Basic Concepts Of Psychiatric Mental Health Nursing 8th Edition by Louise Rebraca Shives -Test Bank

1. When the mental health nurse assesses her client, who has been admitted to an inpatient psychiatric unit for depression, she takes into account that the family will not have income while the client is hospitalized. This assessment by the nurse regarding the impact of client's hospitalization on the family system can best be described as what? A) A theoretical approach, whereby the nurse uses systems-oriented theory to understand her client and to plan his care B) A practical approach, wherein the nurse can now work to get some funds for the family C) An outcome-oriented approach, whereby the nurse sees lack of funds as an outcome D) A somewhat ineffective way to look at this hospitalization because the client is now ill Ans: A Feedback: Assessing the client within the context of his family system is a way to use systems-oriented theory to understand the client. This is a theoretical approach; using theory will assist the nurse to understand the client's family as well as to assess and plan care that will best meet his needs. 2. The nursing theorist Peplau identified which of the following as the essence of psychiatric–mental health nursing? A) Nursing care independent of physicians B) The nurse's use of self C) The nurse–patient relationship D) A neurobiologic approach Ans: C Feedback: Peplau was known for first highlighting the importance of the relationship between the nurse and the patient as the basis for the therapeutic relationship. She believed that this relationship was the essence of psychiatric–mental health nursing. 3. The nurse views her client as an individual who has self-care deficits that need to be addressed. The nurse works with the client to assist him or her to meet self-care needs, such as personal grooming, until the client can care for himself or herself independently. This is an example of which of the following theoretical approaches? A) Parse's Theory of Human Becoming B) Roy's Theory of Adaptation C) Orem's Behavioral Nursing Theory D) Peplau's Interpersonal Theory Ans: C Feedback: Orem's theory includes the concepts of self-care and self-care deficits; the nurse's role is to assist the client to meet self-care deficits until the client can be independent. 4. A psychiatric–mental health nurse gathers information from several nursing theories and combines the client's resources as a unique person with the most suitable theoretical model. The nurse is using which of the following approaches to applying theory to practice? A) Outcome B) Needs C) Eclectic D) Interaction Ans: C Feedback: An eclectic approach to practice implies the use of various models along with the client's personality and individualized resources in order to assess and plan nursing care that is tailored to meet his or her unique needs. 5. The theoretical terms “meaning, rhythmicity, and transcendence” are components of which of the following nursing theorists' work? A) Hildegard Peplau B) Rosemarie Parse C) Sister Callista Roy D) Dorothea Orem Ans: B Feedback: Parse's Theory of Human Becoming posits quality of life from each person's own perspective as the goal of nursing practice. The three themes of meaning, rhythmicity, and transcendence are used by Parse when discussing the role of a nurse in guiding a client or in bearing witness to a client's experiences. 6. A client who had a stroke is experiencing left-sided paralysis. The client has become increasingly depressed because of this inability to complete all his ADLs by himself. This inability is considered a self-care deficit according to which nursing theory? A) Peplau's Interpersonal Theory B) Orem's Behavioral Nursing Theory C) Roy's Theory of Adaptation D) Parse's Theory of Human Becoming Ans: B Feedback: Orem's Behavioral Nursing Theory focuses on self-care deficit. It proposes that the recipients of nursing care are persons who are incapable of continuous self-care or independent care because of health-related or health-derived limitations. The other options are not self-care deficit theories. 7. A female client is being seen in the emergency room after being physically abused by her husband. The nurse, acting as an advocate for the client, explains to the client the importance of being empowered to leave the abusive situation. Which of the following theorists' works most explicitly promotes empowerment of the client? A) Roy B) Peplau C) Parse D) Orem Ans: C Feedback: Parse's theory bears witness to the client's experience and respects the individual's capacity for self-knowing and assists the client in cocreating a valuable space for the client to voice the lived experience of health. 8. According to Roy's Theory of Adaptation, coping behaviors occur in four adaptive modes. Which of the following is incongruent with the classification of an adaptive mode? A) Interdependence B) Role function C) Self-concept D) Psychologic Ans: D Feedback: According to Roy's Theory of Adaptation, coping behavior occurs in four adaptive modes: physiologic, self-concept, role function, and interdependence. 9. The mental health nurse is teaching a client about a psychotropic medication that he has prescribed. The nurse, in this instance, is functioning with which type of approach to nursing practice? A) Needs B) Interaction C) Outcome D) Eclectic Ans: B Feedback: The interaction-oriented approach is used by nurses who rely on interactions and include themselves in the sphere of their actions. They counsel, guide, and teach clients, helping them to find meaning in their situations. The needs-oriented approach encompasses the nurse performing physiologic and psychosocial activities for the client. The outcome-oriented approach focuses on maintaining and promoting energy and harmony with the environment. The eclectic approach is an individualized style that incorporates the client's own resources as a unique person with the most suitable theoretical model. 10. A mental health nurse is discussing potentially adverse effects of electroconvulsive therapy (ECT). According to Peplau's Interpersonal Theory, the nurse is functioning in which of the following nursing roles? A) Therapist B) Manager C) Teacher D) Socializing agent Ans: C Feedback: Peplau believed that the nurse serves as a therapist, counselor, socializing agent, manager, technical nurse, mother surrogate, and teacher. In this situation, the nurse is functioning in the teacher mode. 11. The nurse is providing care for a client of Chinese descent who has been admitted to the hospital for the treatment of depression. It has become clear during the client's time of stay in the hospital that the client and his family understand his illness and treatment options in a way that is informed by their culture. Which of the following nursing theorists prioritizes the role of culture in assessment and care? A) Roy B) Orem C) Leininger D) Parse Ans: C Feedback: Leininger's Theory of Cultural Care Diversity and Universality states that caring is universal and varies transculturally. It is based on the nurse's need to be aware of and sensitive to the cultural needs of clients. 12. Carolyn's course of treatment for anorexia nervosa has been largely unsuccessful, a fact that has caused frustration for some members of the interdisciplinary team. Which of the following statements would suggest that the team plans to implement the Tidal Model in Carolyn's treatment? A) “I think we need to accept that this may be the way that Carolyn demonstrates her self-actualization.” B) “Ultimately, she does have what it takes to recover and she's the only one who truly knows what is best for her.” C) “We need to stop trying to 'treat' Carolyn and start embracing her.” D) “I think we've been focusing too much on her physiological health and ignoring her felt needs.” Ans: B Feedback: The Tidal Models is based on the beliefs that recovery is possible, change is inevitable, clients know what is best for them, clients possess all the resources they need to begin recovery, clients are the teachers and nurses are the pupils, and nurses need to be creatively curious to learn what needs to be done to help the client. The other statements do not reflect these beliefs. 13. Which of the following statements most accurately summarizes the basis of the Tidal Model? A) Mental health is available to all. B) The human condition is dominated by stressors. C) Soul, mind, and body are separate entities. D) Change is inevitable and continuous. Ans: D Feedback: The Tidal Model focuses on the continuous process of change inherent in all people. 14. A psychiatric–mental health nurse is providing care for a client who lives in the community. Which of the following preconditions is necessary before Peplau's Interpersonal Theory becomes an accurate framework for the nurse's practice? A) Prolonged contact between the nurse and the client B) Cultural similarity between the nurse and the client C) Self-awareness and desire to change on the part of the client D) The client's acknowledgment of the inadequacy of his coping skills Ans: A Feedback: Peplau's theory focuses primarily on the nurse–client relationship in which problem-solving skills are developed. It is considered effective in long-term care, home health, and psychiatric settings where time allows for the development of a nurse–client relationship and, hopefully, a resolution to promote health. 15. Hans has schizophrenia and uses marijuana heavily. His living situation has been unstable in recent years, and he has been living in a rooming house for the past several months. His landlord, however, has contacted the home health nurse because of the squalor of Hans' room and frequent disturbances. What aspect of Hans' situation would be prioritized within the framework of Orem's Behavioral Nursing Theory? A) The cultural meaning that Hans assigns to his illness and substance use B) Hans' inability to embrace the inevitability of change in his life C) Hans' relationship with the nurse and the other care providers in his life D) The gap between what Hans needs and what he can provide for himself Ans: D Feedback: Orem focuses on self-care deficit in nursing. Leininger's theory prioritizes culture, while the Tidal Model emphasizes the inevitability of change. The relationship between the client and the nurse is a primary focus of Peplau's Interpersonal Theory. 16. The wife of a client has said about her husband, “I think that what it comes down to is that he really has a hard time processing and accommodating the pressures and stressors that come at him as he goes through his life.” The nurse should recognize that the wife's statement summarizes the theoretical perspective of which theorist? A) Roy B) Parse C) Leininger D) Orem Ans: A Feedback: Roy's Theory of Adaptation, modeled from a behavioral theory, states that human beings are biopsychosocial adaptive systems who use coping mechanisms to adapt to both internal and external stimuli. As such, the theory emphasizes the individual's response to perceived stressors. 17. A new program has been launched with the goal of fostering the development of life skills for community-dwelling clients with mental illness, aiming to teach them how to shop, cook, and manage money more effectively. This program demonstrates what approach to practice? A) Eclectic approach B) Outcome-oriented approach C) Interaction-oriented approach D) Needs-oriented approach Ans: D Feedback: Supplementing knowledge and teaching skills to clients are activities that are central to the needs-oriented approach to nursing. Such a program is less likely to prioritize the relationship focus of the interaction-oriented approach or the emphasis on health environments that is associated with the outcome-oriented approach. The eclectic approach is more individualized to the nurse's perspectives, priorities, and skills. 18. Which of the following statements best empowers a nursing student to develop and implement the eclectic approach to nursing? A) “Just as every client is an individual, you too are an individual with particular strengths and skills.” B) “The ultimate expert on a client's condition is the care team.” C) “Don't let anyone tell you that you don't have the power to cause positive change in a client's life and health.” D) “Having a holistic approach to care means that you have to set aside things like theories, models, and frameworks.” Ans: A Feedback: The eclectic approach is an individualized style that incorporates the client's own resources as a unique person with the most suitable theoretical model. The emphasis in this approach is on the uniqueness of clients and nurses. This does not, however, necessitate ignoring or discarding theories or frameworks. 19. After many years of intravenous heroin use, Scott has been admitted to an inpatient treatment facility. An application of Leininger's theory of nursing would emphasize which of the following aspects of Scott's life? A) His physiological state B) His culture C) His coping skills D) His awareness of needs Ans: B Feedback: Leininger's Theory of Cultural Care Diversity and Universality is based on the nurse's need to be aware of and sensitive to the cultural needs of clients. This consideration supersedes the importance of physical health, coping skills, or awareness of needs. 20. Which of the following statements best describes the relationship between nursing theory and nursing research? A) Nursing theory and nursing research are mutually exclusive. B) Nursing theory utilizes a more holistic view of caring than does nursing research. C) Nursing research informs nursing theory and nursing theory informs nursing research. D) Nursing research is synonymous with nursing theory. Ans: C Feedback: The relationship between nursing theory and nursing research is cyclical in nature. Nursing research informs the content of nursing theories and nursing theories stimulate nurse scientists to explore significant problems in the field of nursing. 1. A 74-year-old widow is being seen in the mental health clinic. She has never fully regained the level of activity she had prior to her husband's death. She continues to have symptoms of depression and has not been able to work or volunteer. In addition, she complains of “anxiety attacks” that occur nearly every night. What type of grief reaction is this client exhibiting? A) She is experiencing a normal grief reaction and does not need any intervention at this time. B) She is experiencing a prolonged reaction but within normal limits of the grieving process. C) She is having a prolonged reaction to her husband's death, but since she is surrounded by family members who support her, she does not need any interventions at this time. D) She is experiencing an unresolved, or dysfunctional, grieving reaction. She needs to have a comprehensive mental health assessment. Ans: D Feedback: In the case of dysfunctional grief, it is important to treat as soon as possible. Unresolved grieving can lead to other psychological, as well as physical, problems if left untreated. Even in the case of extensive family support, medications are often needed to assist the individual to recover completely from this type of grief reaction. 2. A client with terminal cancer is discussing health care alternatives with the nurse. The nurse would be correct in giving which of the following explanations of advance care planning? A) A plan for care in the event that the individual is rendered unconscious while hospitalized B) A plan for parent disposition that is drawn up by the children when parent(s) reach the age of 75 C) A plan drawn up by the primary nurse that delineates the steps to be taken by nurses on opposite shifts in the event of the client's death D) A plan that involves a thoughtful, facilitated discussion encompassing a lifetime of values, beliefs, and goals to complete an advance directive Ans: D Feedback: Advance care planning is a thoughtful, facilitated discussion encompassing a lifetime of values, beliefs, and goals and involves completing an advance directive, such as a Living Will, Health Care Directive, or Health Care Proxy. Advance care planning allows the individual to participate fully in decisions regarding end-of-life care or care during catastrophic illness. 3. A client has just been diagnosed with terminal brain cancer and given approximately two months to live. He wishes to visit his mother soon to “say goodbye.” The nurse acknowledges this reaction as which of the following? A) Anticipatory B) Bereavement C) Mourning D) Loss Ans: A Feedback: Anticipatory grief refers to the reactions that occur when an individual, family, significant other, or friends are expecting a loss or death to occur. Bereavement is the process of grief that includes feelings of sadness, insomnia, poor appetite, deprivation, and desolation. Mourning describes an individual's outward expression of grief regarding the loss of a loved object or person. Loss is a change in the status of a significant object or situation. 4. A nurse is caring for a client with terminal cancer. The client states, “If I promise to change my bad habits, the cancer will go away.” The nurse knows that this statement is an example of which of Kubler-Ross' stages of grief? A) Denial B) Anger C) Bargaining D) Acceptance Ans: C Feedback: This scenario is an example of bargaining to prolong one's life. Denial serves as a temporary escape from reality. In the anger stage, the client appears difficult, demanding, and ungrateful. In the acceptance stage, the client has achieved an inner and outer peace due to a personal victory over fear. 5. A client's quality of life is decreasing as a result of uncontrolled diabetes. Which of the following types of loss is the client experiencing? A) Anticipatory B) Unexpected C) Gradual D) Sudden Ans: C Feedback: Loss of function due to a medical condition usually causes a gradual loss over time. It would not be considered sudden, unexpected, or anticipatory at this point. 6. A client is exhibiting dysfunctional grieving. When obtaining a health history, the nurse would expect which assessment finding to be noted? A) Stupor B) Hostility C) Euphoria D) Calmness Ans: B Feedback: Clinical features of dysfunctional grief include expressions of distress or denial of the loss, changes in eating and sleeping patterns, and mood disturbances such as anger, hostility, and crying. The other options would not necessarily occur in a client with dysfunctional grieving. 7. The Patient Self-Determination Act (PDSA) advocates which of the following ethical principles? A) Justice B) Autonomy C) Beneficence D) Veracity Ans: B Feedback: The PDSA was passed in 1990 and states that every competent individual has the right to make decisions about his or her health care (autonomy). Justice encompasses fair and equal treatment for all. Beneficence is doing good. Veracity is a term for “to be truthful.” 8. A client is inquiring to the nurse about hospice care. The nurse would be correct in giving which information regarding this form of end-of-life care? A) A terminal diagnosis is required. B) The client must wish to pursue aggressive treatment. C) Chronically ill patients qualify. D) It limits support to the client during the dying process. Ans: A Feedback: Hospice care refers to a program that supports the client and family through the dying process and the surviving family members through the process of bereavement. To qualify for hospice, the individual must be terminally ill with a life expectancy of 6 months or less. 9. At what age do children typically begin to accept death as a final state? A) 7 years B) 10 years C) 13 years D) 16 years Ans: A Feedback: Children from the ages of 6 to 9 begin to accept death as a final state. 10. A client with end-stage renal disease has appointed his son to make decisions in the event that he is not able to. The nurse understands that the client is displaying autonomy in using which type of advance care planning? A) Dying declaration exception to hearsay B) Living will C) Health care proxy D) Durable health care power of attorney Ans: D Feedback: A durable health care power of attorney or health care proxy permits an individual to name a health care decision maker or surrogate to make medical decisions in the event that the individual is unable to make these decisions or give informed consent. Dying declaration exception to hearsay allows statements referred to as “death bed declarations” to be honored by the medical and nursing staff. A living will is a document filled out by the client with specific instructions addressing issues of CPR, life support, and emergency measures. 11. The nurse is providing care for a group of siblings following the unexpected death of their father. The nurse should recognize which of the following principles about children and the death of a parent? A) Most children are able to adapt to the death of a parent, provided they are supported. B) The grief process undergone by children normally excludes active mourning. C) The emotional trauma of losing a parent is not experienced fully until adulthood. D) Children typically move through the grieving process much more quickly than adults. Ans: A Feedback: It has been found that most children and adolescents can adapt effectively to the death of a parent and even learn and grow from the experience; however, they cannot do it alone. Children mourn, and the trauma of losing a parent is not delayed until adulthood. Children do not necessarily go through the stages of grief more quickly than adults. 12. An 81-year-old woman has been experiencing episodes of increasing forgetfulness in recent months, a problem that prompted her to seek care from her primary care physician. After tests and referrals, she has just received a diagnosis of early-stage Alzheimer's disease. What type of loss is this woman most likely to experience? A) Sudden and perceived B) Gradual and observable C) Temporary and unexpected D) Anticipatory and perceived Ans: B Feedback: Cognitive declines are typically gradual in progression and the effects are readily observable to others. Such a loss would likely be unexpected and anticipatory, but it would not be perceived (ie, invisible to others) or temporary. 13. Anticipatory grief has the potential to facilitate what? A) Clear examination of treatment options B) Admission to hospice care C) An earlier and less painful death D) Acceptance of impending death Ans: D Feedback: Anticipatory grief allows the individual and others to get used to the reality of the loss or death and to complete unfinished business. 14. Mr. Taylor's lung cancer has recently metastasized to his bones, resulting in a sudden worsening of his prognosis and a sharp increase in his pain. Despite his earlier declarations to “fight this thing to the bitter end” and the absence of a living will, he has now informed the nurse that the only medication he now wants is for pain control. How should the care team respond to Mr. Taylor's statement? A) Maintain aggressive medical treatment until Mr. Taylor produces a written statement. B) Discontinue medical treatment if Mr. Taylor's family members unanimously agree. C) Document and honor Mr. Taylor's wishes. D) Refer the matter to the hospital's ethics committee. Ans: C Feedback: The dying declaration exception to hearsay allows statements referred to as “death bed declarations” to be honored by the medical and nursing staff. For example, a client, who is aware that death is imminent and has not completed a living will, may inform the nursing staff that he wants all medication, including intravenous (IV) therapy, to be discontinued. Such a request can be honored if documented. 15. After receiving word from his oncologist that his tumor is malignant, the patient says to the nurse, “If you people had the faintest clue what you were doing, I wouldn't be like this.” The nurse should recognize that the patient may be experiencing which stage of grief? A) Denial B) Anger C) Bargaining D) Depression Ans: B Feedback: The patient's hostile statement indicates that he may be in the anger stage of grief, during which an individual may become difficult or demanding. 16. The nurse is providing care for a hospital patient who has a living will. Which of the following interventions is most appropriate for this patient? A) Intravenous analgesics B) Cardiopulmonary resuscitation (CPR) C) Total parenteral nutrition (TPN) D) Respiratory ventilation Ans: A Feedback: CPR, TPN, and ventilation are considered life-sustaining treatments that would likely be precluded by a living will. Pain medications, however, are considered supportive care. 17. Prior to his cognitive deterioration from an organic brain disease, a client established a durable health care power of attorney. This document allows the person designated in the document to do what? A) Distribute the client's possessions after his death. B) Make treatment decisions on the client's behalf. C) Override the client's expressed wishes. D) Pursue all available treatment options until death. Ans: B Feedback: A durable health care power of attorney permits an individual to name a health care decision maker or surrogate to make medical decisions in the event that the individual is unable to make these decisions or give informed consent. The document does not direct the distribution of the client's assets after death nor is it intended to contradict the client's wishes. 18. Mr. Tan's latest diagnostic imaging tests reveal severe and untreatable heart disease, but his family is adamant that the care team refrain from revealing this finding to Mr. Tan. The nurse should recognize that which of the following factors may underlie the family's wishes? A) The family members may have an inadequate understanding of the severity of his condition. B) The family may be enacting their own form of anticipatory grief by keeping Mr. Tan uninformed. C) The family may prefer to avoid making difficult decisions about treatment options. D) The family may be “protecting” Mr. Tan or ensuring that he does not lose hope. Ans: D Feedback: Culturally diverse families (eg, Asian Americans) may believe that explicitly telling the client bad news will cause unnecessary suffering or cause the client to lose hope. This is not likely a consequence of misunderstanding a diagnosis, grieving, or avoiding difficult decisions. 19. A patient's acquired immunodeficiency syndrome (AIDS) has progressed to the point that he is now eligible for hospice care. What is the primary focus of hospice care? A) Comfort, dignity, and personal growth near the end of life B) The use of nonapproved or experimental treatments that cannot be performed in the hospital setting C) Withholding medical interventions in order to focus on an individual's spiritual needs D) Reframing the death process into a positive and enlightening event Ans: A Feedback: The essential philosophy of hospice care is the focus on comfort, dignity, and personal growth at life's end. Hospice care is not a venue for experimental medical treatment. Despite the focus on wholeness at the end of life, hospice care does not promote death as always being “positive” or “enlightening.” Curative treatments are not typically undertaken, but medical treatments such as pain control are common and important. 20. Amelia's children have downplayed her grief following the death of her partner, claiming that their mother and her partner were only together for a few months and that “he was no good for her anyways.” Amelia is at risk of experiencing what? A) Unresolved grief B) Atypical grief C) Disenfranchised grief D) Dysfunctional grief Ans: C Feedback: Disenfranchised grief is a term that describes the experience of individuals whose grief is not acknowledged or supported by their social network or who are excluded from participating in grief-related rituals.