Test Bank - Psychiatric Nursing: Contemporary Practice (6th Edition by Boyd)

Test Bank - Psychiatric Nursing: Contemporary Practice (6th Edition by Boyd) Table of Contents Table of Contents 1 Chapter 01: Psychiatric-Mental Health Nursing and Evidence-Based Practice 2 Chapter 02: Mental Health and Mental Disorders 6 Chapter 03: Cultural and Spiritual Issues Related to Mental Health Care 10 Chapter 04: Patient Rights and Legal Issues 14 Chapter 05: Mental Health Care in the Community 18 Chapter 06: Ethics, Standards, and Nursing Frameworks 21 Chapter 07: Psychosocial Theoretic Basis of Psychiatric Nursing 25 Chapter 08: Biologic Foundations of Psychiatric Nursing 29 Chapter 09: Communication and the Therapeutic Relationship 33 Chapter 10: The Psychiatric-Mental Health Nursing Process 37 Chapter 11: Psychopharmacology, Dietary Supplements, and Biologic Interventions 41 Chapter 12: Cognitive Interventions in Psychiatric Nursing 46 Chapter 13: Group Interventions 50 Chapter 14: Family Assessment and Interventions 54 Chapter 15: Mental Health Promotion for Children and Adolescents 58 Chapter 16: Mental Health Promotion for Young and Middle-Aged Adults 61 Chapter 17: Mental Health Promotion for Older Adults 64 Chapter 18: Stress and Mental Health 68 Chapter 19: Management of Anger, Aggression, and Violence 72 Chapter 20: Crisis, Loss, Grief, Response, Bereavement, and Disaster Management 76 Chapter 21: Suicide Prevention: Screening, Assessment, and Intervention 80 Chapter 22: Schizophrenia and Related Disorders: Nursing Care of Persons with Thought Disorders Chapter 23: Depression: Management of Depressive Moods and Suicidal Behavior Chapter 24: Bipolar Disorders: Management of Mood Lability Chapter 25: Anxiety Disorders: Management of Anxiety, Phobia, and Panic Chapter 26: Obsessive Compulsive and Related Disorders Chapter 27: Trauma and Stressor Related Disorders Chapter 28: Personality and Borderline Personality Disorder: Management of Emotional Dysregulation and Self-Harm 84 92 96 99 103 105 106 Chapter 29: Antisocial Personality and Disruptive, Impulse Control, and Conduct Disorders 109 Chapter 30: Addiction and Substance-Related Disorders Chapter 31: Eating Disorders: Management of Eating and Weight Chapter 32: Somatic Symptom and Related Disorders Chapter 33: Nursing Care of Persons with Insomnia and Sleep Problems Chapter 34: Sexual Disorders: Management of Sexual Dysfunction and Paraphilias Chapter 35: Mental Health Assessment of Children and Adolescents Chapter 36: Mental Health Disorders of Childhood and Adolescence Chapter 37: Mental Health Assessment of Older Adults Chapter 38: Neurocognitive Disorders Chapter 39: Caring for Persons Who Are Homeless and Mentally Ill Chapter 40: Caring for Persons With Co-occurring Mental Disorders Chapter 41: Caring for Survivors of Violence and Abuse Chapter 42: Caring for Persons With Mental Illness and Criminal Behavior Chapter 43: Caring for Medically Compromised Persons 113 117 121 125 129 132 135 139 142 146 150 154 158 162 Chapter 01: Psychiatric-Mental Health Nursing and Evidence-Based Practice 1. A group of nursing students are reviewing information about the evolution of mental health care and are discussing the recommendations of the final report of the Joint Commission on Mental Illness and Health. The students demonstrate understanding of this information when they identify that the report recommended an increase in which of the following? A) Numbers of mental health hospitals B) State funding for mental health care C) Clinics supplemented by general hospital units D) Use of psychotherapy by psychiatrists 2. A nurse is reviewing the American Nurses Association’s Statement on Psychiatric Nursing Practice published in 1967, which sanctioned the involvement of psychiatricmental health nurses in the provision of holistic nursing care. Integrating knowledge of the various theories and views of mental health and illness, the nurse identifies which of the following as most strongly linked to this holistic approach? A) Sigmund Freud’s psychoanalytic theory B) Florence Nightingale’s Notes on Nursing C) Hildegarde D) Clifford Beers’ A Mind That Found Itself E) Peplau’s Interpersonal Relations in Nursing 3. A nursing instructor is preparing a presentation about key events and people that influenced the development of contemporary mental health and illness care. When describing the effects of World War II, which of the following would the instructor include? A) People began to view mental illness as more commonplace and acceptable. B) The biologic understanding of mental illness was almost fully developed. C) Deinstitutionalization occurred in response to the community health movement. D) Mental illnesses became categorized as psychoses or neuroses. 4. A nursing student is presenting a discussion of the history of psychiatricmental health nursing and its place within nursing history. Which of the following would be most appropriate to include? A) Certification for the psychiatricmental health nursing specialty was first emphasized by Mary Adelaide Nutting. B) Psychiatric nurses played a part in seeing that all deinstitutionalized patients got treatment at community mental health centers. C) There is a historical link between the first nursing program to admit male students and the first training school for psychiatric nursing. D) The first graduate program in psychiatric nurses was established in response to the publication of psychiatric nursing specialty journals. 5. Two nursing students are discussing psychiatricmental health nursing and the role it has played in nursing’s overall history. Which statement is most accurate? A) The importance of using therapeutic communication was stressed by Nightingale. B) The use of self-care to enhance the immune system was taught by Dorothea Dix. C) The moral treatment of mental illness was a primary focus of deinstitutionalization. D) Peplau was the first nurse to stress the importance of therapeutic communication. 6. When reviewing the evolution of mental health and illness care, which event is associated with mental disorders beginning to be viewed as illnesses requiring treatment? A) Establishment of Pennsylvania Hospital in Philadelphia B) Quaker establishment of asylums C) Creation of the state hospital system D) Freud’s views on the causes of mental illnesses 7. A psychiatricmental health nurse is working on a committee that is developing programs that integrate the objectives for mental health and mental disorders as identified in Healthy People 2020. Which type of program would be least appropriate? A) Single substance abuse treatment programs B) Depression screening programs for primary care providers C) Mental health programs for the homeless population D) Employment programs for those with serious mental illness 8. A nursing instructor is describing the concept of evidence-based practice in psychiatricmental health nursing. Which of the following would the instructor include as being important? Select all that apply. A) Research findings B) Expert opinion C) Clinical experiences D) Patient data E) Established routines 9. The following events are important in the development of psychiatricmental health nursing practice. Which event occurred first? A) Publication of Standards of Psychiatric-Mental Health Nursing by the ANA B) Publication of Standards of Child and Adolescent Psychiatric and Mental Health Nursing Practice C) Establishment of the first graduate program in psychiatric nursing at Rutgers University D) Publication of the first psychiatric nursing text, Nursing Mental Disease, by Harriet Bailey 10. A nurse is preparing a presentation about the current status of mental health services in the United States. Which statement would the nurse include as the most reflective of this status? A) Mental health care in the United States is equally accessible to individuals. B) Mental illness ranks second in terms of causing disability in comparison. C) Mental health care primarily focuses on the cure of mental illness. D) Mental health care services are inadequate and fragmented. 11. A group of students are reviewing the goals identified by the New Freedom Commission on Mental Health. The students demonstrate understanding of this report when they identify which of the following as a goal? A) Mental health is viewed as one component of overall health. B) The consumer and family are the driving forces for mental health care. C) Screening is of greater importance than assessment and referral for services. D) Disparities in mental health services are decreased. 12. The following are important legislative and policy efforts influencing current mental health care. Which of the following is the most recent? A) Mental Health: A Report of the Surgeon General B) New Freedom Commission on Mental Health C) Action for Mental Health D) Mental Retardation Facilities and Community Mental Health Centers Construction Act 13. As part of a career day presentation to a group of nursing students, a psychiatricmental health nurse plans to describe how this specialty developed. Which individual would the nurse describe as playing a major role in the development of specialty training programs for psychiatric nurses? A) Mary Adelaide Nutting B) Hildegarde Peplau C) Harriet Bailey D) Linda Richards 14. A psychiatricmental health nurse is asked to be a guest speaker at a community fund-raising event for mental health services. Which of the following would the nurse emphasize as the primary goal of mental health services? A) Access to affordable mental health care B) Removal of exclusions because of preexisting conditions C) Recovery from mental illness D) Effective treatment for mental health care needs 15. A psychiatricmental health nurse is implementing evidence-based practice. The nurse understands that this approach is developed by doing which of the following first? A) Conducting research B) Identifying a clinical question C) Determining outcomes D) Collaborating with the patient 16. A group of students are reviewing information about mental health care after World War II. The students demonstrate understanding of this information when they identify which of the following as a result of the National Mental Health Act? A) Discovery of psychopharmacology B) Passage of the Hill-Burton Act C) Establishment of the National Institute of Mental Health D) Development of community mental health centers 17. When providing care to a patient, the psychiatricmental health nurse is implementing the therapeutic use of self. The nurse is applying the concepts based on the work of which individual? A) Hildegarde Peplau B) Florence Nightingale C) Dorothea Dix D) Sigmund Freud 18. After teaching a class to a group of nursing students about the historical perspectives of mental health care, the instructor determines that the group has understood the information when they identify which of the following as a common belief about mental illness during the medieval period? A) Mental illness in an individual was the result of being possessed by demons. B) A person was removed from a contaminated environment to protect him or her. C) Exorcisms were used as primary mode of treatment to cleanse the person of his or her sins. D) The focus was on moral treatment to promote the individual’s safety and comfort. Chapter 02: Mental Health and Mental Disorders 1. A nursing instructor is describing the DSM-IV-TR to a group of nursing students. Which of the following would the instructor include as the primary purpose of this classification? A) Provide a commonly understood diagnostic category for clinical practice. B) Describe treatment modalities for psychiatric disorders and mental illnesses. C) Identify various etiologies for mental disorders based on family histories. D) Provide optimal outcomes for treatment for individuals with mental illnesses. 2. A nurse is providing care to a patient with a mental disorder classified by the DSM-IV-TR. The nurse understands that although the first three axes appear to contain all the diagnostic information about a patient, a truly accurate picture of the client is incomplete without considering other factors such as an estimate of current functioning and: A) Life stressors B) Cultural background C) Marital status D) Genetic history 3. A patient’s global assessment functioning reveals that he has minimal symptoms with good functioning in all areas. Which score would the nurse correlate with these findings? A) 94 B) 82 C) 75 D) 63 4. A female patient was admitted to the hospital with pneumonia, and in the course of her treatment, it was determined that she was experiencing alcohol dependence because she began experiencing alcohol withdrawal while she was in the hospital. When the psychiatrist who was called in as a consultant documented the patient’s mental disorder, he identified her alcohol dependence on which axis? A) Axis I B) Axis II C) Axis III D) Axis IV 5. A 25-year-old woman who recently had abdominal surgery was admitted to the psychiatric unit, where it was determined that she had a borderline personality disorder. During the first week on the unit, it was determined that she also has diabetes. Her diabetes mellitus would be listed in which axis of her DSM-IV-TR diagnosis? A) Axis I B) Axis II C) Axis III D) Axis IV 6. As part of a class activity, nursing students are engaged in a small group discussion about the epidemiology of mental illness. Which statement best explains the importance of epidemiology in understanding the impact of mental disorders? A) Epidemiology helps promote understanding of the patterns of occurrence associated with mental disorders. B) Epidemiology helps explain research findings about the neurophysiology that causes mental disorders. C) Epidemiology provides a thorough theoretical explanation of why specific mental disorders occur. D) Epidemiology predicts when a specific psychiatric client will recover from a specific mental disorder. 7. A nurse is working in a community mental health center that provides care to a large population of Asian descent. When developing programs for this community, which of the following would be most important for the nurse to address? A) Public stigma B) Self-stigma C) Label avoidance D) Negative life events 8. A group of students are reviewing the multiaxial diagnostic system of the DSM-IV-TR. The students demonstrate understanding of the axes when they identify that each axis represents which of the following? A) An evidence-based research finding B) An experimental design to guide care C) A domain of information D) A laboratory test finding 9. A nursing student is assigned to care for a patient diagnosed with schizophrenia. When talking about this patient in a clinical postconference, the student would use which terminology when referring to the patient? A) Committed patient B) Schizophrenic C) Schizophrenic patient D) Person with schizophrenia 10. Mrs. Green is a patient on a psychiatric unit. At the time of her admission, her dog was killed when a car accidentally ran over it; in addition to that, she just found out that her mother has been diagnosed with colon cancer. This information would be addressed in which DSM-IV axis? A) Axis I B) Axis II C) Axis III D) Axis IV 11. A nursing student is reviewing journal articles about major depression. One of the articles describes the number of persons newly diagnosed with the disorder during the past year. The student interprets this as which of the following? A) Rate B) Prevalence C) Point prevalence D) Incidence 12. While working in a community mental health treatment center, the nurse overhears one of the receptionists saying that one of the patients is really psycho. Later in the day, the nurse talks with the receptionist about the comment. This action by the nurse demonstrates an attempt to address which issue? A) Lack of knowledge B) Public stigma C) Label avoidance D) Self-stigma 13. After teaching a group of students about mental health and mental illness, the instructor determines that the teaching was successful when the group identifies which of the following as reflecting mental disorders? A) Capacity to interact with others B) Ability to deal with ordinary stress C) Alteration in mood or thinking D) Lack of impaired functioning 14. A nurse is preparing a presentation for a local community group about mental disorders and plans to include how mental disorders are different from medical disorders. Which statement would be most appropriate for the nurse to include? A) Mental disorders are defined by an underlying biological pathology. B) Numerous laboratory tests are used to aid in the diagnosis of mental disorders. C) Cluster of behaviors, thoughts, and feelings characterize mental disorders. D) Manifestations of mental disorders are within normal, expected parameters. 15. Which of the following would a nurse identify as being categorized as Axis I in the DSM-IV-TR? Select all that apply. A) Paranoid personality disorder B) Posttraumatic stress disorder C) Anorexia nervosa D) Mental retardation E) Unemployment F) Coronary artery disease 16. A psychiatricmental health nurse is providing care for a patient with a mental disorder. The patient is participating in the decision-making process. The nurse interprets this as which component of recovery? A) Self-direction B) Empowerment C) Person-centered D) Holistic 17. A nurse is explaining recovery to the family of a patient diagnosed with a mental disorder. Which statement would be most appropriate for the nurse to include about this process? A) It is a step-by-step process from being ill to being well. B) The patient focuses mainly on the emotional aspects of his condition. C) The patient is helped to live a meaningful life to his fullest potential. D) Although peer support is important, the self-acceptance is essential. 18. A psychiatricmental health nurse is preparing a presentation about recovery for a group of newly hired nurses for the mental health facility. Which of the following would the nurse identify as one of the most important concepts? A) Self-direction B) Peer support C) Respect D) Hope 19. The nurse is reviewing the medical record of a patient and notes the information below. Which of the following would be found on Axis III? Select all that apply. A) Cocaine dependence B) Bipolar I disorder C) Chronic obstructive pulmonary disorder D) Cellulitis E) Homelessness F) Arrest for cocaine possession with intent to sell 20. A college-aged student and his friend arrive at the student health center. The friend reports that the patient has been having difficulties concentrating, remembering, and thinking. He’s had quite a few research papers due this past week. After ruling out other problems, the nurse determines that the patient is experiencing a culture-bound syndrome. Which of the following would the nurse most likely suspect? A) Ataque de nervios B) Brain fog C) Mal de ojo D) Shenjing shuairo Chapter 03: Cultural and Spiritual Issues Related to Mental Health Care 1. When reviewing several studies about Hispanic Americans and their use of mental health care facilities, the nurse notes that this cultural group tends to use all other resources before seeking help from mental health professionals. Which of the following would the nurse identify as a reason for this belief about many mental health facilities? A) Require periods of hospitalization B) Do not provide 24-hour emergency services C) Are not reimbursed by third party payers D) Do not accommodate their cultural needs 2. A nurse is preparing a presentation about mental health problems associated with specific cultural groups. When describing mental health problems associated with Asian Americans, Polynesians, and Pacific Islanders, the nurse would address high rates of which of the following? A) Schizophrenia B) Manic disorders C) Dementia D) Suicide 3. The nurse is doing an assessment interview of a patient. During the interview, the patient comments, Our people are connected with nature. Our world, our seasons, and our weatherthey all have many lessons to teach us. The nurse interprets the patient’s statement as an expression of which of the following? A) Religiousness B) Tribal law C) Spirituality D) Ecological values 4. A psychiatricmental health nurse is providing care to a patient who has recently emigrated to the United States from Eastern Europe. Which of the following would be least effective in providing culturally competent care? A) Demonstrating a genuine interest in the patient B) Avoiding assumptions about the patient’s culture C) Speaking to the patient in his native language. D) Acquiring information about the patient’s country. 5. A psychiatricmental health nurse working in a Veteran’s Administration Medical Center is meeting with a military wife who is an Asian American. The woman is to be joining a support group for wives of veterans who have posttraumatic stress syndrome. When asking her to describe her husband’s mental health problems, which response would the nurse most likely expect? A) Oh, he may seem depressed, but it is just a vitamin deficiency. It runs in his family. B) I know the war messed his mind up. He’ll never be the same. C) Sometimes he hallucinates that he is back in Vietnam. D) He just stays to himself; he never talks to me about what is bothering him. 6. A psychiatricmental health nurse is working with a patient who is being treated for depression. Which patient statement would indicate that her spirituality is intact? A) My church friends came to visit me this past Sunday afternoon. B) Nothing will ever be the same again; my life is not worth living. C) I know I am as well off as I can be under the circumstances. D) I know God must be punishing me for all my sins. 7. A patient is being treated for prostate cancer; his prognosis is very poor. The patient has a strong faith, and he has been active in his church for many years. He is concerned about his health and the challenges he faces as his cancer progresses. Which comment by the nurse reflects the most appropriate spiritual nursing intervention for the patient? A) I’ll take you to visit my church if you can get a pass. B) You have to belong to the same church I do if you’re going to go to heaven. C) Would you like me to bring you a guided imagery audiotape? D) We can pray together if you’d like. 8. A psychiatricmental health nurse is teaching a class about social factors associated with mental illness at a community health center. When describing the influence of poverty and effects of the downward economic spiral on mental health, which population would the nurse identify as being the most at risk? A) Older adults B) Individuals with physical disabilities C) Single-parent families D) Homeless individuals 9. During an assessment, the patient states, We rely on our large extensive family for moral support and help and we treat our elders with a great deal of respect. If someone gets sick, the family takes care of him. The nurse interprets this as indicating which of the following? A) Acculturation B) Cultural identity C) Cultural competence D) Linguistic competence 10. Within the context of the culture of poverty, which of the following most clearly describes why individuals who are part of this culture become trapped in a downward economic spiral? A) Unemployment causes poverty; a lack of willpower and motivation can, in turn, cause unemployment in people who do not have a strong work ethic. B) Individuals lack the finances to pay rent, so they eventually do not have an address to use in filling out job applications. C) Characteristics of poverty (joblessness and lack of financial independence) can, in turn, contribute to attributes (feelings of powerlessness and low self-esteem) that sustain poverty. D) Poverty is passed on from generation to generation; individuals learn at an early age that there is no way to escape living in poverty. 11. A group of nursing students are reviewing information about spirituality and religiousness. The group demonstrates understanding of these concepts when they identify religiousness as which of the following? A) Feeling of connectedness B) Way of interpreting life events C) Relationship with a unifying force D) Community participation in common worship 12. A nursing instructor is preparing a class about rural cultures and the influence on mental health problems. Which of the following would the instructor include as impacting the use of mental health services for this group? Select all that apply. A) Limited access to care B) Lack of available resources C) Geographical similarities D) Diverse cultural groups E) Consistency in treatment approaches 13. A psychiatricmental health nurse is working on developing cultural competence. Which of the following would be most appropriate for the nurse to do? A) Research information about the cultures of the population being served after assessing the patients. B) Recognize that one’s own culture is the predominant way of addressing a patient’s health care needs. C) Assume that any individual of a racial or ethnic group is the same as another individual in that group. D) Demonstrate an appreciation of and a genuine interest in the individual and his or her cultural beliefs. 14. During assessment, a patient tells the nurse that he follows Buddhist beliefs. The nurse would integrate understanding of which of the following when developing the patient’s plan of care? A) Desire is the cause of all human suffering and misery. B) Self-indulgence is necessary to reach nirvana. C) Present behavior is based on current unhappiness. D) Salvation is achieved through faith and humility. 15. After teaching a group of students about the beliefs associated with the major religions, the instructor determines that additional teaching is needed when the students identify which belief as associated with Confucianism? A) People are born good. B) People are assigned to castes. C) Authority figures are respected. D) Self-responsibility leads to improvement. 16. During an interview, a patient states, God does not exist for me. The nurse interprets this statement as reflecting which of the following? A) Animism B) Agnosticism C) Atheism D) Polytheism 17. After reviewing the major beliefs of Hinduism, a nursing student identifies the following castes. The student demonstrates understanding by identifying which of the following as the highest caste? A) Kshatriyas B) Vaisyas C) Brahmans D) Untouchables 18. The nurse is assessing an Asian American patient. During the interview, the nurse determines that the patient likely follows Taoism based on which statement? A) Purity and balance guide all of my actions. B) I strive to be in happy harmony with nature. C) Nature’s powers must be respected in life. D) God is worshipped out of love, not fear. Chapter 04: Patient Rights and Legal Issues 1. A nurse is explaining advance care directives, or living wills, to a patient and the patient’s spouse. Which of the following would the nurse include in the description? A) The document tells what treatment is to be omitted if the patient is unable to make the decision. B) It requires that the patient sign the living will document while an attorney is present. C) The patient’s physician must act as a witness when the patient signs the document. D) An attorney draws up the papers to be given to the patient and his or her family. 2. A psychiatricmental health nurse determines that a patient is competent when he is able to do which of the following? A) Speak coherent English. B) Communicate his or her choices. C) Write a living will. D) Comply with the medical regimen. 3. A patient receives a court order for commitment. Which of the following best exemplifies the concept of least restrictive environment? A) Involuntary commitment to an outpatient community mental health center B) Medication administration for sedation so the patient cannot get out of bed C) Placing the patient in a locked padded room in response to threats of self-harm D) Allowing the patient to make the decision about whether treatment is necessary 4. A nurse is caring for a patient who is hospitalized for a mental disorder. The nurse is legally obligated to breach the patient’s confidentiality if the patient states which of the following? A) I think that the federal government is spying on me. B) I get really ‘turned on’ by your appearance. C) That doctor I had today really made me angry. D) When I get out of here, I’m going to kill my neighbor. 5. Which patient would the nurse determine to be the most likely a candidate for involuntary commitment? A) The client who refuses to take the prescribed medication B) The client who is screaming in the street disturbing neighbors C) The client who refuses to participate in the planned therapy D) The client with a mental disorder who is homeless 6. The nurse is providing care to a male patient who is hospitalized with a diagnosis of schizophrenia. Which of the following would be appropriate for the nurse to include in the patient’s medical record? A) Patient states that he had a good night with no complaints. B) Complained of being unable to sleep because he heard voices throughout the night. C) Had a typical night without incidence of insomnia or nightmares. D) Acted crazily throughout the night; kept hearing voices and noises. 7. A nurse working on the psychiatric unit receives a telephone call from the employer of one of the patients on the unit. The employer asks to be sent a copy of Mr. Murray’s latest laboratory work and psychological testing results so Mr. Murray’s medical records in employee health can be kept up to date. Based on the nurse’s knowledge about issues surrounding breach of confidentiality, which response would be the most appropriate? A) I’m sorry; we’re not allowed to give out that information about our patient. B) I’ll have to get the patient’s signed consent before we can send that information to you. C) I am unable to acknowledge whether or not a Mr. Murray is a patient on this unit. D) Sure, give me your address, and I will see that the information is sent to you. 8. A patient is going to be discharged this afternoon from the mental health unit. The patient asks the nurse if a copy of his medical record could be sent to the psychologist he will be seeing on an outpatient basis. Which response by the nurse would be most appropriate? A) Sure, we’ll have that information sent out in today’s mail. B) You will need to sign written authorization for us before we can do this. C) I think it would just be best if you just told your psychologist everything he needs to know. D) How are you feeling about being discharged this afternoon? 9. A patient’s psychiatrist informs her that he thinks she needs to participate in a 3-month outpatient aftercare program after her discharge. Which of the following would protect the patient’s right to request a second opinion before agreeing to this suggestion? A) Self-determinism B) Least restrictive environment C) Confidentiality D) Mandates to inform 10. A nurse is preparing to administer an as-needed (PRN) medication. Which of the following would the nurse need to keep in mind when documenting administration? A) It requires a separate entry that includes reason for administration, dosage, route, and response to the medication the first time it is administered to a patient. B) It requires a separate entry that includes reason for administration, dosage, route, and response to the medication every time it is administered to a patient. C) It requires a separate entry that includes reason for administration, dosage, and route the first time it is administered to a patient. D) It requires a separate entry that includes reason for administration, dosage, and route every time it is administered to a patient. 11. A nursing instructor is preparing a class discussion on the topic of self-determinism. Which of the following would the instructor expect to include? Select all that apply. A) Personal autonomy as a key value B) Choices based on pleasing others C) Activities reflect personal goals D) Right to refuse treatment E) Lack of empowerment 12. A group of nursing students are reviewing information about internal rights protection systems. The students demonstrate understanding of this information when they identify which of the following as an example? A) American Hospital Association B) American Public Health Association C) State mental health provider D) The Joint Commission 13. After teaching a class about competency and how it is assessed, the nursing instructor determines the need for additional instruction when the class identifies which ability as being evaluated? A) Communication of choices B) Understanding of relevant information C) Appreciation for situation and consequences D) Discussion of what is right and wrong 14. A patient is involuntarily committed without a court order. The nurse understands that the emergency short-term hospitalization can occur for which time frame? A) A maximum of 24 hours B) 48 to 92 hours C) 3 to 5 days D) One week 15. A nurse is explaining the distinction between confidentiality and privacy. Which of the following would the nurse include as reflecting privacy? A) Part of personal life not governed by society’s laws B) Ethical duty for nondisclosure C) Involvement of two individuals D) Knowledge of treatment costs and benefits 16. A psychiatricmental health patient has an advance care directive on his medical record. A clinician provides treatment that disregards the patient’s directive. The clinician would be liable for which of the following? A) Assault B) Battery C) Medical battery D) False imprisonment 17. A group of students are preparing a class presentation about negligence. Which of the following would the group include as an element required for proving negligence? Select all that apply. A) Duty to provide care B) Proximate cause C) Resultant damages D) Breach of duty E) Cause in fact F) Evidence of mistake 18. A psychiatricmental health nurse is documenting information in a patient’s medical record. Which of the following would be least likely to increase the nurse’s legal liability? A) Patient reported that he was feeling better today than yesterday. B) Administered haloperidol 10 mg IM stat as ordered for agitation. C) Patient was talking with another staff member and started screaming. D) Applied restraints to all four patient extremities. 19. After teaching a class of nursing students about the rights of persons receiving mental health services, the instructor determines a need for additional instruction when the students identify which of the following as a right? A) Freedom from restraints or seclusion B) Access to one’s own mental health records on request C) An individualized written treatment plan D) Refuse treatment during an emergency situation Chapter 05: Mental Health Care in the Community 1. A nursing instructor is explaining the concept of the continuum of care to a group of students. Which of the following would the nurse include in this description? A) Care provided in episodic intervals B) System of care that focuses primarily on wellness C) A single organization as responsible for care delivery D) Integrated system spanning illness to wellness states 2. The nurse is employed by a long-term residential treatment center that provides care to a variety of patients with chronic mental disorders. Which role would the nurse primarily assume when working with these patients? A) Therapist B) Medication administrator C) Mediator D) Educator 3. A patient has threatened to kill his wife, and it is not anticipated that this crisis will resolve itself. The patient is to be admitted to an inpatient psychiatric unit on an involuntary basis. When explaining to the family about this plan, the nurse would identify which of the following as the focus of care? A) Long-term therapy B) Rehabilitative services C) Acute symptom stabilization D) 24-hour supervision 4. A nurse is reviewing information about the various types of outpatient mental health care programs. The nurse demonstrates understanding of these types when identifying which of the following as involved in providing the most intensive outpatient nursing care? A) Partial hospitalization programs B) Crisis intervention programs C) Outpatient detoxification programs D) Rehabilitation programs 5. A patient who has attempted suicide with a drug overdose has been released from an inpatient setting and has returned to school. The patient continues to need routine psychiatric services. The nurse anticipates that this patient will most likely be referred to which of the following? A) Partial hospitalization program B) In-home mental health care C) Intensive outpatient program D) Crisis center in the community 6. The nurse is caring for a group of patients in a partial hospitalization program. The nurse would most likely be involved in which of the following activities? A) Facilitating a drug abuse prevention group B) Providing spiritual assessment and related interventions C) Teaching patients how to plan a menu and to shop for groceries D) Providing an educational group about the nutritional content of canned foods 7. A nurse is providing in-home mental health care and determines that the care was effective when the patient demonstrated which of the following? A) A need for continued intensive monitoring in the home B) A need for crisis intervention services on an ongoing basis C) A decrease in admission frequency to inpatient psychiatric hospitals D) A dependence on parents to participate in the patient’s care 8. A patient with a psychiatric disorder is considering joining a clubhouse with other patients who have mental disorders. The patient asks the nurse to explain what services the clubhouses provide. Which response by the nurse would be most accurate? A) They are open 24 hours a day to provide care and support for the clubhouse members. B) They are run entirely by psychiatric mental health nurses. C) Their primary focus is on providing ongoing intensive psychotherapy for patients in a group setting D) They are predominately run by psychiatric patients with minimal assistance from mental health staff. 9. The nurse is working as part of the interdisciplinary staff of a psychiatric inpatient facility who are developing discharge plans for a patient who requires alternative housing arrangements. The patient will be referred to a personal care home. When explaining this housing arrangement to the patient, which of the following would the nurse include? A) You’ll be living with a family in their home, and the family will help supervise and support you. B) You’ll be living in an apartment with a roommate, and a staff member will come by to check on you. C) You’ll be living in a house with about 50 other people and receive 24-hour supervision and assistance. D) You’ll be living in a house with about six to 10 other people, and a health care attendant will provide 24-hour supervision. 10. A nurse is developing a community education program for a local women’s club on the topic of managed care in mental health. Which of the following would the nurse include as the main focus? A) Cost savings B) Consistent third-party reimbursement C) Improved access to less costly services D) Individualized care for additional inpatient stays 11. When working within the continuum of care, which of the following occurs first? A) Referral B) Transfer C) Assessment D) Discharge planning 12. A nurse who is working as part of an interdisciplinary team is looking at potential outpatient services for a patient. The patient requires a setting that provides a program of about 4 hours per day, three times per week with a 24-hour crisis and consultation service. The nurse would identify which of the following as appropriate? A) Primary care setting B) Ambulatory level one C) Ambulatory level two D) Multimodal outpatient setting 13. After teaching a group of students about the service and patient variables used when determining settings along the continuum of behavioral care, the instructor determines that the teaching was successful when the students identify which of the following as a service variable? A) Signs and symptoms B) Milieu C) Risk D) Social support 14. The parents of a young adult diagnosed with schizophrenia are providing care for the patient in their home. During a home visit, the parents state, It’s been so difficult taking care of our son. We need a break. But he needs constant supervision. Which of the following would be appropriate for the nurse to suggest? A) Partial hospitalization B) Acute inpatient care C) Respite residential care D) Intensive outpatient program 15. A patient is referred to a psychosocial rehabilitation program. When explaining this type of care to the patient, the nurse would emphasize which of the following? A) Intensive treatment that prepares the patient to live in the community B) Services that promote the patient’s reintegration into the community C) Detoxification services for alcohol and drugs in an outpatient setting D) Frequent monitoring within a therapeutic milieu for relapse prevention 16. As part of an interdisciplinary team, a nurse is assisting with a patient assessment to determine the most appropriate setting for treatment. The team decides that an acute ambulatory setting would be most appropriate. Which of the following would support the team’s decision? A) The patient exhibits moderate to severe symptoms. B) The patient demonstrates marked impairment in two areas of daily life C) The patient is unable to contract for treatment beyond initial care. D) The patient demonstrates a limited ability to seek support. Chapter 06: Ethics, Standards, and Nursing Frameworks 1. When applying the biopsychosocial model to client care, the nurse integrates the psychological domain when involved with which of the following? A) Behavior therapy B) Family support C) Nutritional therapy D) Sleep hygiene measures 2. A nursing instructor is describing the impact of technology and electronic health records on psychiatricmental health care. Which of the following would the instructor identify as a major challenge associated with it? A) Maintaining confidentiality B) Establishing educational models C) Decreasing fragmented care D) Defining professional standards more clearly 3. A psychiatric nursing class is discussing current trends in mental health care. A student voices the opinion that there should be equitable access to mental health care and resources for those who live in rural areas, for those without health insurance, and for those with very little income. The student nurse’s opinion most closely reflects which ethical principle? A) Nonmaleficence B) Paternalism C) Veracity D) Justice 4. A nursing student is initiating a relationship with an assigned patient. After meeting and spending approximately 20 minutes talking with the patient, the student makes arrangements to visit again after lunch. After lunch, fellow classmates invite the student to go to the gym with them and a group of patients to play volleyball. The student starts to go with them but then remembers the promise to meet with the patient. The student decides to stay behind and talk to with her patient. The student’s decision reflects which ethical principle? A) Autonomy B) Beneficence C) Fidelity D) Veracity 5. In a postclinical conference, a group of students are engaged in a discussion with their instructor. The instructor repeatedly has the students analyze and evaluate the nursing interventions implemented throughout the clinical experience. The students are engaged in which of the following? A) Therapeutic use of self B) Critical thinking C) Interdisciplinary care D) Planning care 6. A group of students is reviewing the functions of psychiatric nurses. The students demonstrate understanding of the information when they identify which of the following as an advanced practice level function? A) Milieu therapy B) Promotion of self-care C) Psychopharmacology interventions D) Health promotion activities 7. A nursing instructor has prepared a lecture about the scope and standards of practice of psychiatric nurses. The instructor determines that the teaching was effective when the students identify which of the following as common to both basic and advanced level practice? A) Case management B) Program development C) Clinical supervision D) Community interventions 8. A nurse is working on developing ways to meet the challenge of knowledge development. Which of the following would be most appropriate? A) Access new information through continuing education programs. B) Improve access to community psychiatric care for all populations. C) Reduce the burden of mental illness by fighting stigma. D) Provide culturally competent, high-quality nursing care. 9. A 22-year-old patient with schizophrenia is refusing his antipsychotic medication. He states, I don’t like the dopey way it makes me feel. I feel like I’m walking under water when I take it. The nurse explains to him, Your schizophrenia is caused by a chemical imbalance in your brain, and this medication helps fix that chemical imbalance. You need to take it so your symptoms will get better. This conversation reflects a conflict between which two types of ethical principles? A) Autonomy and justice B) Paternalism and veracity C) Justice and nonmaleficence D) Autonomy and beneficence 10. A nurse is faced with an ethical dilemma involving a patient. Which question would be most important for the nurse to ask first when engaging in the process of ethical decision making? A) What are my own feelings about the situation? B) What assumptions am I making that need more data? C) What do I know about the situation? D) What do I know about the patient’s values? 11. A psychiatricmental health nurse is adhering to the standards of practice. When engaging in clinical decision making, the nurse is integrating which of the following as the foundation? A) Developmental issues B) Nursing process C) Commitment D) Accountability 12. A group of nursing students are reviewing the standards of professional performance. The students demonstrate understanding when they identify which as a standard of professional performance? A) Prescriptive authority B) Consultation C) Planning D) Collegiality 13. A psychiatricmental health nurse is providing care to patients with a mental illness and is investigating factors related to the patient safety, delivery of care services, and cost effectiveness. The nurse is involved with which area of professional performance? A) Education B) Quality of practice C) Resource utilization D) Collaboration 14. An instructor is preparing a class for a group of students about professional organizations and the leadership provided. Which of the following would the instructor include as an important function of the International Society of Psychiatric-Mental Health Nurses? A) Advocating for mental health nursing practice through liaison activities B) Advancing psychiatricmental health nursing practice C) Improving mental health care for culturally diverse individuals D) Providing a strong voice for psychiatricmental health nurses 15. When applying the biopsychosocial model for a patient with a mental health problem, the nurse addresses the psychological domain when assessing which of the following? A) Sleep patterns B) Feelings C) Family functioning D) Cultural groups 16. A nurse had developed a plan of care for a patient with depression. Which nursing diagnosis would reflect the social domain? A) Imbalanced Nutrition, Less Than Body Requirements related to lack of appetite. B) Powerlessness related to feelings of lack of control over the situation. C) Ineffective Role Performance related to inability to participate as family provider D) Risk for Suicide related to depressed mood and feelings of oneself as a failure 17. The plan of care for a patient with schizophrenia identifies the following outcomes. Which of the following would the nurse identify as addressing the biologic domain? Select all that apply. A) Improving problem-solving skills B) Promoting economic stability C) Minimizing adverse effects of drug therapy D) Improving nutritional status E) Providing family education 18. A nurse is engaged in exercises to develop self-awareness. The nurse is using which tool? A) Interdisciplinary care B) Reflection C) Plan of care D) Clinical reasoning Chapter 07: Psychosocial Theoretic Basis of Psychiatric Nursing 1. A group of nursing students are reviewing information about Freud’s personality structure. The students demonstrate understanding of this information when they identify the ability to form mutually satisfying relationships as a function of which of the following? A) Defense mechanisms B) Unconscious C) Id D) Ego 2. When describing the influence of Harry Stack Sullivan on psychiatricmental health nursing, which of the following would the instructor address as a major concept? A) Interpersonal relations B) Harmony between the individual and society C) Collective unconscious D) Unconditional positive regard 3. A nursing student is to provide a class presentation about interpersonal and psychoanalytic theories. As part of this presentation, the student is planning to address the major way these two categories differ. Which of the following would the student include as key to interpersonal theories? A) Human relationships B) Instincts C) Drives D) Potential for goodness 4. A psychiatricmental health nurse is integrating Carl Rogers’ theory into the plan of care for a patient with a mental illness. The nurse incorporates understanding of this theory by acknowledging that the therapist accomplishes which of the following? A) Provide validation of the terminology used during the session. B) Focus on the client’s instinctual drives. C) Recognize an understanding of the client’s basic needs. D) Develop unconditional positive regard for the client. 5. A nurse is demonstrating behaviors that the treatment team is attempting to get the patient to develop. The nurse is integrating which theory? A) Erikson’s model of psychosocial development B) Albert Bandura’s social cognitive theory C) Skinner’s operant conditioning D) Freud’s psychoanalytic model 6. An instructor is preparing a class discussion on the various theoretical models used in psychiatricmental health nursing. When describing cognitive theories, which statement would the instructor include? A) The theories attempt to explain the mental processes development and effects on behavior. B) The theories attempt to describe how people learn and act. C) The theories attempt to link internal thought processes with behavior. D) The theories attempt to explain normal human growth and development. 7. When integrating the Neuman systems model while caring for a patient with a mood disorder, the nurse would focus on which of the following about the patient? A) Behaviors B) Relationships C) Self-care activities D) Stressors 8. The nurse is integrating Peplau’s model when providing care to a patient with a mental illness. Which of the following would the nurse identify as a key component? A) Suffering B) Anxiety C) Self-care D) Nonverbal behaviors 9. A group of nursing students are reviewing information about the various nursing theorists and their application to psychiatricmental health nursing. The students demonstrate understanding when they identify which theorist as responsible for developing the theory of cultural care diversity and universality? A) Madeleine Leininger B) Sister Calista Roy C) Hildegard Peplau D) Dorothea Orem 10. A patient is being discharged from the psychiatric unit this afternoon, and the nurse needs to teach the patient about discharge medications. The patient is exhibiting signs of moderate anxiety about the upcoming discharge. Based on Peplau’s views regarding anxiety, the nurse would expect to implement the teaching plan at which time? A) When his anxiety stabilizes at its current level B) When his anxiety decreases to a mild level C) When he is completely free of anxiety D) When his anxiety escalates to the panic level 11. A nursing instructor is integrating Piaget’s theory of cognitive development into the discussion of learning and mental health issues affecting adolescents. The instructor would identify this age group as in which stage? A) Concrete operations B) Preoperational C) Formal operations D) Sensorimotor 12. While working with an older male patient, the nurse begins to think that the patient reminds the nurse of her grandfather and responds as if she was the granddaughter. The nurse is developing which of the following? A) Empathy B) Transference C) Countertransference D) Modeling 13. A psychiatricmental health nurse is working on an inpatient unit that uses a privilege system. The nurse understands that this intervention integrates which group of theories? A) Behavioral B) Developmental C) Humanistic D) Cognitive 14. A group of nursing students are reviewing the various theories that form the basis for psychiatricmental health nursing. The students demonstrate understanding of these theories when they identify which theorist as addressing female development? Select all that apply. A) Maslow B) Gilligan C) Bandura D) Miller E) Thorndike 15. When describing the major concepts of Jean Watson’s theory to a group of nursing students, which of the following would the nurse expect to include? Select all that apply. A) Freedom B) Paradox C) Carative factors D) Rhythmicity E) Caritas field F) Mystery 16. A nurse is applying King’s model to a nursepatient interaction by identifying the outcome as which of the following? A) Transaction B) Adaptation C) Transpersonal caring D) Self-system 17. The nurse is assessing a young adult and determines that the individual has achieved successful resolution of the previous stage of growth and development, evidenced by demonstrating which of the following? A) Drive and hope B) Direction and purpose C) Devotion and fidelity D) Production and care 18. A group of nursing students are reviewing information about psychodynamic theories. The students demonstrate a need for additional study when they identify which of the following as a humanistic theorist? A) Carl Jung B) Carl Rogers C) Abraham Maslow D) Frederick Perls 19. The nurse is assessing a patient with anxiety and observes the patient yelling and screaming. The nurse, integrating Peplau’s theory, interprets this behavior as which of the following? A) Panic behaviors B) Relief behaviors C) Empathetic linkage D) Social distance 20. The nurse is watching a video that depicts a patient and therapist interacting. The patient is asked to say whatever comes to his mind. The nurse identifies this as which of the following? A) Dream work B) Free associations C) Gestalt therapy D) Classical conditioning 21. A nurse is developing a plan of care integrating Maslow’s hierarchy of needs. Which of the following would the nurse identify as the priority? A) Activity level B) Predictable social environment C) Acceptance from family D) Positive self-image Chapter 08: Biologic Foundations of Psychiatric Nursing 1. A nurse is teaching a medication class to a group of psychiatric patients. One of them asks the nurse why he has so much more trouble learning now when he’s in his 60s than he did when he was younger. Which of the following concepts would the nurse integrate into the response? A) The extrapyramidal motor system B) The amygdala C) Neuroplasticity D) Psychoneuroimmunology 2. Which of the following would a nursing instructor identify when describing the area of the brain involved with verbal language function, including areas for both receptive and expressive speech? A) Right hemisphere B) Parietal lobe C) Occipital lobe D) Left hemisphere 3. A nurse is developing a plan of care for a patient experiencing expressive aphasia. The nurse incorporates knowledge that the patient most likely has sustained damage to which of the following? A) The postcentral gyrus B) Broca’s area C) Basal ganglia D) The hippocampus 4. The nurse is caring for an older adult who has experienced damage to the frontal lobe after an automobile accident. The nurse anticipates that the patient will have difficulty with which of the following? A) Smell B) Concept formation C) Receptive speech D) Hearing 5. The nurse is caring for a patient who has experienced damage to the parietal lobes of the brain. The nurse anticipates that the patient with have difficulty with which of the following? A) Perceiving sensory input B) Calculating a math problem C) Seeing objects in front of him D) Speaking fluently 6. A patient has been diagnosed with memory dysfunction associated with Alzheimer’s disease. The nurse determines that damage to the patient’s brain includes deterioration of temporal lobe structures and the nerves of which of the following? A) Basal ganglia B) Limbic system C) Frontal lobe D) Hippocampus 7. The nurse is caring for a hospitalized patient who has a disorder of the hypothalamus. When developing the patient’s plan of care, in which of the following areas would the nurse anticipate a problem? A) Sleep B) Constipation C) Speech D) Motor activity 8. A patient who is scheduled to undergo a sleep deprivation electroencephalogram (EEG) in the morning is experiencing moderate anxiety about the procedure. Based on an understanding of this test, which of the following would the nurse avoid? A) Explaining in depth what to expect during the upcoming procedure B) Administering a benzodiazepine medication prescribed for anxiety C) Taking a thorough history of her use of prescribed and illicit drugs D) Giving her a noncaffeinated beverage of her choice 9. A nursing instructor asks a student to explain the influence of chronobiology on depression. Which of the following would the student include when responding? A) The exact location of genes leads to identifying the gene responsible for causing depression. B) A break in the corpus coliseum blocks information exchange between the right and left hemispheres. C) Damage to the posterior areas of the parietal lobe leads to altered discriminative sensory function. D) Internal and external triggers can elicit biologic rhythm changes indicative of clinical depression. 10. When describing the various neurotransmitters, which of the following would the nurse identify as the primary cholinergic neurotransmitter? A) Dopamine B) Acetylcholine C) Norepinephrine D) Serotonin 11. A group of nursing students are reviewing the various neurotransmitters. The students demonstrate understanding when they identify which of the following as a neuropeptide? A) Melatonin B) Serotonin C) Glutamate D) Gamma-aminobutyric acid 12. The nurse is assessing a patient experiencing anxiety and observes increased sweating and gooseflesh. The nurse understands that these are the result of which substance? A) Acetylcholine B) Norepinephrine C) Serotonin D) Histamine 13. A nurse is developing a plan of care for a patient diagnosed with schizophrenia. The nurse integrates knowledge of this disorder, identifying which neurotransmitter as being primarily involved? A) Acetylcholine B) Dopamine C) Norepinephrine D) Serotonin 14. A group of students are reviewing information about neurotransmitter subtypes. The group demonstrates understanding of the information when they identify which neurotransmitter as having muscarinic and nicotinic receptors? A) Serotonin B) Gamma-aminobutyric acid (GABA) C) Dopamine D) Acetylcholine 15. A nurse is involved in gathering information about the inheritance of mental disorders using population genetics. Which of the following would the nurse be least likely to be evaluating? A) Concordance rates B) Occurrence in first-degree relatives C) Risk factor analysis D) Adoptions studies 16. A nurse is reading a journal article about psychoneuroimmunology. Which information would the nurse most likely find? Select all that apply. A) Neurotoxin’s role in receptor site damage B) Hypothalamicpituitarythyroid axis disruption C) Static activity of natural killer cells in response to stress D) Hypothalamic damage leading to immune dysfunction E) Interruption in the typical circadian rhythm cycle 17. A patient is scheduled for a challenge test. Which of the following would the nurse include when explaining this test to the patient? A) Intravenous administration of a substance to induce symptoms B) Application of electrodes to the scalp for monitoring C) Evaluation electrical impulses recorded on graph paper D) Exposure to a flashing strobe light to elicit abnormal activity 18. A patient with depression tells the nurse that he is to have a test that involves the recording of an electroencephalogram (EEG) throughout the night. The nurse most likely identifies this testing as which of the following? A) Sleep deprivation EEG B) Polysomnography C) Evoked potentials D) Functional magnetic resonance imaging 19. A group of nursing students are reviewing the role of serotonin in psychiatric disorders. The students demonstrate a need for additional study when they identify which disorder as being associated with its dysfunction? A) Depression B) Obsessive-compulsive disorder C) Panic disorder D) Schizophrenia 20. When describing neuronal transmission, an instructor describes the area where the electrical intracellular signal becomes a chemical one. The instructor is describing which of the following? A) Soma B) Synaptic cleft C) Terminal D) Receptor site Chapter 09: Communication and the Therapeutic Relationship 1. A nurse has engaged in self-awareness and has come to understand his own personal beliefs and attitudes and has recognized some prejudicial ideas. Based on this understanding, which of the following would the nurse now be able to accomplish? A) Have a therapeutic relationship with a patient. B) Influence patients with certain biases. C) Change learned behaviors. D) Formulate values and morals. 2. When engaged in therapeutic communication in a therapeutic relationship with a patient with a mental health problem, which of the following would be most important for the nurse to keep in mind? A) The nurse should self-disclose when indicated. B) The patient is the primary focus of the interaction. C) The nurse should have an empathetic relationship with the patient. D) The patient’s conversations should be recorded. 3. A hospitalized patient diagnosed with depression asks the nurse, Should I go home this weekend? Which response by the nurse uses the technique of reflection? A) Should you go home for the weekend? B) Home means what to you? C) It sounds as if you don’t want to go home this weekend. D) I doubt that you really should go home this weekend. 4. A patient who is hospitalized with depression tells the nurse, I don’t want to take the medication because I’m afraid I’ll become suicidal. Which response by the nurse would be most appropriate? A) Have you ever thought about hurting yourself? B) It’s important that you take this medication. C) I agree with you. I wouldn’t want to take this medication either. D) Another patient took that medication, and he really felt better. 5. A female psychiatric patient is talking to the nurse about her reasons for being hospitalized. She begins to discuss her relationship with her female significant other. The patient is describing the things in her relationship that are making her uncomfortable, and she asks the nurse, Should I break up with my partner? Which response by the nurse would be most effective in building rapport between the patient and nurse? A) Of course you should; being a lesbian is just not natural. B) Yes, I think you should pursue building a relationship with a man. C) It sounds like you’re beginning to be uncomfortable in this relationship. D) You need to focus on yourself rather than the relationship right now. 6. A patie