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29. An individual hiking in the forest encounters a large poisonous snake on the path. Which change in this individual’s vital signs is most likely?

a. Pulse rate changes from 90 to 72.

b. Respiratory rate changes from 22 to 18.

c. Complaints of intestinal cramping begin.

d. Blood pressure changes from 114/62 to 136/78.

ANS: D

This frightening experience would stimulate the sympathetic nervous system, causing a release of norepinephrine, an excitatory neurotransmitter. It prepares the body for fight or flight. Increased blood pressure, pupil size, respiratory rate, and pulse rate signify release of norepinephrine. Intestinal cramping would be associated with stimulation of the parasympathetic nervous system.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 3-5, 50 (Figure 3-1) TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity a. Galantamine b. Valproate c. Buspirone d. Tacrine

30. Consider these medications: carbamazepine, lamotrigine, gabapentin. Which medication below also belongs to this group?

ANS: B

The medications listed in the stem are mood stabilizers, anticonvulsant types. Valproate (Depakote) is also a member of this group. The distracters are drugs for treatment of Alzheimer’s disease and anxiety.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 3-33, 34 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity a. Write the appointment day, time, and location on a piece of paper and give it to the player. b. Log the appointment day, time, and location into the player’s cell phone calendar feature. c. Ask the health care provider to admit the patient to the hospital overnight. d. Verbally inform the patient of the appointment day, time, and location.

31. A professional football player is seen in the emergency department after losing consciousness from an illegal block. Prior to discharge, the nurse assists the patient to schedule an outpatient computed tomography (CT) scan for the next day. Which strategy should the nurse use to ensure the patient remembers the appointment?

ANS: B

This player may have suffered repeated head injuries with damage to the hippocampus. The hippocampus has significant role in maintaining memory. Logging the appointment into the player’s cell phone calendar will remind him of the appointment the next day. Paper will be lost, and the patient is unlikely to remember verbal instruction. Hospitalization is unnecessary. See relationship to audience response question. Caution: This question requires students to apply previous learning regarding central nervous system anatomy and physiology.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 3-12 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment

Multiple Response

1. A nurse prepares to administer a second-generation antipsychotic medication to a patient diagnosed with schizophrenia. Additional monitoring for adverse effects will be most important if the patient has which co-morbid health problems? (Select all that apply.)

a. Parkinson’s disease b. Grave’s disease c. Hyperlipidemia d. Osteoarthritis e. Diabetes

ANS: A, C, E

Antipsychotic medications may produce weight gain, which would complicate care of a patient with diabetes, and increase serum triglycerides, which would complicate care of a patient with hyperlipidemia. Parkinson’s disease involves changes in transmission of dopamine and acetylcholine, so these drugs would also complicate care of this patient. Osteoarthritis and Grave’s disease should have no synergistic effect with this medication.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 3-37, 38, 40 TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity

2. Questions the nurse could ask that would be nonjudgmental when obtaining information about a patient’s use of complementary and herbal remedies include (Select all that apply) a. “You don’t regularly take herbal remedies, do you?” b. “What herbal medicines have you used to relieve your symptoms?” c. “What over-the-counter medicines, vitamins, and nutritional supplements do you use?” d. “What differences in your symptoms do you notice when you take herbal supplements?” e. “Have you experienced problems from using herbal and prescription drugs at the same time?”

ANS: B, C, D, E

The correct responses are neutral in tone and do not express bias for or against the use of complementary or herbal medicines. The distracter, worded in a negative way, makes the nurse’s bias evident.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 3-45 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Amygdala b. Hippocampus c. Occipital lobe d. Temporal lobe e. Basal ganglia

3. An individual is experiencing problems with memory. Which of these structures are most likely to be involved in this deficit? (Select all that apply.)

ANS: A, B, D

The frontal and temporal lobes of the cerebrum play a key role in the storage and processing of memories. The amygdala and hippocampus also play roles in memory. The occipital lobe is predominantly involved with vision. The basal ganglia influence integration of physical movement, as well as some thoughts and emotions.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 3-7, 12, 16, 50 (Figure 3-5) TOP: Nursing Process: Planning

MSC: Client Needs: Physiological Integrity a. “Sometimes there are physical causes for psychiatric symptoms. This test will help us understand whether that is the situation.” b. “Some mental illnesses are evident on fMRIs. This test will give information to help us plan the best care for your brother.” c. “This test will indicate whether your brother has been taking his psychotropic medications as prescribed.” d. “It sounds like you do not truly believe your brother had a mental illness.” e. “It would be better for you to discuss your concerns with the health care provider.”

4. A patient’s sibling says, “My brother has a mental illness, but the doctor ordered a functional magnetic resonance image (fMRI) test. That test is too expensive and will just increase the hospital bill.” Select the nurse’s best responses. (Select all that apply.)

ANS: A, B

The correct responses provide information to the sibling. Modern imaging techniques are important tools in assessing molecular changes in mental disease and marking the receptor sites of drug action, which can help in treatment planning. Psychiatric symptoms can be caused by anatomical or physiologic abnormalities. There is no evidence of denial in the sibling’s comment. The nurse can answer this question rather than referring it to the physician/health care provider. An fMRI does not demonstrate adherence to the medication regime.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 3-13, 58 (Table 3-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Physiological Integrity

Chapter 04: Treatment Settings

Halter: Varcarolis’ Foundations of Psychiatric Mental Health Nursing: A Clinical Approach, 8th Edition

Multiple Choice

1. Inpatient hospitalization for persons with mental illness is generally reserved for patients who a. present a clear danger to self or others. b. are noncompliant with medication at home. c. have limited support systems in the community. d. develop new symptoms during the course of an illness.

ANS: A

Hospitalization is justified when the patient is a danger to self or others, has dangerously decompensated, or needs intensive medical treatment. The distracters do not necessarily describe patients who require inpatient treatment.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 4-18 to 20

TOP: Nursing Process: Assessment

MSC: Client Needs: Safe, Effective Care Environment a. Postpone the patient’s discharge from the hospital. b. Contact the landlord who evicted the patient to further discuss the situation. c. Arrange a temporary place for the patient to stay until new housing can be arranged. d. Determine whether the adverse medication reaction was genuine because the patient had nowhere to live.

2. A patient was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the case manager learned that the patient received a notice of eviction immediately prior to admission. Select the case manager’s most appropriate action.

ANS: C

The case manager should intervene by arranging temporary shelter for the patient until an apartment can be found. This activity is part of the coordination and delivery of services that falls under the case manager role. None of the other options is a viable alternative.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 4-10, 40 (Table 4-1)

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. Helping a person diagnosed with a serious mental illness learn to manage money b. Restraining an agitated patient who has become aggressive and assaultive c. Teaching school-age children about the dangers of drugs and alcohol d. Genetic counseling with a young couple expecting their first child

3. Select the example of tertiary prevention.

ANS: A

Tertiary prevention involves services that address residual impairments, with a goal of improved independent functioning. Restraint is a secondary prevention. Genetic counseling and teaching school-age children about substance abuse and dependence are examples of primary prevention.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 4-16, 17 TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance

4. A patient diagnosed with schizophrenia had an exacerbation related to medication non-adherence and was hospitalized for 5 days. The patient’s thoughts are now more organized and discharge is planned. The patient’s family says, “It’s too soon for discharge. We will just go through all this again.” The nurse should a. ask the case manager to arrange a transfer to a long-term care facility. b. notify hospital security to handle the disturbance and escort the family off the unit. c. explain that the patient will continue to improve if the medication is taken regularly. d. contact the health care provider to meet with the family and explain the discharge rationale.

ANS: C

Patients do not stay in a hospital until every symptom disappears. The nurse must assume responsibility to advocate for the patient’s right to the least restrictive setting as soon as the symptoms are under control and for the right of citizens to control health care costs. The health care provider will use the same rationale. Shifting blame will not change the discharge. Security is unnecessary. The nurse can handle this matter.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 4-18, 40 (Table 4-1), 48 (Box 4-2)

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment

5. A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor’s closet is locked. These observations relate to a. coordinating care of patients. b. management of milieu safety. c. management of the interpersonal climate. d. use of therapeutic intervention strategies.

ANS: B

Nursing staff are responsible for all aspects of milieu management. The observations mentioned in this question directly relate to the safety of the unit. The other options, although part of the nurse’s concerns, are unrelated to the observations cited.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 4-23, 24 TOP: Nursing Process: Evaluation

MSC: Client Needs: Safe, Effective Care Environment

6. The patients below were evaluated in the emergency department. The psychiatric unit has one bed available. Which patient should be admitted? The patient a. feeling anxiety and a sad mood after separation from a spouse of 10 years. b. who self-inflicted a superficial cut on the forearm after a family argument. c. experiencing dry mouth and tremor related to taking antipsychotic medication. d. who is a new parent and hears voices saying, “Smother your baby.”

ANS: D

Admission to the hospital would be justified by the risk of patient danger to self or others. The other patients have issues that can be handled with less restrictive alternatives than hospitalization.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 4-20 TOP: Nursing Process: Assessment

MSC: Client Needs: Safe, Effective Care Environment a. Explore ways to help the patient stop smoking. b. Report the situation to the manager of the shelter. c. Assess the patient’s weight; determine foods and amounts eaten. d. Arrange hospitalization for the patient in order to formulate a new treatment plan.

7. A suspicious, socially isolated patient lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. Select a community psychiatric nurse’s best initial action.

ANS: C

Assessment of biopsychosocial needs and general ability to live in the community is called for before any other action is taken. Both nutritional status and income adequacy are critical assessment parameters. A patient may be able to maintain adequate nutrition while eating only one meal a day. The rule is to assess before taking action. Hospitalization may not be necessary. Smoking cessation strategies can be pursued later.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 4-9, 17, 18 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity a. A patient was not allowed to have visitors. b. A patient’s belongings were searched at admission. c. A patient with suicidal ideation was placed on continuous observation. d. Physical restraint was used after a patient was assaultive toward a staff member.

8. A nurse surveys medical records. Which finding signals a violation of patients’ rights?

ANS: A

The patient has the right to have visitors. Inspecting patients’ belongings is a safety measure. Patients have the right to a safe environment, including the right to be protected against impulses to harm self.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 4-21, 48 (Box 4-2) TOP: Nursing Process: Evaluation

MSC: Client Needs: Safe, Effective Care Environment eBay: testbanks_and_xanax a. Resolve the crisis with the least restrictive intervention possible. b. Swift intervention is justified to maintain the integrity of a therapeutic milieu. c. Rights of an individual patient are superseded by the rights of the majority of patients. d. Patients should have opportunities to regain control without intervention if the safety of others is not compromised.

9. Which principle has the highest priority when addressing a behavioral crisis in an inpatient setting?

ANS: A

The rule of using the least restrictive treatment or intervention possible to achieve the desired outcome is the patient’s legal right. Planned interventions are nearly always preferable. Intervention may be necessary when the patient threatens harm to self.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 4-21, 23, 24, 48 (Box 4-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment

10. Clinical pathways are used in managed care settings to a. stabilize aggressive patients. b. identify obstacles to effective care. c. relieve nurses of planning responsibilities. d. streamline the care process and reduce costs.

ANS: D

Clinical pathways provide guidelines for assessments, interventions, treatments, and outcomes as well as a designated timeline for accomplishment. Deviations from the timeline must be reported and investigated. Clinical pathways streamline the care process and save money. Care pathways do not identify obstacles or stabilize aggressive patients. Staff are responsible for the necessary interventions. Care pathways do not relieve nurses of the responsibility of planning; pathways may, however, make the task easier.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 4-23 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. Advocate b. Case manager c. Milieu manager d. Provider of care

11. A nurse receives these three phone calls regarding a newly admitted patient.

• The psychiatrist wants to complete an initial assessment.

• An internist wants to perform a physical examination.

• The patient’s attorney wants an appointment with the patient. The nurse schedules the activities for the patient. Which role has the nurse fulfilled?

ANS: B

Nurses on psychiatric units routinely coordinate patient services, serving as case managers as described in this scenario. The role of advocate would require the nurse to speak out on the patient’s behalf. The role of milieu manager refers to maintaining a therapeutic environment. Provider of care refers to giving direct care to the patient.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 4-10, 13, 49 (Box 4-3) TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment a. Hygiene assistance b. Diversional activities c. Assistance with job hunting d. Building assertiveness skills

12. Which aspect of direct care is an experienced, inpatient psychiatric nurse most likely to provide for a patient?

ANS: D

Assertiveness training relies on the counseling and psychoeducational skills of the nurse. Assistance with personal hygiene would usually be accomplished by a psychiatric technician or nursing assistant. Diversional activities are usually the province of recreational therapists. The patient would probably be assisted in job hunting by a social worker or vocational therapist.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 4-10, 11, 49 (Box 4-3) TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance a. Kindness b. Autonomy c. Compassion d. Professionalism

13. Which characteristic would be more applicable to a community mental health nurse than to a nurse working in an operating room?

ANS: B

A community mental health nurse often works autonomously. Kindness, compassion, and professionalism apply to both nurses.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 4-17 TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment

14. Which patient would be most appropriate to refer for assertive community treatment (ACT)?

A patient diagnosed with a. a phobic fear of crowded places. b. a single episode of major depressive disorder. c. a catastrophic reaction to a tornado in the community. d. schizophrenia and four hospitalizations in the past year.

ANS: D

ACT provides intensive case management for persons with serious persistent mental illness who live in the community. Repeated hospitalization is a frequent reason for this intervention. The distracters identify mental health problems of a more episodic nature.

PTS: 1 DIF: Cognitive Level: Apply (Application) eBay: testbanks_and_xanax

REF: Pages 4-12, 13

TOP: Nursing Process: Planning

MSC: Client Needs: Safe, Effective Care Environment a. Obtain the information from the patient’s medical record and relay it to the caller. b. Inform the caller that all information about patients is confidential. c. Refer the request for information to the patient’s case manager. d. Refer the request to the health care provider.

15. The unit secretary receives a phone call from the health insurer for a hospitalized patient. The caller seeks information about the patient’s projected length of stay. How should the nurse instruct the unit secretary to handle the request?

ANS: C

The case manager usually confers with insurers and provides the treatment team with information about available resources. The unit secretary should be mindful of patient confidentiality and should neither confirm that the patient is an inpatient nor disclose other information.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 4-10, 13, 49 (Box 4-3)

TOP: Nursing Process: Implementation

MSC: Client Needs: Safe, Effective Care Environment a. Assisting a person diagnosed with a serious mental illness to fill a pill-minder b. Helping school-age children identify and describe normal emotions c. Leading a psychoeducational group in a community care home d. Medicating an acutely ill patient who assaulted a staff person

16. Select the example of primary prevention.

ANS: B

Primary preventions are directed at healthy populations with a goal of preventing health problems from occurring. Helping school-age children describe normal emotions people experience promotes coping, a skill that is needed throughout life. Assisting a person with serious and persistent mental illness to fill a pill-minder is an example of tertiary prevention. Medicating an acutely ill patient who assaulted a staff person is a secondary prevention. Leading a psychoeducational group in a community care home is an example of tertiary prevention.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 4-16, 17

TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance a. Primary b. Secondary

17. Which level of prevention activities would a nurse in an emergency department employ most often?