Chapter 8 Assessment - psychiatric nursing test bank

SHEILA L. VIDEBECK TEST BANK



Chapter 8: Assessment

1. When assessing a patient's mental health status, which of the following describe
the purpose of the psychosocial assessment? Select all that apply.
A) To assess the client's current emotional state
B) To assess the client's mental capacity
C) To assess the client's behavioral function
D) To assess the client's plan of care
E) To assess the client's physical health status
Ans: A, B, C
Feedback:
The purpose of the psychosocial assessment is to construct a picture of the client's
current emotional state, mental capacity, and behavioral function. This assessment
serves as the basis for developing a plan of care to meet the client's needs. The client's
physical health status would need to be completed as another assessment or an extended
assessment.


2. Which of the following factors influencing assessment is under the nurse's control?
A) Client participation and feedback
B) Client's health status
C) Nurse's attitude and approach
D) Client's ability to understand
Ans: C
Feedback:
The factors that influence assessment include client participation and feedback, client's
health status, client's ability to understand, client's previous experiences, and
misconceptions about health care. The only one of these that is under the control of the
nurse is the nurse's attitude and approach.


3. Which of the following are components of the assessment of thought process and
content? Select all that apply.
A) What the client is thinking
B) Abstract thinking abilities
C) How the client is thinking
D) Clarity of ideas
E) Self-harm or suicide urges
Ans: A, C, D, E
Feedback:
The components of the assessment of thought process and content include content (what
the client is thinking), process (how the client is thinking), clarity of ideas, self-harm, or
suicide urges. Abstract thinking abilities are an element of the abnormal sensory
experiences or misperception assessment.




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4. A client is being evaluated for dementia. The nurse knows that a client who is able to
complete very few tasks is most likely to have
A) a greater cognitive deficit.
B) A less precise mental status exam.
C) more potential for agitation.
D) no bearing on mental status.
Ans: A
Feedback:
The fewer tasks the client competes accurately, the greater the cognitive deficit. The
other choices are not true.


5. During the assessment, the nurse asks the client to describe his problems. The purpose
of this question is to obtain information about the client's
A) admitting diagnosis.
B) communication skills.
C) perception of the problem.
D) personal needs.
Ans: C
Feedback:
The question will elicit information about the client's view or perspective of the
problem.


6. A delusion represents a problem in which of the following areas?
A) Memory
B) Motivation
C) Orientation
D) Thinking
Ans: D
Feedback:
A delusion is a fixed false idea or thought. Memory relates to the client's knowledge of
past events. Motivation relates to the client's interest in doing things. Orientation relates
to the client's perception of reality.




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7. The nurse asks a patient to list the days of the week in reverse order. The nurse is
assessing which of the following?
A) Concentration
B) Memory
C) Orientation
D) Abstract thinking
Ans: A
Feedback:
The nurse assesses the client's ability to concentrate by asking the client to perform
certain tasks such as repeating the days of the week backward. The nurse directly
assesses memory, both recent and remote, by asking questions with verifiable answers.
Orientation refers to the client's recognition of person, place, and time. Abstract thinking
is to making associations or interpretations about a situation or comment.


8. When the nurse asks the client to restate the following in his or her own words, which
sensorium and intellectual process is the nurse attempting to identify? The nurse states,
ìA stitch in time saves nine.î
A) The client's orientation
B) The client's memory
C) The client's ability to concentrate
D) The client's ability to use abstract thinking
Ans: D
Feedback:
When the nurse states, ìA stitch in time saves nine,î and asks the client to restate it in his
or her own words, the nurse is assessing the client's ability to use abstract thinking. The
client's orientation is recognizing person, place, and time. The client's memory, both
recent and remote, can be assessed by asking the client questions that have verifiable
answers. The client's ability to concentrate can be assessed by asking the client to
perform certain tasks including spelling the word ìworldî backward.




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