Exam (elaborations) NUR 425 PHARM PSYCH FINAL STUDY GUIDE NOTES EXAM

Exam (elaborations) NUR 425 PHARM PSYCH FINAL STUDY GUIDE NOTES EXAM 1. A patient’s wandering and hostility levels have increased per family reports. What should concern the nurse in this patient who is taking memantine (Namenda) 10 mg/d? - The patient is not taking enough of the medication 2. What statement by the patient indicates an understanding of how to relieve some side effects associated with the use of benzotropine mesylate (Cogentin)? “I can suck on hard candy or chew sugarless gum to prevent dry mouth” Pharm Kee 27 1. The nurse is caring for a patient who has begun taking chlorpromazine HCl (Thorazine) 75 mg BID to treat schizophrenia. A family member tells the nurse that the patient’s agitation, hallucinations, and delusional symptoms have improved, but the patient continues to withdraw from social interaction and won’t bathe unless reminded to do so. The nurse will tell the family member that a. all symptoms will eventually resolve over time with this medication. b. the patient may need an increased dose of the antipsychotic medication. c. these results may indicate that the patient does not have schizophrenia. d. they should consider discussing adding another medication. ANS: D 2. The nurse is assessing a young adult patient with schizophrenia who recently began taking fluphenazine (Prolixin). The patient is exhibiting spasms of facial muscles along with grimacing, and the nurse notes upward eye movements. The nurse suspects which side effect? a. Acute dystonia b. Akathisia c. Pseudoparkinsonism d. Tardive dyskinesia ANS: A 3. The nurse is preparing to administer loxapine (Loxitane) 50 mg to a patient who has schizophrenia. The patient has been taking this medication twice daily for 15 months. The nurse notes smacking lip movements and involuntary movements of all extremities. Which action by the nurse is correct? a. Administer the medication as ordered to treat these symptoms of psychosis. b. Hold the dose and notify the provider of these medication adverse effects. c. Request an order for an anticholinergic medication such as benztropine (Cogentin). d. Suggest that the provider increase the dose to 125 mg twice daily. ANS: B 4. A patient who takes loxapine (Loxitane) to treat schizophrenia is noted to be restless and fidgety and is pacing around the room. The nurse caring for this patient will perform which action? a. Contact the provider to discuss changing to benztropine (Cogentin). b. Notify the provider of these symptoms and request an order for lorazepam (Ativan). c. Question the patient about adherence to the drug regimen. d. Recognize these signs of a serious adverse drug reaction and notify the provider. ANS: B NUR 425 PHARM PSYCH FINAL STUDY GUIDE NOTES EXAM 5. A patient arrives in the emergency department with dehydration. The patient reports taking fluphenazine (Prolixin) to treat schizophrenia. The nurse notes rigid muscles and an altered mental status. The patient has a temperature of 103.6° F, a heart rate of 98 beats per minute, and a blood pressure of 90/58 mm Hg. The nurse will anticipate administering which medication? a. Dantrolene (Dantrium) b. Haloperidol (Haldol) c. Propranolol (Inderal) d. Tetrabenazine (Xenazine) ANS: A 6. The parent of a young adult who has schizophrenia is concerned that the patient spits out pills that are given. The nurse will suggest contacting the patient’s provider to discuss which intervention? a. Changing to a liquid form of the mediation b. Providing a home health nurse to supervise medication administration c. Teaching the patient the importance of taking the medication d. Weekly intramuscular injections of the medication ANS: A 7. The nurse is preparing to administer intramuscular haloperidol (Haldol) to a patient who has schizophrenia. What action will the nurse perform? a. Massage the site after injecting the medication to ensure complete absorption. b. Teach the patient to return every week to receive medication doses. c. Use a small bore needle when injecting the medication. d. Use the Z-track method and inject the medication into deep muscle tissue. ANS: D 8. The nurse is teaching a patient who will be discharged home on a typical antipsychotic medication to treat schizophrenia. Which statement by the patient indicates a need for further teaching? a. “I should not drink alcohol while taking this medication.” b. “I should use a heating pad to treat muscle spasms while taking this medication.” c. “I should use sunscreen while taking this medication.” d. “I will need frequent blood tests while taking this medication.” ANS: B 9. A patient who is about to begin taking the atypical antipsychotic medication clozapine (Clozaril) is concerned about side effects. What information will the nurse include when teaching the patient about this medication? a. “You are more likely to experience dry mouth, constipation, and urinary retention.” b. “You may experience weight gain, drowsiness, and headaches.” c. “You will not experience extrapyramidal side effects with this medication.” d. “You will not need frequent lab work while taking this medication.” ANS: B 10. A family member of a patient who has been taking fluphenazine (Prolixin) for 3 months calls to report that the patient is exhibiting agitation and restlessness. The nurse learns that the patient’s delusional thinking and hallucinations have stopped since taking the medication. The nurse will perform which action? a. Reassure the family member that tolerance to these side effects will subside over time. b. Remind the family member that complete drug effects may not occur for several more weeks. c. Suggest that the family member contact the provider to discuss an order for a benzodiazepine. d. Tell the family member to withhold the medication and notify the patient’s provider. ANS: C 11. A patient has been taking risperidone (Risperdal) for 2 weeks. The patient reports drowsiness and headache. What will the nurse do? a. Counsel the patient to request changing to aripiprazole (Abilify). b. Reassure the patient that these are common side effects of the medication. c. Suggest that the patient have serum glucose testing. d. Suggest that these may be signs of agranulocytosis. ANS: B 12. The nurse is performing a medication history on a patient who reports taking lorazepam (Ativan) for the past 6 months to treat an anxiety disorder. The patient states that the medication is not working as well as previously. The nurse will a. contact the provider to discuss changing to another benzodiazepine. b. notify the provider and discuss increasing the dose of lorazepam. c. suspect worsening of the anxiety disorder. d. understand that the patient has developed tolerance to this drug. ANS: D 13. A patient who is taking chlorpromazine calls the clinic to report having reddish-brown urine. What action will the nurse take? a. Notify the provider and request orders for creatinine clearance and BUN levels. b. Reassure the patient that this is a harmless side effect of this medication. c. Tell the patient to come to the clinic for a urinalysis. d. Tell the patient to discard any drug on hand and request a new prescription. ANS: B 14. A patient has begun taking buspirone hydrochloride (BuSpar) 7.5 mg twice daily to treat acute anxiety and calls 1 week later to report little change in symptoms. What will the nurse tell the patient? a. “Therapeutic effects may not be evident for another week.” b. “The provider may need to increase the dose to 15 mg twice daily.” c. “Notify the provider and request an order for another anxiolytic.” d. “Stop taking the drug and notify the provider that it doesn’t work.” ANS: A 15. A patient who is taking fluphenazine (Prolixin) to treat psychosis is experiencing symptoms of acute dystonia. While performing a medication history, the nurse learns that the patient takes herbal medications. Which herbal supplement would be of concern? a. Ginkgo b. Ginseng c. Kava kava d. St. John’s wort ANS: C 16. A patient is brought to the emergency department with decreased respirations and somnolence. The nurse notes a heart rate of 60 beats per minute and a blood pressure of 80/58 mm Hg. The patient is known to take alprazolam (Xanax) to treat anxiety. Which medication will the nurse anticipate the provider to order? a. Benztropine (Cogentin) b. Flumazenil (Romazicon) c. Lorazepam (Ativan) d. Propranolol (Inderal) ANS: B 17. A patient arrives in the emergency department complaining of difficulty breathing, dizziness, sweating, and heart palpitations. The patient reports having had similar episodes previously. The nurse will expect the provider to order which medication? a. Flumazenil (Romazicon) b. Haloperidol (Haldol) c. Lorazepam (Ativan) d. Propranolol (Inderal) ANS: C 18. The nurse is teaching a patient about taking an anxiolytic agent to treat grief-related anxiety. Which statement by the patient indicates understanding of the teaching? a. “I may have wine with dinner to help with relaxation.” b. “I may need to take this medication for up to a year.” c. “I may stop taking the medication when my symptoms go away.” d. “I should try psychotherapy or a support group in addition to the medication.” ANS: D BOOK QUESTIONS 1. The nurse suspects that a patient who is experiencing facial grimacing, involuntary upward eye movement, and muscle spasms of the tongue and face may have which condition? -Acute dystonia 2. A patient ask the nurse to explain how antipsychotic drugs work to make him feel better. The nurse understands that antipsychotics act in which way? -Blocking actions of epinephrine. 3. Ant antipsychotic agent, fluphenazine (Prolixin), is ordered for a patient with psychosis. The nurse understands that this agent can lead to extrapyramidal symptoms that may be treated with which medication? -benztropine (Cogentin) 4. An atypical antipsychotic is prescribed for a patient with psychosis. The nurse understands that this category of medications includes which drugs? (Select all that apply) -clozapine (Clozaril), olanzapine (Zyprexa), aripiprazole (Abilify) 5. A patient is prescribed lorazepam (Ativan). What does the nurse know to be true regarding lorazepam? -It may cause anterograde amnesia and sleep-related behaviors. 6. A patient is receiving aripiprazole (Abilify) Which nursing intervention(s) will the nurse include in the patient’s care plan? (Select all that apply) -Remain with the patient until the medication is swallowed, monitor vital signs to detect orthostatic hypotension, assess the patient for evidence of neuroleptic malignant syndrome. 7. A patient appears to have had an overdose of phenothiazines. The nurse anticipates that which interventions(s) may be used? (Select all that apply) - Gastric lavage, adequate hydration, maintaining an airway, activated charcoal administration. PHARM STUDY GUIDE QUESTIONS 1. Neuroleptic drugs are useful in the management of which type of illness? -Psychotic disorders 2. The patient has been started on an antipsychotic medication for treatment for her schizophrenia. She asks the nurse when she will start to feel better. What is the nurse’s best response? - “Responses vary, but it may be about 6 weeks.” 3. The patient has been started on chlorpromazine HCL (Thorazine) or treatment of intractable pain. What information will the nurse include in the patients education about this class of medication? - “Change positions slowly from sitting to standing to prevent orthostatic hypotension.” 4. Typical and traditional antipsychotic may cause extrapyramidal symptoms (EPS) or pseudoparkinsonism. Which symptom is considered an extrapyramidal symptom? - Shuffling gait. 5. What agent would the nurse expect to give to decrease EPS? - Benztropine (Cogentin) 6. Phenothiazines are grouped into 3 categories based on their side effects. In which group is fluphenazine (Prolixin)? - Piperazine 7. The patient has been prescribed fluphenazine (Prolixin) for treatment for schizophrenia. What information should the nurse include in the patient teaching for this medication? (select all that apply) -Notify your healthcare provider if you have dizziness, headache or nausea; This medication must be taken every day; You should not drink alcohol when taking this medication. 8. The 72 yr old patient has recently been diagnosed with schizophrenia. This healthcare provider has prescribed fluphenazine (Prolixin) 20 mg/day. In reviewing his medications prior to discharge from the hospital, the nurse notes the dose, What should concern the nurse about the amount of medication is prescribed? - The patients dose should be 25% to 50% less than the adult dose. 9. A patient presents to the emergency department with an overdose of chlorpromazine HCL (Thorazine). What is the priority action by the nurse? -Maintain the airway. 10. The 58 yr old patient presents to the emergency department. He is highly a danger to self and others. The healthcare provider has ordered haloperidol (Haldol) 5 mg IM. What should the nurse know about this medication when giving it as an antipsychotic? - It has a sedative effect on agitated, combative patients. 11. What is the drug category for atypical antipsychotics? - Serotonin/dopamine antagonists. 12. The atypical antipsychotics have a weak affinity for the D2 receptors. Consequently, what happens to the occurrence of EPS when taking these medications? -Fewers EPS 13. Atypical antipsychotics have a stronger affinity for which type of receptors that block serotonin receptors? - D4 14. The patient has just been prescribed risperidone (Risperdal). What side effects should the nurse include in the health teaching about this medication? -Hyperglycemia 15. The medication alprazolam belongs to which anxiolytic drug group? - Benzodiazepines 16. The patients has been started on IM extended release olanzapine due to noncompliance with the oral medication regimen. What does the nurse know is/are benefits(s) of this medication? (select all that apply) - Only required to be given every 2-4 weeks; few to no extrapyramidal symptoms; does not cause agranulocytosis. 17. Which patient(s) should not be taking fluphenazine (Prolixin)? (Select all that apply) -35 yr old with hepatitis C; 47 yr old with subcortical brain damage; 53 yr old with blood dyscrasias. 18. Lorazepam is an anxiolytic drug; however, it may be prescribed for other purposes. For which other conditions(s) might be prescribed? (select all that apply) - Alcohol withdrawal, anxiety associated with depression, preoperative medication, status epilepticus. Pharm Kee 23 1. An older patient exhibits a shuffling gait, lack of facial expression, and tremors at rest. The nurse will expect the provider to order which medication for this patient? a. Carbidopa-levodopa (Sinemet) b. Donepezil (Aricept) c. Rivastigmine (Exelon) d. Tacrine (Cognex) ANS: A 2. A nursing student asks the nurse to differentiate the pathology of Alzheimer’s disease from that of Parkinson’s disease. Which description is correct? a. Alzheimer’s disease involves a possible excess of acetylcholine and neuritic plaques. b. Alzheimer’s disease is caused by decreased amounts of dopamine and degeneration of cholinergic neurons. c. Parkinson’s disease is characterized by an imbalance of dopamine and acetylcholine. d. Parkinson’s disease involves increased dopamine production and decreased acetylcholine. ANS: C 3. The spouse of a patient newly diagnosed with mild, unilateral symptoms of Parkinson’s disease (PD) asks the nurse what, besides medication, can be done to manage the disease. The nurse will a. counsel the spouse that parkinsonism is a normal part of the aging process in some people. b. recommend exercise, nutritional counseling, and group support to help manage the disease. c. tell the spouse that the disease will not progress if mild symptoms are treated early. d. tell the spouse that medication therapy can be curative if drugs are begun in time. ANS: B 4. A patient who has Parkinson’s disease is being treated with the anticholinergic medication benztropine (Cogentin). The nurse will tell the patient that this drug will have which effect? a. Helping the patient to walk faster b. Improving mental function c. Minimizing symptoms of bradykinesia d. Reducing some of the tremors ANS: D 5. The nurse is preparing to administer a first dose of benztropine (Cogentin) to a patient diagnosed with parkinsonism. The nurse would notify the patient’s provider if the patient had a history of which condition? a. Asthma b. Glaucoma c. Hypertension d. Irritable bowel disease ANS: B 6. The nurse is caring for a patient who is receiving trihexyphenidyl (Artane) to treat parkinsonism. The patient reports having a dry mouth, and the nurse notes a urine output of 300 mL in the past 8 hours. Which action will the nurse perform? a. Encourage increased oral fluids. b. Obtain an order for intravenous fluids. c. Report the urine output to the provider. d. Request an order for renal function tests. ANS: C 7. A nursing student asks the nurse why patients who have parkinsonism receive a combination of carbidopa and levodopa. The nurse will explain that the combination product a. allows larger doses of levodopa to be given without causing increased adverse reactions. b. causes more levodopa to be converted to dopamine before crossing the blood-brain barrier. c. eliminates almost all drug side effects of both levodopa and carbidopa. d. reduces peripheral side effects by inhibiting decarboxylase in the peripheral nervous system. ANS: D 8. Which antiviral medication improves symptoms of Parkinson’s disease in some patients? a. Acyclovir (Zovirax) b. Amantadine HCl (Symmetrel) c. Interferon (INF) d. Zanamivir (Relenza) ANS: B 9. A patient who has parkinsonism has been taking carbidopa-levodopa and has shown improvement in symptoms but develops dystonic movements, nausea, and vomiting. Which medication will the nurse expect the provider to order for this patient to replace carbidopa-levodopa? a. Amantadine HCl (Symmetrel) b. Benztropine (Cogentin) c. Bromocriptine mesylate (Parlodel) d. Tacrine (Cognex) ANS: C 10. A patient who has parkinsonism will begin taking selegiline HCl (Eldepryl) to treat symptoms. What information will the nurse include when teaching this patient about this drug? a. “Avoid consuming foods that are high in tyramine.” b. “This drug will prevent the need to take levodopa.” c. “You may have red wine with dinner on occasion.” d. “You will not have serious drug interactions with this drug.” ANS: A 11. A patient who has parkinsonism will begin taking carbidopa-levodopa. What information will the nurse include when teaching this patient about this medication? a. “Call your health care provider immediately if your urine or perspiration turn a dark color.” b. “Rise slowly from your bed or your chair to avoid dizziness and falls.” c. “Take the drug with foods high in protein to improve drug delivery.” d. “Discontinue the drug if you experience insomnia.” ANS: B 12. The nurse is teaching a patient who has Parkinson’s disease about the side effects of carbidopalevodopa. Which statement by the patient indicates a need for further teaching? a. “I may experience urinary retention, dry mouth, and constipation.” b. “I may feel dizzy at first, but this side effect will go away with time.” c. “I should report nightmares and mental disturbances to my provider.” d. “I should take the drug with food to increase absorption.” ANS: D 13. A patient is taking entacapone (Comtan) along with carbidopa-levodopa to treat parkinsonism. The nurse notes that the patient’s urine is orange in color. The nurse will a. notify the provider of possible drug toxicity. b. reassure the patent that this is a harmless side effect. c. request an order for liver function tests. d. request an order for a urinalysis. ANS: B 14. The nurse is caring for an 80-year-old patient who has Alzheimer’s disease who will begin taking rivastigmine (Exelon). What will the nurse include in the plan of care for this patient? a. Administer the drug once daily. b. Assist the patient to stand and walk. c. Give the drug with food to increase absorption. d. Use nonsteroidal anti-inflammatory drugs (NSAIDs) instead of acetaminophen for pain. ANS: B 15. The nurse is providing teaching for the family of a patient who has been newly diagnosed with Alzheimer’s disease (AD). Which statement by the family member indicates understanding of the teaching? a. “Alzheimer’s disease is a chronic, progressive condition.” b. “Alzheimer’s disease affects memory but not personality.” c. “The onset of Alzheimer’s disease is usually between 65 and 75 years.” d. “With proper treatment, symptoms of this disease can be arrested.” ANS: A 16. The nurse is teaching a family member about an elderly parent’s new prescription for tacrine (Cognex) to treat Alzheimer’s disease (AD). The family member asks what to expect from this drug. The nurse will respond that the patient will a. demonstrate improved ambulation. b. have reversal of all symptoms. c. have decreased deterioration of cognition. d. show improved communication ability. ANS: C 17. The nurse is helping to develop a plan of care for a patient who has advanced Alzheimer’s disease. The patient will be taking a new medication. Which is a realistic goal for this patient? a. Demonstrate improved cognitive function. b. Exhibit improved ability to provide self-care. c. Receive appropriate assistance for care needs. d. Show improved memory for recent events. ANS: C BOOK QUESTIONS 1. Which of the following assessment findings could the nurse see in a patient with parkinsonism? (Select all that apply) -Muscle rigidity, involuntary tremors, bradykinesia. 2. A patient is receiving carbidopa-levodopa for parkinsonism. What should the nurse know about this drug? - Carbidopa-levodopa may lead to excessive salivation. 3. The nurse has initiated teaching for a family member of a patient with Alzheimer’s disease. The nurse realizes more teaching is needed if the family member makes which statement? - “It may take several medication to cure the disease. 4. A patient is taking rivastigmine (Exelon). The nurse should teach the patient and family which information about rivastigmine? -That GI distress is a common side effect. 5. Which is a nursing intervention of a patient taking carbidopa-levodopa for parkinsonism? -Inform the patient that perspiration may be dark and stain clothing. 6. What would the nurse teach a patient who is taking anticholinergic therapy for parkinsonism (Select all that apply) - avoid alcohol, cigarettes and caffeine; relieve dry mouth with hard candy or ice chips; use sunglasses to reduce photophobia; receive routine eye examinations. 7. A patient is taking rivastigmine (Exelon) to improve cognitive function. What should the nurse teach the patient/family member to do? (Select all that apply) -Rise slowly to avoid dizziness; remove obstacles from pathways to avoid injury; closely follow the drug dosing schedule. CHAPTER 1 1. Which outcome, focused on recovery, would be expected in the plan of care for a patient living in the community with serious and persistent mental illness? Within 3 months, the patient will: a. deny suicidal ideation. b. report a sense of well-being. c. take medications as prescribed. d. attend clinic appointments on time. ANS: B Recovery emphasizes managing symptoms, reducing psychosocial disability, and improving role performance. The goal of recovery is to empower the individual with mental illness to achieve a sense of meaning and satisfaction in life and to function at the highest possible level of wellness. The incorrect options focus on the classic medical model rather than recovery. 2. A patient is hospitalized for depression and suicidal ideation after their spouse asks for a divorce. Select the nurse's most caring comment. a. "Let's discuss some means of coping other than suicide when you have these feelings." b. "I understand why you're so depressed. When I got divorced, I was devastated too." c. "You should forget about your marriage and move on with your life." d. "How did you get so depressed that hospitalization was necessary?" ANS: A The nurse's communication should evidence caring and a commitment to work with the patient. This commitment lets the patient know the nurse will help. Probing and advice are not helpful or therapeutic interventions. 3. In the shift-change report, an off-going nurse criticizes a patient who wears heavy makeup. Which comment by the nurse who receives the report best demonstrates advocacy? a. "This is a psychiatric hospital. Craziness is what we are all about." b. "Let's all show acceptance of this patient by wearing lots of makeup too." c. "Your comments are inconsiderate and inappropriate. Keep the report objective." d. "Our patients need our help to learn behaviors that will help them get along in society." ANS: D Accepting patients' needs for self-expression and seeking to teach skills that will contribute to their wellbeing demonstrate respect and are important parts of advocacy. The on-coming nurse needs to take action to ensure that others are not prejudiced against the patient. Humor can be appropriate within the privacy of a shift report but not at the expense of respect for patients. Judging the off-going nurse in a critical way will create conflict. Nurses must show compassion for each other. 4. A nurse assesses a newly admitted patient with depression. Which statement is an example of "attending"? a. "We all have stress in life. Being in a psychiatric hospital isn't the end of the world." b. "Tell me why you felt you had to be hospitalized to receive treatment for your depression." c. "You will feel better after we get some antidepressant medication started for you." d. "I'd like to sit with you a while so you may feel more comfortable talking with me." ANS: D Attending is a technique that demonstrates the nurse's commitment to the relationship and reduces feelings of isolation. This technique shows respect for the patient and demonstrates caring. Generalizations, probing, and false reassurances are nontherapeutic. 5. A patient shows the nurse an article from the Internet about a health problem. Which characteristic of the web site's address most alerts the nurse that the site may have biased and prejudiced information? a. Address ends in ".org." b. Address ends in ".com." c. Address ends in ".gov." d. Address ends in ".net." ANS: B Financial influences on a site are a clue that the information may be biased. ".com" at the end of the address indicates that the site is a commercial one. ".gov" indicates that the site is maintained by a government entity. ".org" indicates that the site is nonproprietary; the site may or may not have reliable information, but it does not profit from its activities. ".net" can have multiple meanings. 6. A nurse says, "When I was in school I learned to call upset patients by name to get their attention, but I read a descriptive research study that says that this approach doesn't work. I'm going stop calling patients by name." Which statement is the best appraisal of this nurse's comment? a. One descriptive research study rarely provides enough evidence to change practice. b. Staff nurses apply new research findings only with the help from clinical nurse specialists. c. New research findings should be incorporated into clinical algorithms before using them in practice. d. The nurse misinterpreted the results of the study. Classic tenets of practice do not change. ANS: A Descriptive research findings provide evidence for practice but must be viewed in relation to other studies before practice changes. One study is not enough. Descriptive studies are low on the hierarchy of evidence. Clinical algorithms use flow charts to manage problems and do not specify one response to a clinical problem. Classic tenets of practice should change as research findings provide evidence for change. 7. Two nursing students discuss career plans after graduation. One student wants to enter psychiatric nursing. The other student asks, "Why would you want to be a psychiatric nurse? All they do is talk. You'll lose your skills." Select the best response by the student interested in psychiatric nursing. a. "Psychiatric nurses practice in safer environments than other specialties. Nurse-to-patient ratios must be better because of the nature of patients' problems." b. "Psychiatric nurses use complex communication skills, as well as critical thinking, to solve multidimensional problems. I'm challenged by those situations." c. "I think I'll be good in the mental health field. I do not like clinical rotations in school, so I don't want to continue them after I graduate." d. "Psychiatric nurses don't have to deal with as much pain and suffering as medical surgical nurses. That appeals to me." ANS: B The practice of psychiatric nursing requires a different set of skills than medical surgical nursing, although substantial overlap does exist. Psychiatric nurses must be able to help patients with medical and mental health problems, reflecting the holistic perspective these nurses must have. Nurse-patient ratios and workloads in psychiatric settings have increased, similar to other specialties. Psychiatric nursing involves clinical practice, not simply documentation. Psychosocial pain is real and can cause as much suffering as physical pain. 8. Which research evidence would most influence a group of nurses to change their practice? a. Expert committee report of recommendations for practice b. Systematic review of randomized controlled trials c. Nonexperimental descriptive study d. Critical pathway ANS: B Research findings are graded using a hierarchy of evidence. A systematic review of randomized controlled trials is Level A and provides the strongest evidence for changing practice. Expert committee recommendations and descriptive studies lend less powerful and influential evidence. A critical pathway is not evidence; it incorporates research findings after they have been analyzed. 9. A bill introduced in Congress would reduce funding for the care of people with mental illnesses. A group 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 ANS: A An advocate defends or asserts another's cause, particularly when the other person lacks the ability to do that for him- or herself. Examples of individual advocacy include helping patients understand their rights or make decisions. On a community scale, advocacy includes political activity, public speaking, and publication in the interest of improving the individuals with mental illness; the letter-writing campaign advocates for that cause on behalf of patients who are unable to articulate their own needs. 10. An informal group of patients discuss their perceptions of nursing care. Which comment best indicates a patient's perception that his or her nurse is caring? a. "My nurse always asks me which type of juice I want to help me swallow my medication." b. "My nurse explained my treatment plan to me and asked for my ideas about how to make it better." c. "My nurse told me that if I take all the medicines the doctor prescribes I will get discharged soon." d. "My nurse spends time listening to me talk about my problems. That helps me feel like I'm not alone." ANS: D Caring evidences empathic understanding, as well as competency. It helps change pain and suffering into a shared experience, creating a human connection that alleviates feelings of isolation. The remaining options give examples of statements that demonstrate advocacy or giving advice. 11. A patient who immigrated to the United States from Honduras was diagnosed with schizophrenia. The patient took an antipsychotic medication for 3 weeks but showed no improvement. Which resource should the treatment team consult for information on more effective medications for this patient? a. Clinical algorithm b. Clinical pathway c. Clinical practice guideline d. International Statistical Classification of Diseases and Related Health Problems (ICD) ANS: A A clinical algorithm is a guideline that describes diagnostic and/or treatment approaches drawn from large databases of information. These guidelines help the treatment team make decisions cognizant of an individual patient's needs, such as ethnic origin, age, or gender. A clinical pathway is a map of interventions and treatments related to a specific disorder. Clinical practice guidelines summarize best practices about specific health problems. The ICD classifies diseases. 12. Which historical nursing leader helped focus practice to recognize the importance of science in psychiatric nursing? a. Abraham Maslow b. Hildegard Peplau c. Kris Martinsen d. Harriet Bailey ANS: B Although all these leaders included science as an important component of practice, Hildegard Peplau most influenced its development in psychiatric nursing. Maslow was not a nurse, but his theories influence how nurses prioritize problems and care. Bailey wrote a textbook in the 1930s on psychiatric nursing interventions. Kris Martinsen emphasized the importance of caring in nursing practice. 13. A nurse consistently strives to demonstrate caring behaviors during interactions with patients. Which reaction by a patient indicates this nurse is effective? A patient reports feeling: a. distrustful l of others. b. connected with others. c. uneasy about the future. d. discouraged with efforts to improve. ANS: B A patient is likely to respond to caring with a sense of connectedness with others. The absence of caring can make patients feel distrustful, disconnected, uneasy, and discouraged. 1. 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." What is the new graduate's best analysis of this comment? Select all that apply. a. The experienced nurse may have lost sight of patients' individuality, which may compromise the integrity of practice. b. New research findings must be continually integrated into a nurse's practice to provide the most effective care. c. Experience provides mental health nurses with the tools and skills needed for effective professional practice. d. Experienced psychiatric nurses have learned the best ways to care for psychotic patients through trial and error. e. Effective psychiatric nurses should be continually guided by an intuitive sense of patients' needs. ANS: A, B Evidence-based practice involves using research findings to provide the most effective nursing care. Evidence is continually emerging; therefore, nurses cannot rely solely on experience. The effective nurse also maintains respect for each patient as an individual. Overgeneralization compromises that perspective. Intuition and trial and error are unsystematic approaches to care. 2. Which patient statements identify qualities of nursing practice with high therapeutic value? (Select all that apply.) "The nurse: a. talks in language I can understand." b. helps me keep track of my medications." c. is willing to go to social activities with me." d. lets me do whatever I choose without interfering." e. looks at me as a whole person with different needs." ANS: A, B, E Each correct answer demonstrates caring is an example of appropriate nursing foci: communicating at a level understandable to the patient, using holistic principles to guide care, and providing medication supervision. The incorrect options suggest a laissez-faire attitude on the part of the nurse, when the nurse should instead provide thoughtful feedback and help patients test alternative solutions or violate boundaries. BOOK QUESTIONS 1. In which scenario is it most urgent for the nurse to act as a patient advocate? A. An Adult cries and experiences anxiety after a near- miss MVA on the way to work. B. A homeless adult diagnosed with schizophrenia lives in a community expecting a category 5 hurricane C. A 14-year-old girl’s grades decline because she consistently focuses on her appearance and social networking D. A parent allows the prescription to lapse for 1 day for their 8 year old child’s medications for ADHD. Answer: B 2. The nurse interacts with a veteran of WWII. The veteran says, “Veterans modern wars whine and complain all the time. Back when I was in the service, you kept your feelings to your self.” Select the nurse’s best response. A. “American society in the 1940s expected WWII soldiers to be strong.” B. “WWII was fought in traditional way but the enemy is more difficult to identify in todays wars.” C. “We now have a better understanding of how trauma affects people and the importance of research based, compassionate care.” D. “Intermittent explosive disorder (IEDs), which were not used during WWII, produce traumatic brain injuries that must be treated.” Answer: C 3. A patient reports to the primary care provider about sleeplessness, constant fatigue, and sadness. In our current health care climate, what is most likely the treatment approach that would be offered to this patient? A. Group therapy B. Individual psychotherapy C. Complimentary Therapy D. Psychopharmacological Therapy Answer: D 4. The nurse prepares outcomes to the pan of care for an adult diagnosed with mental illness. Which strategy recognizes the current focus of treatment services for this population? A. The pt diagnoses are confirmed using advances neuroimaging techniques B. The nurse confers with the tx team to verify the pts significant disability C. The nurse prioritizes problems accordance to Maslow’s hierarchy of needs D. The pt and family participates actively in establishing priorities and selecting interventions. Answer: D 5. Which scenario best demonstrates empathetic Caring? A. A nurse provides comfort to a colleague after an error of medication administration B. A nurse works a fourth extra shift in 1 week to maintain adequate unit staffing. C. A nurse identifies a violation of confidentiality and makes a report to an agency privacy officer D. A nurse conscientiously reads current literature to stay aware of new EBP. Answer: A CHAPTER 2 1. A nurse explains multiaxial diagnoses to a psychiatric technician. Which information is accurate? a. It is a template for treatment planning. b. Nursing and medical diagnoses are included. c. Assessments of several aspects of functioning are included. d. It incorporates the framework of a specific biopsychosocial theory. ANS: C The use of five axes requires an assessment beyond the diagnosis of a mental disorder and includes relevant medical conditions, psychosocial and environmental problems, and global assessment of functioning. The Diagnostic and Statistical Manual of Mental Disorders (fourth edition, text revision) (DSM-IV-TR) is not a template for treatment planning and does not use a specific biopsychosocial theory. Nursing diagnoses are not included in multiaxial diagnoses. 2. Which documentation of diagnosis would a nurse expect for a person with mental illness? a. I Rheumatoid arthritis II 100 III Posttraumatic stress disorder IV Arrested for shoplifting 2 months earlier V None b. I Mental retardation II Histrionic personality disorder III 75 IV Hypertension V Home destroyed by tornado last year c. I Schizophrenia, paranoid II Death of spouse last year III 40 IV None V Alcohol abuse d. I Generalized anxiety disorder II Avoidant personality disorder III Fibromyalgia IV Declared bankruptcy 6 months ago V 60 ANS: D The option beginning with a diagnosis of generalized anxiety disorder places a clinical disorder on Axis I, a personality disorder on Axis II, a medical problem on Axis III, a psychosocial problem on Axis IV, and global assessment of functioning (GAF) on Axis V. The other options misplace and incorrectly order the clinical data. 3. A patient is admitted to the psychiatric hospital for assessment and evaluation. 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. ANS: B A patient who reports having a consistently negative mood is describing a mood alteration. The incorrect options describe mentally healthy behaviors and common problems that do not indicate mental illness. 4. 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. ANS: C The patient's ability to identify healthy coping behaviors indicates adaptive, healthy behavior and demonstrates an increased ability to recover from severe stress. Describing feelings associated with loss and stress does not move the patient toward adaptation. The remaining options are maladaptive behaviors. 5. 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. DSM-IV-TR b. Nursing Diagnosis Manual c. A psychiatric nursing textbook d. A behavioral health reference manual ANS: A The DSM-IV-TR gives the criteria used to diagnose each mental disorder. The Nursing Diagnosis Manual focuses on nursing diagnoses. A psychiatric nursing textbook or behavioral health reference manual may not contain diagnostic criteria. 6. 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. ANS: C Because mental health and mental illness are relative concepts, assessment of functioning is made by using a continuum. Mental health is not based on conformity; some mentally healthy individuals do not conform to society's norms. Most individuals occasionally display illogical or irrational thinking. The rate of intellectual and emotional growth is not the most useful criterion to assess mental health or mental illness. 7. 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. ANS: A The patient feels the need for multiple explanations of new tasks at work and, despite being 40 years of age, allows both parents to make all decisions. These behaviors indicate a poorly developed self-concept. 8. 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." ANS: D Mental illness affects many people at various times in their lives. No class, culture, or creed is immune to the challenges of mental illness. The correct response also demonstrates the use of reflection, a therapeutic communication technique. It is not true that mental illness affects 50% of the population in any given year. Asking patients if they blame themselves is an example of probing. 9. A critical care nurse asks a psychiatric nurse about the difference between a DSM-IV-TR diagnosis and a nursing diagnosis. Select the psychiatric nurse's best response. a. "No functional difference exists between the two diagnoses