, Experienced Violence
CHAPTER LIST
UNIT VI Care and Recovery for People with Mental
Disorders
UNIT I Mental Health Care in Contemporary Society Chapter 24: Schizophrenia and Related Disorders:
Chapter 1: Psychiatric–Mental Health Nursing and Nursing Care of People with Thought Disorders Chapter
Evidence-Based Practice 25: Depression: Nursing Care of People with Depressive
Chapter 2: Mental Health and Mental Disorders: Moods and Suicidal Behavior
Fighting Stigma and Promoting Recovery Chapter 26: Bipolar and Related Disorders: Nursing Care
Chapter 3: Cultural Communities, Gender, and Spiritual of People with Mood Lability
Considerations Related to Mental Health Care Chapter 27: Anxiety Disorders: Nursing Care of People
Chapter 4: Nursing Ethics, Patient Rights, and Legal with Anxiety, Panic, and Phobia
Issues Chapter 28: Obsessive-Compulsive and Related
Chapter 5: Mental Health Care in the Community Disorders: Nursing Care of People with Obsessions and
Compulsions
UNIT II Foundations of Psychiatric Nursing Chapter 29: Trauma- and Stressor-Related Disorders:
Chapter 6: Psychosocial-Spiritual Basis of Psychiatric Nursing Care of People with Posttraumatic Stress and
Nursing Other Related Disorders
Chapter 7: Biologic Foundations of Psychiatric Nursing Chapter 30: Personality Disorders: Nursing Care of
Chapter 8: Recovery Framework for Psychiatric–Mental People with Personality and Impulse-Control Disorders
Health Nursing Chapter 31: Substance-Related Disorders: Nursing Care
of People with Substance Use and Other Compulsive
UNIT III Contemporary Psychiatric Nursing Practice Disorders
Chapter 9: Communication and the Therapeutic Chapter 32: Eating Disorders: Nursing Care of People
Relationship with Eating and Weight-Related Disorders
Chapter 10: Clinical Judgment Nursing Care Planning in Chapter 33: Somatic Symptom and Related Disorders:
Psychiatric–Mental Health Nursing Care of People with Somatization
Chapter 11: Psychopharmacology and Biologic Chapter 34: Sleep–Wake Disorders: Nursing Care of
Interventions People with Insomnia and Sleep Disorders
Chapter 12: Complementary Therapies and Integrative Chapter 35: Sexual Disorders: Nursing Care of People
Health with Sexual Dysfunction and Paraphilias
Chapter 13: Cognitive Interventions in Psychiatric
Nursing UNIT VII Care of Children and Adolescents
Chapter 14: Group Interventions Chapter 36: Mental Health Assessment of Children and
Chapter 15: Family Assessment and Interventions Adolescents
Chapter 37: Mental Disorders of Childhood and
UNIT IV Mental Health Across the Lifespan Adolescence
Chapter 16: Mental Health Promotion for Childhood
and Adolescence UNIT VIII Care of Older Adults
Chapter 17: Mental Health Promotion for Young and Chapter 38: Mental Health Assessment of Older Adults
Middle Adulthood Chapter 39: Neurocognitive Disorders: Nursing Care of
Chapter 18: Mental Health Promotion for Older Older Adults with Delirium and Dementia
Adulthood
UNIT IX Care of Special Populations
UNIT V Prevention of Mental Disorders Chapter 40: Care of Veterans with Mental Health Needs
Chapter 19: Stress and Mental Health Chapter 41: Care of People Experiencing Housing
Chapter 20: Safety and De-Escalation Practices Instability and Mental Illness
Chapter 21: Crisis, Loss, Grief, Response, Bereavement, Chapter 42: Care of People with Co-occurring Mental
and Disaster Management Disorders
Chapter 22: Suicide Prevention: Screening, Assessment, Chapter 43: Care of People Who Are Medically
and Intervention
Compromised
Chapter 23: Mental Health Care for People Who Have
,Chapter 1: Psychiatric--Mental Health Nursing and
Evidence-Based Practice
Multiple Choice
1. A psychiatric--mental health nurse is explaining the scope of practice for
psychiatric nursing. Which function represents a core responsibility reserved
exclusively for an advanced practice registered nurse (APRN) rather than a basic-
level psychiatric nurse?
A. Maintaining a therapeutic environment and promoting safety on an inpatient unit.
B. Conducting individual psychotherapy and prescribing psychotropic medications.
C. Educating clients and families regarding symptom management and coping skills.
D. Administering prescribed psychotropic medications and monitoring for adverse
effects.
Answer: B
Rationale: The American Nurses Association (ANA) scope and standards of psychiatric--
mental health nursing practice delineate basic versus advanced practice roles.
Psychotherapy, prescriptive authority, and ordering diagnostic tests are reserved for
advanced practice registered nurses (PMH-APRNs). Basic-level PMH registered nurses
perform intake assessments, health teaching, medication administration, and milieu
management.
2. A nurse is conducting a comprehensive assessment of a client using the
biopsychosocial framework. Which domain of this model includes evaluating the
client's family dynamics, cultural background, and socioeconomic status?
A. Spiritual domain
B. Social domain
C. Biological domain
D. Psychological domain
Answer: B
Rationale: The social domain of the biopsychosocial model encompasses theories and
concepts related to family structures, cultural influences, social support networks,
community resources, and socioeconomic status. The biological domain focuses on
,neurobiology and physical health, while the psychological domain addresses cognitive,
emotional, and behavioral processes.
3. In evidence-based practice (EBP), which source of evidence is considered the
highest level of research evidence for guiding clinical nursing interventions?
A. Opinions of clinical experts and consensus committees
B. Individual non-randomized controlled quasi-experimental studies
C. Systematic reviews or meta-analyses of randomized controlled trials
D. Single descriptive or qualitative research studies
Answer: C
Rationale: In the hierarchy of evidence-based practice, systematic reviews and meta-
analyses of well-designed randomized controlled trials (RCTs) provide the highest rigor
and strongest empirical basis for clinical decision-making. Qualitative studies, expert
opinions, and non-randomized trials rank lower on the evidence hierarchy.
4. A newly hired psychiatric nurse reads about evidence-based practice (EBP)
during orientation. Which statement best describes the integration of components
necessary to achieve true evidence-based clinical practice?
A. Synthesizing research evidence, clinical expertise, and client values and
preferences.
B. Prioritizing provider clinical experience over empirical research data and client
choices.
C. Relying strictly on systematic research findings regardless of institutional
resources.
D. Adopting standardized clinical pathways established by health maintenance
organizations.
Answer: A
Rationale: Evidence-based practice in psychiatric nursing requires the integration of
three essential components: the best available empirical research evidence, clinical
nursing expertise, and the unique values, culture, and personal preferences of the client.
5. A basic-level psychiatric nurse is developing a plan of care for a client
experiencing acute anxiety. Which intervention is appropriate for a basic-level
psychiatric--mental health nurse to independently plan and implement?
A. Ordering baseline liver function tests for psychotropic monitoring.
B. Implementing therapeutic communication techniques and anxiety de-escalation.
C. Prescribing a low-dose benzodiazepine for acute relief.
D. Conducting cognitive-behavioral therapy sessions.
,Answer: B
Rationale: Therapeutic communication, crisis de-escalation, health teaching, and
supportive care are within the autonomous scope of practice for basic-level psychiatric--
mental health registered nurses. Psychotherapy, lab ordering, and medication
prescribing require advanced practice licensure.
6. A nurse is reviewing the American Nurses Association (ANA) Standards of
Professional Performance for Psychiatric--Mental Health Nursing. Which activity
aligns with the standard of Quality of Practice?
A. Systematically evaluating the safety, effectiveness, and efficiency of nursing care.
B. Developing an individualized care plan addressing identified client goals.
C. Analyzing assessment findings to determine nursing diagnoses.
D. Collecting comprehensive health data using evidence-based assessment tools.
Answer: A
Rationale: Standard 10 (Quality of Practice) requires the psychiatric nurse to
systematically evaluate the quality, effectiveness, and safety of clinical nursing practice.
Collection of health data corresponds to Assessment (Standard 1), and diagnosis
formulation corresponds to Diagnosis (Standard 2).
7. A psychiatric nurse wishes to implement an evidence-based relaxation
technique for clients on an inpatient unit. What is the nurse's first step in the
evidence-based practice process?
A. Evaluating the clinical outcomes of the intervention after implementation.
B. Formulating a clear, searchable clinical question using the PICOT format.
C. Critically appraising research articles found in literature databases.
D. Searching for clinical practice guidelines on hospital intranets.
Answer: B
Rationale: The evidence-based practice process begins with framing a concise,
answerable clinical question using the PICOT format (Patient/Population, Intervention,
Comparison, Outcome, Timeframe). This clear formulation guides efficient literature
searching and critical appraisal.
8. A client admitted with major depressive disorder reports that taking walks in
nature helps relieve sadness. How should the psychiatric nurse integrate this
preference into the evidence-based care plan?
A. Incorporate structured outdoor physical activity into the daily therapeutic
schedule.
, B. Document the request but defer action until an APRN completes a psychiatric
evaluation.
C. Discourage the practice, as outdoor walking is not an evidence-based clinical
therapy.
D. Inform the client that physical exercise must be replaced by formal medication
therapy.
Answer: A
Rationale: Evidence-based practice mandates honoring client preferences alongside
clinical research. Physical exercise in natural settings is supported by empirical research
for depression symptom management; integrating this preference respects client
autonomy and strengthens holistic care planning.
9. A nurse is assessing a client from a biological domain perspective. Which
assessment finding represents data within the biological domain of psychiatric
nursing?
A. The client expresses feeling overwhelmed by sudden financial distress.
B. The client reports strong reliance on a local church support group.
C. The client exhibits a abnormal baseline electrocardiogram with a prolonged QTc
interval.
D. The client demonstrates poor self-esteem during social interactions.
Answer: C
Rationale: The biological domain encompasses physical health, neuroanatomy,
physiological responses, and laboratory or diagnostic studies such as an
electrocardiogram (ECG). Financial status, peer support, and self-esteem fall under
psychological or social domains.
10. A basic-level psychiatric nurse is caring for a client who requests formal marital
counseling. Which action by the nurse demonstrates proper understanding of
professional role boundaries?
A. Providing personal opinions and marital advice during individual nursing
assessments.
B. Advising the client that marital therapy is inappropriate during psychiatric
hospitalization.
C. Initiating joint marital counseling sessions during afternoon visiting hours.
D. Referring the couple to a licensed advanced practice psychiatric nurse or family
therapist.
Answer: D
,Rationale: Formal psychotherapy and couple/family therapy fall outside the basic-level
PMH registered nurse scope of practice. Recognizing professional limits and referring
clients to qualified advanced practice providers or specialized family therapists ensures
safe, legal, and competent care.
11. A psychiatric nurse unit manager notices that re-admission rates for clients
with bipolar disorder are increasing. Applying the evidence-based practice
framework, how should the nurse manager approach this problem?
A. Immediately implement a mandatory daily post-discharge telephone protocol
without review.
B. Formulate a clinical question regarding post-discharge interventions and appraise
relevant research.
C. Assume the re-admissions are unavoidable due to the chronic nature of bipolar
illness.
D. Discipline nursing staff for failing to deliver adequate discharge education.
Answer: B
Rationale: An evidence-based approach to quality improvement involves identifying a
clinical practice problem, translating it into a focused clinical question, systematically
searching for and appraising empirical evidence, and implementing evidence-supported
solutions evaluated against measurable outcome metrics.
12. A nurse evaluates a clinical trial testing a new psychosocial intervention. The
nurse notes that the study lacked a control group and had a high drop-out rate.
How should the nurse interpret these research findings?
A. Recommend the intervention immediately to replace existing evidence-based care
plans.
B. Disregard the study entirely because qualitative data were not gathered.
C. Recognize methodological limitations that decrease the internal validity and
strength of evidence.
D. Accept the conclusions as definitive proof that the intervention should be adopted
unit-wide.
Answer: C
Rationale: Critical appraisal requires assessing study design and methodology. A lack of
a control group and significant attrition reduce internal validity and increase bias,
meaning the study provides lower-level evidence that must be interpreted cautiously
before clinical adoption.
13. During a multi-disciplinary team meeting, a basic-level nurse advocates for
including family psychoeducation in a client's treatment plan. The physician
,dismisses the request, stating it takes too much time. Which action by the nurse
best demonstrates professional nursing leadership and standard of practice?
A. Conduct family psychoeducation off-shift without documenting the activity.
B. Present empirical research evidence showing family psychoeducation reduces
psychiatric relapse rates.
C. Yield to the physician's authority and remove family psychoeducation from
nursing notes.
D. Inform the client that the healthcare team refuses to involve family members in
care planning.
Answer: B
Rationale: Psychiatric nurses function as collaborative advocates for evidence-based
interventions. Presenting peer-reviewed empirical evidence demonstrating the clinical
efficacy of family psychoeducation in reducing relapse promotes evidence-based care
and interprofessional collaboration while upholding nursing standards.
Fill-in-the-Blank / Short Answer
14. Advanced practice registered nurses in psychiatric--mental health nursing
possess legal authority to conduct formal individual and group __________, a
primary health intervention non-permissible for basic-level PMH nurses.
Answer: psychotherapy
Rationale: Psychotherapy is an advanced practice intervention requiring specialized
graduate-level education, supervised clinical training, and advanced licensure. Basic-
level psychiatric nurses conduct therapeutic interactions and supportive counseling, but
not formal psychotherapy.
15. In evidence-based practice, formulating a clinical question often utilizes the
__________ acronym to structure components including population, intervention,
comparison, outcome, and time.
Answer: PICOT
Rationale: The PICOT framework (Patient/Population, Intervention, Comparison,
Outcome, Timeframe) standardizes clinical question formulation to conduct effective
literature searches and retrieve target research evidence.
Case Study / Clinical Judgment Scenarios
16. A 34-year-old female client diagnosed with schizophrenia is admitted to an
acute inpatient psychiatric unit following an exacerbation of auditory
hallucinations. The basic-level staff nurse conducts an initial assessment, identifies
, nursing diagnoses, administers ordered antipsychotic medications, and notices
that the client becomes anxious in noisy communal areas. The nurse provides a
quiet environment, teaches deep-breathing exercises, and assists the client with
personal hygiene. Later, the client asks the nurse to prescribe a higher dose of
medication and conduct formal analytical psychoanalysis. Which action should the
nurse take next?
A. Informs the client that all psychiatric interventions must be performed exclusively
by the attending physician.
B. Refuses to interact with the client further due to unrealistic requests regarding
professional boundaries.
C. Explains the basic nursing role, continues supportive coping interventions, and
refers the requests to the provider.
D. Agrees to conduct psychoanalysis sessions and increases the client's bedtime
antipsychotic dosage.
Answer: C
Rationale: The basic-level PMH nurse operates within defined legal boundaries by
offering supportive coping mechanisms, managing the milieu, and administering
medications, while correctly identifying that medication prescribing and formal
psychoanalysis require an advanced practice provider or physician. Referring those
specific requests maintains professional role limits and ensures safety.
17. A psychiatric unit nursing committee is reviewing protocol options to reduce
physical restraint usage for agitated clients. The team formulates a PICOT
question, conducts a comprehensive literature search, and identifies three
randomized controlled trials demonstrating that sensory de-escalation rooms
significantly reduce agitation and restraint rates. The committee appraises the
evidence, consults with unit staff regarding feasibility, presents the evidence to
hospital leadership, and designs an implementation plan with staff training and
outcome tracking. How should the nurse manager evaluate the committee's
clinical approach?
A. The committee failed to follow proper procedures by searching for research
before consulting leadership.
B. The committee effectively applied the systematic steps of the evidence-based
practice process to improve care.
C. The committee relied too heavily on empirical research rather than historical unit
traditions.
D. The committee violated scope of practice guidelines by proposing changes to unit
restraint protocols.
CHAPTER LIST
UNIT VI Care and Recovery for People with Mental
Disorders
UNIT I Mental Health Care in Contemporary Society Chapter 24: Schizophrenia and Related Disorders:
Chapter 1: Psychiatric–Mental Health Nursing and Nursing Care of People with Thought Disorders Chapter
Evidence-Based Practice 25: Depression: Nursing Care of People with Depressive
Chapter 2: Mental Health and Mental Disorders: Moods and Suicidal Behavior
Fighting Stigma and Promoting Recovery Chapter 26: Bipolar and Related Disorders: Nursing Care
Chapter 3: Cultural Communities, Gender, and Spiritual of People with Mood Lability
Considerations Related to Mental Health Care Chapter 27: Anxiety Disorders: Nursing Care of People
Chapter 4: Nursing Ethics, Patient Rights, and Legal with Anxiety, Panic, and Phobia
Issues Chapter 28: Obsessive-Compulsive and Related
Chapter 5: Mental Health Care in the Community Disorders: Nursing Care of People with Obsessions and
Compulsions
UNIT II Foundations of Psychiatric Nursing Chapter 29: Trauma- and Stressor-Related Disorders:
Chapter 6: Psychosocial-Spiritual Basis of Psychiatric Nursing Care of People with Posttraumatic Stress and
Nursing Other Related Disorders
Chapter 7: Biologic Foundations of Psychiatric Nursing Chapter 30: Personality Disorders: Nursing Care of
Chapter 8: Recovery Framework for Psychiatric–Mental People with Personality and Impulse-Control Disorders
Health Nursing Chapter 31: Substance-Related Disorders: Nursing Care
of People with Substance Use and Other Compulsive
UNIT III Contemporary Psychiatric Nursing Practice Disorders
Chapter 9: Communication and the Therapeutic Chapter 32: Eating Disorders: Nursing Care of People
Relationship with Eating and Weight-Related Disorders
Chapter 10: Clinical Judgment Nursing Care Planning in Chapter 33: Somatic Symptom and Related Disorders:
Psychiatric–Mental Health Nursing Care of People with Somatization
Chapter 11: Psychopharmacology and Biologic Chapter 34: Sleep–Wake Disorders: Nursing Care of
Interventions People with Insomnia and Sleep Disorders
Chapter 12: Complementary Therapies and Integrative Chapter 35: Sexual Disorders: Nursing Care of People
Health with Sexual Dysfunction and Paraphilias
Chapter 13: Cognitive Interventions in Psychiatric
Nursing UNIT VII Care of Children and Adolescents
Chapter 14: Group Interventions Chapter 36: Mental Health Assessment of Children and
Chapter 15: Family Assessment and Interventions Adolescents
Chapter 37: Mental Disorders of Childhood and
UNIT IV Mental Health Across the Lifespan Adolescence
Chapter 16: Mental Health Promotion for Childhood
and Adolescence UNIT VIII Care of Older Adults
Chapter 17: Mental Health Promotion for Young and Chapter 38: Mental Health Assessment of Older Adults
Middle Adulthood Chapter 39: Neurocognitive Disorders: Nursing Care of
Chapter 18: Mental Health Promotion for Older Older Adults with Delirium and Dementia
Adulthood
UNIT IX Care of Special Populations
UNIT V Prevention of Mental Disorders Chapter 40: Care of Veterans with Mental Health Needs
Chapter 19: Stress and Mental Health Chapter 41: Care of People Experiencing Housing
Chapter 20: Safety and De-Escalation Practices Instability and Mental Illness
Chapter 21: Crisis, Loss, Grief, Response, Bereavement, Chapter 42: Care of People with Co-occurring Mental
and Disaster Management Disorders
Chapter 22: Suicide Prevention: Screening, Assessment, Chapter 43: Care of People Who Are Medically
and Intervention
Compromised
Chapter 23: Mental Health Care for People Who Have
,Chapter 1: Psychiatric--Mental Health Nursing and
Evidence-Based Practice
Multiple Choice
1. A psychiatric--mental health nurse is explaining the scope of practice for
psychiatric nursing. Which function represents a core responsibility reserved
exclusively for an advanced practice registered nurse (APRN) rather than a basic-
level psychiatric nurse?
A. Maintaining a therapeutic environment and promoting safety on an inpatient unit.
B. Conducting individual psychotherapy and prescribing psychotropic medications.
C. Educating clients and families regarding symptom management and coping skills.
D. Administering prescribed psychotropic medications and monitoring for adverse
effects.
Answer: B
Rationale: The American Nurses Association (ANA) scope and standards of psychiatric--
mental health nursing practice delineate basic versus advanced practice roles.
Psychotherapy, prescriptive authority, and ordering diagnostic tests are reserved for
advanced practice registered nurses (PMH-APRNs). Basic-level PMH registered nurses
perform intake assessments, health teaching, medication administration, and milieu
management.
2. A nurse is conducting a comprehensive assessment of a client using the
biopsychosocial framework. Which domain of this model includes evaluating the
client's family dynamics, cultural background, and socioeconomic status?
A. Spiritual domain
B. Social domain
C. Biological domain
D. Psychological domain
Answer: B
Rationale: The social domain of the biopsychosocial model encompasses theories and
concepts related to family structures, cultural influences, social support networks,
community resources, and socioeconomic status. The biological domain focuses on
,neurobiology and physical health, while the psychological domain addresses cognitive,
emotional, and behavioral processes.
3. In evidence-based practice (EBP), which source of evidence is considered the
highest level of research evidence for guiding clinical nursing interventions?
A. Opinions of clinical experts and consensus committees
B. Individual non-randomized controlled quasi-experimental studies
C. Systematic reviews or meta-analyses of randomized controlled trials
D. Single descriptive or qualitative research studies
Answer: C
Rationale: In the hierarchy of evidence-based practice, systematic reviews and meta-
analyses of well-designed randomized controlled trials (RCTs) provide the highest rigor
and strongest empirical basis for clinical decision-making. Qualitative studies, expert
opinions, and non-randomized trials rank lower on the evidence hierarchy.
4. A newly hired psychiatric nurse reads about evidence-based practice (EBP)
during orientation. Which statement best describes the integration of components
necessary to achieve true evidence-based clinical practice?
A. Synthesizing research evidence, clinical expertise, and client values and
preferences.
B. Prioritizing provider clinical experience over empirical research data and client
choices.
C. Relying strictly on systematic research findings regardless of institutional
resources.
D. Adopting standardized clinical pathways established by health maintenance
organizations.
Answer: A
Rationale: Evidence-based practice in psychiatric nursing requires the integration of
three essential components: the best available empirical research evidence, clinical
nursing expertise, and the unique values, culture, and personal preferences of the client.
5. A basic-level psychiatric nurse is developing a plan of care for a client
experiencing acute anxiety. Which intervention is appropriate for a basic-level
psychiatric--mental health nurse to independently plan and implement?
A. Ordering baseline liver function tests for psychotropic monitoring.
B. Implementing therapeutic communication techniques and anxiety de-escalation.
C. Prescribing a low-dose benzodiazepine for acute relief.
D. Conducting cognitive-behavioral therapy sessions.
,Answer: B
Rationale: Therapeutic communication, crisis de-escalation, health teaching, and
supportive care are within the autonomous scope of practice for basic-level psychiatric--
mental health registered nurses. Psychotherapy, lab ordering, and medication
prescribing require advanced practice licensure.
6. A nurse is reviewing the American Nurses Association (ANA) Standards of
Professional Performance for Psychiatric--Mental Health Nursing. Which activity
aligns with the standard of Quality of Practice?
A. Systematically evaluating the safety, effectiveness, and efficiency of nursing care.
B. Developing an individualized care plan addressing identified client goals.
C. Analyzing assessment findings to determine nursing diagnoses.
D. Collecting comprehensive health data using evidence-based assessment tools.
Answer: A
Rationale: Standard 10 (Quality of Practice) requires the psychiatric nurse to
systematically evaluate the quality, effectiveness, and safety of clinical nursing practice.
Collection of health data corresponds to Assessment (Standard 1), and diagnosis
formulation corresponds to Diagnosis (Standard 2).
7. A psychiatric nurse wishes to implement an evidence-based relaxation
technique for clients on an inpatient unit. What is the nurse's first step in the
evidence-based practice process?
A. Evaluating the clinical outcomes of the intervention after implementation.
B. Formulating a clear, searchable clinical question using the PICOT format.
C. Critically appraising research articles found in literature databases.
D. Searching for clinical practice guidelines on hospital intranets.
Answer: B
Rationale: The evidence-based practice process begins with framing a concise,
answerable clinical question using the PICOT format (Patient/Population, Intervention,
Comparison, Outcome, Timeframe). This clear formulation guides efficient literature
searching and critical appraisal.
8. A client admitted with major depressive disorder reports that taking walks in
nature helps relieve sadness. How should the psychiatric nurse integrate this
preference into the evidence-based care plan?
A. Incorporate structured outdoor physical activity into the daily therapeutic
schedule.
, B. Document the request but defer action until an APRN completes a psychiatric
evaluation.
C. Discourage the practice, as outdoor walking is not an evidence-based clinical
therapy.
D. Inform the client that physical exercise must be replaced by formal medication
therapy.
Answer: A
Rationale: Evidence-based practice mandates honoring client preferences alongside
clinical research. Physical exercise in natural settings is supported by empirical research
for depression symptom management; integrating this preference respects client
autonomy and strengthens holistic care planning.
9. A nurse is assessing a client from a biological domain perspective. Which
assessment finding represents data within the biological domain of psychiatric
nursing?
A. The client expresses feeling overwhelmed by sudden financial distress.
B. The client reports strong reliance on a local church support group.
C. The client exhibits a abnormal baseline electrocardiogram with a prolonged QTc
interval.
D. The client demonstrates poor self-esteem during social interactions.
Answer: C
Rationale: The biological domain encompasses physical health, neuroanatomy,
physiological responses, and laboratory or diagnostic studies such as an
electrocardiogram (ECG). Financial status, peer support, and self-esteem fall under
psychological or social domains.
10. A basic-level psychiatric nurse is caring for a client who requests formal marital
counseling. Which action by the nurse demonstrates proper understanding of
professional role boundaries?
A. Providing personal opinions and marital advice during individual nursing
assessments.
B. Advising the client that marital therapy is inappropriate during psychiatric
hospitalization.
C. Initiating joint marital counseling sessions during afternoon visiting hours.
D. Referring the couple to a licensed advanced practice psychiatric nurse or family
therapist.
Answer: D
,Rationale: Formal psychotherapy and couple/family therapy fall outside the basic-level
PMH registered nurse scope of practice. Recognizing professional limits and referring
clients to qualified advanced practice providers or specialized family therapists ensures
safe, legal, and competent care.
11. A psychiatric nurse unit manager notices that re-admission rates for clients
with bipolar disorder are increasing. Applying the evidence-based practice
framework, how should the nurse manager approach this problem?
A. Immediately implement a mandatory daily post-discharge telephone protocol
without review.
B. Formulate a clinical question regarding post-discharge interventions and appraise
relevant research.
C. Assume the re-admissions are unavoidable due to the chronic nature of bipolar
illness.
D. Discipline nursing staff for failing to deliver adequate discharge education.
Answer: B
Rationale: An evidence-based approach to quality improvement involves identifying a
clinical practice problem, translating it into a focused clinical question, systematically
searching for and appraising empirical evidence, and implementing evidence-supported
solutions evaluated against measurable outcome metrics.
12. A nurse evaluates a clinical trial testing a new psychosocial intervention. The
nurse notes that the study lacked a control group and had a high drop-out rate.
How should the nurse interpret these research findings?
A. Recommend the intervention immediately to replace existing evidence-based care
plans.
B. Disregard the study entirely because qualitative data were not gathered.
C. Recognize methodological limitations that decrease the internal validity and
strength of evidence.
D. Accept the conclusions as definitive proof that the intervention should be adopted
unit-wide.
Answer: C
Rationale: Critical appraisal requires assessing study design and methodology. A lack of
a control group and significant attrition reduce internal validity and increase bias,
meaning the study provides lower-level evidence that must be interpreted cautiously
before clinical adoption.
13. During a multi-disciplinary team meeting, a basic-level nurse advocates for
including family psychoeducation in a client's treatment plan. The physician
,dismisses the request, stating it takes too much time. Which action by the nurse
best demonstrates professional nursing leadership and standard of practice?
A. Conduct family psychoeducation off-shift without documenting the activity.
B. Present empirical research evidence showing family psychoeducation reduces
psychiatric relapse rates.
C. Yield to the physician's authority and remove family psychoeducation from
nursing notes.
D. Inform the client that the healthcare team refuses to involve family members in
care planning.
Answer: B
Rationale: Psychiatric nurses function as collaborative advocates for evidence-based
interventions. Presenting peer-reviewed empirical evidence demonstrating the clinical
efficacy of family psychoeducation in reducing relapse promotes evidence-based care
and interprofessional collaboration while upholding nursing standards.
Fill-in-the-Blank / Short Answer
14. Advanced practice registered nurses in psychiatric--mental health nursing
possess legal authority to conduct formal individual and group __________, a
primary health intervention non-permissible for basic-level PMH nurses.
Answer: psychotherapy
Rationale: Psychotherapy is an advanced practice intervention requiring specialized
graduate-level education, supervised clinical training, and advanced licensure. Basic-
level psychiatric nurses conduct therapeutic interactions and supportive counseling, but
not formal psychotherapy.
15. In evidence-based practice, formulating a clinical question often utilizes the
__________ acronym to structure components including population, intervention,
comparison, outcome, and time.
Answer: PICOT
Rationale: The PICOT framework (Patient/Population, Intervention, Comparison,
Outcome, Timeframe) standardizes clinical question formulation to conduct effective
literature searches and retrieve target research evidence.
Case Study / Clinical Judgment Scenarios
16. A 34-year-old female client diagnosed with schizophrenia is admitted to an
acute inpatient psychiatric unit following an exacerbation of auditory
hallucinations. The basic-level staff nurse conducts an initial assessment, identifies
, nursing diagnoses, administers ordered antipsychotic medications, and notices
that the client becomes anxious in noisy communal areas. The nurse provides a
quiet environment, teaches deep-breathing exercises, and assists the client with
personal hygiene. Later, the client asks the nurse to prescribe a higher dose of
medication and conduct formal analytical psychoanalysis. Which action should the
nurse take next?
A. Informs the client that all psychiatric interventions must be performed exclusively
by the attending physician.
B. Refuses to interact with the client further due to unrealistic requests regarding
professional boundaries.
C. Explains the basic nursing role, continues supportive coping interventions, and
refers the requests to the provider.
D. Agrees to conduct psychoanalysis sessions and increases the client's bedtime
antipsychotic dosage.
Answer: C
Rationale: The basic-level PMH nurse operates within defined legal boundaries by
offering supportive coping mechanisms, managing the milieu, and administering
medications, while correctly identifying that medication prescribing and formal
psychoanalysis require an advanced practice provider or physician. Referring those
specific requests maintains professional role limits and ensures safety.
17. A psychiatric unit nursing committee is reviewing protocol options to reduce
physical restraint usage for agitated clients. The team formulates a PICOT
question, conducts a comprehensive literature search, and identifies three
randomized controlled trials demonstrating that sensory de-escalation rooms
significantly reduce agitation and restraint rates. The committee appraises the
evidence, consults with unit staff regarding feasibility, presents the evidence to
hospital leadership, and designs an implementation plan with staff training and
outcome tracking. How should the nurse manager evaluate the committee's
clinical approach?
A. The committee failed to follow proper procedures by searching for research
before consulting leadership.
B. The committee effectively applied the systematic steps of the evidence-based
practice process to improve care.
C. The committee relied too heavily on empirical research rather than historical unit
traditions.
D. The committee violated scope of practice guidelines by proposing changes to unit
restraint protocols.
