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Advanced Practice Psychiatric Nursing 2nd Edition Tusaie Fitzpatrick Test bank Full ACCESS Test Bank From Link Below https://nursylab.com/products/advanced-practice-psychiatric-n ursing-2nd-edition-tusaie-fitzpatrick-test-bank/ TestBank Directly From The publisher, 100% Verified Answers. COVERS ALL CHAPTERS. Download Immediately
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Advanced Practice Psychiatric Nursing, Second Edition: Integrating Psychotherapy, Psychopharmacology, and Complementary and Alternative Approaches Across the Lifespan 2nd Edition Test Bank
O M
Chapter 1 Theoretical Understandings and Evidence Base for Practice
.C
MULTIPLE CHOICE
LD
1. Which understanding is the basis for the nursing actions focused on minimizing mental health
O R
promotion of families with chronically mentally ill members? a. Family members are at an increased risk for mental illness.
W
b. The mental health care system is not prepared to deal with family crises.
KS
c. Family members are seldom prepared to cope with a chronically ill individual.
BA
N
d. The chronically mentally ill receive care best when delivered in a formal setting.
ST
ANS: A
When families live with a dominant member who has a persistent and severe mental disorder the
TE
outcomes are often expressed as family members who are at increased risk for physical and
G
mental illnesses. The remaining options are not necessarily true.
N
2. Which nursing activity shows the nurse actively engaged in the primary prevention of mental
R
SI
disorders?
U
a. Providing a patient, whose depression is well managed, with medication on time
W W W
.N
b. Making regular follow-up visits to a new mother at risk for post-partum depression c. Providing the family of a patient, diagnosed with depression, information on suicide prevention d. Assisting a patient who has obsessive compulsive tendencies prepare and practice for a job interview
ANS: B
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Primary prevention helps to reduce the occurrence of mental disorders by staying involved with a patient. Providing medication and information on existing illnesses are examples of secondary prevention which helps to reduce the prevalence of mental disorders. Assisting a mentally ill
O M
patient with preparation for a job interview is tertiary prevention since it involves rehabilitation. 3. Which intervention reflects attention being focused on the patients intentions regarding his
LD
.C
diagnosis of severe depression? a. Being placed on suicide precautions
O R
b. Encouraging visits by his family members
c. Receiving a combination of medications to address his emotional needs
KS
W
d. Being asked to decide where he will attend his prescribed therapy sessions
N
ANS: D
BA
A primary factor in patient treatment includes consideration of the patients intentions regarding
ST
his or her own care. Patients are central to the process that determines their care as their abilities allow. Under the guidance of PMH nurses and other mental health personnel, patients are
TE
encouraged to make decisions and to actively engage in their own treatment plans to meet their
G
needs. The remaining options are focused on specifics of the determined plan of care.
N
4. When a patients family asks why their chronically mentally ill adult child is being discharged
SI
to a community-based living facility, the nurse responds:
U
R
a. It is a way to meet the need for social support.
.N
b. It is too expensive to keep stabilized patients in acute care settings.
W W W
c. This type of facility will provide the specialized care that is needed. d. Being out in the community will help provide hope and purpose for living.
ANS: D
Hospitalization may be necessary for acute care, but, when patients are stabilized, they move into community-based, patient-centered settings or are discharged home with continued outpatient treatment in the community. Concentrated efforts are made to reduce the patients sick role by
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providing opportunities for the development of a purposeful life and instilling hope for each patients future. Although social support is important, such a living arrangement is not the only way to achieve it. Although acute care is expensive, it is not the major concern when determining
O M
long-term care options. Community-based facilities are not the only option for specialized care. 5. What is the best explanation to offer when the mother of a chronically ill teenage patient asks,
LD
.C
Under what circumstances would he be considered incompetent?
O R
a. When you can provide the court with enough evidence to show that he is not able to care for himself safely.
W
b. It is not likely that someone his age would be determined to be incompetent regardless of his mental condition.
KS
c. He would have to engage in behavior that would result in harm to himself or to someone else; like you or his siblings.
BA
N
d. If the illness becomes so severe that his judgment is impaired to the point where the decisions he makes are harmful to himself or to others.
ST
ANS: D
TE
When a person is unable to cognitively process information or to make decisions about his or her own welfare, the person may be determined to be mentally incompetent. Providing self-care is
G
not the only criteria considered. Age is not a factor considered. The decision is often based on
SI
N
the potential for such behavior.
R
6. Which psychiatric nursing intervention shows an understanding of integrated care?
.N
U
a. A chronically abused woman is assessed for anxiety.
W W W
b. A manic patient is taken to the gym to use the exercise equipment. c. The older adult diagnosed with depression is monitored for suicidal ideations. d. A teenager who refuses to obey the units rules is not allow to play video games.
ANS: A
The majority of health disciplines now recognize that mental disorders and physical illnesses are closely linked. The presence of a mental disorder increases the risk for the development of
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physical illnesses and vice versa. Assessing a chronically abused individual for anxiety call should attention to the psychiatric disorder that could develop from the abuse. The remaining options show interventions that are appropriate for the mental disorder.
O M
7. What reason does the nurse give the patient for the emphasis and attention being paid to the
.C
recovery phase of their treatment plan?
LD
a. Recovery care, even when intensive, is less expensive than acute psychiatric care.
O R
b. Effective recovery care is likely to result in fewer relapses and subsequent hospitalizations.
W
c. Planning for recovery care is time consuming and involves dealing with many complicated details.
N
KS
d. Recovery care is usually done on an outpatient basis and so is generally better accepted by patients.
BA
ANS: B
ST
Much attention is paid to recovery care since effective recovery care helps improve patient outcomes and thus minimize subsequent hospitalizations. Recovery care is not necessarily less
TE
expensive than acute care. Although effective recovery care planning may be time consuming
N
well accepted by patients.
G
and detail oriented, that is not the reason for implementing it. Recovery care is not necessarily
SI
8. The nurse is attending a neighborhood meeting where a half-way house is being proposed for
R
the neighborhood when a member of the community states, We dont want the facility; we
U
especially dont want violent people living near us. The response by the nurse that best addresses
W W W
.N
the publics concern is: a. In truth, most individuals with psychiatric disorder are passive and withdrawn and pose little threat to those around them. b. The mentally ill seldom behave in the manner they are portrayed by movies; they are people just like the rest of us. c. Patients with psychiatric disorder are so well medicated that they do not display violent behaviors. d. The mentally ill deserve a safe, comfortable place to live among people who truly care for them.
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ANS: A A major reason for the existence of the stigma placed on persons with mental illness is lack of knowledge. The main fear is of violence, although only a small percentage of patients with
O M
mental illness display this behavior. Providing the public with accurate information can help
.C
reduce stigma. The remaining options do not directly address the concerns stated.
LD
9. Which activity shows that a therapeutic alliance has been established between the nurse and
O R
patient?
W
a. The nurse respects the patients right to privacy when visitors are spending time with the patient.
KS
b. The patient is eagerly attending all group sessions and working independently on identifying their personal stressors.
N
c. The patient is freely describing their feelings related to the physical and emotional trauma they experienced as a child with the nurse.
ST
BA
d. The nurse dutifully administers the patients medications on time and with appropriate knowledge of the potential side effects.
TE
ANS: C
G
A primary aspect of working with patients in any setting and particularly in the psychiatric
N
setting is the development of a therapeutic alliance with the patient. Such an alliance is
SI
established on trust. It is a professional bond between the nurse and the patient that serves as a
R
vehicle for patients to freely discuss their needs and problems in the absence of the nurses
U
criticism or judgment. Any nurse has an obligation to respect the patients rights and administer
.N
care effectively. The patients willingness to participate in the plan of care reflects self
W W W
motivation.
10. Mental health care reform has called for parity between psychiatric and medical diagnoses. Which is an example of such parity? a. Depression treatment is not paid for as readily as is treatment for asthma. b. The mentally ill patient will be protected by law against social stigma. c. Medical practitioners are trained to be proficient at treating mental disorders.
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d. Psychiatric service reimbursement will be equivalent to that of medical services. ANS: D
O M
The term parity as used here refers to payments for mental health services that equal payment schedules for medical or surgical conditions. The remaining options(B and C) do not relate to
.C
financial reimbursement or funds allocated for mental health care being equal to those of medical
LD
diagnoses.
O R
MULTIPLE RESPONSE
W
1. Which assessment findings suggest to the nurse that this patient has characteristics seen in an
KS
individual who has reached self-actualization? Select all that apply.
N
a. Reports to have, found peace and security in my religious faith
BA
b. Effectively changed occupations when a chronic vision problem worsened c. Has consistently earned a six-figure salary as an architect for the last 10 years
ST
d. Has been in a supportive, loving relationship with the same individual for 15 years
G
TE
e. Provides free literacy tutoring help at the local homeless shelter 3 evenings a week
SI
N
ANS: A, B, D, E
R
Characteristics of self actualization would include: spiritual well-being, open and flexible,
W W W
.N
actualization.
U
relationally fulfilled, and generosity toward others. Salary doesnt necessarily reflect self-
2. Which nursing activities represent the tertiary level of mental health care? Select all that apply.
a. Providing a depression screening at a local college b. Helping a mental-challenged patient learn to make correct change c. Reporting an incidence of possible elder abuse to the appropriate legal agency d. Regularly assessing a patients understanding of their prescribed antidepressants
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e. Providing a 6-week parenting class to teenage parents through a local high school ANS: B, D
O M
Tertiary prevention reduces the residual effects of the disorder such as depression and mental
retardation. There is no quaternary level of prevention. Primary prevention reduces occurrences
.C
of mental disorders such as screenings and parenting classes, and secondary prevention reduces
LD
the prevalence of disorders as evidenced by assessing knowledge.
O R
3. Which nursing actions indicate an understanding of the priority issues currently facing
W
psychiatric mental health nursing today? Select all that apply.
a. Working on the facilitys Safe Use of Restraints Policy revision committee
KS
b. Advocating for increased salaries for all levels of psychiatric mental health nurses
BA
N
c. Attending a political rally for increased state funding for mental health service providers
ST
d. Offering an in-service to facility staff regarding the cultural implications of caring for the Hispanic patient
TE
e. Joining the state nursing committee working on the role and scope of practice of the advanced practice psychiatric nurse
N
G
ANS: A, C, D, E
SI
Priority issues include funding, safety issues in psychiatric treatment centersparticularly the use
R
of patient restraints, quality-of-care issues, access to health care for minority populations, and
.N
U
standardization of advanced practice nurse roles.
W W W
4. Which assessment findings describe risk factors that increase the potential risk for mental illness? Select all that apply. a. Possesses high tolerance for stress b. Is very curious about how things work c. Admits to being a member of an ethnic gang d. Only practicing Jew among school classmates e. Has a younger sibling who is mentally challenged
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ANS: C, D, E Risk factors are internal predisposing characteristics and external influences that increase a persons vulnerability and potential for developing mental disorders. Types of risk factors and
O M
examples include the following: having a mentally-challenged family member in the home;
belonging to a punitive gang; and being the object of reject or bullying. The remaining options
LD
.C
are protective factors.
5. Which nursing actions show a focus on the fundamental goals that guide psychiatric mental
O R
health nurses in providing patient care? Select all that apply.
W
a. Offering an informational session of identifying signs of depression at a local senior center
KS
b. Attending a workshop on evidence practice interventions for the chronically depressed patient
BA
N
c. Keeping strict but appropriate boundaries with a patient diagnosed with a personality disorder
ST
d. Asking a parent who has just experienced the death of a child if they could consider talking with a grief counselor
G
TE
e. Identifying what help a patient diagnosed with Alzheimers disease will need with instrumental activities of daily living (IADLs)
SI
N
ANS: A, B, D, E
R
Standard objectives guide PMH nurses and members of related disciplines in the care of patients
U
(individuals, families, communities, and organizations). The objectives and criteria are as
.N
follows: the promotion and protection of mental health, the prevention of mental disorders, the treatment of mental disorders, and recovery and rehabilitation. Keeping appropriate boundaries is
W W W
a generalized nursing responsibility.
Chapter 2. Shared Decision Making: Concordance Between Psychiatric-Mental Health Advanced Practice Registered Nurse and Client MULTIPLE CHOICE
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1. The patient asks the nurse, Ive heard the student nurses talk about the nursing process. Why is there so much emphasis on using the nursing process? The response that explains the need for nurses to understand and use the nursing process is:
O M
a. Do you think you have a better method we might use?
.C
b. The nursing process is a systematic problem-solving method encompassing all components necessary to care for patients.
LD
c. Using the nursing process is a way of legitimizing our profession and placing us on an equal footing with the pure sciences.
W
O R
d. The nursing process is a unidimensional, static, linear approach used to guide nurses as they make clinical judgments.
KS
ANS: B
N
This response best explains the importance of the nursing process by description and relationship
BA
to patient care. Suggesting that the patient may have a better method is challenging and does not address the question posed by the patient. Providing legitimacy to the profession is a very limited
ST
explanation for use of the nursing process. The nursing process is not one-dimensional, static, or
TE
linear.
2. When preparing to conduct a nursing history and assessment on a patient transferred from the
G
emergency department (ED) whose family believes the patient to be a questionable historian due
SI
N
to cognitive impairment, the nurse initially begins the interview by:
R
a. Reviewing the ED chart
U
b. Contacting the admitting physician
.N
c. Directing the questions to the family members
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d. Establishing a line of communication with the patient
ANS: D
The nurse should begin establishing the nursepatient relationship by initially directing the questions to the patient. The nurse can confirm information and/or obtain supplementary information from the sources identified by the other options.
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3. The nurse shows the ability to effectively state a nursing diagnosis reflective of the implications of depression on a patients life processes when stating in the patients plan of care that:
.C
LD
b. Patient will initiate and support conversation with nurse therapist by (date 3 weeks in future).
O M
a. Patient outcomes were partially attained. Implementation of present plan to continue.
O R
c. Oral medication for anxiety should be administered when depression is assessed to be at the moderate level.
W
d. Impaired verbal communication r/t impoverished thoughts secondary to depression as evidenced by monosyllabic responses.
KS
ANS: D
N
This statement contains the various components of a nursing diagnosis while expressing the
BA
existence of an altered life process. The remaining options reflect other steps, such as evaluation
ST
and intervention planning.
TE
4. When engaging in outcomes identification, the nurse:
G
a. Interviews and collects patient-focused data
N
b. Re-assesses the patients physical and emotional status evaluation
SI
c. Reviews the patients existing problems and projects the results of the nursing care
W W W
ANS: C
.N
U
R
d. Considers the patients presenting symptoms and identifies nursing-related problems
Outcomes are projections of expected influence that nursing interventions will have on the patient. Interviewing and collecting data is involved in the assessment process, re-assessing is involved in the evaluation process, and identifying related nursing problems is involved in determining appropriate nursing diagnoses.
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5. While discussing assessment of suicidal patients, a novice nurse mentions, I was taught to always base my care on concrete, evidence-based scientific reasoning and never to rely on intuition. Which response by the experienced nurse shows understanding of intuitive reasoning?
O M
a. Thats wise, because intuition went out of favor with the scientific revolution.
LD
c. Its possible that intuition about suicidality is generated by transfer of feelings from the patient to the nurse.
.C
b. Critical thinking and intuition are at opposite poles. Keep relying on your expertise.
W
O R
d. Its been determined that intuition is nothing more that extrasensory perception, so some folks have it, and some dont.
KS
ANS: C
N
A strong hunch or a gut feeling is an example of intuitive reasoning that is believed to come from
BA
the therapeutic relationships sharing of feelings between nurse and patient. Most nurses agree that intuition is compatible with scientific reasoning, because both are likely linked to practice
ST
and experience. A nurse learns intuitive reasoning through clinical practice rather than from
TE
school or books.
6. A nurse shows effective critical thinking skills directed towards nursing care of a cognitively
N
G
impaired patient who continues to socially isolate by:
SI
a. Clearly stating that the patient must socially interact once daily
R
b. Documenting that the patient continues to resist socialization
.N
U
c. Asking the patient to identify which unit activity they are willing to attend
W W W
d. Suggesting that staff take the patient with them when running errands off the unit ANS: D
Critical thinking in this case involves the creation of alternative solutions to a problem that was not resolved by conventional methods. The remaining options, although not inappropriate, do not show critical thinking skills
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7. A depressed patient shares with the nurse that he, has been thinking about ending it all. Based on NANDA recommendations, the nurse: a. Implements suicide precautions for this patient
O M
b. Includes Risk for Self Harm to the patients care plan
.C
c. Documents regarding the patients safety every 15 minutes
LD
d. Reviews the patients chart for references to past incidences of hopeless
O R
ANS: B
NANDA states that a nurse is able to change any actual diagnosis on the NANDA list to a risk
W
diagnosis if the problem has not occurred yet. The remaining options, although not inappropriate,
KS
do not related to NANDA.
N
8. The nurse shows an understanding of the appropriate use of nursing outcomes regarding
BA
triggers for a patient diagnosed with chronic alcohol abuse when stating:
ST
a. Can you work on identifying three situations that cause you to abuse alcohol?
TE
b. Ill help you to identify three triggers for your drinking during todays session. c. Im pleased youve identified three situations that trigger your abuse of alcohol.
N
G
d. Do you think you will be able to avoid the three triggers that cause you to drink?
R
SI
ANS: C
U
Outcomes sometimes referred to as behavioral goals are used to describe and evaluate the
.N
effectiveness of nursing interventions. The correct option shows that the patient was successful at
W W W
accomplishing an outcome inferring the nursing interventions were successful. The remaining options do not indicate an evaluation of success or failure. 9. When a patient experiencing acute depression asks what the difference is between a medical and a nursing diagnosis, the nurse responds best when stating: a. Actually they are very similar in that they both are concerned with helping you get better and lead a happier life.
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b. Medical diagnoses are focused on why you are depressed whereas nursing diagnoses are concerned about making your life less sad.
.C
d. The medical diagnosis identifies that you are experiencing depression whereas the nursing diagnosis identifies how the depression is affecting you.
O M
c. Nursing diagnoses are more directed at caring for you, unlike medical diagnoses that focus on finding the cause for your problem.
LD
ANS: D
O R
The medical diagnosis involves identifying a mental or physical problem that results in the symptoms that negatively affect a patients life. Although the nurse is knowledgeable about the
W
disorders and their treatments, the nursing diagnosis focuses mainly on the patients responses to the disorder and the effects that the disorder has on the patient. The types of diagnoses have
KS
different foci that result in different actions and concerns.
therapeutic patient care outcomes when:
BA
N
10. A nurse best shows an understanding of the role of evidence-based research in achieving
ST
a. Subscribing to and reading a monthly psychiatric research nursing journal
TE
b. Working on a committee to revise current facility policies regarding the use of chemical restraints
N
G
c. Registering to attend a psychiatric workshop on newly developed psychotropic medication therapies
U
R
SI
d. Asking an experienced staff member to review the interventions being proposed for a newly admitted patient
.N
ANS: B
W W W
Evidence-based practice is based on evidence and scientific principles that have been developed through research. The more closely clinical practice reflects relevant research, the more likely it is that patients will receive the best available care. The option that infers action directed at implementing the research is the one that shows best understanding. Reliance only on experience is not reflective of quality nursing care. 11. When caring for a patient admitted with a diagnosis if bipolar disorder, managed care regulations is the driving force behind the nurses use of:
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