Mental Health Exam 3 TB. CH.
16,17, 24,27,28,29
QUESTIONS AND CORRECT
ANSWERS
GRADE A+
1.
A nurse works with a client diagnosed with posttraumatic stress disorder (PTSD) who has
frequent flashbacks as well as persistent symptoms of arousal. Which intervention should be
included in the plan of care?
a. Trigger flashbacks intentionally in order to help the client learn to cope with them.
b. Explain that the physical symptoms are related to the psychological state.
c. Encourage repression of memories associated with the traumatic event.
d. Support "numbing" as a temporary way to manage intolerable feelings. ANS: B
Persons with PTSD often experience somatic symptoms or sympathetic nervous system arousal
that can be confusing and distressing. Explaining that these are the body's responses to
psychological trauma helps the client understand how such symptoms are part of the illness and
something that will respond to treatment. This decreases powerlessness over the symptoms and
helps instill a sense of hope. It also helps the client to understand how relaxation, breathing
exercises, and imagery can be helpful in symptom reduction. The goal of treatment for PTSD is
to come to terms with the event so treatment efforts would not include repression of memories or
numbing. Triggering flashbacks would increase client distress.
Four teenagers died in an automobile accident. One week later, which behavior by the parents
of these teenagers most clearly demonstrates resilience?
a. visiting their teenager's grave daily.
b. returning immediately to employment.
c. discussing the accident within the family only.
d. creating a scholarship fund at their child's high school. ANS: D
Resilience refers to positive adaptation or the ability to maintain or regain mental health despite
adversity. Loss of a child is among the highest risk situations for maladaptive grieving. The
parents who create a scholarship fund are openly expressing their feelings and memorializing
their child. The other parents in this question are isolating themselves and/or denying their
feelings. Visiting the grave daily shows active continued mourning but is not as strongly
indicative of resilience as the correct response.
After the sudden death of his wife, a man says, "I can't live without her ... she was my whole
,life." What is the nurse's most therapeutic reply?
a. "Each day will get a little better."
b. "Her death is a terrible loss for you."
c. "It's important to recognize that she is no longer suffering."
d. "Your friends will help you cope with this change in your life." ANS: B
Adjustment disorders may be associated with grief. A statement that validates a bereaved
person's loss is more helpful than false reassurances and clichés. It signifies understanding.
4. A woman just received notification that her husband died. She approaches the nurse who cared
for him during his last hours and says angrily, "If you had given him your undivided attention, he
would still be alive." How should the nurse analyze this behavior?
a. The comment suggests potential allegations of malpractice.
b. In some cultures, grief is expressed solely through anger.
c. Anger is an expected emotion in an adjustment disorder.
d. The client had ambivalent feelings about her husband. ANS: C
Symptoms of adjustment disorder run the gamut of all forms of distress including guilt,
depression, and anger. Anger may protect the bereaved from facing the devastating reality of
5. A wife received news that her husband died of heart failure and called her family to come to
the hospital. She angrily tells the nurse who cared for him, "He would still be alive if you had
given him your undivided attention." What is the nurse's best intervention?
a. Say to the wife, "I understand you are feeling upset. I will stay with you until your family
comes."
b. Say to the wife, "Your husband's heart was so severely damaged that it could no longer
pump."
c. Say to the wife, "I will call the health care provider to discuss this matter with you."
d. Hold the wife's hand in silence until the family arrives. ANS: A
The nurse builds trust and shows compassion in the face of adjustment disorders. Therapeutic
responses provide comfort. The nurse should show patience and tact while offering sympathy
and warmth. The distracters are defensive, evasive, or placating.
6. A child drowned while swimming in a local lake 2 years ago. Which behavior indicates the
child's parents have adapted to their loss?
a. visiting their child's grave daily.
b. maintaining their child's room as the child left it 2 years ago.
c. keeping a place set for the dead child at the family dinner table.
d. throwing flowers on the lake at each anniversary date of the accident. ANS: D
Test bank Varcarolis' Foundations of Psychiatric-Mental Health Nursing 9th Edition 177
Resilience refers to positive adaptation or the ability to maintain or regain mental health despite
adversity. Loss of a child is among the highest risk situations for an adjustment disorder and
maladaptive grieving. The parents who throw flowers on the lake on each anniversary date of the
accident are openly expressing their feelings. The other behaviors are maladaptive because of
isolating themselves
7. A store clerk was killed during a robbery 2 weeks ago. His widow, who has a long history of
schizoaffective disorder, cries spontaneously when talking about his death. What is the nurse's
most therapeutic response?
a. "Are you taking your medications the way they are prescribed?"
b. "This loss is harder to accept because of your mental illness. Do you think you
, should be hospitalized?"
c. "I'm worried about how much you are crying. Your grief over your husband's
death has gone on too long."
d. "The unexpected death of your husband is very painful. I'm glad you are able to
talk about your feelings." ANS: D
The client is expressing feelings related to the loss, and this is an expected and healthy behavior.
This client is at risk for a maladaptive response because of the history of a serious mental illness,
but the nurse's priority intervention is to form a therapeutic alliance and support the cli
Which scenario demonstrates a dissociative fugue?
a. After being caught in an extramarital affair, a man disappeared but then
reappeared months later with no memory of what occurred while he was missing.
b. A man is extremely anxious about his problems and sometimes experiences dazed
periods of several minutes passing without conscious awareness of them.
c. A woman finds unfamiliar clothes in her closet, is recognized when she goes to
new restaurants, and complains of "blackouts" despite not drinking.
d. A woman reports that when she feels tired or stressed, it seems like her body is not
real and is somehow growing smaller. A
9.
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
The nurse who is counseling a client with dissociative identity disorder should understand that
which assessment is of the highest priority?
a. risk for self-harm.
b. cognitive function.
c. memory impairment.
d. condition of self-esteem. A
A client states, "I feel detached and weird all the time. It is as though I am looking at life through
a cloudy window. Everything seems unreal. It really messes up things at work and school." This
scenario is most suggestive of which health problem?
a. Acute stress disorder
b. Dissociative amnesia
c. Depersonalization disorder
d. Disinhibited social engagement disorder C
The unlicensed assistive personnel (UAP) says to the nurse, "That client with amnesia looks fine,
but when I talk to her, she seems vague. What should I be doing for her?" What is the nurse's
best reply?
a. "Spend as much time with her as you can and ask questions about her life."
b. "Use short, simple sentences and keep the environment calm and protective."
c. "Provide more information about her past to reduce the mysteries that are causing
anxiety."
d. "Structure her time with activities to keep her busy, stimulated, and regaining
concentration." B
12. A client diagnosed with depersonalization disorder tells the nurse, "It's starting again. I feel
as though I'm going to float away." Which intervention would be most appropriate at this point?
a. Notify the health care provider of this change in the client's behavior.
b. Engage the client in a physical activity such as exercise.
c. Isolate the client until the sensation has diminished.
16,17, 24,27,28,29
QUESTIONS AND CORRECT
ANSWERS
GRADE A+
1.
A nurse works with a client diagnosed with posttraumatic stress disorder (PTSD) who has
frequent flashbacks as well as persistent symptoms of arousal. Which intervention should be
included in the plan of care?
a. Trigger flashbacks intentionally in order to help the client learn to cope with them.
b. Explain that the physical symptoms are related to the psychological state.
c. Encourage repression of memories associated with the traumatic event.
d. Support "numbing" as a temporary way to manage intolerable feelings. ANS: B
Persons with PTSD often experience somatic symptoms or sympathetic nervous system arousal
that can be confusing and distressing. Explaining that these are the body's responses to
psychological trauma helps the client understand how such symptoms are part of the illness and
something that will respond to treatment. This decreases powerlessness over the symptoms and
helps instill a sense of hope. It also helps the client to understand how relaxation, breathing
exercises, and imagery can be helpful in symptom reduction. The goal of treatment for PTSD is
to come to terms with the event so treatment efforts would not include repression of memories or
numbing. Triggering flashbacks would increase client distress.
Four teenagers died in an automobile accident. One week later, which behavior by the parents
of these teenagers most clearly demonstrates resilience?
a. visiting their teenager's grave daily.
b. returning immediately to employment.
c. discussing the accident within the family only.
d. creating a scholarship fund at their child's high school. ANS: D
Resilience refers to positive adaptation or the ability to maintain or regain mental health despite
adversity. Loss of a child is among the highest risk situations for maladaptive grieving. The
parents who create a scholarship fund are openly expressing their feelings and memorializing
their child. The other parents in this question are isolating themselves and/or denying their
feelings. Visiting the grave daily shows active continued mourning but is not as strongly
indicative of resilience as the correct response.
After the sudden death of his wife, a man says, "I can't live without her ... she was my whole
,life." What is the nurse's most therapeutic reply?
a. "Each day will get a little better."
b. "Her death is a terrible loss for you."
c. "It's important to recognize that she is no longer suffering."
d. "Your friends will help you cope with this change in your life." ANS: B
Adjustment disorders may be associated with grief. A statement that validates a bereaved
person's loss is more helpful than false reassurances and clichés. It signifies understanding.
4. A woman just received notification that her husband died. She approaches the nurse who cared
for him during his last hours and says angrily, "If you had given him your undivided attention, he
would still be alive." How should the nurse analyze this behavior?
a. The comment suggests potential allegations of malpractice.
b. In some cultures, grief is expressed solely through anger.
c. Anger is an expected emotion in an adjustment disorder.
d. The client had ambivalent feelings about her husband. ANS: C
Symptoms of adjustment disorder run the gamut of all forms of distress including guilt,
depression, and anger. Anger may protect the bereaved from facing the devastating reality of
5. A wife received news that her husband died of heart failure and called her family to come to
the hospital. She angrily tells the nurse who cared for him, "He would still be alive if you had
given him your undivided attention." What is the nurse's best intervention?
a. Say to the wife, "I understand you are feeling upset. I will stay with you until your family
comes."
b. Say to the wife, "Your husband's heart was so severely damaged that it could no longer
pump."
c. Say to the wife, "I will call the health care provider to discuss this matter with you."
d. Hold the wife's hand in silence until the family arrives. ANS: A
The nurse builds trust and shows compassion in the face of adjustment disorders. Therapeutic
responses provide comfort. The nurse should show patience and tact while offering sympathy
and warmth. The distracters are defensive, evasive, or placating.
6. A child drowned while swimming in a local lake 2 years ago. Which behavior indicates the
child's parents have adapted to their loss?
a. visiting their child's grave daily.
b. maintaining their child's room as the child left it 2 years ago.
c. keeping a place set for the dead child at the family dinner table.
d. throwing flowers on the lake at each anniversary date of the accident. ANS: D
Test bank Varcarolis' Foundations of Psychiatric-Mental Health Nursing 9th Edition 177
Resilience refers to positive adaptation or the ability to maintain or regain mental health despite
adversity. Loss of a child is among the highest risk situations for an adjustment disorder and
maladaptive grieving. The parents who throw flowers on the lake on each anniversary date of the
accident are openly expressing their feelings. The other behaviors are maladaptive because of
isolating themselves
7. A store clerk was killed during a robbery 2 weeks ago. His widow, who has a long history of
schizoaffective disorder, cries spontaneously when talking about his death. What is the nurse's
most therapeutic response?
a. "Are you taking your medications the way they are prescribed?"
b. "This loss is harder to accept because of your mental illness. Do you think you
, should be hospitalized?"
c. "I'm worried about how much you are crying. Your grief over your husband's
death has gone on too long."
d. "The unexpected death of your husband is very painful. I'm glad you are able to
talk about your feelings." ANS: D
The client is expressing feelings related to the loss, and this is an expected and healthy behavior.
This client is at risk for a maladaptive response because of the history of a serious mental illness,
but the nurse's priority intervention is to form a therapeutic alliance and support the cli
Which scenario demonstrates a dissociative fugue?
a. After being caught in an extramarital affair, a man disappeared but then
reappeared months later with no memory of what occurred while he was missing.
b. A man is extremely anxious about his problems and sometimes experiences dazed
periods of several minutes passing without conscious awareness of them.
c. A woman finds unfamiliar clothes in her closet, is recognized when she goes to
new restaurants, and complains of "blackouts" despite not drinking.
d. A woman reports that when she feels tired or stressed, it seems like her body is not
real and is somehow growing smaller. A
9.
TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity
The nurse who is counseling a client with dissociative identity disorder should understand that
which assessment is of the highest priority?
a. risk for self-harm.
b. cognitive function.
c. memory impairment.
d. condition of self-esteem. A
A client states, "I feel detached and weird all the time. It is as though I am looking at life through
a cloudy window. Everything seems unreal. It really messes up things at work and school." This
scenario is most suggestive of which health problem?
a. Acute stress disorder
b. Dissociative amnesia
c. Depersonalization disorder
d. Disinhibited social engagement disorder C
The unlicensed assistive personnel (UAP) says to the nurse, "That client with amnesia looks fine,
but when I talk to her, she seems vague. What should I be doing for her?" What is the nurse's
best reply?
a. "Spend as much time with her as you can and ask questions about her life."
b. "Use short, simple sentences and keep the environment calm and protective."
c. "Provide more information about her past to reduce the mysteries that are causing
anxiety."
d. "Structure her time with activities to keep her busy, stimulated, and regaining
concentration." B
12. A client diagnosed with depersonalization disorder tells the nurse, "It's starting again. I feel
as though I'm going to float away." Which intervention would be most appropriate at this point?
a. Notify the health care provider of this change in the client's behavior.
b. Engage the client in a physical activity such as exercise.
c. Isolate the client until the sensation has diminished.
