NSG 350 Mental Health

NSG 350 Mental Health In 1952, Hildegard Peplau defined the psychiatric nurse's role as a: a. professional who helps patients with attitude adjustment. b. nurse who is extensively trained to care for psychiatric patients. c. resource person, a teacher, a leader, and a counselor to patients. d. professional who is certified to conduct psychosocial therapy sessions. ANS: C c. resource person, a teacher, a leader, and a counselor to patients. 2. The contribution of Linda Richards that remains a part of contemporary psychiatric nursing practice is the idea that: a. psychiatric nurses should have advanced preparation. b. nurses should assess both the physical and the emotional needs of patients. c. psychotic behavior must be controlled before serious psychotherapy begins. d. basic physical needs must always be met before emotional needs are addressed. ANS: B b. nurses should assess both the physical and the emotional needs of patients. 3. A nurse states, "I plan ways for patients assigned to me to participate in their own care and to be actively involved in all of the activities on the unit." This approach demonstrates the concept of: a. social accountability. b. therapeutic community. c. nurse-patient relationship. d. multidisciplinary mental health team. ANS: B b. therapeutic community. 4. Hildegard Peplau's classic article "Interpersonal Techniques: The Crux of Psychiatric Nursing" directed psychiatric nursing's future growth by stating that the primary role of the psychiatric nurse was that of: a. leader. b. teacher. c. counselor. d. surrogate parent. ANS: C c. counselor. 5. When teaching the orientation portion of a psychiatric nursing course, which statement would the instructor be most likely to make to the students? a. "There is one approved theoretical framework for psychiatric nursing practice." b. "Psychiatric nursing has yet to be recognized as a core mental health discipline." c. "Contemporary practice of psychiatric nursing is primarily focused on inpatient care." d. "The psychiatric nursing patient may be an individual, a family, a group, or even a community." ANS: D d. "The psychiatric nursing patient may be an individual, a family, a group, or even a community." 6. For psychiatric nurses in the 1980s and 1990s, the scope of practice began to change to include: a. psychiatric care and medical care given by the home care nurse. b. new advances in the fields of psychobiology and technology. c. psychoanalytical therapy provided by the psychiatric nurse in the outpatient setting. d. new advances in the psychodynamic model of therapy made by the psychiatric nurse in the inpatient setting. ANS: B b. new advances in the fields of psychobiology and technology. 7. During orientation to the inpatient psychiatric unit, new staff members are told, "Address all patients by their title and surname unless you are directed by the patient to do otherwise." The belief that underlies this directive is that: a. every person is worthy of respect. b. every individual has the potential to change. c. the goals of the individual are growth, health, autonomy, and self-actualization. d. the person functions as a holistic being who reacts to the environment as a whole person. ANS: A a. every person is worthy of respect. 8. A psychiatric aide says, "I don't know why that patient does all that silly giggling and posturing. It's senseless!" The best reply to this comment would address the psychiatric nursing principle that states: a. every individual has the potential to change. b. illness can be a growth-producing experience for the individual. c. all behavior is meaningful, arising from personal needs and goals. d. everyone has the right to self-determination that includes the pursuit of health. ANS: C c. all behavior is meaningful, arising from personal needs and goals. 9. The role of the psychiatric nurse in today's contemporary practice settings is: a. centered on the nurse-patient partnership. b. concentrated on psychosomatic therapies. c. centered on management of the patient's daily needs. d. caring for chronically ill psychiatric patients in acute-care settings. ANS: A a. centered on the nurse-patient partnership. 10. The primary opportunity provided by psychiatric clinical rotations for nursing students is an opportunity to: a. become familiar with patients who have chronic psychiatric mental health issues. b. work with patients who have psychiatric as well as physical health issues. c. learn to work with patients with various psychiatric mental health issues. d. learn to care for patients who have emotional disorders. ANS: C c. learn to work with patients with various psychiatric mental health issues. 11. Case supervision is a psychiatric nursing activity that falls within the nursing practice domain of: a. community education. b. communication. c. management. d. direct care. ANS: D d. direct care. 12. When one considers the roles and functions of psychiatric nursing, the overlap of communication and management roles is seen in the function of: a. teaching. b. delegation. c. direct care. d. collaboration. ANS: D d. collaboration 13. The major determinants of the roles in which a psychiatric nurse engages are: a. personal preference and age. b. local custom and physician support. c. state law and personal qualifications. d. work setting and personal preference. ANS: C c. state law and personal qualifications. 14. Nursing should increase its role in the advocating of funding for outcome studies because these studies: a. increase patient compliance with therapeutic regimens. b. document quality, cost, and effectiveness of psychiatric nursing. c. update psychiatric nursing specialists on new practice developments. d. lead to the implementation of untried interventions and practice guidelines. ANS: B b. document quality, cost, and effectiveness of psychiatric nursing. 15. New opportunities for psychiatric nursing practice have emerged as psychiatric hospitals have changed from large institutions providing custodial care to: a. small units providing acute inpatient care. b. integrated clinical systems providing a full continuum of care. c. community-based home care systems focused on the chronically mentally ill. d. agencies more concerned with mental health promotion than providing direct care. ANS: B b. integrated clinical systems providing a full continuum of care. 16. A psychiatric nurse uses leadership skills to strengthen the profession by: a. working as a change agent advocating for patients, families, and communities. b. volunteering time each week to outpatient clinics in poor neighborhoods. c. voting for candidates in local elections who will advocate for nurses. d. working for state government representatives at local voting sites. ANS: A a. working as a change agent advocating for patients, families, and communities. 17. In the 1960s, the psychiatric nurse began to shift to primary prevention and psychiatric nursing practice began to focus more on community care. This focus was initiated by which act? a. The Primary Prevention Act of 1960 b. The Deinstitutionalization Act of 1961 c. The Therapeutic Community Act of 1962 d. The Community Mental Health Centers Act of 1963 ANS: D d. The Community Mental Health Centers Act of 1963 18. A nurse is contemplating a change from a medical-surgical nursing psychiatric nursing unit in a community hospital. Which intervention would help the nurse identify the supportiveness of the new unit? a. Orientation to last at least 2 weeks with the charge nurse of the day and a scheduled daily task assignment b. A mentor for the first 6 weeks in the unit and a schedule for progression of learning throughout the orientation phase into the unit c. Nursing team meetings for each shift daily to discuss patients' conditions, unit census, and an orientation schedule to include the nurses' responsibilities d. A consistent daily patient assignment to help the nurse become more autonomous and daily reading assignments to be discussed with a preceptor daily ANS: D d. A consistent daily patient assignment to help the nurse become more autonomous and daily reading assignments to be discussed with a preceptor daily 19. It is essential that psychiatric nurses become aware of their ability in the area of positive political action. The nurse can best achieve this goal by: a. raising donations for a local community health center. b. becoming involved in an election campaign for a local sheriff. c. becoming an active volunteer working regularly at a crisis center. d. working on a city committee to help register local voters. ANS: D d. working on a city committee to help register local voters. 1. When considering psychiatric nursing roles and functions, in order to delegate effectively the nurse must have knowledge of the domains of: (Select all that apply.) a. management. b. communication. c. direct care. d. teaching. e. collaboration. ANS: A, C a. management. c. direct care. 2. To derive the theoretical framework of psychiatric nursing, knowledge from which sciences is included? (Select all that apply.) a. Psychosocial b. Biophysical c. Personality behavior d. Human behavior e. Psychodynamics f. Psychobiology ANS: A, B, C, D a. Psychosocial b. Biophysical c. Personality behavior d. Human behavior 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's understanding of the difference between a social and a therapeutic relationship is primarily based on the: a. kind of information given. b. amount of emotion invested. c. degree of satisfaction obtained. d. type of responsibility involved. ANS: D d. type of responsibility involved 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 quadrant: a. 1. b. 2. c. 3. d. 4. ANS: A a. 1 3. Which strategy can the nursing student use to foster authenticity in therapeutic relationships with patients? a. Reading and discussing textbook assignments with a study group b. Modeling behaviors with patients on the behaviors of a clinically competent staff nurse c. Attending patient-centered clinical conferences on the assigned psychiatric inpatient unit d. Analyzing feelings associated with psychiatric clinical experience with the help of instructors and peers ANS: D 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? a. Doing something with the choice in a pattern of life b. Choosing freely from alternatives c. Being happy with the choice d. Affirming the choice publicly ANS: A a. Doing something with the choice in a pattern of life 5. A nurse makes observations that a depressed patient is more energetic and is smiling much more. Still, the nurse shares with the unit manager that when thinking about the patient a sense of hopelessness surfaces. The nurse manager replies: a. "Sometimes it's best to disregard subjective perceptions like that and focus on the objective signs." b. "Pay attention to your feelings. They can provide valuable clues about the patient's feelings." c. "You should share your perceptions with the patient and seek an explanation." d. "Confrontation can be a useful tool in situations like this." ANS: B b. "Pay attention to your feelings. They can provide valuable clues 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: a. role modeling. b. self-exploration. c. altruistic thinking. d. value clarification. ANS: B b. self-exploration. 7. A nurse's most appropriate initial action during the preinteraction phase of a relationship with a homosexual patient should be to: a. examine personal feelings about homosexuality. b. review the literature that pertains to the human sexual response. c. attempt to identify the underlying reasons for the patient's values. d. focus on a method to assist the patient with changing personal sexual values. ANS: A a. examine personal feelings about homosexuality 8. A nurse engaged in the preinteraction phase of the nurse-patient relationship will: a. consider what he or she has to offer the patient. b. form a workable but detailed contract. c. review the general goals of a therapeutic relationship. d. plan for the first interaction with the patient. e. identify existing stressors affecting the relationship. ANS: D d. plan for the first interaction with the patient. 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: a. unknown. b. open-ended. c. specified and agreed to. d. closed to negotiation or agreement. ANS: C c. specified and agreed to. 10. Which task would be most appropriate to focus on during the introductory phase of work with a teenage patient with low self-esteem? a. Mutual formulation of a contract b. Nurse's self-analysis of strengths c. Promotion of patient use of constructive coping mechanisms d. Review of progress of therapy and goal attainment with patient ANS: A a. Mutual formulation of a contract 11. A patient admitted with a diagnosis of schizophrenia, paranoid type, coldly tells a nurse during the admission interview, "I am here because my family brought me here and locked me up." The nurse's best response would be: a. "How has hospitalization affected your life?" b. "Do you feel angry or resentful about being hospitalized?" c. "I see you are angry about being here. I hope that after we talk you will feel differently." d. "We are here to protect you and see that you do not harm yourself or others in your anger." ANS: C c. "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? a. "How long have you felt this way?" b. "We're all here to help you get better." c. "What do you think the hospital can do for you?" d. "Tell me more so that I can better understand." ANS: D d. "Tell me more so that I can better understand." 13. In the initial sessions a patient frequently asks the nurse for money and expresses doubt about the nurse's ability to help. Which principle provides guidance for the nurse in this situation? a. This behavior is typical of transference reactions. b. All patients have feelings of insecurity and low self-esteem. c. Manipulative behavior is part of this patient's psychopathology. d. Testing behavior is common during the introductory phase of a relationship. ANS: D d. Testing behavior is common during the introductory phase of a relationship. 14. A young adult has been receiving treatment for an anxiety disorder. Which statement by the patient confirms that the nurse and patient are most likely entering the terminal phase of the therapeutic relationship? a. "My anxiety seems to be a result of having so much to get done." b. "I don't know whether I'll be able to handle things alone." c. "I can't seem to be able to manage going to school and working." d. "I need to find a way that can help me manage my anxiety." ANS: B b. "I don't know whether I'll be able to handle things alone." 15. A psychiatric nurse will recognize which action as demonstration of resistance behavior? a. Regularly referring to himself as a "loser" b. Becoming tearful during every therapy session about abuse c. Asking to postpone a therapy session until after visiting hours d. Consistently describing his drug use as starting "a little while ago" ANS: A a. Regularly referring to himself as a "loser" 16. During the working phase of the relationship, the nurse assesses that the patient may be demonstrating resistance. The most appropriate way to deal with this would be to: a. assist the patient in exploring his or her past for uncovered issues and conflicts. b. clarify, share observations, and reflect content and feelings with the patient. c. confront the patient with the behavior and state, "You will be expected to work harder." d. avoid mentioning the therapeutic barrier and wait until the patient again indicates readiness. ANS: B b. clarify, share observations, and reflect content and feelings with the patient. 17. A patient reports seeing a "frightening" face on the wall of the dayroom. A nurse attempts to calm her by providing an explanation for the flawed perception of what she saw. The nurse would implement this strategy by stating: a. "Let's see if anyone else has seen those frightening faces on the walls of the dayroom." b. "The shadows of the tree outside the window make strange shapes on the dayroom walls." c. "Have you ever seen frightening faces like that on the dayroom walls before today?" d. "Did someone in the dayroom tell you there were frightening faces on the walls?" ANS: B b. "The shadows of the tree outside the window make strange shapes on the dayroom walls." 18. A patient says to a nurse, "My spouse and I get along just fine. We usually agree on everything." The nurse observes nonverbal communication that disagrees with what the patient has verbally communicated. Which of the patient's actions is incongruent with her statement? a. Getting up from her chair while making the statement b. Walking toward the nurse while talking about her spouse c. Staring down at her shoes during the conversation d. Smiling while talking with the nurse ANS: C c. Staring down at her shoes during the conversation 19. A nurse tells a patient who is feeling guilty about an infidelity to call the spouse and beg for forgiveness. According to the transactional model of communication, the nurse's response originated from which state? a. Adult b. Child c. Parent d. Complementary ANS: C c. Parent 20. According to transactional analysis theory, when a patient finally recognizes the importance of being medication-compliant, which type of transaction has occurred? a. Ulterior b. Crossed c. Incongruent d. Complementary ANS: D d. Complementary 21. When the nurse suggests the patient communicate to her employer how overwhelmed she is by the workload, the patient responds, "Yes but I'll get fired if I do that." According to transactional analysis theory, this is an example of a(n) _____ transaction. a. ulterior b. crossed c. congruous d. complementary ANS: A a. ulterior 22. A patient who is currently in an abusive marriage shares, "Some days I think it's just not worth it. I'd be better off if we separated." The nurse uses restating as a therapeutic communication technique when responding: a. "Are you sure you are ready to be on your own?" b. "Can I help you work on a safe, realistic plan to leave?" c. "You think you would be better off without your spouse?" d. "How much thought have you given to leaving the marriage?" ANS: C c. "You think you would be better off without your spouse?" 23. When a patient is late for three consecutive therapy sessions, the nurse implements perception sharing as a communication technique when stating: a. "You say how important therapy is to you, but you can't seem to get here on time." b. "Do you think it's polite being late for therapy sessions like this?" c. "Do you have really good reasons for being late so often?" d. "I feel that you aren't ready to work on your problems." ANS: D d. "I feel that you aren't ready to work on your problems." 24. The therapeutic communication technique of suggesting is appropriate to use when it: a. meets the patient's unmet dependency needs. b. shifts responsibility from the patient to the health care professional. c. is used during the working stage to present alternative coping strategies. d. is used early in the nurse-patient relationship to provide sound, everyday advice. ANS: C c. is used during the working stage to present alternative coping strategies. 25. A teenager being treated for oppositional defiance behavior states: "I wish my parents would stop treating me like an irresponsible child." The nurse implements confrontation as a therapeutic technique when responding: a. "How can they treat you like an adult when you are only a teenager?" b. "You want to be treated like an adult, but is it adult-like when you skip school?" c. "Your parents have a legal responsibility to care for you until you are eighteen." d. "Your parents are worried about giving you more freedom than you can handle." ANS: B b. "You want to be treated like an adult, but is it adult-like when you skip school?" 26. Which statement is true of planning the timing for the use of confrontation? a. Confrontation should never be used during the orientation phase of the relationship. b. Confrontation is useful during the working phase to focus on specific patient discrepancies. c. Confront patients with their limitations early in the relationship and with their assets later in therapy. d. Confront patients when other therapeutic action dimensions have proven ineffective. ANS: B b. Confrontation is useful during the working phase to focus on specific patient discrepancies. 27. The nurse suspects that a client has a problem with the action dimension of immediacy when she states, "You can't tell people very much about yourself; it gives them too much power over you." The nurse responds: a. "It sounds as though people have tried to control you inappropriately in the past." b. "It's reasonable for you to be suspicious of me until I've earned your trust." c. "Allowing yourself to trust people will be a step toward getting well." d. "It appears that you aren't ready to discuss your problems yet." ANS: B b. "It's reasonable for you to be suspicious of me until I've earned your trust." 28. A chronically depressed patient has been diagnosed with having a dependent personality. The nurse suspects that the situation has resulted in dependence transference when the patient shares that: a. "Leaving the hospital and helpful, caring people like you will be really hard." b. "Over the weeks we've been meeting I've come to feel as though you are a very special person." c. "I think of you as being sent from heaven to guide me out of this darkness of the soul." d. "I know I can count on you to chart my course back to health. I will do whatever you say." ANS: D d. "I know I can count on you to chart my course back to health. I will do whatever you say." 29. A nurse tells the unit supervisor, "I'm having a difficult time empathizing with my patient especially since he is so unwilling to change. Talking with him makes me feel both frustrated and depressed." The supervisor may suspect that the cause of the barrier in this nurse-client relation is the: a. existence of countertransference on the part of the nurse. b. patient's demonstration of resistance to the prescribed plan of care. c. violation of a therapeutic boundary by either the nurse or the patient. d. nurse's ineffective use of therapeutic verbal communication techniques. ANS: A a. existence of countertransference on the part of the nurse. 1. Which statement can a nurse use to best describe the Stuart Stress Adaptation Model to someone who is unfamiliar with it? a. "The model recognizes the limitations of the nursing process and organizes treatment along critical pathways." b. "The model bases psychiatric nursing practice on principles derived from nursing science and establishes generic goals for each discrete stage of psychiatric treatment." c. "The model integrates biopsychosociocultural, environmental, and legal-ethical aspects of psychiatric nursing care into a unified framework for practice throughout the care continuum." d. "The model is based primarily on the medical model and organizes psychiatric nursing practice according to discrete treatment stages, selected treatment settings, and legal mandates." ANS: C c. "The model integrates biopsychosociocultural, environmental, and legal-ethical aspects of psychiatric nursing care into a unified framework for practice throughout the care continuum." 2. A nurse states, "I don't understand why the Stuart Stress Adaptation Model uses both the health/illness and adaptation/maladaptation continua." The best reply is: a. "The more information that's contained within the model, the more realistically it represents life." b. "The model recognizes that nature is ordered as a social hierarchy from simple to complex. The health/illness continuum is a simple concept; the adaptation/maladaptation continuum is more complex." c. "To integrate the theory of four stages of psychiatric treatment, Stuart had to have a health/illness frame of reference. The adaptation/maladaptation continuum was necessary to complement the holistic framework." d. "The health/illness continuum reflects a medical world view, whereas the adaptation/maladaptation continuum is derived from nursing's world view. The two reflect the complementary nature of the nursing and medical models of practice." ANS: D d. "The health/illness continuum reflects a medical world view, whereas the adaptation/maladaptation continuum is derived from nursing's world view. The two reflect the complementary nature of the nursing and medical models of practice." 3. A patient in the emergency room of a local community hospital is crying uncontrollably and repeating over and over, "He will hurt me if I don't get away from him. You have to help me, please." Which of the following interventions reflects attention to care in the manner advocated by the assumptions stated in the Stuart Stress Adaptation Model? a. Getting a health care provider to prescribe a sedative for the patient b. Asking the patient to provide more details about "what he will do" c. Beginning the nursing process by conducting a nursing assessment d. Putting the patient in a quiet room to minimize environmental stimuli ANS: C c. Beginning the nursing process by conducting a nursing assessment 4. An adolescent who belongs to a neighborhood gang has been caught both lying and stealing by a parent. After psychiatric testing determines that the adolescent is able to adequately test reality and has no symptoms of a major psychiatric disorder, the most likely finding will be that the child's behavior demonstrates: a. healthy deviant. b. healthy conformist. c. unhealthy deviant. d. unhealthy conformist. ANS: A a. healthy deviant. 5. Which criterion of mental health is a nurse assessing when exploring a patient's sense of selfdetermination, balance between dependence and independence, and acceptance of the consequences of behavior? a. Autonomy b. Integration c. Reality perception d. Environmental mastery ANS: A a. Autonomy 6. A patient states, "Sometimes I hear voices when no one else is in the room telling me that people are plotting to hurt me." This patient is experiencing impairment of which criterion of mental health? a. Autonomy b. Integration c. Reality perception d. Environmental mastery ANS: C c. Reality perception 7. A nurse documents that a patient is appropriately emotionally responsive, in control, and expresses a unified philosophy of life. This implies that the patient has met the mental health criterion of: a. autonomy. b. integration. c. reality perception. d. environmental mastery. ANS: B b. integration. 8. A patient mentions, "No one else I know is mentally ill." What reply would help the patient understand the extent of mental illness? a. "You are not unique; many people experience mental illness." b. "Let's concern ourselves with you and getting you well again." c. "Being among people who understand your problem and want to help is what is important." d. "You are truly not alone; almost 50% of adults experience some kind of mental illness. ANS: D d. "You are truly not alone; almost 50% of adults experience some kind of mental illness. 9. On the basis of predictions from the Global Burden of Disease Study, mental health professionals should be most concerned with increasing primary prevention efforts for: a. alcohol abuse. b. schizophrenia. c. bipolar disorder. d. major depressive disorder. ANS: D d. major depressive disorder. 10. The spouse of a patient with major depressive disorder tells a nurse, "I feel hopeless about my spouse's condition. It's not like a physical illness that he can recover from." Which response will best reassure the spouse? a. "That's not true. People with mental illness get well more than 90% of the time." b. "While your concerns about your spouse's recovery are understandable, great strides have been made with the use of new antidepressants." c. "It's not right to try to make comparisons between the effectiveness of treatment of mental and physical illnesses. It's like comparing apples and oranges." d. "New studies show that treatment of depression is effective 65% to 80% of the time, whereas treatments for heart disease and cancer are often only 40% effective." ANS: D d. "New studies show that treatment of depression is effective 65% to 80% of the time, whereas treatments for heart disease and cancer are often only 40% effective." 11. The greatest barrier to treatment for the mentally ill can be minimized by: a. possessing adequate insurance coverage. b. implementing effective treatment modalities. c. employing sufficient numbers of mental health practitioners. d. formulating appropriate, accurate assessment tools for diagnosis. ANS: A a. possessing adequate insurance coverage. 12. Which predisposing factors most influence mental illness? a. Risk factors that influence a person's vulnerabilities and the type and amount of resources used to handle stress b. Biological factors, such as genetic background, general health, nutritional status, and exposure to toxins c. Psychological factors, such as intelligence, morale, self-concept, motivation, and past experiences d. Sociocultural characteristics, such as education, income, occupation, culture, religion, and relatedness ANS: A a. Risk factors that influence a person's vulnerabilities and the type and amount of resources used to handle stress 13. Precipitating stressors are stimuli that: a. society views as being deviant or troublesome. b. the family views as disruptive or burdensome. c. the patient views as challenging, threatening, or demanding. d. the nurse views as noxious, overwhelming, or culturally unacceptable. ANS: C c. the patient views as challenging, threatening, or demanding. 14. Which individual would a nurse consider to be at the highest risk for the onset of stress-related problems? a. A patient whose beloved parent died 3 months ago and who has lost a job because of corporate restructuring. The patient states, "Living with loss and the threat of loss makes me feel helpless." b. A patient who was passed over for promotion and quit to start a new business. The patient states, "This is just one of a series of challenges I've faced in my life." c. A patient who is graduating from college and will be married in one month. The patient states, "I'm anticipating the changes these events will make in my life." d. A married patient whose new business is growing slowly and who plans to adopt a child. The patient says, "I think I'm in control of my destiny." ANS: A a. A patient whose beloved parent died 3 months ago and who has lost a job because of corporate restructuring. The patient states, "Living with loss and the threat of loss makes me feel helpless." 15. A nurse taking the history of a patient diagnosed with depression discovers that the patient has a number of life strains and daily hassles. The patient and patient's spouse argue frequently, the teenage children in the family are rebellious, and there is seldom enough money to meet all the bills. In what way is this information relevant? a. Negative life events are more likely to negatively affect physical health than mental health. b. Daily hassles are a source of considerable stress and may affect mood more than major misfortunes. c. Life strains associated with the work role are most predictive of the development of major depression. d. Stressful life events are largely overrated as precipitating stressors that lead to the onset of symptoms. ANS: B b. Daily hassles are a source of considerable stress and may affect mood more than major misfortunes. 16. A patient has decided to resign from a job that involved many daily hassles. Using Caplan's theory of response to stress, the patient can be seen to be using: a. behavior that adjusts the patient's appraisal of the stress. b. behavior that allows the patient to escape from the stressful environment. c. intrapsychic behavior in order to defend against unpleasant emotional arousal. d. intrapsychic behavior to come to terms with the event by internal readjustment. ANS: B b. behavior that allows the patient to escape from the stressful environment. 17. A patient newly diagnosed with Chron's disease shares she is spending several hours each week on the Internet seeking information about the illness. The nurse can correctly hypothesize that this patient is initially: a. engaged in a search for meaning. b. devising a new coping strategy. c. making a social attribution. d. making a social comparison. ANS: A a. engaged in a search for meaning. 18. A major difference between coping resources and coping mechanisms is that: a. coping resources are adaptive, whereas coping mechanisms are usually maladaptive. b. coping resources are assets, whereas coping mechanisms can be assets or liabilities. c. individuals have multiple coping resources, but coping mechanisms are limited in number. d. available coping resources are more predictive of outcome than are the coping mechanisms used. ANS: B b. coping resources are assets, whereas coping mechanisms can be assets or liabilities. 19. A comparison of the nursing and medical models of care shows that: a. nurses assess disease states and causes. b. physicians assess risk factors and vulnerability. c. nursing intervention focuses on curative treatments. d. nursing diagnoses focus on the effectiveness of coping responses. ANS: D d. nursing diagnoses focus on the effectiveness of coping responses. 20. Nursing diagnoses: a. provide a way for all health professionals to view a patient holistically and to combat the problem of mind-body dualism. b. complement medical diagnoses and are best described as the patient's behavioral response to stress. c. offer an alternative to health professionals who wish to use complementary treatment modalities in lieu of traditional medical treatment. d. contribute little in the everyday clinical setting but do provide nurses with a common language to use for research on outcomes of standard nursing interventions. ANS: B b. complement medical diagnoses and are best described as the patient's behavioral response to stress. 21. The spouse of a patient diagnosed with schizophrenia asks a nurse, "How will I know if my spouse becomes psychotic?" The nurse replies: a. "His behavior will become very unpredictable." b. "Speech becomes very disorganized and inappropriate." c. "Social skills are greatly impaired resulting in the tendency to isolate." d. "He will demonstrate thinking and behaviors that are based in reality." ANS: C c. "Social skills are greatly impaired resulting in the tendency to isolate." 22. The nurse initiates the nursing process for the purpose of managing the psychiatric care for a patient with a maladaptive stress response when: a. admission orders have been written by the admitting physician. b. diagnostic tests rule out the presences of any organic pathology. c. the patient relationship with the nurse has been established. d. the nurse makes initial contact with the patient. ANS: D d. the nurse makes initial contact with the patient. 23. A patient became acutely anxious and hysterical in response to the stress of the patient's home being destroyed by fire the previous evening. A nurse assesses the patient's treatment stage as: a. crisis. b. acute. c. maintenance. d. health promotion. ANS: A a. crisis. 24. A patient became acutely anxious and hysterical in response to the stress of the patient's home being destroyed by fire the previous evening. The immediate nursing goal for the patient is the: a. patient will be stabilized. b. illness will go into remission. c. patient will completely recover. d. patient will achieve optimal wellness. ANS: A a. patient will be stabilized. 25. A delusional patient believes that the accidental death of a child was actually caused by aliens. He has become severely anxious believing he is also in danger. During the acute stage of treatment, the expected outcome of nursing care is the: a. patient will experience symptom relief. b. nurse will validate the patient's strengths. c. patient will identify vulnerabilities that led to the symptoms. d. nurse will focus on the patient's quality of life and well-being. ANS: A a. patient will experience symptom relief. 26. A patient is diagnosed with bipolar disorder and hospitalized. According to the Stuart Stress Adaptation Model, nursing interventions for this stage of treatment will focus on: a. inspiring and validating the patient. b. managing the environment to provide safety. c. mutual treatment planning, modeling, and teaching adaptive responses. d. reinforcement of the patient's adaptive coping responses and advocacy. ANS: C c. mutual treatment planning, modeling, and teaching adaptive responses. 27. A patient was diagnosed with bipolar disorder and hospitalized. The symptoms went into remission, and the patient was recently discharged to the community. During this stage of treatment the expected outcome will be that the patient will: a. be safe from harm. b. experience symptom relief. c. demonstrate improved functioning. d. attain an optimal quality of life in the community. ANS: C c. demonstrate improved functioning. 28. A nurse caring for a patient suspects that the patient has a personality disorder in addition to presenting with maladaptive stress response. To confirm this, the nurse would look in the patient's medical record on the DSM-IV-TRAxis: a. I. b. II. c. IV. d. V. ANS: B b. II. 29. A nurse caring for a patient wonders how the patient's functioning has been evaluated in the past. To learn this, the nurse would look in the medical record on the DSM-IV-TR Axis: a. I. b. II. c. IV. d. V. ANS: D d. V. 30. A nurse caring for a patient would look at DSM-IV-TR Axis III to obtain information about the patient's: a. clinical syndromes. b. general medical conditions. c. global assessment of functioning. d. psychosocial and environmental problems. ANS: B b. general medical conditions. 1. A nurse assessing a patient is interested in the patient's appraisal of a recent divorce as a stressor. To obtain this information, it is important for the nurse to gather data about which of the patient's responses. (Select all that apply.) a. Affective b. Behavioral c. Physiological d. Cognitive e. Ethical ANS: A, B, C, D a. Affective b. Behavioral c. Physiological d. Cognitive 1. When a patient asks the nurse, "What are neurotransmitters?" The nurse replies that neurotransmitters are: a. "the chemical messengers that cause brain cells to turn on or off." b. "small clumps of cells that alert the other brain cells to receive messages." c. "tiny areas of the brain that are responsible for controlling our emotions." d. "weblike structures that provide connections among various parts of the brain." ANS: A a. "the chemical messengers that cause brain cells to turn on or off." 2. A patient tells a nurse, "My doctor says my problem may be with the neurotransmitters in my brain but I don't understand what that means." The nurse responds: a. "Let's begin with exploring what your doctor has told you about your problem." b. "We should start with a discussion about any concerns you have about having a neurotransmitter disorder." c. "First let me say that neurotransmitter problems can usually be treated or cured with medication therapy." d. "What you need to understand is that neurotransmitters are chemical messengers in the brain responsible for brain communication." ANS: A a. "Let's begin with exploring what your doctor has told you about your problem." 3. Which part of the brain is responsible for fine motor coordination? a. Medulla b. Thalamus c. Cerebellum d. Temporal lobe ANS: C c. Cerebellum 4. Which neurotransmitter is located only in the brain, particularly in the raphe nuclei of the brainstem, and is implicated in depression? a. Norepinephrine b. Acetylcholine c. Dopamine d. Serotonin ANS: D d. Serotonin 5. What part of the brain is responsible for regulating pituitary hormones and is known to regulate the body's temperature? a. Thalamus b. Cerebellum c. Limbic system d. Hypothalamus ANS: D d. Hypothalamus 6. Which neurotransmitter is involved in the movement disorders seen in Parkinson disease and in the deficits seen in schizophrenia and other psychoses? a. Dopamine b. Melatonin c. Serotonin d. Norepinephrine ANS: A a. Dopamine 7. A nurse explains to a patient undergoing diagnostic testing which brain imaging technique measures brain structure? a. Computed tomography (CT) b. Positron emission tomography (PET) c. Brain electrical activity mapping (BEAM) d. Single-photon emission computed tomography (SPECT) ANS: A a. Computed tomography (CT) 8. The objective information that has helped mental health professionals understand that schizophrenia has a biological component has been obtained primarily from which of the following? a. Genetic studies b. Patient histories c. Comparisons of blood chemistries d. Magnetic resonance imaging (MRI) studies ANS: D d. Magnetic resonance imaging (MRI) studies 9. A genetic counselor is called to see patients with genetic questions or concerns. With which patient would it be most appropriate for the counselor to speak? a. A pregnant patient with sickle cell anemia b. A patient who has made a recent suicide attempt c. A patient prescribed the most drugs for the treatment of chronic disorders d. A patient with schizophrenia who had multiple hospital admissions in the last year ANS: A a. A pregnant patient with sickle cell anemia 10. A patient tells a nurse, "My daughter is pregnant with our first grandchild and my son-in-law has a sibling with cystic fibrosis. Is there a chance the baby might have this disease?" Which response is best? a. "This is not an inherited disorder." b. "You should speak to a genetic counselor." c. "Science has not yet developed gene testing for this disease." d. "There are new treatments for this illness that are readily available." ANS: B b. "You should speak to a genetic counselor." 11. Pharmacogenetics will eventually allow researchers to do which of the following? a. Remove the genes that cause illness. b. Allow the design of custom drugs. c. Develop foods that fight disease. d. Splice genes to improve health. ANS: B b. Allow the design of custom drugs. 12. A patient tells a nurse, "My doctor thinks my problem is serious but it can be treated with medications. Does that mean I'll always have to be treated with drugs?" The nurse replies: a. "How would you feel about being on medications for a lifetime?" b. "What concerns do you have about having a serious mental disorder?" c. "Did your doctor suggest your problem was related to neurotransmitter problems?" d. "What do you know about this condition that the doctor is preparing to treat with medications?" ANS: A a. "How would you feel about being on medications for a lifetime?" 13. The function of the limbic system is to: a. regulate emotional behavior. b. perform abstract reasoning. c. facilitate critical decision making. d. coordinate stress-related responses. ANS: A a. regulate emotional behavior. 14. A patient states, "I'm going to have a positron emission tomography (PET) scan. What are the doctors going to learn from it?" The best reply would be that they focus on: a. "identifying structures like tumors and scars." b. "highlighting activity in various portions of the brain." c. "outlining the structures of the brain more clearly." d. "providing data to support new treatment modalities." ANS: B b. "highlighting activity in various portions of the brain." 15. A patient mentions, "My doctor told me I was going to have a PET scan that would show where my brain has bright spots. Does that mean I'm getting an electrical jolt like in electroconvulsive therapy (ECT)?" The best reply would be: a. "PET scans and ECT treatments are entirely different." b. "A PET scan is a diagnostic test, and an ECT treatment is a form of therapy." c. "A PET scan involves a substance, not electricity, that travels to the brain and produces a bright spot where the brain is active." d. "PET scans show us the electrical activity of the brain in the form of light bands." ANS: C c. "A PET scan involves a substance, not electricity, that travels to the brain and produces a bright spot where the brain is active." 16. A patient diagnosed with depression tells a nurse, "I don't feel rested. It's as though I didn't sleep at all." Comments by night shift staff show that the patient slept through most of the night. How can these two observations be reconciled? a. The patient is considered the more accurate reporter. b. The staff observations are more objective than the patient's statement. c. Studies show that people with depression have disturbed sleep cycles that can result in sleep deprivation. d. People with depression characteristically underreport sleep satisfaction because of cognition flaws. ANS: C c. Studies show that people with depression have disturbed sleep cycles that can result in sleep deprivation. 17. The spouse of a patient recently diagnosed with cancer asks, "What do you think about the relationship of stress and the development of cancer? My spouse has been under a huge amount of stress at work, and now they've diagnosed cancer." The answer that best reflects the current thinking about psychoneuroimmunology is: a. "It's thought that the immune system is negatively affected by high stress." b. "The research hasn't been focused directly on the link between cancer and stress." c. "Your spouse's situation may reflect a coincidence. There is little concrete evidence that stress makes one prone to physical illness." d. "Grief and depression are known to cause physical illness, but other types of stress have not been implicated as illness producers." ANS: A a. "It's thought that the immune system is negatively affected by high stress." 18. A patient's spouse asks a nurse, "Why are they wasting money doing all these tests on my spouse? The hallucinations and delusions make the mental illness obvious!" The best reply would be: a. "Don't be upset. We are using the most modern approach to caring for your spouse." b. "I know you must be worried about costs, but having these tests is very necessary." c. "Physical illnesses can cause psychiatric symptoms. We must be sure of what we are treating." d. "I think that you are upset about your spouse's illness and not thinking clearly. To avoid harm, physical illness must be ruled out." ANS: C c. "Physical illnesses can cause psychiatric symptoms. We must be sure of what we are treating." 19. A couple tells a nurse that they are concerned about having children because there is bipolar disorder in first-degree relatives of each of them. What advice should the nurse give? a. "Do not have children." b. "Seek genetic counseling." c. "Do as your conscience dictates." d. "Bipolar disorder is not hereditary." ANS: B b. "Seek genetic counseling." 20. A patient demonstrates disoriented thinking and irrational ideas. A nurse can anticipate that a PET scan would most likely show dysfunction in the brain's _____ lobe. a. frontal b. parietal c. occipital d. temporal ANS: A a. frontal 21. A family member asks a mental health nurse, "I am reading a lot of information about gene therapy in the news lately. Will gene therapy be able to help my spouse, who has schizophrenia?" Which response by the nurse is best? a. "Gene therapy for schizophrenia is common in Europe but has not yet become popular in the United States." b. "Gene therapy for schizophrenia is available, but the high cost prohibits most people from taking advantage of it." c. "Gene therapy is still an experimental field and is not likely to be used to treat mental health disorders in the near future." d. "Gene therapy has already shown promise in treating schizophrenia, but not enough large-scale studies have been carried out to date." ANS: C c. "Gene therapy is still an experimental field and is not likely to be used to treat mental health disorders in the near future." 22. A patient with a history of depression reports not feeling well rested in recent weeks. Before making the assumption that the complaint is related to depression, a nurse should investigate whether the patient has had any recent changes in: a. work schedule that affect the hours of sleep. b. vacations taken within the same time zone. c. fluid intake with reduced overall intake of water. d. food intake with decreased intake of heavy foods before bedtime. ANS: A a. work schedule that affect the hours of sleep. 1. A depressed patient scheduled for an MRI asks about the purpose of the test and whether it will hurt. The response would include that the test: (Select all that apply.) a. takes a picture of the brain. b. is used to diagnose mental illness. c. should not produce any physical pain. d. may be uncomfortable if tight spaces bother you. e. machinery produces loud noises while the test is being conducted. ANS: A, C, D, E a. takes a picture of the brain. c. should not produce any physical pain. d. may be uncomfortable if tight spaces bother you. e. machinery produces loud noises while the test is being conducted. 17. A patient newly diagnosed with Chron's disease shares she is spending several hours each week on the Internet seeking information about the illness. The nurse can correctly hypothesize that this patient is initially: a. engaged in a search for meaning. b. devising a new coping strategy. c. making a social attribution. d. making a social comparison. ...