episodes that involve auditory hallucinations. The teaching is planned for times when the client is free of these symptoms. Which of the following would the

15. nurse instruct the client to do first? A)

Use skills to tolerate painful feelings.

Practice deep abdominal breathing.

Identify early internal cues of distress.

Refer to cards listing potential symptoms.

Answer Key 1. A 2. A 3. C 4. A 5. C 6. A 7. B 8. A, C, D, E 9. A, B 10. C 11. B 12. D 13. B, C, D, E 14. B, C, E 15. B

Chapter 29- Antisocial Personality and Other Personality and Impulse The nurse is preparing to assess a client with a paranoid personality trait. The nurse integrates knowledge of this condition, anticipating that the client’s affect and behavior 1. will most likely be which of the following? A)

Angry and hostile

Flirtatious and seductive

Fearful and anxious

Friendly and open The nurse is caring for a client with schizoid personality trait. When developing the plan

2. of care for the client, which of the following would the nurse most likely include? A)

Social skills training

Anger management training

Relaxation techniques

Coping skills training A nursing instructor is preparing a teaching plan for a class of nursing students about antisocial personality disorder. Which of the following would the nurse include as a term

3. often used to describe the behaviors associated with this condition? Select all that apply. A)

Psychopath

Manipulator

Criminality

Sociopath

Psychotic

4. A nurse is reading a journal article about the various theories associated with the

development of antisocial personality disorder. The article mentions difficult temperament as a possible theory. The nurse demonstrates understanding of this concept when identifying which of the following as a key behavior associated with a difficult temperament? Select all that apply. A)

Aggression

Inattention

Hyperactivity

Impulsivity

Depression

Paranoia A nurse is developing a plan of care for a client diagnosed with an antisocial personality disorder who has been admitted to the inpatient psychiatric unit. Which of the following

5. would the nurse most likely include? Select all that apply. A)

Developing a therapeutic relationship

Bargaining about the unit rules

Holding the client responsible for behavior

Discouraging client from discussing thoughts

Using a firm, lecture-like approach for teaching A nurse is working with the family of a client who has been diagnosed with antisocial personality disorder. Which of the following would be most important for the nurse to

6. focus on when teaching the family about this disorder? A)

Anger management

Boundary setting

Medication therapy

Self-responsibility

7. A group of nursing students is reviewing information about antisocial personality

disorder. The students demonstrate understanding of this disorder when they state which of the following? A)

The disorder occurs more frequently in women.

The individual must be at least 18 years of age.

The disorder is found primarily in Asian individuals.

Alcohol abuse disorder rarely accompanies this disorder. A nurse is providing care to a client with antisocial personality disorder. As part of the plan of care, the client is to participate in a problem-solving group. The nurse understands

8. that this intervention is effective based on which rationale? A)

It requires the client to develop attachments.

It sets up specific boundaries for the client.

It helps reinforce self-responsibility.

It avoids confrontation about dysfunctional patterns.

TESTBANKSELLER.COM

The nurse is reviewing the medical record of a client diagnosed with antisocial personality disorder. The nurse notes that the client has had numerous episodes involving irritability, aggressiveness, and impulsivity and has exhibited callousness toward others. Based on this information, which nursing diagnosis would the nurse most likely identify 9. as a priority? A)

Risk for Other-Directed Violence

Risk for Self-Injury

Risk for Suicide

Risk for Self-Directed Violence

10. A client is brought into the emergency department because of complaints from the neighbors that the client was acting strangely. The nurse assesses the client and suspects schizotypal personality disorder based on assessment of which of the following? Select all

that apply. A)

Magical beliefs

Hallucinations

Paranoia

Avoidance of eye contact

Meticulous dress A nurse is assessing a client diagnosed with avoidant personality disorder. Which of the

11. following would the nurse most likely expect to find? Select all that apply. A)

Shyness

Feelings of inadequacy

Feelings of superiority

Perfectionism

Detail oriented A group of nursing studentsTiE s rSeT viB ew inE foLrm nC abOoM ut schizoid personality trait. The AiNngKS LaEtiRo. students demonstrate understanding of the information when they identify which disorder

12. as the most common comorbid disorder? A)

Depression

Substance abuse

Avoidant personality disorder

Anxiety A nurse is interviewing a client and suspects that the client may have narcissistic

13.1 personality disorder. Which client statement would help support the nurse’s suspicions? 3 I have a very important position in life; everyone I know wants to be like me. . A)

My wife is poisoning my food so she can get rid of me and marry her boss.

I like to work alone because then I can let my thoughts wander.

I’m always the life of the party, making new friends all the time.

A nurse is developing a teaching plan for a client with an impulse-control disorder. The nurse is planning to explain the emotional aspects associated with the behavior as part of the plan. Which of the following would the nurse describe as occurring first before the 14. individual commits the act? A)

Remorse

Tension

Regret

Pleasure A nurse is reading an article about a young girl who developed gastrointestinal symptoms from a hair ball because of a ritual that she engaged in. The girl would pull out hair over several hours to relieve tension and anxiety and then eat the hair. The nurse most likely is

15. reading an article about which of the following? A)

Kleptomania

Trichotillomania

Pyromania

Intermittent explosive disorder A nurse is working with a client who is a compulsive gambler. Which of the following

16. would the nurse emphasize as crucial for relapse prevention? Select all that apply A)

Medication therapy

Family involvement

Identification of triggers

Anger management

Milieu management

17. A nursing instructor is describing depressive and negativistic personality traits to a group of nursing students. The instructor determines that the teaching was successful when the

students identify which of the following as characteristic of negativistic personality traits? Select all that apply. A)

Anhedonia

Hostility

Pessimism

Oppositionality

Guilt

Answer Key 1. A 2. A 3. A, D 4. A, B, C, D 5. A, C 6. B 7. B 8. C 9. A 10. A, C, D 11. A, B 12. C 13. A 14. B 15. B 16. B, C 17. B, D, E

Chapter 30- Addiction and Substance-Related Disorders A client has been prescribed naltrexone (Trexan) for treatment of alcohol dependence. The nurse has explained the drug’s purpose to the client. The nurse determines that the client has understood the instructions when the client identifies which of the following 1. about the drug? A)

Causes itching if alcohol is consumed

Produces the euphoria of alcohol

Reduces the appeal of alcohol

Improves appetite and nutritional status An adolescent client tells the nurse that he or she occasionally sniffs airplane glue. When discussing the effects of long-term use of inhalants, which of the following would

2. the nurse most likely include? A)

Tremors and CNS arousal

Enhanced normal heart rhythms

Enhanced attention focus and memory

Brain damage and cognitive abnormalities A client tells the nurse that he is committed to trying to quit smoking. When teaching the

3. client about smoking cessation, which of the following would the nurse include? A)

Success usually involves more than one type of intervention.

Relapse is fairly rare within the first year of quitting.

Ear acupressure is a highly proven method for quitting.

Education is key for smoking cessation.

4. The nurse is completing the admission of a client who is seeking treatment for

alcoholism. He tells the nurse that the last time he had any alcohol to drink was at 10:00 AM before he left for the hospital. The nurse closely monitors the client. Which of the following would lead the nurse to suspect that the client is experiencing stage 1 of alcohol withdrawal syndrome? Select all that apply. A)

Slight diaphoresis

Hand tremors

Intermittent confusion

Heart rate of 135 beats/min

Normal blood pressure A nurse is talking with a 57-year-old client who has been a heavy drinker for many years. The client is being treated for alcoholism, and this is her second week as an inpatient on the psychiatric unit. It is 5:00 AM, and the client has been having difficulty sleeping. The client is an orthopedic nurseT, E anSdTaB ltA hoNuK ghSsEhL eL isEcR lo. thCeO dM in a hospital-issued gown and robe, she is wearing a stethoscope around her neck that the nurse recognizes as belonging to one of the staff nurses. When the nurse asks her why she is wearing the stethoscope and where she got it, the client gives her a long and involved reply that basically describes how her nursing supervisor came to visit and gave it to her to wear so she’d remember to get well. The nurse suspects that the client may be experiencing which of the

5. following? A)

Wernicke’s syndrome

Delirium tremens

Korsakoff’s psychosis

Malignant hyperthermia

6. A nurse is using motivational therapy with a female client with alcoholism. The client, who is unwilling to consider changing her drinking behavior, emphatically states, I am

not an alcoholic; you can’t make me stop drinking. Which response by the nurse would be most appropriate? A)

You have to stop drinking and driving; you could kill someone.

You’re right; you’re not an alcoholic.

You should consider what you are doing to your marital relationship.

You’re the only one who can make yourself stop drinking. A 52-year-old male client who has a history of alcohol dependence is admitted to a detoxification unit. He has tremors, he is anxious, his pulse has risen from 98 to 110 beats/min, his blood pressure has risen from 140/88 to 152/100 mm Hg, and his temperature is six tenths of a degree above normal. He is slightly diaphoretic. Which

7. nursing diagnosis would be the priority? A)

Disturbed Thought Processes

Risk for Injury

Ineffective Coping

Ineffective Denial A nurse is working with a client who is addicted to heroin. The nurse engages in harm

8. reduction by teaching the client about which of the following? A)

Using bleach solution to disinfect dirty needles

Problem solving

Healthy coping skills

Proper use of naltrexone (Trexan)

9. A 20-year-old man arrives at the emergency department by ambulance. He is unconscious, with slow respirations and pinpoint pupils. There are tracks visible on his arms. The friend who came with him reports that the client had just shot up heroin when he became unconscious. Which medication would the nurse most likely

expect to administer? A)

Naloxone

Naltrexone

Bupropion

Varenicline A nurse is obtaining a history from a client who drinks about 6 cups of coffee and several diet cola drinks per day. The client states, I just cut down my coffee and soda intake to one per day. Which of the following would the nurse most likely expect to assess?

10. Select all that apply. A)

Headache

Fatigue

Yawning

Flushing

Diuresis A group of nursing students is reviewing information about substances that are abused. The students demonstrate understanding of the information when they identify which of

11. the following as stimulants? Select all that apply. A)

Alcohol

Cocaine

Heroin

Nicotine

Phencyclidine A client is receiving methadone maintenance therapy. After teaching the client about this treatment, the nurse determines that the teaching was successful when the client states

12.1 which of the following? 2 I can have a glass of wine with dinner if I choose. . A)

I should eat small frequent meals if I get nauseated.

I should take the drug on an empty stomach.

I might experience diarrhea with this drug. A client with a history of alcohol abuse is participating in a 12-step Alcoholics Anonymous (AA) program. The nurse determines that the client is at step two when he

13.1 states which of the following? 3 I’ve admitted to myself and others the wrongdoings I’ve done. . I realize that there is a higher power that can help me. A) I know now that I am powerless over alcohol. B) I am making amends to all those that I’ve harmed. C) A nurse is preparing an inservice program about substance abuse and its etiology. Which D) of the following would the nurse most likely include in the presentation when discussing possible psychologic etiologies? 14.1 4 . A)

Low self-esteem

Genetic predisposition

Dysfunctional family

Peer influence A client is brought into the emergency department because he was involved in an automobile accident. His blood alcohol level (BAL) is 0.10 mg %. Based on this finding,

15. the nurse would expect to assess which of the following? A)

Difficulty with coordination

Stupor

Emotional lability

Ataxia A client with a history of opioid abuse is exhibiting manifestations of moderate

16. withdrawal. Which of the following would the nurse expect to assess?

Rhinorrhea

Lacrimation

Dilated pupils

Dysphoria A nurse is implementing a brief intervention with a client who is abusing alcohol. The

17. nurse most likely would be involved with which of the following? A)

Asking the client questions about alcohol use

Negotiating a conversation with the client to reduce use

Pointing out the inconsistencies in thoughts, feelings, and action

Helping the client change the way he thinks about a situation A client with a history of substance abuse is involved in a skills training group. Which of the following would the client be involved with to enhance intrapersonal coping skills?

18. Select all that apply.

TESTBANKSELLER.COM

Substance refusal skills

Problem solving

Anger awareness

Emergency planning

Social support networking A client is brought to the emergency department after having overdosed on cocaine. When assessing the client, which of the following would the nurse expect to find? Select

19. all that apply. A)

Euphoria

Seizures

Cardiac arrhythmia

Paranoia

Dilated pupils

A client is prescribed disulfiram as part of his alcohol treatment program to prevent relapse. The client asks the nurse, How will this drug help me? Which response by 20.2 the nurse would be most appropriate? 0 It will help to cure your alcoholism. . A)

It can help to prevent you from drinking.

It makes the withdrawal symptoms less troublesome.

It helps to clear the alcohol out of your body.

Answer Key 1. C 2. D 3. A 4. A, B, E 5. C 6. D 7. B 8. A 9. A 10. A, B, C 11. B, D 12. B 13. B 14. A 15. A 16. C 17. B 18. B, C, D

19. B, C 20. B

Chapter 31- Eating Disorders- Management of Eating and Weight While caring for a client with anorexia nervosa, the nurse anticipates that the client would 1. have difficulty making which of the following comments? A)

I’m mad at you because you won’t let me go on a pass unless I gain weight!

I need to have everything in its place and perfect.

If I gain a pound, I’ll just keep gaining weight.

I am very involved in preparing my food and counting calories. A nurse is performing an admission assessment for an adolescent girl with an eating disorder who is being admitted to the psychiatric unit. Which statement would the nurse

2. interpret as most likely supporting the client’s diagnosis? A)

My father was always very thin.

I’ve never really liked myself.

I have a lot of confidence in myself.

I feel really close to my parents and my brother. A client with bulimia nervosa is being treated at an outpatient clinic and is prescribed a selective serotonin reuptake inhibitor (SSRI). Which of the following would the nurse

3. include when teaching the client about the prescribed medication? A)

Closely monitor your fluid intake while taking this medication.

Stop taking this medication if it causes weight gain.

Expect menstrual irregularities, particularly if they’ve occurred previously. Report any weight changes that occur during the first few weeks this medication is

taken.

4. The nurse is caring for several hospitalized clients with anorexia nervosa. The nurse

would be especially alert for which of the following if noted in the clients’ histories? A)

Paranoia

Primary insomnia

Depression

Aggression The nurse is preparing to discharge a client who has been hospitalized with anorexia

5. nervosa. Which of the following would the nurse include in the teaching plan? A)

Knowing the calorie content of numerous foods

Learning strategies to control impulses

Describing physiologic consequences of anorexia nervosa

Setting realistic goals A client with bulimia nervosa is scheduled for a visit to the clinic. When assessing this

6. client, which of the following would the nurse expect to find? A)

Impulsivity

Panic

Hyperactivity

Delusions The nurse is planning to explain the purpose of the behavioral therapy technique of selfmonitoring to a client with bulimia nervosa. The nurse would emphasize keeping a diary

7. to record which of the following? A)

Feelings of hunger

Efforts at distraction

Environmental stimuli

Rigid rules about eating

8. A psychiatric mental health nurse working in the community is planning an educational program for fifth and sixth grade teachers. Which of the following would the nurse

include? Discussion of strategies the teachers can use to counteract the role media plays in A)

encouraging eating disorders Emphasis on the need for teachers to focus their prevention efforts on female

students Stressing of the need to allow students to eat without undue attention or supervision

to prevent inadvertently influencing eating patterns Clarification that peer pressure is not typically problematic in children who are in

the fifth and sixth grades The nurse is initiating a group for adolescent girls diagnosed with anorexia nervosa. Many of the clients in the group are irritable and resent having to attend. One of them comments, This is a stupid waste of time! Which of the response by the nurse would

9. be most appropriate? A)

If you feel that way, then you can just leave.

You sound irritated; tell me about what is bothering you.

You were assigned to this group by your therapist, so you must participate.

Sit down and be quiet; your peers would appreciate some peace and quiet. An adolescent is brought to the emergency department by her parents because they were concerned about their daughter’s appearance. The client appears emaciated and pale. The parents tell the nurse that the client has been diagnosed with anorexia nervosa. A history and physical examination and laboratory testing are completed. Which of the following would lead the nurse to suspect that the client will be admitted to the hospital? Select all

10.1 that apply. 0 . A)

Blood pressure of 110/60 mm Hg

Elevated serum potassium level

Decreased serum magnesium level

Heart rate of 40 beats/min

Statements of being hopeless A group of nursing students is reviewing the similarities and differences between bulimia nervosa and binge-eating disorder. The students demonstrate understanding when they

11. identify which characteristics as specific to binge-eating disorder? Select all that apply. A)

Clients typically are obese.

Clients refrain from purging behaviors.

Binge-eating periods are shorter.

Clients engage in overexercising.

Feelings of guilt do not occur after binging. A nursing instructor is reviewing the various theories related to anorexia nervosa. Which of the following would the instructor include when describing theories related to the

12.1 biologic domain? Select all that apply. 2 . A)

Genetic vulnerability

Separation individuation

Role pressures

Dieting leading to starvation

Pursuit of thinness

Decreased serotonin activity A nurse is preparing a presentation for a local middle school health class about eating disorders as a means for prevention and early detection. Which of the following would the nurse incorporate into the presentation as being common to both anorexia nervosa and

13. bulimia nervosa? Select all that apply. A)

Body dissatisfaction

Feelings of control

Obsessiveness

Boundary problems

Sexuality fears

Cognitive distortions A nurse is reviewing the plan of care for a client with anorexia nervosa and notes a behavioral plan for increasing weight. The nurse correlates this intervention with which

14. nursing diagnosis? A)

Disturbed Body Image

Anxiety

Imbalanced Nutrition: Less Than Body Requirements

Ineffective Coping A nurse is interviewing a client diagnosed with bulimia nervosa about her family and her relationship with her mother. Which statement by the client would the nurse least likely

15.1 associate with bulimia nervosa? 5 My mother is my confidante for everything. . A)

My mother’s happiness depends on me.

My family basically has very few rules.

My mother and I are close but not joined at the hip.

A nurse is developing a plan of care for a client newly diagnosed with bulimia nervosa. Which of the following would the nurse expect to implement in conjunction with pharmacologic therapy?

16.1 6 . A)

Behavioral therapy

Cognitive behavioral therapy

Interpersonal therapy

Family therapy

17. While talking with a client with an eating disorder, the client states, I’ve gained 2

pounds, so soon I’ll be over 100 pounds. The nurse interprets this as which of the following? A)

Magnification

Selective abstraction

Overgeneralization

Dichotomous thinking

Answer Key 1. A 2. B 3. D 4. C 5. D 6. A 7. C 8. A 9. B 10. C, D, E 11. A, B 12. A, D, F 13. A, C, F 14. C 15. D 16. B 17. D

Chapter 32- Somatic Symptom Disorders The nurse is caring for a client with complex somatic symptom disorder. When assessing 1. this client, the nurse would be especially alert for symptoms of which of the following? A)

Depression

Avoidant personality disorder

Delirium

Bipolar disorder A client has made multiple visits to the clinic. The nurse suspects that the client may be

2. experiencing complex somatic symptom disorder based on which of the following? A)

Expressions of concern about psychological problems

Indications that parents were always in good health

Reports of the same syTmEpS toTmBsAreNpK eaSteEdL lyLER.COM

Evidence of a need for social support from her friends A client is being assessed for complex somatic symptom disorder. Which client statement

3. would the nurse interpret as most likely supporting this diagnosis? It’s like my foot is asleep all the time; I can’t feel anything that touches my A)

foot.

I’m losing weight no matter what or how much I eat.

I am always in pain; there is nothing I can do to relieve it.

It seems like I am always having diarrhea at the most inconvenient times. A client diagnosed with complex somatic symptom disorder and depression is prescribed medication therapy to treat both the pain and the symptoms of depression. When teaching

4. the client about the medication, which of the following would the nurse emphasize? A)

Need for signing a no-suicide contract

Avoidance of foods that contain aged cheese

Use of sunscreen when exposed to bright sunlight

Limiting of the amount of water ingested The nurse is preparing to interview a client diagnosed with complex somatic symptom disorder. The nurse anticipates that the client will most likely exhibit which of the

5. following? A)

No facial expression during the interview

Intermittent nodding and glancing at the clock on the wall

Altered mental status

Rapidly changing moods during the interview The nurse is assisting in planning a series of group therapy sessions with several female clients diagnosed with complex somatic symptom disorder. The nurse plans to focus the

6. sessions on which of the following as a priority? A)

Causes of medical illnesses

Positive self-talk

Side effects of medications

Assertiveness skills The nurse is caring for a client in the neighborhood clinic. The client tells the nurse that ever since he was an adolescent, he has avoided social situations because he has one ear that is obviously bigger than the other ear. The nurse observes that one of the client’s ears does not appear to be larger than the other ear. The nurse suspects that the

7. client may be experiencing which of the following? A)

Complex somatic symptom disorder

Functional neurologic symptoms

Factitious disorder

Body dysmorphic disorder

A client is admitted to the mental health unit with a diagnosis of factitious disorder. When 8. reviewing the client’s history, which of the following would the nurse most likely find? A)

Intentional self-injurious behavior

Pain to achieve a self-serving goal

Malingering to avoid work

Parents who were restrictive A client is admitted to the mental health unit because she was found trying to inject diluted feces into her hospitalized child’s intravenous line. The client has a history of similar attempts of harming the child. The nurse would most likely suspect which of the

9. following? A)

Schizoid personality traits

Munchausen’s syndrome by proxy

Functional neurologic symptoms

Borderline personality disorder While assessing a client thought to have a factitious disorder, the nurse asks the client to describe when she felt nurtured as a child. Which response would the nurse interpret as

10.1 supporting the client’s diagnosis? 0 I never felt nurtured or loved when I was growing up. . A)

The only time I felt loved and appreciated was when I made the honor roll at school.

B) C) D)

The only time I ever felt loved was when I was sick enough to miss school. I felt loved and accepted when my father apologized for spanking me so hard. A nursing instructor is describing complex somatic symptom disorder to a group of nursing students. The instructor determines that the teaching was successful when the students state which of the following?

11.1 1 .

The disorder typically is diagnosed in men.

The first symptom usually appears during adolescence.

The disorder commonly occurs with substance abuse.

Highly educated individuals often develop this disorder. The husband of a client diagnosed with complex somatic symptom disorder asks the nurse, What causes this condition? Which response by the nurse would be most

12.1 accurate? 2 There is definitely an underlying genetic link for this disorder. . A)

Your wife is experiencing chronic stress that causes hypoarousal.

The symptoms reflect an emotion that your wife cannot verbalize.

The symptoms reflect an internal preoccupation with events.

A client with complex somatic symptom disorder is complaining of significant pain in the joints. When providing care to this client, which of the following would be most important for the nurse to keep in mind?

13.1 3 . A)

Opioid analgesics are the primary mode of therapy.

The client’s experience of pain is real.

Complementary therapies are usually of little benefit.

Outcomes need to reflect the biologic aspects of the pain. A client with complex somatic symptom disorder also has anxiety. Which of the

14. following would the nurse expect to be prescribed? A)

Monoamine oxidase inhibitor (MAOI)

Selective serotonin reuptake inhibitor (SSRI)

Tricyclic antidepressant (TCA)

Atypical antipsychotic

15. A nurse is providing care for a client who has complex somatic symptom disorder and is exhibiting anxiety about having a severe illness. Which of the following would be

appropriate for the nurse to do? Select all that apply. A)

Listening closely to the client’s report of symptoms

Discouraging the client from talking about fears

Acknowledging that what the client is saying may be real

Encouraging the client to write down symptoms in a journal

Reviewing symptom pattern with the client A nursing instructor is preparing a class about functional neurologic symptoms. Which of the following would the instructor most likely include as an assessment finding? Select all

16. that apply. A)

Difficulty swallowing

Spasticity

Urinary frequency

Aphonia

Blindness A client with body dysmorphic disorder is admitted to the inpatient unit. Based on the nurse’s understanding about this disorder, the nurse would assess this client closely for

17. which of the following? A)

Suicidal ideation

Escalating violence

Anorexia

Psychosis A nurse is working with a client diagnosed with complex somatic symptom disorder. Which of the following would the nurse identify as the most difficult aspect of providing

18. care to this client? A)

Managing the client’s pain.

Relieving the client’s anxiety.

Developing the therapeutic relationship.

Monitoring the client’s treatment program. A nurse is evaluating the outcomes for a client diagnosed with complex somatic symptom disorder. Which of the following would the nurse most likely identify as interfering with

19. achievement? A)

Outcomes were stated in realistic terms

Outcomes addressed overall issues

Outcomes indicated small successes

Outcomes were identified for specific behaviors A nurse is preparing a plan of care for a client diagnosed with body dysmorphic disorder.

20. Which nursing diagnosis would the nurse most likely identify as the priority? A)

Disturbed Body Image

Ineffective Coping

Low Self-Esteem

Risk for Other-Directed Violence

Answer Key 1. A 2. C 3. C 4. B 5. D 6. D 7. D 8. A 9. B 10. C

11. B 12. C 13. B 14. B 15. A, C, D, E 16. A, D, E 17. A 18. C 19. B 20. A

Chapter 33- Sleep Disorders- Management of Insomnia and Sleep Problems A nurse is giving a presentation to a community group about sleep and its relationship to health. In explaining the relationship between REM sleep and body temperature, which 1. statement by the nurse would be most appropriate? A)

There is no observable relationship between REM sleep and body temperature. With higher levels of REM sleep, we also experience higher body

temperatures.

Our REM sleep and body temperature cycles are inversely related. The extent of our experience of REM sleep is directly proportional to a rise in

body temperature. The nurse is assessing the sleep patterns of a 70-year-old female client with a mental disorder. Based on the knowledge of circadian rhythms and the influence of age, which of the following would the nurse anticipate that the client would report about her sleep

2. pattern? When I was younger, I didn’t notice any differences in how I felt in the morning A)

or evening.

Now it seems like I am sleepier at night and more alert in the morning.

When I worked days, I’d always have trouble feeling sleepy in the morning.

When I was younger, the amount of sleep I got didn’t seem to matter. A student nurse is preparing a nursing care plan for a client who has insomnia and is experiencing sleep deprivation. Which nursing diagnosis would the nurse most likely

3. identify as reflecting a priority care issue?

Risk for Injury

Ineffective Coping

Deficient Knowledge

Anxiety A female client who is receiving counseling at a community health center has complained about being unable to sleep at each of the last three weekly sessions. The nurse interviews the family members to determine the effect of the client’s problem on them. Which

4. response would the nurse most likely expect to hear? A)

It really hasn’t seemed to be a problem for us.

There’s been little change in how she gets along with other family members.

The not sleeping has really had a positive effect on her and us.

It’s been exhausting living with her these past few weeks. The nurse is discussing sleep enhancing strategies with a client who is experiencing

5. insomnia. Which of the following would be most appropriate for the nurse to suggest? Eat right before you go to bed as long as it is something rich that will make you A)

sleepy.

Try exercising a bit right before your bedtime so you will feel tired and sleepy.

Drinking a warm cup of tea right before bedtime will help to relax you.

Establish a regular time for going to bed and getting up in the morning. A nurse is working with a psychiatric client who was admitted to the inpatient facility and is being discharged. The client asks the nurse what he should do when he goes home to

6. promote getting adequate sleep. Which response by the nurse would be most appropriate? Go to bed at the same time every night and watch a television show that relaxes A)

you.

Save your bedroom for sleeping; that means no work and no TV in the

bedroom. C)

Why don’t you ask your psychiatrist for a prescription for a sleeping pill?

Make sure to keep the bedroom warm and toasty. A client with a mental disorder is being discharged from the inpatient unit. During the client’s stay in the hospital, the client eventually was able to get an adequate night’s sleep even though the client had experienced chronic insomnia over the years. The client’s spouse asks the nurse what the family can do in the client’s home environment to promote

7. healthy sleep. Which response by the nurse would be most appropriate? A)

It is basically up to your husband to focus on promoting his own sleep. You might consider a glass of wine about 30 minutes before he is ready to go to

bed.

Remember to keep stimulating activities at a minimum before he goes to bed.

Give him a spicy snack with a warm cup of tea at night before bedtime. A client has been admitted to the psychiatric unit with a diagnosis of narcolepsy. Which

8. client statement would the nurse interpret as reflecting this condition? A)

Sometimes when I’m falling asleep, I see and hear things that my wife doesn’t. I often have brief periods of intense excitement when going to sleep, and my legs

won’t hold still.

I lie there and worry all night, and it keeps me awake. I just can’t relax. I think my sleep pattern is messed up because I took sleeping pills when I was

younger. A nurse is preparing a presentation on sleep disorders for a community group. Which of the following would the nurse include when explaining the differences between

9. narcolepsy and obstructive sleep apnea syndrome? A)

Symptoms of both disorders are essentially the same, so it is difficult to

differentiate between the two disorders. People with narcolepsy awaken from a nap feeling rested and replenished, but B)

those with obstructive sleep apnea do not. People with obstructive sleep apnea syndrome can experience temporary

paralysis with naps. Naps are not recommended for clients with narcolepsy because of their

association with severe loss of muscle tone. A nurse is working with a client diagnosed with insomnia. When developing a teaching

10.1 plan for the client, which sleep promotion intervention would the nurse implement first? 0 . A)

Encouraging the client to consider stopping smoking

Instructing the client to keep regular bedtimes and rising times

Encouraging the client to take frequent naps

Administering prescribed sleep medications A nurse is obtaining information about a client’s sleep patterns and asks him about the total amount of sleep time compared with the amount of time spent in bed. The nurse is

11. assessing which of the following? A)

Sleep latency

Sleep architecture

Sleep efficiency

Sleep wake cycle A group of nursing students is reviewing information about factors affecting the pattern and quality of sleep. The students demonstrate a need for additional review when they

12. identify which of the following? A)

Sleep patterns are relatively constant across the lifespan.

Women report more problems with sleep than men.

Working night shifts and sleeping during the day can affect sleep.

Environmental influences on sleep can be internal or external. The sleep history of a client experiencing sleep problems reveals that the client ingests a significant amount of caffeine each day. When reviewing the effect of caffeine on sleep with the client, which of the following would the nurse incorporate into the discussion as

13. a caffeine effect? A)

Decreased sleep latency

Increased total sleep time

Decreased REM sleep

Increased slow-wave sleep A client with insomnia is taught to avoid watching television, eating, and doing work in

14. the bedroom. Which technique is being used? A)

Sleep restriction

Relaxation training

Cognitive behavior therapy

Stimulus control A client with insomnia is prescribed zolpidem. When describing the action of this medication to the client, the nurse would incorporate information related to the

15. medication’s effect on which of the following? A)

GABA

Serotonin

Dopamine

Norepinephrine A group of nursing students is reviewing the various agents used to treat insomnia. The students demonstrate an understanding of the information when they identify which agent

16. as a melatonin receptor agonist? A)

Trazodone

Estazolam

Mirtazapine

Ramelteon A nursing instructor is describing the prevalence of obstructive sleep apnea (OSA) as being greater in individuals with mental health disorders. Which disorders would the

17. instructor include as being associated with OSA? Select all that apply. A)

Depression

Borderline personality disorder

Schizophrenia

Posttraumatic stress disorder

Anxiety After teaching a class about circadian rhythm disorders, a nursing instructor determines that the teaching was successful when the class identifies which of the following as a

18.1 subtype? Select all that apply. 8 . A)

Delayed sleep phase

Nightmare

Sleep terror

Jet lag

Shift work

Answer Key 1. C 2. B 3. A 4. D 5. D

6. B 7. C 8. A 9. B 10. B 11. C 12. A 13. C 14. D 15. A 16. D 17. A, D, E 18. A, D, E

Chapter 34- Sexual Disorders- Management of Sexual Dysfunction A group of nursing students is reviewing information about sexual development. The students demonstrate understanding of the information when they describe biosexual 1. identity as which of the following? A)

Conviction of belonging to the male or female gender

Outward expression of gender

Sexual attraction to opposite, same, or both sexes

Anatomic and physiologic state of being male or female When describing the events associated with the determination of sex of a fetus, which of

2. the following would the nurse most likely include in the discussion? A)

Genes on the Y chromosome

Formation of ovaries

Rising testosterone levels

Neurochemical inhibition A nurse is preparing a presentation for a local senior group about sexuality and sexual behaviors in older adults. Which of the following would the nurse need to address? Select

3. all that apply. A)

Decreased vaginal lubrication

Decreased amount of sperm

Enhanced clitoral response

Thickening of vaginal mucosa

Increased ejaculation time

4. A woman comes to the clinic for a routine visit. While interviewing the client and

obtaining a sexual history, the client states, I’ve always wondered what is happening in my body when I become sexually aroused. The nurse would incorporate an understanding of which of the following as the control mechanism? A)

Sympathetic nervous system

Endocrine system

Parasympathetic nervous system

Central nervous system A nurse is preparing a teaching plan for a client about the sexual response cycle integrating the theoretical model described by Masters and Johnson. Which of the

5. following would the nurse describe as occurring first? A)

Erotic feelings

Penile erection

Vaginal lubrication

Increased muscle tension A female client is diagnosed with female orgasmic disorder and is receiving treatment by a qualified sex therapist. The client and her partner are being taught sensate focus. Which

6. of the following would the couple be required to do first? A)

Have sexual intercourse.

Engage in genital touching.

Participate in nongenital contact.

Use masturbation. A nurse is reviewing the medical record of a client with a sexual dysfunction. Which of the following if noted in the client’s history would the nurse identify as a possible

7. contributing factor? Select all that apply. A)

Antihypertensive therapy

Diabetes

Peptic ulcer disease

Appendectomy at age 15 years

Occasional alcohol use A client with premature ejaculation is prescribed sertraline as part of the treatment plan. The nurse explains the medication to the client, informing him that the effectiveness of

8. the drug will most likely be evident in approximately which time frame? A)

5 to 7 days

1 to 2 weeks

3 to 4 weeks

6 to 8 weeks A client with erectile dysfunction who is prescribed sildenafil asks the nurse, When

9. should I take the medication? Which response by the nurse would be most appropriate? A)

You should take it every morning when you first get up.

Take it about ½ to 2 hours before you have sexual activity.

You need to take it about 5 minutes before you have intercourse.

Take it at night before bedtime.

TESTBANKSELLER.COM

A sexual history of a female client reveals that the client has a normal sex drive and reports of orgasm through means other than intercourse. The client also has a history of being raped several years ago. The client reports spasms of the perineal and outer vaginal muscles when vaginal intercourse is attempted. The nurse interprets these findings as 10. suggesting which of the following? A)

Priapism

Dyspareunia

Sexual aversion disorder

Vaginismus

11. A client diagnosed with male orgasmic dysfunction is receiving desensitization as part of

the treatment plan. The nurse understands that this treatment focuses on achieving which of the following? A)

Decrease the pressure to perform

Increase awareness of pleasurable sensations

Eliminate spectatoring

Decrease anxiety and fear A nurse identifies the nursing diagnosis of Ineffective Sexuality Patterns based on which

12. of the following? A)

The sexual problem is causing dissatisfaction for the client.

The client has experienced a change in sexual functioning.

The client is feeling inadequacy related to the sexual problem.

The client believes that sexual activity is unrewarding. A client has been admitted to the inpatient psychiatric facility as part of a court-ordered

TESTBANKSELLER.COM

program. The client was arrested numerous times over the past several months for exposing his genitals and masturbating in public in front of an elementary school. The 13. nurse interprets this behavior as reflecting which of the following? A)

Frotteurism

Exhibitionism

Sexual masochism

Voyeurism A group of students is reviewing medications used to treat erectile dysfunction. The students demonstrate understanding of the information when they identify which of the

14. following as being administered by injection? A)

Tadalafil

Papaverine

Alprostadil

Vardenafil A nursing instructor is preparing a class discussion about sexual disorders. Which of the

15. following would the instructor include when describing gender identity disorders? A)

They typically involve same-sex identification.

The individual experiences discomfort about his or her own assigned sex.

Recurrent intense sexual urges lead to significant distress.

Changes in sexual desire and response are key characteristics.

Answer Key 1. D 2. A 3. A, B, E 4. C 5. A 6. C 7. A, B 8. B 9. B 10. D 11. D 12. B 13. B 14. B 15. B

Chapter 35- Mental Health Assessment of Children and Adolescents The nurse is preparing to interview a 6-year-old girl and her mother in an outpatient 1. psychiatric setting. To establish a treatment alliance with the child, the nurse should: A)

Tell the child she watches Sesame Street all the time.

Talk to the child while standing up and looking down at her.

Tell the child that this must be a bit scary for her.

Ask the parent if the child can be interviewed alone. A nurse is interviewing a 12-year-old child in an outpatient psychiatric setting. Which of the following would be most appropriate for the nurse to say to establish a high degree of

2. credibility? A)

How would you describe your parents?

Tell me about your best friend.

I have several teddy bears; would you like one to hold?

You’d get along better with your parents if you’d follow their advice. To establish rapport with a 10-year-old child who is hospitalized in a psychiatric setting,

3. which statement by the nurse would be most appropriate? A)

Let’s compare your situation to that of Cinderella’s in the fairy tale.

I’m going to use the DECA tool to measure your self-control and initiative.

Let’s have you draw a picture of yourself.

Would you like to play a game of checkers with me? The nurse is caring for an adolescent in the outpatient psychiatric setting. To help the adolescent feel more in control of the initial therapy sessions, which statement by the

4. nurse would be most appropriate?

I won’t share anything that you don’t want me to with your parents.

Adolescents often feel a distrust of authority figures. Is that true with you?

Your parents care a great deal about you. That’s why you are here.

If something is uncomfortable for you, you don’t have to talk about it. A child and the child’s family visit a psychiatric outpatient setting because the parent is concerned about the child’s behavior at school. The child scores 65 on the Global Assessment of Functioning (GAF) scale. The nurse interprets this finding as which of the

5. following? A)

The child requires inpatient therapy.

The child is experiencing homicidal thoughts.

The child is functioning well in the area of school.

The child can be treated effectively as an outpatient. The nurse is assessing an 8-year-old child’s self-concept. Which of the following would

6. be least appropriate for the nurse to ask? A)

If you had three wishes, what would you wish for?

What would you like to be when you grow up?

What subjects do you like best in school?

What did you have for breakfast this morning? A nurse in an outpatient clinic is assessing a child, and the nurse will interview the child and the child’s parents separately. Which of the following comments would the nurse

7. anticipate the child making during the upcoming interview? A)

I can’t get along with my parents.

I yell at my parents a lot.

I’m sad a lot, and I have trouble sleeping.

I refuse to do what my parents tell me to.

8. A nurse is performing an assessment interview of a 14-year-old boy who is being

admitted to an adolescent substance abuse unit. His parents are concerned about their son’s repeated problems at school that they associate with his drug use. The boy stalks into the office, abruptly sits down, crosses his arms, and says, Okay, ask your stupid questions, but don’t expect me to cooperate! Which response by the nurse would be most appropriate? A)

Your attitude is offensive; I can see why your parents brought you here.

Why don’t we wait until you’ve calmed down a bit to start the interview?

Why are you so angry?

You seem pretty upset. Tell me about what is upsetting you. The nurse is beginning an assessment interview with an 8-year-old girl who has been brought in for counseling by her parents. When beginning the interview, which question

9. would be most appropriate for the nurse to ask first? A)

How are you feelinT g?E STBANKSELLER.COM

How old are you?

Has anyone told you about why you are here today?

Why do you think I’m talking to you alone without your parents here? A nurse is interviewing a 12-year-old boy who has been diagnosed with depression. The client’s depression was triggered by the death of his father 2 years ago. The nurse

10. interprets which comment made by the boy as reflecting egocentrism? If I hadn’t yelled at my dad and told him to go away, he never would have A)

died.

I’m still sad because my dad died a couple of years ago.

I think I’m just experiencing normal grieving. My father was the best friend I ever had; I still can’t believe he’s gone forgood.

A nurse is preparing an inservice presentation for a group of staff psychiatric nurses who will be providing care to children and adolescents in a new outpatient psychiatric clinic. When describing important issues related to interviewing children, which of the following 11. would the nurse emphasize? Select all that apply. A)

Use of simple terms such as sad or nervous instead of depressed or anxious.

Need for individualization of questions based on judgment and discretion.

Use of questions that lead the child to the response desired.

Speaking in longer sentences that include a description of what is being asked.

Need for the child’s statements and behaviors to guide the interview. A nurse is preparing to assess a 9-year-old child who has been sexually abused. Which of

12. the following would be the priority for the nurse? A)

Finding out when the abuse occurred

Documenting the assessment for use in court

Using anatomically correct dolls to elicit information

Ensuring that the environment is safe and supportive A group of nursing students is reviewing information about stress and coping in children. The students demonstrate a need for additional study when they identify which of the

13. following as a stressful experience for a child? A)

Death of a pet

Chronic illness

Racial discrimination

Social support A nurse is preparing to interview a 4-year-old preschooler. Which of the following would

14. be most effective to use for the assessment? A)

Direct, simple questions

Play materials such as blocks

Pediatric anxiety rating scale

Children’s Depression Inventory A group of nursing students is reviewing information about temperament and its effect on the child’s behavior. The students demonstrate understanding of the concept when they

15. identify which of the following as characteristic of temperament. Select all that apply. A)

Emotional bonding

Sequential growth processes

Activity level

Adaptability

Insecurity A nurse is preparing to complete a mental status examination of an adolescent who is experiencing behavioral problems at school. When assessing the adolescent’s thought processes, which of the following would the nurse need to keep in mind about this age

16. group? Select all that apply. A)

View of things in a concrete manner

Ability to look at things hypothetically

Beginning ability to use logic

Ability to use abstract thinking

Difficulty in putting feelings into words After completing the mental status assessment of a 9-year-old boy, the nurse documents the findings. Which of the following would the nurse document as reflecting the child’s

17. motor activity? Select all that apply. A)

Favorite story, Huckleberry Finn

Short attention span

Hyperalertness

Went to the park last weekend

Nail biting

History of temper tantrums

Answer Key 1. C 2. B 3. D 4. D 5. D 6. D 7. C 8. D 9. C 10. A 11. A, B, E 12. D 13. D 14. B 15. C, D 16. B, D 17. C, E

Chapter 36- Psychiatric Disorders of Childhood and Adolescence The nurse is counseling a family whose 4-year-old child has mild mental retardation. The nurse is working with the family on realistic long-term goals. Which of the following 1. would be most appropriate? A)

Locating suitable residential placement for the child

Finding a foster home for the child

Achieving independent functioning of the child as an adult

Preventing the onset of psychiatric disorders in the child The nurse is counseling a family whose child has autism. When describing this condition,

2. which of the following would the nurse most likely include? A)

Connection to ineffective parental practices

Detection after the child enters school

Onset before child is 2.5 years old

Girls are more frequently affected than boys The nurse is caring for a family with a 3-year-old child who has autism disorders. When developing the teaching plan for the parents, which of the following would the nurse most

3. likely include? A)

The child is at higher risk for seizure disorders as well.

The child’s IQ will typically be higher than that of other children.

Dyslexia also may be a comorbid condition.

A structured physical environment is an important aspect.

4. The nurse is giving a presentation comparing and contrasting autism disorder and Asperger syndrome. Which of the following would the nurse include as differentiating

Asperger syndrome from autism disorder? A)

Children typically do not engage in stereotypic behavior.

They display age-appropriate intelligence.

The children often reverse pronouns when speaking.

They appear aloof and indifferent to others. The mother of a child with Asperger disorder tells the nurse that her child has few playmates. She states, He has such poor social skills with other children, and he strongly rejects any change in his routine by throwing a tantrum. Based on this

5. information, the nurse identifies which nursing diagnosis as the priority? A)

Self-Care Deficits related to repeated tantrums

Risk for Injury related to Asperger disorder

Ineffective Family Coping related to having a child with Asperger disorder

Risk for Social Isolation related to poor social skills of the child

TESTBANKSELLER.COM

The nurse is caring for a 3½-year-old child with autism who has been hospitalized. The child rocks continuously without any danger present to the child’s safety. Which 6. intervention by the nurse would be most appropriate? A)

Continue to monitor the child’s behaviors.

Hold the child until the child stops rocking.

Ignore the child’s rocking behavior.

Place the child in a time out area until the rocking stops. A child diagnosed with autism is hospitalized in an inpatient mental health unit. When developing the plan of care for this child, which of the following would the nurse most

7. likely include? A)

Ensuring that a variety of caregivers are available for the child

Providing a consistent, structured environment with predictable routines

Allowing the child frequent visits off the unit to provide stimulation

Sending the child to the time out” area if the child repeats phrases continuallyThe school nurse is caring for a 7-year-old child who has demonstrated a significantly lower-than-average score for mental age on standardized tests in reading. However, the child’s IQ scores were within the average range. The nurse interprets this information as

8. suggesting which of the following? A)

Communication disorder

Attention deficit hyperactivity disorder

Asperger syndrome

Dyslexia The nurse is counseling a parent whose child has a communication disorder. Which of the

9. following would the nurse emphasize when teaching the parent about this disorder? A)

Providing the child with nonverbal activities

Initiating conversations with the child frequently

Stopping the child’s conversation if stuttering begins

Asking the physician for medication to improve the child’s speech A nurse is assessing a child who is suspected of having attention deficit hyperactivity disorder. Which of the following would the nurse identify as reflecting impulsiveness in

10. the child? A)

Inability to wait his turn

Restlessness

Difficulty completing a task

Risk-taking behavior The history of a child newly diagnosed with ADHD reveals that the child is experiencing

11. sleeping difficulties. Which agent would the nurse most likely use? A)

Methylphenidate

Atomoxetine

Bupropion

Clonidine After teaching the parents of a child diagnosed with ADHD about the disorder and its treatment, the nurse determines that the teaching has been effective when the parents state

12.1 which of the following? 2 We need to remember that our son is not a bad kid; he just has difficulty with . impulse control and attention. A)

We need to be careful so he doesn’t develop a substance abuse problem as he grows older.

We should stop the medication after 2 months to see how effective it is in really controlling his symptoms.

C) D)

We should set up regular routines for him but not worry if he violates the limits once in a while. A 10-year-old child with Tourette’s disorder is receiving haloperidol as part of his treatment plan. When assessing the child at a follow up visit, which statement by the child

13.1 would lead the nurse to suspect that he is experiencing a side effect of the drug? 3 Sometimes I feel like I’m so sleepy. . A)

I’m eating about the same amount as before.

My muscles seem pretty flexible lately.

I think I’m much more alert with this drug.

A group of nursing students is reviewing information about disruptive behavior disorders. The students demonstrate understanding of the topic when they identify which of the following as an externalizing disorder?

14.1 4 . A)

Anxiety

Depression

Schizophrenia

Conduct disorder A nurse is providing parent training for parents of a child diagnosed with a disruptive behavior disorder involving the use of time out. When describing how to implement this,

15. which of the following would the nurse identify as the first step? A)

Having the child recount the reason for the time out

Clearly identifying what is required for the child

Informing the child what will happen because of the behavior

Placing the child in a designated area removed from others A 12-year-old child is brought to the mental health clinic by his parents because of a court-ordered evaluation. When assessing the child, which of the following would lead

16. the nurse to suspect that the child has a conduct disorder? Select all that apply. A)

Destruction of neighbor’s car on two separate occasions

Arrests for petty larceny several times

Repetitive disobedience of parents

Blaming of others for problems

Evidence of overt lying The nurse is preparing to initiate a behavioral treatment program for a child with

17. encopresis. Which of the following would the nurse most likely implement first? A)

Administration of mineral oil

Bowel cleansing

Low-fiber diet

Toilet sitting after each meal A nurse is assessing an 8-year-old girl with a mood disorder. Which of the following

18. would the nurse most likely expect to assess? A)

Statement from the child that she feels sad

Behavioral problems

Recurrent obsessions

Ritualistic behavior A group of nurses is reviewing medications used to treat attention deficit hyperactivity disorder. The students demonstrate understanding of the information when they identify

19. methylphenidate as which of the following? A)

Selective serotonin reuptake inhibitor

Psychostimulant

Noradrenergic reuptake inhibitor

Alpha agonist The parents of a child with ADHD bring the child for a follow-up visit. During the visit, they tell the nurse that the child receives his first dose of methylphenidate (Ritalin) at about 7:30 AM every morning before leaving for school. The teacher and school nurse have noticed a return in the child’s overactivity and distractibility just before lunch. The child’s second dose is scheduled for about 12 noon. Which of the following might the nurse suggest as a possible solution to control the child’s symptoms a bit more

20. effectively? A)

Giving the second dose at 1 PM or later.

Switching to a longer acting preparation.

Splitting the early morning dose in half.

Switching to another class of medication.

Answer Key 1. C 2. C 3. D

4. B 5. D 6. C 7. B 8. D 9. B 10. D 11. B 12. A 13. A 14. D 15. B 16. A, B, E 17. B 18. B 19. B 20. B

Chapter 37- Mental Health Assessment of Older Adults A nurse is caring for a 76-year-old patient with a hearing deficit caused by presbycusis. Which of the following would be most appropriate for the nurse to do when 1. communicating with the patient? A)

Use a higher volume of speech.

Address the client’s family members.

Ask if the client can use sign language.

Use lower pitched tones. The nurse is caring for a 78-year-old client who is taking an anticholinergic medication and complains of dry mouth. Which of the following would be most appropriate for the

2. nurse to suggest? A)

Chew hard candies.

Rinse the mouth with a mouthwash.

Use more seasonings on food.

Drink decaffeinated beverages often. An elderly client tells the nurse that she had been constipated for the last few days and decided to use an over-the-counter fiber laxative that is dissolved in water. When reviewing the use of this laxative with the client, which of the following would the nurse

3. include as a possible side effect? A)

Diarrhea

Nausea

Flatus

Stomach pain

An 80-year-old client visits the mental health clinic with her daughter. During the assessment process, the client tells the nurse that she is taking an antidepressant, an antibiotic, and an occasional aspirin. Which question would be most important for the 4. nurse to ask? A)

How much grapefruit juice do you drink on a daily basis?

How much orange juice do you drink on a daily basis?

How much tomato juice do you drink on a daily basis?

How much grape juice do you drink on a daily basis? While caring for an 88-year-old client suspected of having dementia, the nurse assesses the client for a common delusional thought. Which of the following would the nurse

5. interpret as a common delusion? A)

I am the king of the universe.

Creatures are living in my closet.

The government has people following me.

My roommate keeps stealing my clothes. The nurse is assessing a 78-year-old client who lives alone in his own home. To assess the client’s instrumental activities of daily living, which question would be most appropriate

6. to ask? A)

How often do you bathe or shower?

How many times do you change clothes during the day?

How often do you cook meals for yourself?

How often do you go to the store to buy groceries?

7. The nurse is assessing a client who has a history of heavy drinking and who lost his wife to cancer during the previous year. He reports that he isn’t getting as much sleep as he used to when he was younger. Which question would be most appropriate to ask the client

to determine if the change in his sleep pattern is related to normal aging or depression? A)

How much did you sleep when you were younger?

Is it hard for you to fall asleep or remain asleep during the night?

Why do you think you continue to ingest so much alcohol?

What used to help you go to sleep? A couple is concerned that the husband’s father may be developing depression. In

8. questioning the couple, which of the following statements would support their concern? Dad has been crying off and on now for over 2 weeks since Mom died. He’s also A)

still having trouble sleeping. Dad is agitated and anxious; he’s been that way for a month now since Mom

died. It’s been over 2 months now since Mom died, and Dad keeps crying; he can’t eat

or sleep. Mom’s funeral was last week, and Dad hasn’t been able to eat or sleep since

then. A nurse is providing an in-service educational program for beginning nurses regarding mental health assessment needs of the older adult. One of the topics addressed is the importance of interviewing family members in addition to the older adult client. The nurse tells the audience that family members are sometimes able to give a more accurate history if the client has memory impairment. The nurse also emphasizes that interviewing

9. family members provides which of the following? A)

A more accurate picture of the social support resources available

Evaluation of the family’s ability to effectively care for the older client

Determination of the extent of the client’s memory impairment

A much needed period of respite and support for the family members

Assessment of an older adult client reveals that the client is receiving psychiatric medications. The client states, I get dizzy periodically and have trouble walking. 10.1 Which of the following should the nurse do first? 0 Compare the client’s baseline blood pressure with the client’s current blood . pressure. A) B)

Instruct the client to stop taking the psychiatric medications.

Interview the client’s family about the client’s coping skills and current stress level.

Suggest the client periodically use an alcohol-based mouthwash several times a day.The nurse is planning to assess a client’s anxiety level using the Rating Anxiety in Dementia Scale because the client also has dementia. When using this scale which of the

11. following areas would the nurse assess? Select all that apply. A)

Apprehension

Motor tension

Life satisfaction

Boredom

Autonomic hyperactivity

Worry A nurse is preparing a presentation for a group of colleagues about suicide and the older adult population. Which of the following would the nurse include in this presentation?

12. Select all that apply. A)

Suicide is less of a risk in this population as compared with middle-aged adults.

Married African American men are at the greatest risk for suicide in this group.

Depression is the greatest risk factor for suicide in this population group.

White women account for the highest number of suicide deaths in this age group. Recent behavior changes and loss of support are important assessment areas for

suicide risk.

A group of nursing students is reviewing information about age-related changes occurring in cognition and intellectual performance. The students demonstrate understanding of the 13. information when they identify which of the following as a normal cognitive change? A)

Disorientation to time

Slowed information processing

Diminished executive functioning

Restricted judgment A nurse is assessing an older adult client. Which of the following would the nurse

14. interpret as most indicative of mental health and wellness? A)

Keeping social contacts to a minimum

Interacting with others in the environment

Relying solely on family for assistance

Experiencing bereavement

TESTBANKSELLER.COM

A nurse is using the Neuropsychiatric Inventory to assess an older adult client who is exhibiting behavior problems related to dementia. When using this tool, which of the 15. following would the nurse assess? Select all that apply. A)

Dysphoria

Inhibition

Apathy

Level of orientation

Memory

Anxiety A nurse has used the Geriatric Depression Scale (short form) to assess an older adult client for depression. Which score would lead the nurse to suspect that the client is mildly

16. depressed? A) 3

B) 5 C) 8

Answer Key 1. D 2. B 3. C 4. A 5. D 6. D 7. B 8. C 9. B 10. A 11. A, B, E, F 12. C, E 13. B 14. B 15. A, B, C, F 16. C

Chapter 38- Delirium, Dementias, and Other Related Disorders An older adult client is brought to the emergency department after ingesting an unknown substance. The client, who appears to have dementia, has tremors, ataxia of the upper and lower extremities, depression, and confusion. The nurse suspects ingestion of which of 1. the following? A)

Lead

Aluminum

Manganese

Mercury An adolescent client is seen in the emergency department with symptoms of dementia, tremors, and ataxia. The client had been sniffing glue with a friend. The nurse suspects

2. the client’s symptoms were caused by poisoning with which of the following? A)

Mercury

Lead.

Toluene

Arsenic The nurse is assessing a client who has received a tentative diagnosis of delirium. The nurse is explaining to the family about the major cause of the client’s condition. Which

3. statement by the nurse would be most appropriate? A)

Basically, this diagnosis is based on the client’s inability to talk normally. Your report of gradually developing confusion over time was the basis for the

diagnosis.

His diagnosis is primarily based on the rapid onset of his change in

consciousness. D)

The client’s exposure to an infectious agent led us to determine the diagnosis. As part of a follow-up home visit to an 80-year-old client who has had surgery, the nurse discusses the client’s risk for delirium with his family members. Which of the following

4. would the nurse include as placing the client at increased risk? Select all that apply. A)

Urinary tract infection

Hypertension

Acute stress

Bone fractures

Dehydration

Electrolyte balance The nurse is caring for a client diagnosed with delirium who has been brought for treatment by his son. While taking the client’s history, which question would be most

5. appropriate for the nurse to ask the client’s son? A)

Has your father taken any medications recently?

Are you aware of your father falling or injuring his head in any way?

Has your father had a recent stroke?

Has your father experienced any major losses recently? The nurse makes a home visit to a family caring for a client with Alzheimer’s disease. The client’s wife tells the nurse that she hasn’t been out of the house for more than 2 weeks because her sister has been unable to help her care for the client. Which nursing

6. diagnosis would the nurse identify as the priority? A)

Ineffective Family Coping related to care of a client with Alzheimer’s disease

Risk for Activity Intolerance related to Alzheimer’s disease

Caregiver Role Strain related to social isolation

Powerlessness related to seclusion and long-term care of client

A daughter brings her mother, who has Alzheimer’s disease, to the clinic. The client has been taking a cholinesterase inhibitor medication for 1 month. When assessing the client, 7. the nurse would be alert for the possibility of which side effect? A)

Gastrointestinal distress

Mild headache

Muscle tics

Blurred vision A son brings his mother to the clinic for an evaluation. The son’s mother has moderate Alzheimer’s disease without delirium. The nurse assesses the client for which of the

8. following as the priority? A)

Hearing deficits

Mania

Strange verbalizations

Catastrophic reactions A client is admitted to the hospital with dementia related to Parkinson’s disease. The client is being treated for a fractured tibia from a recent fall. The nurse should assess the

9. client’s history for use of which type of medication? A)

Anticholinergics

Dopamine agonists

Anxiolytics

Benzodiazepines While the nurse is caring for a hospitalized client in the advanced stages of Alzheimer’s disease, the client begins to have a catastrophic reaction to feeding himself. Which of the

10. following should the nurse do first? A)

Remain calm and reassuring.

Restrain the client temporarily.

Draw the curtains to darken the room.

Offer to feed the client. While reviewing the medical record of a client with moderate dementia of the Alzheimer type, the nurse notes that the client has been receiving memantine. The nurse identifies

11. this drug as which type? A)

Atypical antipsychotic

Cholinesterase inhibitor

NMDA receptor antagonist

Benzodiazepine A group of nursing students is reviewing information about delirium and dementia. The students demonstrate a need for additional review when they identify which of the

12. following as characteristics of dementia? A)

Fluctuating changes within a 24-hour period

Possible hallucinations

Normal psychomotor activity

Globally impaired cognition A client is brought to the emergency department by his wife. The wife states that over the past few hours, the client has become disoriented and confused. He didn’t know where he was and didn’t seem to recognize me or be able to carry on a coherent conversation. The nurse suspects delirium. When reviewing the client’s medication history with the wife, use of which of the following would alert the nurse to a potential cause? Select all

13. that apply. A)

Propranolol

Acetaminophen

Diphenhydramine

Verapamil

Quinidine A nurse is assessing a client diagnosed with Alzheimer’s disease. As part of the assessment, the nurse asks the client to identify common objects. The nurse is assessing

14. for which of the following? A)

Aphasia

Apraxia

Agnosia

Executive functioning A nursing instructor is preparing a presentation on the etiology of Alzheimer’s disease. When discussing the role of neurotransmitters in the course of the disease, which of the

15. following would the instructor most likely emphasize? A)

Serotonin

Acetylcholine

Dopamine

Norepinephrine When assessing a client with dementia, the nurse identifies that the client is experiencing hallucinations. Based on the nurse’s understanding of this disorder, which type of

16. hallucination would the nurse expect as most common? A)

Auditory

Visual

Gustatory

Olfactory

17. A nurse is talking with the husband of a female client diagnosed with Alzheimer’s disease. During the conversation, the husband tells the nurse that she often begins to scream and curse for no apparent reason . The nurse interprets this as which of the

following? A)

Hypersexuality

Disinhibition

Hypervocalization

Apathy After teaching a group of nursing students about Alzheimer’s disease and appropriate nursing care, the instructor determines that the teaching was successful when the students identify which of the following as the foundation for providing care to the client and

18. family? A)

Therapeutic relationship

Medication therapy

Injury prevention

Functional independence

TESTBANKSELLER.COM

A nurse is providing care to a client with Alzheimer’s disease who is exhibiting suspiciousness and delusional thinking. Which of the following would be most important 19. for the nurse to do with this client? A)

Tell the client that he is experiencing delusions.

Confront the client about his distorted thinking.

Correct the client’s interpretation of the situation.

Determine the trigger for the distorted thinking. A client with Alzheimer’s disease is admitted to the acute care facility for treatment of an infection. Assessment reveals that the client is anxious. When developing the client’s plan

20. of care, which of the following would be least appropriate to include? A)

Frequently provide reality orientation.

Simplify the client’s routines.

Limit the number of choices to be made.

Establish predictable routines.

Answer Key 1. D 2. C 3. C 4. A, C, D, E 5. A 6. C 7. A 8. D 9. A 10. A 11. C 12. A 13. A, C, E 14. C 15. B 16. B 17. C 18. A 19. D 20. A

Chapter 39- Caring for Persons Who Are Homeless and Mentally Ill The nurse is working in a shelter for homeless men. When planning the care for these clients, the nurse integrates understanding that men who have been homeless for a long 1. period of time often feel a sense of which of the following? A)

Depersonalization

Strong coping skills

Self-efficacy

Fear of failure A nurse is presenting a talk on homelessness and its effect on individuals. The nurse

2. describes the resiliency of homeless individuals based on which of the following? A)

Strong community supports

Available family resources

Coping with extreme stressors

Local governmental intervention The nurse is caring for a homeless client who has been seen in the mobile clinic every week for the past month because of a foot infection. Which nursing diagnosis would the

3. nurse most likely identify as the priority? A)

Social Isolation related to homelessness

Ineffective Health Maintenance related to homelessness

Chronic Low Self-Esteem related to foot disorder and homelessness

Imbalanced Nutrition, less than body requirements, related to poor eating

4. A new graduate nurse is considering taking a job that focuses on meeting the mental health needs of homeless populations. During the graduate nurse’s pre-employment

interview, the graduate nurse asks the interviewer what characteristics are common in this population. Which response by the interviewer would be most likely? Most of them have very little education and, consequently, they work in menial A)

jobs when they can get them. They come from a variety of backgrounds, and they often experience chronic

illness and are unemployed. They have often squandered their financial resources, and most are from poorer

rural and urban backgrounds. Most are frail elderly people, and many are mentally ill. However, very few are

addicts or alcoholics. A nurse is assessing a 49-year-old homeless male client. The nurse fashions the assessment process based on the understanding that the client would most likely

ow g?ANKSELLER.COM 5. demonstrate which of the foTllE SiTnB A)

Cooperation and talkativeness to share his ideas

Agreement to allow a complete physical examination

Desire for in-depth discussion of his condition

Resistance and caution about the interaction A nurse has formulated several nursing diagnoses for a homeless client after a thorough nursing assessment. Of these, which of the following would the nurse determine as the

6. priority? A)

Anxiety

Powerlessness

Imbalanced nutrition

Impaired social interaction

7. The nurse is helping a 56-year-old homeless woman develop a plan for after discharge.

Which of the following would be most appropriate to include? Contacting the woman’s daughter as a possible source of support after the client’s A)

discharge Contacting the woman’s parents as a possible source of support after the client’s

discharge Providing the woman with a three-ring binder full of resources that will promote

independent living Providing the woman with telephone numbers of various local health care insurance

companies A nursing instructor is preparing a teaching plan for a group of nursing students who will be working with homeless populations. As part of the class, the instructor will be including information about barriers to successful treatment of homeless clients who are mentally ill. Which reason w strSuE ctL orLiE ncRlu.dCeOasMcontributing to lack of ToEuSldTtBheAiNnK

8. compliance with psychotropic medications? A)

Mistrust of medical personnel

Lack of proper medication storage

Chemical dependence on prescription medications

Lack of motivation and literacy skills A nurse is working for a mobile homeless treatment program. Which method would the

9. nurse most likely use to provide follow-up care to clients? A)

Seeing them by appointment at a clinic office

Riding a bicycle to wherever the client happens to be

Meeting the client in a public place easily accessible by taxi

Using the telephone to determine how well the clients are doing

10. A nurse is teaching an in-service education class about caring for homeless populations.

When explaining the difference between the care provided by Safe Havens and Shelter Plus Care, which of the following would the nurse include? Shelter Plus Care offers more services to a larger population than does Safe A)

Havens.

Safe Havens provides shelter for as many as 100 people at a time. Safe Havens provides traditional support services as well as short-term

housing. Shelter Plus Care offers a variety of supportive services in addition to long-term

housing. A nursing instructor is preparing a class on individuals who are homeless and mentally ill for a group of nursing students. When describing the characteristics of this population,

11.1 which of the following would the instructor most likely include? Select all that apply. 1 . A)

Individuals usually recTeE ivS eT psByA chNiaKtrSicEcLaL reEinRo.uCtpOaM tient units.

Their physical health is likely to be worse than that of other homeless individuals.

Most have easy access to disability or other types of benefits. Individuals typically are more often involved with the legal system than other

homeless people. An individual with a mental illness has the greatest risk of becoming homeless than

others. The nurse is developing a plan of care for a client who has been admitted to the inpatient unit after being brought to the emergency department by law enforcement. Assessment in the emergency department revealed that the client is homeless and has been diagnosed with posttraumatic stress syndrome. The client also has a history of substance abuse. When reviewing the client’s medical record, which of the following would the nurse

12.1 identify as contributing to the client’s homelessness? Select all that apply. 2 .

Diagnosis of posttraumatic stress syndrome

Involved participation of family members

Part-time employment as a custodian

History of substance abuse

Recent loss of public assistance support After describing the various legislative efforts to address the issue of homelessness in the United States, a nursing instructor determines that the teaching was successful when the students identify which of the following as addressing the need for a continuum of care

13. approach? A)

Bringing Home America Act

Affordable Care Act

American Recovery and Reinvestment Act

McKinney-Vento Homeless Assistance Act

TESTBANKSELLER.COM

A nurse working in an emergency homeless shelter is interviewing a woman who has just arrived with her two small children. When assessing this client, the nurse would expect 14. the woman to report which of the following as the reason for seeking shelter? A)

Substance abuse

Domestic violence

Unemployment

Imprisonment A group of nurses is in a discussion about the homeless population in their community as a means for developing appropriate programs for this group. Which statement by one of

15.1 the members indicates a need for the group to address the nurse’s stereotypical thinking? 5 Homeless individuals must be creative in figuring out ways to survive. . A)

People who are homeless come from all walks of life.

If the person lives on the street, he will not accept services.

Most people are homeless for a relatively short period of time.

A nurse is developing a plan of care for a male client who is homeless. Which of the 16.1 following would the nurse do first? 6 . A)

Refer the client to social services to access necessary benefits.

Provide the client with a list of facilities that are safe.

Discuss how the client can maintain his privacy.

Stabilize the client’s physical health status. A client who is homeless and mentally ill is being discharged to an Assertive Community Treatment (ACT) program. The nurse interprets this as including which of the following

17. services? Select all that apply. A)

Substance abuse management

Medication monitoring

Counseling

Living skills classes

Shelter for one night

Answer Key 1. A 2. C 3. B 4. B 5. D 6. C 7. A 8. B 9. B

10. D

11. B, D 12. A, C, D, E 13. D 14. B 15. C 16. D 17. A, B, C

Chapter 40- Caring for Persons With Cooccurring Mental Disorders A client with major depression visits the mental health clinic and tells the nurse that he has recently started using marijuana quite frequently. The nurse determines that the 1. manifestation of the client’s co-occurring disorder reflects which of the following? A)

Primary mental illness with subsequent substance use

Primary substance abuse disorder with psychopathologic sequelae

Dual primary diagnoses

A common etiology The nurse is planning a presentation for a group of mental health care providers on the topic of co-occurring disorders. The nurse plans to include information about health care providers and their response to these clients. Which of the following would the nurse

2. include as a major reason for these clients being often underserved and undertreated? Providers often focus treatment on the 12-step programs for substance abuse A)

treatment. They commonly underdiagnose personality disorders in those who take illicit

substances.

Providers commonly ignore the existence of concurrent mental health disorders.

They have difficulty determining which problem is in most immediate need.The nurse is caring for a female adolescent client diagnosed with depression and

3. substance abuse. Which of the following would be most appropriate for the nurse to do? A)

Determine if the client is experiencing hyperactivity.

Ask her if she is having thoughts of harming herself.

Determine if the client is exhibiting Wernicke’s syndrome.

Ask the client if she has had problems with excessive anxiety. A client with schizophrenia and substance abuse disorder is admitted to a detoxification program. The client has been prescribed neuroleptic medications for schizophrenia. When caring for this client, the nurse would implement interventions to reduce the client’s risk for relapse, integrating knowledge that relapse frequently is secondary to which of the

4. following? A)

Poor social skills

Lack of vocational skills

Medication non-adherence

Dysfunctional family systems A nurse is teaching a group of hospitalized clients who have co-occurring disorders involving cognitive disorders and alcoholism about the relapse cycle. Which statement

5. would the nurse most likelyTinEcSluTdB eA duNrK inS gE thLisLtE eaRch.iC ngOsMession? After you are discharged, there is a tendency to use alcohol rather than your prescribed medications to self-medicate your psychiatric symptoms. This allows your psychiatric symptoms to surface again, and they, in turn, lead to rehospitalization. Your symptoms are again controlled with medications until you A)

are discharged, and the cycle starts all over again. Your alcoholism causes you to hallucinate, and you need to take prescribed medications to control the hallucinations. When you try to stop drinking and stay abstinent, your hallucinations disappear; consequently, you stop taking your prescribed medications because they’re gone. Then you celebrate with alcohol, and this triggers a relapse; the alcoholism causes hallucinations, and the whole thing

starts over again.

Your dependence on alcohol and your psychiatric illness are unrelated. Experiencing disturbing thoughts does not cause alcoholism, and alcoholism does C)

not cause your disturbing thoughts. It all boils down to medication compliance. The cycle is triggered by repeated attempts to stop drinking. Without the levels of alcohol your system has come to tolerate, you begin to develop psychiatric symptoms. Then you have to be hospitalized and treated for your psychosis again. Everything is fine until the next time you try to stop drinking, and then the cycle

repeats itself. A nurse is interviewing a client who has a co-occurring diagnosis. The client is trying to explain why it is so easy to start drinking again even though hospitalization and prescribed medications can eventually control his mental problems. Which

6. statement by the client would the nurse interpret as reflecting the client’s beliefs?

TESTBANKSELLER.COM

It just seems easier and cheaper to go out and get a bottle or a fix than it does to A)

keep paying for medications with money I don’t have. If I come out of the hospital and keep taking my prescribed medications, I know I will function better, but I won’t be able to escape my feelings or feel high like I do

when I drink. I just don’t like the side effects my prescribed medications cause, and, besides

that, I can never remember to take them at specific times or with food. I don’t like to take them because then my spouse expects me to be more responsible and to help around the house more often. I don’t have to be bothered

with that when I drink or use.

7. A nurse is working as part of an interdisciplinary treatment team for a client diagnosed with a mental illness and substance abuse disorder. As part of the recovery process, which

of the following would be most important for the team to do initially? Provide a series of short-term hospitalizations that apply leverage to pressure the A)

client into adhering to a prescribed treatment regimen. Establish rules that will enhance the client’s recognition of staff as authority figures

who know what is best for the client’s care and well-being. Use heavy confrontation, intense emotional pressure, and discouragement of the use

of medications since all medications have the potential to be addictive. Provide immediate help with a situational crisis the client is experiencing to promote

trust in the client and have the client buy into the treatment process. A client has a co-occurring diagnosis of alcoholism and bipolar disorder. He was brought to the emergency department by two policemen who had broken up a fight that the client had gotten into in a neighborhood bar. The client is intrusive and verbose about having diplomatic immunity and hiT sE prSeT ssB inA gNnK eeS dEtoLtL ouErRth.eCbOisM tate area to promote his bid for the presidency. The client has had multiple admissions to the hospital’s psychiatric unit, and he has almost always experienced alcohol withdrawal syndrome immediately after his

8. previous admissions. Which of the following would be a priority for this client? Administering prescribed mood-stabilizing medications to control his delusional A)

thinking because doing so will curtail his desire to drink Taking baseline vital signs and then monitoring them on an ongoing basis to

ascertain if the client is exhibiting early signs of alcohol withdrawal Suggesting that client refrain from being intrusive and annoying others with his

constant chatter about his delusional thinking

Referring the client to an outpatient community substance abuse treatment center because his addiction has to be adequately addressed before his bipolar problems can

be effectively treated The parents of a client with schizophrenia who also abuses alcohol asks the nurse, What can we do to help our son from relapsing after he is discharged from the 9. hospital? Which response by the nurse would be most appropriate? There’s really not much you can do; your son is responsible for maintaining his A)

own sobriety. Avoid letting him take any mood-altering chemicals because they may trigger his

delusional thinking. Make sure he goes to at least two Alcoholics Anonymous meetings a week, gets a

sponsor, and calls his sponsor on a daily basis. Report any side effects he develops so they can be treated and therefore won’t

tempt him to stop taking his prescribed medications. A nurse is readmitting a clieTnE tw ithBaAcNoK -oScE cuLrrLinEgRd. iaC gnOoMses of schizophrenia and alcohol ST abuse who has relapsed. The client says, I’m just a failure. I’ll never be anything but

10. just a drunk. Which response by the nurse would be most appropriate? Relapse is a normal part of recovery; you can learn from this experience so it will A)

be easier to avoid it or a similar one in the future. Face it, you will always be an alcoholic, and relapse is inevitable because it is

part of the illness. If you didn’t have disturbed thoughts from your schizophrenia, you wouldn’t be

tempted to drink. Please clarify something for me. When you say, ‘just a drunk,’ what exactly are

you trying to say?

11. A group of nursing students are reviewing information about co-occurring disorders and risks for substance abuse. The students demonstrate understanding of the information

when they identify which psychiatric disorder as being associated with the highest risk for substance abuse? A)

Mania

Panic disorder

Antisocial personality disorder

Phobias When describing the relapse cycle to a group of families of clients experiencing co-

12. occurring disorders, which of the following would the nurse identify as occurring first? A)

Hospitalization

Decompensation

Stabilization

Discharge The nurse is reviewing a client’s medical record and finds that he has received treatment

TESTBANKSELLER.COM

for his co-occurring disorders in the primary health care setting. The nurse interprets this 13. as which quadrant of care? A)

Category I

Category II

Category III

Category IV A nurse is working with a client with co-occurring disorders who is in the early stages of recovery. The client has been abstained from using alcohol for the past 3 weeks. During a follow-up visit, the nurse is working on teaching the client about the effects of alcohol on his body. Which of the following would be most important for the nurse to keep in mind

14. about the client? A)

The client will be highly suggestible to information, being unable to reason

critically. B)

The alcohol abuse has destroyed the brain cells that are necessary for learning. Some cognitive impairment may be present that hinders his ability to learn new

things. The underlying effects of the substance abuse will prevent him from being able to

learn. A nurse is working with a client with depression and substance abuse on ways to promote recovery. Which of the following would be most important for the nurse to include?

15.1 Select all that apply. 5 . A)

A positive social network

Compliance to treatment

Avoidance of hospitalization

Supportive housing

Community vocational rehabilitation A client with co-occurring disorders of schizophrenia and substance abuse is admitted for treatment. Which of the following would the nurse be least likely to identify as a priority

16. for this client? A)

Assessment

Group therapy

Control of psychiatric symptoms

Treatment of withdrawal symptoms

Answer Key 1. A 2. D 3. B

4. C 5. A 6. B 7. D 8. B 9. D 10. A 11. C 12. B 13. A 14. C 15. A, B, D, E 16. B

Chapter 41- Caring for Survivors of Violence The nurse is talking to a female client who is a survivor of intimate partner violence. The woman relates that her husband has been told that he has the characteristics of an antisocial personality disorder. The woman also informs the nurse that her husband has an extensive criminal record. The nurse interprets this information and suspects that the 1. woman’s husband would most likely demonstrate which behavior? A risk for moderate to severe violence with people both within and outside his A)

family

Intermittent remorse for the violence and abuse that he commits

Symptoms of depression along with harboring feelings of inadequacy

Purposefully remain socially isolated from people other than those in his family The nurse is caring for a young adult in the mental health clinic. The client tells the nurse that he was physically neglected as a child. The nurse should assess the client for

2. symptoms of which of the following? A)

Major depression

Schizophrenia

Narcissistic personality disorder

Panic disorder The emergency department nurse is assessing a female client with traumatic injuries. To assess whether or not the client’s injuries have resulted from abuse, which question would

3. be most appropriate for the nurse to ask the client? A)

Is your partner being mean to you?

Why do you think your husband has beaten you?

It looks like someone has hurt you. Tell me about it.

Can you describe the person who did this to you? A female client has been admitted to the inpatient psychiatric facility with a diagnosis of posttraumatic stress disorder after a history of violence by her boyfriend. During the

4. initial assessment interview, which assessment would be the priority? A)

Nutritional status

Hydration status

Sleep patterns

Suicide risk The nurse is caring for a family in which the elderly mother has been a victim of abuse and neglect by her 48-year-old son. Which of the following would be most important for

5. the nurse to keep in mind before interviewing the family? A)

A top nursing priority will be to legally remove the son from the home. The main focus of the nurse’s actions should be on improving the elderly mother’s

self-esteem. The nurse must allow the elderly mother to decide if she wants to leave the situation

C) D)

or not. Placement for the elderly woman in a nursing home within the community is crucial.A nurse is working with a female client who is anticipating the possibility of leaving an abusive relationship. In helping the client make the decision to leave or to stay in the

6. abusive situation, which of the following would be most important for the nurse to do? Ensure that the client can effectively describe the behaviors inherent in each phase A)

of the cycle of domestic violence. Inform the client that if she leaves the abusive situation, there is a possibility her

partner will attempt to murder her.

Assist the client in finding a new apartment and a new job so she will be safe after

she leaves her current situation. Suggest that the client legally change her name and move out of state so she will be D)

safe from future harm. A nurse is conducting a public information seminar on the topic of rape and sexual assault at a local community center. Which of the following would the nurse include when

7. describing power rapists? Committed by sadistic perpetrators who plan the rape before committing it to A)

experience erotic enjoyment in response to the victim’s suffering Target very young or elderly victims, may involve extreme force, and often results

in victim injury Are not planned ahead of time and result from the perpetrator being obsessed with

uncontrollable sexual urges Target victims near theTaEgS eT ofBtA heNpKeS rpEeL traLtoErR s. anCdOinMvolve minimal physical force

and intimidation in controlling their victims The school nurse is aware that a student has requested aspirin three times during the past week because his back hurts. The nurse has noticed that he often wears long-sleeved sweaters and sweatshirts even in warm weather. The nurse suspects that the student may be the victim of physical abuse. The nurse is preparing to ask the child about his ongoing backache. Which of the following would the nurse anticipate being reported by the child

8. if he was being abused? A)

Explain that his father is beating him on a regular basis.

Give a far-fetched explanation not logically connected to his injuries.

Give the same reason his sister would give were she asked to explain his injuries.

Carefully explain that his mother disciplines him because she loves him.

9. A nurse is presenting a program to a church group about domestic violence. During the

presentation, a member of the audience asks the nurse to explain what intergenerational transmission of violence means because he has seen that phrase used in the media. Which of the following responses by the nurse would be most appropriate? People who are violent are that way because of the various neurochemical A)

imbalances in their brains. People who grow up in violent home situations tend to be involved in domestic

violence situations as an adult. Recent research has identified a gene that is responsible for transmission of a risk

for violent behavior that is passed on from generation to generation. Domestic violence seems to skip every other generation when it is traced in

families. A group of nursing studentsTiE s rSeT viB ew inE foLrm nC abOoM ut intimate partner violence AiNngKS LaEtiRo. (IPV). The group demonstrates understanding of this topic when they identify which of

10.1 the following? 0 Men are more likely to be seriously injured even though more women are typically . victims. A) B)

Men may not consider behaviors such as slapping or shoving as abuse. IPV in same-sex couples occurs less frequently as compared with heterosexual

relationships.

The reactions to IPV are similar in male and female victims. A nurse is assessing a survivor of intimate partner violence. During the interview, the nurse determines that the survivor’s partner is using power and control over the client

11.1

through coercion and threats. Which client statement would lead the nurse to suspect this? He always tells me that the abuse never happened.

He tells me who I can and cannot see.

He tells me that he’ll tell child services I’m a bad mother.

He acts like he’s the master of his castle and I’m his servant. A nurse is preparing a presentation for an adolescent and young adult community group about stalking. Which group would the nurse identify as having the highest risk of being

12.1 stalked? 2 . A)

Boys and young men, ages 12 to 21 years

Men, ages 24 to 28 years

Girls and young women, ages 10 to 18 years

Women, ages 18 to 24 years A group of nursing students is reviewing information about the types of abuse. The students demonstrate understanding of the information when they identify stalking as a

13. crime of which of the following? A)

Violence

Intimidation

Jealousy

Fear A nurse is assessing a client who is a survivor of abuse. Which of the following would be

14. most appropriate to use when conducting a lethality assessment? A)

Danger Assessment Screen

Abuse Assessment Screen

Burgess-Partner Abuse Scale

Beck Depression Inventory A nurse is interviewing a client who is a survivor of abuse. The client is telling the nurse about how the violence occurred. Which statement would the nurse interpret as reflecting

15. phase 3 of the cycle of violence?

He threw me against the wall and started punching my face.

He yells at me for not having dinner waiting for him when he came home.

He calls me stupid and incompetent, asking himself why he ever married me.

He tells me that he is sorry and that he will never hit me again. A nurse is working with a client who is a survivor of violence on developing a safety

16.1 plan. Which of the following would the nurse address first? 6 . A)

Devising an escape route

Recognizing the signs of danger

Identifying a safe place to hide

Identifying a signal to indicate it is safe to leave A guest lecturer from a treatment program for perpetrators of abuse is describing the program to a group of nursing students. The program uses cognitive behavioral techniques. Which of the following would the lecturer include as a focus of the program?

17. Select all that apply. A)

Identifying what the perpetrator thinks about before the incident

Determining the perpetrator’s emotional and physical responses to the thoughts

Exploring the perpetrator’s actions that eventually lead to violence

Identifying the behaviors in the survivor that led to the violence

Determining the extent of guilt or remorse experienced by the perpetrator

Answer Key 1. A 2. A 3. C 4. D 5. C

6. B 7. D 8. B 9. B 10. B 11. C 12. D 13. B 14. A 15. D 16. B 17. A, B, C

Chapter 42- Caring for Persons With Mental Illness and Criminal Behavior A nurse’s friend is considering going into forensic nursing and asks the nurse to explain the connection between mental illness and being convicted of a crime. Which response by 1. the nurse would be most accurate? Mentally ill men are less likely than non mentally ill men to be convicted of a A)

crime. Mentally ill women are less likely than non mentally ill women to be convicted

of a crime. Women who are incarcerated are more likely to receive mental health services

than men. African American offenders often receive more mental health treatment than

other offenders. A nursing instructor is explaining to a group of nursing students that in addition to facing the stigma associated with being mentally ill, forensic clients who are mentally ill also experience the stigma associated with being a criminal. One of the students asks the instructor how the stigma associated with criminality might influence nursing care. Which

2. response by the instructor would be most appropriate? Nurses may be reluctant to care for mentally ill criminals because of unrealistic A)

fears for their own safety and that of their other clients. Nurses may prefer to care for forensic clients because they do not believe

criminals can be mentally ill.

An example would be volunteering to work only with forensic clients because of

the belief that forensic clients experience only mild mental health problems. An example would be unfounded fear of what such clients might do after they are D)

discharged from treatment. A nurse is giving a public presentation on the topic of forensic psychiatric care at a community center in a community that is considering building a forensic facility. The nurse is explaining about how someone who is found to be unfit to stand trial is subsequently hospitalized in a forensic mental health facility. A member of the audience asks, What is the purpose of the hospitalization? Which response by the nurse

3. would be most appropriate? A)

Basically, they are kept under protective custody as long as necessary.

Efforts are focused on helping the client become ‘fit’ to stand trial.

Treatment is focused on determining the correct diagnosis.

The main purpose iT sE hoSldTinBgAtN heKcSliE enLtLuE ntR il.aCnO ew M trial date can be set. A psychiatric nursing instructor is trying to explain to a group of students how clients identified as guilty but mentally ill (GBMI) and not guilty by reason of insanity (NGRI) differ. Which of the following would be most appropriate for the instructor to include in

4. the discussion? GBMI clients are treated in a hospital setting, and they are often discharged sooner A)

than NGRI clients. NGRI clients are treated in a correctional setting, and they are discharged sooner

than GBMI clients. GBMI clients are treated in a hospital setting, and their discharge is handled through

the correctional parole system. NGRI clients are treated in a hospital setting, and their discharge is determined by

the courts.

When preparing the plan of care for a forensic client, a nurse determines not to investigate the details of the crime. Which of the following best supports the rationale for the nurse’s 5. decision? A)

Knowing the crime details would be extremely frightening for the nurse.

Denying the crime details will help to protect the nurse from undue anxiety.

It will keep the nurse’s attitudes about the crime from influencing care. It will help maintain proper professional boundaries between the nurse and the

client. A nurse has just transferred from a general psychiatric unit to work on a forensic psychiatric unit. The nurse finds it easier to communicate with these clients because, for the most part, their inappropriate behaviors and cognitive disorders have responded positively to treatment. Many of the clients have been on the unit for 3 or more years, and the nurse has been unable toTnEoSteTaBnA yN inK diScaEtoLrL sE ofRp.syCcO hiMatric problems in several of the clients. The nurse has grown exceptionally close to one client who has gone out of his way to make the nurse feel welcome and appreciated. One afternoon in December, the client asks the nurse for her address so he can send her a Christmas card. Which response

6. by the nurse would be most appropriate? A)

Sure, let me write it down for you; it would be great to hear from you. I read that you molested a 4-year-old girl. I have a 2-year-old child. I would be

crazy to give you my address. We need to get to know each other better before I would feel comfortable about

giving you my address. It is inappropriate for me to give you my address because our relationship is

professional rather than social.

7. The nurse is performing an admission assessment on a forensic client. Which of the

following would be most important for the nurse to include when explaining the purpose of the assessment to the client? This is just a routine assessment, and we will be discussing specific events that A)

have led to you being admitted to this unit. I will be asking you questions so we can determine how to best meet your

needs. It is important during this initial assessment that you relate the specific details of

the crimes of your case so we can effectively treat you. I will be asking you questions that will focus on mental health and behavioral

issues rather than on the specific details of any crimes associated with your case. A group of nurses who have recently been hired to work in the mental health division of a large federal prison system are undergoing orientation. A nurse is discussing medication administration for the clientT s.EW chAsN taKteSmEeL ntLwEoR u. ldCthOeMnurse most likely include in this ShTiB

8. presentation? Our inmates have to take their medication; to facilitate this, most of our oral A)

medications are dissolved in water before we hand them to a prisoner. Our inmates have the same rights as any clients do. If they refuse medications and

become a danger to themselves, we still cannot give any medications. Our inmates have to take their medications; we routinely give them injections so

they can’t check their medications. If our inmates refuse to take their medications, we have to get a court order that

mandates compliance with prescribed medications. A nurse is discussing follow-up care with a forensic client who is being discharged the following week. The client asks the nurse what problems to expect regarding his follow-

9. up care. Which response by the nurse would be most appropriate?

You probably won’t experience any difficulty in finding the care you need after A)

you are discharged. You will have to find weekly transportation back to the inpatient forensic unit for

your follow-up care. You may experience some difficulty in finding a community provider who will be

willing to offer you care because providers generally have a long waiting list. You may experience some difficulty in finding a community provider to provide

you care because of safety and liability concerns. A student nurse has been asked by the mental health nursing instructor to plan educational interventions for a forensic client with whom the student has been working. Which of the

10.1 following would be most important for the student nurse to include in the plan? 0 . A)

Explanation of the genetic and neurologic factors associated with criminal behavior Description of informaTtiE onST abBoA utNpK erStiE neLnL t le ga.l C anOdMcourt proceedings that are ER

pending Explanation of how nutrition and exercise can promote physical and mental well-

being A list of community providers the client’s family members can contact for assistance

and support A nurse is working with a forensic client on de-escalation techniques. Which activity

11.1 would be most appropriate as a grounding physical activity? 1 . A)

Drumming

Rocking in a rocking chair

Aerobic exercise

Yoga

12. A nurse is working with a forensic client on early recognition. On which area would the

nurse and client focus? A)

Medication side effects

Aggressive behavior signals

Violations of informed consent

Discharge needs A psychiatric nurse who works with forensic clients is describing the roles and responsibilities to a group of nursing students. Which of the following would the nurse

13. emphasize as critical before initiating medication therapy for a forensic client? A)

Court order for medication

Determination of not guilty by reason of insanity

Informed consent

Identification of history for aggression A client with mental illness and arrested has been found to be unfit to stand trial, and the

TESTBANKSELLER.COM

client is admitted to a forensic mental health facility. The nurse understands that the client 14. can be hospitalized for up to which duration to become fit? A)

3 months

6 months

1 year

5 years The nurse is reviewing the medical record of a forensic client who has been found not

15. guilty by reason of insanity. The nurse interprets this to mean which of the following? A)

The client knows that he committed a wrongful act.

The client is unable to control actions at the time of the crime.

The client is unable to assist in his defense.

The client’s mental illness is a factor in the crime.

Answer Key

1. C 2. A 3. B 4. D 5. C 6. D 7. D 8. A 9. D 10. B 11. C 12. B 13. C 14. C 15. B

Chapter 43- Caring for Medically Compromised Persons The nurse is developing a plan of care for a client with chronic pain caused by osteoarthritis. The client’s pain has been severe and prolonged. Which of the following 1. would the nurse identify as a priority assessment? A)

Grief

Panic disorder

Bulimia

Depression A client visits the clinic and complains of chronic pain in her leg as a result of a fall 6 months ago. Which of the following would be most important for the nurse to do first

2. when developing the client’s plan of care? A)

Acknowledge the client’s pain.

Identify situations that increase the pain.

Have the client rate her pain from 1 to 10.

Review the client’s current medications. The nurse is caring for a client diagnosed with HAND resulting from AIDS. Which of the

3. following would be most important for the nurse to assess? A)

Sensory impairment

Cognitive impairment

Social behaviors

Anxiety state

4. A client visits the clinic and tells the nurse about experiencing chronic stress on the job for the past 3 months. When teaching the client about chronic stress, which of the

following would the nurse include as a possible result? A)

Lung disorders

Renal disorders

Infections

Thyroid disorders A client visits the emergency department after she was raped in her apartment. The nurse assesses the client’s ability to adapt to the trauma by assessing her social support systems

5. and which of the following? A)

Ability to effectively activate coping strategies

Evidence of body image disturbance

Type of affect reflected in nonverbal communication

Degree of fear response reflected in nonverbal communication The nurse is caring for four clients who are simultaneously being treated for chronic

TESTBANKSELLER.COM

medical conditions and psychiatric conditions. Which client would the nurse anticipate as 6. being most resistive to taking medications for both conditions? A)

Male client who is exhibiting push of speech

Female client who is having difficulty sleeping

Male client who is convinced he is the president’s twin brother

Female client who cannot establish and maintain eye contact A female client is being treated for depression that has occurred secondary to a chronic cardiopulmonary condition. Which antidepressant would the nurse anticipate being

7. prescribed for this client? A)

Trazodone (Desyrel)

Bupropion (Wellbutrin)

Fluoxetine (Prozac)

Amitriptyline (Elavil)

A 22-year-old college student was involved in an automobile accident that resulted in permanent cognitive and physical disability. The night of the accident, the client and his friends had been celebrating a friend’s birthday at a local bar. The friend who was celebrating a birthday had been driving, and he was killed during the accident. The client feels guilty about his friend’s death. Which of the following would be a priority 8. assessment for this client? A)

Risk for suicide

Level of depression

Social support systems

Financial status A client has had a major stroke, and she is struggling to adjust to living with the consequent changes and permanent disabilities because of problems related to speech and mobility. The nurse is makiT ngEaShToBmAeNvK isS it E anLdLaEssRe. ssC esOtM he client closely based on the

9. understanding that the client is at increased risk for which of the following? A)

Bipolar I disorder

Major depressive disorder

Generalized anxiety disorder

Posttraumatic stress disorder A nurse is trying to determine whether a client is exhibiting symptoms of depression or of her medical illness. Which of the following group of symptoms would indicate to the

10. nurse that the client may be experiencing depression in addition to being medically ill? A)

Problems sleeping, decreased appetite, and frequent crying

Low self-esteem, decreased appetite, and problems sleeping

Feeling guilty, difficulty making decisions, and low self-esteem

Loss of energy, difficulty making decisions, and problems sleeping

A group of nursing students is reviewing information about barriers to pain management. The group demonstrates the need for additional study when they identify which of the 11. following as a barrier? A)

Fear of tolerance

Adequate reimbursement

Concern for being a good client

Reluctance to report pain A nursing instructor is describing how pain can impact a client psychosocially. As part of the discussion, the instructor explains the pain response. Which of the following would

12. the instructor include as excitatory amino acids involved? Select all that apply. A)

Somatostatin

Substance P

L-glutamate

Serotonin

N-methyl-D-aspartate

Endorphins A client with heart disease who had a myocardial infarction 2 months ago comes to the clinic for a follow-up visit. While assessing the client, the nurse would be alert most

13. likely for the development of which of the following responses? Select all that apply. A)

Personality disorder

Depression

Substance abuse disorder

Anxiety disorder

Delirium

14. A nurse is reviewing the medication history of a client with a medical illness who is also exhibiting signs and symptoms of depression and agitation. Which medications would the

nurse identify as possibly contributing to the client’s current state? Select all that apply. A)

Clonidine

Ibuprofen

Acetaminophen

Baclofen

Carvedilol A nurse is assessing a client with HIV who has developed HAND. The nurse determines that the client’s extrapyramidal system has been affected when the client exhibits which

15. of the following? Select all that apply. A)

Ataxia

Inattention

Tremors

Spasticity

Memory loss After teaching a group of nursing students about the connections between mental health and medical disorders on clients and families, the instructor determines the need for

16. additional teaching when the students identify which of the following as an effect? A)

Increased motivation for self-care

Prolonged hospitalization

Delayed recovery

Increased financial strain

Answer Key 1. D 2. A 3. B

4. C 5. A 6. C 7. C 8. A 9. B 10. C 11. B 12. C, E 13. B, D 14. A, B, D 15. A, C, D 16. A