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NURS 410 psych test 1 (ch 1-3, 5-6) PQ's

Terms in this set (169)

A new staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional interventions?
a. Conduct mental health assessments
b. Establish therapeutic relationships
c. Individualize nursing care plans
d. Prescribe psychotropic medication
d. Prescribe psychotropic medication
Two nursing students discuss their career plans after graduation. One student wants to enter psychiatric nursing. The other asks, "Why would you want to be a psychiatric nurse? The only thing they do is talk. You'll lose all your skills." Select the best response.
a. "Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of the patients' problems."
b. "Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations."
c. "I think I will be good in the mental health field. I did not like clinical rotations in school, so I do not want to continue them after I graduate."
d. "Psychiatric nurses do not have to deal with as much pain and suffering as medical-surgical nurses do. That appeals to me."
b. "Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations."
A new bill introduced in Congress would reduce funding for care of persons with mental illness. Groups of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled?
a. Advocacy
b. Attending
c. Recovery
d. Evidence-based practice
a. Advocacy
An informal group of patients discusses their perceptions of nursing care. Which comment best indicates a patient perceived the nurse was caring? "My nurse:
a. always asks me which type of juice I want to help me swallow my medication."
b. explained my treatment plan to me and asked for my ideas about how to make it better."
c. told me that if I take all the medicines the doctor prescribes, then I will get discharged soon."
d. spends time listening to me talk about my problems. That helps me feel like I'm not alone."
d. spends time listening to me talk about my problems. That helps me feel like I'm not alone."
Which finding best indicates that a patient has a mental illness? The patient:
a.responds to rules, routines, and customs of a group.
b. reports mood is consistently sad, discouraged, and hopeless.
c. performs tasks attempted within the limits set by own abilities.
d. is able to see the difference between the "as if" and the "for real."
b. reports mood is consistently sad, discouraged, and hopeless.
Which finding best indicates that the goal "Demonstrate mentally healthy behavior" was achieved? A patient:
a. sees self as approaching ideals and capable of meeting demands.
b. seeks others to assume responsibility for major areas of own life.
c. behaves without considering the consequences of personal actions.
d. aggressively meets own needs without considering the rights of others.
a. sees self as approaching ideals and capable of meeting demands.
A nurse encounters an unfamiliar psychiatric disorder on a new patient's admission form. To determine criteria used to establish this diagnosis, the nurse should consult which resource?
a. Diagnostic and Statistical Manual of Mental Disorders
b. A nursing diagnosis handbook
c. A psychiatric nursing textbook
d. A behavioral health reference manual
a. Diagnostic and Statistical Manual of Mental Disorders
Which documentation of diagnosis would a nurse expect in a psychiatric treatment setting?
a. I Acute renal failure
II 75
III Bipolar disorder I, mixed
IV Loss of disability benefits 2 months ago
V None
b. I Schizophrenia, paranoid type
II Death of spouse last year
III 60
IV None
V Diabetes, type 2
c. I Polysubstance dependence
II Narcissistic Personality Disorder
III 90
IV Hyperlipidemia
V Charges pending for assault
d. I Major Depression
II Avoidant Personality Disorder
III Hypertension
IV Home destroyed by hurricane last year
V 80
d. I Major Depression
II Avoidant Personality Disorder
III Hypertension
IV Home destroyed by hurricane last year
V 80
A nurse explains the multiaxial DSM-IV-TR to a psychiatric technician and includes information that it:
a. focuses on plans for treatment.
b. includes nursing and medical diagnoses.
c. classifies problems in multiple areas of functioning.
d. uses the framework of a specific biopsychosocial theory.
c. classifies problems in multiple areas of functioning.
A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information?
a. The ICD-10
b. Nursing Outcomes Classification
c. Diagnostic and Statistical Manual of Mental Disorders
d. The ANA Psychiatric-Mental Health Nursing Scope and Standards of Practice
c. Diagnostic and Statistical Manual of Mental Disorders
Which comment most clearly shows a speaker views mental illness with stigma?
a. "Some mental illnesses are inherited."
b. "Most people with mental illness are unmotivated."
c. "Severe environmental stress sometimes causes mental illness."
d. "Some mental illnesses are brain disorders resulting from changes in how impulses are transmitted."
b. "Most people with mental illness are unmotivated."
A newly admitted patient is uncommunicative about recent life events. The nurse suspects marital and economic problems, but the social worker's assessment is not yet available. Select the nurse's best action.
a. Focus assessment questions on these two topics.
b. Ask another patient who shares a room with this patient.
c. Avoid seeking information on these topics at this time.
d. Refer to axis IV of the DSM-IV-TR in the medical record.
d. Refer to axis IV of the DSM-IV-TR in the medical record.
The Diagnostic and Statistical Manual of Mental Disorders classifies:
a. deviant behaviors.
b. people with mental disorders.
c. present disability or distress.
d. mental disorders people have.
d. mental disorders people have.
A nurse participating in a community health fair is asked, "What is the most prevalent mental disorder in the United States?" Select the nurse's best response.
a. Schizophrenia
b. "Why do you ask?"
c. Bipolar disorder
d. Alzheimer's disease
d. Alzheimer's disease
In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill? One who:
a. describes hearing God's voice speaking.
b. is usually pessimistic but strives to meet personal goals.
c. is wealthy and gives away $20 bills to needy individuals.
d. always has an optimistic viewpoint about life and having own needs met.
a. describes hearing God's voice speaking.
A patient's relationships are intense and unstable. The patient initially idealizes the significant other and then devalues them, resulting in frequent feelings of emptiness. This patient will benefit from interventions to develop which aspect of mental health?
a. Effectiveness in work
b. Communication skills
c. Productive activities
d. Fulfilling relationships
d. Fulfilling relationships
Which belief will best support a nurse's efforts to provide patient advocacy during a multidisciplinary patient care planning session?
a. All mental illnesses are culturally determined.
b. Schizophrenia and bipolar disorder are cross-cultural disorders.
c. Symptoms of mental disorders are unchanged from culture to culture.
d. Assessment findings in mental disorders reflect a person's cultural patterns.
d. Assessment findings in mental disorders reflect a person's cultural patterns.
A nurse is part of a multidisciplinary team working with groups of depressed patients. Half the patients receive supportive interventions and antidepressant medication. The other half receives only medication. The team measures outcomes for each group. Which type of study is evident?
a. Prevalence
b. Clinical epidemiology
c. Descriptive epidemiology
d. Experimental epidemiology
b. Clinical epidemiology
The spouse of a patient with schizophrenia says, "I don't understand how nurturing or toilet training in childhood has anything to do with this incredibly disabling illness." Which response by the nurse will best help the spouse understand this disorder?
a. "This illness is the result of genetic factors."
b. "Psychological stress is at the root of most mental disorders."
c. "It must be frustrating for you that your spouse is sick so much of the time."
d. "New findings show that this condition more likely has biological rather than psychological origins."
d. "New findings show that this condition more likely has biological rather than psychological origins."
A 40-year-old who lives with parents and works at an unchallenging job says, "I'm as happy as anyone else, even though I don't socialize much outside of work. My work is routine, but when new things come up, my boss explains things a few times to make sure I catch on. At home, my parents make decisions for me, and I go along with their ideas." The nurse should identify interventions to improve this patient's:
a. self-concept.
b. overall happiness.
c. appraisal of reality.
d. control over behavior.
a. self-concept.
Select the best response for the nurse who receives a query from another mental health professional seeking to understand the difference between a DSM-IV-TR diagnosis and a nursing diagnosis.
a. "There is no functional difference between the two. Both identify human disorders."
b. "The DSM-IV-TR diagnosis disregards culture, whereas the nursing diagnosis takes culture into account."
c. "The DSM-IV-TR diagnosis is associated with present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems."
d. "The DSM-IV-TR diagnosis affects the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for phenomena a patient is experiencing."
d. "The DSM-IV-TR diagnosis affects the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for phenomena a patient is experiencing."
An experienced nurse says to a new graduate, "When you've practiced as long as I have, you'll instantly know how to take care of psychotic patients." Which information should the new graduate consider when analyzing this comment? You may select more than one answer.
a. The experienced nurse may have lost sight of patients' individuality, which may compromise the integrity of practice.
b. New research findings should be integrated continuously into a nurse's practice to provide the most effective care.
c. Experience provides mental health nurses with the essential tools and skills needed for effective professional practice.
d. Experienced psychiatric nurses have learned the best ways to care for mentally ill patients through trial and error.
e. An intuitive sense of patients' needs guides effective psychiatric nurses.
a. The experienced nurse may have lost sight of patients' individuality, which may compromise the integrity of practice.
b. New research findings should be integrated continuously into a nurse's practice to provide the most effective care.
A patient asks the nurse, "I read an article online about psychosocial factors that influence depression. What are psychosocial factors?" Examples a nurse could cite to support the premise that a patient's depression may be influenced by psychosocial factors include: (Select all that apply)
a. having a hostile and over involved family.
b. having two first-degree relatives with bipolar disorder.
c. feeling strong guilt over having an abortion when one's religion forbids it.
d. experiencing the death of a parent a month before the onset of depression.
e. experiencing symptom remission when treated with antidepressant medication.
a. having a hostile and over involved family.
c. feeling strong guilt over having an abortion when one's religion forbids it.
d. experiencing the death of a parent a month before the onset of depression.
A patient in the emergency department says, "The voices say someone is stalking me. They want to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a threat." Which aspect(s) of mental health should be of greatest immediate concern to the nurse? Select all that apply.
a. Happiness
b. Appraisal of reality
c. Control over behavior
d. Effectiveness in work
e.Healthy self-concept
b. Appraisal of reality
c. Control over behavior
e.Healthy self-concept
A family has a long history of conflicted relationships among the members. Which family member's comment best reflects a mentally healthy perspective?
a. "I've made mistakes but everyone else in this family has also."
b. "I remember joy and mutual respect from our early years together."
c. "I will make some changes in my behavior for the good of the family."
d. "It's best for me to move away from my family. Things will never change."
c. "I will make some changes in my behavior for the good of the family."
A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information?
a. Nursing Outcomes Classification (NOC)
b. DSM-V
c. The ANA's Psychiatric-Mental Health Nursing Scope and Standards of Practice
d. ICD-10
b. DSM-V
Which individual is demonstrating the highest level of resilience? One who
a. is able to repress stressors.
b. becomes depressed after the death of a spouse.
c. lives in a shelter for 2 years after the home is destroyed by fire.
d. takes a temporary job to maintain financial stability after loss of a permanent job.
d. takes a temporary job to maintain financial stability after loss of a permanent job.
Which disorder is an example of a culture-bound syndrome?
a. Epilepsy
b. Schizophrenia
c. Running amok
d. Major depressive disorder
C. Running amok
A category 5 tornado occurred in a community of 400 people. Many homes and businesses were destroyed. In the 2 years following the disaster, 140 individuals were diagnosed with posttraumatic stress disorder (PTSD). Which term best applies to these newly diagnosed cases?
a. Prevalence
b. Comorbidity
c. Incidence
d. Parity
C. Incidence
Which component of treatment of mental illness is specifically recognized by Quality and Safety Education for Nurses (QSEN)?
a. All genomes are unique.
b. Care is centered on the patient.
c. Healthy development is vital to mental health.
d. Recovery occurs on a continuum from illness to health.
B. Care is centered on the patient.
Select the best response for the nurse to a question from another health professional regarding the difference between a diagnosis in DSM-V and a nursing diagnosis.
a. "There is no functional difference between the two. Both identify human disorders."
b. "The DSM-V diagnosis disregards culture, whereas the nursing diagnosis takes culture into account."
c. "The DSM-V diagnosis describes causes of disorders whereas a nursing diagnosis does not explore etiology."
d. "The DSM-V diagnosis guides medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for issues a patient is experiencing."
d. "The DSM-V diagnosis guides medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for issues a patient is experiencing."
Which nursing intervention below is part of the scope of an advanced practice psychiatric/mental health nurse rather than a basic level registered nurse?
a. Coordination of care
b. Health teaching
c. Milieu therapy
d. Psychotherapy
d. Psychotherapy
Which findings are signs of a person who is mentally healthy? (Select all that apply.)
a. Says, "I have some weaknesses, but I feel I'm important to my family and friends."
b. Adheres strictly to religious beliefs of parents and family of origin.
c. Spends all holidays alone watching old movies on television.
d. Considers past experiences when deciding about the future.
e. Experiences feelings of conflict related to changing jobs.
a. Says, "I have some weaknesses, but I feel I'm important to my family and friends."
d. Considers past experiences when deciding about the future.
e. Experiences feelings of conflict related to changing jobs.
The mental health status of a particular client can best be assessed by considering ...
placement on a continuum from health to illness
Which of the following best demonstrates party related to mental health care?
A client's mental health coverage is equal to his medical/surgical coverage
A nursing diagnosis for a client with a psychiatric disorder serves the purpose of....
providing a framework for selecting appropriate interventions
An individual is found to consistently wear only a bathrobe and neglect the cleanliness of his apartment. When neighbors ask him to stop his frequent outbursts of operatic arias, he acts outraged and tells them he must sing daily and will not promise to be quieter. This behavior supports that he is .....
not demonstrating any definitive signs of mental illness
In order to best differentiate whether an Asian client is demonstrating a mental illness when attempting suicide is to
A. ask the client whether he views himself as being depressed.
B. identify his culture's view regarding suicide.
C. explain to him that suicide is often regarded as a desperate act.
D. assess the client for other examples of depressive behaviors.
B. identify his culture's view regarding suicide
The nurse planning care for a mentally ill client bases interventions on the concept that the client ....
has areas of strength on which to build
A 14-year-old belongs to a neighborhood gang, engages in sexually promiscuous behavior, and has a history of school truancy but reports that her parents are just old- fashioned and don't understand her. The assessment data supports that the client

A. is displaying deviant behavior.
B. cannot accurately appraise reality.
C. is seriously and persistently mentally ill.
D. should be considered for group home placement.
A. is displaying deviant behavior
A client tells the mental health nurse "I am terribly frightened! I hear whispering that someone is going to kill me." Which criterion of mental health can the nurse assess as lacking?
Appraisal of reality
Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with electroconvulsive therapy (ECT)?
A. experimental
B. descriptive
C. clinical
D. analytic
C. Clinical
These severe mental illnesses are recognized across cultures:
A antisocial and borderline personality disorders.
B schizophrenia and bipolar disorder.
C bulimia and anorexia nervosa.
D amok and social phobia.
B. schizophrenia & bipolar disorder
The prevalence rate over a 12-month period for major depressive disorder is...
greater than the prevalence rate for generalized anxiety
Which statement about diagnosis of a mental disorder is true?
Culture may cause variations in symptoms for each clinical disorder.
A nurse's identification badge includes the term, "Psychiatric Mental Health Nurse." A client with a history of paranoia asks, "What does that title mean?" The nurse responds best by answering:
A. "Don't be afraid; it means I'm here to help, not hurt, you."
B. "Psychiatric mental health nurses care for people with mental illnesses."
C. "We have the specialized skills needed to care for those with mental illnesses."
D. "The nurses who work in mental health facilities have that title."
C. "We have the specialized skills needed to care for those mental illnesses."
Current information suggests that the most disabling mental disorders are the result of:
A) biological influences.
B) psychological trauma.
C) learned ways of behaving.
D) faulty patterns of early nurturance.
A. biological influences
Which statement best describes the DSM-5?
It is a medical psychiatric assessment system.
The quantitative study of the distribution of mental disorders in human populations is called
epidemiology
A parent says, "My 2-year-old child refuses toilet training and shouts 'No!' when given directions. What do you think is wrong?" Select the nurse's best reply.
a. "Your child needs firmer control. It is important to set limits now."
b. "This is normal for your child's age. The child is striving for independence."
c. "There may be developmental problems. Most children are toilet trained by age 2."
d. "Some undesirable attitudes are developing. A child psychologist can help you develop a plan."
b. "This is normal for your child's age. The child is striving for independence."
A nurse wants to find information on current evidence-based research, programs, and practices regarding mental illness and addictions. Which resource should the nurse consult?
a. American Psychiatric Association
b. American Psychological Association (APA)
c. Clinician's Quick Guide to Interpersonal Psychotherapy
d. Substance Abuse and Mental Health Services Administration (SAMHSA)
d. Substance Abuse and Mental Health Services Administration (SAMHSA)
A 26-month-old displays negative behavior, refuses toilet training, and often says, "No!" Which psychosocial crisis is evident?
a. Trust versus mistrust
b. Initiative versus guilt
c. Industry versus inferiority
d. Autonomy versus shame and doubt
d. Autonomy versus shame and doubt
A 4-year-old grabs toys from other children and says, "I want that now!" From a psychoanalytic perspective, this behavior is a product of impulses originating in which system of the personality?
a. Id
b. Ego
c. Superego
d. Preconscious
a. Id
The parent of a 4-year-old rewards and praises the child for helping a sibling, being polite, and using good manners. These qualities are likely to be internalized and become part of which system of the personality?
a. Id
b. Ego
c. Superego
d. Preconscious
c. Superego
A nurse supports a parent for praising a child who behaves in helpful ways to others. When this child behaves with politeness and helpfulness in adulthood, which feeling will most likely result?
a. Guilt
b. Anxiety
c. Humility
d. Self-esteem
d. Self-esteem
An adult says, "I never know the answers," and "My opinion does not count." Which psychosocial crisis was unsuccessfully resolved for this adult?
a. Initiative versus guilt
b. Trust versus mistrust
c. Autonomy versus shame and doubt
d. Generativity versus self-absorption
c. Autonomy versus shame and doubt
Which statement by a patient would lead the nurse to suspect unsuccessful completion of the psychosocial developmental task of infancy?
a. "I know how to do things right, so I prefer jobs where I work alone rather than on a team."
b. "I do not allow other people to truly get to know me."
c. "I depend on frequent praise from others to feel good about myself."
d. "I usually need to do things several times before I get them right."
b. "I do not allow other people to truly get to know me."
A patient is suspicious and frequently manipulates others. To which psychosexual stage do these traits relate?
a. Oral
b. Anal
c. Phallic
d. Genital
a. Oral
A patient expresses a desire to be cared for by others and often behaves in a helpless fashion. Which stage of psychosexual development is most relevant to the patient's needs?
a. Latency
b. Phallic
c. Anal
d. Oral
d. Oral
A nurse listens to a group of recent retirees. One says, "I volunteer with Meals on Wheels, coach teen sports, and do church visitation." Another laughs and says, "I'm too busy taking care of myself to volunteer to help others." Which psychosocial developmental task do these statements contrast?
a. Trust and mistrust
b. Intimacy and isolation
c. Industry and inferiority
d. Generativity and self-absorption
d. Generativity and self-absorption
An adult dies in a tragic accident. Afterward, the siblings plan a funeral service. Which statement by a sibling best indicates a sense of self-actualization?
a. "Of all of us, I am the most experienced with planning these types of events."
b. "Funerals are supposed to be conducted quietly, respectfully, and according to a social protocol."
c. "This death was unfair but I hope we can plan a service that everyone feels is a celebration of life."
d. "This death was probably the consequence of years of selfish and inconsiderate behavior by our sibling."
c. "This death was unfair but I hope we can plan a service that everyone feels is a celebration of life."
A student nurse says, "I don't need to interact with my patients. I learn what I need to know by observation." An instructor can best interpret the nursing implications of Sullivan's theory to this student by responding:
a. "Interactions are required in order to help you develop therapeutic communication skills."
b. "Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills."
c. "Observing patient interactions will help you formulate priority nursing diagnoses and appropriate interventions."
d. "It is important to pay attention to patients' behavioral changes, because these signify adjustments in personality."
b. "Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills."
A nurse consistently encourages patient to do his or her own activities of daily living. If the patient is unable to complete an activity, the nurse helps until the patient is once again independent. This nurse's practice is most influenced by which theorist?
a. Betty Neuman
b. Patricia Benner
c. Dorothea Orem
d. Joyce Travelbee
c. Dorothea Orem
A nurse uses Maslow's hierarchy of needs to plan care for a patient diagnosed with mental illness. Which problem will receive priority? The patient
a. refuses to eat or bathe.
b. reports feelings of alienation from family.
c. is reluctant to participate in unit social activities.
d. is unaware of medication action and side effects.
a. refuses to eat or bathe.
Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly mute. Which technique applies?
a. Encourage the child to observe others talking.
b. Include the child in small group activities.
c. Give the child a small treat for speaking.
d. Teach the child relaxation techniques.
c. Give the child a small treat for speaking.
The parent of a child diagnosed with schizophrenia tearfully asks the nurse, "What could I have done differently to prevent this illness?" Select the nurse's best response.
a. "Although schizophrenia results from impaired family relationships, try not to feel guilty. No one can predict how a child will respond to parental guidance."
b. "Schizophrenia is a biological illness resulting from changes in how the brain and nervous system function. You are not to blame for your child's illness."
c. "There is still hope. Changing your parenting style can help your child learn to cope effectively with the environment."
d. "Most mental illnesses result from genetic inheritance. Your genes are more at fault than your parenting."
b. "Schizophrenia is a biological illness resulting from changes in how the brain and nervous system function. You are not to blame for your child's illness."
A nurse influenced by Peplau's interpersonal theory works with an anxious, withdrawn patient. Interventions should focus on
a. rewarding desired behaviors.
b. use of assertive communication.
c. changing the patient's self-concept.
d. administering medications to relieve anxiety.
b. use of assertive communication.
A patient participated in psychotherapy weekly for 5 months. The therapist used free association, dream analysis, and facilitated transference to help the patient understand conflicts and foster change. Select the term that applies to this method.
a. Rational-emotive behavior therapy
b. Psychodynamic psychotherapy
c. Cognitive-behavioral therapy
d. Operant conditioning
b. Psychodynamic psychotherapy
Consider this comment from a therapist: "The patient is homosexual but has kept this preference secret. Severe anxiety and depression occur when the patient anticipates family reactions to this sexual orientation." Which perspective is evident in the speaker?
a. Theory of interpersonal relationships
b. Classical conditioning theory
c. Psychosexual theory
d. Behaviorism theory
a. Theory of interpersonal relationships
A psychotherapist works with an anxious, dependent patient. Which strategy is most consistent with psychoanalytic psychotherapy?
a. Identifying the patient's strengths and assets
b. Praising the patient for describing feelings of isolation
c. Focusing on feelings developed by the patient toward the therapist
d. Providing psychoeducation and emphasizing medication adherence
c. Focusing on feelings developed by the patient toward the therapist
A person says, "I was the only survivor in a small plane crash. Three business associates died. I got depressed and saw a counselor twice a week for 4 weeks. We talked about my feelings related to being a survivor, and I'm better now." Which type of therapy was used?
a. Systematic desensitization
b. Psychoanalysis
c. Behavior modification
d. Interpersonal psychotherapy
d. Interpersonal psychotherapy
Which technique is most applicable to aversion therapy?
a. Punishment
b. Desensitization
c. Role modeling
d. Positive reinforcement
a. Punishment
A patient says to the nurse, "My father has been dead for over 10 years, but talking to you is almost as comforting as the talks he and I had when I was a child." Which term applies to the patient's comment?
a. Superego
b. Transference
c. Reality testing
d. Counter-transference
b. Transference
A college student received an invitation to attend the wedding of a close friend who lives across the country. The student is afraid of flying. Which type of therapy would be most helpful for this patient?
a. Psychoanalysis
b. Aversion therapy
c. Systematic desensitization
d. Short-term dynamic therapy
c. Systematic desensitization
A patient repeatedly stated, "I'm stupid." Which statement by that patient would show progress resulting from cognitive-behavioral therapy?
a. "Sometimes I do stupid things."
b. "Things always go wrong for me."
c. "I always fail when I try new things."
d. "I'm disappointed in my lack of ability."
a. "Sometimes I do stupid things."
A patient says, "All my life I've been surrounded by stupidity. Everything I buy breaks because the entire American workforce is incompetent." This patient is experiencing a
a. self-esteem deficit.
b. cognitive distortion.
c. deficit in motivation.
d. deficit in love and belonging.
b. cognitive distortion.
A patient is fearful of riding on elevators. The therapist first rides an escalator with the patient. The therapist and patient then stand in an elevator with the door open for 5 minutes and later with the elevator door closed for 5 minutes. Which technique has the therapist used?
a. Classic psychoanalytic therapy
b. Systematic desensitization
c. Rational emotive therapy
d. Biofeedback
b. Systematic desensitization
A patient says, "I always feel good when I wear a size 2 petite." Which type of cognitive distortion is evident?
a. Disqualifying the positive
b. Overgeneralization
c. Catastrophizing
d. Personalization
b. Overgeneralization
Which comment best indicates a patient is self-actualized?
a. "I have succeeded despite a world filled with evil."
b. "I have a plan for my life. If I follow it, everything will be fine."
c. "I'm successful because I work hard. No one has ever given me anything."
d. "My favorite leisure is walking on the beach, hearing soft sounds of rolling waves."
d. "My favorite leisure is walking on the beach, hearing soft sounds of rolling waves."
A nurse presents a community education program about mental illness. Which comment by a participant best demonstrates a correct understanding of mental illness from a biological perspective?
a. "Some people experience life events so traumatic that they cannot be overcome."
b. "Disturbed and conflicted family relationships are usually a starting place for mental illness."
c. "My friend has had bipolar disorder for years and many problems have resulted. It's not her fault."
d. "Mental illness is the result of developmental complications that cause a person not to grow to their full potential."
c. "My friend has had bipolar disorder for years and many problems have resulted. It's not her fault."
Which patient is the best candidate for brief psychodynamic therapy?
a. An accountant with a loving family and successful career who was involved in a short extramarital affair
b. An adult with a long history of major depression who was charged with driving under the influence
c. A woman with a history of borderline personality disorder who recently cut both wrists
d. An adult male recently diagnosed with anorexia nervosa
a. An accountant with a loving family and successful career who was involved in a short extramarital affair
A patient states, "I'm starting cognitive-behavioral therapy. What can I expect from the sessions?" Which responses by the nurse would be appropriate? (Select all that apply.)
a. "The therapist will be active and questioning."
b. "You will be given some homework assignments."
c. "The therapist will ask you to describe your dreams."
d. "The therapist will help you look at your ideas and beliefs about yourself."
e. "The goal is to increase subjectivity about thoughts that govern your behavior."
a. "The therapist will be active and questioning."
b. "You will be given some homework assignments."
d. "The therapist will help you look at your ideas and beliefs about yourself."
Which comments by an elderly person best indicate successful completion of the individual's psychosocial developmental task? (Select all that apply.)
a. "I am proud of my children's successes in life."
b. "I should have given to community charities more often."
c. "My relationship with my father made life more difficult for me."
d. "My experiences in the war helped me appreciate the meaning of life."
e. "I often wonder what would have happened if I had chosen a different career."
a. "I am proud of my children's successes in life."
d. "My experiences in the war helped me appreciate the meaning of life."
Which comments by an adult best indicate self-actualization? (Select all that apply.)
a. "I am content with a good book."
b. "I often wonder if I chose the right career."
c. "Sometimes I think about how my parents would have handled problems."
d. "It's important for our country to provide basic health care services for everyone."
e. "When I was lost at sea for 2 days, I gained an understanding of what is important."
a. "I am content with a good book."
d. "It's important for our country to provide basic health care services for everyone."
e. "When I was lost at sea for 2 days, I gained an understanding of what is important."
Which activities represent the art of nursing? (Select all that apply.)
a. Administering medications on time to a group of patients
b. Listening to a new widow grieve her husband's death
c. Helping a patient obtain groceries from a food bank
d. Teaching a patient about a new medication
e. Holding the hand of a frightened patient
b. Listening to a new widow grieve her husband's death
c. Helping a patient obtain groceries from a food bank
e. Holding the hand of a frightened patient
Which therapies involve electrical brain stimulation for treatment of mental illness? (Select all that apply.)
a. Aversion therapy
b. Operant conditioning
c. Systematic desensitization
d. Electroconvulsive therapy (ECT)
e. Transcranial magnetic stimulation (TMS)
d. Electroconvulsive therapy (ECT)
e. Transcranial magnetic stimulation (TMS)
An important difference between the developmental theories of Freud and Erikson is ...
Erikson viewed individual growth in terms of social setting.
Maslow's theory of humanistic psychology has provided nursing with a framework for...
holistic assessment
The premise underlying behavioral therapy is
a. Behavior is learned and can be modified.
b. Behavior is a product of unconscious drives.
c. Motives must change before behavior changes.
d. Behavior is determined by cognitions; change in cognitions produces new behavior.
A. Behavior is learned and can be modified.
The nurse planning care for a 14-year-old needs to take into account that the developmental task of adolescence is to:
a. establish trust.
b. gain autonomy.
c. achieve identity.
d. develop a sense of industry.
C. achieve identity
Sullivan viewed anxiety as:
A) emotional experience felt after the age of 5 years.
B) a sign of guilt in adults.
C) any painful feeling or emotion arising from social insecurity.
D) adults trying to go beyond experiences of guilt and pain.
C. Any painful feeling or emotion arising from social insecurity
Which statement best clarifies the difference between the art and the science of nursing?
The art is the care, compassion, and advocacy component, and the science is the applied knowledge base.
Which client problem would be most suited to the use of interpersonal therapy?
a. Disturbed sensory perception
b. Impaired social interaction
c. Medication noncompliance
d. Dysfunctional grieving
D. Dysfunctional grieving
A cognitive therapist would help a client restructure the thought "I am stupid!" to...
"What I did was stupid."
The nurse providing anticipatory guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by
a. giving the child what he is asking for.
b. scolding the child when he displays tantrum behaviors.
c. spanking the child at the onset of the tantrum behaviors.
d. ignoring the tantrum and giving attention when the child acts appropriately.
D. ignoring the tantrum and giving attention when the child acts appropriately
Freud believed that individuals cope with anxiety by using ...
defense mechanisms
One implication of Freud's theory of the unconscious on psychiatric mental health nursing is related to the consideration that conscious and unconscious influences can help nurses better understand
a. the root causes of client suffering.
b. the client's immature behavior.
c. the client's interpersonal interactions.
d. the client's psychological ability to reason.
A. the root causes of client suffering
According to Freud, the nurse recognizes that a client experiencing dysfunction of the conscious as part of the mind will have problems with...
all material that the person is aware of at any one time
When asked, the nurse explains that a client's id is
a. the control over the emotional frustration he feels over the loss of his job.
b. the source of his instincts to save himself from hurting himself.
c. not in place since he was abused after the age of 5 months.
d. able to differentiate his believed experiences and reality.
B. the source of his instincts to save himself from hurting himself
As a result of Harry Stack Sullivan's work, the mental health nurse is involved in providing clients with
a. security operations.
b. psychoanalysis.
c. analysis of behavior patterns.
d. a psychotherapeutic environment.
D. a psychotherapeutic environment
The nurse is working with a client experiencing both post-partum depression and very low self-esteem. The client is distrustful of unit staff and "just wants to go home."

Initially, the nurse's priority is to...
establish trust with the client
Using Maslow's model of needs, the nurse providing care for an anxious client identifies the priority intervention to be
a. assessing the client's success at fulfilling her appropriate developmental level tasks.
b. assessing the client for her strengths upon which a nurse-client relationship can be based.
c. planning one-on-one time with the client to assist in identifying the fears behind her anxiety.
d. evaluating the client's ability to learn and retain essential information regarding her condition.
B. assessing the client for her strengths upon which a nurse-client relationship can be based
A suspicious client who smokes several packs of cigarettes daily and drinks large quantities of coffee and soda as he is able to afford reacts to every nursing intervention with sarcasm. When asking for advice, the nurse manager's most helpful response is
a. "You are dealing with a very difficult and resistant client; just keep with your plan."
b. "If you haven't been able to establish client trust by now, ask for a change of assignment."
c. "Remember that sarcasm represents the oral-stage fixation of development."
d. "You are attempting to work with a client who likes to keep others off-balance."
C. "Remember that sarcasm represents the oral-stage fixation of development"
A client with a history of three failed engagements is concerned about being "too possessive." This concern supports a need for which type of therapy?
Interpersonal
An 86-year-old, previously healthy and independent, falls after an episode of vertigo. Which behavior by this patient best demonstrates resilience? The patient:
a. says, "I knew this would happen eventually."
b. stops attending her weekly water aerobics class.
c. refuses to use a walker and says, "I don't need that silly thing."
d. says, "Maybe some physical therapy will help me with my balance."
d. says, "Maybe some physical therapy will help me with my balance."
Which organization actively seeks to reduce the stigma associated with mental illness through public presentations such as "In Our Own Voice" (IOOV)?
a. American Psychiatric Association (APA)
b. National Alliance on Mental Illness (NAMI)
c. United States Department of Health and Human Services (USDHHS)
d. North American Nursing Diagnosis Association International (NANDA-I)
b. National Alliance on Mental Illness (NAMI)
A patient is admitted to the psychiatric hospital. Which assessment finding best indicates that the patient has a mental illness? The patient:
a. describes coping and relaxation strategies used when feeling anxious.
b. describes mood as consistently sad, discouraged, and hopeless.
c. can perform tasks attempted within the limits of own abilities.
d. reports occasional problems with insomnia.
b. describes mood as consistently sad, discouraged, and hopeless.
The goal for a patient is to increase resiliency. Which outcome should a nurse add to the plan of care? Within 3 days, the patient will:
a. describe feelings associated with loss and stress.
b. meet own needs without considering the rights of others.
c. identify healthy coping behaviors in response to stressful events.
d. allow others to assume responsibility for major areas of own life.
c. identify healthy coping behaviors in response to stressful events.
A nurse at a behavioral health clinic sees an unfamiliar psychiatric diagnosis on a patient's insurance form. Which resource should the nurse consult to discern the criteria used to establish this diagnosis?
a. A psychiatric nursing textbook
b. NANDA International (NANDA-I )
c. A behavioral health reference manual
d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
A nurse must assess several new patients at a community mental health center. Conclusions concerning current functioning should be made on the basis of:
a. the degree of conformity of the individual to society's norms.
b. the degree to which an individual is logical and rational.
c. a continuum from mentally healthy to unhealthy.
d. the rate of intellectual and emotional growth.
c. a continuum from mentally healthy to unhealthy.
A 40-year-old adult living with parents states, "I'm happy but I don't socialize much. My work is routine. When new things come up, my boss explains them a few times to make sure I understand. At home, my parents make decisions for me, and I go along with them." A nurse should identify interventions to improve this patient's:
a. self-concept.
b. overall happiness.
c. appraisal of reality.
d. control over behavior.
a. self-concept.
A patient tells a nurse, "I have psychiatric problems and am in and out of hospitals all the time. Not one of my friends or relatives has these problems." Select the nurse's best response.
a. "Comparing yourself with others has no real advantages."
b. "Why do you blame yourself for having a psychiatric illness?"
c. "Mental illness affects 50% of the adult population in any given year."
d. "It sounds like you are concerned that others don't experience the same challenges as you."
d. "It sounds like you are concerned that others don't experience the same challenges as you."
A critical care nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and a nursing diagnosis. Select the psychiatric nurse's best response.
a. "No functional difference exists between the two diagnoses. Both serve to identify a human deviance."
b. "The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis includes cultural variables."
c. "The DSM-5 diagnosis profiles present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems."
d. "The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience."
d. "The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience."
The spouse of a patient diagnosed with schizophrenia says, "I don't understand why childhood experiences have anything to do with this disabling illness." Select the nurse's response that will best help the spouse understand this condition.
a. "Psychological stress is actually at the root of most mental disorders."
b. "We now know that all mental illnesses are the result of genetic factors."
c. "It must be frustrating for you that your spouse is sick so much of the time."
d. "Although this disorder more likely has a biological rather than psychological origin, the support and involvement of caregivers is very important."
d. "Although this disorder more likely has a biological rather than psychological origin, the support and involvement of caregivers is very important."
Which belief by a nurse supports the highest degree of patient advocacy during a multidisciplinary patient care planning session?
a. All mental illnesses are culturally determined.
b. Schizophrenia and bipolar disorder are cross-cultural disorders.
c. Symptoms of mental disorders are constant from culture to culture.
d. Some symptoms of mental disorders may reflect a person's cultural patterns.
d. Some symptoms of mental disorders may reflect a person's cultural patterns.
A patient's history shows intense and unstable relationships with others. The patient initially idealizes an individual and then devalues the person when the patient's needs are not met. Which aspect of mental health is a problem?
a. Effectiveness in work
b. Communication skills
c. Productive activities
d. Fulfilling relationships
d. Fulfilling relationships
In the majority culture of the United States, which individual is at greatest risk to be incorrectly labeled mentally ill?
a. Person who is usually pessimistic but strives to meet personal goals
b. Wealthy person who gives $20 bills to needy individuals in the community
c. Person with an optimistic viewpoint about life and getting his or her own needs met
d. Person who attends a charismatic church and describes hearing God's voice
d. Person who attends a charismatic church and describes hearing God's voice
A participant at a community education conference asks, "What is the most prevalent type of mental disorder in the United States?" Select the nurse's best response.
a. "Why do you ask?"
b. "Schizophrenia"
c. "Affective disorders"
d. "Anxiety disorders"
d. "Anxiety disorders"
A nurse wants to find a description of diagnostic criteria for a person diagnosed with schizophrenia. Which resource should the nurse consult?
a. U.S. Department of Health and Human Services
b. Journal of the American Psychiatric Association
c. North American Nursing Diagnosis Association International (NANDA-I)
d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
d. Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
A patient in the emergency department reports, "I hear voices saying someone is stalking me. They want to kill me because I found the cure for cancer. I will stab anyone that threatens me." Which aspects of mental health have the greatest immediate concern to a nurse? Select all that apply.
a. Happiness
b. Appraisal of reality
c. Control over behavior
d. Effectiveness in work
e. Healthy self-concept
b. Appraisal of reality
c. Control over behavior
e. Healthy self-concept
Which statements most clearly reflect the stigma of mental illness? Select all that apply.
a. "Many mental illnesses are hereditary."
b. "Mental illness can be evidence of a brain disorder."
c. "People claim mental illness so they can get disability checks."
d. "If people with mental illness went to church, they would be fine."
e. "Mental illness is a result of the breakdown of the American family."
c. "People claim mental illness so they can get disability checks."
d. "If people with mental illness went to church, they would be fine."
e. "Mental illness is a result of the breakdown of the American family."
Planning for patients with mental illness is facilitated by understanding that inpatient hospitalization is generally reserved for patients who:
a. present a clear danger to self or others.
b. are noncompliant with medications at home.
c. have no support systems in the community.
d. develop new symptoms during the course of an illness.
a. present a clear danger to self or others.
A patient is hospitalized for a reaction to a psychotropic medication and then is closely monitored for 24 hours. During a predischarge visit, the case manager learns the patient received a notice of eviction on the day of admission. The most appropriate intervention for the case manager is to:
a. cancel the patients discharge from the hospital.
b. contact the landlord who evicted the patient to discuss the situation.
c. arrange a temporary place for the patient to stay until new housing can be arranged.
d. document that the adverse medication reaction was feigned because the patient had nowhere to live.
c. arrange a temporary place for the patient to stay until new housing can be arranged.
A multidisciplinary health care team meets 12 hours after an adolescent is hospitalized after a suicide attempt. Members of the team report their assessments. What outcome can be expected from this meeting?
a. A treatment plan will be formulated.
b. The health care provider will order neuroimaging studies.
c. The team will request a court-appointed advocate for the patient.
d. Assessment of the patients need for placement outside the home will be undertaken.
a. A treatment plan will be formulated.
The relapse of a patient diagnosed with schizophrenia is related to medication noncompliance. The patient is hospitalized for 5 days, medication is restarted, and the patients thoughts are now more organized. The patients family members are upset and say, Its too soon for discharge. Hospitalization is needed for at least a month. The nurse should:
a. call the psychiatrist to come explain the discharge rationale.
b. explain that health insurance will not pay for a longer stay for the patient.
c. call security to handle the disturbance and escort the family off the unit.
d. explain that the patient will continue to improve if medication is taken regularly.
d. explain that the patient will continue to improve if medication is taken regularly.
A nurse assesses an inpatient psychiatric unit, noting that exits are free from obstruction, no one is smoking, the janitors closet is locked, and all sharp objects are being used under staff supervision. These observations relate to:
a. management of milieu safety.
b. coordinating care of patients.
c. management of the interpersonal climate.
d. use of therapeutic intervention strategies.
a. management of milieu safety.
The following patients are seen in the emergency department. The psychiatric unit has one bed available. Which patient should the admitting officer recommend for admission to the hospital? The patient who:
a. is experiencing dry mouth and tremor related to side effects of haloperidol (Haldol).
b. is experiencing anxiety and a sad mood after a separation from a spouse of 10 years.
c. self-inflicted a superficial cut on the forearm after a family argument.
d. is a single parent and hears voices saying, Smother your infant.
d. is a single parent and hears voices saying, Smother your infant.
A student nurse prepares to administer oral medications to a patient diagnosed with major depressive disorder, but the patient refuses the medication. The student nurse should:
a. tell the patient, Ill get an unsatisfactory grade if I dont give you the medication.
b. tell the patient, Refusing your medication is not permitted. You are required to take it.
c. discuss the patients concerns about the medication, and report to the staff nurse.
d. document the patients refusal of the medication without further comment.
c. discuss the patients concerns about the medication, and report to the staff nurse.
A nurse surveys the medical records for violations of patients rights. Which finding signals a violation?
a. No treatment plan is present in record.
b. Patient belongings are searched at admission.
c. Physical restraint is used to prevent harm to self.
d. Patient is placed on one-to-one continuous observation.
a. No treatment plan is present in record.
Which principle takes priority for the psychiatric inpatient staff when addressing behavioral crises?
a. Resolve behavioral crises using the least restrictive intervention possible.
b. Rights of the majority of patients supersede the rights of individual patients.
c. Swift intervention is justified to maintain the integrity of the therapeutic milieu.
d. Allow patients opportunities to regain control without intervention if the safety of other patients is not compromised.
a. Resolve behavioral crises using the least restrictive intervention possible.
To provide comprehensive care to patients, which competency is more important for a nurse who works in a community mental health center than a psychiatric nurse who works in an inpatient unit?
a. Problem-solving skills
b. Calm and caring manner
c. Ability to cross service systems
d. Knowledge of psychopharmacology
c. Ability to cross service systems
A suspicious and socially isolated patient lives alone, eats one meal a day at a nearby shelter, and spends the remaining daily food allowance on cigarettes. Select the community psychiatric nurses best initial action.
a. Report the situation to the manager of the shelter.
b. Tell the patient, You must stop smoking to save money.
c. Assess the patients weight; determine the foods and amounts eaten.
d. Seek hospitalization for the patient while a new plan is being formulated.
c. Assess the patients weight; determine the foods and amounts eaten.
A patient diagnosed with schizophrenia has been stable in the community. Today, the spouse reports the patient is expressing delusional thoughts. The patient says, Im willing to take my medicine, but I forgot to get my prescription refilled. Which outcome should the nurse add to the plan of care?
a. Nurse will obtain prescription refills every 90 days and deliver them to the patient.
b. Patients spouse will mark dates for prescription refills on the family calendar.
c. Patient will report to the hospital for medication follow-up every week.
d. Patient will call the nurse weekly to discuss medication-related issues.
b. Patients spouse will mark dates for prescription refills on the family calendar.
A community mental health nurse has worked for 6 months to establish a relationship with a delusional, suspicious patient. The patient recently lost employment and stopped taking medications because of inadequate money. The patient says, Only a traitor would make me go to the hospital. Which solution is best?
a. Arrange a bed in a local homeless shelter with nightly onsite supervision.
b. Negotiate a way to provide medication so the patient can remain at home.
c. Hospitalize the patient until the symptoms have stabilized.
d. Seek inpatient hospitalization for up to 1 week.
b. Negotiate a way to provide medication so the patient can remain at home.
A community psychiatric nurse facilitates medication compliance for a patient by having the health care provider prescribe depot medications by injection every 3 weeks at the clinic. For this plan to be successful, which factor will be of critical importance?
a. Attitude of significant others toward the patient
b. Nutritional services in the patients neighborhood
c. Level of trust between the patient and the nurse
d. Availability of transportation to the clinic
d. Availability of transportation to the clinic
Which assessment finding for a patient living in the community requires priority intervention by the nurse? The patient:
a. receives Social Security disability income plus a small check from a trust fund.
b. lives in an apartment with two patients who attend day hospital programs.
c. has a sibling who is interested and active in care planning. d. purchases and uses marijuana on a frequent basis.
d. purchases and uses marijuana on a frequent basis.
A patient tells the nurse at the clinic, I havent been taking my antidepressant medication as directed. I leave out the midday dose. I have lunch with friends and dont want them to ask me about the pills. Select the nurses most appropriate intervention.
a. Investigate the possibility of once-daily dosing of the antidepressant.
b. Suggest to the patient to take the medication when no one is watching.
c. Explain how taking each dose of medication on time relates to health maintenance.
d. Add the following nursing diagnosis to the plan of care: Ineffective therapeutic regimen management, related to lack of knowledge.
a. Investigate the possibility of once-daily dosing of the antidepressant.
A community psychiatric nurse assesses that a patient diagnosed with a mood disorder is more depressed than on the previous visit a month ago; however, the patient says, I feel the same. Which intervention supports the nurses assessment while preserving the patients autonomy?
a. Arrange for a short hospitalization.
b. Schedule weekly clinic appointments.
c. Refer the patient to the crisis intervention clinic.
d. Call the family and ask them to observe the patient closely.
b. Schedule weekly clinic appointments.
A patient hurriedly tells the community mental health nurse, Everythings a disaster! I cant concentrate. My disability check didnt come. My roommate moved out, and I cant afford the rent. My therapist is moving away. I feel like Im coming apart. Which nursing diagnosis applies?
a. Decisional conflict, related to challenges to personal values
b. Spiritual distress, related to ethical implications of treatment regimen
c. Anxiety, related to changes perceived as threatening to psychological equilibrium
d. Impaired environmental interpretation syndrome, related to solving multiple problems affecting security needs
c. Anxiety, related to changes perceived as threatening to psychological equilibrium
Which patient would a nurse refer to partial hospitalization? An individual who:
a. spent yesterday in the 24-hour supervised crisis care center and continues to be actively suicidal.
b. because of agoraphobia and panic episodes needs psychoeducation for relaxation therapy.
c. has a therapeutic lithium level and reports regularly for blood tests and clinic follow-up.
d. states, Im not sure I can avoid using alcohol when my spouse goes to work every morning.
d. states, Im not sure I can avoid using alcohol when my spouse goes to work every morning.
Which employers health plan is required to include parity provisions related to mental illnesses?
a. Employer with more than 50 employees
b. Cancer thrift shop staffed by volunteers
c. Daycare center that employs 7 teachers
d. Church that employs 15 people
a. Employer with more than 50 employees
A nurse can best address factors of critical importance to successful community treatment for persons with mental illness by including assessments related to which of the following? Select all that apply.
a. Housing adequacy and stability
b. Income adequacy and stability
c. Family and other support systems
d. Early psychosocial development
e. Substance abuse history and current use
a. Housing adequacy and stability
b. Income adequacy and stability
c. Family and other support systems
e. Substance abuse history and current use
A community member asks a nurse, People diagnosed with mental illnesses used to go to a state hospital. Why has that changed? Select the nurses accurate responses. Select all that apply.
a. Science has made significant improvements in drugs for mental illness, so now many people may live in their communities.
b. A better selection of less restrictive settings is now available in communities to care for individuals with mental illness.
c. National rates of mental illness have declined significantly. The need for state institutions is actually no longer present.
d. Most psychiatric institutions were closed because of serious violations of patients rights and unsafe conditions.
e. Federal legislation and payment for treatment of mental illness have shifted the focus to community rather than institutional settings.
a. Science has made significant improvements in drugs for mental illness, so now many people may live in their communities.
b. A better selection of less restrictive settings is now available in communities to care for individuals with mental illness.
e. Federal legislation and payment for treatment of mental illness have shifted the focus to community rather than institutional settings.
A psychiatric nurse best implements the ethical principle of autonomy when he or she:
a. intervenes when a self-mutilating patient attempts to harm self.
b. stays with a patient who is demonstrating a high level of anxiety.
c. suggests that two patients who are fighting be restricted to the unit.
d. explores alternative solutions with a patient, who then makes a choice.
d. explores alternative solutions with a patient, who then makes a choice.
Which action by a psychiatric nurse best supports a patients right to be treated with dignity and respect?
a. Consistently addressing a patient by title and surname.
b. Strongly encouraging a patient to participate in the unit milieu.
c. Discussing a patients condition with another health care provider in the elevator.
d. Informing a treatment team that a patient is too drowsy to participate in care planning.
a. Consistently addressing a patient by title and surname.
Two hospitalized patients fight when they are in the same room. During a team meeting, a nurse asserts that safety is of paramount importance and therefore the treatment plans should call for both patients to be secluded to prevent them from injuring each other. This assertion:
a. reveals that the nurse values the principle of justice.
b. reinforces the autonomy of the two patients.
c. violates the civil rights of the two patients.
d. represents the intentional tort of battery.
c. violates the civil rights of the two patients.
In a team meeting a nurse says, Im concerned whether we are behaving ethically by using restraint to prevent one patient from self-mutilation while the care plan for another patient who has also self-mutilated calls for one-on-one supervision. Which ethical principle most clearly applies to this situation?
a. Beneficence
b. Autonomy
c. Fidelity
d. Justice
d. Justice
Which scenario is an example of a tort?a. The primary nurse does not complete the plan of care for a patient within 24 hours of the patients admission.
b. An advanced practice nurse recommends that a patient who is dangerous to self and others be voluntarily hospitalized.
c. A patients admission status is changed from involuntary to voluntary after the patients hallucinations subside.
d. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent violence because a unit is short staffed.
d. A nurse gives an as-needed dose of an antipsychotic drug to a patient to prevent violence because a unit is short staffed.
A nurses neighbor asks, Why arent people with mental illness kept in state institutions anymore? What is the nurses best response?
a. Many people are still in psychiatric institutions. Inpatient care is needed because many people who are mentally ill are violent.
b. Less restrictive settings are now available to care for individuals with mental illness.
c. Our nation has fewer persons with mental illness; therefore fewer hospital beds are needed.
d. Psychiatric institutions are no longer popular as a consequence of negative stories in the press.
b. Less restrictive settings are now available to care for individuals with mental illness.
Which nursing intervention demonstrates false imprisonment?
a. A confused and combative patient says, Im getting out of here and no one can stop me. The nurse restrains this patient without a health care providers order and then promptly obtains an order.
b. A patient has been irritating, seeking the attention of nurses most of the day. Now a nurse escorts the patient down the hall, saying, Stay in your room or youll be put in seclusion.
c. An involuntarily hospitalized patient with suicidal ideation runs out of the psychiatric unit. A nurse rushes after the patient and convinces the patient to return to the unit.
d. An involuntarily hospitalized patient with suicidal ideation attempts to leave the unit. A nurse calls the security team and uses established protocols to prevent the patient from leaving.
b. A patient has been irritating, seeking the attention of nurses most of the day. Now a nurse escorts the patient down the hall, saying, Stay in your room or youll be put in seclusion.
A patient should be considered for involuntary commitment for psychiatric care when he or she:
a. is noncompliant with the treatment regimen.
b. sells and distributes illegal drugs.
c. threatens to harm self and others.
d. fraudulently files for bankruptcy.
c. threatens to harm self and others.
A nurse at the mental health center prepares to administer a scheduled injection of haloperidol decanoate (Haldol depot) to a patient with schizophrenia. As the nurse swabs the site, the patient shouts, Stop! I dont want to take that medicine anymore. I hate the side effects. Select the nurses best initial action.
a. Stop the medication administration procedure and say to the patient, Tell me more about the side effects youve been having.
b. Say to the patient, Since Ive already drawn the medication in the syringe, Im required to give it, but lets talk to the doctor about skipping next months dose.
c. Proceed with the injection but explain to the patient that other medications are available that may help reduce the unpleasant side effects.
d. Notify other staff members to report to the room for a show of force and proceed with the injection, using restraint if necessary.
a. Stop the medication administration procedure and say to the patient, Tell me more about the side effects youve been having.
Several nurses are concerned that agency policies related to restraint and seclusion are inadequate. Which statement about the relationship of substandard institutional policies and individual nursing practice should guide nursing practice?
a. The policies do not absolve an individual nurse of the responsibility to practice according to the professional standards of nursing care.
b. Agency policies are the legal standard by which a professional nurse must act and therefore override other standards of care.
c. In an institution with substandard policies, the nurse has a responsibility to inform the supervisor and leave the premises.
d. Interpretation of policies by the judicial system is rendered on an individual basis and therefore cannot be predicted.
a. The policies do not absolve an individual nurse of the responsibility to practice according to the professional standards of nursing care.
A newly admitted patient who is acutely psychotic is a private patient of the senior psychiatrist. To whom does the psychiatric nurse who is assigned to this patient owe the duty of care?
a. Health care provider
b. Profession
c. Hospital
d. Patient
d. Patient
An example of a breach of a patients right to privacy occurs when a nurse:
a. asks a family to share information about a patients prehospitalization behavior.
b. discusses the patients history with other staff members during care planning.
c. documents the patients daily behaviors during hospitalization.
d. releases information to the patients employer without consent.
d. releases information to the patients employer without consent.
An adolescent hospitalized after a violent physical outburst tells the nurse, Im going to kill my father, but you cant tell anyone. Select the nurses best response.
a. Youre right. Federal law requires me to keep that information private.
b. Those kinds of thoughts will make your hospitalization longer.
c. You really should share this thought with your psychiatrist. d. I am required to share information with the treatment team.
d. I am required to share information with the treatment team.
A voluntarily hospitalized patient tells the nurse, Get me the forms for discharge against medical advice so I can leave now. What is the nurses best initial response?
a. I cant give you those forms without your health care providers knowledge.
b. I will get them for you, but lets talk about your decision to leave treatment.
c. Since you signed your consent for treatment, you may leave if you desire.
d. Ill get the forms for you right now and bring them to your room.
b. I will get them for you, but lets talk about your decision to leave treatment.
The family of a patient whose insurance will not pay for continuing hospitalization considers transferring the patient to a public psychiatric hospital. The family expresses concern that the patient will never get any treatment. Which reply by the nurse would be most helpful?
a. Under the law, treatment must be provided. Hospitalization without treatment violates patients rights.
b. Thats a justifiable concern because the right to treatment extends only to the provision of food, shelter, and safety.
c. Much will depend on other patients, because the right to treatment for a psychotic patient takes precedence over the right to treatment of a patient who is stable.
d. All patients in public hospitals have the right to choose both a primary therapist and a primary nurse.
a. Under the law, treatment must be provided. Hospitalization without treatment violates patients rights.
Which individual with a mental illness may need emergency or involuntary hospitalization for mental illness? The individual who:
a. resumes using heroin while still taking methadone.
b. reports hearing angels playing harps during thunderstorms.
c. throws a heavy plate at a waiter at the direction of command hallucinations.
d. does not show up for an outpatient appointment with the mental health nurse.
c. throws a heavy plate at a waiter at the direction of command hallucinations.
A patient being treated in an alcohol rehabilitation unit reveals to the nurse, I feel terrible guilt for sexually abusing my 6-year-old child before I was admitted. Based on state and federal law, the best action for the nurse to take is to:
a. anonymously report the abuse by telephone to the local child abuse hotline.
b. reply, Im glad you feel comfortable talking to me about it. c. respect the nurse-patient relationship of confidentiality.
d. file a written report on the agency letterhead.
a. anonymously report the abuse by telephone to the local child abuse hotline.
The spouse of a patient who has delusions asks the nurse, Are there any circumstances under which the treatment team is justified in violating the patients right to confidentiality? The nurse must reply that confidentiality may be breached:
a. under no circumstances.
b. at the discretion of the psychiatrist.
c. when questions are asked by law enforcement.
d. if the patient threatens the life of another person.
d. if the patient threatens the life of another person.
A nurse cares for an older adult patient admitted for treatment of depression. The health care provider prescribes an antidepressant medication, but the dose is more than the usual adult dose. The nurse should:
a. implement the order.
b. consult a drug reference.
c. give the usual geriatric dosage.
d. hold the medication and consult the health care provider.
d. hold the medication and consult the health care provider.
A patient diagnosed with schizophrenia believes evil spirits are being summoned by a local minister and verbally threatens to bomb a local church. The psychiatrist notifies the minister. The psychiatrist has:
a. released information without proper authorization.
b. demonstrated the duty to warn and protect.
c. violated the patients confidentiality.
d. avoided charges of malpractice.
b. demonstrated the duty to warn and protect.
After leaving work, a staff nurse realizes that documentation of the administration of a medication to a patient was omitted. This off-duty nurse telephones the unit and tells the nurse, Please document the administration of the medication I forgot to do. My password is alpha1. The nurse should:
a. fulfill the request.
b. refer the matter to the charge nurse to resolve.
c. access the record and document the information.
d. report the request to the patients health care provider.
b. refer the matter to the charge nurse to resolve.
A patient diagnosed with mental illness asks a psychiatric technician, Whats the matter with me? The technician replies, Your wing nuts need tightening. The nurse who overheard the exchange should take action based on:
a. violation of the patients right to be treated with dignity and respect.
b. the nurses obligation to report caregiver negligence.
c. preventing defamation of the patients character.
d. supervisory liability.
a. violation of the patients right to be treated with dignity and respect.
Which documentation of a patients behavior best demonstrates a nurses observations?
a. Isolates self from others. Frequently fell asleep during group. Vital signs stable.
b. Calmer and more cooperative. Participated actively in group. No evidence of psychotic thinking.
c. Appeared to hallucinate. Patient frequently increased volume on television, causing conflict with others
d. Wears four layers of clothing. States, I need protection from dangerous bacteria trying to penetrate my skin.
d. Wears four layers of clothing. States, I need protection from dangerous bacteria trying to penetrate my skin.
A nurse volunteers for a committee that must revise the hospital policies and procedures for suicide precautions. Which resources would provide the best guidance? Select all that apply.
a. Diagnostic and Statistical Manual of Mental Disorders (fifth edition) (DSM-5)
b. States nurse practice act
c. State and federal regulations that govern hospitals
d. Summary of common practices of several local hospitals
e. American Nurses Association Scope and Standards of Practice for PsychiatricMental Health Nursing
c. State and federal regulations that govern hospitals
e. American Nurses Association Scope and Standards of Practice for PsychiatricMental Health Nursing
In which situations does a nurse have a duty to intervene and report? Select all that apply.
a. A peer is unable to write behavioral outcomes.
b. A health care provider consults the Physicians Desk Reference.
c. A peer tries to provide patient care in an alcohol-impaired state.
d. A team member has violated the boundaries of a vulnerable patient.
e. A patient refuses a medication prescribed by a licensed health care provider.
c. A peer tries to provide patient care in an alcohol-impaired state.
d. A team member has violated the boundaries of a vulnerable patient.
Which situations qualify as abandonment on the part of a nurse? (Select all that apply.) The nurse:
a. allows a patient with acute mania to refuse hospitalization without taking further action.
b. terminates employment without referring a seriously mentally ill for aftercare.
c. calls police to bring a suicidal patient to the hospital after a suicide attempt.
d. refers a patient with persistent paranoid schizophrenia to community treatment.
e. asks another nurse to provide a patients care because of concerns about countertransference.
a. allows a patient with acute mania to refuse hospitalization without taking further action.
b. terminates employment without referring a seriously mentally ill for aftercare.
Sets found in the same folder