ReviewVarcarolis Foundations of Psychiatric Mental Health Nursing_exam_1

ReviewVarcarolis Foundations of Psychiatric Mental Health Nursing_exam_1. Chapter 01: Mental Health and Mental Illness 1. A new staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional interventions? d. Prescribe psychotropic medication 2. Two nursing students discuss their career plans after graduation. One student wants to enter psychiatric nursing. The other asks, “Why would you want to be a psychiatric nurse? The only thing they do is talk. You’ll lose all your skills.” Select the best response. b. “Psychiatric nurses use complex communication skills as well as critical thinking to solve multidimensional problems. I am challenged by those situations.” 3. A new bill introduced in Congress would reduce funding for care of persons with mental illness. Groups of nurses write letters to their elected representatives in opposition to the legislation. Which role have the nurses fulfilled? a. Advocacy 4. An informal group of patients discusses their perceptions of nursing care. Which comment best indicates a patient perceived the nurse was caring? “My nurse: d. spends time listening to me talk about my problems. That helps me feel like I’m not alone.” 5. Which finding best indicates that a patient has a mental illness? The patient: b. reports mood is consistently sad, discouraged, and hopeless. 6. Which finding best indicates that the goal “Demonstrate mentally healthy behavior” was achieved? A patient: a. sees self as approaching ideals and capable of meeting demands. 7. A nurse encounters an unfamiliar psychiatric disorder on a new patient’s admission form. To determine criteria used to establish this diagnosis, the nurse should consult which resource? a. Diagnostic and Statistical Manual of Mental Disorders 8. Which documentation of diagnosis would a nurse expect in a psychiatric treatment setting? d. I Major Depression II Avoidant Personality Disorder III Hypertension IV Home destroyed by hurricane last year V 80 ANS: D 9. A nurse explains the multiaxial DSM-IV-TR to a psychiatric technician and includes information that it: c. classifies problems in multiple areas of functioning. 10. A nurse wants to find a description of diagnostic criteria for anxiety disorders. Which resource would have the most complete information? c. Diagnostic and Statistical Manual of Mental Disorders 11. Which comment most clearly shows a speaker views mental illness with stigma? b. “Most people with mental illness are unmotivated.” 12. Complete this analogy. NANDA : clinical judgment :: NIC : _________________ b. nursing actions 13. A college student said, “Most of the time I’m happy and feel good about myself. I have learned that what I get out of something is proportional to the effort I put into it.” Which number on this mental health continuum should the nurse select? Mental Illness Mental Health 1 2 3 4 5 e. 5 14. A newly admitted patient is uncommunicative about recent life events. The nurse suspects marital and economic problems, but the social worker’s assessment is not yet available. Select the nurse’s best action. d. Refer to axis IV of the DSM-IV-TR in the medical record. 15. The Diagnostic and Statistical Manual of Mental Disorders classifies: d. mental disorders people have. 16. A nurse participating in a community health fair is asked, “What is the most prevalent mental disorder in the United States?” Select the nurse’s best response. d. Alzheimer’s disease 17. In the majority culture of the United States, which individual has the greatest risk to be labeled mentally ill? One who: a. describes hearing God’s voice speaking. 18. A patient’s relationships are intense and unstable. The patient initially idealizes the significant other and then devalues them, resulting in frequent feelings of emptiness. This patient will benefit from interventions to develop which aspect of mental health? d. Fulfilling relationships 19. A patient is depressed, mute, and motionless. According to family members, the patient has refused to bathe or eat for a week. The patient’s global assessment of functioning score is: d. 10 20. Which belief will best support a nurse’s efforts to provide patient advocacy during a multidisciplinary patient care planning session? d. Assessment findings in mental disorders reflect a person’s cultural patterns. 21. A nurse is part of a multidisciplinary team working with groups of depressed patients. Half the patients receive supportive interventions and antidepressant medication. The other half receives only medication. The team measures outcomes for each group. Which type of study is evident? b. Clinical epidemiology 22. The spouse of a patient with schizophrenia says, “I don’t understand how nurturing or toilet training in childhood has anything to do with this incredibly disabling illness.” Which response by the nurse will best help the spouse understand this disorder? d. “New findings show that this condition more likely has biological rather than psychological origins.” 23. A 40-year-old who lives with parents and works at an unchallenging job says, “I’m as happy as anyone else, even though I don’t socialize much outside of work. My work is routine, but when new things come up, my boss explains things a few times to make sure I catch on. At home, my parents make decisions for me, and I go along with their ideas.” The nurse should identify interventions to improve this patient’s: a. self-concept. 24. The psychiatric nurse addresses axis I of the DSM as the focus of treatment but must also consider physical health problems that may affect treatment. Which axis contains the desired information? b. III 25. Select the best response for the nurse who receives a query from another mental health professional seeking to understand the difference between a DSM-IV-TR diagnosis and a nursing diagnosis. d. “The DSM-IV-TR diagnosis affects the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for phenomena a patient is experiencing.” 1. An experienced nurse says to a new graduate, “When you’ve practiced as long as I have, you’ll instantly know how to take care of psychotic patients.” Which information should the new graduate consider when analyzing this comment? You may select more than one answer. a. The experienced nurse may have lost sight of patients’ individuality, which may compromise the integrity of practice. b. New research findings should be integrated continuously into a nurse’s practice to provide the most effective care. 2. A patient asks the nurse, “I read an article online about psychosocial factors that influence depression. What are psychosocial factors?” Examples a nurse could cite to support the premise that a patient’s depression may be influenced by psychosocial factors include: (Select all that apply) a. having a hostile and overinvolved family. c. feeling strong guilt over having an abortion when one’s religion forbids it. d. experiencing the death of a parent a month before the onset of depression. 3. A patient in the emergency department says, “The voices say someone is stalking me. They want to kill me because I developed a cure for cancer. I have a knife and will stab anyone who is a threat.” Which aspect(s) of mental health should be of greatest immediate concern to the nurse? Select all that apply. b. Appraisal of reality c. Control over behavior e. Healthy self-concept Varcarolis: Foundations of Psychiatric Mental Health Nursing, 6th Edition Chapter 02: Relevant Theories and Therapies for Nursing Practice Test Bank 1. A 2-year-old child often displays negative behaviors. The parent says, “My child refuses toilet training and shouts ‘No!’ when given directions. What do you think is wrong?” Select the nurse’s best reply. b. “This is normal for your child’s age. The child is striving for independence.” 2. A 26-month-old displays negative behavior, refuses toilet training, and often says, “No!” Which stage of psychosexual development is evident? b. Anal 3. A 26-month-old displays negative behavior, refuses toilet training, and often says, “No!” Which psychosocial crisis is evident? d. Autonomy versus shame and doubt 4. A 4-year-old grabs toys from siblings and says, “I want that now!” The siblings cry, and the child’s parent becomes upset with the behavior. Using Freudian theory, the nurse can interpret this behavior as a product of impulses originating in the: a. id. 5. The parent of a 4-year-old rewards and praises the child for helping a younger sibling, being polite, and using good manners. The nurse supports the use of praise related to these behaviors. These qualities will likely be internalized and become part of the child’s: c. superego. 6. A nurse supports a parent for praising a child behaving in a helpful way. When this child behaves with politeness and helpfulness in adulthood, which feeling will most likely result? d. Self-esteem 7. A patient says, “I never know the answers,” and “My opinion doesn’t count.” The nurse correctly assesses that this patient had difficulty resolving which psychosocial crisis? c. Autonomy versus shame and doubt 8. Which patient statement would lead the nurse to suspect unsuccessful completion of the developmental task of infancy? b. “I’m afraid to allow anyone to really get to know me.” 9. A patient is suspicious and frequently manipulates others. To which psychosexual stage do these traits relate? a. Oral 10. A patient expresses the desire to be cared for by others and often behaves in a helpless fashion. The patient’s needs relate to which stage of psychosexual development? d. Oral 11. A nurse listens to a group of recent retirees. One says, “I volunteer with Meals on Wheels, coach teen sports, and do church visitation.” Another laughs and says, “I’m too busy taking care of myself to volunteer to help others.” Which developmental task do these statements contrast? d. Generativity and self-absorption *12.Although ego defense mechanisms and security operations are unconsciously determined and designed to relieve anxiety, the major difference is: d. security operations address interpersonal relationship activities. 13. A student nurse says, “I don’t need to interact with my patients. I learn what I need to know by observation.” An instructor can best interpret the nursing implications of Sullivan’s theory to this student by responding: b. “Nurses cannot be isolated. We must interact to provide patients with opportunities to practice interpersonal skills.” 14. A psychiatric technician says, “Common sense is the most important part of working with people who have milambien . Theories are just something to fill up textbooks.” The nurse wants to educate the technician by identifying which common use of Sullivan’s theory? c. The structure of the therapeutic milieu of most behavioral health units 15. A nurse uses Maslow’s hierarchy of needs to plan care for a patient with mental illness. Which problem will receive priority? The patient: a. refuses to eat or bathe. 16. Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly mute. Which technique applies? c. Give the child a small treat for speaking. 17. The parent of a child with schizophrenia tearfully asks the nurse, “What could I have done differently to prevent this illness?” Select the nurse’s best response. b. “Schizophrenia is a biological illness resulting from changes in how the brain and nervous system function. You are not to blame for your child’s illness.” 18. A nurse influenced by Peplau’s interpersonal theory works with an anxious, withdrawn patient. Interventions should focus on: d. enhancing the patient’s interactions with others. 19. A patient had psychotherapy weekly for 5 months. The therapist used free association, dream analysis, and facilitated transference to help the patient understand conflicts and foster change. Select the term that applies to this method. c. Psychodynamic psychotherapy 20. Consider a therapist’s statement: “The patient is homosexual but has kept this preference secret. Severe anxiety and depression occur when the patient anticipates family reactions to this sexual orientation.” Which perspective is evident in the speaker? a. Theory of interpersonal relationships 21. A psychotherapist works with an anxious, dependent patient. Which strategy is most consistent with psychoanalytic psychotherapy? c. Focusing on feelings developed by the patient toward the therapist *22.A person says, “I was the only survivor in a small plane crash. Three business associates died. I got depressed and saw a counselor twice a week for 4 weeks. We talked about my feelings related to being a survivor and I’m OK now.” Which type of therapy was used? d. Interpersonal psychotherapy 23. A cognitive strategy the nurse could use to help a dependent patient would be: d. examining the patient’s fears related to being independent. 24. A single parent who is employed full time complains of feelings of inadequacy related to work and family. The parent seeks help from a therapist who specializes in cognitive behavioral therapy. The therapist will treat the parent by: d. helping the parent identify and change faulty thinking. 25. A college student received an invitation to attend the wedding of a close friend who lives across the country. The student is afraid of flying. What type of therapy would the nurse suggest? c. Systematic desensitization 26. A patient would benefit from therapy in which peers as well as staff have a voice in determining patient privileges and psychoeducational topics. Which approach would be best? a. Milieu therapy 27. A patient repeatedly stated, “I’m stupid.” Which statement by the patient shows progress because of cognitive behavioral therapy? a. “Sometimes I do stupid things.” MULTIPLE RESPONSE 1. A patient states, “I’m starting cognitive-behavioral therapy. What can I expect from the sessions?” Which response(s) by the nurse would be appropriate? Select all that apply. a. “The therapist will be active and questioning.” b. “You may be given homework assignments.” d. “The therapist will help you look at ideas and beliefs you have about yourself.” 2. Which comment(s) by an elderly person best indicate successful completion of developmental tasks? Select all that apply. a. “I am proud of my children’s successes in life.” d . “My experiences in the war helped me appreciate the meaning of life.” 3. Which comment(s) by an adult best indicate self-actualization? Select all that apply. a. “I am content with a good book.” d. “It’s important for our country to provide basic health care services for everyone.” e. “When I was lost at sea for 2 days, I gained an understanding of what is important.” . Varcarolis: Foundations of Psychiatric Mental Health Nursing, 6th Edition Chapter 09: Therapeutic Relationships 1. A nurse assesses an elderly patient who was found wandering and confused. The nurse feels sad and reflects, “She’s like my grandmother…so helpless.” Which term best applies to the nurse’s response? c. Countertransference 2. Which statement shows a nurse has empathy for a patient who made a suicide attempt? a. “You must have been very upset to do what you did today.” 3. After several therapeutic encounters with a patient who recently attempted suicide, which behavior should cause the nurse to consider the possibility of countertransference? b. The nurse feels very happy when the patient’s mood begins to lift. 4. How should the nurse respond if a patient says, “Please don’t share information about me with the other people”? b. “I won’t share information with your family or friends without your permission, but I will share information with other staff.” 5. A patient who recently attempted suicide talks with the nurse about wanting to take a walk on hospital grounds. The nurse responds by telling the patient, “I will talk with the psychiatrist on your behalf.” Select the accurate analysis of this interaction. a. The nurse is behaving in an overly helpful way. 6. Termination of a therapeutic nurse-patient relationship has been successful when the nurse: a. discusses with the patient changes that happened during the relationship and evaluates outcomes. 7. Select the desirable outcome for the initial stage of a nurse-patient relationship. The patient will demonstrate behaviors that indicate: b. rapport and trust with the nurse. 8. During which phase of the nurse-patient relationship can a nurse anticipate that patient issues will be explored and resolved? c. Working 9. At what point in the nurse-patient relationship should a nurse first address termination? b. Orientation phase 10. Why should a nurse introduce the matter of a contract during the first session with a new patient? Contracts: b. spell out participation and responsibilities of both parties. 11. A patient frequently asks the nurse for extra snacks, implying more willingness to talk if these items are provided. The nurse should assess this behavior as: d. testing the nurse’s clinical competence. 12. Which remark by a patient indicates movement from orientation to the working phase of a nurse-patient relationship? d. “I want to find ways to deal with my anger without blowing up.” 13. A nurse explains to the family of a mentally ill patient how the nurse-patient relationship differs from other interpersonal relationships. Which is the best explanation? “The focus: a. is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient.” 14. A nurse wants to demonstrate genuineness with a patient diagnosed with schizophrenia. The nurse should: d. be aware of own feelings and use congruent communication strategies. 15. A nurse caring for a withdrawn, suspicious patient recognizes development of feelings of anger toward the patient. The nurse should: d. discuss the anger with a clinician during a supervisory session. 16. Which action by a nurse shows positive regard? d. Staying with a patient who is crying. 17. A nurse is talking with a patient, and 5 minutes remain in the session. This patient has been silent most of the session. Another patient interrupts and says to the nurse, “I really need to talk to you.” The nurse should: b. tell the interrupting patient, “This session is 5 more minutes, then I will talk with you.” 18. A patient says, “People should be allowed to commit suicide without interference from others.” A nurse replies, “You’re wrong. Nothing is bad enough to justify death.” What is the best analysis of this interchange? c. The statements reflect differing values. 19. Which issues should a nurse address during the first interview with a patient with a psychiatric disorder? c. Relationship parameters, the contract, confidentiality, and termination. 20. A psychiatric nurse visits one particular patient before work, seeks out the patient during the shift, and spends a few minutes with the patient after going off duty. Which analysis is accurate? The nurse is: a. overinvolved. 21. Which behavior shows that a nurse values autonomy? The nurse: d. discusses alternatives and helps the patient weigh the consequences. 22. A nurse provided psychiatric home care services to a patient for 6 months, but now the patient will begin a psychosocial rehabilitation program. On the nurse’s final home visit, the patient gives the nurse a gold angel pin and says, “Thank you for being my guardian angel when I needed help.” Select the nurse’s best response. d. “I’m glad you’ve made progress and that I helped, but I cannot accept the gift.” 23. A patient says, “I’m still on restriction, but I want to attend some off-unit activities. Would you ask the doctor to change my privileges?” Select the nurse’s best response. b. “That’s a good topic for you to take up with your doctor.” 24. A community mental health nurse has worked with a patient for 3 years but is moving and must terminate the relationship. When a new nurse begins work with this patient, what is the starting point for the relationship? a. Begin at the orientation phase 25. The nurse tells a peer, “I feel very uncomfortable with a patient and find myself wanting to avoid both informal contacts and scheduled sessions.” Without supervision, which outcome is likely? b. Mutual withdrawal 26. A nurse believes, “I’m the only one who truly understands this patient. Other staff members are too critical.” Which situation is evident? a. Boundary blurring 27. As a patient with mental illness is discharged from a facility, the nurse invites the patient to the annual staff holiday party. Select the best analysis of this scenario. b. The nurse’s action blurs the boundaries of the therapeutic relationship. 28. As a nurse discharges a patient, the patient gives the nurse a card of appreciation made in an arts and crafts group. Select the nurse’s best action. a. Recognize the patient’s thoughtfulness. Express appreciation and accept the card. 29. During the first interview, a nurse notices that a patient does not make eye contact. Which analysis is correct? d. More information is needed to draw a conclusion. RESPONSE 1. Which nursing actions demonstrate consistency and reliability? (Select all that apply.) a. Providing a schedule of daily activities. c. Having the same nurse care for a patient daily. d. Setting a time for regular sessions with a patient. 2. A nurse ends a relationship with a patient. Which action(s) by the nurse should be included in the termination phase? (Select all that apply.) c. Help the patient express feelings about the relationship with the nurse. e. Focus dialogues with the patient on problems that may develop in the future. 3. A psychiatric nurse’s parent had bipolar disorder. The nurse angrily recalls childhood memories of embarrassment about the parent’s behavior. Select the best coping strategies for this nurse. (Select all that apply.) a. Seek ways to use the understanding gained from childhood to help patients cope with their own illnesses. e. Recognize that the feelings may add sensitivity to the nurse’s practice, but supervision is important. Varcarolis: Foundations of Psychiatric Mental Health Nursing, 6th Edition Chapter 10: Communication and the Clinical Interview Test Bank MULTIPLE CHOICE 1. A patient says, “I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn’t rested well.” Which comment would be appropriate if the nurse seeks clarification? d. “Can you give me an example of what you mean by stoned?” 2. A patient with paranoid schizophrenia tells the nurse, "The FBI is listening through fluorescent lights in this room. Be careful what you say." Which response by the nurse would be most therapeutic? b. "It sounds like you’re concerned about your privacy." *3. A patient says, “My marriage is great. My spouse and I usually agree on everything.” The nurse observes the patient’s foot moving continuously and fingers twirling a shirt button. What assessment can the nurse make? The patient’s communication is: b. mixed. 4. A nurse interacts with a newly hospitalized patient. Select the example of offering self. d. “I’d like to sit with you for a while to help you get comfortable talking to me.” 5. Which statement by a nurse may underrate a patient’s feelings and belittle the patient’s concerns? c. “Everything will be all right.” 6. A nurse can best communicate to a patient an interest in listening by: a. restating the feeling or thought the patient has expressed. 7. A patient discloses several concerns and associated feelings. If the nurse wishes to seek clarification, which comment would be appropriate? c. “Am I correct in understanding that…” 8. A patient tells the nurse, “I don’t think I’ll ever get out of here.” Select the nurse’s most therapeutic response. d. “It sounds like you don’t feel like you’re making progress.” 9. Documentation in a patient’s record shows: During 5-minute interaction, patient fidgeted, tapped foot, periodically covered face with hands, looked under chair. Stated, “I enjoy spending time with you.” Which assessment is most accurate? c. The patient’s verbal and nonverbal messages were incongruent. 10. A depressed patient is unable to maintain eye contact with the nurse. The patient’s chin drops, and the patient looks at the floor. Which aspect of communication has the nurse assessed? a. Nonverbal communication 11. During the first interview with a parent whose child died in a car accident, the nurse feels sorry for the patient and reaches out to take the parent’s hand. Select the correct analysis of the nurse’s behavior. d. The gesture is premature. The patient’s cultural and individual interpretation of touch is unknown. 12. A nurse working with a depressed patient used humor to lift the patient’s spirits. At one point, the patient smiled. Select the best analysis. c. The nurse needs supervision. The communication technique is not appropriate. 13. An African American patient says to a white nurse, “You wouldn’t understand me because you live in a white world.” Select the nurse’s best response. d. “Please describe an example of something you think I would not understand.” 14. An Asian American patient rarely showed eye contact. This nursing diagnosis was formulated: Situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions to raise the patient’s self-esteem were not successful; the patient’s eye contact did not improve. Select the best analysis of this scenario. d. The nurse should have assessed the patient’s culture before making this diagnosis and plan. 15. Which remark by the nurse would be an appropriate way to begin an interview session? a. “How shall we start today?” 16. During an interview, a patient attempts to change the focus from self to the nurse by asking personal questions. Select the nurse’s most therapeutic response. d. “The time we spend together is for you to discuss your problems and concerns.” 17. A nurse interviews a patient who is having difficulty with self-expression and staying focused. Select the nurse’s most helpful comment. c. “Tell me what is happening right now.” 18. A nurse documents: “Patient mute despite repeated efforts to elicit speech. No eye contact. Short attention span; less than 1 minute.” Which nursing diagnosis should be considered? d. Impaired verbal communication 19. Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions? c. Silence provides meaningful moments for reflection. 20. A patient is having difficulty making a decision. The nurse is conflicted about whether to provide advice. Which principle usually applies? Giving advice: a. is rarely helpful. 21. The relationship between a nurse and patient as it relates to status and power is best described by which term? d. Complementary 22. Which technique communicates to a patient that a nurse is listening? a. Saying, “You said you were unsure how to handle your feelings.” *23.Which remark by the nurse gives a patient verbal tracking feedback? d. “You’re saying you do not have a good relationship with your children?” 24. A Puerto Rican American patient uses dramatic body language when describing recent life events. Select the most accurate explanation of the patient’s behavior. c. Members of this culture use dramatic body language as the norm. MULTIPLE RESPONSE 1. A patient cries as the nurse explores the patient’s relationship with a deceased parent and says, “I shouldn’t be crying like this. It happened a long time ago.” Which response(s) by the nurse will facilitate communication? (Select all that apply.) b. “I can see that you feel sad about this situation.” c. “The loss of your parent is very painful for you.” d. “Crying is a way of expressing the hurt you’re experiencing.” 2. During a therapy session, a patient cries as the nurse explores the relationship of the patient and her now-deceased mother. The patient sobs, “I shouldn’t be blubbering like this.” A response by the nurse that will hinder communication is: c. “Why do you think you are so upset?” Varcarolis: Foundations of Psychiatric Mental Health Nursing, 6th Edition Chapter 08: The Nursing Process and Standards of Care for Psychiatric Mental Health Nursing 1. Complete this nursing diagnosis: ___________ related to shyness and poorly developed social skills as evidenced by watching television alone at home every evening. d. Social isolation 2. A newly admitted patient is severely depressed, lost 20 pounds over the past month, and expresses hopelessness for the future. Select the priority nursing diagnosis. c. Risk for suicide 3. A severely depressed patient lost 20 pounds over the past month, has chronic low selfesteem, and the intent and a plan for suicide. The patient has taken an antidepressant medication for 1 week. The nurse adds this outcome to the plan of care: Patient will refrain from gestures and attempts to harm self. Which nursing intervention is most directly related to this outcome? a. Implement suicide precautions 4. A patient’s nursing diagnosis is sleep-pattern disturbance. The desired outcome is: Patient will sleep for a minimum of 5 hours nightly by October 31. On November 1, review of sleep data for 6 days shows the patient slept an average of 4 hours nightly and took 2-hour afternoon naps daily. Which evaluation should be documented? d. Never demonstrated 5. An adult patient recently diagnosed with cancer states, “I’ve lived my life according to the Bible. I don’t understand why God has forsaken me.” Which nursing diagnosis applies? d. Disturbed thought processes 6. A patient begins a new program to assist with building social skills. In which part of the plan of care should a nurse record this item? Encourage patient to attend one psychoeducational group daily. d. Implementation 7. Before assessing a new patient, a nurse is told by another health care worker, “I know that patient. No matter how hard we work, there isn’t much improvement by the time of discharge.” The nurse’s responsibility is to: b. assess the patient based on data collected from all sources. 8. A nurse works with a patient to establish outcomes but believes that one outcome suggested by the patient is not in the patient’s best interests. What is the nurse’s best action? c. Explore the consequences if the outcome is achieved. 9. A patient states: “I’m not worth anything. I have negative thoughts about myself. I want to go to sleep and never wake up.” Which nursing intervention has the highest priority? d. Suicide precautions 10. Select the best outcome for a patient with this nursing diagnosis: Impaired social interaction related to sociocultural dissonance as evidenced by stating, “Although I’d like to, I don’t join in because I don’t speak the language very well.” Within 1 week, the patient will: d . select and participate in one group activity per day. 11. Nursing behaviors associated with the implementation phase of the nursing process are concerned with: a. carrying out interventions and coordinating care. 12. Which statement made by a patient should serve as the priority focus for the plan of care? d . “I’ve been hearing the voices of my dead parents.” 13. Which nursing documentation best meets the requirement for problem-oriented charting? c. “S: States ‘I feel like I’m ready to blow up.’ O: Pacing hall, mumbling to self. A: Auditory hallucinations. P: Offer haloperidol 2 mg PO. I: Haloperidol 2 mg PO given at 0900. E: Returned to lounge at 0930 and quietly watched TV.” 14. A nurse assesses an elderly patient brought to the emergency department by a grandchild who found the patient wandering in the front yard saying, “I can’t find my way home.” The patient is confused and unable to answer questions. Select the nurse’s next action. a. Document the confusion. Obtain other assessment data from the grandchild. 15. A nurse asks a patient, “If you had fever and vomiting for 3 days, what would you do?” Which aspect of the mental status examination is the nurse assessing? b. Cognition 16. During an initial assessment, a patient becomes anxious and evasive when the nurse asks, “Have you ever heard voices when no one else was around?” The patient asks, “Why do you need to know that?” Select the nurse’s best response. d. “I can see this subject makes you uncomfortable. We can discuss it another time.” 17. An adolescent asks the nurse, “Why should I tell you anything? You’ll just tell my parents whatever you find out.” Select the nurse’s best reply. b. “Anything you say about feelings is private, but some things like suicidal thinking must be reported to the treatment team.” 18. A nurse assessing a new patient asks, “What is meant by the old saying, ‘You can’t judge a book by looking at the cover’?” Which aspect of cognition is the nurse assessing? d. Abstraction 19. As a nurse assesses an elderly patient, answers seem vague or unrelated to the questions. The patient also leans forward and frowns, listening intently to the nurse. An appropriate question for the nurse to ask would be: a. “Are you having difficulty hearing when I speak?” 20. At what point in an assessment interview could a nurse logically ask, “How does your faith help you in stressful situations?” During the assessment of: d. coping strategies. 21. When a new patient is hospitalized, a nurse takes the patient on a tour, explains rules of the unit, and explains the daily schedule. The nurse has fulfilled which aspect of care coordination? c. Milieu management 22. After formulating the nursing diagnoses for a new patient, what is the nurse’s next action? c. Determine the goals and outcome criteria. MULTIPLE RESPONSE 1. A patient participated reluctantly, answered questions with minimal responses and rarely made eye contact during a nursing assessment. What data should be included when documenting the assessment? You may select more than one answer. a. The patient’s verbal responses. c. A description of the patient’s behavior during the interview. d. Observations related to the patient’s subjective responses. 2. A nurse assessing a patient with a substance use disorder decides to use a standardized rating scale. Which scale(s) are appropriate? More than one answer is correct. a. Addiction Severity Index (ASI) b. Brief Drug Abuse Screen Test (B-DAST) e. Recovery Attitude and Treatment Evaluator (RAATE) 3. After a nurse assesses a new patient with a psychiatric disorder, nursing diagnoses are formulated. Information conveyed by the nursing diagnoses includes: (More than one answer is correct.) c. unmet patient needs present at the moment. d. supporting data that validate the diagnoses. e. probable causes that will be targets for nursing interventions. 4. A patient is very suspicious and states, “The FBI has me under surveillance.” Which strategies should the nurse to use when gathering initial assessment data about this patient? More than one answer is correct. a. Say to the patient, “Tell me about the problem as you see it.” b. Tell the patient medication will help this type of thinking. e. Reassure the patient, “You are safe here.” 5. The scope of practice for an advanced practice psychiatric nurse adds which interventions beyond the basic level? You may select more than one answer. b. Prescribe psychotropic medication d. Consultation with other clinicians e. Psychotherapy Varcarolis: Foundations of Psychiatric Mental Health Nursing, 6th Edition Chapter 03: Biological Basis for Understanding Psychotropic Drugs 1. A patient asks, “What are neurotransmitters? The doctor said mine are imbalanced.” Select the nurse’s best response. d. “Neurotransmitters are natural chemicals that pass messages between brain cells.” 2. The parent of an adolescent with schizophrenia asks the nurse, “My child’s doctor ordered a PET. What kind of test is that?” Select the nurse’s best reply. b. “PET means positron-emission tomography. An injection is given and images are taken. It shows blood flow and activity in the brain.” 3. A patient with a long history of hypertension and diabetes now develops confusion. The health care provider wants to make a differential diagnosis between Alzheimer’s disease or multiple infarcts. Which diagnostic procedure should the nurse expect to prepare the patient for first? c. Computed tomography (CT) scan 4. A patient has delusions and hallucinations. The health care provider wishes to rule out the presence of a brain tumor. For which test will the nurse need to prepare the patient? b. MRI 5. The nurse wants to assess a patient with major depression for disturbances in circadian rhythms. Select the best question for this aspect of the assessment. b. “What are your worst and best times of day?” 6. The nurse administers a medication that potentiates the action of GABA. Which effect would be expected? a. Reduced anxiety ANS: A Increased levels of GABA reduce anxiety. Acetylcholine and substance P are associated with memory enhancement. Thought disorganization is associated with dopamine. 7. A nurse could anticipate that treatment for a patient with memory difficulties might include medications designed to: d. prevent destruction of acetylcholine. ANS: D Increased acetylcholine plays a role in learning and memory. Preventing destruction of acetylcholine by acetylcholinesterase would result in higher levels of acetylcholine, with the potential for improved memory. GABA affects anxiety rather than memory. Increased dopamine would cause symptoms associated with schizophrenia or mania rather than improve memory. Decreasing dopamine at receptor sites is associated with Parkinson’s disease rather than improving memory. *8. A patient has disorganized thinking associated with schizophrenia. Neuroimaging would most likely show dysfunction in which part of the brain? b. Frontal lobe ANS: B The frontal lobe is responsible for intellectual functioning. The hippocampus is involved in emotions and learning. The cerebellum regulates skeletal muscle coordination and equilibrium. The brainstem regulates internal organs. 9. The nurse should assess a patient taking a drug with anticholinergic properties for inhibited function of the: a. parasympathetic nervous system. ANS: A Acetylcholine is the neurotransmitter found in high concentration in the parasympathetic nervous system. When acetylcholine action is inhibited by anticholinergic drugs, parasympathetic symptoms such as blurred vision, dry mouth, constipation, and urinary retention appear. 10. The therapeutic action of neurotransmitter inhibitors that block reuptake cause: b. increased concentration of neurotransmitter in the synaptic gap. ANS: B If the reuptake of a substance is inhibited, it accumulates in the synaptic gap and its concentration increases, permitting ease of transmission of impulses across the synaptic gap. 11. A patient taking medication for mental illness develops restlessness and an uncontrollable need to be in motion. The nurse analyzes that these symptoms relate to which drug action? b. Dopamine-blocking effects ANS: B Medication that blocks dopamine often produces disturbances of movement such as akathisia, because dopamine affects neurons involved in both thought processes and movement regulation. Anticholinergic effects include dry mouth, blurred vision, urinary retention, and constipation. 12. A nurse assesses that a patient has fear as well as increased heart rate and blood pressure. The nurse suspects increased activity of which neurotransmitter? d. Norepinephrine ANS: D Norepinephrine is the neurotransmitter associated with sympathetic nervous system stimulation, preparing the individual for “fight or flight.” GABA is a mediator of anxiety level. A high concentration of histamine is associated with an inflammatory response. A high concentration of acetylcholine is associated with parasympathetic nervous system stimulation. 13. A patient has acute anxiety related to an automobile accident 2 hours ago. The patient needs teaching about drugs from which group? d. Benzodiazepines ANS: D Benzodiazepines provide anxiety relief. Tricyclic antidepressants are used to treat symptoms of depression. Antimania drugs are used to treat bipolar disorder. Antipsychotic drugs are used to treat psychosis. 14. A patient is hospitalized for severe depression. Of the medications listed below, the nurse can expect to provide the patient with teaching about: a. chlordiazepoxide (Librium). b. clozapine (Clozaril). c. sertraline (Zoloft). d. tacrine (Cognex). ANS: C Sertraline (Zoloft) is an SSRI. This antidepressant blocks the reuptake of serotonin, with few anticholinergic and sedating side effects. Clozapine is an antipsychotic. Chlordiazepoxide is an anxiolytic. Tacrine treats Alzheimer’s disease. 5. A patient with bipolar disorder has an unstable mood, aggressiveness, agitation, talkativeness, and irritability. The nurse begins care planning based on the expectation that the health care provider is most likely to prescribe a medication classified as a(n): b. mood stabilizer. ANS: B The symptoms describe mania, which is effectively treated by mood stabilizers such as lithium and selected anticonvulsants (carbamazepine, valproic acid, and lamotrigine). Drugs from the other classifications listed are not effective in the treatment of mania. 16. A drug causes muscarinic receptor blockade. The nurse will assess the patient for a. dry mouth. ANS: A Muscarinic receptor blockade includes atropine-like side effects such as dry mouth, blurred vision, and constipation. Gynecomastia is associated with decreased prolactin levels. Movement defects are associated with dopamine blockade. Orthostatic hypotension is associated with 1 antagonism. 17. A patient begins therapy with a phenothiazine medication. What teaching should the nurse provide related to the drug’s strong dopaminergic effect? d. Report muscle stiffness ANS: D Phenothiazines block dopamine receptors in both the limbic system and basal ganglia. A movement disorder such as dystonia is likely to occur early in the course of treatment and is often heralded by sensations of muscle stiffness. Early intervention with antiparkinsonian medication can increase the patient’s comfort and prevent dystonic reactions. 18. A patient tells the nurse, “My doctor prescribed Paxil (paroxetine) for my depression. I assume I’ll have side effects like I had when I was taking Tofranil (imipramine).” The nurse’s reply should be based on the knowledge that paroxetine is a: d. SSRI. ANS: D Paroxetine is an SSRI and will not produce the same side effects as imipramine, a tricyclic antidepressant. The patient will probably not experience dry mouth, constipation, or orthostatic hypotension. 19. A nurse can anticipate anticholinergic side effects are likely when a patient takes: a. lithium (Lithobid). b. buspirone (BuSpar). c. risperidone (Risperdal). d. fluphenazine (Prolixin). ANS: D Fluphenazine, a conventional antipsychotic, exerts muscarinic blockade, resulting in dry mouth, blurred vision, constipation, and urinary retention. Lithium therapy is more often associated with fluid-balance problems, including polydipsia, polyuria, and edema. Risperidone therapy is more often associated with movement disorders, orthostatic hypotension, and sedation. Buspirone is associated with anxiety reduction without major side effects. 20. Which instruction has priority when teaching a patient taking clozapine (Clozaril)? b. “Report sore throat and fever immediately.” ANS: B Clozapine therapy may produce agranulocytosis; therefore, signs of infection should be immediately reported to the health care provider. In addition, the patient should have white blood cell levels measured weekly. 21. A nurse cares for patients taking various medications, including buspirone (BuSpar), haloperidol (Haldol), carbamazepine (Tegretol), trazodone (Desyrel), and phenelzine (Nardil). The nurse will order a special diet for the patient who takes: a. buspirone. b. haloperidol. c. carbamazepine. d. trazodone. e. phenelzine. ANS: E Patients taking phenelzine, an MAO inhibitor, must be on a low tyramine diet to prevent hypertensive crisis. 22. A nurse instructs a patient taking a drug that inhibits monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of: c. hypertensive crisis. 23. A nurse caring for a patient taking an SSRI will develop outcome criteria related to: a. mood improvement. SSRIs affect mood, relieving depression in many cases. SSRIs do not act to reduce thought disorders. SSRIs reduce depression but have little effect on motor hyperactivity. SSRIs do not produce extrapyramidal symptoms. 24. SSRIs improve depression by which action? SSRIs: c. make more serotonin available at the synaptic gap. Depression is thought to be related to lowered availability of the neurotransmitter serotonin. SSRIs act by blocking reuptake of serotonin, leaving a higher concentration available at the synaptic cleft. SSRIs prevent destruction of serotonin. 25. The laboratory report for a patient taking clozapine (Clozaril) shows a white blood cell count of 3000 mm3 . Select the nurse’s best action. a. Report these results to the health care provider immediately. These laboratory values indicate the possibility of agranulocytosis, a serious side effect of clozapine therapy. These results must be immediately reported to the health care provider, and the drug should be withheld. The health care provider may repeat the test, but in the meantime, the drug should be withheld. 26. A drug blocks the attachment of norepinephrine to 1 receptors. The patient may experience: b. orthostatic hypotension. ANS: B Sympathetic-mediated vasoconstriction is essential for maintaining normal blood pressure in the upright position. Blockage of 1 receptors leads to vasodilation and orthostatic hypotension. Orthostatic hypotension may cause fainting and falls. Teach patients ways of minimizing this phenomenon. 27. A nurse cares for four patients who are receiving clozapine, lithium, fluoxetine, and venlafaxine, respectively. With which patient should the nurse be most alert for alterations in cardiac or cerebral electrical conductivity and fluid and electrolyte imbalance? The patient receiving: a. lithium (Lithobid). b. clozapine (Clozaril). c. fluoxetine (Prozac). d. venlafaxine (Effexor). ANS: A Lithium is known to alter electrical conductivity, producing cardiac dysrhythmias, tremor, convulsions, polyuria, edema, and other symptoms of fluid and electrolyte imbalance. Patients receiving clozapine should be monitored for agranulocytosis. Patients receiving fluoxetine should be monitored for acetylcholine block. Patients receiving venlafaxine should be monitored for heightened feelings of anxiety. 28. An obese patient has schizophrenia. Medications that block which receptors would contribute to further weight gain? a. H1 29. A category 5 hurricane is approaching. Which change in an individual’s vital signs is most likely? d. Blood pressure changes from 114/62 to 136/78 ANS: D This frightening experience would stimulate the sympathetic nervous system, causing a release of norepinephrine, an excitatory neurotransmitter. It prepares the body for fight or flight. Increased blood pressure, pupil size, and pulse rate signify release of norepinephrine. Intestinal cramping would be associated with stimulation of the parasympathetic nervous system. 30. Consider these medications: carbamazepine (Tegretol), lamotrigine (Lamictal), gabapentin (Neurontin). Which medication below also belongs with this group? b. Valproate (Depakote) 31. A patient has difficulty with mathematical calculations. Which area of the brain is most likely involved with this problem? b. parietal lobe The parietal lobe is involved with mathematical calculations, as well as proprioception and sensory information. 1. A nurse prepares to administer antipsychotic medication to a patient with schizophrenia. Additional monitoring for adverse effects will be most important if the patient also has which health problem? Select all that apply. a. Diabetes b. Parkinson’s disease e. Epilepsy ANS: A, B, E Antipsychotic medications may produce weight gain, which would complicate care of a patient with diabetes and/or lower the seizure threshold, which would complicate care of a patient with epilepsy. Parkinson’s disease involves changes in transmission of dopamine and acetylcholine, so these drugs would also complicate care of this patient. 2. Questions that would be nonjudgmental when obtaining information about patient use of herbal remedies include: Select all that apply. b. “What herbal medicines have you used to relieve your symptoms?” c. “What over-the-counter medicines and nutritional supplements do you use?” d. “Have you experienced toxic effects from mixing herbals and prescription drugs?” e. “What differences in your symptoms do you notice when you take ol supplements?” 3. An individual is experiencing problems with memory. Which of these structures are most likely to be involved in this deficit? Select all that apply. a. Amygdala b. Hippocampus d. Temporal lobe Varcarolis: Foundations of Psychiatric Mental Health Nursing, 6th Edition Chapter 11: Understanding Responses to Stress 1. The daughter of a severely depressed patient asks the nurse “What do you think about the relationship between depression and physical illness? Since my mother has been grieving over my father’s death, she has had colds, shingles, and the flu, and she’s usually not one to get sick.” The answer that best reflects the current thinking about psychoimmunology is: d. “Emotions and stress are believed to interfere with white blood cell production and can increase the likelihood of infectious diseases.” 2. A patient with emphysema who has severe shortness of breath and frequent hospitalizations often depends on her portable oxygen tank when she leaves her home. Recently she has not been able to go upstairs to her bedroom at night because of shortness of breath and fear of developing severe breathing difficulty if she continues up the stairs. A support group leader suggests the use of guided imagery. What image would the patient be encouraged to visualize? b. Walking up the stairs in a steady, relaxed manner, taking regular deep breaths needing supplemental oxygen) or restrict her quality of life (sleeping downstairs rather than reducing her anxiety about stair climbing). 3. A nurse who leads group therapy for a group of depressed patients plans to implement a plan of exercise for each patient. The rationale to use when presenting this plan to the treatment team is that exercise: a. has an antidepressant effect comparable to selective serotonin reuptake inhibitors. 4. A recent immigrant from Central America is brought to the clinic by her daughter, who has been a U.S. resident for 10 years. The daughter says the stress of immigration has made her mother unwell. For which expression of stress should the nurse be alert during the assessment interview? b. Somatic complaints 5. A patient reports that financial problems are stressing his marriage. Today he heard rumors about impending cutbacks at work, and he fears he will be laid off. He is wringing his hands, has a pulse rate of 112/minute, respirations are 26/minute, and his blood pressure is 166/88 instead of being in his usual 110-120/76-84 range. Which nursing intervention or recommendation should be used first? c. Slow and deepen breathing via use of a positive, repeated word. 6. According to the Life Changing Event Questionnaire, which situation would most merit a complete assessment of a person’s stress status and coping abilities? a. A person returning to college after his employer ceased operations. 7. A patient newly diagnosed as being HIV-positive seeks the nurse’s advice on how to reduce the risk of infections. The patient states “I used to go to church, and it seems like I was in my best health then. Maybe I should start going to church again.” The reply that shows the best understanding of psychoimmunology is: c. “Studies show that spiritual practices can enhance immune system function.” 8. When the inpatient psychiatric nurse asks the newly-admitted patient to describe her social supports, the patient reports that she is newly divorced, has no siblings, her parents died last year, and she has little contact with her former in-laws, who subtly blame her for the divorce. She has few friends because most of her peers are not nearly as religiously conservative as she is. Which response related to social support would be most therapeutic? b. Discuss how divorce support groups could increase coping and social support. 9. A patient who is experiencing great stress associated with a disturbing new diagnosis asks the nurse, “Do you think saying a prayer would help?” The answer the nurse should give is: b. “You may find prayer gives comfort and lowers your stress.” 10. The nurse planning to teach a patient how to use Benson’s relaxation techniques to treat hypertension is essentially teaching the patient to: a. switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode. 11. A patient tells the nurse, “I’m told that I should reduce the stress in my life, but I have no idea where to start.” Which would be the best initial nursing response? d. “Let’s talk about what is going on in your life and then look at possible options.” 12. A patient tells the nurse “My doctor thinks my problems with stress relate to the negative way I think about things, and he wants me to learn a new way of thinking.” Which response would be in keeping with the doctor’s recommendations? a. Teaching the patient to recognize, reconsider, and reframe irrational thoughts 13. A patient who had been complaining of intolerable stress at work has demonstrated the ability to use progressive muscle relaxation and deep breathing techniques. He will return to the clinic for follow-up evaluation in 2 weeks. Which data will best suggest that the patient is successfully using these techniques to cope more effectively with stress? c. His systolic blood pressure has gone from the 140s to the 120s (mm Hg). *14.The patient tells the nurse, “I’ll never be happy until I’m as successful as my older sister.” The nurse asks the patient to reassess this statement and reframe it. Which reframed statement is most likely to promote coping? c. “I can find contentment in succeeding at my own job level.” 15. A patient tells the nurse that one result of his chronic stress is that he has considerable fatigue. He usually sleeps from 11:00 PM to 6:30 AM. He reports he now sets his alarm to give himself an extra 30 minutes of sleep each morning but feels no better and is rushed for work. Which nursing response would best address the patient’s concerns? c. “Perhaps going to bed a half hour earlier would work better than sleeping later.” 16. A patient reports that he is overwhelmed by stress. Which question would be most important to use in assessing the patient during your first meeting? a. “Tell me about the kinds of things you do to reduce or cope with your stress.” 1. Which changes reflect the short-term physiological response to stress? Select all that apply. a. Cortisol is released, increasing glucogenesis and reducing fluid loss. c. Corticosteroid release increases stamina and impedes digestion. d. Muscular tension, blood pressure, and triglycerides increase. e. Epinephrine is released, increasing heart and respiratory rates. 2. Which nursing interventions are likely to help the patient to cope by addressing the mediators of stress? Select all that apply. a. “A divorce, while stressful, can be the beginning of a new, better phase of life.” c. “Journaling gives one more awareness of how experiences have affected them.” d. “Perhaps a short-term loan from your father will make your layoff less stressful.” f. “I have found a support group for newly divorced persons in your neighborhood.” 3. The nurse wishes to use guided imagery to help her patient relax. Which comment would be appropriate to include in the guided imagery script? Select all that apply. b. “With each breath, you are feeling calmer, more relaxed, almost as if you are floating…” c. “You are alone on a beach, the sun is warm, and you hear only the sound of the surf…” e. “You have grown calm, your mind is still, there is nothing to disturb your wellbeing…” Stuart: Principles and Practice of Psychiatric Nursing, 9th Edition Chapter 02: Therapeutic NursePatient Relationship 1. A novice nurse states, “Psychiatric nursing can’t be very difficult. After all, I believe in showing care and in mutual exchange with my friends.” The experienced nurse formulates a reply based on knowledge of the difference between a social and a therapeutic relationship with emphasis on: 4. the type of responsibility involved. 2. The diagram above is a Johari window that a nurse thinks is accurately self-representative. If the nurse wishes to be more successful in psychiatric nursing, the nurse should make an initial goal to increase the size of: 1. quadrant 1. 3. Which strategy can the nursing student use to foster authenticity in therapeutic relationships with patients? 4. Analyzing feelings associated with psychiatric clinical experience with the help of instructors and peers 4. A person who has always wished to care for “special children” adopts a biracial child and another child who has spina bifida. What is the highest step of the value clarification process that this person has achieved? 1. Doing something with the choice in a pattern of life 5. A nurse who is working with a patient diagnosed with major depression remarks, “My patient seems to be affectively brighter and to have more energy, yet I am struck by a sense of hopelessness and despair when I think about the patient.” The best advice to give this nurse would be: 2. “Pay attention to your feelings. They are a valuable clue about the patient’s feelings.” 6. A new nurse has the following thoughts: “How will I handle things if my patient walks away from me? How will I react if the patient is sexually provocative? How will I cope with a patient who cries?” These thoughts indicate that the nurse is engaged in: 2. self-exploration. 7. A nurse’s most appropriate initial action during the preinteraction phase of a relationship with a homosexual patient should be to: 1. examine his or her own feelings about homosexuality. 8. A nurse who has considered what he or she has to offer a patient, reviewed the general goals of a therapeutic relationship, and planned for the first interaction with the patient has engaged in the tasks appropriate to which phase of the nurse-patient relationship? 4. Preinteraction phase 9. When asked to contrast social superficiality with therapeutic intimacy, an experienced nurse mentor explains to a new nurse that the termination component in therapeutic intimacy is: 3. specified and agreed on. 10. Which task would be most appropriate to focus on during the introductory phase of work with a teenage patient with low self-esteem? 1. Mutual formulation of a contract 11. A patient who is admitted with a diagnosis of schizophrenia, paranoid type, coldly tells a nurse, “I am here because my family brought me here and locked me up.” The best nursing response to use in the introductory session with the patient would be: 3. “I see you are angry about being here. I hope that after we talk you will feel differently.” 12. A patient is admitted to the unit and complains of being depressed. The patient says, “I want to feel like my old self again.” Which nursing response will be most therapeutic? 4. “Tell me more about how things are so that I can better understand.” 13. In the initial sessions a patient frequently asks the nurse for cigarettes and money and expresses doubt about the nurse’s ability to help. Which principle provides guidance for the nurse in this situation? 4. Testing behavior is common during the introductory phase of a relationship.